Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11)

Evidence summary on pain management in thoracoscopic lung cancer surgery

Objective

The study aimed to systematically retrieve, evaluate and summarize evidence on perioperative pain management in adults undergoing thoracoscopic lung cancer surgery, to assist oncology nurses in improving pain assessment and management.

Methods

The research question was established using PIPOST model and a systematic search was conducted in English and Chinese databases, professional society websites and guideline platforms for literature published between January 2017 and December 2024. Included literature types comprised guidelines, systematic reviews, evidence summaries, expert consensus, and standards. After literature searching and screening in January 2025, the remaining guidelines were evaluated by four investigators, while other literature was assessed by two investigators. Evidence was then extracted and graded.

Results

Eighteen articles were included, comprising 5 systematic reviews, 3 guidelines, 2 clinical decisions, 4 evidence summaries, 3 expert consensus, and 1 standard. Twenty-five pieces of evidence across six topics were summarized, covering organizational management, high-risk patient assessment and preoperative education, pain assessment, intraoperative analgesia, multimodal pharmacological strategies, and non-pharmacological interventions.

Conclusions

This evidence summary highlights effective strategies for perioperative pain management in thoracoscopic lung cancer surgery, which could support oncology nurses in implementing comprehensive pain assessment, identifying high-risk patients, and applying diversified analgesic interventions.

Chronic pain in ICU survivors: Potential risk factors and relationship with post-traumatic stress disorder symptoms and health related quality of life

OBJECTIVES

To identify patient characteristics and clinical factors during ICU hospitalization potentially associated with chronic pain occurrence, and to determine its relationship with symptoms of post-traumatic stress disorder (PTSD) and health-related quality of life (HRQoL) at three time points after ICU discharge.

METHODS

Adult ICU survivors were enrolled in a prospective, repeated measures study. The study was carried out in two phases. Phase I was conducted during the first 5 days of survivors' ICU hospitalization where patient characteristics and clinical data were collected. Phase II was conducted via telephone interviews after 3 (T1), 6 (T2) and 12 (T3) months post-ICU discharge, where pain, PTSD-related symptoms, and HRQoL were assessed with the Numeric Rating Scale (NRS), Davidson Trauma Scale (DTS), and 36-Item Short Form Survey version 2 (SF-36v2), respectively.

RESULTS

Data from 59 survivors were analysed, 69.5% of whom were males. The sample's mean age was 52.7 (SD 18.9) years and 62.7% of them reported NRS>3 at T1, indicating chronic pain. After adjusting for sex, age, and APACHE II score, chronic pain was significantly associated with: (a) length of stay in the ICU (OR=1.42; 95%CI: 1.03-1.95; p=0.030) and (b) clinically relevant symptoms of PTSD at T1 (OR=10.04; 95%CI: 2.44-41.24; p=0.001) and T2 (OR=11.90; 95%CI: 1.28-110.49; p=0.029). Lower SF-36v2 scores in all domains at T1, several domains at T2, and two domains at T3 were significantly associated with CP occurrence.

CONCLUSIONS

Of the patient characteristics and clinical factors analysed, only longer length of stay in ICU was significantly associated with higher odds of chronic pain occurrence, which in turn was linked to PTSD-related symptoms and lower HRQoL after ICU discharge.

IMPLICATIONS FOR CLINICAL PRACTICE

Clinical interventions aimed at optimizing ICU length of stay, such as the implementation of early mobility programs and multidisciplinary rehabilitation, may support prevention of chronic pain occurrence and improve long-term outcomes.

The persistent pain enigma: Molecular drivers behind acute-to-chronic transition

The transition from acute to chronic pain is a complex and multifactorial process that presents significant challenges in both diagnosis and treatment. Key mechanisms of peripheral and central sensitization, neuroinflammation, and altered synaptic plasticity contribute to the amplification of pain signals and the persistence of pain. Glial cell activation, particularly microglia and astrocytes, is pivotal in developing chronic pain by releasing pro-inflammatory cytokines that enhance pain sensitivity. This review explores the molecular, cellular, and systemic mechanisms underlying the transition from acute to chronic pain, offering new insights into the molecular and neurobiological mechanisms involved, which are often underexplored in existing literature. It also addresses emerging therapeutic strategies beyond traditional pain management, offering valuable perspectives for future research and clinical applications.

Chronic musculoskeletal pain and its relationship with cognitive function in older adults: A systematic review and meta-analysis

BACKGROUND

The relationship between chronic musculoskeletal pain and cognitive function in older adults remains unclear. This study aimed to investigate whether the cognitive function of older adults with chronic musculoskeletal pain differs from asymptomatic older adults.

METHODS

Four databases (PubMed, Science Direct, Web of Science, and Scopus) were searched. Two researchers independently reviewed the references against the eligibility criteria and performed the quality assessment of included studies using The National Institutes of Health (NIH) - Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

RESULTS

A total of 8484 references were found and ten articles, published between 2006 and 2021, were included. Only one study was classified as being of good quality, the remaining were of fair quality. Independent meta-analysis were performed for global cognition and specific cognitive domains (language, attention/orientation, executive function, memory, processing speed, and visuospatial skills). Differences between older adults with and without chronic musculoskeletal pain were found for the domains of general cognition (k = 10; d = -0.20; 95% CI = -0.38, -0.03; z = -2.25, p = 0.03) and language (k = 8; d =  -0.16; 95% CI = -0.28, -0.05; z = -2.72, p = 0.006), with very low certainty of evidence.

CONCLUSION

Overall, and considering the very low certainty of evidence for both global cognition and specific cognitive domains, we are uncertain about whether cognitive function differs between older adults with and without chronic musculoskeletal pain. Further research is needed comparing cognitive performance between older adults with and without chronic musculoskeletal pain, on the long-term impact of pain on cognitive functioning, and on the mechanisms underlying this potential relationship.

Paramedic analgesia comparing ketamine and morphine in trauma (PACKMaN): a randomised, double-blind, phase 3 trial

Background

Paramedics frequently administer analgesic medications for pain following trauma. Morphine is the most commonly administered strong analgesic. However, it may not be the best option as it may lower blood pressure, depress respiration and there is a risk of dependency. Ketamine might be a better option due to speed of onset and favourable side-effect profile. We sought to compare clinical effectiveness of paramedic administered ketamine and morphine in patients with severe pain following trauma.

Methods

PACKMaN was a double-blinded, randomised controlled, superiority trial, conducted in two regional ambulance services in the UK. Eligible patients were 16 years of age or over, had an acute injury, and articulated a pain score of 7 or greater on a 0-10 numeric rating score (NRS). We excluded pregnant patients, prisoners, those unable to articulate a pain score and anyone lacking capacity. The randomisation list prepared by the study programmer, utilised a permuted, unstratified, block randomisation system (variable size blocks) to achieve an overall ratio of 1:1 control (morphine): intervention (ketamine). Treatment packs were identical in appearance, apart from their unique sequential number. Individual participant randomisation occurred when the attending paramedic opened the treatment pack. The maximum available dose of morphine was 20 mg while the maximum available dose of ketamine was 30 mg. The treating paramedic administered the trial drug slowly, in regular small aliquots, via the intravenous (or intraosseous) route, titrating treatment until the patient reported adequate analgesia or requested that treatment stop due to undesired side effects. Timing of drug administration was not prespecified. The primary outcome was the Sum of Pain Intensity Difference (SPID) score on arrival to the hospital, calculated using patient reported NRS scores. Analysis was performed on an intention to treat basis. PACKMaN is registered with the International Clinical Trials Registry (ISRCTN14124474).

Findings

PACKMaN recruited its first patient on 10/11/2021 and achieved its recruitment target on 16/05/2023. We randomised 449 participants: 219 (49%) received ketamine and 230 (51%) received morphine. The SPID score was 3.5 (SD 2.8) for ketamine and 3.4 (SD 3.0) for morphine. We found no significant difference in efficacy between drugs (adjusted mean difference 0.1, 95%CI -0.4 to 0.6, p = 0.74). There was no significant difference in the incidence of serious adverse events [4 (2%) ketamine; 8 (3%) morphine]. There were no treatment related deaths.

Interpretation

Ketamine did not provide superior analgesia than morphine when used by paramedics to treat acute severe trauma pain. Unexpected adverse events occurred infrequently. Despite analgesia, many patients still experienced pain on arrival at hospital, highlighting the need for further research.

Funding

PACKMaN was funded by the National Institute for Health and Care Research.

Memory deficits in chronic low back pain patients: A scoping review

BACKGROUND

Chronic pain often results in cognitive dysfunction, with memory complaints being the most prevalent cognitive deficits. Our aim was to review the existing literature on memory deficits in the most prevalent chronic pain condition, Chronic Low Back Pain (CLBP).

METHOD

We conducted a scoping review from inception to April 2023, employing a narrow literature research without study design restrictions. We searched on five databases: MEDLINE, Cochrane Library, CINAHL, Scopus and Web of Science. We included studies that compared memory performances between Chronic Low Back Pain patients and healthy controls.

RESULTS

22,368 results were retrieved, and 15,589 were screened. 9 cross-sectional studies met our inclusion criteria. These studies had differences in definitions and measurements of memory functions. CLBP groups showed lower performances in memory tests.

CONCLUSION

This scoping review provides an overview of the literature on memory deficits in CLBP patients. We found discrepancies in definitions and measurements of memory functions, as well as a lack of quantitative data due to limited studies. In each study, CLBP patients exhibited lower performance in memory tests compared to healthy population. It would be interesting to gather more data and to standardize definitions and measurements.

Acoustic Motor Cortex Stimulation Enhances the Descending Analgesic Pathway to Alleviate Chronic Pain in Mice

Chronic pain poses considerable health risks, necessitating the development of effective treatments. Physical modulation of the motor cortex has demonstrated promise for pain relief; however, existing methods require invasive electrode implantation or have limited spatial resolution. Therefore, we developed a non-invasive, high-precision acoustic motor cortex stimulation (aMCS) system to alleviate chronic pain and explore its mechanisms. We developed a wearable aMCS system and employed the spared nerve injury (SNI) method to establish a mouse model of chronic pain. The model mice underwent aMCS with different acoustic parameters, and their pain behaviors were systematically evaluated. Subsequently, we established a long-term spinal cord two-photon system to monitor the effects of aMCS on spinal cord dorsal horn (SCDH) neuronal activity. Next, TRAP2-tdTomato mice were used to examine the effects of aMCS on the motor cortex and other regions of the descending analgesic pathway. Finally, we conducted magnetic resonance imaging, histology, and temperature monitoring to evaluate the safety of aMCS. aMCS with specific parameters significantly ameliorated pain behaviors in a mouse model of chronic pain. Two-photon calcium imaging indicated that aMCS reduced the intensity of neuronal activity in SCDH. Activity mapping in TRAP2-tdTomato mice revealed that aMCS enhanced neuronal activity in the primary motor cortex and zona incerta while diminishing it in the lateral periaqueductal gray and SCDH. Safety assessments confirmed the absence of deleterious effects on the stimulated region. aMCS provides a novel, non-invasive and effective approach to alleviating chronic pain by potentially enhancing the descending analgesic pathway.

Levonorgestrel-Releasing Intrauterine Device: An Effective Treatment for Symptoms of Persistent Pelvic Pain

BACKGROUND

Persistent pelvic pain (PPP) affects 5%-27% of women of reproductive age. The calls for earlier and improved access to surgery to diagnose endometriosis do not address the requirement for symptom management and exclude the 50% of women who undergo a laparoscopy for identical pain symptoms but do not have endometriosis identified. Moreover, current evidence for the management of pelvic pain almost exclusively focuses on patients diagnosed with endometriosis.

AIMS

To investigate the pain scores and overall satisfaction with symptom control in participants with PPP who utilised the levonorgestrel-intrauterine device 52 mg (LNG-IUD), to explore the association between time since last menstrual period (LMP) and other potential factors, including the impact of surgery and surgical findings, on pain outcomes.

MATERIALS AND METHODS

This prospective cohort study recruited participants between February 2015 and December 2017 following outpatient clinic referral for pelvic pain symptoms (dysmenorrhea, non-cyclic pelvic pain, dysuria, dyspareunia or dyschezia). Over 18 months, 72 participants had an LNG-IUD (52 mg) inserted, with 51 completing a follow-up questionnaire 6-18 months after insertion to assess pain outcomes.

RESULTS

Dysmenorrhoea (coefficient = -0.142, p < 0.001) and overall satisfaction with symptom control (coefficient = 0.079, p = 0.020) scores improved linearly with increased months since LMP in LNG-IUD users. In multivariate analysis, the age of onset of symptoms, laparoscopies prior to study entry or during the study period, and a histological diagnosis of endometriosis did not have a significant relationship with pain outcome or overall satisfaction with symptom control.

CONCLUSIONS

This study demonstrates that menstrual suppression with the LNG-IUD, regardless of a diagnosis of endometriosis, significantly improves a woman's overall satisfaction with PPP management. The LNG-IUD is an effective first-line medical management option for patients presenting with PPP.

Predicting chronic post-traumatic head and neck pain: the role of bedside parameters

ABSTRACT

Traumatic brain injury (TBI) annually impacts 69 million individuals worldwide. Mild TBI constitutes approximately 90% of all TBIs. Chronic pain post-mTBI occurs in 29% to 58% of patients. This study aims to introduce a predictive model for chronic pain development in individuals diagnosed with mild traumatic brain injury (mTBI) immediately postinjury. We included individuals who had sustained mTBI in motor vehicle accident (MVA). All patients had initial assessments within the first 72 hours (representing the subacute period) after the injury and performed follow-ups for 1 year. Machine learning model was applied to the integrated measures of clinical pain, pain-related psychological parameters, mTBI clinical signs, and sociodemographic information. This study included 203 patients experiencing acute head or neck pain attributable to mTBI post-MVA. We categorized these patients into 2 groups: patients who progressed to develop chronic head or neck pain (n = 89, 43.8%) and patients who recovered (low/mild pain) (n = 114, 56.2%). Severity of the subacute neck pain, number of painful body areas, and education years were identified as the most significant factors predicting chronic pain. The optimized predictive model demonstrated high efficacy, with an accuracy of 83%, a sensitivity of 92%, and an area under the receiver operating characteristic curve of 0.8. Our findings indicate feasibility in predicting chronic post-MVA pain within the critical 72-hour window postinjury using simple bedside metrics. This approach offers a promising avenue for the early detection of individuals at increased risk for chronic pain, enabling the implementation of targeted early interventions.

The effectiveness of hands-off approaches alone or in combination with hands-on approaches in the treatment of chronic cervical pain within a biopsychosocial framework: A systematic review

PURPOSE

This study aimed to systematically review the current literature comparing hands-off approaches with hands-on approaches from a biopsychosocial perspective of pain processing in people suffering from chronic primary neck pain (CPNP).

METHODS

An electronic search was conducted on PubMed, Web of Science, Scopus, and Cochrane Library. Initial searches were carried out in November 2022, with electronic database searches repeated on November 25, 2024. Eligibility criteria which were randomized controlled trials comparing hands-off approaches alone or in combination with hands-on approaches and hands-on approaches alone in people with CPNP were checked by two independent authors. The risk of bias was assessed using the revised Cochrane Risk of Bias Tool (RoB). The strength of conclusion was determined using the evidence-based guideline development approach.

RESULTS

Fifteen studies with a total of 1029 participants were included in this review. The RoB was rated as low RoB for two studies, some concerns for two studies and high RoB for 11 studies. Pain processing was assessed by pain intensity(100 % of the studies), pain sensitivity(53 % of the studies), pain-related participation in social roles(46 % of the studies), pain-related emotions(26 % of the studies), and pain-related beliefs(6 % of the studies). Limited quality of evidence was found for the hands-off approaches alone being more effective on pain intensity than hands-on approaches alone in the long term. Limited- to moderate-quality of evidence was found for hands-off approaches combined with hands-on approaches, being more effective than hands-on approaches alone in improving pain intensity, pain sensitivity, pain-related participation in social roles, pain-related emotions, and pain-related beliefs in the short-, mid- or long-term.

CONCLUSIONS

The current findings suggest that hands-off approaches alone are superior to hands-on approaches in the long term, at least for pain intensity. Hands-off approaches in combination with hands-on approaches were also more effective than hands-on approaches for pain processing. However, substantial heterogeneity warrants a cautious interpretation of these results. More high-quality, randomized, controlled trials with homogenous data collection and larger sample sizes are needed.

Design and evaluation of a drug-in-adhesive patch for the transdermal delivery of ketoprofen

The purpose of this study was to design a drug-in-adhesive (DIA) patch for transdermal delivery of ketoprofen, using hot-melt pressure-sensitive adhesive as the matrix of the patch. The adhesion properties and skin permeation of the patches were examined, and in vivo pharmacokinetics and tissue distribution of patches were evaluated. The novel ketoprofen patch with high adhesion was prepared by holt-melt method. The effects of different percentages of L-menthol on in vitro permeation were screened, 3% was added as the amount of permeation enhancer and the 24 h cumulative permeation amount(277.46 ± 15.58 µg/cm2) comparable to that of commercial patch MOHRUS®(279.74 ± 29.23 µg/cm2). Pharmacokinetic and the tissue distribution study showed no matter in plasma, muscle or skin, the drug concentration of self-made ketoprofen patch was equivalent to that of commercial patch. These data indicated that the self-made patch provided a new reference for the development of ketoprofen dosage forms and promising alternative strategy for analgesic treatment.

Association Between Physical Activity Levels and Symptoms of Temporomandibular Disorders in Office Workers: A Cross-Sectional Observational Study

BACKGROUND

Sedentary work is a potential health risk factor and may exacerbate painful complaints, while physical activity may serve as a preventive factor for the onset and worsening of musculoskeletal disorders. However, there is scarce evidence on how engaging in leisure physical activity may influence the reporting of temporomandibular dysfunction (TMD) symptoms.

OBJECTIVE

To assess the association between the level of physical activity and TMD symptoms in office workers.

METHODS

This is a cross-sectional study, 225 office workers of both sexes, aged over 18 years, participated in the study. The mean age was 33.65 (± 9.31) years, with a predominantly female sample (67.1%). The TMD Pain Screener determined the presence/absence of TMD symptoms, and the Baecke Habitual Physical Activity Questionnaire (BQHPA) determined the level of physical activity as high/moderate/low.

RESULTS

25.3% of the total sample presented TMD symptoms, of which 19.1% were women. The total BQHPA score showed that 35.5% of the total sample had a high level of physical activity. Regression analysis revealed no association between TMD symptoms and the level of leisure physical activity.

CONCLUSION

Office workers exhibited a low prevalence of TMD symptoms, and the presence of TMD symptoms was not associated with the level of physical activity.

People Living with Chronic Pain Experience a High Prevalence of Decision Regret in Canada: A Pan-Canadian Online Survey

Background(1) To estimate the prevalence of decision regret in chronic pain care, and (2) to identify factors associated with decision regret.DesignWe conducted a pan-Canadian cross-sectional online survey and reported the results following the Checklist for Reporting of Survey Studies guidelines. We recruited a sample of adults experiencing chronic noncancer pain. We used a stratified proportional random sampling based on the population and chronic pain prevalence of each province. We measured decision regret with the Decision Regret Scale (DRS) and decisional needs with the Ottawa Decision Support Framework. We performed descriptive analysis to estimate the prevalence and level of decision regret and multilevel multivariable regression analysis to identify factors associated with regret according to the STRengthening Analytical Thinking for Observational Studies recommendations.ResultsWe surveyed 1,649 people living with chronic pain, and 1,373 reported a most difficult decision from the 10 prespecified ones, enabling the collection of a DRS score. On a scale ranging from 0 to 100 where 1 reflects the presence of decision regret and 25 constitutes important decision regret, the mean DRS score in our sample was 28.8 (s = 19.6). Eighty-four percent of respondents experienced some decision regret and 50% at an important level. We identified 15 factors associated with decision regret, including 4 personal and 9 decision-making characteristics, and 2 consequences of the chosen option. Respondents with low education level and higher decisional conflict experienced more decision regret when the decision was deemed difficult.ConclusionsThis pan-Canadian survey highlighted a high prevalence and level of decision regret associated with difficult decisions for pain care. Decision making in pain care could be enhanced by addressing factors that contribute to decision regret.HighlightsWe conducted an online pan-Canadian survey and collected responses from a wide diversity of people living with chronic pain.More than 84% of respondents experienced decision regret and approximately 50% at an important level.We identified 15 factors associated with decision regret, including 4 personal and 9 decision-making characteristics, and 2 consequences of the chosen option.Our pan-Canadian survey reveals an urgent need of a shared decision-making approach in chronic pain care that can be potentiated by targeting multiple factors associated with decision regret.

Gabapentinoid Dispensing to Children and Adolescents in the U.S

INTRODUCTION

Gabapentin and pregabalin (gabapentinoids) are increasingly prescribed to children and adolescents off label for various conditions despite limited data and concerns for adverse outcomes including misuse and overdose. The extent of gabapentinoid use in children and adolescents is unknown.

METHODS

Nationally representative retail pharmacy dispensing data from IQVIA was used to describe trends in gabapentinoid dispensing to children and adolescents aged ≤19 years from April 2017 through September 2023. The analysis was performed in 2024. Trends by patient age and sex and by prescriber specialty are presented along with median quarterly rates (MQR) and quarterly percentage changes (QPC).

RESULTS

Over the study period, the gabapentinoid dispensing rate was 4534.9/100,000 individuals. The MQR was 168.9/100,000. Between Q2 2017 and Q2 2021, the QPC was not significant (QPC=0.08; 95% CI= -2.9, 0.8) but became significant between Q2 2021 and Q3 2023 (QPC=2.8; 95% CI=1.2, 8.4). Dispensing rates were highest for adolescents aged 10-19 years (MQR=267.3/100,000) and females (MQR=187.6/100,000). Nurse practitioners prescribed the highest percent of gabapentinoids dispensed (17.8%). The total number of gabapentinoids dispensed increased from 2018 to 2022 across all specialties except psychiatry (-14.8%) and internal medicine (-9.2%), with nurse practitioners (48.2%), surgical specialists (48.0%), and addiction medicine specialists (51.2%) representing the largest increases.

CONCLUSIONS

Gabapentinoid receipt among U.S. children and adolescents has increased. Future research can explore factors associated with prescribing including changing epidemiology of pain and psychiatric diagnoses in children and adolescents. Prescribing clinicians should carefully consider the potential risks and benefits of gabapentinoids in clinical practice.

The safety and feasibility of transcranial direct current stimulation and exercise therapy for the treatment of cervicogenic headaches: A randomized pilot trial

OBJECTIVE

Our primary objective was to evaluate the safety and feasibility of transcranial direct current stimulation combined with exercise therapy for the treatment of cervicogenic headache. Our exploratory objectives compared symptoms of headache, mood, pain, and quality of life between active and sham transcranial direct stimulation combined with exercise therapy.

BACKGROUND

Cervicogenic headache arises from injury to the cervical spine or degenerative diseases impacting cervical spine structure resulting in pain, reduced quality of life, and impaired function. Current standard-of-care treatments such as radiofrequency ablation, pharmacotherapy, manual therapy, and exercise therapy lack efficacy for some patients. Transcranial direct current stimulation is a neuromodulation technique that has shown promise in treating chronic pain conditions by positively altering neuronal activity but has not been evaluated as treatment for cervicogenic headache.

METHODS

This double-blind, sham-controlled, randomized, feasibility trial recruited 32 participants between the ages of 18 and 65 years that met the International Classification of Headache Disorders third edition criteria for cervicogenic headache. Participants were randomized to receive either active or sham transcranial direct current stimulation both combined with daily exercise therapy over 6 weeks. Transcranial direct current stimulation was applied over the primary motor cortex ipsilateral to worse pain for 20 min at 2 mA with a 30 s ramp up/down period. Recruitment, retention, and adherence were evaluated for feasibility. Safety was assessed through serious and minor adverse events and an adverse effect questionnaire. Clinical outcome measures assessed headache, pain, quality of life, and mood symptoms at pre-treatment, post-treatment, and 6- and 12-weeks post-treatment.

RESULTS

A total of 97 participants were contacted to participate with 32 recruited, 16 randomized into each group, and 14 completing the treatment protocol in both groups. Within each group 12 (active) and nine (sham) completed treatment within the proposed 6 weeks (three sessions per week), others received 18 sessions but took longer. Exercise therapy was completed on an average of 87% of days for both groups. Transcranial direct current stimulation was safe, with no serious adverse events and one minor adverse event in the active group. Itching was a more common post-intervention complaint in the active group (64% active vs. 43% sham). Exploratory analysis revealed significant group × time interactions for average headache pain from pre- to post-treatment (β = -1.012, 95% confidence interval [CI] -1.751 to -0.273; p = 0.008), 6-weeks (β = -1.370, 95% CI -2.109 to -0.631; p < 0.001), and 12-weeks (β = -1.842, 95% CI -2.600 to -1.085; p < 0.001) post-treatment, and for neck pain from pre- to post-treatment (β = -1.184, 95% CI -2.076 to -0.292; p = 0.010) and 12-weeks (β = -1.029, 95% CI -1.944 to -0.114; p = 0.028) post-treatment favoring active vs. sham. There were no significant group × time interactions for quality of life or mood.

CONCLUSION

The combination of transcranial direct stimulation and exercise therapy is safe and feasible for treating cervicogenic headache. While some promise has been shown for reducing headache and neck pain, larger scale trials with adequate power are needed to confirm these findings.

The causal role of brain circuits in osteoarthritis pain

Osteoarthritis (OA) is a leading cause of chronic pain worldwide, resulting in substantial disability and placing a substantial burden on patients and society. The hallmark symptom of OA is joint pain. Despite extensive research, new treatments for OA pain remain limited, partly owing to a lack of understanding of underlying pain mechanisms. For a long time, OA pain was seen as a reflection of nociceptive activity at the joint level, and the brain has been viewed as a passive recipient of such information. In this Review, we challenge these concepts and discuss how, over time, the activation of peripheral nociceptors leads to adaptations in the brain that dictate the properties and experience of OA pain. These adaptations are further influenced by the inherent properties of the brain. We review general concepts that distinguish pain from nociception, present evidence on the incongruity between joint injury and experience of OA pain, and review brain circuits that are crucial in the perception of OA pain. Finally, we propose a model that integrates nociception, spinal-cord mechanisms, and central nervous system dynamics, each contributing uniquely to pain perception. This framework has the potential to inform the development of personalized treatment strategies.

Prevalence, co-existence, and factors related to a change in geriatric giant syndromes over 2 years: results of the Second Wave of Cognition of Older People, Education, Recreational Activities, NutritIon, Comorbidities, fUnctional Capacity Studies (COPERNICUS)

BACKGROUND

We prospectively examined the prevalence, co-existence, and change of geriatric giant syndromes in older people over 2 years.

METHODS

Two hundred and five older subjects were examined before and after 2 years. Ten geriatric giants were assessed at both time points: cognitive impairment, depression, orthostatic hypotension, polypharmacy, sarcopenia, dynapenia, falls, chronic pain, faecal and urinary incontinence.

RESULTS

Chronic pain, cognitive impairment, and urinary incontinence were three of the most commonly occurring geriatric giants at baseline (57%, 46%, and 40%). The presence of faecal incontinence, urinary incontinence, falls, depression, cognitive impairment, orthostatic hypotension, and polypharmacy was most strongly related to the number of geriatric giants in total at baseline (P < 0.05). A higher intake of dietary antioxidants by one point was related to fewer geriatric giants after 2 years (by 0.04, after adjusting for confounding factors (P = 0.03)).

CONCLUSIONS

Geriatric giant syndromes tend to co-exist and change with high variability over 2 years. Higher intake of antioxidants with diet could be related to fewer geriatric giants over time.

Modified Feature Selection for Improved Classification of Resting-State Raw EEG Signals in Chronic Knee Pain

OBJECTIVE

Diagnosing pain in research and clinical practices still relies on self-report. This study aims to develop an automatic approach that works on resting-state raw EEG data for chronic knee pain prediction.

METHOD

A new feature selection algorithm called "modified Sequential Floating Forward Selection" (mSFFS) is proposed. The improved feature selection scheme can better avoid local minima andexplore alternative search routes.

RESULTS

The feature selection obtained by mSFFS displays better class separability as indicated by the Bhattacharyya distance measures and better visualization results. It also outperforms selections generated by other benchmark methods, boosting the test accuracy to 97.5%.

CONCLUSION

The improved feature selection searches out a compact, effective subset of connectivity features that produces competitive performance on chronic knee pain prediction.

SIGNIFICANCE

We have shown that an automatic approach can be employed to find a compact connectivity feature set that effectively predicts chronic knee pain from EEG. It may shed light on the research of chronic pains and lead to future clinical solutions for diagnosis and treatment.

Is poor dietary quality in adolescence a risk factor for painful temporomandibular disorders and headaches in young adulthood? A prospective study in the Danish National Birth Cohort

OBJECTIVE

To investigate the association between adolescents' dietary quality and the presence of painful temporomandibular disorder (p-TMD) and headaches in young adulthood.

BACKGROUND

P-TMD is a common orofacial pain condition often associated with headaches and discomfort. Some studies have shown that dietary behaviors can impact chronic musculoskeletal pain. Although various factors such as sex, age, psychosocial aspects, and pain sensitivity contribute to p-TMD, the role of nutrition remains unclear.

METHODS

The dietary quality of 32,247 singletons from the Danish National Birth Cohort (DNBC) at age 14 was assessed using the Healthy Eating Index (HEI) encompassing eight domains. Among these, 11,982 (37.1%) individuals completed the TMD pain screener and headache-related queries at age 18 and above. HEI and dietary domains were analyzed as potential risk factors for p-TMD and headaches.

RESULTS

P-TMD was present in 3163 of the 11,982 members of the study population. HEI scores were divided into quartiles, with quartile four indicating the highest dietary quality. Quartile four showed a higher odds ratio (OR) for p-TMD than quartile one (OR = 1.14 [95% confidence interval (CI), 1.01-1.29]), but the significance was lost after adjustment for confounders (adjusted OR [aOR] = 1.12 [95% CI, 0.97-1.30]). Overall dietary quality was not significantly associated with headaches. However, specific dietary quality domains, such as dietary fibers (aOR = 0.97 [95% CI, 0.95-0.99]), fish (aOR = 0.98 [95% CI, 0.97-1.00]), sodium (aOR = 1.03 [95% CI, 1.01-1.06]), and added sugar (aOR = 0.97 [95% CI, 0.95-0.99]) were associated with headaches but not with p-TMD after adjustment.

CONCLUSION

Overall adolescent dietary quality did not significantly associate with p-TMD or headaches in young adulthood after adjusting for confounders. However, specific dietary domains exhibited weak but statistically significant associations with headaches. These findings underscore the interplay between diet and pain, calling for further research to unveil the underlying pathophysiological mechanisms connecting lifestyle, p-TMD, and headaches.

Impact of different foot orthoses on gait biomechanics in individuals with chronic metatarsalgia

BACKGROUND

Foot orthoses (FOs) are commonly prescribed to reduce pain and improve function in individuals with musculoskeletal disorders, including those with chronic metatarsalgia (CM). Reducing the mechanical overload under the metatarsal heads during locomotion is the central point of the treatment for CM. Medially wedged FOs (MWFOs) with a metatarsal pad could further reduce pressure loading under the metatarsal heads and modify foot and ankle biomechanics compared to standard FOs (SFOs).

RESEARCH QUESTION

Do MWFOs further decrease the peak plantar pressure under the metatarsal heads in individuals with CM compared to SFOs? What are the effects of these FOs on foot and ankle 3D kinematics and kinetics in individuals with CM?

METHODS

Twenty-three individuals (17 females and 6 males) with CM were recruited in this cross-sectional descriptive study. Participants walked during three conditions: (1) Shod, (2) SFOs, and (3) MWFOs. Peak plantar pressure, midfoot and ankle angles and moments were calculated and compared across conditions with repeated measure ANOVAs using statistical parametric mapping.

RESULTS

SFOs and MWFOs reduced plantar pressure under the metatarsal heads, ankle plantarflexion angle, and midfoot plantarflexion moment compared to shod. SFOs and MWFOs increased plantar pressure under the medial midfoot. MWFOs reduced plantar pressure under the 1st-2nd-3rd metatarsal heads during the second part of the stance phase and increased plantar pressure under the medial midfoot compared to SFOs. MWFOs also decreased midfoot dorsiflexion and inversion angles, ankle eversion angle, and ankle inversion moment compared to shod.

SIGNIFICANCE

MWFOs were more effective than SFOs in reducing peak pressure under the 1st-2nd-3rd metatarsal heads and modifying lower limb biomechanics during walking. This reduction implies a pressure transfer from the metatarsal heads to the medial midfoot. These findings are promising to find the FOs model most suitable to reduce pain and improve physical function in individuals with CM.

Acceptability of multimodal and multidisciplinary group-based program for chronic low back pain: a qualitative study

BACKGROUND

The Programa d'Atenció Integral pels Pacients amb Dolor Crònic (PAINDOC) is a multimodal and multidisciplinary group-based program that integrates pain neuroscience education, mindfulness meditation, pain psychotherapy, Empowered Relief, and therapeutic exercise. It serves as a therapeutic option for individuals with chronic low back pain, providing them with comprehensive adaptive strategies for pain management.

OBJECTIVE

This qualitative study explores participants' retrospective acceptability of the PAINDOC Program.

METHODS

To ensure demographic variability and information power, a purposive sampling approach was applied. Twelve participants were interviewed through three focus groups, supplemented with four individual semi-structured interviews. Data was analyzed using reflexive thematic analysis and evaluated based on the Therapeutic Framework of Acceptability.

RESULTS

Participants provide positive feedback regarding active pain coping strategies and improved self-management. While certain aspects of the Program were more emphasized, participants integrated tools from all components. Strategies included pain reconceptualization, positive self-talk, or problem-solving. The Program's ethicality was closely linked to individual values and may also be influenced by time constraints of certain program elements, the immediate effects of specific approaches, participant perceptions, and individual preferences.

CONCLUSIONS

The findings provide valuable insights into the acceptability of the PAINDOC Program, guiding future improvements and the development of similar interventions.

"It's kind of just like a never-ending cycle": Young people's experiences of co-existing chronic musculoskeletal pain and mental health conditions

Chronic musculoskeletal pain (CMP) imposes a significant burden on young people (16-24yrs), impacting their physical, social, and emotional wellbeing and functioning during a critical developmental period as they transition from adolescence to young adulthood. The prevalence of mental health conditions also peaks around this age group, with CMP and mental health conditions being frequently comorbid. Existing epidemiological evidence recognises the relationship as bidirectional; however, there is little in-depth qualitative evidence about how young people experience living with co-existing CMP and mental health conditions. A Constructivist Grounded Theory approach was used. Young people, 16-24 years, living in Australia with self-reported co-existing CMP and mental health conditions were invited to participate in interviews to explore their lived and health care experiences. Twenty-one young people were included (five men, one transgender person, one non-binary person, and fourteen women). A core category of 'a feedback loop of pain and mental health', characterised the interconnectedness of CMP and mental health in these young people. This feedback loop was influenced both helpfully and unhelpfully by intrapersonal factors (emotions, cognitions, behaviours), interpersonal factors (healthcare interactions, relationships, and sense of self) and their personal context (societal discourse about pain, and mental health including stigma and environmental factors). 'A feedback loop of pain and mental health' suggests the need for a whole person, interdisciplinary approach that is titrated to the needs of the young person and addresses both CMP and mental health concurrently. Further research is needed to test the clinical utility of such a model. PERSPECTIVE: This study highlights the complex bidirectional feedback loop between chronic musculoskeletal pain and mental health in young people aged 16-24. These findings emphasise the need for interdisciplinary, whole-person approaches to concurrently address both conditions. Future research should explore the clinical utility of such models.

The effect of music therapy for patients with chronic pain: systematic review and meta-analysis

AIMS

To assess the effect of music therapy in improving chronic pain (CP), anxiety, depression, and quality of life using randomized controlled trials, and to explore the role of various moderators in MT effectiveness.

DESIGN

Systematic review and Meta-analysis.

METHODS

We systematically searched four electronic databases for randomized controlled trials that investigated the effects of music therapy on chronic pain, anxiety, depression, and quality of life. We performed a Cochrane risk-of-bias assessment and calculated the pooled standard mean difference in the outcomes of the test and control groups after the intervention period.

RESULTS

Nine randomized controlled trials were retrieved that included a total of 787 patients. Music therapy significantly reduced CP in the test group compared with that in the control group post-intervention and depression, no evidence was observed for improvement in anxiety and quality of life. Subgroup analysis reveals that MT is most effective when interventions are conducted in developed countries, targeting CNMP or cancer pain patients in health centers. The therapy is most effective when patients select their own music, use instruments or earphones, and receive treatment from trained professionals, with an ideal duration of 20 min, except in studies involving postoperative CP or those conducted in developing countries.

CONCLUSIONS

Music therapy effectively reduces CP and depression, but has limited effects on anxiety and quality of life. Its effectiveness varies depending on the specific conditions and CP categories of patients, with differences observed between developing and developed countries. Future research should focus on developing standardized guidelines for music therapy, exploring its long-term effects on pain, anxiety, and quality of life, and conducting high-quality, multicenter RCTs in developing countries to support its global adoption in CP management.

Predicting placebo analgesia responses in clinical trials: where to look next? A meta-analysis of individual patient data

ABSTRACT

Estimating the magnitude of placebo responses across pharmacological and nonpharmacological trials is important for understanding their influence on trial outcomes. Yet, the extent to which more intense placebo interventions like sham acupuncture yield larger analgesic responses than placebo pills, and the factors predicting these responses, remain unclear. This meta-analysis investigated the magnitude and predictors of placebo analgesia responses in pharmacological vs acupuncture trials. Analyses included individual patient data from the placebo arm of 11 randomized controlled trials (RCTs): 9 pharmacological RCTs using placebo pills (N = 2021) and 2 acupuncture RCTs using sham acupuncture (N = 747). All trials were conducted in patients with chronic nociceptive pain (osteoarthritis, N = 2068; low back pain, N = 700). The placebo response was calculated as the change in pain intensity (0-100) between baseline and week 12. A random effects model demonstrated that placebo pills and patients with osteoarthritis exhibited smaller placebo responses than sham acupuncture and patients with low back pain (both P < 0.001, marginal effects). A mixed effects model showed that route of administration interacted significantly with baseline pain, premature termination, and the presence of adverse events. Together, predictors explained 20% to 25% of the individual variance in placebo responses, whereas 75% to 80% remained unaccounted for. In summary, sham acupuncture accounted for slightly larger placebo responses than placebo pills. Since basic trial and patient parameters explained only a small portion of this variability, we might need to start considering the patient's perception of the treatment-including cognition and emotions-to better predict placebo analgesia responses.

Temporal association between chronic pain and frailty occurrence, and the modifiable role of a healthy lifestyle in Chinese middle-aged and older population: a community based, prospective cohort study

BACKGROUND

While western studies suggest a temporal association between chronic pain and frailty, as well as the impacts of healthy lifestyle interventions, these relationships remain underexplored in the Chinese population.

METHODS

We conducted a longitudinal study with 13,601 participants from the China Health and Retirement Longitudinal Study, covering 2011-2018. Pain was assessed via self-report, and frailty was evaluated using a 29-item deficit-accumulation frailty index. Five lifestyle factors, such as physical activity, alcohol consumption, smoking, body mass index, and sleep duration, were assessed, and the participants were categorized into favorable, intermediate, and unfavorable lifestyle groups.

RESULTS

During the 7-year follow-up, 3,356 cases of frailty were discerned. Participants who reported pain at baseline assessment had a higher risk of developing frailty compared to those without pain (hazard ratio [HR] = 1.10; 95%confidence interval [CI], 1.03-1.19). This association was particularly evident in middle-aged individuals (HR = 1.13; 95% CI, 1.01-1.26). Participants with severe pain at baseline assessment had a 1.16-fold higher risk of frailty (95%CI, 1.05-1.28, Ptrend= 0.0067). Among the participants with mild or moderate pain at baseline assessment, the risk of developing frailty was significantly reduced by a favorable lifestyle (HR = 0.62; 95% CI, 0.51-0.76) or intermediate lifestyle (HR = 0.83; 95% CI, 0.70-0.98). Additionally, a favorable lifestyle was significantly associated with a decreased risk of developing frailty in the participants with severe pain at baseline assessment (HR = 0.75; 95%CI, 0.59-0.96). Mediation analysis indicated that a healthy lifestyle could mitigate 2.97% of frailty risk associated with chronic pain.

CONCLUSIONS

Chronic pain is strongly associated with an increased risk of developing frailty in Chinese older population, but the implementation of healthy lifestyles can significantly reduce this risk.

Dexmedetomidine for chronic pain patients with anxiety and depression: a propensity score matching cohort study

BACKGROUND

Chronic pain patients often experience moderate to severe anxiety and depressive symptoms. Growing evidence supporting dexmedetomidine as a potential treatment for mental health conditions, research on its application in chronic pain patients with comorbid anxiety and depression remains limited.

METHODS

Patients who received intravenous infusions of dexmedetomidine during their interventional pain management procedures from January to July 2024 were compared to those who underwent similar procedures without dexmedetomidine infusion during the same period, utilizing propensity score matching.

RESULTS

A total of 290 patients were included in the analysis from January to July 2024. Propensity score matching resulted in 92 matched pairs for further analysis. At the one-month follow-up, the perioperative application of dexmedetomidine was associated with a greater improvement in anxiety and depression disorders, as measured by the Generalized Anxiety Disorder 7-item scale, showing a reduction of -4.43 points (95% CI, -4.98 to -3.88) compared to -2.42 points (95% CI, -2.97 to -1.87) for the local analgesia group and the Patient Health Questionnaire-9 scores indicated a reduction of -6.19 points (95% CI, -6.84 to -5.55) for the dexmedetomidine group versus -3.92 points (95% CI, -4.56 to -3.28) for the local analgesia group. The use of dexmedetomidine was also associated with a greater improvement of pain(-3.32 points vsurs -2.62 points).

CONCLUSIONS

Intraoperative dexmedetomidine significantly improves anxiety and depression in patients with chronic pain. Therefore, dexmedetomidine may serve as a promising adjunctive treatment for chronic pain patients, particularly those with comorbid anxiety and depression.

CLINICAL TRIAL NUMBER

Not applicable.

Navigating the biopsychosocial landscape: A systematic review on the association between social support and chronic pain

The biopsychosocial model is widely used to explain chronic pain conditions. Yet, the role of social aspects including social support is not clear. Literature on social support and chronic pain is still sparse and results inconsistent. The aim of this review is to evaluate the association between social support and different aspects of chronic pain such as pain intensity, pain interference, quality of life, depression and anxiety. We performed a search on Pubmed, Embase, PsycINFO, Cochrane Library, Scopus and CINAHL database entries between January 1, 1980 and May 7, 2024. Two independent investigators selected all longitudinal (prospective or retrospective) and cross-sectional studies in adult populations investigating the effect of perceived social support, social support satisfaction or spousal responses on different aspects of chronic pain (persistent or recurrent pain lasting longer than 3 months). Out of 11,908 queried results, 67 studies met our inclusion criteria. After assessing for risk of bias (adapted version of the "JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies") and quality of evidence (adapted version of the quality assessment tool of Hawker and al.), 35 studies were included in the final analysis. We found that perceived social support was positively associated with quality of life and negatively associated with depression. Social support satisfaction was negatively associated with depression. Spousal responses were positively associated with pain intensity, pain interference and depression. This review found that, in patients with chronic pain, social support is mainly associated with psychological variables. However, most studies were cross-sectional, and most analyses were correlations. There is a need for higher quality longitudinal studies. The type of social support studied should be clearly defined in every study.

Brain morphological changes and associated functional connectivity and lag structures in women with primary dysmenorrhea during the pain-free periovulatory phase

Primary dysmenorrhea(PDM) is defined as painful menstrual cramps without any evident pathology, exhibiting central nervous system(CNS) sensitivity and functional and structural changes in brain regions responsible for pain perception and modulation. Previous imaging studies primarily focused on functional changes, with only a limited number of studies investigated changes in brain morphology, and these studies generally used small sample sizes. It remains largely unknown whether brain structural changes are coupled with functional changes in patients with PDM, as well as the association between structural alterations and prostaglandin levels. This study used voxel-based morphometry(VBM) analysis to examine total and regional gray matter volume(GMV) increases and decreases in a larger sample of 59 patients with PDM and 56 healthy controls(HC) during the pain-free periovulatory phase. Abnormally increased regional GMV were involved in emotional regulation, pain rumination, and network integration functions while decreased regional GMV were involved in pain perception, emotional response, attention regulation, and pain-related visual cortex. This study found that the left mid-cingulate cortex is an important node in pain anticipation and attention, modulation of the salience network(SN), regulation of spinal nociceptive processing via descending control pathways for patients with PDM. Finally, this study examined the directional signaling patterns among these altered regional GMV using Time-Delay method and found that structural alterations were accompanied by changes in functional integration. Our findings provide preliminary insights into the CNS mechanisms underlying the link between structural and functional changes and subjective pain perception, offering valuable information for clinical pain interventions in patients with PDM. PERSPECTIVE: This study used voxel-based morphometry, Time-Delay and NBS-predict to examine gray matter volume alterations and related directional signaling patterns in patients with PDM. Structural alterations accompanied by changes in functional segregation were found during pain-free periovulatory phase.

The Treatment of Cervicogenic Headache with Transcranial Direct Current Stimulation and Exercise Therapy: A Randomized Control Trial Evaluating Functional Outcomes

ObjectiveThe objectives of this study were to evaluate functional outcomes of cervical motor control, strength and endurance following active transcranial direct current stimulation (tDCS) with exercise therapy (ET) compared to sham tDCS/+ET in patient with cervicogenic headache (CGH),DesignThis was a pilot sham-controlled, participant and assessor blinded, randomized controlled trial.MethodsThirty-two participants with CGH were randomized to active tDCS/+ET or sham tDCS/+ET. Participants completed 6-weeks of daily ET concurrently combined with 3 sessions per week of tDCS. Assessments included: craniocervical flexion test (mmHg), cervical isometric strength (N), cervical flexor and extensor endurance (seconds), and range of motion (degrees) pre-treatment, post-treatment, 6-weeks and 12-weeks post treatment. Linear mixed effect models evaluated group-time interactions at each follow-up while accounting for exercise program adherence and sex.ResultsThere were significant group-time interactions for activation scores on the craniocervical flexion test from pre-treatment to post-treatment (β = 1.571; 95%CI[0.155, 2.988]; p = 0.030), 6-weeks (β = 1.571; 95%CI[0.155, 2.988]; p = 0.030), and 12-weeks (β = 1.954; 95%CI[0.465, 3.443]; p = 0.011) favoring the active tDCS/+ET group.ConclusionsActive tDCS/+ET demonstrated significant benefits in deep cervical flexor motor control compared to sham tDCS/+ET that remained improved up to 12 weeks post-treatment. This suggests tDCS/+ET may improve of functional outcomes for patients with CGH.

Clinical Benefits of Ibuprofen Arginine: A Narrative Review

Ibuprofen arginine (IBA) combines well-established analgesic and anti-inflammatory properties with enhanced pharmacokinetics. The addition of arginine significantly improves solubility and absorption, leading to a faster onset of action compared to conventional ibuprofen. Clinical studies consistently demonstrate that IBA achieves meaningful pain relief within a shorter timeframe while maintaining a favorable safety profile. IBA's rapid action is particularly valuable in managing acute exacerbations of chronic pain and preventing central sensitization, thus improving patient comfort, adherence, and overall quality of life. By addressing both the inflammatory and nociceptive components of pain, IBA offers an effective and well-tolerated alternative in multimodal pain management strategies. This review explores the clinical benefits of IBA in pain management among various clinical settings.

Utilisation of Complementary and Alternative Medicine for Temporomandibular Disorders: Insights From Southeast Asian Patients

OBJECTIVES

This study is the first to explore the utilisation of Complementary and Alternative Medicine (CAM) among Southeast Asian temporomandibular disorder (TMD) patients. It examined specific CAM modalities, usage patterns, satisfaction, perceived effectiveness and the factors associated with CAM use for TMDs.

METHODS

Participants were recruited from a multidisciplinary TMD clinic, with diagnoses established using the Diagnostic Criteria for TMDs (DC/TMD). Socio-demographic information, TMD features, psychological status and details of CAM therapies, including usage patterns, were obtained. Satisfaction and perceived effectiveness of CAM modalities were assessed with Likert scales. Data were analysed using Chi-square/non-parametric tests and logistic regression (α = 0.05).

RESULTS

Among the 110 participants, 30.0% did not use CAM, while 70% did, with approximately three-fifths of CAM users applying it for TMDs. Of the latter group, 77.8% employed two or more CAM modalities, with 77.9% of CAM therapies acting as the sole treatment for TMDs. The three most frequently used CAM therapies for TMDs were massage (55.6%), vitamins/dietary supplements (40.0%) and chiropractic care (24.4%). Participants found the following CAM therapies to be both satisfying and effective for TMDs: acupressure, chiropractic care, massage, yoga and meditation. Malay participants were more likely than their Chinese counterparts to utilise CAM for TMDs (OR = 8.18; 95% CI = 1.13-59.29).

CONCLUSIONS

The utilisation of CAM in Southeast TMD patients was high, with 40.9% using it for TMDs. Race appears to be the sole determinant associated with CAM use for TMDs, suggesting the influence of ethno-cultural factors.

Risk factors associated with pain episodes among sickle cell patients that visited Mulago National Referral Hospital-Uganda

BACKGROUND

Sickle cell disease (SCD) is a chronic hematologic disease associated with increased morbidity and mortality. The study aims to investigate the suggested socio-economic and clinical factors and their contribution to the frequency of pain episodes among sickle cell patients in Uganda.

METHOD

We used pre-existing secondary data from sickle cell clinic records at Mulago referral hospital collected in 2019, with a sample of 2532 sickle cell patients. In support of the outcome being count data, the Negative Binomial Regression model was utilized to estimate how the independent factors affected the frequency of pain episodes among the patients.

RESULTS

The frequency of pain episodes was different among age groups as age group (16/24) experienced the highest number of pain episodes on average (Incidence Rate Ratio = 1.39; 95% CI = 1.277-1.522; p = 0.000) compared to young children because as individuals age, pain management declines, and repeated episodes can lead to increased sensitivity, making them more prone to pain. While increased temperature (°C) (fever) increased the frequency of pain episodes by 24% (Incidence Rate Ratio = 1.243; 95% CI = 1.147-1.348; p = 0.000), infection by 27% (Incidence Rate Ratio = 1.27; 95% CI = 1.191-1.354; p < 0.000), other chronic diseases by 11% (Incidence Rate Ratio = 1.11; 95% CI = 1.038-1.188; p < 0.002), malaria by 38% (Incidence Rate Ratio = 1.38; 95% CI = 1.036-1.836; p < 0.027). The rate of hydroxyurea usage was very high at 90%. The intake of the drug reduced the frequency of pain episodes by 34% (Incidence Rate Ratio = 0.662; 95% CI = 0.584-0.750; p < 0.000). According to the observations, there is a high chance that hydroxyurea also had a strong protective against malaria in SCD patients. Nevertheless, there was no evidence that being a male or female would influence the frequency of pain episodes among sickle cell patients.

CONCLUSIONS

These findings are expected to add to the body of knowledge in the health sector, assist in advocacy programs, inform policy, and aid in tailored interventions.

Discovering genetically-supported drug targets for multisite chronic pain through multi-omics Mendelian randomization and single-cell RNA-sequencing

Multisite chronic pain (MCP) is a highly prevalent disorder with substantial unmet therapeutic needs.We conducted multi-omics Mendelian randomization and Bayesian colocalization to identify potential therapeutic targets for MCP. Summary-level data of gene expressions and protein abundance levels were obtained from corresponding quantitative trait loci studies, respectively. Summary-level data for MCP was leveraged from the UK Biobank. The transcriptome-wide association study (TWAS), Mendelian randomization, and Bayesian colocalization approaches were applied to investigate the potential causal effects of gene expressions and protein levels on MCP in both blood and brain tissues. Phenome-wide Mendelian randomization analysis (MR-PheWAS), single-cell sequencing data, protein-protein interaction (PPI), and reaction pathway analysis were further conducted to digging the underlying mechanisms. Our analysis identified and validated two plasma targets for MCP, namely KLC1 and LANCL1, at both gene expression levels and protein levels across multi-methodologies. Moreover, MR-PheWAS observed additional benefits associated with these two targets. Through analyses based on single-cell sequencing data, we identified critical cell types for KLC1, primarily megakaryocytes, and neurons, notably linked to the axon guidance pathway, while LANCL1 showed associations with B lymphocytes, neurons, and the electron transport pathway. In dorsal root ganglions, we identified enrichments of both LANCL1 and KLC1 in putative silent nociceptors. The effects are possibly mediated through axonal transport and the activation of NMDARs, supported by PPI and reaction pathway analysis. Our multi-dimensional analysis suggests that genetically determined KLC1 and LANCL1 are causally linked to MCP risk, holding promise as appealing drug targets for MCP.

Trends in Celecoxib Prescribing: A Single Institution 16-Month Review

Background/Objectives: Celecoxib, a COX-2 selective nonsteroidal anti-inflammatory drug (NSAID), is widely prescribed for pain management due to its efficacy and improved gastrointestinal safety profile compared to traditional NSAIDs. Understanding prescription trends and their comparison to other NSAIDs provides valuable insight into prescribing behaviors in clinical settings. Methods: This retrospective study analyzed celecoxib prescriptions written by three pain management physicians in a single institution over a 16-month period from 1 January 2023 to 30 April 2024. Prescription data were collected and grouped into four 4-month intervals to assess temporal trends. Additionally, we compared celecoxib prescriptions to other commonly prescribed NSAIDs, including ibuprofen, meloxicam, naproxen, and diclofenac. Results: A total of 143 celecoxib prescriptions were identified during the study period, with a steady increase observed across consecutive intervals: 8 prescriptions from January-April 2023, 22 from May-August 2023, 46 from September-December 2023, and 67 from January-April 2024. In comparison, a total of 165 prescriptions were written for other NSAIDs over the same period, with 26 prescriptions from January-April 2023, 41 from May-August 2023, 45 from September-December 2023, and 53 from January-April 2024. While prescriptions for both celecoxib and other NSAIDs increased over time, the rate of celecoxib prescriptions showed a steeper rise. Conclusions: The findings demonstrate a notable increase in celecoxib prescriptions in this pain management clinic, outpacing the growth of other NSAIDs. This trend may reflect increasing provider preference for COX-2 selective inhibitors due to their favorable safety profile and efficacy. Further research is warranted to explore the underlying factors driving these prescribing patterns.

Exploring Pain-Severity and Psychological-Flexibility Trajectories During Group-Based Psychotherapy for Chronic Pain

This study aimed to identify subgroups of patients sharing similar outcome trajectories during group-based psychotherapy for chronic pain, to explore baseline predictors of trajectories, and to describe clinical outcomes as a function of these trajectories. Participants (n = 71) underwent eight weekly sessions of group psychotherapy for chronic pain at a tertiary care multidisciplinary pain treatment center. Pain outcomes, psychological distress, sleep, pain acceptance, and psychological inflexibility were assessed before, during, directly after, and 3 months after the intervention. Using growth mixture modeling, three to four trajectories were identified for pain-severity and psychological-flexibility symptoms during treatment; baseline levels of depression, pain severity, and psychological flexibility predicted trajectory membership. More research is needed to better understand the mechanisms underlying patients' variability in trajectories of symptom change across treatment.

Onset of chronic pain triggered by a lifestyle-change-based weight loss and exercise regimen

Exercise and weight loss are commonly recommended to patients with chronic pain; these interventions can relieve extra stress on the joints, reduce the perception of pain and combat comorbidities such as obesity, anxiety and depression. However, exercise can also exacerbate existing pain, presenting challenges for adherence to exercise and weight loss regimens. Here, we summarise the unique case of a patient who presented with chronic pain that developed during a natural weight loss regimen. The patient sought assessment due to diffuse pain that commenced after significant weight loss and was exacerbated with continued adherence to lifestyle modifications. He received a diagnosis of fibromyalgia and is currently being treated with nerve blocks and local anaesthetic injections of trigger points. This case of onset of fibromyalgia and chronic pain following lifestyle changes and weight loss underscores the need for further research aiming to understand the complex relationship between exercise, weight loss and chronic pain.

An evaluation of the validity, reliability, and psychometric properties of the Turkish version of the functional disability inventory in children and adolescents with chronic pain

PURPOSE

To investigate the cultural adaption, validity, and reliability of the Functional Disability Inventory (FDI) in Turkish children and adolescents with chronic headache.

MATERIALS AND METHODS

The original version of the FDI was translated to Turkish, back-translated and synthesized. The validity of the Turkish version of the FDI was examined using confirmatory factor analysis, discriminant validity and similar scale validation. Internal consistency and test-retest analyses were performed to determine the FDI reliability on 210 children and adolescents with chronic pain and 101 typically developing children and adolescents, all aged 8 to 18 years.

RESULTS

The Turkish version of the FDI was found to have excellent internal consistency (Cronbach's's α = 0.91) and test-retest reliability (ICC = 0.97). The confirmatory factor analysis identified a two-factor structure of the FDI. Scores on the FDI correlated with similar scales. There were significant differences in average total and average item scores of FDI between the two groups.

CONCLUSION

The results of the current study demonstrated that the FDI has appropriate psychometric qualities and is valid and reliable for application among children and adolescents with chronic pain.

CLINICAL TRIAL NUMBER

NCT05422456.

The interplay between pulse width and activation depth in TENS: a computational study

Background

Transcutaneous electrical nerve stimulation (TENS) has been a commonly used modality to relieve aches and pain for over 40 years. Commercially available devices provide multiple therapy modes involving a different combination of frequency and pulse width with intensity. While frequency sets sensation, intensity helps determine tolerability, longer pulse width is reported to induce a feeling of deeper stimulation. In fact, longer pulse width has been empirically shown to deliver current into deeper tissues, but in context of other electrical stimulation modalities. The goal of this study was to unpack the relationship between pulse width and activation depth in TENS.

Methods

A highly realistic, anatomically-based, 3D finite element model of the forearm was used to simulate the electric field (E-field) distribution, as the pulse width is varied. A typical titration-guided mechanism was used to obtain the strength-duration (S-D) curves of a sensory McIntyre-Richardson-Grill (MRG) axonal model simulating the pain-transmitting A-delta fibers. The pulse widths tested ranged from 30 μs to 495 μs.

Results

As expected, shorter pulse widths required more current to achieve activation, resulting in a larger E-field. The S-D curve of the target median nerve indicates a rheobase of 1.75 mA and a chronaxie of 232 µs. When the applied currents are the same, shorter pulse widths result in a smaller volume of tissue activated (VTA) compared to the longer pulse widths. A 21 fold difference in VTA was found between the longest and shortest pulse widths considered. For the conditions tested in the study, an increase in pulse width resulted in an increase in activation depth, exhibiting a linear relationship.

Conclusion

Our findings highlight the impact of pulse width on activation depth. While choice of a given therapy mode is usually based on an ad-hoc desirable sensation basis, medical professionals may consider advocating a certain therapy mode based on the depth of the intended target nerve.

The Added Value of Digital Body Chart Pain Surface Assessment as an Objective Biomarker: Multicohort Study

BACKGROUND

Although it has been well-documented that pain intensity alone is not sufficient to assess chronic pain, the objective pain surface encapsulated in a digital tool might present a major interest in the objective assessment of pain.

OBJECTIVE

This study aims to determine the potential added value of pain surface measurement by determining the correlation between pain surface and pain intensity in chronic pain patients.

METHODS

Two databases from observational prospective and retrospective longitudinal studies including patients with chronic pain were used in this research. Pain intensity was assessed by the Numeric Pain Rating Scale. Pain surface (cm²) and pain typology (neuropathic vs mechanical components) were measured by a specific pain mapping digital tool (PRISMap, Poitiers University Hospital). Patients were asked to draw their pain surface on a computerized tactile interface in a predetermined body (adapted from the patient's BMI). A color code was used to represent pain intensity (very intense, intense, moderate, and low). Simple linear regression was used to assess the proportion of variance in pain surface explained by pain intensity.

RESULTS

The final analysis included 637 patients with chronic pain. The percentage of variance of the pain surface explained by pain intensity was 1.24% (R²=0.0124; 95% CI 0.11%-6.3%). In addition, 424 (66.6%) patients used more than 1 intensity or color, among whom 218 (34.2%) used 2 intensities or colors, 155 (24.3%) used 3 intensities or colors, and 51 (8%) used 4 intensities or colors.

CONCLUSIONS

This study showed that pain intensity and pain surface provide complementary and distinct information that would help to improve pain assessment. Two-thirds of the cohort used 2 or more intensities to describe their pain. Combining pain intensity and pain surface should be strongly considered as a means of improving daily practice assessment of patients with chronic pain in primary and secondary care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02964130; https://clinicaltrials.gov/study/NCT02964130?term=PREDIBACK&rank=2.

Influence of chronic pain on regional brain volume reduction in a general older Japanese population: a longitudinal imaging analysis from the Hisayama Study

Longitudinal analyses of the influence of chronic pain on pain-related regional brain volumes in general populations are warranted. This prospective cohort study investigated the association between the presence of chronic pain at baseline and the subsequent changes in pain-related regional brain volumes among Japanese community-dwelling older residents. Participants aged 65 years or older who underwent brain magnetic resonance imaging (MRI) scans in both 2012 and 2017 were included. According to the presence or absence of chronic pain (defined as pain lasting for longer than 3 months) in 2012, participants were categorized into a 'chronic pain' group and 'no chronic pain' group. Region-of-interest analyses for the ventrolateral prefrontal cortex, dorsolateral prefrontal cortex, orbitofrontal cortex, postcentral gyrus, insular cortex, thalamus, anterior cingulate cortex, posterior cingulate cortex, amygdala and hippocampus were performed using FreeSurfer software. Whole-brain analysis was conducted by voxel-based morphometry. Rates of change in regional brain volume at 5 years after baseline were estimated using analysis of covariance. Among the 766 participants included in the FreeSurfer analysis, 444 (58%) were female and 287 (37%) were categorized into the chronic pain group. The results of FreeSurfer analysis showed that the chronic pain group had significantly greater decreases in regional volume in the postcentral gyrus (-2.187% in the chronic pain group versus -1.681% in the no chronic pain group, P = 0.01), thalamus (-4.400% versus -3.897%, P = 0.006), anterior cingulate cortex (-2.507% versus -1.941%, P = 0.004) and amygdala (-4.739% versus -4.022%, P = 0.03) compared to the no chronic pain group after adjusting for age, sex, education attainment, marital status, hypertension, diabetes, serum total cholesterol level, body mass index, current smoking, current drinking, regular exercise, cerebrovascular lesions on MRI, activities in daily living disability and depressive symptoms. Among the 730 participants included in the voxel-based morphometry analysis, 433 (59%) were female and 272 (37%) were categorized into the chronic pain group. The voxel-based morphometry analysis showed that the chronic pain group had a significantly greater regional volume decrease in the right anterior insula than the no chronic pain group. Our findings suggest that the presence of chronic pain at baseline is associated with a significantly greater decrease in the volume of pain-related brain regions at 5 years after baseline in community-dwelling older Japanese.

Correlation between attention deficit/hyperactivity disorder and chronic pain: a survey of adults in Japan

This cross-sectional epidemiological internet survey assessed whether attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) symptoms are associated with pain chronicity and intensity and explored the relationship between developmental disorder symptoms and pain. Participants were 4028 adults aged 20-64 years who experienced pain, assessed using an 11-point numerical rating scale (NRS), in any body part in the previous 4 weeks. ADHD and ASD symptoms were assessed using the Adult ADHD Self-Report Scale (ASRS) and autism spectrum quotient, respectively. Problems with mental health (PMH) were assessed using the shortened Profile of Mood States. Pathway analyses were performed to examine the association between ADHD symptoms and pain. The chronic pain symptoms (CP) group (N = 1465) scored higher than the non-CP group (N = 2563) for all ASRS variables. ASRS positivity was associated with CP symptoms and increased with increasing NRS score; the CP group showed particularly high positivity (38.3%) with extreme pain. ADHD symptoms were more strongly associated with CP symptoms and intensity than was PMH (0.26 vs. 0.09). ADHD symptoms, but not ASD symptoms, were associated with CP symptoms. ADHD medications reportedly improve coexisting CP; therefore, ADHD screening and treatment may be important for patients with CP, especially those with extreme pain.

Resource-Oriented Case Management to Implement Recommendations for Patients With Chronic Pain and Frequent Use of Analgesics in General Practices (Project RELIEF): Protocol for a Single-Arm Exploratory Feasibility Study

BACKGROUND

Chronic noncancer pain (CNCP) is a frequent reason for counseling in general practice. Current German guidelines emphasize its biopsychosocial etiology and the importance of self-care and nonpharmacological treatment strategies such as education, physical and social activity, and psychological approaches. Comprehensive assessments are necessary to individualize treatment maximally and monitor appropriate use of pain medication. General practitioners face many challenges in implementing holistic pain management, which considers biological, psychological, and social aspects. In project RELIEF (resource-oriented case management to implement recommendations for patients with chronic pain and frequent use of analgesics in general practices), a case management program was developed to facilitate implementation of guideline recommendations on pain management regarding medical assessment and monitoring, patient and practice team education, promotion of self-care strategies, and rational pharmacotherapy.

OBJECTIVE

We evaluated the feasibility of the intervention and study procedures before applying them in a larger cluster randomized controlled trial. Our secondary objective is to estimate potential effects of the complex intervention.

METHODS

A single-arm trial with general practices and patients with CNCP and analgesics use will be conducted, accompanied by a mixed methods process evaluation. The intervention comprises 5 components, including software-supported medical pain history, 3 scheduled structured appointments, e-learning on CNCP for general practitioners and medical assistants, educational material for patients, toolbox with information on (regional) resources for patients and practice teams. Participating practices will be located in the federal state of Baden-Württemberg, Germany, and will recruit eligible patients (adults with CNCP for more than 3 months, with at least moderate pain-related disability, permanent or on-demand use of analgesics or co-analgesics in the previous 4 weeks, and practice team assessed ability to participate actively in the trial). A questionnaire given to the first 150 adult patients entering the practice in February 2025 will help screen eligible patients. The primary objective will be measured by a set of predefined indicators. The key secondary outcome is pain-related disability measured by the Pain Disability Index German version. All participants will be asked to participate in the process evaluation. Outcome evaluation data will be gathered by paper-based and digitally provided questionnaires to be completed by participants. Process evaluation data will be gathered in surveys and a qualitative study. Descriptive analyses will be performed.

RESULTS

Recruitment occurred between October and December 2024. Targeted sample size was 6 practices and 50 patients. The intervention period will be February-June 2025. It is expected that eligible patients will benefit from the intervention and that improved medication management and intensified use of nonpharmacological treatment strategies will reduce pain-related disabilities and other patient-reported outcomes.

CONCLUSIONS

This study will provide valuable information regarding feasibility and potential effects before testing the intervention in a confirmatory cluster randomized controlled trial.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00034831; https://www.drks.de/search/de/trial/DRKS00034831.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/66335.

A retrospective review of psychosocial correlates of chronic pain in cisgender, transgender, and gender-diverse youth receiving evaluation in interdisciplinary pediatric pain clinics

Background

Individuals who experience social marginalization, such as transgender and gender-diverse (TGD) youth, have increased risk for poor health outcomes, including chronic pain. A better understanding of the impact of chronic pain in these populations would improve treatment and aid in reducing health care disparities. Our retrospective review of clinical data examined psychosocial correlates of pain in TGD and cisgender youth with chronic pain.

Aims

The study aim was to explore differences in psychosocial variables between TGD and cisgender youth with chronic pain. In alignment with the minority stress model, we hypothesized worse pain and pain-related disability, poorer quality of life, and more internalizing symptoms in TGD patients. The secondary aim was to explore associations among psychosocial variables in TGD and cisgender youth.

Methods

Data were collected from 140 youth (48 TGD, 92 cisgender) evaluated in pediatric pain clinics. Independent samples t-tests examined group differences in pain intensity, functional disability, quality of life, pain catastrophizing, and internalizing symptoms. Bivariate correlations were conducted for each group, and differences in the strength of correlations were evaluated using Fisher r-to-z. Institutional review board (IRB) approval was obtained for all study procedures at each participating institution prior to extraction of retrospective clinical data (Indiana 240 University IRB Protocol No. 12506, The Ohio State University College of Medicine IRB Protocol No. 16-00937). Informed consent was not required or obtained due to the retrospective nature of the study.

Results

Cisgender patients reported worse pain intensity, whereas TGD patients reported lower quality of life and more internalizing symptoms. In the combined sample, pain intensity was correlated with worse functional disability, poorer quality of life, and more catastrophic thinking. No group differences in the strength of correlations were found.

Conclusions

Results suggest that for TGD youth with chronic pain, internalizing symptoms and quality of life are important targets for treatment and improvement.

Diosmetin Attenuates Painful Symptoms Caused by Antineoplastics Paclitaxel and Anastrozole in Mice

Cancer patients often experience painful symptoms as an adverse effect resulting from various factors, including antineoplastic therapy. Paclitaxel is a chemotherapeutic agent used to treat solid tumours and, unfortunately, causes acute and chronic peripheral neuropathic pain in patients. Anastrozole is an antineoplastic used to treat hormone receptor-positive breast cancer and causes musculoskeletal pain symptoms. The therapies used to control these pain symptoms have limited efficacy and cause adverse effects, highlighting the importance of finding new treatments. Diosmetin is a flavonoid that has shown efficacy in neuropathic, nociplastic, and inflammatory pain models. Therefore, we verified the antinociceptive effects of diosmetin on nociceptive parameters induced by paclitaxel and anastrozole. We investigated the effects of diosmetin (0.015, 0.15 and 1.5 mg/kg; oral route (p.o.)) on nociceptive parameters (mechanical and cold allodynia and pain affective‑motivational behaviour) induced by a single and repeated paclitaxel (1 mg/kg, intraperitoneal (i.p.)) administrations, as well as on the pain-like symptoms (mechanical allodynia, muscle strength, and pain affective‑motivational behaviour) of a single administration of anastrozole (0.2 mg/kg, p.o.) and the combination of both antineoplastics in mice. Diosmetin reduced the nociceptive parameters induced by paclitaxel and anastrozole. In addition, we observed that anastrozole exacerbated the mechanical allodynia induced by paclitaxel, an effect that was also reversed by diosmetin. These results suggest that diosmetin may be an effective therapeutic alternative for the treatment of painful symptoms caused by antineoplastic drugs, such as paclitaxel and anastrozole.

Beyond pain intensity: Validating single-item pain bothersomeness measures

Chronic pain is a complex and multifaceted health condition, rendering pain intensity alone insufficient for comprehensively understanding the impact of pain. Pain bothersomeness scales have been developed to measure pain's impact on life, however lack adequate validation. Our study examines the validity of two single-item measures (5-point and 11-point response scales) for pain bothersomeness. We collected data from 633 treatment-seeking adults with mixed-etiology chronic pain. Pearson correlations were conducted to examine the relationships between each pain bothersomeness item and 20 general and pain-related functioning measures. ANOVAs examined the ability of pain bothersomeness scores to discriminate between eight groupings based on general and pain-related functioning. Linear regressions analyzed pain bothersomeness as a predictor of 14 measures of general and pain-related functioning three months later. Both pain bothersomeness items correlated significantly with 19 functioning measures and discriminated between eight groupings. Controlling for covariates, both items were consistently predictive of worse pain interference (Total adj r² =.34), pain catastrophizing (Total adj r² =.21-.22), depression (Total adj r² =.25-.26), and satisfaction with social roles (Total adj r² =.13-.16) three months later. Both single-item pain bothersomeness items demonstrated consistent concurrent, discriminant, and predictive validity. These low-burden assessments provide valuable information about patient functioning in clinical settings, suggesting their utility in improving chronic pain care. PERSPECTIVE: Both single-item pain bothersomeness measures demonstrated consistent concurrent and discriminant validity. Both items predicted worse pain interference, pain catastrophizing, depression, and social functioning 3-months later.

A network analysis of changing pain cooccurrence in older adults findings from the second wave of the COPERNICUS study

Over one-third of patients with chronic pain report pain at multiple anatomical sites. The current study examined the co-localization of pain and its intensity over a 2-year follow-up period. Kendall rank correlation coefficient (denoted as tau) was applied for the co-occurrence of pain in specific locations. Individuals over the age of 60 years were recruited from the general population in Poland (N = 205, 60-88 years old). The lumbar spine was the most frequently occurring site for chronic pain, present in 31% of individuals at baseline and in 38% after 2 years. The number of pain sites did not change over 2 years (p = 0.53). An increase of co-occurrence between anatomical sites for pain was noted after 2 years. Cervical spine pain co-occurred with pain in the thoracic spine (tau = 0.31), lumbar spine (tau = 0.45), chest (tau = 0.18), hips (tau = 0.17), legs (tau = 0.18), knee(s) (tau = 0.31), and feet (tau = 0.17). The observed increase in pain co-occurrence over 2 years suggests the need for modified approaches to pain treatment in older adults.

Perceived injustice in patients with chronic pain

BACKGROUND

Chronic pain, particularly pain secondary to trauma, is often accompanied by a feeling of perceived injustice. A prevalent feeling of injustice often goes along with a prolonged rehabilitation and problematic development of chronic pain. This feeling also correlates to catastrophizing. To date, too little is known about how the perception of injustice in chronic pain patients is interwoven with a variety of psychological, social and somatic factors. The present study sought to examine whether perceived injustice is correlated with pain level, pain diagnosis, depression, anxiety, stress, quality of life, pain related disability, occupation status and ongoing workers compensation litigation.

MATERIAL AND METHODS

During the three month period, all patients undergoing an interdisciplinary assessment of their chronic pain at our institution (n = 191) were asked to take part in the study. 164 patients (86%) completed the injustice experience questionnaire (IEQ). Data regarding pain level, pain diagnosis, gender, age, depression, anxiety, stress, quality of life, pain related disability, occupation status and ongoing workers compensation litigation were extracted from the patient's charts. Correlations of these data to IEQ scores and differences between distinct subgroups of patients were analysed.

RESULTS

Median total IEQ scores were 36.0 (IQR: 29.0-42.75). Median IEQ scores for the subscale blame and severity were 14.0 (IQR: 10.0-19.5) and 21.0 (IQR: 18.0-24.0) respectively. The IEQ correlated statistically significant with anxiety, depression and stress. No statistically significant differences were found in the IEQ scores between men and women. There was no statistically significant correlation of the IEQ scores with age, neither were statistically significant correlations with pain localizations found. No statistically significant correlation between IEQ scores and the different pain scores were found. IEQ values were higher in patients with pension application and with current sick leave. The presence of biographical factors (i.e. childhood trauma or experiences of emotional neglect) was related with higher IEQ values.

CONCLUSION

The IEQ appears to be more closely related to psychological and social determinants of pain than to somatic factors.

Assessment of Chronic Postsurgical Pain Knowledge Among Surgical Nurses in a Turkish University Hospital

Objective: Chronic postsurgical pain (CPSP) is a significant yet often underrecognized complication following surgical procedures, impacting patients' quality of life. Surgical nurses play a crucial role in postoperative care and pain management, making their knowledge of CPSP essential for improving patient outcomes. The aim of the study was to assess CPSP knowledge among surgical nurses in a Turkish University Hospital. Methods: This descriptive cross-sectional study included a total of 175 nurses. Data were collected from nurses employed in the surgical units of İnönü University hospital between May 15 and June 15, 2023. Personal information and knowledge-level forms created by the researchers were used for data collection. IBM SPSS Statistics v.25 was used for the statistical analysis. Results: The mean CPSP knowledge score of the nurses working in surgical clinics was 9.26 ± 1.40 (min. = 0, max. = 12) and 75.4% of them had sufficient knowledge. Surgical nurses' knowledge level of CPSP was influenced by their education level (p ≤ 0.001) and total duration of employment in the surgical department (p=0.002). Conclusions: Although most surgical nurses had sufficient CPSP knowledge, gaps remained, particularly among those with lower education levels and less experience. Targeted training programs and continuous professional development initiatives are recommended to enhance CPSP awareness and improve postoperative pain management practices.

The inflammatory and genetic mechanisms underlying the cumulative effect of co-occurring pain conditions on depression

Chronic pain conditions frequently coexist and share common genetic vulnerabilities. Despite evidence showing associations between pain and depression, the additive effect of co-occurring pain conditions on depression risk and the underlying mechanisms remain unclear. Leveraging data from 431,038 UK Biobank participants with 14-year follow-up, we found a significantly increased risk of depression incidence in individuals reporting pain, irrespective of body site or duration (acute or chronic), compared with pain-free individuals. The depression risk increased with the number of co-occurring pain sites. Mendelian randomization supported potential causal inference. We constructed a composite pain score by combining individual effects of acute or chronic pain conditions across eight body sites in a weighted manner. We found that depression risks increased monotonically in parallel with composite pain scores. Moreover, some inflammatory markers, including C-reactive protein, partially mediated the association between composite pain scores and depression risk. Considering the high prevalence of comorbid depression and pain, pain screening may help identify high-risk individuals for depression.

Exploring the Role of RhoA/ROCK Signaling in Pain: A Narrative Review

Despite significant progress in understanding the mechanisms of pain and developing therapeutic agents, pain remains a challenging and unresolved clinical issue. The Ras homolog gene family member A (RhoA), a member of the small guanosine triphosphate hydrolases (GTPases) of the Ras homolog family, is involved in transmitting signals that regulate various cellular processes. RhoA exerts its effects through a range of downstream effectors, with Rho-associated kinase (ROCK) being the most extensively studied. Emerging evidence suggests that the RhoA/ROCK signaling pathway plays a crucial role in pain transmission and sensitization. Our work indicates that targeting the RhoA/ROCK signaling pathway may offer a promising therapeutic avenue for alleviating pain.