Espinós Ramírez C, Castellví Obiols P, Martínez-Rodríguez D et al. Acute Postoperative Pain After Caesarean Section, Intensity and Management: A Cohort Multicentre Study. Eur J Pain. 2026; 30: e70183. doi:10.1002/ejp.70183.
The title of this paper was corrected to read as follows: ‘Chronic Postoperative Pain After Caesarean Section, Characteristics and Risk Factors: A Cohort Multicentre Study’ because it focuses on chronic post-surgical pain following elective caesarean section.
In Section 4: Discussion, Paragraph 4, Line 3 in reference to impact of neuropathic pain on quality of life, the sentence should read as follows: ‘Our subset of patients reporting neuropathic characteristics show worse significant quality of life ratings except for impact on humour’.
{"title":"Correction to ‘Acute Postoperative Pain After Caesarean Section, Intensity and Management: A Cohort Multicentre Study’","authors":"","doi":"10.1002/ejp.70208","DOIUrl":"10.1002/ejp.70208","url":null,"abstract":"<p>Espinós Ramírez C, Castellví Obiols P, Martínez-Rodríguez D et al. Acute Postoperative Pain After Caesarean Section, Intensity and Management: A Cohort Multicentre Study. Eur J Pain. 2026; 30: e70183. doi:10.1002/ejp.70183.</p><p>The title of this paper was corrected to read as follows: ‘Chronic Postoperative Pain After Caesarean Section, Characteristics and Risk Factors: A Cohort Multicentre Study’ because it focuses on chronic post-surgical pain following elective caesarean section.</p><p>In Section 4: Discussion, Paragraph 4, Line 3 in reference to impact of neuropathic pain on quality of life, the sentence should read as follows: ‘Our subset of patients reporting neuropathic characteristics show worse significant quality of life ratings except for impact on humour’.</p><p>We apologise for these errors.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70208","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028658","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>Cervicogenic headache lacks comprehensive evidence comparing all available treatments. This study aimed to evaluate the relative efficacy of interventions for reducing headache intensity, frequency and headache-related disability in cervicogenic headache.</p> </section> <section> <h3> Databases and Data Treatment</h3> <p>We conducted a systematic search for randomised controlled trials (RCTs) evaluating pharmacological and non-pharmacological interventions in adults diagnosed with cervicogenic headache. Searches were performed across multiple electronic databases, including PubMed, Scopus, Cochrane Central Register of Controlled Trials, PEDro, ClinicalTrials.gov, and Google Scholar. The primary outcomes were headache intensity and frequency. The secondary outcome was the Headache Impact Test (HIT-6). Data was synthesised using random-effects network meta-analysis, with risk of bias assessed via the Cochrane RoB 2 tool. Treatment hierarchies were established using P-scores.</p> </section> <section> <h3> Results</h3> <p>The review included 41 RCTs involving 1922 participants, with 37 studies contributing to network meta-analysis. Multimodal non-pharmacological approaches demonstrated superior short-term efficacy compared to single-modality and pharmacological interventions. The highest-ranked interventions for both intensity and frequency reduction included manual therapy combined with dry needling (intensity: mean difference [MD] = −5.98, 95% CI: −10.43 to −1.53; frequency: MD = −15.29, 95% CI: −20.99 to −9.59). The combination of manual therapy, exercise, and orthosis demonstrated the greatest reduction in HIT-6 scores (MD = −18.69, 95% CI: −28.62 to −8.76). In contrast, isolated passive treatments such as massage and pharmacological interventions including pregabalin and botulinum toxin demonstrated limited effectiveness.</p> </section> <section> <h3> Conclusions</h3> <p>Multimodal non-pharmacological approaches are superior to single-modality treatments and pharmacological interventions in the short-term management of cervicogenic headache, effectively reducing headache intensity, frequency and headache-related disability.</p> </section> <section> <h3> Significance Statement</h3> <p>This network meta-analysis demonstrates that multimodal non-pharmacological approaches are superior to single-modality treatments and pharmacological interventions in the short-term management of cervicogenic heada
背景和目的：颈源性头痛缺乏比较所有现有治疗方法的综合证据。本研究旨在评估干预措施在减少颈源性头痛的头痛强度、频率和头痛相关残疾方面的相对疗效。数据库和数据处理：我们对随机对照试验（RCTs）进行了系统搜索，以评估诊断为颈源性头痛的成人的药物和非药物干预措施。检索通过多个电子数据库进行，包括PubMed、Scopus、Cochrane Central Register of Controlled Trials、PEDro、ClinicalTrials.gov和谷歌Scholar。主要结局为头痛强度和频率。次要终点是头痛影响试验（HIT-6）。数据采用随机效应网络荟萃分析进行综合，并通过Cochrane RoB 2工具评估偏倚风险。采用p -评分建立治疗等级。结果：本综述纳入41项随机对照试验，涉及1922名参与者，其中37项研究参与网络荟萃分析。与单模态和药物干预相比，多模态非药物方法显示出更好的短期疗效。在强度和频率降低方面，排名最高的干预措施包括手工治疗结合干针（强度：平均差[MD] = -5.98, 95% CI: -10.43至-1.53；频率：MD = -15.29, 95% CI: -20.99至-9.59）。手工治疗、运动和矫形器联合使用可以最大程度地降低HIT-6评分（MD = -18.69, 95% CI: -28.62至-8.76）。相比之下，孤立的被动治疗，如按摩和药物干预，包括普瑞巴林和肉毒杆菌毒素显示有限的效果。结论：在颈源性头痛的短期治疗中，多模式非药物治疗优于单模式治疗和药物干预，可有效降低头痛强度、频率和头痛相关残疾。意义声明：该网络荟萃分析表明，在短期治疗颈源性头痛方面，多模式非药物治疗优于单模式治疗和药物干预，可有效降低头痛强度、频率和头痛相关残疾。
{"title":"The Comparative Efficacy of Treatments for Cervicogenic Headache: A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials","authors":"Nantawan Koonalinthip, Prut Koonalintip, Chernkhuan Stonsaovapak","doi":"10.1002/ejp.70219","DOIUrl":"10.1002/ejp.70219","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>Cervicogenic headache lacks comprehensive evidence comparing all available treatments. This study aimed to evaluate the relative efficacy of interventions for reducing headache intensity, frequency and headache-related disability in cervicogenic headache.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Databases and Data Treatment</h3>\u0000 \u0000 <p>We conducted a systematic search for randomised controlled trials (RCTs) evaluating pharmacological and non-pharmacological interventions in adults diagnosed with cervicogenic headache. Searches were performed across multiple electronic databases, including PubMed, Scopus, Cochrane Central Register of Controlled Trials, PEDro, ClinicalTrials.gov, and Google Scholar. The primary outcomes were headache intensity and frequency. The secondary outcome was the Headache Impact Test (HIT-6). Data was synthesised using random-effects network meta-analysis, with risk of bias assessed via the Cochrane RoB 2 tool. Treatment hierarchies were established using P-scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The review included 41 RCTs involving 1922 participants, with 37 studies contributing to network meta-analysis. Multimodal non-pharmacological approaches demonstrated superior short-term efficacy compared to single-modality and pharmacological interventions. The highest-ranked interventions for both intensity and frequency reduction included manual therapy combined with dry needling (intensity: mean difference [MD] = −5.98, 95% CI: −10.43 to −1.53; frequency: MD = −15.29, 95% CI: −20.99 to −9.59). The combination of manual therapy, exercise, and orthosis demonstrated the greatest reduction in HIT-6 scores (MD = −18.69, 95% CI: −28.62 to −8.76). In contrast, isolated passive treatments such as massage and pharmacological interventions including pregabalin and botulinum toxin demonstrated limited effectiveness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Multimodal non-pharmacological approaches are superior to single-modality treatments and pharmacological interventions in the short-term management of cervicogenic headache, effectively reducing headache intensity, frequency and headache-related disability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This network meta-analysis demonstrates that multimodal non-pharmacological approaches are superior to single-modality treatments and pharmacological interventions in the short-term management of cervicogenic heada","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028611","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}
Asuka Fujishiro, Silvia Lo Vecchio, Rocco Giordano, Gil Yosipovitch, Lars Arendt-Nielsen
Background and Objective
In recent years, studies have suggested an epigenetic fingerprint related to specific diseases and pathological conditions characterised by itch. Epigenetics, defined as modifications that regulate gene expression without altering the DNA sequence, has previously been shown to be involved in pain, but its association with itch remains poorly investigated. This review aims to summarise the current knowledge regarding the involvement of epigenetic modifications in preclinical models and clinical dermatological itch conditions.
Databases and Data Treatment
English-language studies were identified through PubMed and Google Scholar using Medical Subject Heading (MeSH) terms related to itch or pruritus and epigenetics or DNA methylation or histone modification or microRNA or lncRNA or circRNA or non-coding RNA, from inception to January 2025. Non-relevant publications and non-peer-reviewed formats were excluded. Reference lists were also screened for additional studies.
Results
Both preclinical and clinical studies indicate that DNA methylation is involved in the regulation of itch in atopic dermatitis and other pruritic skin conditions, and histone deacetylase inhibitors have the effect of alleviating pruritus. Among miR-711, miR-203b-3p, and miR-let-7b, identified as mediators of itch in animal models, miR-711 and miR-203 were also upregulated in certain clinical models.
Conclusions
A clear association between itch and epigenetic modifications has been demonstrated in both preclinical skin disease models and clinical dermatological conditions. Several of these changes appear consistently across experimental and human studies, suggesting their role as shared molecular regulators of itch.
Significance Statement
Current understanding of the underlying mechanisms of itch remains limited, and optimal treatments for chronic itch have been difficult to develop. Epigenetic modifications in the pathophysiology of itch may contribute to our understanding of itch pathways and pave the way for new, potential treatments.
{"title":"Epigenetic Modification in Preclinical and Clinical Dermatological Itch Conditions","authors":"Asuka Fujishiro, Silvia Lo Vecchio, Rocco Giordano, Gil Yosipovitch, Lars Arendt-Nielsen","doi":"10.1002/ejp.70214","DOIUrl":"10.1002/ejp.70214","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>In recent years, studies have suggested an epigenetic fingerprint related to specific diseases and pathological conditions characterised by itch. Epigenetics, defined as modifications that regulate gene expression without altering the DNA sequence, has previously been shown to be involved in pain, but its association with itch remains poorly investigated. This review aims to summarise the current knowledge regarding the involvement of epigenetic modifications in preclinical models and clinical dermatological itch conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Databases and Data Treatment</h3>\u0000 \u0000 <p>English-language studies were identified through PubMed and Google Scholar using Medical Subject Heading (MeSH) terms related to itch or pruritus and epigenetics or DNA methylation or histone modification or microRNA or lncRNA or circRNA or non-coding RNA, from inception to January 2025. Non-relevant publications and non-peer-reviewed formats were excluded. Reference lists were also screened for additional studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both preclinical and clinical studies indicate that DNA methylation is involved in the regulation of itch in atopic dermatitis and other pruritic skin conditions, and histone deacetylase inhibitors have the effect of alleviating pruritus. Among miR-711, miR-203b-3p, and miR-let-7b, identified as mediators of itch in animal models, miR-711 and miR-203 were also upregulated in certain clinical models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A clear association between itch and epigenetic modifications has been demonstrated in both preclinical skin disease models and clinical dermatological conditions. Several of these changes appear consistently across experimental and human studies, suggesting their role as shared molecular regulators of itch.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Current understanding of the underlying mechanisms of itch remains limited, and optimal treatments for chronic itch have been difficult to develop. Epigenetic modifications in the pathophysiology of itch may contribute to our understanding of itch pathways and pave the way for new, potential treatments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028599","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}
Live Landmark, Hans Fredrik Sunde, Egil A. Fors, Leif Edward Ottesen Kennair, Silje Endresen Reme
<div> <section> <h3> Background</h3> <p>Persistent physical symptoms are common and often result in disability and high healthcare use. To capture how such symptoms co-occur, Bodily Distress Syndrome (BDS, also called Functional Somatic Disorders) was developed as an empirically derived construct, in contrast to consensus-based syndromes such as fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). BDS is distinct from ICD-11 Bodily Distress Disorder and reflects the multisystem symptom pattern described in the Functional Somatic Disorder framework. However, its prevalence, symptom structure and prognostic relevance in pain populations have not been mapped.</p> </section> <section> <h3> Methods</h3> <p>This study included 3762 individuals referred to a tertiary pain clinic. At baseline, participants reported standardised measures of fatigue, insomnia, pain catastrophizing, psychological distress, perceived injustice, health-related quality of life and disability. After 12 months, they reported disability and perceived change. BDS severity was classified from predefined symptom cluster criteria. We examined prevalence, clinical correlates and prognostic utility.</p> </section> <section> <h3> Results</h3> <p>92.5% met the criteria for moderate or severe BDS. They reported more severe physical symptoms, elevated psychological distress and reduced functioning than those not meeting the criteria. Severe BDS was more common among women, those without higher education and individuals outside the workforce. After 12 months, individuals with BDS showed less improvement in functioning and reported lower perceived treatment benefit.</p> </section> <section> <h3> Conclusion</h3> <p>BDS was common in this outpatient hospital cohort and may offer a clinically useful lens for capturing multisystem complexity in specialised pain services. Incorporating BDS screening into routine assessment could help identify individuals with complex symptoms and support more mechanism-oriented treatment approaches.</p> </section> <section> <h3> Significance Statement</h3> <p>Bodily Distress Syndrome (BDS) is highly prevalent in tertiary pain care and linked to more severe symptoms, psychosocial burden and poorer long-term outcomes. The findings support BDS as a clinically useful framework for identifying patients with complex symptom profiles and for guiding interdisciplinary, mechanism-oriented approaches to pain management.</p> </section>
{"title":"Prevalence of Bodily Distress Syndrome and Prediction of Patient Outcomes: Cohort Study of 3762 Individuals With Persistent Pain","authors":"Live Landmark, Hans Fredrik Sunde, Egil A. Fors, Leif Edward Ottesen Kennair, Silje Endresen Reme","doi":"10.1002/ejp.70212","DOIUrl":"https://doi.org/10.1002/ejp.70212","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Persistent physical symptoms are common and often result in disability and high healthcare use. To capture how such symptoms co-occur, Bodily Distress Syndrome (BDS, also called Functional Somatic Disorders) was developed as an empirically derived construct, in contrast to consensus-based syndromes such as fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). BDS is distinct from ICD-11 Bodily Distress Disorder and reflects the multisystem symptom pattern described in the Functional Somatic Disorder framework. However, its prevalence, symptom structure and prognostic relevance in pain populations have not been mapped.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study included 3762 individuals referred to a tertiary pain clinic. At baseline, participants reported standardised measures of fatigue, insomnia, pain catastrophizing, psychological distress, perceived injustice, health-related quality of life and disability. After 12 months, they reported disability and perceived change. BDS severity was classified from predefined symptom cluster criteria. We examined prevalence, clinical correlates and prognostic utility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>92.5% met the criteria for moderate or severe BDS. They reported more severe physical symptoms, elevated psychological distress and reduced functioning than those not meeting the criteria. Severe BDS was more common among women, those without higher education and individuals outside the workforce. After 12 months, individuals with BDS showed less improvement in functioning and reported lower perceived treatment benefit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>BDS was common in this outpatient hospital cohort and may offer a clinically useful lens for capturing multisystem complexity in specialised pain services. Incorporating BDS screening into routine assessment could help identify individuals with complex symptoms and support more mechanism-oriented treatment approaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Bodily Distress Syndrome (BDS) is highly prevalent in tertiary pain care and linked to more severe symptoms, psychosocial burden and poorer long-term outcomes. The findings support BDS as a clinically useful framework for identifying patients with complex symptom profiles and for guiding interdisciplinary, mechanism-oriented approaches to pain management.</p>\u0000 </section>\u0000","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70212","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146007679","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}
Francisco J. Ortega, Maria José Giner, Laura Pérez-Cervera, Emilio Tomás, Raúl Valdesuso, Ismael Navarro, Miguel Delicado-Miralles, Enrique Velasco
<div> <section> <h3> Background</h3> <p>Percutaneous peripheral nerve stimulation (pPNS) protocols that induce synaptic plasticity in animals were recently shown to produce hypoalgesia in humans. However, whether they can relieve pain in a clinical population remains unexplored. Here we investigated the effects of these pPNS protocols in pain symptoms of participants suffering from non-specific neck pain.</p> </section> <section> <h3> Methods</h3> <p>45 participants were divided into three groups: percutaneous Sensory-Threshold burst High-Frequency Stimulation (ST-bHFS), percutaneous Motor-Threshold Theta-Burst Stimulation (MT-TBS) or an active control group receiving 80 Hz TENS. A verbal numerical rating scale (VRNS) was used to assess spontaneous and movement-induced pain. Pain was also evaluated during the week before and the week after treatment, along with maximal strength and electromyography of the upper trapezius.</p> </section> <section> <h3> Results</h3> <p>ST-bHFS produced a clinically relevant and significant reduction in spontaneous pain (1.8 ± 1.6 VRNS, <i>p</i> < 0.001), not detected in MT-TBS (0.8 ± 1.9, <i>p</i> = 0.105) or TENS (0.5 ± 1.3, <i>p</i> = 0.185). All protocols reduced movement-induced pain (MT-TBS 1.9 ± 1.6, <i>p</i> < 0.001; ST-bHFS 1.7 ± 2.2, <i>p</i> = 0.009; TENS 1.4 ± 1.5, <i>p</i> = 0.002), although the reduction in the TENS group did not reach clinical relevance. One week post-treatment, a clinically relevant and significant pain reduction was still present in the pPNS groups (MT-TBS 2.0 ± 1.3, <i>p</i> < 0.001; ST-bHFS 1.7 ± 2.6, <i>p</i> = 0.041), but not in the TENS group (0.7 ± 1.9, <i>p</i> = 0.350). Maximal strength increased significantly in TENS (3.5 ± 5.1 kg, <i>p</i> = 0.019) and MT-TBS groups (2.8 ± 4.2, <i>p</i> = 0.021), without electromyographic changes.</p> </section> <section> <h3> Conclusions</h3> <p>pPNS protocols reduced pain symptomatology in patients with non-specific neck pain. Contrary to TENS, ST-bHFS reduced spontaneous pain and pain reduction lasted for a week in both pPNS groups. These results hold promise for improving the use of pPNS through translation of fundamental pain neuroscience.</p> </section> <section> <h3> Significance Statement</h3> <p>Plasticity-inducing protocols applied through percutaneous peripheral nerve stimulation are an effective non-pharmacological treatment. They represent a clinically relevant option for pain management that could influence clinical practice as well as future fundamental and clinical research.</p> </section>
{"title":"Plasticity-Inducing Percutaneous Peripheral Nerve Stimulation for Treating Neck Pain: A Blinded, Randomised Clinical Trial","authors":"Francisco J. Ortega, Maria José Giner, Laura Pérez-Cervera, Emilio Tomás, Raúl Valdesuso, Ismael Navarro, Miguel Delicado-Miralles, Enrique Velasco","doi":"10.1002/ejp.70207","DOIUrl":"10.1002/ejp.70207","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Percutaneous peripheral nerve stimulation (pPNS) protocols that induce synaptic plasticity in animals were recently shown to produce hypoalgesia in humans. However, whether they can relieve pain in a clinical population remains unexplored. Here we investigated the effects of these pPNS protocols in pain symptoms of participants suffering from non-specific neck pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>45 participants were divided into three groups: percutaneous Sensory-Threshold burst High-Frequency Stimulation (ST-bHFS), percutaneous Motor-Threshold Theta-Burst Stimulation (MT-TBS) or an active control group receiving 80 Hz TENS. A verbal numerical rating scale (VRNS) was used to assess spontaneous and movement-induced pain. Pain was also evaluated during the week before and the week after treatment, along with maximal strength and electromyography of the upper trapezius.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ST-bHFS produced a clinically relevant and significant reduction in spontaneous pain (1.8 ± 1.6 VRNS, <i>p</i> < 0.001), not detected in MT-TBS (0.8 ± 1.9, <i>p</i> = 0.105) or TENS (0.5 ± 1.3, <i>p</i> = 0.185). All protocols reduced movement-induced pain (MT-TBS 1.9 ± 1.6, <i>p</i> < 0.001; ST-bHFS 1.7 ± 2.2, <i>p</i> = 0.009; TENS 1.4 ± 1.5, <i>p</i> = 0.002), although the reduction in the TENS group did not reach clinical relevance. One week post-treatment, a clinically relevant and significant pain reduction was still present in the pPNS groups (MT-TBS 2.0 ± 1.3, <i>p</i> < 0.001; ST-bHFS 1.7 ± 2.6, <i>p</i> = 0.041), but not in the TENS group (0.7 ± 1.9, <i>p</i> = 0.350). Maximal strength increased significantly in TENS (3.5 ± 5.1 kg, <i>p</i> = 0.019) and MT-TBS groups (2.8 ± 4.2, <i>p</i> = 0.021), without electromyographic changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>pPNS protocols reduced pain symptomatology in patients with non-specific neck pain. Contrary to TENS, ST-bHFS reduced spontaneous pain and pain reduction lasted for a week in both pPNS groups. These results hold promise for improving the use of pPNS through translation of fundamental pain neuroscience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Plasticity-inducing protocols applied through percutaneous peripheral nerve stimulation are an effective non-pharmacological treatment. They represent a clinically relevant option for pain management that could influence clinical practice as well as future fundamental and clinical research.</p>\u0000 </section>\u0000 \u0000 ","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003369","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}
Jordi Miró, Elisabet Sánchez-Rodríguez, Mark P. Jensen, Christina Liossi, Susan M. Lord, Inese Gobina, Nathan Skidmore, Mary O'Keeffe, Susan M. Walker, Rocío de la Vega, Pablo Ingelmo, Helen Koechlin, Minna Ståhl, Jennifer Stinson, Rikard K. Wicksell, G. Allen Finley, Jesús Cebrecos, Liesbet Goubert, Francisco Reinoso-Barbero, Daniela C. Rosenberger, Esther M. Pogatzki-Zahn
<div> <section> <h3> Background</h3> <p>Effective treatment of paediatric chronic pain requires a robust and comprehensive set of outcome assessment tools to evaluate treatment effectiveness. Although a core outcome set (COS) exists for clinical trials, its practicability and appropriateness for clinical practice is currently unknown. This cross-sectional study led by the IN-ChildPain group aimed to: (1) identify clinical outcome domains and measures used by clinicians treating children and adolescents with chronic pain, (2) determine which domains are considered mandatory in clinical routine and (3) compare prioritisation across disciplines and countries.</p> </section> <section> <h3> Methods</h3> <p>An online survey, available in eight languages, was conducted eliciting data from clinicians who treat children and adolescents with chronic pain. Percentages of the most commonly used outcomes were calculated, and <i>z</i>-tests were performed to compare study variables based on participants' country income status and professional background.</p> </section> <section> <h3> Results</h3> <p>A total of 193 clinicians from 42 countries participated. The most commonly assessed domains were pain intensity (84%), pain interference (80%) and physical functioning (79%), with higher assessment rates in high-income countries. Pain intensity and interference were deemed mandatory by 93% of participants, followed by physical functioning (92%). However, only 53% reported using patient-reported outcome measures, with the 0–10 Numeric Rating Scale being the most common (94%). Assessment practices varied as a function of country income level and professional background.</p> </section> <section> <h3> Conclusions</h3> <p>The findings highlight the need to develop and implement a COS tailored to the needs and resources of clinicians. Such standardisation would enhance consistency in assessment, enable cross-site benchmarking and promote equitable pain care globally.</p> </section> <section> <h3> Significance</h3> <p>This study provides critical insights into how clinicians assess paediatric chronic pain, highlighting significant global disparities and professional differences in outcome domain prioritisation. By identifying commonly assessed domains, these findings emphasise the need for standardised measures and pave the way for developing a core outcome set tailored to clinical activities. Such an advance is essential for improving the consistency and quality of care f
{"title":"Outcome Assessment in Children and Adolescents With Chronic Pain: An International Clinical Practice Survey","authors":"Jordi Miró, Elisabet Sánchez-Rodríguez, Mark P. Jensen, Christina Liossi, Susan M. Lord, Inese Gobina, Nathan Skidmore, Mary O'Keeffe, Susan M. Walker, Rocío de la Vega, Pablo Ingelmo, Helen Koechlin, Minna Ståhl, Jennifer Stinson, Rikard K. Wicksell, G. Allen Finley, Jesús Cebrecos, Liesbet Goubert, Francisco Reinoso-Barbero, Daniela C. Rosenberger, Esther M. Pogatzki-Zahn","doi":"10.1002/ejp.70216","DOIUrl":"10.1002/ejp.70216","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Effective treatment of paediatric chronic pain requires a robust and comprehensive set of outcome assessment tools to evaluate treatment effectiveness. Although a core outcome set (COS) exists for clinical trials, its practicability and appropriateness for clinical practice is currently unknown. This cross-sectional study led by the IN-ChildPain group aimed to: (1) identify clinical outcome domains and measures used by clinicians treating children and adolescents with chronic pain, (2) determine which domains are considered mandatory in clinical routine and (3) compare prioritisation across disciplines and countries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An online survey, available in eight languages, was conducted eliciting data from clinicians who treat children and adolescents with chronic pain. Percentages of the most commonly used outcomes were calculated, and <i>z</i>-tests were performed to compare study variables based on participants' country income status and professional background.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 193 clinicians from 42 countries participated. The most commonly assessed domains were pain intensity (84%), pain interference (80%) and physical functioning (79%), with higher assessment rates in high-income countries. Pain intensity and interference were deemed mandatory by 93% of participants, followed by physical functioning (92%). However, only 53% reported using patient-reported outcome measures, with the 0–10 Numeric Rating Scale being the most common (94%). Assessment practices varied as a function of country income level and professional background.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings highlight the need to develop and implement a COS tailored to the needs and resources of clinicians. Such standardisation would enhance consistency in assessment, enable cross-site benchmarking and promote equitable pain care globally.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>This study provides critical insights into how clinicians assess paediatric chronic pain, highlighting significant global disparities and professional differences in outcome domain prioritisation. By identifying commonly assessed domains, these findings emphasise the need for standardised measures and pave the way for developing a core outcome set tailored to clinical activities. Such an advance is essential for improving the consistency and quality of care f","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12811898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145988922","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}
Masayuki Koga, Shintaro Fujii, Yuki Nishi, Koki Koyama, Akihisa Maeda, Kanako Fujikawa, Shu Morioka
Background
Pain, fear, and motor function are interrelated. This study aimed to clarify their causal relationships by examining longitudinal changes from the preoperative to the acute postoperative period after total knee arthroplasty (TKA).
Methods
This exploratory prospective observational study included 27 inpatients (mean age, 74.1 years [SD = 9.9]; 40 knees). Pain, fear and motor function were assessed preoperatively and 1 and 2 weeks postoperatively. At each time point, rest pain, motion pain, fear of motion, and kinematic parameters of knee movement (velocity, angle, surplus null and spectral entropy) were measured. The cross-lagged panel model was used to estimate causal relationships.
Results
Longitudinal analysis revealed that reduced movement at 1 week predicted greater rest pain at 2 weeks, and higher rest pain at 1 week predicted more excessive movement irregularity at 2 weeks. Models including preoperative factors did not meet the goodness-of-fit criteria and were therefore excluded.
Conclusions
Pain and motor function predicted each other through distinct factors and pathways during the acute postoperative recovery period after TKA. These interactions may contribute to persistent pain and functional limitations, highlighting the need for targeted early interventions.
Significance
Understanding the temporal relationships between acute postoperative pain and knee kinematics may provide insights into the mechanisms underlying prolonged recovery.
Significance Statement
Excessive behavioural avoidance in the acute postoperative period may be involved in prolonged pain and motor dysfunction after total knee arthroplasty. In this study, longitudinal analysis of pain, fear, and motor impairment (behaviour) was conducted using a cross lagged panel model. Decreased range of motion in the acute phase predicted delayed pain recovery, whereas pain intensity predicted awkward movement. These results may indicate specific problems that should be addressed in the early postoperative period.
{"title":"Temporal Relationship Among Pain, Fear, and Motor Function After Total Knee Arthroplasty: An Exploratory Study","authors":"Masayuki Koga, Shintaro Fujii, Yuki Nishi, Koki Koyama, Akihisa Maeda, Kanako Fujikawa, Shu Morioka","doi":"10.1002/ejp.70210","DOIUrl":"10.1002/ejp.70210","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pain, fear, and motor function are interrelated. This study aimed to clarify their causal relationships by examining longitudinal changes from the preoperative to the acute postoperative period after total knee arthroplasty (TKA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This exploratory prospective observational study included 27 inpatients (mean age, 74.1 years [SD = 9.9]; 40 knees). Pain, fear and motor function were assessed preoperatively and 1 and 2 weeks postoperatively. At each time point, rest pain, motion pain, fear of motion, and kinematic parameters of knee movement (velocity, angle, surplus null and spectral entropy) were measured. The cross-lagged panel model was used to estimate causal relationships.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Longitudinal analysis revealed that reduced movement at 1 week predicted greater rest pain at 2 weeks, and higher rest pain at 1 week predicted more excessive movement irregularity at 2 weeks. Models including preoperative factors did not meet the goodness-of-fit criteria and were therefore excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pain and motor function predicted each other through distinct factors and pathways during the acute postoperative recovery period after TKA. These interactions may contribute to persistent pain and functional limitations, highlighting the need for targeted early interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>Understanding the temporal relationships between acute postoperative pain and knee kinematics may provide insights into the mechanisms underlying prolonged recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Excessive behavioural avoidance in the acute postoperative period may be involved in prolonged pain and motor dysfunction after total knee arthroplasty. In this study, longitudinal analysis of pain, fear, and motor impairment (behaviour) was conducted using a cross lagged panel model. Decreased range of motion in the acute phase predicted delayed pain recovery, whereas pain intensity predicted awkward movement. These results may indicate specific problems that should be addressed in the early postoperative period.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145988951","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}
Shiya Yu, Li Gou, Jielei Huang, Lisheng Wang, Baoyu Chen, Yuan Kang, Lin Yang
Background
Frozen shoulder (FS) has long been considered a localised musculoskeletal disorder, yet FS often involves widespread pain, suggesting central sensory dysregulation. While pressure pain threshold (PPT) assesses mechanical sensitivity, electrical measures such as current perception threshold (CPT) and electrical pain threshold (EPT) may capture various sensory alterations but are rarely applied in FS.
Objective
To map somatosensory alterations in unilateral FS by comparing PPT, CPT, and EPT across multiple regions with matched healthy controls (HC).
Methods
37 unilateral FS participants and 35 matched HCs underwent PPT, CPT, and EPT measurements at lateral deltoid (LD), medial forearm (MF), cervical spine (CS), and lumbar spine (LS). Bilateral LD and MF were tested in FS participants. Between-group and regional differences were analysed using linear mixed models, and correlations with pain intensity were examined.
Results
FS participants exhibited significantly reduced PPT across all sites (d = 1.27–4.55) and increased CPT and EPT at affected LD and CS regions (d = 2.89–4.92). Electrical thresholds were higher over CS than LS in the FS group, whereas the opposite pattern appeared in the HC group. EPT correlated with PPT (ρ = 0.54), and both were negatively associated with pain intensity (ρ = −0.72 and −0.69, p < 0.001).
Conclusions
FS demonstrates mechanical hyperalgesia and electrical hypoesthesia, indicating central neuroplastic changes beyond the affected shoulder.
Significance Statement
This study integrates electrical and mechanical sensory testing, revealing multimodal evidence of central sensitization in FS and offering novel quantitative markers to guide individualised pain assessment and rehabilitation.
{"title":"Frozen Shoulder Is More Than Local Pain: Widespread Sensory Hyperalgesia or Hypoesthesia?","authors":"Shiya Yu, Li Gou, Jielei Huang, Lisheng Wang, Baoyu Chen, Yuan Kang, Lin Yang","doi":"10.1002/ejp.70215","DOIUrl":"10.1002/ejp.70215","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Frozen shoulder (FS) has long been considered a localised musculoskeletal disorder, yet FS often involves widespread pain, suggesting central sensory dysregulation. While pressure pain threshold (PPT) assesses mechanical sensitivity, electrical measures such as current perception threshold (CPT) and electrical pain threshold (EPT) may capture various sensory alterations but are rarely applied in FS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To map somatosensory alterations in unilateral FS by comparing PPT, CPT, and EPT across multiple regions with matched healthy controls (HC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>37 unilateral FS participants and 35 matched HCs underwent PPT, CPT, and EPT measurements at lateral deltoid (LD), medial forearm (MF), cervical spine (CS), and lumbar spine (LS). Bilateral LD and MF were tested in FS participants. Between-group and regional differences were analysed using linear mixed models, and correlations with pain intensity were examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>FS participants exhibited significantly reduced PPT across all sites (<i>d</i> = 1.27–4.55) and increased CPT and EPT at affected LD and CS regions (<i>d</i> = 2.89–4.92). Electrical thresholds were higher over CS than LS in the FS group, whereas the opposite pattern appeared in the HC group. EPT correlated with PPT (<i>ρ</i> = 0.54), and both were negatively associated with pain intensity (<i>ρ</i> = −0.72 and −0.69, <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>FS demonstrates mechanical hyperalgesia and electrical hypoesthesia, indicating central neuroplastic changes beyond the affected shoulder.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This study integrates electrical and mechanical sensory testing, revealing multimodal evidence of central sensitization in FS and offering novel quantitative markers to guide individualised pain assessment and rehabilitation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trail Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: ChiCTR2400086393</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12809871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145988999","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}
Jens Frøjk Axel Dixen, Malene Ravn, Thorvaldur Skuli Palsson, Kristian Kjær-Staal Petersen, Morten Hoegh
Background
Aerobic exercise leads to transient hypoalgesia, but little is known about these effects over extended periods. This study aimed to investigate exercise-induced hypoalgesia (EIH) responses in healthy individuals during long-distance running on a treadmill.
Methods
Thirty healthy participants (18–50 years) completed a 15 km treadmill run. Pain sensitivity was assessed using pain pressure threshold (PPT) before and during the run. Additionally, cuff-PPT (cPPT), cuff-pressure pain tolerance threshold (cPTT), temporal summation of pain (TSP) and conditioned pain modulation (CPM) were assessed with pressure cuff algometry before and during the run. Data were analysed using repeated measures ANOVA. Exploratory subgroups, based on changes in PPT, were identified using latent growth mixture models, and logistic regression was used to predict subgroup membership.
Results
No significant changes were observed over time for PPT, PTT, cPPT or CPM at the group level. TSP decreased significantly after 10 and 15 km (p ≤ 0.004) when compared to baseline. Exploratory analysis identified two distinct subgroups: ‘increasing PPT’ and ‘decreasing PPT’. Subgroup membership was predicted using baseline CPM and EIH (p < 0.045).
Conclusion
This study found no significant changes in PPT, cPPT, or CPM following aerobic exercise. A significant change was observed in TSP. CPM and EIH predicted changes in PPT during the 15 km run (increasing vs. decreasing) in an explorative analysis. Further research should test if baseline tests can predict pro- or anti-nociceptive responses to long-distance running.
Significance Statement
These findings highlight the importance of individual variability in endogenous pain modulation during endurance exercise. The lack of group-level effects underscores the need to move beyond average responses and consider subgroups when studying exercise-induced hypoalgesia. Identifying distinct modulatory profiles may offer insight into personalized exercise interventions and reveal stable traits related to pain regulation. This has potential clinical implications for tailoring exercise as a pain management strategy and for identifying individuals at risk of negative or absent hypoalgesic responses.
{"title":"The Development of the Pain Threshold During a Long-Distance Run","authors":"Jens Frøjk Axel Dixen, Malene Ravn, Thorvaldur Skuli Palsson, Kristian Kjær-Staal Petersen, Morten Hoegh","doi":"10.1002/ejp.70199","DOIUrl":"10.1002/ejp.70199","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Aerobic exercise leads to transient hypoalgesia, but little is known about these effects over extended periods. This study aimed to investigate exercise-induced hypoalgesia (EIH) responses in healthy individuals during long-distance running on a treadmill.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Thirty healthy participants (18–50 years) completed a 15 km treadmill run. Pain sensitivity was assessed using pain pressure threshold (PPT) before and during the run. Additionally, cuff-PPT (cPPT), cuff-pressure pain tolerance threshold (cPTT), temporal summation of pain (TSP) and conditioned pain modulation (CPM) were assessed with pressure cuff algometry before and during the run. Data were analysed using repeated measures ANOVA. Exploratory subgroups, based on changes in PPT, were identified using latent growth mixture models, and logistic regression was used to predict subgroup membership.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant changes were observed over time for PPT, PTT, cPPT or CPM at the group level. TSP decreased significantly after 10 and 15 km (<i>p</i> ≤ 0.004) when compared to baseline. Exploratory analysis identified two distinct subgroups: ‘increasing PPT’ and ‘decreasing PPT’. Subgroup membership was predicted using baseline CPM and EIH (<i>p</i> < 0.045).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study found no significant changes in PPT, cPPT, or CPM following aerobic exercise. A significant change was observed in TSP. CPM and EIH predicted changes in PPT during the 15 km run (increasing vs. decreasing) in an explorative analysis. Further research should test if baseline tests can predict pro- or anti-nociceptive responses to long-distance running.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>These findings highlight the importance of individual variability in endogenous pain modulation during endurance exercise. The lack of group-level effects underscores the need to move beyond average responses and consider subgroups when studying exercise-induced hypoalgesia. Identifying distinct modulatory profiles may offer insight into personalized exercise interventions and reveal stable traits related to pain regulation. This has potential clinical implications for tailoring exercise as a pain management strategy and for identifying individuals at risk of negative or absent hypoalgesic responses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965782","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}
Michelle Hamani, Daniel Ciampi de Andrade, Lisandra Stein Bernardes
Background
The perception and assessment of foetal pain remains a contentious topic due to challenges in evaluating and detecting non-verbal behaviours. While it is widely accepted that newborns experience pain, measured through validated behavioural scales, debate persists regarding the onset of pain perception during intrauterine development.
Methods
We reviewed the available literature to prepare a position paper, aiming to argue that foetuses in their 2nd to 3rd trimester may in fact feel pain and exhibit different shades of consciousness.
Results
Emerging evidence challenges the binary view of consciousness (e.g., present/absent), suggesting that foetuses may possess some aspects of consciousness such as levels of awareness and responsiveness, both necessary and sufficient for pain perception. Advances in 4D ultrasound technology have enabled the assessment of foetal facial expressions indicative of pain, leading to the development of specialised foetal pain behaviour scales. Targeted hand movements, MEG and EEG provide further evidence of goal-directedness and action planning, while engagement in different learning paradigms (ex. habituation) provides evidence for preliminary memory and higher-order cognition.
Conclusions
Research into foetal pain will contribute not only to better clinical care but will enrich the fields of bioethics and neurodevelopmental neuroscience.
Significance
This position paper provides an overview of the current research concerning foetal pain behaviour and awareness. Reflections on foetal pain may bring insights not only to the pain field, but also to neuroethics, clinical and neurodevelopmental sciences.
{"title":"Human Foetuses Experience Pain: A Position Paper","authors":"Michelle Hamani, Daniel Ciampi de Andrade, Lisandra Stein Bernardes","doi":"10.1002/ejp.70206","DOIUrl":"10.1002/ejp.70206","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The perception and assessment of foetal pain remains a contentious topic due to challenges in evaluating and detecting non-verbal behaviours. While it is widely accepted that newborns experience pain, measured through validated behavioural scales, debate persists regarding the onset of pain perception during intrauterine development.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We reviewed the available literature to prepare a position paper, aiming to argue that foetuses in their 2nd to 3rd trimester may in fact feel pain and exhibit different shades of consciousness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Emerging evidence challenges the binary view of consciousness (e.g., present/absent), suggesting that foetuses may possess some aspects of consciousness such as levels of awareness and responsiveness, both necessary and sufficient for pain perception. Advances in 4D ultrasound technology have enabled the assessment of foetal facial expressions indicative of pain, leading to the development of specialised foetal pain behaviour scales. Targeted hand movements, MEG and EEG provide further evidence of goal-directedness and action planning, while engagement in different learning paradigms (ex. habituation) provides evidence for preliminary memory and higher-order cognition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Research into foetal pain will contribute not only to better clinical care but will enrich the fields of bioethics and neurodevelopmental neuroscience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>This position paper provides an overview of the current research concerning foetal pain behaviour and awareness. Reflections on foetal pain may bring insights not only to the pain field, but also to neuroethics, clinical and neurodevelopmental sciences.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933047","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}
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