The concept of nociplastic pain-where to from here?

Features and management of osteoarthritis from the perspective of individuals with osteoarthritis: A systematic review of qualitative studies

Objective

To enable person-centered care, considering beliefs, needs, and priorities of individuals with osteoarthritis (OA) is crucial. Nevertheless, concepts that they consider important are not fully recapitulated in assessment and care. The aim of this study was to clarify how individuals with OA conceive, experience, and manage their OA and pain.

Design

A systematic literature review was conducted including qualitative studies (interviews, focus groups, open questionnaires) regardless of OA joint location. Verbatim quotations relating to OA and OA-related pain were collected and merged in codes. Themes and categories relating to these codes were defined.

Results

The seven databases yielded a total of 9585 studies of which 79 qualitative studies were selected. Analysis of 667 verbatim quotations of 2009 participants led to 117 codes and 24 themes. Themes were grouped into 2 categories, 'features' and 'management'. 'Features' encompassed experiences ranging from common challenges (e.g., adjust to reduced function) to high impact outcomes needing therapeutic attention (e.g., devastating pain). The 'management' category captured positive and negative conceptions associated with pharmacological and cognitive-behavioral self-management, psychoeducation, and interventions. Themes from both categories were classified into four domains: symptoms, functioning, psychological, and social. A fifth domain 'disease' was also used to categorize the themes under 'features'.

Conclusions

Several themes reported by OA individuals are hardly represented in current assessment and recommendations, e.g., fatigue, sleep disturbance, psychosocial impact, and effects on family and caregivers. The reviewed beliefs, needs, and priorities may support individualized screening, complement existing assessment instruments, and can help refine interventions and psychoeducational materials.

Understanding the individual's transition from acute to chronic disabling pain: Opportunities for improved care

When acute pain persists, it is said to become chronic after 3 months. Considerable interest has focused on why acute pain appears to transition to chronic pain in some cases, but not all, especially when it becomes disabling. We examine our current understanding of the processes involved in the progression from an acute injury to disabling chronic pain. Rather than viewing this progression as a time dependent transition with specific static risk factors, we consider whether it might be more helpful to understand this evolution in terms of unique individual pathways. While brief self-report screening questionnaires assessing risk factors may enable us to stratify patients into risk levels, they do not provide information on the unique context and factors contributing to the disabling pain for each person. It is proposed that a 2-step process combining screening and individual assessment of those at high risk will enhance the prospect of both early identification and individually relevant interventions before more lasting changes emerge. Rather than being concerned with arbitrary time limits, it is argued that by aiming to understand the unique developmental pathway for those individuals identified as high risk, early, preventive interventions will be both viable and effective. Even so, there are barriers to the implementation of early assessment and matched treatments, and these remain a challenge for future research.

Neuroanatomy of spinal nociception and pain in dogs and cats: a practical review for the veterinary clinician

Chronic pain is a prevalent condition in companion animals and poses significant welfare challenges. To address these concerns effectively, veterinary clinicians must have a comprehensive understanding of the neuroanatomy of nociception and the intricate processes underlying pain perception. This knowledge is essential for planning and implementing targeted treatment strategies. However, much of the existing information on pain mechanisms is derived from studies on rodents or humans, highlighting the need for further translational research to bridge this gap for veterinary applications. This review aims to provide veterinary clinicians with an in-depth overview of the spinal nociceptive pathways in the dog and cat, tracing the journey from nociceptor activation to cortical processing in the brain. Additionally, the review explores factors influencing nociceptive signaling and pain perception. By enhancing the understanding of these fundamental physiological processes, this work seeks to lay the groundwork for developing effective therapies to manage the complexities of chronic pain in companion animals.