Middle East Pain Registry (MEPAIN): Feasibility Study of Chronic Pain Registry and Pilot Phase Results

Authors

  • Habib Zakeri Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran https://orcid.org/0000-0003-2495-8507
  • Mohammad Radmehr Research Center for Neuromodulation and Pain, Nab Pain Clinic, Shiraz University of Medical Sciences, Shiraz, Iran
  • Aliasghar Karimi Research Center for Neuromodulation and Pain, Nab Pain Clinic, Shiraz University of Medical Sciences, Shiraz, Iran
  • Leala Montazeri Research Center for Neuromodulation and Pain, Nab Pain Clinic, Shiraz University of Medical Sciences, Shiraz, Iran
  • Pegah Pedramfard Research Center for Neuromodulation and Pain, Nab Pain Clinic, Shiraz University of Medical Sciences, Shiraz, Iran https://orcid.org/0000-0001-6440-2672
  • Parisa Mahdiyar Research Center for Neuromodulation and Pain, Nab Pain Clinic, Shiraz University of Medical Sciences, Shiraz, Iran
  • Farnaz Hemati Research Center for Neuromodulation and Pain, Nab Pain Clinic, Shiraz University of Medical Sciences, Shiraz, Iran
  • Atiyeh Ebrahimi Mid Cheshire NHS Foundation Trust. Leighton Hospital, Middlewich Road, Crewe, Cheshire CW1 4QJ, UK
  • Sogand Sadeghi Mazandaran University of Medical Sciences, Sari, Iran https://orcid.org/0009-0000-8683-7773
  • Saba Moalemi Student Research Committee, Shiraz University of Medical Sciences, shiraz, Iran

DOI:

https://doi.org/10.31661/gmj.v14i.3807

Keywords:

Pain; Registry; Low Back Pain; Chronic Pain; Middle East

Abstract

Background: Chronic pain is a significant public health concern due to its long-term disabling effects. To support systematic data collection and improve patient management, the Middle East Pain Registry (MEPAIN) was developed. This study outlines the registry’s design, evaluates its feasibility, and presents initial findings from its pilot phase. Materials and Methods: MEPAIN was launched on July 21, 2024, with data collected via the Zigorat® software platform through January 22, 2025 for this pilot study. Each patient record included demographic details, pain characteristics (pattern, location, intensity), physical exam findings, imaging results, diagnoses, interventions, and follow-up data. Results: A total of 3,903 patients were registered during the six-month pilot. The cohort was 59.5% female, with a mean age of 53.5 ± 14.8 years; 50.2% were Iranian and 49.5% Omani. Lumbar radiculopathy was the most frequent diagnosis. Osteoarthritis and carpal tunnel syndrome predominated among females, while lumbar radiculopathy and discogenic pain were more common in younger patients. Iranians reported higher pain intensity during exacerbations, while Omanis showed greater prevalence of discogenic pain, spinal stenosis, carpal tunnel syndrome, and failed back surgery syndrome. Paresthesia was the most frequently reported symptom, and transforaminal epidural steroid injection was the most common procedure performed. Conclusion: The MEPAIN registry successfully captures comprehensive clinical and procedural data on patients with chronic pain in the Middle East. It offers a robust platform for clinical evaluation and research, supporting future efforts to tailor pain management strategies in regional populations.

References

Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2017;390(10100):1211-59.

https://doi.org/10.1016/S0140-6736(17)32154-2

PMid:28919117

Qiu Y, Li H, Yang Z, Liu Q, Wang K, Li R, et al. The prevalence and economic burden of pain on middle-aged and elderly Chinese people: results from the China health and retirement longitudinal study. BMC Health Services Research. 2020;20(1):600.

https://doi.org/10.1186/s12913-020-05461-6

PMid:32611450 PMCid:PMC7329515

Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain. 2012;13(8):715-24.

https://doi.org/10.1016/j.jpain.2012.03.009

PMid:22607834

Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020;8(6):299.

https://doi.org/10.21037/atm.2020.02.175

PMid:32355743 PMCid:PMC7186678

Linton SJ, Flink IK, Vlaeyen JWS. Understanding the Etiology of Chronic Pain From a Psychological Perspective. Phys Ther. 2018;98(5):315-24.

https://doi.org/10.1093/ptj/pzy027

PMid:29669087

Niknejad B, Bolier R, Henderson CR, Delgado D, Kozlov E, Löckenhoff CE, et al. Association between psychological interventions and chronic pain outcomes in older adults: a systematic review and meta-analysis. JAMA internal medicine. 2018;178(6):830-9.

https://doi.org/10.1001/jamainternmed.2018.0756

PMid:29801109 PMCid:PMC6145761

Mills S, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. British journal of anaesthesia. 2019;123(2):e273-e83.

https://doi.org/10.1016/j.bja.2019.03.023

PMid:31079836 PMCid:PMC6676152

Organization WH. ICD-11 International Classification of Diseases for Mortality and Morbidity .Statistics: 2020; 2020.

Fayaz A, Croft P, Langford RM, Donaldson LJ, Jones GT. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open. 2016;6(6):e010364.

https://doi.org/10.1136/bmjopen-2015-010364

PMid:27324708 PMCid:PMC4932255

Bellows BK, Kuo KL, Biltaji E, Singhal M, Jiao T, Cheng Y, et al. Real-world evidence in pain research: a review of data sources. J Pain Palliat Care Pharmacother. 2014;28(3):294-304.

https://doi.org/10.3109/15360288.2014.941131

PMid:25136897

Dreyer NA, Garner S. Registries for robust evidence. JAMA. 2009;302(7):790-1.

https://doi.org/10.1001/jama.2009.1092

PMid:19690313

Gliklich RE, Dreyer NA, Leavy MB. Registries for Evaluating Patient Outcomes: A User's Guide. 3rd ed: Agency for Healthcare Research and Quality; 2014 2014.

Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain. 2019;160(1):19-27.

https://doi.org/10.1097/j.pain.0000000000001384

PMid:30586067

Hidalgo-Tallón FJ, Torres-Morera LM, Baeza-Noci J, Carrillo-Izquierdo MD, Pinto-Bonilla R. Updated review on ozone therapy in pain medicine. Frontiers in Physiology. 2022;13:840623.

https://doi.org/10.3389/fphys.2022.840623

PMid:35283802 PMCid:PMC8904924

Mills SE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. British Journal of Anaesthesia. 2019;123(2):e273-e83.

https://doi.org/10.1016/j.bja.2019.03.023

PMid:31079836 PMCid:PMC6676152

Stokes AC, Xie W, Lundberg DJ, Hempstead K, Zajacova A, Zimmer Z, et al. Increases in BMI and chronic pain for US adults in midlife, 1992 to 2016. SSM-population Health. 2020;12:100644.

https://doi.org/10.1016/j.ssmph.2020.100644

PMid:33134473 PMCid:PMC7585155

Zelaya CE, Dahlhamer JM, Lucas JW, Connor EM. Chronic Pain and High-impact Chronic Pain Among US Adults, 2019. NCHS Data Brief. 2020 Nov;(390):1-8.

Fillingim RB, Loeser JD, Baron R, Edwards RR. Assessment of chronic pain: domains, methods, and mechanisms. The Journal of Pain. 2016;17(9):T10-T20.

https://doi.org/10.1016/j.jpain.2015.08.010

PMid:27586827 PMCid:PMC5010652

Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, et al. Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults. J Am Acad Orthop Surg Glob Res Rev. 2018;2(3):e088.

https://doi.org/10.5435/JAAOSGlobal-D-17-00088

PMid:30211382 PMCid:PMC6132313

Boonstra AM, Preuper HRS, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. International Journal of Rehabilitation Research. 2008;31(2):165-9.

https://doi.org/10.1097/MRR.0b013e3282fc0f93

PMid:18467932

Margolis RB, Chibnall JT, Tait RC. Test-retest reliability of the pain drawing instrument. Pain. 1988;33(1):49-51.

https://doi.org/10.1016/0304-3959(88)90202-3

PMid:3380550

Licciardone JC, Gatchel RJ, Phillips N, Aryal S. The Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION): registry overview and protocol for a propensity score-matched study of opioid prescribing in patients with low back pain. J Pain Res. 2018;11:1751-60.

https://doi.org/10.2147/JPR.S169275

PMid:30233232 PMCid:PMC6134408

Granan LP, Reme SE, Jacobsen HB, Stubhaug A, Ljosa TM. The Oslo University Hospital Pain Registry: development of a digital chronic pain registry and baseline data from 1,712 patients. Scand J Pain. 2019;19(2):365-73.

https://doi.org/10.1515/sjpain-2017-0160

PMid:30699072

Vadalouca A, Alexopoulou-Vrachnou E, Rekatsina M, Kouroukli I, Anisoglou S, Kremastinou F, et al. The Greek Neuropathic Pain Registry: The structure and objectives of the sole NPR in Greece. Pain Pract. 2022;22(1):47-56.

https://doi.org/10.1111/papr.13049

PMid:34145725

Akerblom S, Cervin M, Perrin S, Rivano Fischer M, Gerdle B, McCracken LM. A network analysis of clinical variables in chronic pain: A Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). Pain Medicine. 2021;22(7):1591-602.

https://doi.org/10.1093/pm/pnaa473

PMid:33706371

Choiniere M, Ware MA, Page MG, Lacasse A, Lanctot H, Beaudet N, et al. Development and Implementation of a Registry of Patients Attending Multidisciplinary Pain Treatment Clinics: The Quebec Pain Registry. Pain Res Manag. 2017;2017:8123812.

https://doi.org/10.1155/2017/8123812

PMid:28280406 PMCid:PMC5322414

Kent P, Kongsted A, Jensen TS, Albert HB, Schiøttz-Christensen B, Manniche C. SpineData-a Danish clinical registry of people with chronic back pain. Clinical Epidemiology. 2015;7:369-80.

https://doi.org/10.2147/CLEP.S83830

PMid:26316820 PMCid:PMC4540159

Ueberall M, Mueller-Schwefe G. The German Pain Practice Registry-A New Way to Use Real-Time Sampled Routine Data For Health-Care Research. Value in Health. 2016;19(7):A631.

https://doi.org/10.1016/j.jval.2016.09.1639

Audet C, Zerriouh M, Nguena Nguefack HL, Julien N, Pagé MG, Guénette L, et al. Where we live matters: a comparison of chronic pain treatment between remote and non-remote regions of Quebec, Canada. Frontiers in Pain Research. 2024;5:1291101.

https://doi.org/10.3389/fpain.2024.1291101

PMid:38468692 PMCid:PMC10925759

Halvorsen U, Bjørnnes AK, Ljosaa TM. Nurse-Led Telephone Follow-Up Intervention for Titrating and Tapering Opioids in Chronic Pain Patients-A Feasibility Study. Journal of Pain Research. 2023:1285-300.

https://doi.org/10.2147/JPR.S394878

PMid:37090765 PMCid:PMC10120593

Nim CG, Kawchuk GN, Schiøttz-Christensen B, O'Neill S. The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial. Scientific Reports. 2020;10(1):14615.

https://doi.org/10.1038/s41598-020-71557-y

PMid:32884045 PMCid:PMC7471938

Lipowski ZJ. Chronic idiopathic pain syndrome. Annals of Medicine. 1990;22(4):213-7.

https://doi.org/10.3109/07853899009148927

PMid:2248755

Jackson T, Thomas S, Stabile V, Shotwell M, Han X, McQueen K. A Systematic Review and Meta-Analysis of the Global Burden of Chronic Pain Without Clear Etiology in Low- and Middle-Income Countries: Trends in Heterogeneous Data and a Proposal for New Assessment Methods. Anesthesia & Analgesia. 2016;123(3):739-48.

https://doi.org/10.1213/ANE.0000000000001389

PMid:27537761

Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311(15):1547-55.

https://doi.org/10.1001/jama.2014.3266

PMid:24737367

Park WM, Kim K, Kim YH. Effects of degenerated intervertebral discs on intersegmental rotations, intradiscal pressures, and facet joint forces of the whole lumbar spine. Computers in Biology and Medicine. 2013;43(9):1234-40.

https://doi.org/10.1016/j.compbiomed.2013.06.011

PMid:23930818

Urits I, Burshtein A, Sharma M, Testa L, Gold PA, Orhurhu V, et al. Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Current Pain and Headache Reports. 2019;23(1):1-10.

https://doi.org/10.1007/s11916-020-0834-5

PMid:31916041

Van Tulder M, Becker A, Bekkering T, Breen A, del Real MTG, Hutchinson A, et al. European guidelines for the management of acute nonspecific low back pain in primary care. European Spine Journal. 2006;15(Suppl 2):s169-s91.

https://doi.org/10.1007/s00586-006-1071-2

PMid:16550447 PMCid:PMC3454540

Flynn T, Fritz J, Whitman J, Wainner R, Magel J, Rendeiro D, et al. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine. 2002;27(24):2835-43.

https://doi.org/10.1097/00007632-200212150-00021

PMid:12486357

Grotle M, Brox JI, Veierød MB, Glomsrød B, Lønn JH, Vøllestad NK. Clinical course and prognostic factors in acute low back pain: patients consulting primary care for the first time. Spine. 2005;30(8):976-82.

https://doi.org/10.1097/01.brs.0000158972.34102.6f

PMid:15834343

Roland M, Morrell D, Morris R. Can general practitioners predict the outcome of episodes of back pain? British Medical Journal (Clinical research ed). 1983;286(6364):523.

https://doi.org/10.1136/bmj.286.6364.523

PMid:6218860 PMCid:PMC1546604

Bužgová R, Kozáková R, Bar M. Pain, physical symptoms and functional assessment in progressive neurological disease in palliative care. BMJ Supportive & Palliative Care. 2020;13:e136-e43.

https://doi.org/10.1136/bmjspcare-2020-002416

PMid:32792418

Hartvigsen L, Kongsted A, Hestbaek L. Clinical examination findings as prognostic factors in low back pain: a systematic review of the literature. Chiropractic & Manual Therapies. 2015;23(1):1-22.

https://doi.org/10.1186/s12998-015-0054-y

PMid:25802737 PMCid:PMC4369880

Hashim MM, Edgeworth DM, Saunders JA, Harmon DC. Patient's perceptions of physical examination in the setting of chronic pain. Ir J Med Sci. 2021;190(1):313-6.

https://doi.org/10.1007/s11845-020-02250-2

PMid:32451763

Harman AL, Nguyen VT. Diagnostic Radiology and Pain in the Rehabilitation Patient. Comprehensive Pain Management in the Rehabilitation Patient. 2017:287-98.

https://doi.org/10.1007/978-3-319-16784-8_20

Maas ET, Juch JNS, Ostelo RWJG, Groeneweg JG, Kallewaard JW, Koes BW, et al. Systematic review of patient history and physical examination to diagnose chronic low back pain originating from the facet joints. European Journal of Pain. 2017;21(3):403-14.

https://doi.org/10.1002/ejp.963

PMid:27723170

Hall BH. Physical Examination for Chronic Pain. Evaluation and Management of Chronic Pain for Primary Care: A Pocket Guide for the Primary Care Provider. 2020:13-26.

https://doi.org/10.1007/978-3-030-47117-0_2

Marcianò G, Vocca C, Evangelista M, Palleria C, Muraca L, Galati C, et al. The pharmacological treatment of chronic pain: from guidelines to daily clinical practice. Pharmaceutics. 2023;15(4):1165.

https://doi.org/10.3390/pharmaceutics15041165

PMid:37111650 PMCid:PMC10144480

Rajeev G. Non-pharmaceutical management of chronic pain. GSC Adv Res Rev. 2023;16(2):158-65.

https://doi.org/10.30574/gscarr.2023.16.2.0112

Ferreira-Dos-Santos G, Hurdle MFB, Clendenen SR, Eldrige JS, Qu W. Autologous Platelet-Rich Plasma Applications in Chronic Pain Medicine: Establishing a Framework for Future Research-A Narrative Review. Pain Physician. 2022;25(1):15-27.

https://doi.org/10.2217/pmt-2022-0070

PMid:36408639

Korownyk CS, Montgomery L, Young J, Moore S, Singer AG, MacDougall P, et al. PEER simplified chronic pain guideline: Management of chronic low back, osteoarthritic, and neuropathic pain in primary care. Canadian Family Physician. 2022;68(3):179-90.

https://doi.org/10.46747/cfp.6803179

PMid:35292455 PMCid:PMC9833192

Rahman S, Kidwai A, Rakhamimova E, Elias M, Caldwell W, Bergese SD. Clinical Diagnosis and Treatment of Chronic Pain. Diagnostics. 2023;13(24):3689.

https://doi.org/10.3390/diagnostics13243689

PMid:38132273 PMCid:PMC10743062

Downloads

Published

2025-04-29

How to Cite

Zakeri, H., Radmehr, M., Karimi, A., Montazeri, L., Pedramfard, P., Mahdiyar, P., … Moalemi, S. (2025). Middle East Pain Registry (MEPAIN): Feasibility Study of Chronic Pain Registry and Pilot Phase Results. Galen Medical Journal, 14, e3807. https://doi.org/10.31661/gmj.v14i.3807

Issue

Vol. 14 (2025): 2025: In Progress

Section

Original Article

License

Copyright (c) 2025 Galen Medical Journal

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

https://creativecommons.org/licenses/by/4.0/