Gender differences in perceived pain and health-related quality of life in people with chronic non-malignant pain: a cross-sectional study

The silence of opioids-dependent chronic pain patients: A text mining analysis from sex and gender perspective

Existing evidence indicates sex-related differences in Prescription Opioid Use Disorder (OUD) in Chronic Non-Cancer Pain (CNCP). However to date, there is scant evidence for other socioeconomic factors in these differences. Our aim was to enquire about the influence of gender and drug copayment of OUD narratives by the text mining analysis. A prospective mixed-methods study was designed and performed at Pain Unit (PU) including 238 real world patients with CNCP divided in controls (n = 206) and OUD cases (n = 32) due to DSM-5 diagnosis Variables related to pain, sleep, mental and health status were collected in together with sex and gender interaction, in pain status, along 30-45 min face-to-face interviews. Sex differences were observed due to women's significantly older ages, with a stronger impact on mental health, and an even stronger one for the OUD women. Globally, OUD cases were more unemployed vs the CNCP controls, and on a significantly higher median opioid daily dose of 90 [100] mg/day. Although OUD participants did more social activities, they tended to use less vocabulary to express themselves regardless of their sex, gender role or economic status. In contrast, the CNCP participants presented more differences driven by their incomes, with "limited" being the most discriminating word for those on low income, followed by "less" and "help". Here, the most significant word of CNCP women was "husband", followed by "tasks". In contrast, gender reproductive roles shared similarities in both sexes, being one of the most discriminatory words "help". The data show that OUD patients seem to have a marked influence of OUD on poorer lexicon and simpler narrative, together with a significant impact of socioeconomic factors on the CNCP narratives. The conclusion suggests to extend the research to better understand the effect of sex, gender and socioeconomic status in CNCP especially on OUD women's health.

Neuropathic Symptoms and Frequency of Chronic Pain in an International Online Sample of Individuals with Sub-Acute and Chronic Stroke

Background/Objectives: Chronic pain is common following a stroke and is associated with increased disability. Yet, little is known about the chronic pain experience in the stroke population. This study aimed to identify and explore the features and neuropathic symptoms of chronic pain in individuals with longstanding stroke. Methods: This observational study utilized an online survey that was developed for individuals who have had a stroke (>3 months). Data sought included participant demographics, medical history, and details of the stroke(s). Participants who reported experiencing chronic pain completed the Numerical Rating Scale for Pain, the Neuropathic Pain Symptom Inventory, and body maps to indicate region(s) of pain. Results: A total of 533 individuals with longstanding stroke participated. Chronic pain was reported as being experienced by 60% of participants and was more frequently experienced by individuals who reported being female (p = 0.002). Moderate or severe pain intensity was commonly reported (mean = 5.98, SD = 1.89). Individuals with chronic pain post-stroke reported a range of neuropathic symptoms rather than a common pain experience, with combinations of spontaneous, paroxysmal, and evoked pains in addition to pain associated with paraesthesia/dysaesthesia. Pain involving the upper limb was the most common region (shoulder 39%, hand and forearm 38%), followed by the lower limb (foot 30%, leg 29%). Having multiple strokes was associated with a higher frequency of chronic pain (p = 0.01), as was peripheral vascular disease (p < 0.001) and lipid disorders (p = 0.001). Conclusions: These findings highlight the varied nature of chronic pain experienced by individuals following a stroke, while also detailing stroke and medical history associated with chronic pain. It builds on existing knowledge of chronic pain post-stroke and provides new insight into the neuropathic symptoms experienced. This knowledge has the potential to assist in the development of tailored interventions based on addressing pain symptomatology and health literacy.

Effectiveness of pain medication tapering in chronic pain patients: a systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis aimed to inventory all outcome measures that are affected by tapering in chronic noncancer pain and to investigate the effectiveness of tapering.

METHODS

A literature search was conducted from inception to April 2024 in MEDLINE via PubMed, Web of Science, SCOPUS, EMBASE, and PsycINFO.

RESULTS

The initial database search identified 3969 articles, which were screened by two independent reviewers. Studies evaluating pain medication tapering in adults with chronic noncancer pain were eligible for inclusion. In total, 57 and 34 articles were included in the systematic review and meta-analysis, respectively. Risk of bias assessment demonstrated poor, fair, and good quality in 30, 24, and three studies, respectively. Pain intensity was the most reported outcome measure, as reported in 28 studies. Furthermore, a random-effect three-level meta-analysis was performed. An overall effect size of 0.917 (95% confidence interval 0.61-1.22; P<0.001) was found, indicating a beneficial effect of tapering. In addition, a statistically significant improvement was demonstrated after tapering for pain intensity, headache disability, the number of headache days per month, anxiety, depression, the number of pills consumed per month, the number of days with medication intake per month, pain catastrophising, and pain interference. No statistically significant effect was observed for physical functioning, mental health-related quality of life, opioid use, pain self-efficacy, and physical health-related quality of life.

CONCLUSIONS

This systematic review revealed a broad range of outcome measures affected by tapering. Owing to the high risk of bias of the included articles, the results of this meta-analysis must be interpreted with caution.

SYSTEMATIC REVIEW PROTOCOL

CRD42023416343 (PROSPERO).

Investigating psychological mechanisms linking pain severity to depression symptoms in women cancer survivors at a cancer center with a rural catchment area

PURPOSE

Women cancer survivors, especially those in rural areas, with high levels of depression may be acutely susceptible to pain due to the ways they think, feel, and behave. The current study seeks to elucidate the relationship between symptoms of depression and pain severity in women cancer survivors, by examining the putative mediators involved in this relationship, specifically their self-efficacy for managing their health, how overwhelmed they were from life's responsibilities, and relational burden.

METHODS

Self-report data were collected from 183 cancer survivors of breast, cervical, ovarian, or endometrial/uterine cancer, who were between 6 months and 3 years post-active therapy.

RESULTS

Women cancer survivors with higher (vs. lower) symptoms of depression had more severe pain. Individual mediation analyses revealed that survivors with higher levels of depression felt more overwhelmed by life's responsibilities and had lower self-efficacy about managing their health, which was associated with greater pain severity. When all mediators were simultaneously entered into the same model, feeling overwhelmed by life's responsibilities significantly mediated the link between survivors' symptoms of depression and their pain severity.

CONCLUSIONS

The relationship between symptoms of depression and pain severity in women cancer survivors may be attributed in part to their self-efficacy and feeling overwhelmed by life's responsibilities. Early and frequent assessment of psychosocial factors involved in pain severity for women cancer survivors may be important for managing their pain throughout the phases of cancer survivorship.

Sex moderates the association between quantitative sensory testing and acute and chronic pain after total knee/hip arthroplasty

OBJECTIVES

Acute postsurgical pain (APSP) may persist over time and become chronic. Research on predictors for APSP and chronic postsurgical pain (CPSP) has produced inconsistent results. This observational study aimed to analyze psychological and psychophysical variables associated with APSP and CPSP after total knee or hip arthroplasty, and to explore the role of sex.

METHODS

Assessments were conducted before surgery, 48 h, and 3 months postsurgery, including questionnaires (sociodemographic, pain related, and psychological) and quantitative sensory testing (QST). Hierarchical linear regression models analyzed potential predictors of APSP and CPSP, and moderation analyses evaluated the role of sex.

RESULTS

The study included 63 participants undergoing total knee (34, 54%) or hip (29, 46%) arthroplasty. Thirty-one (49.2%) were female and 32 (50.8%) were male. APSP (48 h) was associated with impaired conditioned pain modulation (CPM) (β = 0.301, p = 0.019). CPSP (3 months) was associated with being female (β = 0.282, p = 0.029), longer presurgical pain duration (β = 0.353, p = 0.006), knee arthroplasty (β = -0.312, p = 0.015), higher APSP intensity (β = 373, p = 0.004), and impaired CPM (β = 0.126, p = 0.004). In multivariate analysis, these clinical variables were significant predictors of CPSP, unlike sex, and CPM (adj. R 2 = 0.349). Moderation analyses showed that wind-up ratio (WUR) was a significant predictor of APSP in men (WUR × sex: b = -1.373, p = 0.046) and CPM was a significant predictor of CPSP in women (CPM × sex: b = 1.625, p = 0.016).

CONCLUSIONS

Specific QST parameters could identify patients at risk for high-intensity APSP and CPSP, with sex as a moderator. This has important clinical implications for patient care, paving the way for developing tailored preventive pain management strategies.

Managing Non-Cancer Chronic Pain in Frail Older Adults: A Pilot Study Based on a Multidisciplinary Approach

Considering the multidimensionality of chronic pain, it is crucial to develop comprehensive strategies for its effective management. However, establishing well-defined, evidence-based guidelines for such approaches remains challenging. To overcome this, we present the finding from a 4-month intervention to enhance the management of non-cancer chronic pain in older adults with pre-frailty and frailty. The intervention's core elements comprised a multidisciplinary individualized plan, a case manager, and patient education. This pilot study involved 22 participants (≥65 years). It assessed changes in pain frequency and intensity (pain scale), frailty (Fried frailty phenotype criteria), and medication adherence (Brief Adherence Rating Scale) before and after the 4-month intervention. The results were encouraging: pain frequency and intensity and frailty score tended to decrease, and medication adherence showed significant improvement. This preliminary small-scale pilot study provides a foundation for further research and for exploring the potential scalability of this multidisciplinary patient-centred intervention.