New paradigms in pain management after skeletal trauma: Orthopaedic Trauma Association's 2023 Basic Science Focus Forum Symposium

Abstract

Traumatic injuries are associated with significant acute pain and subsequent high risk of the development of chronic pain. However, addressing pain after skeletal trauma presents a complex challenge to achieve effective pain relief that minimizes risk of addiction and does not interfere with functional recovery. The Orthopaedic Trauma Association's 2023 Basic Science Focus Forum aimed to bridge the gap between basic science and clinical outcomes with an educational symposium on pain management designed to foster collaboration and provide practical strategies from the frontiers of pain research. Owing to the subjective and multifaceted nature of pain, the development of effective preclinical and clinical pain assessment measures is the first step to making impactful progress in studying pain. Preclinical models prove a valuable tool for studying the molecular mechanisms associated with pain following orthopaedic trauma. These models also allow study of the efficacy of novel pain management techniques, such as testing novel analgesics. Translating novel analgesics and pain management strategies to the clinic requires that we have accurate methods to describe pain to determine whether new approaches are meaningful. It is also necessary to recognize the patient's role and the importance of patient education in the prevention of pain medication misuse, particularly in light of the current national opioid crisis. Overall, collaboration with orthopaedic surgeons in the application of these strategies in a clinical setting is vital for addressing the downfalls of current pain management efforts and providing patients with safe and effective improvements in pain relief after skeletal trauma.

Keywords: fracture healing; orthopaedic trauma; pain management; patient-reported outcomes; preclinical models.

Figure 1.

Bench to bedside and back again. Improving pain management strategies involves collaboration between basic science research, studies using preclinical models, and evaluation of clinical applications. At the center of pain management research is the goal to provide patients with safe and effective improvements in pain relief after skeletal trauma. This cycle often starts at the bench, with the investigation of the mechanism of analgesics and drug testing in preclinical models. Next in the cycle is the rigorous testing of preclinical pain assays and the development of preclinical models to help determine the effects of analgesics on fracture healing. This also involves the testing of novel analgesic options, such as cannabinoids, to provide evidence-based suggestions for clinicians regarding new pain management strategies. Research does not stop at the bedside, as patient-reported outcomes and the importance of patient education provide valuable information to build the next waves of innovation in pain research. Altogether, cross-disciplinary collaboration is key to high-quality and impactful findings.