European Journal of Pain最新文献

Background: Low back pain (LBP) is increasingly understood as a long-lasting condition with a variable course. Avoidance and persistence behaviour have been described to mediate pain persistence by potentially linking psychosocial factors and biomechanics. The resulting maladaptive changes in musculoskeletal structures can result in movement control impairment (MCI). This investigation aimed to observe avoidance and persistence behaviour and MCI in participants with acute LBP over 1 year and explore their association with pain persistence.

Methods: In this observational cohort study, 165 participants were assessed at five time points: ≤ 1 month (baseline), 2, 3, 6, and 12 months after the onset of acute LBP. Simultaneously collected clinical data such as self-reported outcomes at baseline for avoidance and persistence and assessments of MCI were filled in linear mixed-effects regression models.

Results: The mixed-effects analysis revealed for the adjusted model that a one-point increase in persistence scores resulted in a 3.31-point increase in pain intensity while interacting with state anxiety over time (p = 0.05, 95% confidence interval 0.07-6.07). This effect was not found for avoidance behaviour at baseline (p = 0.21) and MCI.

Conclusions: The relationship between persistence and pain intensity throughout measurement suggests that continuing usual activities beyond pain, coupled with feelings of distress, may lead to persistent LBP. These results underscore the need for a therapeutic shift toward a multidimensional approach that considers the physical and psychological characteristics of persons with LBP. Screening for activity patterns in acute LBP is critical for providing tailored treatment and counselling.

Significance statement: In acute low back pain (LBP), maintaining usual activities despite pain and distress can contribute to the continuation of LBP. Alongside a multidimensional approach that considers physical and psychological factors, attitudes toward daily activities are also important. Screening for both maladaptive and adaptive activity patterns in individuals with acute LBP is essential for effective LBP management, improving patient outcomes, and preventing persistent pain.

Background: Geographic origin may represent a variable capable of influencing health status. This study aims to investigate the presence of differences of disease severity in Italian patients with fibromyalgia from different macro-regions.

Methods: This retrospective, cross-sectional study involved patients included in the Italian Fibromyalgia Registry. Three geographical macro-regions were identified, comprising patients from Northern Italy, Central Italy and Southern Italy. Clinical differences (evaluated through PolySymptomatic Distress Scale [PSD], revised Fibromyalgia Impact Questionnaire [FIQR] and modified Fibromyalgia Assessment Status [FASmod]) among the geographical macro-regions were studied using one-way analysis of variance (ANOVA) and the Scheffé's test.

Results: A total of 6095 patients (5719 females and 376 males) were included, with 1957 from Northern Italy, 2979 from Central Italy and 1159 from Southern Italy. All studied clinical indices showed a trend indicative of greater disease severity in Southern Italy, followed by Northern Italy and then Central Italy (mean values for PSD: 19.97 ± 6.20 in Northern Italy, 18.61 ± 7.12 in Central Italy, 23.01 ± 5.66 in Souther Italy). These differences were statistically significant for the overall scores of all studied indices, evaluated with ANOVA (all p < 0.001) and in the head to head comparisons, evaluted with Scheffé's test.

Conclusions: Geographic background is significantly associated with variations in the severity of fibromyalgia in Italian patients.

Significance statement: This is the first study to demonstrate geographical origin-dependent intra-national differences in the severity of fibromyalgia. The results confirm the necessity of considering fibromyalgia within the context of the biopsychosocial model and of implementing healthcare policies targeted towards the most underserved regions.

Background and objectives: Central sensitization (CS) is believed to play a role in many chronic pain conditions. Direct non-invasive recording from single nociceptive neurons is not feasible in humans, complicating CS establishment. This review discusses how secondary hyperalgesia (SHA), considered a manifestation of CS, affects physiological measures in healthy individuals and if these measures could indicate CS. It addresses controversies about heat sensitivity changes, the role of tactile afferents in mechanical hypersensitivity and detecting SHA through electrical stimuli. Additionally, it reviews the potential of neurophysiological measures to indicate CS presence.

Databases and data treatment: Four databases, PubMed, ScienceDirect, Scopus and Cochrane Library, were searched using terms linked to 'hyperalgesia'. The search was limited to research articles in English conducted in humans until 2023.

Results: Evidence for heat hyperalgesia in the SHA area is sparse and seems to depend on the experimental method used. Minimal or no involvement of tactile afferents in SHA was found. At the spinal level, the threshold of the nociceptive withdrawal reflex (RIII) is consistently reduced during experimentally induced SHA. The RIII area and the spinal somatosensory potential (N13-SEP) amplitude are modulated only with long-lasting nociceptive input. At the brain level, pinprick-evoked potentials within the SHA area are increased.

Conclusions: Mechanical pinprick hyperalgesia is the most reliable behavioural readout for SHA, while the RIII threshold is the most sensitive neurophysiological readout. Due to scarce data on reliability, sensitivity and specificity, none of the revised neurophysiological methods is currently suitable for CS identification at the individual level.

Significance: Gathering evidence for CS in humans is a crucial research focus, especially with the increasing interest in concepts such as 'central sensitization-like pain' or 'nociplastic pain'. This review clarifies which readouts, among the different behavioural and neurophysiological proxies tested in experimental settings, can be used to infer the presence of CS in humans.

Background: Motivation can be investigated with the BIS (Behavioural Inhibition System)/BAS (Behavioural Activation System) scale. BAS regulates the motivation to approach goal-oriented outcomes, particularly rewarding stimuli and situations, while BIS regulates escape and avoidance of unpleasant outcomes. Chronic whiplash-associated disorders (WAD) is a heterogenous pain condition with known alterations in motivated behaviour. The study aimed (1) to investigate the relationship between BIS/BAS, and pain and disability with quality of life and psychological measures in chronic WAD; (2) to determine if BIS and/or BAS mediate the relationships between pain, disability, and psychological symptoms and quality of life.

Methods: 254 chronic WAD patients participated in the study. Outcome measures were assessed using self-report questionnaires. BIS/BAS scores were compared to published normative data. Differences in health outcomes for participants within/outside normative 95% confidence intervals were compared and correlations with health measures tested. Mediation models explored bi-directional associations between stress, anxiety, depression, post-traumatic stress severity, pain catastrophizing, and quality of life with pain and disability.

Results: Participants who exceeded normative 95% confidence intervals for BIS demonstrated higher scores for pain interference, disability and all mental health measures. No mediating role of BIS/BAS on the relation between pain and disability with quality of life and health outcomes could be confirmed.

Conclusions: A comparatively large proportion of the sample exceeded the 95% confidence interval for BIS and BAS scores with associations of these scores with health outcomes, but altered motivation to approach goal-oriented outcomes appears to play only a subordinate role in chronic WAD.

Significance statement: In line with current theories, we found a large proportion (30%-50%) of patients with whiplash-associated disorders (WAD) showing signs of altered function in the Behavioural Inhibition System (BIS) and Behavioural Activation System (BAS) suggesting altered reward processing and motivation in these patients. While such altered functions showed associations with pain interference, disability and all mental health measures, reward processing could no be demonstrated as a pathogenetically relevant factor in chronic WAD patients.

Background: For the treatment of chronic pain, interdisciplinary treatment programs are recommended. Despite continuous adaptation and optimization of this cost- and time-intensive and comprehensive form of therapy, it is not successful in some patients. As personality disorders have an important influence on social interaction and behaviour, the aim of our study was to identify the possible impact of patients with personality disorders on group dynamics and to analyse the influence of group dynamics on individual therapy outcomes.

Methods: We conducted a prospective observational study in patients with chronic pain (N = 104) who participated in a 5-week interdisciplinary treatment program. The main outcome parameters were psychological state and pain intensity before and after the program.

Results: In contrast to our clinical assumption, we found that neither the type nor the number of patients with personality accentuation or personality disorders had a clinically relevant influence on group dynamics and that even a negative group dynamic did not negatively influence the individual therapy outcome.

Discussion: This trial analysed the connection between group dynamics and therapy outcome of multimodal pain therapies in chronic pain patients considering the factor of personality disorders. Our data demonstrated that neither the type nor the number of patients with personality disorders had a clinically relevant influence on group dynamics and that even a negative group dynamic did not negatively influence the individual therapy outcome. Hence, clinicians should not be afraid to include patients with personality disorders in their treatment programs.

Significance statement: The study emphasizes that clinicians may include patients with personality disorders in multimodal pain treatment programs and groups, provided that the maintenance of a close therapeutic bond with the patient and within the interdisciplinary team is given.

Background: Chronic pain, affecting approximately 20% of the global population, is the leading cause of disability worldwide. Transgender individuals are disproportionately exposed to chronic pain risk factors compared with the cisgender population. This study compares the incidence of chronic pain between transgender and cisgender individuals and examines the impact of gender affirming hormone therapy, anxiety, and depression on chronic pain.

Methods: The study analysed medical records data of 56,470 transgender men and 41,882 transgender women in the TrinetX database. Six cohorts were created: transgender women either receiving oestrogen or no intervention, transgender men receiving testosterone or no intervention and cohorts of cisgender males and females. Unmatched age-adjusted incidence rates were calculated. Then cohorts were matched on 22 chronic pain-associated covariates and the rate of new chronic pain diagnoses was compared between those receiving hormone therapy and those without.

Results: We observed significantly higher rates of chronic pain among transgender individuals compared with cisgender counterparts. Transgender men on testosterone therapy and transgender women on oestrogen therapy exhibited an increased likelihood of chronic pain diagnoses compared with those not receiving hormone therapy. Individuals with anxiety and depression were more likely to be diagnosed with chronic pain.

Conclusion: This study demonstrates a significant burden of chronic pain in transgender individuals, with an increased risk among those receiving hormone therapy. Our study, the first to assess chronic pain in a large cohort of transgender patients, provides support for a potential association between hormone therapy and risk of chronic pain diagnosis. Further research is required to understand causal mechanisms and to develop improved screening and management of chronic pain in transgender populations.

Significance statement: Our study, featuring the largest cohort of Transgender and Gender Diverse (TGD) individuals assembled to date, reveals critical disparities in chronic pain among TGD populations, notably those on hormone therapy, compared with the cisgender population. It highlights the urgent need for specialized screening and treatment for this vulnerable population, and research into hormone therapy's impact on pain. These insights aim to foster more effective, personalized healthcare, enhancing the well-being and quality of life for the TGD community.