AAAPT: Assessment of the Acute Pain Trajectory

• Published in: Pain medicine (Malden, Mass.) Vol. 22; no. 3; pp. 533 - 547
• Main Authors: Bayman, Emine O, Oleson, Jacob J, Rabbitts, Jennifer A
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.03.2021
• Subjects: Acute & Perioperative Pain Section; Acute pain; Addictions; Analgesics; Care and treatment; Classification; Diagnosis; Latent class analysis; Medical care; Methods; Needs assessment; Pain; Pain management; Practice guidelines (Medicine); Regression analysis; Statistical analysis; Taxonomy; United States; Acute Pain; Trajectory; Latent Class Analyses (LCA); Random Intercept; Random Slope
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnaa440

Abstract Objective Define and contrast acute pain trajectories vs. the aggregate pain measurements, summarize appropriate linear and nonlinear statistical analyses for pain trajectories at the patient level, and present methods to classify individual pain trajectories. Clinical applications of acute pain trajectories are also discussed. Setting In 2016, an expert panel involving the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), American Pain Society (APS), and American Academy of Pain Medicine (AAPM) established an initiative to create a pain taxonomy, named the ACTTION-APS-AAPM Pain Taxonomy (AAAPT), for the multidimensional classification of acute pain. The AAAPT panel commissioned the present report to provide further details on analysis of the individual acute pain trajectory as an important component of comprehensive pain assessment. Methods Linear mixed models and nonlinear models (e.g., regression splines and polynomial models) can be applied to analyze the acute pain trajectory. Alternatively, methods for classifying individual pain trajectories (e.g., using the 50% confidence interval of the random slope approach or using latent class analyses) can be applied in the clinical context to identify different trajectories of resolving pain (e.g., rapid reduction or slow reduction) or persisting pain. Each approach has advantages and disadvantages that may guide selection. Assessment of the acute pain trajectory may guide treatment and tailoring to anticipated symptom recovery. The acute pain trajectory can also serve as a treatment outcome measure, informing further management. Conclusions Application of trajectory approaches to acute pain assessments enables more comprehensive measurement of acute pain, which forms the cornerstone of accurate classification and treatment of pain.