Annabel Vetterlein, Sarah Kirrinnis, Merlin Monzel, Ana-Laia König Guasch, Martin Reuter
Background
A growing body of research reports positive consequences of acute pain, including emotional self-regulation. Pain as a pleasurable experience has also been regarded in the context of sadomasochistic (SM) interest, albeit quantitative empirical evidence is scarce. Recently, an elevated prevalence of chronic pain (CP) has been reported in SM practitioners; however, in absence of a control group. To contribute to research in the field, we strove to see whether we could replicate the finding and further aimed to identify psychological predictors of SM.
Method
A total of 617 participants (N = 242 with SM sexual preference) completed an online questionnaire battery comprising psychometric instruments for the measurement of pain attitudes, sensation seeking and pain sensitivity. An age- and sex-matched sample was created to control for their respective influence.
Results
CP prevalence in the SM subsample was 47.2%, which we found to be significantly increased compared to the prevalence in the non-SM subsample (29.4%). Neither sex nor age seemed to explain the relationship. There were no interaction effects of SM × CP on pain attitudes. A hierarchical logistic regression model explained around 42% of the variance in SM, with CP, sensation seeking, and viewing pain as a challenge as significant predictors.
Conclusions
We replicated an increased CP prevalence in SM and ruled out previous sampling biases. We further extended evidence on factors predicting SM sexual preference. Large-scale, representative and prospective studies are needed to corroborate the idea of SM as a coping strategy used by some CP patients.
Significance Statement
We demonstrated a significantly elevated chronic pain prevalence of around 47% in individuals with sadomasochistic sexual preference, ruling out previously discussed sampling biases. Possibly, sadomasochistic practise is used as a coping strategy by some chronic pain patients. We further presented a model of pain-related and psychological variables explaining around 42% of variance in sadomasochistic sexual preference in general. The results are discussed in terms of their potential to inform pain management strategies.
{"title":"Gaining the Upper Hand? Further Evidence of Pain as a Pleasurable Experience and the Unexpected Relationship Between Sadomasochistic Sexual Preference and Chronic Pain","authors":"Annabel Vetterlein, Sarah Kirrinnis, Merlin Monzel, Ana-Laia König Guasch, Martin Reuter","doi":"10.1002/ejp.70230","DOIUrl":"10.1002/ejp.70230","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A growing body of research reports positive consequences of acute pain, including emotional self-regulation. Pain as a pleasurable experience has also been regarded in the context of sadomasochistic (SM) interest, albeit quantitative empirical evidence is scarce. Recently, an elevated prevalence of chronic pain (CP) has been reported in SM practitioners; however, in absence of a control group. To contribute to research in the field, we strove to see whether we could replicate the finding and further aimed to identify psychological predictors of SM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A total of 617 participants (<i>N</i> = 242 with SM sexual preference) completed an online questionnaire battery comprising psychometric instruments for the measurement of pain attitudes, sensation seeking and pain sensitivity. An age- and sex-matched sample was created to control for their respective influence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>CP prevalence in the SM subsample was 47.2%, which we found to be significantly increased compared to the prevalence in the non-SM subsample (29.4%). Neither sex nor age seemed to explain the relationship. There were no interaction effects of SM × CP on pain attitudes. A hierarchical logistic regression model explained around 42% of the variance in SM, with CP, sensation seeking, and viewing pain as a challenge as significant predictors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We replicated an increased CP prevalence in SM and ruled out previous sampling biases. We further extended evidence on factors predicting SM sexual preference. Large-scale, representative and prospective studies are needed to corroborate the idea of SM as a coping strategy used by some CP patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>We demonstrated a significantly elevated chronic pain prevalence of around 47% in individuals with sadomasochistic sexual preference, ruling out previously discussed sampling biases. Possibly, sadomasochistic practise is used as a coping strategy by some chronic pain patients. We further presented a model of pain-related and psychological variables explaining around 42% of variance in sadomasochistic sexual preference in general. The results are discussed in terms of their potential to inform pain management strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12882782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137282","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}
Rebecca Mountford, Greta Mattocks, Heike L. Rittner, Janne Gierthmühlen, Daniel Ciampi de Andrade, Jee Youn Moon, Tara Packham, Janet H. Bultitude, Michael C. Ferraro, Peter D. Drummond, Arnas Tamasauskas, Andreas Goebel
<div> <section> <h3> Background</h3> <p>Shoulder-hand syndrome (SHS) is a neurological disorder characterised by pain, loss of function, and trophic changes in the shoulder and hand of the affected limb. SHS shares a number of features with Complex Regional Pain Syndrome (CRPS). Historically, several terms have been used interchangeably with SHS, obfuscating clinical presentation. This review aimed to characterise the presentation of SHS to provide a full clinical picture for clinicians and researchers. Furthermore, we aimed to examine whether symptoms differ between triggered and idiopathic SHS, as indicated in previous research.</p> </section> <section> <h3> Methods</h3> <p>A systematic search of three databases (PubMed, Web of Science and Google Scholar) and bibliographies was performed. Articles published from 1940 to 2025 describing symptoms of shoulder-hand syndrome in any context were screened for eligibility. Papers were excluded if they used alternative terms in place of ‘shoulder-hand syndrome’, such as reflex sympathetic dystrophy.</p> </section> <section> <h3> Results</h3> <p>16,843 articles were identified, with 33 meeting the inclusion criteria. The clinical presentation of SHS was similar across included studies, with some variations observed between post-hemiplegic (PH) and post-myocardial infarction (PM) SHS patients. The predominant symptoms were pain in the shoulder, accompanied by pain and swelling of the hand. PH patients exhibited more trophic symptoms (e.g., nail growth changes, skin thickening), while PM patients demonstrated joint contractures and stiffness.</p> </section> <section> <h3> Conclusions</h3> <p>This review provides a detailed description of the symptoms of shoulder-hand syndrome, including both triggered and idiopathic cases. We hypothesize that SHS might be a sub-type of CRPS; however, more research is required to validate this categorization.</p> </section> <section> <h3> Significance Statement</h3> <p>This review provides a detailed description of the symptoms of shoulder-hand syndrome. This information may be useful for clinicians and researchers examining cases of SHS and possibly contrast this with CRPS. A concerted effort to phenotype these patients, including the influence of inciting events, using modern techniques such as quantitative sensory testing would be useful. We propose that SHS may be a sub-type of CRPS and if confirmed should be classified accordingly, however more research is needed.</p>
背景：肩手综合征（SHS）是一种神经系统疾病，其特征是受累肢体的肩部和手部疼痛、功能丧失和营养改变。SHS与复杂局部疼痛综合征（CRPS）有许多共同特征。历史上，有几个术语与SHS互换使用，混淆了临床表现。本综述旨在描述SHS的表现特征，为临床医生和研究人员提供完整的临床图像。此外，我们的目的是检查触发性和特发性SHS之间的症状是否不同，正如先前的研究所表明的那样。方法：系统检索PubMed、Web of Science和谷歌Scholar三个数据库和参考文献。从1940年到2025年发表的描述任何情况下肩-手综合征症状的文章均被筛选为合格。如果论文用其他术语代替“肩手综合症”，比如反射性交感神经营养不良，则被排除在外。结果：共纳入文献16843篇，符合纳入标准33篇。在所有纳入的研究中，SHS的临床表现相似，在偏瘫（PH）后和心肌梗死（PM）后SHS患者之间观察到一些差异。主要症状为肩部疼痛，并伴有手部疼痛和肿胀。PH患者表现出更多的营养症状（如指甲生长改变，皮肤增厚），而PM患者表现为关节挛缩和僵硬。结论：这篇综述提供了肩-手综合征症状的详细描述，包括触发和特发性病例。我们推测SHS可能是CRPS的一个亚型；然而，需要更多的研究来验证这种分类。意义声明：本综述提供了肩-手综合征症状的详细描述。这些信息可能对临床医生和研究人员检查SHS病例有用，并可能将其与CRPS进行比较。共同努力对这些患者进行表型分析，包括刺激性事件的影响，使用定量感官测试等现代技术将是有用的。我们认为SHS可能是CRPS的一个亚型，如果得到证实，应该进行相应的分类，但需要更多的研究。
{"title":"Clinical Presentation of Shoulder-Hand Syndrome: A Systematic Review","authors":"Rebecca Mountford, Greta Mattocks, Heike L. Rittner, Janne Gierthmühlen, Daniel Ciampi de Andrade, Jee Youn Moon, Tara Packham, Janet H. Bultitude, Michael C. Ferraro, Peter D. Drummond, Arnas Tamasauskas, Andreas Goebel","doi":"10.1002/ejp.70205","DOIUrl":"10.1002/ejp.70205","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Shoulder-hand syndrome (SHS) is a neurological disorder characterised by pain, loss of function, and trophic changes in the shoulder and hand of the affected limb. SHS shares a number of features with Complex Regional Pain Syndrome (CRPS). Historically, several terms have been used interchangeably with SHS, obfuscating clinical presentation. This review aimed to characterise the presentation of SHS to provide a full clinical picture for clinicians and researchers. Furthermore, we aimed to examine whether symptoms differ between triggered and idiopathic SHS, as indicated in previous research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of three databases (PubMed, Web of Science and Google Scholar) and bibliographies was performed. Articles published from 1940 to 2025 describing symptoms of shoulder-hand syndrome in any context were screened for eligibility. Papers were excluded if they used alternative terms in place of ‘shoulder-hand syndrome’, such as reflex sympathetic dystrophy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>16,843 articles were identified, with 33 meeting the inclusion criteria. The clinical presentation of SHS was similar across included studies, with some variations observed between post-hemiplegic (PH) and post-myocardial infarction (PM) SHS patients. The predominant symptoms were pain in the shoulder, accompanied by pain and swelling of the hand. PH patients exhibited more trophic symptoms (e.g., nail growth changes, skin thickening), while PM patients demonstrated joint contractures and stiffness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This review provides a detailed description of the symptoms of shoulder-hand syndrome, including both triggered and idiopathic cases. We hypothesize that SHS might be a sub-type of CRPS; however, more research is required to validate this categorization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This review provides a detailed description of the symptoms of shoulder-hand syndrome. This information may be useful for clinicians and researchers examining cases of SHS and possibly contrast this with CRPS. A concerted effort to phenotype these patients, including the influence of inciting events, using modern techniques such as quantitative sensory testing would be useful. We propose that SHS may be a sub-type of CRPS and if confirmed should be classified accordingly, however more research is needed.</p>\u0000 ","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12887613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118313","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</h3> <p>Autonomic nervous system–based nociception monitors have been proposed to optimise intraoperative opioid administration. While they reduce intraoperative opioid use, evidence on postoperative outcomes remains limited. We conducted a systematic review and meta-analysis to evaluate their effects on postoperative pain, opioid consumption and complications.</p> </section> <section> <h3> Methods</h3> <p>MEDLINE, EMBASE, LILACS, Google Scholar, Cochrane and ClinicalTrials.gov were searched for randomised controlled trials comparing intraoperative nociception monitoring with standard care and reporting postoperative outcomes. Risk of bias was assessed per Cochrane guidance. Data were pooled with random-effects models (RevMan 5.4.1). Continuous outcomes were summarised as mean or standardised mean differences (95% CI) and dichotomous outcomes as risk ratios (95% CI).</p> </section> <section> <h3> Results</h3> <p>Thirty-eight RCTs comprising 3243 patients were included. Post-anaesthesia care unit (PACU) opioid consumption was lower in monitor-guided groups (mean difference −0.6 mg, 95% CI –1.00 to −0.19). Likewise, 24-h morphine consumption decreased (mean difference −2.56 mg, 95% CI –4.01 to −1.11); however, these reductions did not reach the minimal clinically important difference. PACU and 24-h pain scores, as well as the incidence of postoperative nausea and vomiting, respiratory events, urinary retention, delirium and chronic postsurgical pain (CPSP), were not significantly different between groups.</p> </section> <section> <h3> Conclusions</h3> <p>Intraoperative nociception monitors modestly reduce early postoperative opioid requirements, but without clinically meaningful benefit. No improvements were observed in postoperative pain or complications. These findings suggest that, despite their impact on intraoperative opioid titration, nociception monitors do not improve patient-centered postoperative outcomes.</p> </section> <section> <h3> Significance</h3> <p>This systematic review and meta-analysis shows that intraoperative autonomic nervous system-based nociception monitors significantly reduce postoperative opioid consumption at PACU discharge and 24 hours, but the effect size does not reach the minimal clinically important difference. Pain scores and postoperative complications are not significantly impacted. These findings suggest that, while nociception monitors influence intraoperative opioid titration, t
背景：基于自主神经系统的伤害感觉监测器已被提出用于优化术中阿片类药物给药。虽然它们减少了术中阿片类药物的使用，但关于术后结果的证据仍然有限。我们进行了系统回顾和荟萃分析，以评估它们对术后疼痛、阿片类药物消耗和并发症的影响。方法：检索MEDLINE、EMBASE、LILACS、谷歌Scholar、Cochrane和ClinicalTrials.gov中比较术中痛感监测与标准护理和报告术后结果的随机对照试验。根据Cochrane指南评估偏倚风险。采用随机效应模型（RevMan 5.4.1）合并数据。连续结局总结为平均或标准化平均差异（95% CI），二分类结局总结为风险比（95% CI）。结果：纳入38项随机对照试验，共3243例患者。麻醉后护理单元（PACU）阿片类药物消耗在监护仪引导组较低（平均差异-0.6 mg, 95% CI -1.00至-0.19）。同样，24小时吗啡用量减少（平均差异-2.56 mg, 95% CI -4.01至-1.11）；然而，这些减少并没有达到最小的临床重要差异。PACU和24小时疼痛评分，以及术后恶心呕吐、呼吸事件、尿潴留、谵妄和慢性术后疼痛（CPSP）的发生率在两组间无显著差异。结论：术中伤害感受监测可适度减少术后早期阿片类药物需求，但无临床意义。术后疼痛或并发症未见改善。这些发现表明，尽管它们对术中阿片类药物滴定有影响，但伤害感受监测仪并不能改善以患者为中心的术后结果。意义：本系统综述和荟萃分析显示，术中基于自主神经系统的伤害感觉监测可显著减少PACU出院和24小时术后阿片类药物消耗，但效应大小未达到临床重要差异的最小值。疼痛评分和术后并发症没有明显影响。这些发现表明，虽然伤害感受监测影响术中阿片类药物滴定，但其对术后结果的临床益处仍然有限。试验注册：PROSPERO号：CRD42023490440；ClinicalTrials.gov识别码：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023490440。
{"title":"A Systematic Review and Meta-Analysis of Postoperative Opioid Consumption, Pain and Complications Following Intraoperative Autonomic Nervous System-Based Nociception Monitoring","authors":"Mathias A. A. Pietrancosta, Valeria Martinez","doi":"10.1002/ejp.70227","DOIUrl":"10.1002/ejp.70227","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Autonomic nervous system–based nociception monitors have been proposed to optimise intraoperative opioid administration. While they reduce intraoperative opioid use, evidence on postoperative outcomes remains limited. We conducted a systematic review and meta-analysis to evaluate their effects on postoperative pain, opioid consumption and complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>MEDLINE, EMBASE, LILACS, Google Scholar, Cochrane and ClinicalTrials.gov were searched for randomised controlled trials comparing intraoperative nociception monitoring with standard care and reporting postoperative outcomes. Risk of bias was assessed per Cochrane guidance. Data were pooled with random-effects models (RevMan 5.4.1). Continuous outcomes were summarised as mean or standardised mean differences (95% CI) and dichotomous outcomes as risk ratios (95% CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-eight RCTs comprising 3243 patients were included. Post-anaesthesia care unit (PACU) opioid consumption was lower in monitor-guided groups (mean difference −0.6 mg, 95% CI –1.00 to −0.19). Likewise, 24-h morphine consumption decreased (mean difference −2.56 mg, 95% CI –4.01 to −1.11); however, these reductions did not reach the minimal clinically important difference. PACU and 24-h pain scores, as well as the incidence of postoperative nausea and vomiting, respiratory events, urinary retention, delirium and chronic postsurgical pain (CPSP), were not significantly different between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Intraoperative nociception monitors modestly reduce early postoperative opioid requirements, but without clinically meaningful benefit. No improvements were observed in postoperative pain or complications. These findings suggest that, despite their impact on intraoperative opioid titration, nociception monitors do not improve patient-centered postoperative outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>This systematic review and meta-analysis shows that intraoperative autonomic nervous system-based nociception monitors significantly reduce postoperative opioid consumption at PACU discharge and 24 hours, but the effect size does not reach the minimal clinically important difference. Pain scores and postoperative complications are not significantly impacted. These findings suggest that, while nociception monitors influence intraoperative opioid titration, t","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12866743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112521","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}
Ae Jeong Jo, Eunjung Choo, Sejung Kim, Nam Kyung Je, Iyn-Hyang Lee
<div> <section> <h3> Background</h3> <p>Continuity of care is a core element of high-quality primary care and may prevent inappropriate opioid use. However, evidence on its association with opioid initiation among opioid-naïve adults with non-cancer pain remains scarce.</p> </section> <section> <h3> Methods</h3> <p>We conducted a population-based cohort study using South Korea's national claims data (2015–2022). The study included 392,988 adults aged ≥ 20 years diagnosed in 2016 with musculoskeletal and connective tissue disorders who received outpatient primary care without prior opioid exposure. Continuity of care was measured using the Bice–Boxerman Continuity of Care Index (COCI) and categorised as high (≥ 0.90), medium (0.48–< 0.90), or low (< 0.48). The primary outcomes were the incidence of new opioid prescriptions and a composite indicator of potentially inappropriate opioid prescribing, defined by five criteria.</p> </section> <section> <h3> Results</h3> <p>Among 392,988 participants, 52,670 (13.4%) initiated opioid therapy. Compared with the high-continuity group, the medium- and low-continuity groups had 1.27-fold (95% CI, 1.25–1.28) and 1.43-fold (95% CI, 1.41–1.45) higher risks of opioid initiation, respectively. High continuity was associated with a median delay of 303 days in opioid initiation. Potentially inappropriate prescribing occurred in 12.1% of opioid users, with higher risks in the medium- (adjusted hazard ratio [aHR] = 1.26; 95% CI, 1.23–1.28) and low-continuity groups (aHR = 1.41; 95% CI, 1.39–1.44).</p> </section> <section> <h3> Conclusions</h3> <p>Higher continuity of primary care was associated with delayed opioid initiation and reduced inappropriate opioid prescribing among adults with non-cancer pain. Strengthening continuity-focused interventions may help mitigate opioid-related harms and promote safer pain management.</p> </section> <section> <h3> Significance Statement</h3> <p>Relational continuity in primary care plays a key role in shaping opioid prescribing patterns among adults with non-cancer pain. Using nationwide data, our findings suggest that stronger continuity is associated with more cautious opioid use, including delayed initiation and a lower likelihood of inappropriate prescribing. These results highlight the importance of fostering ongoing, trust-based relationships between patients and primary care providers as a strategy to reduce unnecessary opioid exposure and promote safer, patient-centered pain management. Strengthening continuity in primary care may therefore have meaningful implications fo
{"title":"Continuity of Primary Care and Delayed Opioid Initiation in Non-Cancer Pain: A Cohort Study","authors":"Ae Jeong Jo, Eunjung Choo, Sejung Kim, Nam Kyung Je, Iyn-Hyang Lee","doi":"10.1002/ejp.70226","DOIUrl":"10.1002/ejp.70226","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Continuity of care is a core element of high-quality primary care and may prevent inappropriate opioid use. However, evidence on its association with opioid initiation among opioid-naïve adults with non-cancer pain remains scarce.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a population-based cohort study using South Korea's national claims data (2015–2022). The study included 392,988 adults aged ≥ 20 years diagnosed in 2016 with musculoskeletal and connective tissue disorders who received outpatient primary care without prior opioid exposure. Continuity of care was measured using the Bice–Boxerman Continuity of Care Index (COCI) and categorised as high (≥ 0.90), medium (0.48–< 0.90), or low (< 0.48). The primary outcomes were the incidence of new opioid prescriptions and a composite indicator of potentially inappropriate opioid prescribing, defined by five criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 392,988 participants, 52,670 (13.4%) initiated opioid therapy. Compared with the high-continuity group, the medium- and low-continuity groups had 1.27-fold (95% CI, 1.25–1.28) and 1.43-fold (95% CI, 1.41–1.45) higher risks of opioid initiation, respectively. High continuity was associated with a median delay of 303 days in opioid initiation. Potentially inappropriate prescribing occurred in 12.1% of opioid users, with higher risks in the medium- (adjusted hazard ratio [aHR] = 1.26; 95% CI, 1.23–1.28) and low-continuity groups (aHR = 1.41; 95% CI, 1.39–1.44).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Higher continuity of primary care was associated with delayed opioid initiation and reduced inappropriate opioid prescribing among adults with non-cancer pain. Strengthening continuity-focused interventions may help mitigate opioid-related harms and promote safer pain management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Relational continuity in primary care plays a key role in shaping opioid prescribing patterns among adults with non-cancer pain. Using nationwide data, our findings suggest that stronger continuity is associated with more cautious opioid use, including delayed initiation and a lower likelihood of inappropriate prescribing. These results highlight the importance of fostering ongoing, trust-based relationships between patients and primary care providers as a strategy to reduce unnecessary opioid exposure and promote safer, patient-centered pain management. Strengthening continuity in primary care may therefore have meaningful implications fo","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104321","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}
Patric Bialas, Jonas Tesarz, Elmar Brähler, Beate Muschalla, Markus Zenger, Bjarne Schmalbach, Winfried Häuser
Background
The Graded Chronic Pain Scale-Revised (GCPS-R) enables a standardised measure of chronic pain severity. Only sparse data are available on the prevalence of chronic pain stages assessed by the GCPS-R and the predictors of high-impact chronic pain (HICP) in the general European population.
Methods
A cross-sectional cohort study surveyed 2498 people ≥ 16 years living in Germany in 2025. Self-reported measures were obtained for demographic variables, chronic pain stages and disease load (Patient Health Questionnaire 4 and chronic illness). Potential predictors of HICP (age, gender, education, net income, probable depressive and anxiety disorder, chronic illness) compared to no and mild-impact and to bothersome chronic pain were assessed by adjusted univariate and multivariate logistic regression analyses.
Results
Response rate was 37.9%. The prevalence of chronic pain present most or every day prior to 3 months was 11.4 (95% CI, 7.7% to 15.1%) of which 1.1% (−2.9% to 5.0%) with mild impact chronic pain; 3.3% (−0.6% to 7.2%) with bothersome impact chronic pain; and 7.1% (3.3% to 10.9%) with HICP. HICP compared to no and mild chronic pain was predicted in multivariate-adjusted analysis by age, lower educational level, lower income, probable anxiety and/or depressive disorder and chronic illness. Multivariate-adjusted analysis did not show significant associations of HICP with the selected variables when compared to bothersome pain.
Conclusions
Biological, psychological and social factors are associated with HICP. Targeted pain services for populations at highest risk for HICP need to be developed.
Significance Statement
The prevalence of bothersome and high-impact chronic pain rather than prevalence rates of any chronic pain might provide evidence in support of pain specialist care. Identifying risk factors of high-impact chronic pain in specific populations could lead to an improved understanding of the risk factors, causes and consequences of chronic pain. European public health policies could be influenced by gathering data on high-impact chronic pain in other European countries.
{"title":"Prevalence and Predictors of High-Impact Chronic Pain in the General German Population","authors":"Patric Bialas, Jonas Tesarz, Elmar Brähler, Beate Muschalla, Markus Zenger, Bjarne Schmalbach, Winfried Häuser","doi":"10.1002/ejp.70229","DOIUrl":"10.1002/ejp.70229","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Graded Chronic Pain Scale-Revised (GCPS-R) enables a standardised measure of chronic pain severity. Only sparse data are available on the prevalence of chronic pain stages assessed by the GCPS-R and the predictors of high-impact chronic pain (HICP) in the general European population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional cohort study surveyed 2498 people ≥ 16 years living in Germany in 2025. Self-reported measures were obtained for demographic variables, chronic pain stages and disease load (Patient Health Questionnaire 4 and chronic illness). Potential predictors of HICP (age, gender, education, net income, probable depressive and anxiety disorder, chronic illness) compared to no and mild-impact and to bothersome chronic pain were assessed by adjusted univariate and multivariate logistic regression analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Response rate was 37.9%. The prevalence of chronic pain present most or every day prior to 3 months was 11.4 (95% CI, 7.7% to 15.1%) of which 1.1% (−2.9% to 5.0%) with mild impact chronic pain; 3.3% (−0.6% to 7.2%) with bothersome impact chronic pain; and 7.1% (3.3% to 10.9%) with HICP. HICP compared to no and mild chronic pain was predicted in multivariate-adjusted analysis by age, lower educational level, lower income, probable anxiety and/or depressive disorder and chronic illness. Multivariate-adjusted analysis did not show significant associations of HICP with the selected variables when compared to bothersome pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Biological, psychological and social factors are associated with HICP. Targeted pain services for populations at highest risk for HICP need to be developed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>The prevalence of bothersome and high-impact chronic pain rather than prevalence rates of any chronic pain might provide evidence in support of pain specialist care. Identifying risk factors of high-impact chronic pain in specific populations could lead to an improved understanding of the risk factors, causes and consequences of chronic pain. European public health policies could be influenced by gathering data on high-impact chronic pain in other European countries.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146092535","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}
Julie Rønne Pedersen, Andreas Kristian Pedersen, Randi Eltved, Per Føge Jensen, Inés Sabrido, Melissa Hedegaard, Morten Rune Blichfeldt-Eckhardt, Susanne Haase Hansson, Henrik Bjarke Vægter
<div> <section> <h3> Background</h3> <p>Chronic pain frequently co-occurs with multiple somatic comorbidities. However, little is known about how these conditions naturally cluster in patients with high-impact chronic pain. This study aimed to describe somatic comorbidities and identify clusters of co-occurring diseases in patients with high-impact chronic pain referred to specialised interdisciplinary treatment and to examine associations between these clusters and patient-reported physical health, mental health and pain distribution.</p> </section> <section> <h3> Methods</h3> <p>A cross-sectional study was conducted with 10,256 chronic pain patients referred to specialised interdisciplinary pain treatment using data from the Danish PainData registry. Somatic comorbidities were self-reported from a list of 16 diseases and conditions. Exploratory factor analysis with tetrachoric correlations identified clusters of comorbidities. Physical and mental health were evaluated using the PROMIS-10 Global Health questionnaire and pain distribution was assessed by a 71-area pain drawing. Statistical analyses, including ANOVA and Kruskal–Wallis tests, evaluated differences in patient-reported outcomes between disease clusters.</p> </section> <section> <h3> Results</h3> <p>Patients reported a median of three somatic comorbidities, with migraine (56%), herniated disc/spinal disorders (53%) and osteoarthritis (42%) being most prevalent. Factor analysis revealed six disease clusters, including systemic illness, cardiovascular disease, musculoskeletal disorders, metabolic-vascular conditions, allergy-respiratory issues and neurosensory disturbances. Distinct clusters of co-occurring diseases and conditions were associated with poorer physical health and more widespread pain.</p> </section> <section> <h3> Conclusions</h3> <p>Somatic comorbidities were highly prevalent in this large chronic pain cohort, with six disease clusters associated with varying levels of physical health and pain distribution. These findings highlight the need for stratified approaches in pain care, informed by somatic disease clustering.</p> </section> <section> <h3> Significance Statement</h3> <p>This study identifies distinct clusters of somatic comorbidities among patients with high-impact chronic pain and links them to health outcomes. Understanding these clusters may help clinicians tailor more precise, stratified pain interventions and offers basic scientists insight into potential underlying mechanisms connecting chronic pain with systemic disease patterns.</p> </section>
{"title":"Beyond the Pain: Patterns of Somatic Comorbidity in Patients With High-Impact Chronic Pain Referred to Specialised Interdisciplinary Treatment","authors":"Julie Rønne Pedersen, Andreas Kristian Pedersen, Randi Eltved, Per Føge Jensen, Inés Sabrido, Melissa Hedegaard, Morten Rune Blichfeldt-Eckhardt, Susanne Haase Hansson, Henrik Bjarke Vægter","doi":"10.1002/ejp.70217","DOIUrl":"10.1002/ejp.70217","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic pain frequently co-occurs with multiple somatic comorbidities. However, little is known about how these conditions naturally cluster in patients with high-impact chronic pain. This study aimed to describe somatic comorbidities and identify clusters of co-occurring diseases in patients with high-impact chronic pain referred to specialised interdisciplinary treatment and to examine associations between these clusters and patient-reported physical health, mental health and pain distribution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study was conducted with 10,256 chronic pain patients referred to specialised interdisciplinary pain treatment using data from the Danish PainData registry. Somatic comorbidities were self-reported from a list of 16 diseases and conditions. Exploratory factor analysis with tetrachoric correlations identified clusters of comorbidities. Physical and mental health were evaluated using the PROMIS-10 Global Health questionnaire and pain distribution was assessed by a 71-area pain drawing. Statistical analyses, including ANOVA and Kruskal–Wallis tests, evaluated differences in patient-reported outcomes between disease clusters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients reported a median of three somatic comorbidities, with migraine (56%), herniated disc/spinal disorders (53%) and osteoarthritis (42%) being most prevalent. Factor analysis revealed six disease clusters, including systemic illness, cardiovascular disease, musculoskeletal disorders, metabolic-vascular conditions, allergy-respiratory issues and neurosensory disturbances. Distinct clusters of co-occurring diseases and conditions were associated with poorer physical health and more widespread pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Somatic comorbidities were highly prevalent in this large chronic pain cohort, with six disease clusters associated with varying levels of physical health and pain distribution. These findings highlight the need for stratified approaches in pain care, informed by somatic disease clustering.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This study identifies distinct clusters of somatic comorbidities among patients with high-impact chronic pain and links them to health outcomes. Understanding these clusters may help clinicians tailor more precise, stratified pain interventions and offers basic scientists insight into potential underlying mechanisms connecting chronic pain with systemic disease patterns.</p>\u0000 </section>\u0000 ","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085195","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}
Juan J. Amer-Cuenca, Juan F. Lisón, Francisco José Ferrer-Sargues, Gemma Biviá-Roig, Rosa M. Baños, Laura Badenes-Ribera, María D. Arguisuelas
<div> <section> <h3> Background</h3> <p>Transcutaneous electrical nerve stimulation (TENS) is a widely used non-pharmacological method for pain management, though its effectiveness in individuals with chronic low back pain (CLBP) is uncertain. Previous studies and systematic reviews have not systematically analysed the influence of TENS dosing parameters on treatment outcomes.</p> </section> <section> <h3> Objectives</h3> <p>To assess the impact of TENS on pain relief in individuals with CLBP and to explore the dose-dependent effects of TENS parameters on pain relief.</p> </section> <section> <h3> Methods</h3> <p>A systematic review and meta-analysis was conducted following PROSPERO registration. Searches were performed in PubMed, Cochrane and Scopus databases. A total of 29 studies out of 1162 screened were included. Study quality was assessed using the PEDro scale and RoB-2 tool. Meta-analyses using random- and mixed-effects models were conducted.</p> </section> <section> <h3> Results</h3> <p>The initial random-effects model showed no significant effect of TENS on pain (<i>d</i><sub>+</sub> = 0.16, <i>p</i> > 0.050, <i>k</i> = 64) when dosing parameters were not considered. However, moderator analyses comparing TENS with control or placebo groups revealed that appropriate intensity was associated with larger effects than inappropriate intensity (Δ<i>d</i><sub>+</sub>≈0.67; <i>F</i>(1, 16) = 7.27, <i>p</i> = 0.016), with subgroup estimates of <i>d</i><sub>+</sub> = 0.97 (95% CI 0.65–1.30; <i>k</i> = 12) versus <i>d</i><sub>+</sub> = 0.30 (95% CI −0.11 to 0.72; <i>k</i> = 6). Frequency, number of sessions and electrode placement showed no significant impact.</p> </section> <section> <h3> Conclusions</h3> <p>TENS can reduce pain in individuals with CLBP when delivered at a sensory-level intensity that is clearly perceptible and titrated throughout the session. Fixed intensity and stimulation strong enough to elicit muscle contractions are generally not recommended. These findings support the relevance of dosing in optimising TENS effectiveness. Overall, the certainty of evidence appears low due to the high risk of bias and substantial heterogeneity.</p> </section> <section> <h3> Significance Statement</h3> <p>This meta-analysis provides a comprehensive synthesis of the evidence on transcutaneous electrical nerve stimulation (TENS) for pain relief
背景：经皮神经电刺激（TENS）是一种广泛使用的非药物治疗疼痛的方法，尽管其对慢性腰痛（CLBP）患者的有效性尚不确定。以前的研究和系统评价没有系统地分析TENS给药参数对治疗结果的影响。目的：评估TENS对CLBP患者疼痛缓解的影响，并探讨TENS参数对疼痛缓解的剂量依赖性。方法：在PROSPERO注册后进行系统评价和荟萃分析。在PubMed、Cochrane和Scopus数据库中进行检索。总共纳入了1162项研究中的29项。采用PEDro量表和rob2工具评估研究质量。采用随机和混合效应模型进行meta分析。结果：初始随机效应模型显示，不考虑给药参数时，TENS对疼痛无显著影响（d+ = 0.16, p > = 0.050, k = 64）。然而，比较TENS与对照组或安慰剂组的调节分析显示，适当强度比不适当强度的影响更大（Δd+≈0.67；F(1,16) = 7.27, p = 0.016），亚组估计d+ = 0.97 （95% CI 0.65-1.30; k = 12）与d+ = 0.30 （95% CI -0.11至0.72;k = 6）。频率、次数和电极放置无显著影响。结论：当在整个过程中以清晰可感知和滴定的感觉水平强度给予TENS时，可以减轻CLBP患者的疼痛。通常不建议使用固定强度和足以引起肌肉收缩的刺激。这些发现支持剂量与优化TENS有效性的相关性。总的来说，由于高偏倚风险和大量异质性，证据的确定性似乎很低。意义声明：本荟萃分析全面综合了经皮神经电刺激（TENS）缓解慢性腰痛（CLBP）疼痛的证据，并特别关注刺激参数作为异质性来源的作用。通过系统地检查剂量相关特征，特别是刺激强度，这项工作有助于澄清为什么以前的综述报告的结果不一致。结果表明，剂量不足可能会模糊潜在的镇痛作用，强调了在解释现有试验时参数报告和实施的重要性。总的来说，本综述提供了一个临床和方法学上相关的框架，为未来高质量试验的设计提供信息，并指导在多模式CLBP治疗中对TENS进行更细致的评估。试验注册：PROSPERO: CRD42023468176。
{"title":"Dose–Response Effects of Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain: A Systematic Review and Meta-Analysis","authors":"Juan J. Amer-Cuenca, Juan F. Lisón, Francisco José Ferrer-Sargues, Gemma Biviá-Roig, Rosa M. Baños, Laura Badenes-Ribera, María D. Arguisuelas","doi":"10.1002/ejp.70222","DOIUrl":"10.1002/ejp.70222","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transcutaneous electrical nerve stimulation (TENS) is a widely used non-pharmacological method for pain management, though its effectiveness in individuals with chronic low back pain (CLBP) is uncertain. Previous studies and systematic reviews have not systematically analysed the influence of TENS dosing parameters on treatment outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the impact of TENS on pain relief in individuals with CLBP and to explore the dose-dependent effects of TENS parameters on pain relief.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis was conducted following PROSPERO registration. Searches were performed in PubMed, Cochrane and Scopus databases. A total of 29 studies out of 1162 screened were included. Study quality was assessed using the PEDro scale and RoB-2 tool. Meta-analyses using random- and mixed-effects models were conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The initial random-effects model showed no significant effect of TENS on pain (<i>d</i><sub>+</sub> = 0.16, <i>p</i> > 0.050, <i>k</i> = 64) when dosing parameters were not considered. However, moderator analyses comparing TENS with control or placebo groups revealed that appropriate intensity was associated with larger effects than inappropriate intensity (Δ<i>d</i><sub>+</sub>≈0.67; <i>F</i>(1, 16) = 7.27, <i>p</i> = 0.016), with subgroup estimates of <i>d</i><sub>+</sub> = 0.97 (95% CI 0.65–1.30; <i>k</i> = 12) versus <i>d</i><sub>+</sub> = 0.30 (95% CI −0.11 to 0.72; <i>k</i> = 6). Frequency, number of sessions and electrode placement showed no significant impact.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>TENS can reduce pain in individuals with CLBP when delivered at a sensory-level intensity that is clearly perceptible and titrated throughout the session. Fixed intensity and stimulation strong enough to elicit muscle contractions are generally not recommended. These findings support the relevance of dosing in optimising TENS effectiveness. Overall, the certainty of evidence appears low due to the high risk of bias and substantial heterogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This meta-analysis provides a comprehensive synthesis of the evidence on transcutaneous electrical nerve stimulation (TENS) for pain relief","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085216","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}
Carlos Eduardo Dutra Rufato, Mayara Colpo Prado, Bernardo Antonio Agostini, Mateus Bertolini Fernandes dos Santos, Rafael Sarkis-Onofre
Background
To evaluate whether sponsorship influences the reporting of positive results and the occurrence of selective outcome reporting (SOR) in randomised controlled trials (RCTs) investigating pharmacologic interventions for postoperative pain management following third molar extraction.
Methods
This meta-research included RCTs comparing at least one active drug with placebo, two active drugs, or combination thereof, and reporting outcomes related to pain reduction after third molar extraction. Searches were conducted in PubMed, Scopus and Web of Science without date restrictions and last search was performed on 2024 August. Study selection was performed in Rayyan QCRI, with two independent reviewers screening titles, abstracts and full texts. Data extraction was also conducted independently by two reviewers, collecting information on year of publication, trial design, number of groups, placebo comparisons, sample size (number of patients/teeth), follow-up losses, statistical significance of results, protocol registration and funding disclosures. Selective outcome reporting was assessed by comparing registered protocols with published outcomes. Associations between sponsorship status and both SOR and positive result reporting were analysed using chi-square test (α = 0.05).
Results
A total of 430 RCTs were included. No association was found between sponsorship status and SOR (p = 0.861), nor between sponsorship status and the reporting of positive results (p = 0.241).
Conclusions
In this sample, sponsorship was not associated with either selective outcome reporting or the likelihood of reporting positive results in RCTs on postoperative pain management after third molar extraction.
Significance Statement
The absence of sponsorship bias in RCTs on third molar extraction suggests that industry-funded and non-sponsored studies provide comparably reliable evidence, supporting clinicians in making unbiased, evidence-based decisions for postoperative pain management in third molar surgery.
背景：评估赞助是否会影响随机对照试验（rct）中阳性结果的报告和选择性结果报告（SOR）的发生，这些随机对照试验（rct）研究了第三磨牙拔牙术后疼痛管理的药物干预。方法：本荟萃研究纳入了至少一种有效药物与安慰剂、两种有效药物或其组合进行比较的随机对照试验，并报告了第三磨牙拔牙后疼痛减轻的相关结果。在PubMed、Scopus和Web of Science中进行了检索，没有日期限制，最后一次检索是在2024年8月进行的。研究选择在Rayyan QCRI中进行，由两名独立审稿人筛选标题、摘要和全文。数据提取也由两位审稿人独立进行，收集发表年份、试验设计、组数、安慰剂比较、样本量（患者数/牙数）、随访损失、结果的统计显著性、方案注册和资金披露等信息。通过比较注册方案和已发表的结果来评估选择性结果报告。采用卡方检验分析赞助状况与SOR和阳性结果报告的相关性（α = 0.05）。结果：共纳入430项rct。赞助状态与SOR之间没有关联（p = 0.861），赞助状态与阳性结果报告之间也没有关联（p = 0.241）。结论：在本样本中，赞助与选择性结果报告或报告第三磨牙拔牙后术后疼痛管理的随机对照试验中阳性结果的可能性无关。意义声明：关于第三磨牙拔牙的随机对照试验中没有赞助偏倚表明，行业资助和非资助的研究提供了相当可靠的证据，支持临床医生对第三磨牙手术术后疼痛管理做出公正的、基于证据的决策。
{"title":"Sponsorship Bias in Randomised Controlled Trials on Postoperative Pain After Third Molar Extraction: A Meta-Research Study","authors":"Carlos Eduardo Dutra Rufato, Mayara Colpo Prado, Bernardo Antonio Agostini, Mateus Bertolini Fernandes dos Santos, Rafael Sarkis-Onofre","doi":"10.1002/ejp.70213","DOIUrl":"10.1002/ejp.70213","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>To evaluate whether sponsorship influences the reporting of positive results and the occurrence of selective outcome reporting (SOR) in randomised controlled trials (RCTs) investigating pharmacologic interventions for postoperative pain management following third molar extraction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This meta-research included RCTs comparing at least one active drug with placebo, two active drugs, or combination thereof, and reporting outcomes related to pain reduction after third molar extraction. Searches were conducted in PubMed, Scopus and Web of Science without date restrictions and last search was performed on 2024 August. Study selection was performed in Rayyan QCRI, with two independent reviewers screening titles, abstracts and full texts. Data extraction was also conducted independently by two reviewers, collecting information on year of publication, trial design, number of groups, placebo comparisons, sample size (number of patients/teeth), follow-up losses, statistical significance of results, protocol registration and funding disclosures. Selective outcome reporting was assessed by comparing registered protocols with published outcomes. Associations between sponsorship status and both SOR and positive result reporting were analysed using chi-square test (<i>α</i> = 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 430 RCTs were included. No association was found between sponsorship status and SOR (<i>p</i> = 0.861), nor between sponsorship status and the reporting of positive results (<i>p</i> = 0.241).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this sample, sponsorship was not associated with either selective outcome reporting or the likelihood of reporting positive results in RCTs on postoperative pain management after third molar extraction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>The absence of sponsorship bias in RCTs on third molar extraction suggests that industry-funded and non-sponsored studies provide comparably reliable evidence, supporting clinicians in making unbiased, evidence-based decisions for postoperative pain management in third molar surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12859532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146092455","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}
Wolnei Caumo, Bárbara Regina França, Jaira Ehlers, Stela Maris de Jezus Castro, Rogério Boff Borges, Vania Naomi Hirakata, Graziele Borges Bueno, Iraci LS da Torres, Felipe Fregni
Background
Expectations shape therapeutic outcomes, yet their systematic assessment remains limited in clinical and research settings. To address this gap, we developed and validated the Brief Instrument for the Assessment of Treatment Expectations in Chronic Pain (BITEC) using Item Response Theory.
Methods
The study comprised four phases. (I) Twenty-one items were generated from expectation constructs and refined to 11 through a Delphi review (≥ 80% agreement). (II) Comprehensibility was tested in 30 women with fibromyalgia, and the scale was applied to 484 chronic pain patients; items (0–10) were recoded into four categories, and IRT reduced them to nine. (III) The final version was administered to 1127 adults with chronic pain (79.3% fibromyalgia; 20.7% nociceptive/neuropathic), and latent-class modelling defined low–high expectation cutoffs. (IV) Construct validity was assessed via discriminant analyses in calibration (n = 1127) and validation (n = 242) samples to evaluate whether BITEC levels differentiated diagnostic groups, pain impact and catastrophizing. (V) We developed a bedside app to support expectation-level classification.
Results
The nine-item BITEC showed discrimination between high and low expectations (AUC 0.915; 95% CI 0.897–0.933; sensitivity 79%, specificity 96%). Across both samples, BITEC demonstrated construct validity, distinguishing expectation categories based on symptom severity, catastrophizing and pain burden. Expectation levels varied across pain phenotypes, decreasing from nociceptive pain (56.1%) to fibromyalgia (42.7%) and multiple pain conditions (26.9%). Higher symptom severity was associated with higher expectations.
Conclusion
BITEC is a brief, reliable, theory-grounded instrument for stratifying treatment expectations in chronic pain; applicability across treatment modalities and clinical contexts warrants further investigation.
Significance Statement
Expectations strongly shape therapeutic outcomes but remain difficult to measure. The BITEC, a brief IRT-based tool, offers a reliable way to classify treatment expectations in chronic pain, supporting personalised care and improving clinical decision-making.
背景：期望影响治疗结果，但其系统评估在临床和研究环境中仍然有限。为了解决这一差距，我们使用项目反应理论开发并验证了慢性疼痛治疗期望评估简短工具（BITEC）。方法：研究分为四个阶段。(I)从期望构建中产生21个项目，并通过德尔菲评价（一致性≥80%）将其细化为11个项目。（二）对30例纤维肌痛女性患者进行可理解性测试，对484例慢性疼痛患者应用该量表；项目（0-10）重新编码为4类，IRT将其减少到9类。（III）最终版本对1127名患有慢性疼痛的成年人（79.3%为纤维肌痛，20.7%为伤害性/神经性）进行了研究，潜伏类模型定义了低-高期望临界值。（IV）通过对校准（n = 1127）和验证（n = 242）样本进行判别分析，评估构建效度，以评估BITEC水平是否区分诊断组、疼痛影响和灾难化。（五）开发床边应用，支持期望等级分类。结果：9个项目的BITEC具有高期望值和低期望值的区分性（AUC 0.915; 95% CI 0.897-0.933；敏感性79%，特异性96%）。在这两个样本中，BITEC证明了结构有效性，根据症状严重程度、灾难化和疼痛负担区分期望类别。期望水平因疼痛表型而异，从伤害性疼痛（56.1%）下降到纤维肌痛（42.7%）和多重疼痛（26.9%）。症状严重程度越高，期望值越高。结论：BITEC是一种简单、可靠、有理论依据的慢性疼痛治疗预期分层工具；在治疗方式和临床情况下的适用性值得进一步研究。意义声明：期望强烈影响治疗结果，但仍然难以衡量。BITEC是一种简短的基于irt的工具，提供了一种可靠的方法来分类慢性疼痛的治疗预期，支持个性化护理和改善临床决策。
{"title":"Development and Validation of the Brief Inventory of Treatment Expectations in Chronic Pain (BITEC)","authors":"Wolnei Caumo, Bárbara Regina França, Jaira Ehlers, Stela Maris de Jezus Castro, Rogério Boff Borges, Vania Naomi Hirakata, Graziele Borges Bueno, Iraci LS da Torres, Felipe Fregni","doi":"10.1002/ejp.70211","DOIUrl":"10.1002/ejp.70211","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Expectations shape therapeutic outcomes, yet their systematic assessment remains limited in clinical and research settings. To address this gap, we developed and validated the Brief Instrument for the Assessment of Treatment Expectations in Chronic Pain (BITEC) using Item Response Theory.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study comprised four phases. (I) Twenty-one items were generated from expectation constructs and refined to 11 through a Delphi review (≥ 80% agreement). (II) Comprehensibility was tested in 30 women with fibromyalgia, and the scale was applied to 484 chronic pain patients; items (0–10) were recoded into four categories, and IRT reduced them to nine. (III) The final version was administered to 1127 adults with chronic pain (79.3% fibromyalgia; 20.7% nociceptive/neuropathic), and latent-class modelling defined low–high expectation cutoffs. (IV) Construct validity was assessed via discriminant analyses in calibration (<i>n</i> = 1127) and validation (<i>n</i> = 242) samples to evaluate whether BITEC levels differentiated diagnostic groups, pain impact and catastrophizing. (V) We developed a bedside app to support expectation-level classification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The nine-item BITEC showed discrimination between high and low expectations (AUC 0.915; 95% CI 0.897–0.933; sensitivity 79%, specificity 96%). Across both samples, BITEC demonstrated construct validity, distinguishing expectation categories based on symptom severity, catastrophizing and pain burden. Expectation levels varied across pain phenotypes, decreasing from nociceptive pain (56.1%) to fibromyalgia (42.7%) and multiple pain conditions (26.9%). Higher symptom severity was associated with higher expectations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>BITEC is a brief, reliable, theory-grounded instrument for stratifying treatment expectations in chronic pain; applicability across treatment modalities and clinical contexts warrants further investigation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Expectations strongly shape therapeutic outcomes but remain difficult to measure. The BITEC, a brief IRT-based tool, offers a reliable way to classify treatment expectations in chronic pain, supporting personalised care and improving clinical decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085249","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}
Maura McCarron, Francis Agnew, Claire Briggs, Jason Brooks, Martin Dempster, Jackie Granleese, Danielle Rainey, Kevin E. Vowles
<div> <section> <h3> Background</h3> <p>Education is considered a foundational component of chronic pain treatment. In response to challenges relating to accessibility and scalability, health services have increasingly adopted online formats for delivering pain education programmes. However, little is known about how patients experience these digital interventions, particularly in relation to engagement, meaning-making, and perceived impact. This study aimed to explore participant experiences of completing an online education programme for chronic pain.</p> </section> <section> <h3> Methods</h3> <p>The study adopted an Interpretative Phenomenological Analysis (IPA) methodological framework, which informed the development of the interview schedule, the sampling strategy, and the analytic process. Semi-structured interviews were conducted with 10 adults who completed a 6-week programme, Pain Retrained, which delivered education on chronic pain in a group setting via Microsoft Teams. The intervention was provided by an interdisciplinary team with 2 h of clinician contact per week.</p> </section> <section> <h3> Results</h3> <p>Analyses identified two principal themes, “It was a stretch” and “And now I can move on”. Participants expanded their understanding of chronic pain from a biomedical model to a more integrated biopsychosocial perspective, which supported a constructive shift toward engaging with evidence-based care and self-management.</p> </section> <section> <h3> Conclusion</h3> <p>This study offers novel insights into participants' experiences of an online pain education programme. The online format enhanced accessibility and made a longer-duration intervention more feasible for individuals. This structure allowed relational and temporal processes to support reconceptualization and importantly, reorientation to evidence-based care. Findings highlight the value of participatory, interdisciplinary education delivered in a format that accommodates the realities of living with chronic pain.</p> </section> <section> <h3> Significance Statement</h3> <p>This research advances understanding of how education can lay the foundation for recovery in chronic pain. A pivotal contribution is the identification of <i>reorientation to evidence-based treatments</i> as a core process within pain education. These findings extend current models of pain education by highlighting experiential elements critical to change. The insights offer actionable direction for c
{"title":"Pain Retrained: Participant Perspectives of an Online, Interdisciplinary Chronic Pain Education Programme","authors":"Maura McCarron, Francis Agnew, Claire Briggs, Jason Brooks, Martin Dempster, Jackie Granleese, Danielle Rainey, Kevin E. Vowles","doi":"10.1002/ejp.70223","DOIUrl":"10.1002/ejp.70223","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Education is considered a foundational component of chronic pain treatment. In response to challenges relating to accessibility and scalability, health services have increasingly adopted online formats for delivering pain education programmes. However, little is known about how patients experience these digital interventions, particularly in relation to engagement, meaning-making, and perceived impact. This study aimed to explore participant experiences of completing an online education programme for chronic pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study adopted an Interpretative Phenomenological Analysis (IPA) methodological framework, which informed the development of the interview schedule, the sampling strategy, and the analytic process. Semi-structured interviews were conducted with 10 adults who completed a 6-week programme, Pain Retrained, which delivered education on chronic pain in a group setting via Microsoft Teams. The intervention was provided by an interdisciplinary team with 2 h of clinician contact per week.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Analyses identified two principal themes, “It was a stretch” and “And now I can move on”. Participants expanded their understanding of chronic pain from a biomedical model to a more integrated biopsychosocial perspective, which supported a constructive shift toward engaging with evidence-based care and self-management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study offers novel insights into participants' experiences of an online pain education programme. The online format enhanced accessibility and made a longer-duration intervention more feasible for individuals. This structure allowed relational and temporal processes to support reconceptualization and importantly, reorientation to evidence-based care. Findings highlight the value of participatory, interdisciplinary education delivered in a format that accommodates the realities of living with chronic pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This research advances understanding of how education can lay the foundation for recovery in chronic pain. A pivotal contribution is the identification of <i>reorientation to evidence-based treatments</i> as a core process within pain education. These findings extend current models of pain education by highlighting experiential elements critical to change. The insights offer actionable direction for c","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12854195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085245","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}
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