ENTRUST-PE: A New Framework for Trustworthy Pain Research

Chronic pain affects hundreds of millions of people worldwide and is a leading cause of disability, yet the evidence base guiding its treatment is often compromised by a range of serious and systemic shortcomings. These include inadequate research governance, inequity and discriminatory practices, insufficient engagement of patients and other stakeholders, poor methodological rigour, questionable research practices, incomplete reporting, and limited transparency and accessibility of data. In addition, research findings are too often communicated without appropriate balance, blurring the lines between interpretation and speculation. While these issues are not unique to pain research, their combined effect in this field leads to increased bias and uncertainty, wasted resources, and the proliferation of low-value care. Ultimately, this impedes progress toward effective treatments and exacerbates the burden on individuals living with chronic pain.

The ENTRUST-PE project, funded under ERA-Net NEURON’s 2022 Networking Group Call (NWGC) on chronic pain, took on this challenge directly. Led by Prof. Neil O’Connell (Brunel University of London), this international, interdisciplinary network brought together over 20 experts—including clinicians, researchers, methodologists, and a patient advocate—to tackle a pressing question: How can we enhance the trustworthiness of pain research?

From Network to Framework

Over the course of a year, the ENTRUST-PE consortium met several times—virtually and in-person - including a 2-day meeting at Brunel University of London. These meetings culminated in the development of the ENTRUST-PE Framework, a practical and comprehensive tool for guiding stakeholders across the research ecosystem.

The framework is built around seven Core Values:

• Integrity and Governance
• Equity, Diversity, and Inclusivity
• Patient and Public Involvement and Engagement (PPIE)
• Methodological Rigour
• Openness and Transparency
• Balanced Communication
• Data Authenticity

Each value is linked to universal behaviours and specific recommendations tailored to stakeholder groups—including researchers, funders, journals, institutions, and policy bodies. For example, funders are encouraged to adopt equity and transparency as explicit quality indicators in funding decisions, while researchers are urged to embed public involvement throughout the research process. The framework also offers practical tools: a white paper, stakeholder-specific factsheets, an explainer video, and curated resources—all designed to help operationalize these values in everyday research practice.

As Prof. Andrew Rice, a partner in ENTRUST-PE, noted, the ENTRUST-PE framework’s strength lies in how it consolidates key concerns—particularly in preclinical research—and offers tailored, actionable guidance for diverse stakeholders.

Early Impact and Future Ambitions

The ENTRUST-PE framework has already been showcased at multiple major events, including two workshops at the International Association for the Study of Pain (IASP) World Congress, a UK Society for Back Pain Research meeting, a European Pain Federation (EFIC)congress in  Lyon,  an Advanced Pain Discovery Platform (APDP)  conference in the UK, and a British Pain Society webinar. A high-profile “call to action” paper was recently published with the Journal of Pain and the framework has been endorsed by the IASP, EFIC, USASP (United States Association for the Study of Pain) and the Australian Pain Society, with additional endorsements expected.

In July 2025, editors of 15 leading pain and anaesthesiology journals (see sidebar for details) co-published a jointly signed editorial that endorses ENTRUST-PE and commits their journals to the framework’s principles—an unprecedented show of field-wide support.

Funding bodies are also taking notice: a recent UK National Institute for Health and Care Research (NIHR) funding call invited applicants to “consider consulting the ENTRUST-PE resources when designing their study.”

Key resources are available via:

• entrust-pe.org
• OSF preprint repository

ENTRUST-PE partners are now seeking opportunities to evaluate the framework’s implementation in real-world settings and to further investigate each of its elements through applied research. Looking ahead, Dr. Keith Smart, a partner in ENTRUST-PE, envisions the framework becoming embedded in professional standards and training curricula, helping to shape research conduct from the earliest stages.

While the ENTRUST-PE framework has been met with enthusiasm and endorsed by major stakeholders, the team also recognises that implementation is both the most critical and the most resource-intensive phase. As Prof. Rice notes, “Real and meaningful implementation—and in time, revisiting and revising the framework—are crucial.” Future initiatives and dedicated support will be essential to ensure the framework's impact is sustained.

This novel call aimed to foster collaboration across sectors, disciplines, and career stages to address the complex, multidimensional nature of chronic pain. ENTRUST-PE stands as a model of what these consortia can achieve—bringing together patient voices, seasoned researchers, and fresh perspectives to generate widely usable outputs.

As Prof. O'Connell noted, “I don’t believe we could have achieved this without the funding. The ability to put the network in a room together for 2 days and to produce accessible knowledge translation materials was just invaluable. The joint enterprise of applying for the funding is also a great way to launch that collaborative enterprise.”. This emphasis on collaboration was echoed by Prof. Rice, who said that so much came of the face-to-face meeting that could not have been achieved by email or Zoom. This served as an excellent example of why in-person interaction is so important, even as we rightly weigh the financial and environmental costs. Moreover, he mentioned that having early- and mid-career researchers and people with lived experience (PWLE) as part of the team—and ensuring they felt their voices were genuinely valued—was critical to the success of the project.