Editorial Commitment to Trust and Integrity in Science: Implications for Pain and Anesthesiology Research

We are a group of journal editors¹ dedicated to advancing discoveries and innovations in basic, translational, and clinical research across anesthesiology and pain-related disciplines, which play a crucial role in reducing the burden of pain, improving health, enhancing perioperative outcomes, and optimizing healthcare delivery. Across scientific disciplines, concerns have been raised about research quality and trustworthiness (Wallach et al. 2018; Ioannidis 2024). While these challenges are not unique to pain and anesthesiology research, we recognize this as a judicious opportunity to raise awareness and collaborate across our journals to align and strengthen initiatives to enhance research integrity, trust, and impact across our field.

In a 2005 landmark paper, John Ioannidis concluded with the dramatic and troubling assertion that “most published research findings are false,” stimulating a large focus in the biomedical research community on understanding issues of integrity, reproducibility, and replication that continues to be relevant to this day (Ioannidis 2005). Indeed, there are many instances in which authors, institutions, funders, publishers and journals have failed to embody the core values that produce trustworthy science. The trustworthiness of research is affected by both intentional actions (e.g., fabrication and falsification of data, lack of rigor, image manipulation) and unintentional actions (e.g., inadequate oversight, awareness and understanding of both technical and scientific issues). Most concerning are instances of research misconduct including fabrication, falsification, or plagiarism sometimes revealed by failure to replicate or reproduce results, duplication of publications, a rise in the number of retractions (Hemmings and Shafer 2020; Audisio et al. 2022), and calls for larger numbers of papers to be retracted (e.g., Ioannidis 2024). In support of Ioannidis's disquiet, some reviews (e.g., Open Science Collaboration 2015; Camerer et al. 2018) report low replication rates of positive findings in the social and life sciences across clinical trials, epidemiological research, and molecular studies.

In anesthesiology specifically, low agreement has been found between randomized clinical trials (RCTs) and meta-analytic findings for clinical pain interventions, where positive findings in meta-analyses were often not confirmed by subsequent large RCTs. For example, using individual patient data from RCTs published in Anaesthesia, Carlisle (2021) demonstrated that almost half of the databases had false data as detected from the duplication of figures, tables, and other data from published work; the duplication of data in the rows and columns of spreadsheets; impossible values; and incorrect data analytic strategies and calculations.

Reproducibility, clinical validity, and utility in pain and anesthesiology research are often compromised by non-representative samples (e.g., limited representation on characteristics such as race, ethnicity, age, sex/gender, or socioeconomic status that do not match population-level data of those most affected by pain) (Palermo et al. 2023; Davis 2025; Milam and Pandit 2025), reliance on surrogate outcomes with limited clinical relevance, underutilization of common data elements and core outcome sets, underpowered studies prone to false-negative results, and flawed statistical analysis plans that generate misleading conclusions (Moore et al. 2023).

To ensure integrity of the literature, retraction of articles may be necessary due to such issues as major errors, data fabrication, plagiarism, or unethical research practices. Authors are encouraged to identify errors in their own work and may request a corrigendum to correct the literature. However, when ethical issues are brought to a journal's attention, they have a duty to investigate, and when there is conclusive evidence, to impose a retraction to alert readers that the findings and conclusions cannot be relied upon (COPE: Committee on Publication Ethics 2019). Retractions, when reported, can have a widespread impact due to the interconnectedness of studies attributed to the same authors (Shafer 2011). In the field of anesthesiology, The Retraction Watch Leaderboard (2025) indicates four of the top ten authors are anesthesiologists, and two of these individuals occupy the top two positions (https://retractionwatch.com/the-retraction-watch-leader-board/). Systematic reviews have summarized characteristics of retracted publications for research misconduct in pain (e.g., Ferraro et al. 2023) and anesthesiology research (e.g., Nair et al. 2020). Concerns regarding retractions in all scientific fields are particularly noteworthy because they undermine trust in science, can have a lasting impact on conclusions made about treatments and, ultimately, impact clinical practice. In one study by O'Connell et al. (2023). a set of 8 untrustworthy trials (i.e., identified due to concerns including data anomalies and implausible results), in spinal pain was determined to substantially impact the results of subsequent recommendations made in systematic reviews and international clinical practice guidelines in management of spinal pain.

Meta-research studies regarding open science practices highlight critical remaining gaps across many fields in reproducible research practices, open access data, and availability of protocols (e.g., Wallach et al. 2018). In Lee et al. (2018) examined open science efforts in the pain field including preregistration of trials, sharing code, data, reproducible workflows, and the use of reporting guidelines. Among ten pain journals, a low level of engagement with open and transparent research policies was identified at that time. Cashin et al. (2021) also reviewed the policies of ten leading pain journals and determined that there were few journal policies adhering to transparency standards for review and publication. These observations have fueled many recent efforts and initiatives in open science including in pain and anesthesiology research.

Open and transparent research practices as embodied in the “open science” movement provide a more complete and accurate report of the research conducted and what was found, and share important aspects of the research process (e.g., availability of study materials, data and code) (Okonya et al. 2020). Trust and transparency are interwoven because when research is conducted and reported openly and transparently it increases confidence in the findings by enabling verification, replication, and critical appraisal.

Recommendations were made for short-term as well as more extended-term actions and behaviors for several different stakeholder groups (e.g., researchers, institutions, publishers, funders, policymakers and regulators, peer reviewers) to support trustworthy research within each of the core values of ENTRUST. These recommendations are intended to guide the development of a strategy for enhancing trustworthy research, rather than serving as a mandated policy.

From the perspective of engagement with our journals, here we focus on recommendations for researchers and editors/publishers.

We strongly recommend that researchers thoroughly review the proposed framework, which we as editors endorse, and explore the full suite of resources available through the ENTRUST-PE network project. These can be accessed at https://entrust-pe.org and on the Open Science Framework (https://osf.io/cua7g/?view_only=ec1d9e6b1d774dbca9306ff5ae4dec67). The initiative is designed to support researchers to understand how to conduct and report science in a manner that enhances the transparency and trustworthiness of their work. By following these recommendations, researchers can provide the highest quality of research and facilitate confidence in pain science. Moreover, peer reviewers and consumers of research can be alert to potential issues of methodological rigor, transparency, lack of equity and inclusivity, and markers of potential data inauthenticity or research misconduct that play a critical role in raising concerns to editors and publishers when these are identified. Recently, both the International Association for the Study of Pain (IASP) (2024) and the European Pain Federation (2025) endorsed the ENTRUST-PE initiative, recognizing that trustworthy research not only benefits investigators and healthcare professionals but also serves patients and the public by promoting science that produces more effective pain management strategies.

For a concise, actionable summary, we reproduce the guidance provided by O'Connell et al. (2025) which outlines practical suggestions researchers can implement immediately to align with the core values of the ENTRUST-PE framework (see Table 1).

As editors of journals in the fields of pain and anesthesiology, we wish to amplify the ENTRUST-PE framework (O'Connell et al. 2025) and support efforts to promote, teach, and enforce principles and values underpinning high quality and trustworthy research. Here, we highlight four areas where we collectively aspire to take a leadership role in enhancing the trustworthiness of research in the journals we serve.

Ultimately, as a community of scientists and clinicians in pain and anesthesiology, we must recognize that trust is a dynamic and multi-faceted concept. It requires ongoing effort to maintain, once lost is hard to regain, and it is built through consistent actions and open communication. Resources are available through the ENTRUST-PE framework that can guide actions and values to promote trust and integrity. These principles apply to all scientific fields beyond those that are pain-related and we encourage other specialties to harmonize such efforts. As editors, we will work together to advance the trustworthiness of research through upholding rigorous standards, ethical conduct, and open dialogue. By doing so, we can strengthen the foundation of trust in research and ensure that anesthesia and pain science continue to optimally inform care for people undergoing anesthesia or living with pain.

Tonya M. Palermo, Didier Bouhassira, Karen D. Davis, Hugh C. Hemmings Jr, Robert W. Hurley, Joel Katz, Jaideep J. Pandit, Theodore J. Price, Michael E. Schatman, Stephan K. W. Schwarz, Dennis C. Turk, Marc Van de Velde, Matthew D. Wiles, Tony L. Yaksh, and David Yarnitsky: conceptualization. Tonya M. Palermo: writing – original draft. Tonya M. Palermo, Didier Bouhassira, Karen D. Davis, Hugh C. Hemmings Jr, Robert W. Hurley, Joel Katz, Jaideep J. Pandit, Theodore J. Price, Michael E. Schatman, Stephan K. W. Schwarz, Dennis C. Turk, Marc Van de Velde, Matthew D. Wiles, Tony L. Yaksh, and David Yarnitsky: writing – review and editing. Tonya M. Palermo: supervision.

None of the authors have disclosures directly related to this work. T.M.P. receives research grant funding from NIH, provides consultation to TriveniBio, and serves as Editor-in-Chief, The Journal of Pain. D.B. serves as Editor-in-Chief, European Journal of Pain. K.D.D. serves as Editor-in-Chief, PAIN. H.C.H. receives research grant funding from NIH and serves as Editor-in-Chief, British Journal of Anaesthesia. R.W.H. has received cooperative research grants from NIH and Nevro Inc., provides expert/consulting to State Farm, and serves as Editor-in-Chief, Pain Medicine. J.K. is the Research Director of ManagingLife and serves as Editor-in-Chief, Canadian Journal of Pain. J.J.P. is Editor-in-Chief, Anesthesia & Analgesia. T.J.P. is a co-founder of and holds equity in 4E Therapeutics, NuvoNuro, PARMedics, Nerveli, and Doloromics, has received research grants from AbbVie, Eli Lilly, Grunenthal, Evommune, GSK, l\Hoba Therapeutics, and The National Institutes of Health, and serves as Editor-in-Chief, Neurobiology of Pain. M.Vd.V. has received honoraria for lectures and/or consultancy from CSL Behring, CSL Vifor, BBraun, Werfen, Viatris, CAF-DCF and Aquettant, and serves as Editor-in-Chief, European Journal of Anesthesiology. M.E.S. is Senior Medical Advisor, APURANO Pharma, and serves as Editor-in-Chief, Journal of Pain Research. S.K.W.S. holds the Dr. Jean Templeton Hugill Chair in Anesthesia, supported by the Dr. Jean Templeton Hugill Endowment for Anesthesia Memorial Fund (Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada) and gratefully acknowledges the Department of Anesthesia, St. Paul's Hospital/Providence Health Care (Vancouver, BC, Canada) for ongoing support. S.K.W.S. serves as Editor-in-Chief, Canadian Journal of Anesthesia. D.C.T. holds the John and Emma Bonica Endowed Chair in Anesthesiology & Pain Research at the University of Washington, has received research grants from NIH and NIOSH, and has provided consultation to Vertex. D.C.T. is also Associate Director of Analgesic, Anesthetic, and Addiction Clinical Trials Translations, Innovations, Opportunities, and Networks & Pediatric Anesthesia Safety Initiative (ACTTION/PASI). D.C.T. serves as Editor-in-Chief, Clinical Journal of Pain. M.D.W. serves as Editor-in-Chief, Anaesthesia. T.L.Y. is co-founder of Raft Pharmaceuticals, serves on the Scientific Advisory Board for Navega Therapeutics, and serves as the Editor-in-Chief for Frontiers in Pain Research. D.Y. is a partner in a current Horizons grant, holds equity in BrainsGate and Theranica, and receives honorariums from Dr Reddy and from IASP. D.Y. serves as Editor-in-Chief, PAIN Reports.