EFIC Taskforce:

Towards a consented definition for multimodal pain treatment

Multimodal treatment is often recommended for many pain conditions. Despite this, the concept of multimodal treatment remains subject to different interpretations, with no consented definition, and a lack of agreement on the discrete modalities that comprise such treatment across disciplines (e.g. physiotherapy, medicine). The International Society for the Study of Pain (IASP) defines multimodal treatment as “the concurrent use of separate therapeutic interventions with different mechanisms of action within one discipline aimed at different pain mechanisms”. The evidence underpinning the IASP definition is unclear, and a less ambiguous and more clinically relevant definition is needed. Poor conceptual clarity and the absence of a clinical relevant definition of multimodal treatment undermines the development of a robust evidence base, resulting in inconsistent and inadequate pain policies, pain care delivery, and pain curricula.

Objective: Tackle the conceptual inconsistency by generating consensus on a definition for multimodal treatment and its discrete elements (i.e., types of modalities)

End product: Consented definition of multimodal pain treatment, including considerations of what should represent best practice for European healthcare systems, as well as what should constitute a minimum standard

Task force composition: Led by Prof Michiel Reneman and Dr Mary O’Keeffe. Members are Associate Professor Brona Fullen, Professor Thomas Tölle, Professor Rolf-Detlef Treede, Professor Ulrike Kaiser, Professor Kevin Vowles, and Professor Beatrice Korwisi

Progress so far: The task force has completed scoping reviews of the literature (in Pubmed, Google Scholar, PROSPERO, Clinicaltrials.gov, and International Classification of Health Interventions website) to identify current definitions of multimodal and modality. After analysis and discussions, the Task Force have draft definitions for both Multimodal and Modality in the area of pain. These will be presented to the wider research and clinical community in 2023 to reach consensus on the best definition.

Significance: This study will lead to a consented standardised definition of multimodal pain treatment. The definition and elements, through ongoing refinement, will contribute to a robust evidence base that will underpin pain policy development and the systematic and effective teaching, delivery, measurement and evaluation of multimodal treatment in pain conditions.