Justin Coffeen | Working in a Chronic Pain Clinic and What It Taught Me About Patient Data

Between 2013 and 2017, Justin Coffeen worked in a medical chronic pain clinic alongside his chiropractic practice. His work there included instructing patients in physical rehabilitation and performing Functional Capacity Evaluations — structured assessments used to determine a patient’s ability to perform physical tasks, typically in the context of workers’ compensation or disability determinations. That experience with chronic pain populations and functional assessment has shaped how he thinks about participant data in a research context.

What Chronic Pain Patients Teach You About Reporting

Patients experiencing chronic pain present a specific challenge in clinical settings: their symptoms are real but often invisible, and their ability to describe them varies widely. Pain is subjective, and the language available to describe it is imprecise. Two patients with similar diagnoses may describe their pain in completely different terms, using different intensity scales, different descriptors, and different reference points for what “normal” feels like. A clinician who is not attentive to this variation will misread patient reports.

That challenge is directly relevant to clinical research, particularly in trials where patient-reported outcomes are primary or secondary endpoints. A participant’s report of symptom severity is a data point. Its reliability depends on how well the assessment tool captures what the participant is actually experiencing, and how well the site team facilitates accurate reporting rather than inadvertently steering it.

Functional Capacity Evaluations and Objective Measurement

Functional Capacity Evaluations added another dimension to this experience. An FCE is a structured, standardized assessment — it follows a protocol, it produces quantifiable outputs, and it needs to be administered consistently to be valid. The patient’s subjective experience matters, but it is evaluated in relation to observable functional performance. A patient may report that they cannot lift ten pounds; the FCE assesses whether that report is consistent with their actual performance across a range of tasks.

That interplay between subjective report and objective measurement is present throughout clinical research. A participant may report a symptom that is not consistent with the biomarker data, or may not report a symptom that the clinical assessment reveals. Source documentation needs to capture both. The research professional’s job is not to adjudicate between them but to record both accurately so that the clinical team and the sponsor can assess what is happening.

Patient Instruction and Participant Communication

The instructional component of Justin Coffeen’s chronic pain clinic work — teaching patients physical rehabilitation techniques — also developed skills that apply to research. Teaching a patient to perform a rehabilitation exercise correctly requires clarity, patience, and the ability to recognize when the patient has understood the instruction and when they have not. A patient who performs an exercise incorrectly because the instruction was unclear is not failing at rehabilitation. The instruction was insufficient.

The same principle applies to participant instruction in clinical research. A participant who completes a diary incorrectly, or who takes study medication at the wrong time, may be doing so because the instructions they received were not clear. Attribution matters. If the research team assumes participant error when the source is instruction failure, the problem will not be corrected.

What Carries Forward

The years Justin Coffeen spent in a chronic pain clinic were formative in a specific way: they produced direct experience with populations whose clinical presentations are complex, whose self-reports require careful interpretation, and whose engagement with a clinical process depends on the quality of the provider-patient relationship. Clinical research populations are not identical to chronic pain patients, but the skills developed in that context — attentive listening, precise documentation, patient instruction — apply across the clinical research settings he has worked in since.