441: The AsCent pain risk stratification tool: healthcare professionals’ and researchers’ perspectives

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Assessment and Measurement of Pain/Nociception, Quantitative Sensory testing (static and dynamic, e.g., HPT, PPT, CPM, TSP, offset analgesia), Treatment/management

Background and Aims: Pain is commonly experienced in individuals with musculoskeletal conditions. The central nervous system (CNS), and particularly dysfunctional CNS processing, is thought to play a key role in understanding pain in these conditions. Current assessment methods of dysfunctional CNS processing are not feasible in clinical settings. The Assessing Central Aspects of Pain (AsCent) study aims to combine clinical quantitative sensory testing with the Central Aspects of Pain Questionnaire to create a novel risk stratification tool to identify people at risk of persistent or worsening pain likely due to dysfunction within the CNS. The aim of this study was to qualitatively explore the perceptions of healthcare professionals (HCPs) and researchers working in chronic musculoskeletal pain about the perceived utility, feasibility and acceptability of the AsCent risk stratification tool.

Methods: One-to-one semi-structured interviews were conducted online with HCPs, including rheumatologists, physiotherapists, clinical academics, nurses, occupational therapists, pharmacists and researchers (N= 22) with an interest in chronic musculoskeletal pain. Participants were provided with written information material and a series of short videos that demonstrated the new tool prior to the interview. Questions included participants’ role in supporting people with pain and previous experience of assessments, their overall perceptions about the feasibility and acceptability of the AsCent tool within their practice, and recommendations for further development. All interviews were transcribed verbatim, and reflexive thematic analysis conducted, utilising both semantic and latent coding through the lens of the Extended Normalisation Process Theory [1].

Results: Participants felt the tool would be easy to use and implement across a range of healthcare settings (particularly physiotherapy and pain clinics) to support pain management. The tool had novel clinical relevance and could help validate patients’ pain experiences. Information from the tool was perceived as useful for informing patient care and treatment pathways, evaluating treatment response, and participants identified relevant opportunities within such pathways. Participants provided context-specific considerations for implementing the tool in clinical practice such as timing in the patient journey and ensuring data can be used as a means to supporting care rather than overcomplicating it. Several barriers like time and resources were raised. Overall, the tool was considered acceptable, feasible with good utility for improving care for individuals with chronic musculoskeletal pain.

Conclusions: HCPs and researchers deemed the risk stratification tool for identifying people with persistent or worsening pain likely due to CNS dysfunction to be acceptable, feasible, and useful for improving pain management for chronic musculoskeletal pain. Context-specific considerations are required for implementation across different healthcare settings, with some HCPs suggesting assessment-specific appointments similar to diagnostic testing. HCPs’ and researchers’ impressions of the tool overall appear to overlap with patients; there are also some conflicts between HCPs/researchers and patients. Overall, the risk stratification tool has potential for early, targeted intervention, based on a mechanistic understanding of an individual's pain.

References: May, C. (2013). Towards a general theory of implementation. Implementation Science, 8(1), 18.

Presenting Author: Stephanie L. Smith
Submitting Author: Georgia Clay

Senior Author: Stephanie L. Smith

IASP 2026 Global Year theme of Neuropathic Pain: No

• Georgia Clay: PhD - Academic Rheumatology, University of Nottingham, Nottingham, United Kingdom; School of Psychology, Sport Science and Wellbeing, University of Lincoln, Lincoln, United Kingdom; Arthritis UK Pain Centre, University of Nottingham, Nottingham, United Kingdom; NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
• Fiona Moffatt: PhD - School of Health Sciences, University of Nottingham, Nottingham, United Kingdom; Arthritis UK Pain Centre, University of Nottingham, United Kingdom
• Stevie Vanhegan: NA - Independent consultant, Nottingham, United Kingdom
• Caroline Abbott: NA - Independent consultant, St Albans, United Kingdom
• Fiona Pearce: PhD - Lifespan and Population Health, University of Nottingham, Nottingham, United Kingdom; Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
• Kirsty Bannister: PhD - Department of Life Sciences, Imperial College London, United Kingdom
• Thomas Graven-Nielsen: PhD - Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
• David Walsh: PhD - Academic Rheumatology, University of Nottingham, Nottingham, United Kingdom; Arthritis UK Pain Centre, University of Nottingham, United Kingdom; NIHR Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom; Honorary Consultant, Sherwood Forest Hospitals NHS Foundation Trust, Sutton in Ashfield, United Kingdom
• Stephanie L. Smith: PhD - Academic Rheumatology, University of Nottingham, Nottingham, United Kingdom; Arthritis UK Pain Centre, University of Nottingham, United Kingdom; NIHR Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom