Abstract
<p>Objectives: To develop and implement a co-creation process for common language and multi-stakeholder engagement to produce a shared causal framework that helps identify meaningful research questions in the context of psychosocial processes in pain and guide data modelling decisions.Design: Participatory co-design study using facilitated workshops and iterative synthesis to develop a ‘Dream’ Directed Acyclic Graph (Dream-DAG). The Dream-DAG represented an idealised visual causal map unconstrained by available study measures or specific dataset limitations. We used a storm metaphor where different components of the storm (i.e., thunder or lightning) mirror the temporal and causal inference features in DAGs (i.e., exposure or confounding).Setting: A UK-based multidisciplinary pain research consortium involving researchers, clinicians and public contributors.Participants: 12 participants took part, including 4 experts by experience living with chronic pain and 8 professionals including a wide range of researchers (from quantitative and qualitative fields), clinicians and data scientists. Participants were invited because of their lived, clinical, methodological or data-related expertise relevant to psychosocial processes in pain.Results: Through the workshops we developed a shared language for causal thinking, a co-created Dream-DAG, and an operationalised set of hypothesised pathways to inform future data modelling within pain research. The variables and pathways of interest identified as part of this process cover a wide range of concepts considered relevant to the development and maintenance of pain. This included individual factors such as anxiety and loss of identity, interpersonal factors such as disruption to relationships, and the broader role of social worlds. Importantly, the DAG mapped the order of influences and highlighted disruption to relationships as a potential mediating indirect pathway between pain-related experiences and ongoing pain impact. The process also supported translation of experiential, clinical and methodological knowledge into testable research questions for use within existing life-course datasets.Conclusion: Collaboration using metaphor-based causal diagram development can support multidisciplinary pain research teams to integrate expertise from multiple viewpoints which is vital to ensure that research questions are meaningful to those with chronic pain. The resulting Dream-DAG provides a transparent, theory-informed and experience-informed framework for future empirical analyses, with operationalised and testable hypothesised pathways, although further work is needed to evaluate its transferability to other research teams, datasets and health contexts.</p>