Søren Grøn, Melker Johansson, Kim Rose Olsen, Bart Koes, Stine Haugaard Clausen, Alice Kongsted
Background
Individuals with low back pain (LBP) have high healthcare use (HCU). It is currently unclear whether self-management supportive interventions can decrease HCU among patients with LBP. The aim of this study was to investigate changes in visits to primary care and redeemed prescriptions of analgesics after enrolment in a self-management supportive programme compared to usual care.
Methods
This quasi-experimental study included adults with LBP who enrolled in the Danish GLA:D Back programme between 2018 and 2022. GLA:D Back is a structured 10-week programme of group-based patient education and supervised exercises aiming to enhance self-management skills. HCU was obtained from national registries as the total quarterly visits to primary care (general practitioner, physiotherapists or chiropractor) or quarterly total redeemed defined daily doses (DDD) of analgesics (paracetamol, non-steroidal anti-inflammatory drugs or opioids).
Results
We included 4205 individuals. From 2 to 14 quarters post-enrolment, the additional quarterly reduction in HCU after the programme compared to the control group was −1.1 (95% CI −1.5 to −0.8) visits to primary care and −5.3 (95% CI −9.2 to −2.2) DDDs of redeemed analgesics. Sensitivity analyses questioned the statistical significance of the reduction in analgesic use, but results for people with LBP duration > 1 year were robust for both outcomes. The largest reductions were observed in those with high HCU at baseline.
Conclusion
Participation in a structured self-management programme led to a sustained reduction in primary care visits and analgesic use over a 3-year period, although regression to the mean may partly explain these reductions.
Significance Statement
This quasi-experimental study demonstrated that a structured self-management supportive programme for low back pain reduced future healthcare use, especially among individuals with long-lasting pain or high initial healthcare use. These findings suggest a potential to alter healthcare use through structured interventions to support self-management.
背景：腰痛（LBP）患者有较高的医疗保健使用（HCU）。目前尚不清楚自我管理支持干预是否能降低LBP患者的HCU。本研究的目的是调查参加自我管理支持计划后与常规护理相比，初级保健和镇痛药处方的就诊变化。方法：这项准实验研究纳入了2018年至2022年间参加丹麦GLA:D Back项目的LBP成人患者。GLA:D Back是一个为期10周的结构化项目，以小组为基础的患者教育和监督练习，旨在提高自我管理技能。HCU从国家登记处获得，作为每季度对初级保健（全科医生、物理治疗师或脊椎指压治疗师）的总访问量，或每季度对镇痛药（扑热息痛、非甾体抗炎药或阿片类药物）的总补偿日剂量（DDD）。结果：纳入4205人。从入组后的第2至14个季度，与对照组相比，该方案后HCU的额外季度减少为-1.1次（95% CI -1.5至-0.8）初级保健就诊和-5.3次（95% CI -9.2至-2.2）DDDs。敏感性分析对镇痛药使用减少的统计学意义提出了质疑，但对于腰痛持续时间为10 - 10年的患者，两项结果都是稳健的。在基线时高HCU患者中观察到最大的减少。结论：参与结构化的自我管理计划导致3年内初级保健就诊和止痛药使用持续减少，尽管回归均值可能部分解释了这些减少。意义声明：这项准实验研究表明，对腰痛进行结构化的自我管理支持方案可以减少未来的医疗保健使用，特别是在长期疼痛或初始医疗保健使用高的个体中。这些发现表明，通过结构化干预来支持自我管理，有可能改变医疗保健使用。
{"title":"Change in Healthcare Use After a Self-Management Supportive Intervention for Low Back Pain—A Quasi-Experimental Study","authors":"Søren Grøn, Melker Johansson, Kim Rose Olsen, Bart Koes, Stine Haugaard Clausen, Alice Kongsted","doi":"10.1002/ejp.70170","DOIUrl":"10.1002/ejp.70170","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Individuals with low back pain (LBP) have high healthcare use (HCU). It is currently unclear whether self-management supportive interventions can decrease HCU among patients with LBP. The aim of this study was to investigate changes in visits to primary care and redeemed prescriptions of analgesics after enrolment in a self-management supportive programme compared to usual care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This quasi-experimental study included adults with LBP who enrolled in the Danish GLA:D Back programme between 2018 and 2022. GLA:D Back is a structured 10-week programme of group-based patient education and supervised exercises aiming to enhance self-management skills. HCU was obtained from national registries as the total quarterly visits to primary care (general practitioner, physiotherapists or chiropractor) or quarterly total redeemed defined daily doses (DDD) of analgesics (paracetamol, non-steroidal anti-inflammatory drugs or opioids).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 4205 individuals. From 2 to 14 quarters post-enrolment, the additional quarterly reduction in HCU after the programme compared to the control group was −1.1 (95% CI −1.5 to −0.8) visits to primary care and −5.3 (95% CI −9.2 to −2.2) DDDs of redeemed analgesics. Sensitivity analyses questioned the statistical significance of the reduction in analgesic use, but results for people with LBP duration > 1 year were robust for both outcomes. The largest reductions were observed in those with high HCU at baseline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Participation in a structured self-management programme led to a sustained reduction in primary care visits and analgesic use over a 3-year period, although regression to the mean may partly explain these reductions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This quasi-experimental study demonstrated that a structured self-management supportive programme for low back pain reduced future healthcare use, especially among individuals with long-lasting pain or high initial healthcare use. These findings suggest a potential to alter healthcare use through structured interventions to support self-management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70170","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145502658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Background and Objective</h3> <p>Atraumatic musculoskeletal pain, regardless of the affected body region, is a highly prevalent condition impacting over 25% of the global population and contributing significantly to the burden of disease. A common study design compares physiotherapy or exercise therapy alone to the same intervention combined with MT (A vs. A + B). This study design is inherently flawed due to its inability to isolate the effect of treatment B, the potential for interaction effects, and the lack of control for non-specific contextual factors. The goal of this study was to compile studies using that approach and to examine the short-, medium-, and long-term effects of the addition of MT to a control treatment.</p> </section> <section> <h3> Databases and Data Treatment</h3> <p>This scoping review identified 95 randomised controlled trials (RCTs) with a systematic literature search in the electronic bibliographic databases MEDLINE (via PubMed), EBSCO, and PEDro.</p> </section> <section> <h3> Results</h3> <p>Long-term effects were absent, and medium-term effects were infrequent. Approximately half of the studies reported statistically significant effects in the immediate or short-term follow-up; however, these effects were of limited clinical relevance and susceptible to methodological issues. Furthermore, studies with lower methodological quality were more likely to report significant effects (85%), whereas medium- and high-quality studies showed positive results in only 50% of cases.</p> </section> <section> <h3> Conclusions</h3> <p>This review highlights significant research gaps and provides methodological insights. The study design in question is therefore methodologically problematic, as it tends to generate positive short-term results without providing clear answers or meaningful clinical implications for researchers and clinicians.</p> </section> <section> <h3> Significance Statement</h3> <p>This scoping review summarizes studies using an ‘A vs. A+B design’, where manual therapy is added to usual care, with or without a sham control. The review identifies a lack of medium- or long-term effectiveness and highlights a methodological bias toward generating positive short- or immediate-term results of questionable clinical relevance. Based on these findings, we provide several recommendations to improve future research and to support clinicians in interpreting the current evidence base.</p> </sect
背景和目的：非外伤性肌肉骨骼疼痛，无论受影响的身体部位如何，都是一种非常普遍的疾病，影响着全球25%以上的人口，并显著增加了疾病负担。一项常见的研究设计比较了单独的物理治疗或运动治疗与同样的干预联合MT （A vs. A + B）。由于无法隔离治疗B的效果、潜在的相互作用效应以及缺乏对非特异性背景因素的控制，本研究设计本身就存在缺陷。本研究的目的是汇编使用该方法的研究，并检查在对照治疗中添加MT的短期、中期和长期效果。数据库和数据处理：本综述通过在电子书目数据库MEDLINE（通过PubMed）、EBSCO和PEDro中进行系统文献检索，确定了95项随机对照试验（rct）。结果：无长期疗效，中期疗效少见。大约一半的研究报告了即时或短期随访的统计显著效果；然而，这些效果的临床相关性有限，而且容易受到方法学问题的影响。此外，方法学质量较低的研究更有可能报告显著效果（85%），而中等和高质量的研究仅在50%的病例中显示阳性结果。结论：本综述突出了重要的研究差距，并提供了方法学上的见解。因此，有问题的研究设计在方法学上是有问题的，因为它倾向于产生积极的短期结果，而没有为研究人员和临床医生提供明确的答案或有意义的临床意义。意义声明：本范围综述总结了使用“A与A+B设计”的研究，在常规护理中加入手工治疗，有或没有假对照。该综述确定了缺乏中期或长期有效性，并强调了方法偏向于产生临床相关性可疑的积极的短期或即时结果。基于这些发现，我们提出了一些建议，以改进未来的研究，并支持临床医生解释当前的证据基础。
{"title":"Evaluating Manual Therapy in Musculoskeletal Pain: Why Certain Trial Designs May Overestimate Effectiveness—A Scoping Review","authors":"Jean-Pascal Grenier, Alex Thiel","doi":"10.1002/ejp.70150","DOIUrl":"10.1002/ejp.70150","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>Atraumatic musculoskeletal pain, regardless of the affected body region, is a highly prevalent condition impacting over 25% of the global population and contributing significantly to the burden of disease. A common study design compares physiotherapy or exercise therapy alone to the same intervention combined with MT (A vs. A + B). This study design is inherently flawed due to its inability to isolate the effect of treatment B, the potential for interaction effects, and the lack of control for non-specific contextual factors. The goal of this study was to compile studies using that approach and to examine the short-, medium-, and long-term effects of the addition of MT to a control treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Databases and Data Treatment</h3>\u0000 \u0000 <p>This scoping review identified 95 randomised controlled trials (RCTs) with a systematic literature search in the electronic bibliographic databases MEDLINE (via PubMed), EBSCO, and PEDro.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Long-term effects were absent, and medium-term effects were infrequent. Approximately half of the studies reported statistically significant effects in the immediate or short-term follow-up; however, these effects were of limited clinical relevance and susceptible to methodological issues. Furthermore, studies with lower methodological quality were more likely to report significant effects (85%), whereas medium- and high-quality studies showed positive results in only 50% of cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This review highlights significant research gaps and provides methodological insights. The study design in question is therefore methodologically problematic, as it tends to generate positive short-term results without providing clear answers or meaningful clinical implications for researchers and clinicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This scoping review summarizes studies using an ‘A vs. A+B design’, where manual therapy is added to usual care, with or without a sham control. The review identifies a lack of medium- or long-term effectiveness and highlights a methodological bias toward generating positive short- or immediate-term results of questionable clinical relevance. Based on these findings, we provide several recommendations to improve future research and to support clinicians in interpreting the current evidence base.</p>\u0000 </sect","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70150","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145502608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cho Wai Geoffrey Yu, Kanya Wongwitwichote, Michael Mansfield, Janet A. Deane, Valter Devecchi, Deborah Falla
Background
Patients with non-specific neck pain often develop persistent or recurrent pain and associated disability. This review investigated which physical and psychological factors predict persistent and recurrent neck pain and disability.
Databases and Data Treatment
Five databases were searched from inception to January 31, 2025. After data extraction, the Quality in Prognosis Studies tool (QUIPS) was used for risk of bias assessment and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to assess the certainty of evidence for each factor's predictive capability for neck disability, pain intensity and incidence.
Results
Six prospective cohort studies were selected. Three studies were rated with high overall risk of bias and three with moderate overall risk of bias. Consistent findings supported that high pain catastrophizing and psychological distress predict persistent and recurrent pain, disability and incidence with low to moderate certainty of evidence. There was inconsistency of results or limited studies reporting association between neck flexion strength, cold pain threshold tested over the tibialis anterior, pressure pain threshold tested over the neck or tibialis anterior, conditioned pain modulation, neck extensor endurance, and temporal summation with disability. In addition, there was low certainty of evidence which showed no relationship between cervical range of motion, cold pain threshold tested over the neck and neck extensor strength with disability.
Conclusions
Pain catastrophizing and psychological distress were identified as predictors of persistent and recurrent neck pain, disability and incidence. Further studies are needed to confirm findings of an association between physical factors with future neck pain and disability.
Significance Statement
This review provides evidence to support the addition of early assessment of pain catastrophizing and psychological distress to identify patients that are more susceptible to persistent and recurrent neck pain. When warranted, psychological interventions targeting maladaptive beliefs, pain-related anxiety and catastrophizing may be required to minimize persistent and recurrent neck pain and disability.
{"title":"Physical and Psychological Predictors for Persistent and Recurrent Non-Specific Neck Pain: A Systematic Review","authors":"Cho Wai Geoffrey Yu, Kanya Wongwitwichote, Michael Mansfield, Janet A. Deane, Valter Devecchi, Deborah Falla","doi":"10.1002/ejp.70168","DOIUrl":"10.1002/ejp.70168","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with non-specific neck pain often develop persistent or recurrent pain and associated disability. This review investigated which physical and psychological factors predict persistent and recurrent neck pain and disability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Databases and Data Treatment</h3>\u0000 \u0000 <p>Five databases were searched from inception to January 31, 2025. After data extraction, the Quality in Prognosis Studies tool (QUIPS) was used for risk of bias assessment and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to assess the certainty of evidence for each factor's predictive capability for neck disability, pain intensity and incidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six prospective cohort studies were selected. Three studies were rated with high overall risk of bias and three with moderate overall risk of bias. Consistent findings supported that high pain catastrophizing and psychological distress predict persistent and recurrent pain, disability and incidence with low to moderate certainty of evidence. There was inconsistency of results or limited studies reporting association between neck flexion strength, cold pain threshold tested over the tibialis anterior, pressure pain threshold tested over the neck or tibialis anterior, conditioned pain modulation, neck extensor endurance, and temporal summation with disability. In addition, there was low certainty of evidence which showed no relationship between cervical range of motion, cold pain threshold tested over the neck and neck extensor strength with disability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pain catastrophizing and psychological distress were identified as predictors of persistent and recurrent neck pain, disability and incidence. Further studies are needed to confirm findings of an association between physical factors with future neck pain and disability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This review provides evidence to support the addition of early assessment of pain catastrophizing and psychological distress to identify patients that are more susceptible to persistent and recurrent neck pain. When warranted, psychological interventions targeting maladaptive beliefs, pain-related anxiety and catastrophizing may be required to minimize persistent and recurrent neck pain and disability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12611179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145494998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gabriella Elisabeth Stamp, Antonia Louise Wadley, Stella Iacovides
Background
Individuals with chronic pain are both more likely to have an insecure adult attachment style and impaired conditioned pain modulation (CPM) than pain-free individuals. This study investigated whether impaired CPM is seen in pain-free individuals and determined associations with attachment.
Method
A CPM test paradigm was used to determine the differences in the measures of pain across attachment anxiety and avoidance dimensions in pain-free females in a neutral social context. First, static (heat pain threshold, heat pain tolerance, and cold pain intensity) and dynamic (cumulative pain load) measures of pain were explored.
Results
One hundred and three females were recruited (median [IQR] age: 21 [20–23] years). We found no associations between attachment dimensions and static measures of pain (ps > 0.05). Higher attachment anxiety, but not avoidance, was associated with an increase in pain intensity over time (Estimate [95% CI] = 0.15 [0.06–0.25], p-value = 0.002), and increased average test stimulus pain intensity rating both before (Estimate [95% CI] = 0.15 [0.07–0.23], p-value < 0.001) and during (Estimate [95% CI] = 0.36 [0.23–0.48], p-value < 0.001) conditioning. In the 78% (80/103) who completed the full CPM procedure, there was no association between CPM effect and attachment anxiety (Estimate [95% CI] = −3.79 [−8.62 to 1.03], p = 0.122) or avoidance (Estimate [95% CI] = 0.25 [−4.88 to 5.38], p = 0.923). Effective CPM was seen in 90% (72/80).
Conclusion
Impaired CPM was not seen in pain-free individuals suggesting that impaired endogenous analgesia may develop from chronic pain, rather than cause chronic pain.
Significance Statement
Individuals with chronic pain are both more likely to have an insecure adult attachment style and impaired conditioned pain modulation (CPM) than pain-free individuals. This is the first study to investigate a link between attachment and experimental pain using a conditioned pain modulation (CPM) paradigm in a neutral social context. Impaired CPM was not seen in pain-free individuals, suggesting that impaired endogenous analgesia may develop from chronic pain, rather than cause chronic pain.
{"title":"Adult Attachment Is Not Associated With Conditioned Pain Modulation in Healthy Females in a Neutral Social Context","authors":"Gabriella Elisabeth Stamp, Antonia Louise Wadley, Stella Iacovides","doi":"10.1002/ejp.70172","DOIUrl":"10.1002/ejp.70172","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Individuals with chronic pain are both more likely to have an insecure adult attachment style and impaired conditioned pain modulation (CPM) than pain-free individuals. This study investigated whether impaired CPM is seen in pain-free individuals and determined associations with attachment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A CPM test paradigm was used to determine the differences in the measures of pain across attachment anxiety and avoidance dimensions in pain-free females in a neutral social context. First, static (heat pain threshold, heat pain tolerance, and cold pain intensity) and dynamic (cumulative pain load) measures of pain were explored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred and three females were recruited (median [IQR] age: 21 [20–23] years). We found no associations between attachment dimensions and static measures of pain (<i>p</i>s > 0.05). Higher attachment anxiety, but not avoidance, was associated with an increase in pain intensity over time (Estimate [95% CI] = 0.15 [0.06–0.25], <i>p</i>-value = 0.002), and increased average test stimulus pain intensity rating both before (Estimate [95% CI] = 0.15 [0.07–0.23], <i>p</i>-value < 0.001) and during (Estimate [95% CI] = 0.36 [0.23–0.48], <i>p</i>-value < 0.001) conditioning. In the 78% (80/103) who completed the full CPM procedure, there was no association between CPM effect and attachment anxiety (Estimate [95% CI] = −3.79 [−8.62 to 1.03], <i>p</i> = 0.122) or avoidance (Estimate [95% CI] = 0.25 [−4.88 to 5.38], <i>p</i> = 0.923). Effective CPM was seen in 90% (72/80).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Impaired CPM was not seen in pain-free individuals suggesting that impaired endogenous analgesia may develop from chronic pain, rather than cause chronic pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Individuals with chronic pain are both more likely to have an insecure adult attachment style and impaired conditioned pain modulation (CPM) than pain-free individuals. This is the first study to investigate a link between attachment and experimental pain using a conditioned pain modulation (CPM) paradigm in a neutral social context. Impaired CPM was not seen in pain-free individuals, suggesting that impaired endogenous analgesia may develop from chronic pain, rather than cause chronic pain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nora Bakaa, Ayda Babakhamseh, Natalie Chan, Marianne de Vera, Julie Finnigan, Rebecca Ramdelall, Brianna Tang, Lee-Ran Goodman, Lisandra Ameida de Oliveira, Paulo Carvalho do Nascimento, Yuva Venkata Raghava Neelapala, Stephanie Di Pelino, Luciana G Macedo
Objective
The purpose of this systematic review was to identify and evaluate the quality of cross-cultural adaptations of the six core outcome measures (NRS, SF-12, PROMIS, ODI, RMDQ and VAS) for low back pain (LBP) and assess their psychometric properties.
Methods
Medline, EMBASE, Emcare and CINAHL databases were searched from inception to August 2024. Eligible studies included those assessing core LBP outcome measures in adults with LBP. The COSMIN checklist was used to assess the quality of cross-cultural adaptations and evaluate the psychometric properties. Additionally, the COSMIN risk of bias tool and GRADE approach were employed to assess study quality and provide levels of evidence.
Results
A total of 82 studies were included. Among them, 35 studies examined the cross-cultural adaptations of the ODI, 25 for the RMDQ, 4 for PROMIS, 1 for SF-12 and 2 for NRS/VAS. The quality of cross-cultural adaptations was generally poor or fair due to inadequate reporting of pre-testing processes and small sample sizes. Most psychometric properties were rated as having an inadequate risk of bias, with evidence quality ranging from very low to low.
Conclusion
This review highlights that the cross-cultural adaptations of the five core LBP outcome measures have generally been conducted with low quality. To improve the adaptation process, studies should employ larger sample sizes and standardised pre-testing procedures. Additional research is needed to explore a broader range of psychometric properties of cross-cultural adaptations, ensuring better validity, reliability and comparability across adapted versions.
Significance Statement
Improving the quality of cross-cultural adaptations of LBP outcome measures is crucial to ensuring that assessments are culturally relevant and accurate across diverse populations, leading to better-informed clinical decisions and equitable care for patients with LBP globally.
{"title":"Cross-Cultural Adaptation and Psychometric Properties of Low Back Pain Core Outcome Measures: A Systematic Review","authors":"Nora Bakaa, Ayda Babakhamseh, Natalie Chan, Marianne de Vera, Julie Finnigan, Rebecca Ramdelall, Brianna Tang, Lee-Ran Goodman, Lisandra Ameida de Oliveira, Paulo Carvalho do Nascimento, Yuva Venkata Raghava Neelapala, Stephanie Di Pelino, Luciana G Macedo","doi":"10.1002/ejp.70152","DOIUrl":"10.1002/ejp.70152","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The purpose of this systematic review was to identify and evaluate the quality of cross-cultural adaptations of the six core outcome measures (NRS, SF-12, PROMIS, ODI, RMDQ and VAS) for low back pain (LBP) and assess their psychometric properties.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Medline, EMBASE, Emcare and CINAHL databases were searched from inception to August 2024. Eligible studies included those assessing core LBP outcome measures in adults with LBP. The COSMIN checklist was used to assess the quality of cross-cultural adaptations and evaluate the psychometric properties. Additionally, the COSMIN risk of bias tool and GRADE approach were employed to assess study quality and provide levels of evidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 82 studies were included. Among them, 35 studies examined the cross-cultural adaptations of the ODI, 25 for the RMDQ, 4 for PROMIS, 1 for SF-12 and 2 for NRS/VAS. The quality of cross-cultural adaptations was generally poor or fair due to inadequate reporting of pre-testing processes and small sample sizes. Most psychometric properties were rated as having an inadequate risk of bias, with evidence quality ranging from very low to low.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This review highlights that the cross-cultural adaptations of the five core LBP outcome measures have generally been conducted with low quality. To improve the adaptation process, studies should employ larger sample sizes and standardised pre-testing procedures. Additional research is needed to explore a broader range of psychometric properties of cross-cultural adaptations, ensuring better validity, reliability and comparability across adapted versions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Improving the quality of cross-cultural adaptations of LBP outcome measures is crucial to ensuring that assessments are culturally relevant and accurate across diverse populations, leading to better-informed clinical decisions and equitable care for patients with LBP globally.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>CRD42023413077</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70152","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145502597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Floriane Rousseaux, Émilie Giguère, Mathieu Landry, Mathieu Piché, Maedeh Mostanadi, Pierre Augier, Jessica Simon, Aminata Bicego, Marie-Elisabeth Faymonville, Anne-Sophie Nyssen, David Ogez, Pierre Rainville, Audrey Vanhaudenhuyse
<div> <section> <h3> Background</h3> <p>Hypnosis (H) and virtual reality (VR) are effective behavioural interventions to influence acute pain perception. Hypnotic suggestions have also been shown to modulate the nociceptive flexion reflex (NFR), suggesting the activation of descending modulatory mechanisms affecting spinal nociceptive activity. The combination of these techniques, virtual reality hypnosis (VRH), may reduce pain, but research on their comparative efficacy and mechanisms requires further experimental investigation. This study compared the effects of relaxation hypnosis, VR and VRH on pain perception and nociceptive physiological responses.</p> </section> <section> <h3> Methods</h3> <p>Twenty-four healthy participants were tested at baseline followed by three experimental conditions (relaxation hypnosis, VR, VRH) in a counterbalanced order. Pain intensity and unpleasantness, as well as NFR amplitude evoked by noxious transcutaneous electrical stimulation, were measured. Bayesian statistics assessed evidence for analgesic effects on each variable.</p> </section> <section> <h3> Results</h3> <p>The strength of evidence in favour of our hypotheses was categorised as follow: BF = 1–3: anecdotal evidence; BF = 3–10: moderate evidence and BF > 10: strong evidence. For NFR values, Bayesian paired-sample T-tests provided anecdotal support for the efficacy of relaxation hypnosis (BF + 0 = 2.11) and stronger evidence for VR (BF + 0 = 10.94) and VRH (BF + 0 = 14). For pain intensity, moderate evidence supported reductions with relaxation hypnosis (BF + 0 = 9.18), while strong evidence was found for VR (BF + 0 = 27.99) and low to moderate for VRH (BF + 0 = 5.88). Similarly, unpleasantness showed anecdotal reduction with hypnosis (BF + 0 = 1.9), and moderate evidence supported VR (BF + 0 = 4.86) and VRH (BF + 0 = 7.18). Across all measures, no significant differences were found between hypnosis, VR and VRH.</p> </section> <section> <h3> Conclusion</h3> <p>These findings suggest that these techniques did not differentially affect NFR, pain intensity, or unpleasantness.</p> </section> <section> <h3> Significance Statement</h3> <p>The strength of this fundamental study is to directly compare hypnosis, VR, and VRH on both pain perception and physiological responses. It shows that VR alone is effective, while adding hypnosis does not always lead to better results and the combination could even create interference in some cases. This article helps to
{"title":"Comparison of Experimental Pain Modulation by Hypnosis, Virtual Reality and Virtual Reality Hypnosis in Healthy Individuals","authors":"Floriane Rousseaux, Émilie Giguère, Mathieu Landry, Mathieu Piché, Maedeh Mostanadi, Pierre Augier, Jessica Simon, Aminata Bicego, Marie-Elisabeth Faymonville, Anne-Sophie Nyssen, David Ogez, Pierre Rainville, Audrey Vanhaudenhuyse","doi":"10.1002/ejp.70166","DOIUrl":"10.1002/ejp.70166","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypnosis (H) and virtual reality (VR) are effective behavioural interventions to influence acute pain perception. Hypnotic suggestions have also been shown to modulate the nociceptive flexion reflex (NFR), suggesting the activation of descending modulatory mechanisms affecting spinal nociceptive activity. The combination of these techniques, virtual reality hypnosis (VRH), may reduce pain, but research on their comparative efficacy and mechanisms requires further experimental investigation. This study compared the effects of relaxation hypnosis, VR and VRH on pain perception and nociceptive physiological responses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-four healthy participants were tested at baseline followed by three experimental conditions (relaxation hypnosis, VR, VRH) in a counterbalanced order. Pain intensity and unpleasantness, as well as NFR amplitude evoked by noxious transcutaneous electrical stimulation, were measured. Bayesian statistics assessed evidence for analgesic effects on each variable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The strength of evidence in favour of our hypotheses was categorised as follow: BF = 1–3: anecdotal evidence; BF = 3–10: moderate evidence and BF > 10: strong evidence. For NFR values, Bayesian paired-sample T-tests provided anecdotal support for the efficacy of relaxation hypnosis (BF + 0 = 2.11) and stronger evidence for VR (BF + 0 = 10.94) and VRH (BF + 0 = 14). For pain intensity, moderate evidence supported reductions with relaxation hypnosis (BF + 0 = 9.18), while strong evidence was found for VR (BF + 0 = 27.99) and low to moderate for VRH (BF + 0 = 5.88). Similarly, unpleasantness showed anecdotal reduction with hypnosis (BF + 0 = 1.9), and moderate evidence supported VR (BF + 0 = 4.86) and VRH (BF + 0 = 7.18). Across all measures, no significant differences were found between hypnosis, VR and VRH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These findings suggest that these techniques did not differentially affect NFR, pain intensity, or unpleasantness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>The strength of this fundamental study is to directly compare hypnosis, VR, and VRH on both pain perception and physiological responses. It shows that VR alone is effective, while adding hypnosis does not always lead to better results and the combination could even create interference in some cases. This article helps to ","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12599604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145480890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ariane Delgado-Sanchez, Christiana Charalambous, Hannah Safi, Anthony Jones, Christopher Brown, Nelson J. Trujillo-Barreto
Background
The weighting of somatosensory input and pain expectation during pain perception is promising for pain phenotyping, with good test–retest reliability. Yet, their concurrent validity with neural and psychological variables requires further investigation.
Objectives
In this cross-sectional study, we investigated the concurrent validity of these weights with EEG source correlates of the somatosensory and expectation components during pain processing.
Methods
Participants completed a cued pain paradigm, with EEG recorded during pain expectation and perception. We used Bayesian inference to estimate the participant-specific weighting of somatosensory input, expectations and trait-like bias, and identified sources of brain activity at different stages of the cued pain task (early anticipation, late anticipation and post-stimulation). We correlated the estimated weights with EEG source activity across individuals.
Results
As hypothesised, the weight placed on somatosensory input correlated with source activity in areas related to attention (middle frontal gyrus) and sensory processing (postcentral gyrus) during late anticipation. The expectation weight positively correlated with activity in areas related to attention (middle frontal gyrus) and semantic processing (medial temporal gyrus). We found no significant correlations between any of the weights and analgesic or hyperalgesic psychological variables (mindfulness, pain catastrophising and attachment).
Conclusion
Our findings support the concurrent validity of sensory and expectation weights with related EEG source activity in pain perception, reinforcing their utility in pain phenotyping and paving the way for more personalised pain management.
Significance
Our findings support the concurrent validity of sensory and expectation weights extracted through a Bayesian model. This finding supports the use of these weights for pain phenotyping.
{"title":"EEG Correlates of the Influence of Somatosensory Input, Expectations and Trait-Like Bias on Pain Perception","authors":"Ariane Delgado-Sanchez, Christiana Charalambous, Hannah Safi, Anthony Jones, Christopher Brown, Nelson J. Trujillo-Barreto","doi":"10.1002/ejp.70154","DOIUrl":"https://doi.org/10.1002/ejp.70154","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The weighting of somatosensory input and pain expectation during pain perception is promising for pain phenotyping, with good test–retest reliability. Yet, their concurrent validity with neural and psychological variables requires further investigation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>In this cross-sectional study, we investigated the concurrent validity of these weights with EEG source correlates of the somatosensory and expectation components during pain processing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants completed a cued pain paradigm, with EEG recorded during pain expectation and perception. We used Bayesian inference to estimate the participant-specific weighting of somatosensory input, expectations and trait-like bias, and identified sources of brain activity at different stages of the cued pain task (early anticipation, late anticipation and post-stimulation). We correlated the estimated weights with EEG source activity across individuals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>As hypothesised, the weight placed on somatosensory input correlated with source activity in areas related to attention (middle frontal gyrus) and sensory processing (postcentral gyrus) during late anticipation. The expectation weight positively correlated with activity in areas related to attention (middle frontal gyrus) and semantic processing (medial temporal gyrus). We found no significant correlations between any of the weights and analgesic or hyperalgesic psychological variables (mindfulness, pain catastrophising and attachment).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings support the concurrent validity of sensory and expectation weights with related EEG source activity in pain perception, reinforcing their utility in pain phenotyping and paving the way for more personalised pain management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>Our findings support the concurrent validity of sensory and expectation weights extracted through a Bayesian model. This finding supports the use of these weights for pain phenotyping.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70154","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145470076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Immunological pathophysiological mechanisms have been postulated in Complex Regional Pain Syndrome (CRPS).Clinical features suggest abnormal immune activation, supported in laboratory studies. The purpose of this review is to systematically review the effects of therapies that can modulate the immune system in persistent CRPS.
Methods
Articles were screened from PubMed, Embase, Scopus, clinicaltrials.gov, ISRCTN databases and Web of Science for articles, studies and conference abstracts in CRPS and immune therapies from inception up to April 2024. Titles and abstracts were screened, followed by reading the full text and reference lists to determine the final articles for analysis. Studies were restricted to adults and a duration of disease greater than 1 year. Randomised controlled trials were appraised using the Cochrane Risk of Bias (RoB2).
Results
A total of 1404 studies were yielded, and 23 articles were retrieved for full-text analysis after reviewing the titles, texts and abstracts. A narrative synthesis was used due to the heterogeneity of studies. The immune therapies used were glucocorticoids, thalidomide/lenalidomide, immunoglobulin, plasmapheresis, mycophenolate, anti-TNF-alpha inhibitors and epidermal growth factor receptor inhibitors. There were 16 reports of beneficial effects from non-randomised trials, case series and case reports of treatment with immunomodulating drugs or interventions. Small randomised trials of low-dose immunoglobulin, epidermal growth factor receptor inhibitors and mycophenolate suggest possible treatment benefit, but larger randomised trials of immunoglobulin and lenalidomide demonstrated no effect.
Conclusion
The emergence of novel immune therapies for persistent CRPS shows promise, but evidence based on high-quality randomised trials remains limited and does not show a positive effect.
Significance Statement
This work summarises the current use of immune-modulating therapies in managing patients with persistent Complex Regional Pain Syndrome (CRPS). It complements the current interest in immunological approaches to pain management with the increasing role of immune mechanisms in both pain and CRPS. While promise has been shown in small case reports and cohort studies, the need for high-quality clinical trials is highlighted by the few large randomised controlled trials.
背景：复杂局部疼痛综合征（CRPS）的免疫病理生理机制已被提出。临床特征提示异常免疫激活，实验室研究支持。本综述的目的是系统地回顾在持续性CRPS中可以调节免疫系统的治疗效果。方法：从PubMed、Embase、Scopus、clinicaltrials.gov、ISRCTN数据库和Web of Science数据库中筛选自成立至2024年4月CRPS和免疫治疗领域的文章、研究和会议摘要。筛选标题和摘要，然后阅读全文和参考文献列表，以确定最后要分析的文章。研究仅限于成人，且病程大于1年。随机对照试验采用Cochrane偏倚风险（RoB2）进行评价。结果：共纳入1404篇研究，检索到23篇文章进行全文分析。由于研究的异质性，采用了叙事综合。使用的免疫疗法有糖皮质激素、沙利度胺/来那度胺、免疫球蛋白、血浆置换、霉酚酸盐、抗tnf - α抑制剂和表皮生长因子受体抑制剂。从非随机试验、病例系列和免疫调节药物或干预治疗的病例报告中，有16份有益效果的报告。低剂量免疫球蛋白、表皮生长因子受体抑制剂和霉酚酸盐的小型随机试验提示可能的治疗益处，但免疫球蛋白和来那度胺的大型随机试验显示没有效果。结论：针对持续性CRPS的新型免疫疗法的出现显示出了希望，但基于高质量随机试验的证据仍然有限，并且没有显示出积极的效果。意义声明：这项工作总结了目前免疫调节疗法在治疗持续性复杂局部疼痛综合征（CRPS）患者中的应用。它补充了目前对疼痛管理的免疫方法的兴趣，免疫机制在疼痛和CRPS中的作用越来越大。虽然小病例报告和队列研究显示出了希望，但为数不多的大型随机对照试验强调了对高质量临床试验的需求。
{"title":"Immunological Therapy in Persistent Complex Regional Pain Syndrome: A Systematic Review and Narrative Synthesis","authors":"David Pang, Jonathan Royds, Andreas Goebel","doi":"10.1002/ejp.70156","DOIUrl":"10.1002/ejp.70156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Immunological pathophysiological mechanisms have been postulated in Complex Regional Pain Syndrome (CRPS).Clinical features suggest abnormal immune activation, supported in laboratory studies. The purpose of this review is to systematically review the effects of therapies that can modulate the immune system in persistent CRPS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Articles were screened from PubMed, Embase, Scopus, clinicaltrials.gov, ISRCTN databases and Web of Science for articles, studies and conference abstracts in CRPS and immune therapies from inception up to April 2024. Titles and abstracts were screened, followed by reading the full text and reference lists to determine the final articles for analysis. Studies were restricted to adults and a duration of disease greater than 1 year. Randomised controlled trials were appraised using the Cochrane Risk of Bias (RoB2).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1404 studies were yielded, and 23 articles were retrieved for full-text analysis after reviewing the titles, texts and abstracts. A narrative synthesis was used due to the heterogeneity of studies. The immune therapies used were glucocorticoids, thalidomide/lenalidomide, immunoglobulin, plasmapheresis, mycophenolate, anti-TNF-alpha inhibitors and epidermal growth factor receptor inhibitors. There were 16 reports of beneficial effects from non-randomised trials, case series and case reports of treatment with immunomodulating drugs or interventions. Small randomised trials of low-dose immunoglobulin, epidermal growth factor receptor inhibitors and mycophenolate suggest possible treatment benefit, but larger randomised trials of immunoglobulin and lenalidomide demonstrated no effect.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The emergence of novel immune therapies for persistent CRPS shows promise, but evidence based on high-quality randomised trials remains limited and does not show a positive effect.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This work summarises the current use of immune-modulating therapies in managing patients with persistent Complex Regional Pain Syndrome (CRPS). It complements the current interest in immunological approaches to pain management with the increasing role of immune mechanisms in both pain and CRPS. While promise has been shown in small case reports and cohort studies, the need for high-quality clinical trials is highlighted by the few large randomised controlled trials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Atena Saito, Jens Laigaard, Pernille Bjersand Sunde, Caroline Folkersen, Ida Houtved Rasmussen, Selma Pedersen Kjartansdóttir, Ole Mathiesen, Anders Karlsen
Background
The minimal important difference (MID) is established for pain intensity scores in acute pain management, but not for rescue opioid consumption. This scoping review aimed to estimate the MID in rescue opioid consumption for acute pain among adult patients in the postoperative and emergency settings.
Methods
We searched MEDLINE, Embase, CENTRAL, clinicaltrials.gov and clinicaltrialsregister.eu for studies published in English from inception to May 2024. We included studies investigating the MID of rescue opioid consumption in adults with acute pain in the postoperative and emergency settings. Because limited studies explicitly investigated the MID, we also included studies assessing the dose–response relationship between opioid consumption and relevant anchors (e.g., pain intensity scores). The primary outcome was MID for 0–24 h rescue opioid consumption; secondary outcomes included longer postoperative periods.
Results
We screened 11,748 citations and included 14 studies (8190 patients). Three studies explicitly evaluated MID for rescue opioid consumption. In the remaining 11 studies, we estimated the MID using a 10-point difference (0–100 scale) in pain intensity score as an anchor. The anchor-based estimates ranged from 2 to 5 mg IV morphine equivalents, varying by population, method and context.
Conclusions
Based on the currently available evidence, we propose a provisional MID of 5 mg IV morphine equivalent in rescue opioid consumption for acute pain. This is lower than the value used in most sample size calculations.
Significance Statement
These results can guide sample size calculations and support patient-centered approaches in acute pain settings.
{"title":"Minimal Important Difference for Rescue Opioid Consumption in Adults With Acute Pain: A Scoping Review","authors":"Atena Saito, Jens Laigaard, Pernille Bjersand Sunde, Caroline Folkersen, Ida Houtved Rasmussen, Selma Pedersen Kjartansdóttir, Ole Mathiesen, Anders Karlsen","doi":"10.1002/ejp.70151","DOIUrl":"10.1002/ejp.70151","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The minimal important difference (MID) is established for pain intensity scores in acute pain management, but not for rescue opioid consumption. This scoping review aimed to estimate the MID in rescue opioid consumption for acute pain among adult patients in the postoperative and emergency settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched MEDLINE, Embase, CENTRAL, clinicaltrials.gov and clinicaltrialsregister.eu for studies published in English from inception to May 2024. We included studies investigating the MID of rescue opioid consumption in adults with acute pain in the postoperative and emergency settings. Because limited studies explicitly investigated the MID, we also included studies assessing the dose–response relationship between opioid consumption and relevant anchors (e.g., pain intensity scores). The primary outcome was MID for 0–24 h rescue opioid consumption; secondary outcomes included longer postoperative periods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We screened 11,748 citations and included 14 studies (8190 patients). Three studies explicitly evaluated MID for rescue opioid consumption. In the remaining 11 studies, we estimated the MID using a 10-point difference (0–100 scale) in pain intensity score as an anchor. The anchor-based estimates ranged from 2 to 5 mg IV morphine equivalents, varying by population, method and context.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Based on the currently available evidence, we propose a provisional MID of 5 mg IV morphine equivalent in rescue opioid consumption for acute pain. This is lower than the value used in most sample size calculations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>These results can guide sample size calculations and support patient-centered approaches in acute pain settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>PROSPERO identifier: CRD42024547409</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145451342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giovanna Laura Neves Antonio Gaban, Jonas Bloch Thorlund, Kristian Kjær-Staal Petersen, Thomas Graven-Nielsen, Pia Schou, Henrik Bjarke Vægter
Background
Central modulatory pain mechanisms may influence improvements after exercise in low back pain (LBP). This observational study explored whether temporal summation of pain (TSP) and exercise-induced hypoalgesia (EIH) are associated with improvements in resting pain and movement-evoked pain, as it may improve the understanding of variation in effectiveness after an exercise program in individuals with LBP.
Methods
At baseline and after an 8-week exercise program, ratings of resting pain and movement-evoked pain on a 0–10 numerical rating scale (NRS) were assessed in 69 individuals with LBP. Cuff algometry at the lower leg (recording of the pain intensity to 10 repeated painful cuff stimulation) and pressure pain thresholds at the low back and leg immediately before and after a 6-min walking test were used to assess baseline TSP and EIH, respectively. Linear regression analyses adjusted for age and gender were used to assess the strength and direction of associations between baseline TSP and EIH with pain improvements (baseline minus Week 8).
Results
Resting-pain NRS scores were reduced by 0.9 (0.5–1.3) and movement-evoked pain by 0.9 (0.4–1.5) after 8 weeks of exercise. Higher baseline TSP was associated with improvement in resting pain (B = 0.29, p = 0.014), but not significantly with improvement in movement-evoked pain. Baseline EIH, regardless of the site point, was not significantly associated with resting or movement-evoked pain improvements.
Conclusion
This study suggests that higher TSP at baseline is weakly but significantly associated with larger improvement in resting-pain intensity after an 8-week exercise program in people with LBP but this should be confirmed in larger studies.
Significance Statement
Assessing central pain mechanisms may help identify individuals more likely to benefit from therapy, guiding personalised exercise-based treatments. Thus, this exploratory study provides preliminary evidence that higher baseline TSP is associated with greater improvements in resting pain following an exercise intervention. However, neither TSP nor EIH were associated with movement-evoked pain changes. These findings highlight the potential clinical relevance of evaluating central pain mechanisms when designing rehabilitation strategies for pain relief in LBP.
背景：中枢调节疼痛机制可能影响运动后腰痛（LBP）的改善。这项观察性研究探讨了疼痛的时间累积（TSP）和运动诱发的痛觉减退（EIH）是否与静息疼痛和运动诱发的疼痛的改善有关，因为它可以提高对LBP患者运动计划后有效性变化的理解。方法：在基线和8周运动计划后，对69名腰痛患者的静息疼痛和运动诱发疼痛进行0-10数值评定量表（NRS）评分。分别采用下肢袖带测量法（记录疼痛强度至10次重复疼痛袖带刺激）和6分钟步行试验前后腰背部和腿部的压力痛阈值来评估基线TSP和EIH。采用调整了年龄和性别的线性回归分析来评估基线TSP和EIH与疼痛改善（基线减去第8周）之间关联的强度和方向。结果：运动8周后，静息痛NRS评分降低0.9(0.5 ~ 1.3)，运动诱发痛评分降低0.9（0.4 ~ 1.5）。较高的基线TSP与静息疼痛的改善相关（B = 0.29, p = 0.014），但与运动诱发疼痛的改善无显著关系。基线EIH，无论在哪个部位，与静息或运动诱发的疼痛改善没有显著相关。结论：本研究表明，基线时较高的TSP与腰痛患者进行8周运动后静息疼痛强度的改善有微弱但显著的相关性，但这需要在更大规模的研究中得到证实。意义声明：评估中枢性疼痛机制可能有助于识别更有可能从治疗中受益的个体，指导个性化的基于运动的治疗。因此，这项探索性研究提供了初步证据，表明运动干预后，较高的基线TSP与静息疼痛的改善有关。然而，TSP和EIH均与运动引起的疼痛变化无关。这些发现强调了在设计缓解腰痛的康复策略时评估中枢性疼痛机制的潜在临床意义。
{"title":"Baseline Pain Summation Predicts Resting but Not Movement Pain Relief After Exercise in Low Back Pain","authors":"Giovanna Laura Neves Antonio Gaban, Jonas Bloch Thorlund, Kristian Kjær-Staal Petersen, Thomas Graven-Nielsen, Pia Schou, Henrik Bjarke Vægter","doi":"10.1002/ejp.70164","DOIUrl":"10.1002/ejp.70164","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Central modulatory pain mechanisms may influence improvements after exercise in low back pain (LBP). This observational study explored whether temporal summation of pain (TSP) and exercise-induced hypoalgesia (EIH) are associated with improvements in resting pain and movement-evoked pain, as it may improve the understanding of variation in effectiveness after an exercise program in individuals with LBP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>At baseline and after an 8-week exercise program, ratings of resting pain and movement-evoked pain on a 0–10 numerical rating scale (NRS) were assessed in 69 individuals with LBP. Cuff algometry at the lower leg (recording of the pain intensity to 10 repeated painful cuff stimulation) and pressure pain thresholds at the low back and leg immediately before and after a 6-min walking test were used to assess baseline TSP and EIH, respectively. Linear regression analyses adjusted for age and gender were used to assess the strength and direction of associations between baseline TSP and EIH with pain improvements (baseline minus Week 8).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Resting-pain NRS scores were reduced by 0.9 (0.5–1.3) and movement-evoked pain by 0.9 (0.4–1.5) after 8 weeks of exercise. Higher baseline TSP was associated with improvement in resting pain (<i>B</i> = 0.29, <i>p</i> = 0.014), but not significantly with improvement in movement-evoked pain. Baseline EIH, regardless of the site point, was not significantly associated with resting or movement-evoked pain improvements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study suggests that higher TSP at baseline is weakly but significantly associated with larger improvement in resting-pain intensity after an 8-week exercise program in people with LBP but this should be confirmed in larger studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Assessing central pain mechanisms may help identify individuals more likely to benefit from therapy, guiding personalised exercise-based treatments. Thus, this exploratory study provides preliminary evidence that higher baseline TSP is associated with greater improvements in resting pain following an exercise intervention. However, neither TSP nor EIH were associated with movement-evoked pain changes. These findings highlight the potential clinical relevance of evaluating central pain mechanisms when designing rehabilitation strategies for pain relief in LBP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145451276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号