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Open research questions in Pain Management and Opioid Use

75 unresolved questions extracted from the limitations and future-work sections of 1,172 Pain Management and Opioid Use papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • On the other hand, limited knowledge and misconceptions about pain, fear and negative perceptions of pain medication, expression challenges, individual and contextual limitations, knowledge and competency and collaboration challenges, professional constraints, organizational and policy deficiencies, resource and workforce constraints, and care coordination and continuity challenges, were key barriers to optimal postoperative pain management.

    Factors influencing optimal postoperative pain management: a systematic scoping review · 2026 · DOI

  • To date, PAT has not been studied among people living with both demoralization and chronic pain nor has it been studied as part of routine multidisciplinary outpatient palliative care.

    Psilocybin-Assisted Early Palliative Care for Demoralization and Chronic Pain: An Open-Label Pilot Study · 2026 · DOI

  • 18 Adjustment for procedure type using ANCOVA confirmed that the imbalance in excision versus biopsy distribution did not significantly affect outcomes, although future studies may explore how different procedure intensities impact analgesic response. 20 However, the study was limited to a single observation period, and the short duration precludes conclusions regarding delayed or cumulative side effects, such as tramadol-induced nausea, dizziness, or sedation, and the rare hematologic toxicity associated with metamizole.

    Comparative Clinical Effectiveness, Safety, and Cost-Effectiveness of Intravenous Tramadol versus Metamizole for Post-Procedural Pain Management · 2026 · DOI

  • Patients who received heat therapy prior to presenting to the emergency department analgesia, suggesting a possible therapeutic role through localized its accessibility, cultural venom this integration of the acceptance, and intervention into modern clinical practice warrants further investigation.

    Integrating Traditional Knowledge in Emergency Medicine: The Role of Heat Application in Scorpion Stings · 2026 · DOI

  • derived from large-scale data analyses (18). Collectively, these technological advancements not only improve the effectiveness of pain management and the efficiency of clinical processes but also enhance patients’ treatment experiences and quality of life, supporting the emergence of personalized, technology-driven next-generation pain management paradigms.

    Postoperative Pain Assessment: Emerging Technologies and Clinical Implications · 2026 · DOI

  • including the use of non-validated measurement instruments, reliance on single method approaches and an emphasis on robust rather commercial assessment (14). This gap is particularly important given the growing international adoption of the PainChek® app. As uptake expands across jurisdictions and settings, rigorous and well-reported usability evaluation is needed to support scale-up and and implementation studies. Therefore, this study aimed to evaluate the usability of the Portuguese version of the PainChek® in application residential care facilities in Portugal.

    Towards person-centered pain management in dementia: usability of a digital medical device in Portuguese residential care facilities · 2026 · DOI

  • 18 Summarise key results with reference to study objectives ( Pain reduction similar; tramadol more cost-effective; no adverse events (Pages 9–10)) 19 Discuss limitations of the study, taking into account sources of potential bias or imprecision.

    Dataset and Supporting Materials for: Comparative Effectiveness, Safety, and Cost Analysis of Intravenous Tramadol and Metamizole in Post-Procedural Pain Management among Cancer Patients at RSUD Jayapura · 2026 · DOI

  • This qualitative study has several strengths that are important to consider along with its limitations. Our sample included a heterogeneous representation of older Spanish-speaking adults from diverse regions in Latin America, including the Caribbean, Central, and South America (i.e., Colombia, Perú, México, Puerto Rico, Nicaragua, Guatemala, El Salvador). While the study provided insight into the needs of an ethnically diverse Spanish-speaking patient sample, it was limited by the underrepresentation of male participants and other intersecting identities. Additionally, because nearly all participants were monolingual (93.7%) and only one was bilingual (6.3%), our analysis focused on socio-cultural and contextual rather than linguistic experiences. Future research should examine the role of language more directly when developing intervention content and assess how Spanish- speaking older Latino adults engage with culturally and linguistically tailored programs. However, it is important to note that the cultural and linguistic needs identified in this patient sample, with an average of 21.5 years in the United States, may be differ from recently immigrated community-dwelling older adults who may have unique language-related needs and face greater pain-related challenges. Studying diverse experiences will be critical to refining the language and delivery of pain management interventions among Spanish- speaking populations. Another strength of this qualitative work was its rigorous design, which yielded rich and inferential insights, rather than generalizable conclusions on the complex and nuanced relationships between chronic pain and multilevel factors shaping their pain experiences. Lastly, we used back-translation to ensure the linguistic accuracy of the interview script and translated transcripts from Spanish to English to facilitate data analysis with a third coder who was non-Spanish speaking. Translating qualitative stories from Spanish to English and the back-translation of interview scripts may have resulted in the loss of the essence of participants’ perspectives or the cultural relevance of the questions being asked and the content of the transcriptions. To minimize this, two bilingual and bicultural researchers reviewed and compared the translations in English next to Spanish to ensure accuracy and relevance. Our study is the first to use the SEM framework and qualitative methods to understand the lived experiences of Spanish-speaking Latino older adults with chronic pain in a community setting. Findings of this qualitative study enabled us to culturally tailor a mind-body and activity-based pain management intervention for a socioeconomically disadvantaged sample of Spanish-speaking older Latino adults. This study adds to the limited knowledge of the complex and multilayered factors contributing to the worsening of their chronic pain J Cross Cult Gerontol. Author manuscript; available in PMC 2026 April 07.

    A Qualitative Analysis of Multi-level Influences on Chronic Pain among Spanish-speaking Older Latino Adults in a Community Clinic in the United States · 2026 · DOI

  • While this study offers a unique characterization of TRP, several limitations should be considered. First, the single- center, tertiary-clinic design introduces selection bias, as our cohort represents patients referred for refractory pain 647 Page 8 of 9 Supportive Care in Cancer (2026) 34:647 following inadequate response to standard pharmacologic management. Therefore, the prevalence and mechanistic complexity of TRP should be interpreted with caution when generalizing to the broader survivor population. Second, the retrospective design relies on the quality of clinical documentation. Although we used a structured multi-physician coding framework, some granular treatment- exposure details (e.g., radiotherapy dosages) were unavail- able. In addition, we could not determine whether differ- ences in interventional procedure completion were driven by clinician- or patient-related factors. We did not systematically capture detailed functional out- comes, such as work capacity or patient-reported interference with daily activities. Although ECOG performance status was available, it may not fully reflect pain-related functional impairment. Given the refractory nature of the cohort, a sub- stantial functional burden is likely; however, this could not be formally quantified. Future studies should incorporate stand- ardized measures of functional impact to better define the clini- cal burden of treatment-related pain. Finally, pain mechanisms were determined by expert clinical evaluation rather than quantitative sensory testing (QST), which may have provided a more standardized physi- ologic characterization.

    Treatment-related pain in refractory cancer pain: prevalence, mechanisms, and clinical implications in a tertiary referral cohort · 2026 · DOI

  • Building on previous insights, we propose the following recommendations to optimise pain management for sedated and ventilated patients. Collaborative engagement from all stakeholders may be essential to achieve this goal and improve outcomes across organ- isational levels. Table 2 provides a summary of these recommendations.

    Optimising pain management in intensive care setting: Insights from a realist evaluation · 2026 · DOI

  • Design evidence-based, user-friendly pain management interventions. Translate guidelines into practice using implementation science. Use research findings to inform conditions for sustainable implementation. Invest in infrastructure and resources. Identify and address barriers to implementation. Foster stakeholder relationships through communication. Provide ongoing education and quality assurance. Offer constructive feedback in a supportive environment. Promote interprofessional collaboration and shared mental models. Challenge professional hierarchies and support nurses’ autonomy. Create safe spaces for discussion and innovation. Advocate for nurses’ roles in intervention development. Provide coaching, feedback, and recognition systems. Address team tensions to enhance performance. Update knowledge and skills in pain management. Understand consequences of poor pain assessment. Embrace change and assert professional identity. Accept and act on constructive feedback. Update pain management evidence. Facilitate inclusive education across shifts and employment types. Engage champions (e.g., clinical nurse specialists) for bedside consistency. Integrate advanced pain management education into nursing curricula. Ensure induction programs include pain management skills. 9 S. Hamadeh and L. Garvey International Journal of Nursing Studies Advances 10 (2026) 100515 Empowering a clinical nurse specialist or nurse champion who is embedded within the team can further strengthen education and engagement during implementation (Hamadeh et al., 2024d). Including pain management training in induction programmes for new staff also promotes consistency and shared understanding from the outset (Hamadeh et al., 2024d).

    Optimising pain management in intensive care setting: Insights from a realist evaluation · 2026 · DOI

  • We have synthesised evidence from a realist evaluation study, emphasising the critical role of contextual features (sociocultural, organisational, professional, and individual) in shaping the successful implementation of pain management interventions in intensive care settings. Given the limited research in this domain, these insights are particularly valuable for guiding practice. Realist evaluations aim to uncover context–mechanism–outcome configurations; however, real-world contexts are often highly complex and dynamic. Capturing all relevant contextual variables can be challenging, sometimes resulting in incomplete or over- simplified explanations. While realist evaluation offers rich insights into “what works, for whom, and under what circumstances,” its transferability to other settings may be limited (Pawson & Tilley, 1997). Furthermore, program theories were developed and refined through interpretive processes, which can introduce researcher bias if not carefully managed. To mitigate this risk, we employed an iterative process of retroduction and ensured transparency throughout (Hamadeh et al., 2024d). Future researchers should examine how the refined theories apply to different stakeholder configurations (e.g., physicians, allied health professionals, and hospital administrators) and explore their responses to implementation. Additionally, studies should assess the sustainability of interventions and prioritise comprehensive, consistent reporting to strengthen the evidence base and inform future implementation efforts.

    Optimising pain management in intensive care setting: Insights from a realist evaluation · 2026 · DOI

  • Fifth, the low utilization thresholds that the au- thors employed have not been examined in prior studies, and their validity as an indicator of clinically meaningful PCA use remains to be established.

    Beyond opioid dosage: temporal dynamics of intravenous patient-controlled analgesia use captured by electronic device logs—a post hoc analysis of three randomized controlled trials · 2026 · DOI

  • Standardized pain management guidelines and stepwise protocols for pain assessment and management in long-term care facilities may contribute to reducing the underdiagnosis and undertreatment of pain in individuals with dementia. Structured approaches, such as the Sta-op! method support systematic observation and identification of pain-related behaviors. Using this method in combination with the guidelines on pain in people with dementia, such as the Verenso Guideline, may promote increased use of non-pharmacological interventions for pain management (28). To our knowledge, this is the first study to provide an overview of how pain is observed, assessed, and managed in Dutch long-term care facilities. Strengths of this study include mixed-methods sequential explanatory design and the use of in-depth interviews to contextualize survey findings. The nationwide distribution of the survey contributes to the generalizability of the findings. Also, findings like the emphasis on behavioral changes as key indicators of pain in individuals with impaired communication are likely relevant beyond the Dutch context and reflect issues faced in long-term care facilities be several internationally. However, acknowledged. Participants were not asked to specify their longterm care facility, limiting insight into organizational diversity. Therefore, there could be a bias where facilities with solidly embedded pain management programs participated in the study, while facilities with less embedded programs did not. Also, participant were not asked which specific observational pain scales were used in practice. This information could have provided insight into the usability of different instruments. The small restricts number of managers generalizability for these groups. Another is that different subgroups have different roles in the interprofessional team that provides the pain observations and management, but the subgroups were too small to analyze separately. Both survey and interview data may be subject to socially desirable responses, and the study title may have led to overreporting of nonpharmacological intervention use. Self-reported measures of pain are widely considered the gold standard, including in populations with dementia. However, in the present study, specific inquiries regarding the utilization of self-report instruments for pain assessment were not conducted. Consequently, it remains unclear whether self-reports are employed in individuals with dementia, the frequency of their use, or whether individuals are first asked about their pain experience prior to implementing observational assessment tools. Additionally, most participants were female and highly educated, which may limit representativeness.

    Observing and treating pain in people living with dementia in long-term care facilities · 2026 · DOI

  • of pharmacological interventions in older persons (15). Analgesics can cause adverse effects in people with dementia, such as drowsiness and an increased risk of falling. For this reason, non-pharmacological interventions are often preferred as a first step for treating mild pain, while pharmacological treatment may be added for moderate to severe pain to achieve a synergistic effect (15).

    Observing and treating pain in people living with dementia in long-term care facilities · 2026 · DOI

  • Although possible mediating and overlapping pathways have been proposed in the development of MSK pain in IBD, the multifactorial nature of painful conditions is not well understood nor fully captured.

    Profile of musculoskeletal pain in patients with inflammatory bowel disease: a study protocol for assessing the multidimensional experience of self-reported pain · 2018 · DOI

  • 11 Although the exact mechanism remains unclear, researchers believe inflammation, viral infection, and neuronal hyperexcitability by opioids lead to neuronal damage over time.

    HIV pain management challenges and alternative therapies · 2017 · DOI

  • This study fills this gap in knowledge by systematically comparing medical cannabis users who use or do not use PPM, with an emphasis on understanding whether concurrent use of cannabis and PPM is associated with more serious forms of alcohol and other drug involvement.

    Use of Prescription Pain Medications Among Medical Cannabis Patients: Comparisons of Pain Levels, Functioning, and Patterns of Alcohol and Other Drug Use · 2015 · DOI

  • Results revealed that CBT reduced pain intensity in 43% of trials, the efficacy of online and in-person formats were comparable, and military veterans and individuals with cancer-related chronic pain were understudied.

    Chronic Pain and Cognitive Behavioral Therapy · 2015 · DOI

  • BACKGROUND: Few studies have examined the potential relationship between pain and aggressive behavioral symptoms in nursing home (NH) residents with dementia as a function of resident communicative status (ability to self-report pain).

    Pain and Aggression in Nursing Home Residents With Dementia · 2015 · DOI

  • Research limitations/implications – Although cross-sectional and geographically restricted, this study lays the foundation for additional research on reasons for underutilization of recommended healthcare and lack of pain management in low-income Hispanic immigrants who are overweight and have chronic pain.

    Healthcare underutilization in overweight Mexican Americans with chronic pain · 2012 · DOI

  • Research needs include continued empirical investigation of the behavioral conceptualization model presented, empirical demonstration of efficacy with those painful conditions and patient types with insufficient research support, treatment matching studies, comparative efficacy (including cost) studies, and efficacy with combined treatment approaches.

    Behavioral conceptualization and treatment for chronic pain. · 2006 · DOI

  • Relatively little is known, however, about who these users are, the range of health and social consequences associated with their use, and the presence of illicit NA use on the inner city street.

    Under the Counter · 2005 · DOI

  • Despite significant progress in surgical treatment methods, the impact of these methods on the quality of life of patients remains insufficiently studied.

    Analysis of the quality of life of patients with haemorrhoids. · 2026 · DOI

  • These barriers may include insufficient knowledge, inade‐ quate training, limited institutional support, and at‐ titudinal biases. Thus, there is a distinct gap in the literature and clinical practice regarding the education and empowerment of nurses in this critical domain.

    Effect of Structured Educational Program on Nurses’ Attitudes and their Barriers toward Pain Relief Measures for Postpartum Mothers · 2026 · DOI

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