Exploring patient preference heterogeneity for pharmacological treatments for chronic pain: A latent class analysis

David A. Walsh, Marco Boeri*, Lucy Abraham, Jo Atkinson, Andrew G Bushmakin, Joseph C. Cappelleri, Brett Hauber, Kathleen Klein, Leo Russo, Lars Viktrup, Dennis Turk

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)
42 Downloads (Pure)


Background: Several pharmaceutical treatments for chronic pain caused by osteoarthritis (OA) and chronic low back pain (CLBP) are available or currently under development, each associated with different adverse events (AEs) and efficacy profiles. It is therefore important to understand what trade-offs patients are willing to make when choosing between treatments. 

Methods: A discrete-choice experiment (DCE) was conducted with 437 adults with chronic pain caused by OA and/or CLBP. Respondents were presented with a series of scenarios and asked to choose between pairs of hypothetical treatments, each defined by six attributes: level of symptom control; risks of heart attack, rapidly progressive osteoarthritis and dependency; frequency and mode of administration and cost. Attributes were based on known profiles of oral nonsteroidal anti-inflammatory drugs, opioids and injected nerve growth factor inhibitors, the last of which were under clinical development at the time of the study. Data were analysed using a latent class (LC) model to explore preference heterogeneity. 

Results: Overall, respondents considered improving symptom control and reducing risk of physical dependency to be the most important attributes. The LC analysis identified four participant classes: an ‘efficacy-focused’ class (33.7%), a ‘cost-averse’ class (29.4%), a ‘physical-dependence–averse’ class (19.6%) and a ‘needle-averse’ class (17.3%). Subgroup membership was incompletely predicted by participant age and their responses to comprehension questions. 

Conclusions: Preference heterogeneity across respondents indicates a need for a personalized approach to offering treatment options. Symptom improvement, cost, physical dependence and route of administration might be important to different patients. 

Significance: Multiple treatment options that differ substantially in terms of efficacy and adverse events are available for the management of chronic pain. With a growing emphasis on a patient-centred care model that incorporates patients’ priorities and values into treatment decisions, there is a need to understand how individuals with chronic musculoskeletal pain balance the benefits and risks of treatment and how treatment priorities vary among individuals. This study was designed to identify patient preferences for different characteristics of treatments for the management of chronic pain and to investigate how preferences differ among respondents.

Original languageEnglish
Pages (from-to)648-667
Number of pages20
JournalEuropean Journal of Pain (United Kingdom)
Issue number3
Early online date08 Jan 2022
Publication statusPublished - Mar 2022

Bibliographical note

Funding Information:
Lucy Abraham, Jo Atkinson, Andrew Bushmakin, Joseph Cappelleri, Brett Hauber and Leo Russo are employees of and hold stock and/or stock options in Pfizer Inc. Lars Viktrup is an employee of Eli Lilly and Company and holds stock. Marco Boeri and Kathleen Klein are employees of RTI Health Solutions, who were paid consultants to Pfizer in connection with the development of this manuscript. In the past 36 months, Dennis C. Turk has received research grants and contracts from the US Food and Drug Administration and US National Institutes of Health and has received compensation for consulting on clinical trials and patient preferences from AccelRx, Eli Lilly and Company, Flexion, GlaxoSmithKline, Pfizer and Swing Therapeutics. Professor Walsh declares a personal financial interest in his employment by the University of Nottingham who received funding for his salary from the UK Government, Sherwood Forest Hospitals NHS Foundation Trust and UKRI. In the past 36 months David Walsh declares the following non‐personal financial interests: consultancy through his employment with the University of Nottingham to Pfizer Ltd, Eli Lilly, AbbVie Ltd, Galapagos and Reckitt Benckiser Health Ltd and GlaxoSmithKline Plc, and responsibilities for investigator‐led grants outside the work in this manuscript held by the University of Nottingham from Pfizer Ltd and Eli Lilly and Company.

Funding Information:
This study was sponsored by Pfizer Inc. and Eli Lilly and Company. The authors affiliated with Pfizer Inc. and Eli Lilly and Company participated in designing the study, interpreting the data and writing the manuscript and approved the final version for publication.

Publisher Copyright:
© 2021 Pfizer Inc. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC®

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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