Christina Mema, Julia A. Glombiewski, Christopher Milde, Ulrike Basten, Julia Karbach, Tanja Könen, Tanja Lischetzke, Lea Schemer
Background
Emotion regulation (ER) is considered a transdiagnostic mechanism underlying chronic pain (CP) and depression in theoretical models such as the Örebro framework. Yet most work has focused on between-person differences rather than within-person dynamics.
Methods
This study examined whether individuals with CP show lower ER success than those without CP (NCP), whether ER or pain regulation (PR) success varies with pain experience and negative emotions at within- and between-person levels, and whether pain duration exacerbates these effects via reduced self-efficacy. Participants included a CP group (n = 176) and an NCP group (n = 161) who completed baseline assessments and a 2-week ambulatory assessment (AA) with five daily surveys.
Results
The CP group had significantly lower ER success than the NCP group (moderate effect: d = −0.48). Within the CP group, ER success decreased with higher-than-usual pain experience (large within-person effect: d = −0.72) and higher overall pain experience (moderate between-person effect: d = −0.55). Similarly, higher-than-usual negative emotions (moderate within-person effect: d = −0.43) and higher overall negative emotions (small between-person effect: d = −0.36) were linked to lower PR success. Pain duration did not moderate the relationship between pain experience and ER success.
Conclusion
Findings align with the Örebro model, suggesting that pain flare-ups and negative mood strain the ER system and contribute to ER difficulties in CP, though long-term processes were not captured by pain duration or self-efficacy.
Significance Statement
By zooming in on within-person dynamics, this study adds to growing research on ER difficulties as a transdiagnostic factor underlying chronic pain and co-occurring emotional problems. Clinically, our findings highlight the potential of just-in-time interventions integrated with ER-focused pain management, offering support at moments of greatest need.
{"title":"Emotion Regulation in Chronic Pain Is Impaired When Pain Is High: Results From a Large Ambulatory Assessment Study","authors":"Christina Mema, Julia A. Glombiewski, Christopher Milde, Ulrike Basten, Julia Karbach, Tanja Könen, Tanja Lischetzke, Lea Schemer","doi":"10.1002/ejp.70204","DOIUrl":"10.1002/ejp.70204","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Emotion regulation (ER) is considered a transdiagnostic mechanism underlying chronic pain (CP) and depression in theoretical models such as the Örebro framework. Yet most work has focused on between-person differences rather than within-person dynamics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study examined whether individuals with CP show lower ER success than those without CP (NCP), whether ER or pain regulation (PR) success varies with pain experience and negative emotions at within- and between-person levels, and whether pain duration exacerbates these effects via reduced self-efficacy. Participants included a CP group (<i>n</i> = 176) and an NCP group (<i>n</i> = 161) who completed baseline assessments and a 2-week ambulatory assessment (AA) with five daily surveys.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The CP group had significantly lower ER success than the NCP group (moderate effect: <i>d</i> = −0.48). Within the CP group, ER success decreased with higher-than-usual pain experience (large within-person effect: <i>d</i> = −0.72) and higher overall pain experience (moderate between-person effect: <i>d</i> = −0.55). Similarly, higher-than-usual negative emotions (moderate within-person effect: <i>d</i> = −0.43) and higher overall negative emotions (small between-person effect: <i>d</i> = −0.36) were linked to lower PR success. Pain duration did not moderate the relationship between pain experience and ER success.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Findings align with the Örebro model, suggesting that pain flare-ups and negative mood strain the ER system and contribute to ER difficulties in CP, though long-term processes were not captured by pain duration or self-efficacy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>By zooming in on within-person dynamics, this study adds to growing research on ER difficulties as a transdiagnostic factor underlying chronic pain and co-occurring emotional problems. Clinically, our findings highlight the potential of just-in-time interventions integrated with ER-focused pain management, offering support at moments of greatest need.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892305","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}
Jonas Eck, Stephan Bigalke, Martin Schmelz, Daniela Constanze Rosenberger, Bruno Pradier, Frank Rutsch, Claudia Sommer, Frank Birklein, Daniel Segelcke, Esther Pogatzki-Zahn
Background
Peripheral neuropathies (PNP) cause a wide range of symptoms of which pruritus and pain are a major burden to patients. Clarifying their mechanisms will facilitate the adequate symptom management. In contrast to neuropathic pain, neuropathic pruritus has long been understudied. We investigate inhibitory pruritus mechanisms in patients with PNP.
Methods
A total of 39 participants (median age: 57 years [27–81], 25♀/14♂), including 16 patients with PNP and pruritus (PNPPRU) and 8 with PNP but without pruritus (PNPNO-PRU), and 15 controls, were enrolled and phenotyped using dynamic and static quantitative sensory testing, determination of intradermal nerve fibre density, and conditioned pain (CPM) and itch (CIM) modulation. For CIM, an electrically induced itch test stimulus (TS) was applied with an individual itch intensity of > 30 NRS (0–100). A cold-water bath (contralateral side) served as the conditioning stimulus (CS). Itch, pain intensity and the desire to scratch upon TS were rated before, during and after the CS was applied.
Results
Using our novel CIM protocol, well-controlled and stable itch was electrically induced in controls and in both PNP groups, regardless of whether or not pruritus was a symptom. Concomitant painful cold stimuli reduced electrically induced itch in all three groups to a similar degree. However, PNPPRU patients had significantly shorter itch inhibition (CIM effects) compared to controls and PNPNO-PRU, whereas CPM effects were not different between groups.
Conclusions
The results show reduced endogenous itch inhibition in patients with chronic itch, which represents a possible mechanism of chronic pruritus in PNP.
Significance Statement
Reduced itch inhibition is associated with the symptom of chronic pruritus in PNP patients, suggesting that reduced descending itch inhibition may facilitate chronic itch in peripheral neuropathy.
{"title":"Reduced Descending Itch Inhibition in Peripheral Neuropathy Patients With Chronic Pruritus","authors":"Jonas Eck, Stephan Bigalke, Martin Schmelz, Daniela Constanze Rosenberger, Bruno Pradier, Frank Rutsch, Claudia Sommer, Frank Birklein, Daniel Segelcke, Esther Pogatzki-Zahn","doi":"10.1002/ejp.70190","DOIUrl":"10.1002/ejp.70190","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Peripheral neuropathies (PNP) cause a wide range of symptoms of which pruritus and pain are a major burden to patients. Clarifying their mechanisms will facilitate the adequate symptom management. In contrast to neuropathic pain, neuropathic pruritus has long been understudied. We investigate inhibitory pruritus mechanisms in patients with PNP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 39 participants (median age: 57 years [27–81], 25♀/14♂), including 16 patients with PNP and pruritus (PNP<sub>PRU</sub>) and 8 with PNP but without pruritus (PNP<sub>NO-PRU</sub>), and 15 controls, were enrolled and phenotyped using dynamic and static quantitative sensory testing, determination of intradermal nerve fibre density, and conditioned pain (CPM) and itch (CIM) modulation. For CIM, an electrically induced itch test stimulus (TS) was applied with an individual itch intensity of > 30 NRS (0–100). A cold-water bath (contralateral side) served as the conditioning stimulus (CS). Itch, pain intensity and the desire to scratch upon TS were rated before, during and after the CS was applied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Using our novel CIM protocol, well-controlled and stable itch was electrically induced in controls and in both PNP groups, regardless of whether or not pruritus was a symptom. Concomitant painful cold stimuli reduced electrically induced itch in all three groups to a similar degree. However, PNP<sub>PRU</sub> patients had significantly shorter itch inhibition (CIM effects) compared to controls and PNP<sub>NO-PRU</sub>, whereas CPM effects were not different between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The results show reduced endogenous itch inhibition in patients with chronic itch, which represents a possible mechanism of chronic pruritus in PNP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Reduced itch inhibition is associated with the symptom of chronic pruritus in PNP patients, suggesting that reduced descending itch inhibition may facilitate chronic itch in peripheral neuropathy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12764315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892287","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}
Víctor Riquelme-Aguado, María Elena González-Álvarez, Silvia Di-Bonaventura, Leonardo Rodríguez-Lagos, Alazne Zabarte del Campo, Francisco Gómez-Esquer, Gema Díaz-Gil, Antonio Gil-Crujera
<div> <section> <h3> Introduction</h3> <p>Fibromyalgia (FM) is a multifactorial syndrome involving chronic pain and psychological distress. Psychological traits such as anxiety, depression, and catastrophising are linked to symptom severity. Genetic variability may contribute to these dimensions through mechanisms related to pain modulation and stress response.</p> </section> <section> <h3> Objectives</h3> <p>To examine associations between selected genetic polymorphisms and psychological variables in women with FM.</p> </section> <section> <h3> Methods</h3> <p>A cross-sectional study was conducted in 67 women diagnosed with FM. Pain intensity, FM impact and psychological variables—anxiety, depression and catastrophising—were assessed using validated questionnaires. Saliva samples were collected and 10 SNPs were genotyped (<i>COMT</i> rs4680, <i>DRD3</i> rs6280, <i>OPRM1</i> rs1799971, <i>BDNF</i> rs6265, <i>MAOA</i> rs1137070, <i>FKBP5</i> rs1360780, <i>IL6</i> rs1800796, <i>TNF</i> rs1800629, <i>IL10</i> rs1800896, <i>IFITM3</i> rs12252). Correlations were assessed using Pearson or Spearman coefficients, and associations were examined using ANOVA or Kruskal–Wallis with Tukey or Mann–Whitney post hoc tests.</p> </section> <section> <h3> Results</h3> <p>Pain intensity correlated with depression (<i>r</i> = 0.476, <i>p</i> < 0.001), catastrophising (<i>r</i> = 0.414, <i>p</i> < 0.001), and anxiety (<i>r</i> = 0.314, <i>p</i> = 0.009). Catastrophising was related to depression (<i>r</i> = 0.615, <i>p</i> < 0.001), anxiety (<i>r</i> = 0.453, <i>p</i> < 0.001), and kinesiophobia (<i>r</i> = 0.445, <i>p</i> < 0.001). <i>BDNF</i> rs6265 was associated with catastrophising (<i>p</i> = 0.044), <i>OPRM1</i> rs1799971 with anxiety (<i>p</i> = 0.030), and <i>MAOA</i> rs1137070 with depression (<i>p</i> = 0.020).</p> </section> <section> <h3> Conclusions</h3> <p>Psychological variables in FM are interrelated and linked to pain perception. <i>BDNF</i>, <i>OPRM1</i> and <i>MAOA</i> polymorphisms are associated with indices of psychological vulnerability, underscoring the importance of integrating genetic and psychological perspectives to understand variability in FM.</p> </section> <section> <h3> Significance Statement</h3> <p>Genetic variability influences psychological vulnerability in fibromyalgia. Specific variants were associated with key psy
{"title":"Associations Between Genetic Polymorphisms and Psychological Variables in Women With Fibromyalgia: A Cross-Sectional Study","authors":"Víctor Riquelme-Aguado, María Elena González-Álvarez, Silvia Di-Bonaventura, Leonardo Rodríguez-Lagos, Alazne Zabarte del Campo, Francisco Gómez-Esquer, Gema Díaz-Gil, Antonio Gil-Crujera","doi":"10.1002/ejp.70201","DOIUrl":"10.1002/ejp.70201","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Fibromyalgia (FM) is a multifactorial syndrome involving chronic pain and psychological distress. Psychological traits such as anxiety, depression, and catastrophising are linked to symptom severity. Genetic variability may contribute to these dimensions through mechanisms related to pain modulation and stress response.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To examine associations between selected genetic polymorphisms and psychological variables in women with FM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study was conducted in 67 women diagnosed with FM. Pain intensity, FM impact and psychological variables—anxiety, depression and catastrophising—were assessed using validated questionnaires. Saliva samples were collected and 10 SNPs were genotyped (<i>COMT</i> rs4680, <i>DRD3</i> rs6280, <i>OPRM1</i> rs1799971, <i>BDNF</i> rs6265, <i>MAOA</i> rs1137070, <i>FKBP5</i> rs1360780, <i>IL6</i> rs1800796, <i>TNF</i> rs1800629, <i>IL10</i> rs1800896, <i>IFITM3</i> rs12252). Correlations were assessed using Pearson or Spearman coefficients, and associations were examined using ANOVA or Kruskal–Wallis with Tukey or Mann–Whitney post hoc tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Pain intensity correlated with depression (<i>r</i> = 0.476, <i>p</i> < 0.001), catastrophising (<i>r</i> = 0.414, <i>p</i> < 0.001), and anxiety (<i>r</i> = 0.314, <i>p</i> = 0.009). Catastrophising was related to depression (<i>r</i> = 0.615, <i>p</i> < 0.001), anxiety (<i>r</i> = 0.453, <i>p</i> < 0.001), and kinesiophobia (<i>r</i> = 0.445, <i>p</i> < 0.001). <i>BDNF</i> rs6265 was associated with catastrophising (<i>p</i> = 0.044), <i>OPRM1</i> rs1799971 with anxiety (<i>p</i> = 0.030), and <i>MAOA</i> rs1137070 with depression (<i>p</i> = 0.020).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Psychological variables in FM are interrelated and linked to pain perception. <i>BDNF</i>, <i>OPRM1</i> and <i>MAOA</i> polymorphisms are associated with indices of psychological vulnerability, underscoring the importance of integrating genetic and psychological perspectives to understand variability in FM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Genetic variability influences psychological vulnerability in fibromyalgia. Specific variants were associated with key psy","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12750501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145855143","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}
Audrey P. Wang, Michael Green, Peter Humburg, G. Lorimer Moseley, James McAuley, Caroline D. Rae
Background
Treatment of chronic pain conditions such as complex regional pain syndrome (CRPS) has been underpinned by the concept of the condition being driven or maintained by disorganisation of the sensory system. Previously reported differences in brain structure and function between individuals with CRPS and healthy controls have supported this concept, although results have been mixed.
Methods
In a cross-sectional study, we examined white matter structure in the brains of people with CRPS and healthy controls (n = 42) using high angular resolution diffusion imaging at 3 Tesla and analysed the data using a fixel-based approach.
Results
We found no significant differences in any diffusion measures between participants with CRPS and controls. Linear regression analyses and equivalence tests demonstrated that fibre density cross-section measures were indistinguishable between the two groups; neither CRPS symptomology nor opioid use could be explained by any white matter structural differences detected by diffusion imaging.
Conclusions
A relatively large sample size and fine-grained methods add confidence to our findings. These results argue against permanent brain changes that prevent recovery in CRPS.
Significance Statement
In one of the largest studies of white matter structure in complex regional pain syndrome, fixel-based high angular resolution diffusion scans showed no significant difference to controls and were statistically equivalent. This indicates that white matter structural change is unlikely to be of clinical significance in CRPS. This points to functional changes underpinning the deficits associated with the condition and highlights improving neural function through movement-based approaches such as graded motor imagery, graded exposure, desensitisation and functional movement rehabilitation approaches.
{"title":"White Matter Structure in Complex Regional Pain Syndrome: A High Angular Resolution and Fixel-Based Study","authors":"Audrey P. Wang, Michael Green, Peter Humburg, G. Lorimer Moseley, James McAuley, Caroline D. Rae","doi":"10.1002/ejp.70202","DOIUrl":"10.1002/ejp.70202","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Treatment of chronic pain conditions such as complex regional pain syndrome (CRPS) has been underpinned by the concept of the condition being driven or maintained by disorganisation of the sensory system. Previously reported differences in brain structure and function between individuals with CRPS and healthy controls have supported this concept, although results have been mixed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In a cross-sectional study, we examined white matter structure in the brains of people with CRPS and healthy controls (<i>n</i> = 42) using high angular resolution diffusion imaging at 3 Tesla and analysed the data using a fixel-based approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found no significant differences in any diffusion measures between participants with CRPS and controls. Linear regression analyses and equivalence tests demonstrated that fibre density cross-section measures were indistinguishable between the two groups; neither CRPS symptomology nor opioid use could be explained by any white matter structural differences detected by diffusion imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A relatively large sample size and fine-grained methods add confidence to our findings. These results argue against permanent brain changes that prevent recovery in CRPS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>In one of the largest studies of white matter structure in complex regional pain syndrome, fixel-based high angular resolution diffusion scans showed no significant difference to controls and were statistically equivalent. This indicates that white matter structural change is unlikely to be of clinical significance in CRPS. This points to functional changes underpinning the deficits associated with the condition and highlights improving neural function through movement-based approaches such as graded motor imagery, graded exposure, desensitisation and functional movement rehabilitation approaches.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145855104","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}
Angélica Maria França Paiva Tibúrcio, Daniel Steffens, Amanda Aparecida Oliveira Leopoldino, Elen Cristina da Mata, Juscelio Pereira da Silva, Juliana Magalhães Machado Barbosa, Isabela Paiva Tibúrcio, Leani Souza Máximo Pereira
Background
Low back pain (LBP) represents the leading cause of years lived with disability (YLD) globally. Among older adults, non-specific LBP constitutes a predominant determinant of functional decline, diminished quality of life (QoL) and considerable socioeconomic burden. This study aimed to assess the impact of pain intensity and disability on healthy-related quality of life (HRQoL) in older adults with non-specific LBP over 12 months.
Methods
602 participants from the BACE-Brazil cohort with acute non-specific LBP were followed for 12 months, 156 were excluded from the analysis due to missing data on the Short Form-36 Questionnaire (SF-36), leaving a final sample of 446 participants. Pain intensity was assessed using the Numerical Rating Scale (NRS), disability with the Roland Morris Disability Questionnaire (RMDQ) and HRQoL with the Short Form-36 (SF-36). Linear regression models examined the relationships between pain, disability and HRQoL, adjusting for sociodemographic and clinical covariates.
Results
In the longitudinal analysis of 446 older adults (mean age 67 ± 7 years, 84.9% women), greater pain intensity was significantly associated with reductions in the physical component of HRQoL, but not with the emotional component. In contrast, worsening disability was associated with declines in both physical and emotional components of HRQoL.
Conclusion
In older adults with acute non-specific LBP, disability exerts a stronger and broader impact on HRQoL than pain intensity. Interventions targeting functional independence may therefore be more effective in preserving HRQoL than strategies focused solely on pain reduction.
Significance Statement
This is the first longitudinal study in a developing country showing that disability, rather than pain intensity, exerts the greatest long-term impact on both physical and emotional quality of life in older adults with acute non- specific low back pain. These findings highlight the need for interventions that prioritise functional preservation and disability reduction, rather than solely focusing on pain relief, to improve outcomes and guide clinical decision-making for this growing and vulnerable population.
{"title":"Is Quality of Life in Older Adults With Non-Specific Low Back Pain Influenced by Pain or Disability? Longitudinal Data From the Back Complaints in the Elders Brazil Cohort","authors":"Angélica Maria França Paiva Tibúrcio, Daniel Steffens, Amanda Aparecida Oliveira Leopoldino, Elen Cristina da Mata, Juscelio Pereira da Silva, Juliana Magalhães Machado Barbosa, Isabela Paiva Tibúrcio, Leani Souza Máximo Pereira","doi":"10.1002/ejp.70191","DOIUrl":"10.1002/ejp.70191","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Low back pain (LBP) represents the leading cause of years lived with disability (YLD) globally. Among older adults, non-specific LBP constitutes a predominant determinant of functional decline, diminished quality of life (QoL) and considerable socioeconomic burden. This study aimed to assess the impact of pain intensity and disability on healthy-related quality of life (HRQoL) in older adults with non-specific LBP over 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>602 participants from the BACE-Brazil cohort with acute non-specific LBP were followed for 12 months, 156 were excluded from the analysis due to missing data on the Short Form-36 Questionnaire (SF-36), leaving a final sample of 446 participants. Pain intensity was assessed using the Numerical Rating Scale (NRS), disability with the Roland Morris Disability Questionnaire (RMDQ) and HRQoL with the Short Form-36 (SF-36). Linear regression models examined the relationships between pain, disability and HRQoL, adjusting for sociodemographic and clinical covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the longitudinal analysis of 446 older adults (mean age 67 ± 7 years, 84.9% women), greater pain intensity was significantly associated with reductions in the physical component of HRQoL, but not with the emotional component. In contrast, worsening disability was associated with declines in both physical and emotional components of HRQoL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In older adults with acute non-specific LBP, disability exerts a stronger and broader impact on HRQoL than pain intensity. Interventions targeting functional independence may therefore be more effective in preserving HRQoL than strategies focused solely on pain reduction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This is the first longitudinal study in a developing country showing that disability, rather than pain intensity, exerts the greatest long-term impact on both physical and emotional quality of life in older adults with acute non- specific low back pain. These findings highlight the need for interventions that prioritise functional preservation and disability reduction, rather than solely focusing on pain relief, to improve outcomes and guide clinical decision-making for this growing and vulnerable population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145855075","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}
Yoshnee Foolchand, Avgustina Kuzminova, Marc-Henri Louis, Arthur Courtin, Patricia Dessart, André Mouraux, Samar M. Hatem
Objective
To establish normative values for contact heat evoked potentials (CHEP) and cold evoked potentials (CEP), providing a reference for evaluating small fibre neuropathy (SFN) and spinothalamic tract (STT) function.
Methods
Thermal quantitative sensory testing and sensory nerve conduction studies were conducted for screening subjects. CHEP and CEP were recorded from the distal volar forearm and foot dorsum of 80 healthy participants (26–75 years) using a 1.2 cm2 contact thermal stimulator (ramp: 300°C/s, heat: 60°C, cold: 10°C, duration: 200 ms). Age-grouped descriptive statistics were computed. Results between age groups, stimulation sites and sex were compared.
Results
Upper limb CEP showed > 90% detection rates across all ages. N2P2 amplitudes were larger in upper compared to lower limbs (CHEP: p = 0.032; CEP: p < 0.001). N2P2 amplitudes decreased with age for CHEP (p < 0.001) and CEP (p = 0.002). Latencies did not vary between age groups or between limbs (CHEP: p = 0.600; CEP: p = 0.351).
Conclusions
This normative dataset will support the clinical integration of CHEP and CEP as an objective and non-invasive technique for evaluating small fibre and STT function.
Significance Statement
Normative data for contact heat evoked potentials (CHEP) and cold evoked potentials (CEP) were established across age groups in healthy adults, marking a key step toward their use in routine clinical neurophysiology. CHEP and CEP N2P2 amplitudes were consistently larger in upper than lower limbs, with the greatest age-related decline in the feet. Notably, CEP from the upper limbs showed the highest visualisation rates (> 90%) across all ages.
{"title":"Normative Values for Contact Heat and Cold Evoked Potentials","authors":"Yoshnee Foolchand, Avgustina Kuzminova, Marc-Henri Louis, Arthur Courtin, Patricia Dessart, André Mouraux, Samar M. Hatem","doi":"10.1002/ejp.70196","DOIUrl":"10.1002/ejp.70196","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To establish normative values for contact heat evoked potentials (CHEP) and cold evoked potentials (CEP), providing a reference for evaluating small fibre neuropathy (SFN) and spinothalamic tract (STT) function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Thermal quantitative sensory testing and sensory nerve conduction studies were conducted for screening subjects. CHEP and CEP were recorded from the distal volar forearm and foot dorsum of 80 healthy participants (26–75 years) using a 1.2 cm<sup>2</sup> contact thermal stimulator (ramp: 300°C/s, heat: 60°C, cold: 10°C, duration: 200 ms). Age-grouped descriptive statistics were computed. Results between age groups, stimulation sites and sex were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Upper limb CEP showed > 90% detection rates across all ages. N2P2 amplitudes were larger in upper compared to lower limbs (CHEP: <i>p</i> = 0.032; CEP: <i>p</i> < 0.001). N2P2 amplitudes decreased with age for CHEP (<i>p</i> < 0.001) and CEP (<i>p</i> = 0.002). Latencies did not vary between age groups or between limbs (CHEP: <i>p</i> = 0.600; CEP: <i>p</i> = 0.351).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This normative dataset will support the clinical integration of CHEP and CEP as an objective and non-invasive technique for evaluating small fibre and STT function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Normative data for contact heat evoked potentials (CHEP) and cold evoked potentials (CEP) were established across age groups in healthy adults, marking a key step toward their use in routine clinical neurophysiology. CHEP and CEP N2P2 amplitudes were consistently larger in upper than lower limbs, with the greatest age-related decline in the feet. Notably, CEP from the upper limbs showed the highest visualisation rates (> 90%) across all ages.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145849556","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}
Karin Due Bruun, Maria Charlotte Reiersoel Moerkeberg, Julie Roenne Pedersen, Daniel Broholm, Morten Rune Blichfeldt-Eckhardt, Lotte Abildgren
Background
The opioid system is involved in the regulation of pain as well as stress homeostasis. Stress-induced opioid dysregulation has been proposed as a mechanism for pain development in patients with fibromyalgia (FM) and chronic low back pain (cLBP). However, the evidence to support this hypothesis is conflicting.
Methods
We conducted a systematic literature search in MEDLINE, EMBASE, and the Cochrane Library database to investigate whether patients with FM or cLBP exhibit (1) different levels of endogenous opioids or anti-opioids in body fluids or tissue samples, or (2) altered levels of opioid receptor expression or availability compared to pain-free controls.
Results
We identified 33 studies eligible for inclusion in the review, investigating 863 patients and 636 pain-free controls. Three meta-analyses of beta-endorphin levels in blood and cerebrospinal fluid (CSF) were performed, revealing no significant differences between patients with FM or cLBP and controls. However, the grading of the evidence was very low. Mu-opioid receptor (MOR) dysfunction emerged as a potential feature of FM, with some evidence suggesting reduced MOR binding in the brain and decreased MOR expression in immune cells.
Conclusions
Current evidence does not support altered peripheral endorphin levels in FM or cLBP, while emerging PET findings indicate reduced central MOR availability in FM. These results suggest receptor-level dysregulation rather than peripheral opioid deficits. Limitations mainly arose from low sample sizes and inadequate study methodologies, underscoring the need for well-designed studies with larger sample sizes to clarify the role of endogenous opioid dysfunction in FM and cLBP.
Significance
This systematic review highlights emerging evidence of mu-opioid receptor dysfunction in fibromyalgia, despite no consistent differences in beta-endorphin levels. The findings underscore significant methodological limitations in existing studies and point to the need for rigorous, well-powered research to clarify the role of endogenous opioid dysregulation in chronic pain.
{"title":"A Systematic Review With Meta-Analysis of Endogenous Opioid System Biomarkers in Patients With Chronic Axial Pain, Chronic Widespread Pain, and Fibromyalgia","authors":"Karin Due Bruun, Maria Charlotte Reiersoel Moerkeberg, Julie Roenne Pedersen, Daniel Broholm, Morten Rune Blichfeldt-Eckhardt, Lotte Abildgren","doi":"10.1002/ejp.70192","DOIUrl":"10.1002/ejp.70192","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The opioid system is involved in the regulation of pain as well as stress homeostasis. Stress-induced opioid dysregulation has been proposed as a mechanism for pain development in patients with fibromyalgia (FM) and chronic low back pain (cLBP). However, the evidence to support this hypothesis is conflicting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic literature search in MEDLINE, EMBASE, and the Cochrane Library database to investigate whether patients with FM or cLBP exhibit (1) different levels of endogenous opioids or anti-opioids in body fluids or tissue samples, or (2) altered levels of opioid receptor expression or availability compared to pain-free controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 33 studies eligible for inclusion in the review, investigating 863 patients and 636 pain-free controls. Three meta-analyses of beta-endorphin levels in blood and cerebrospinal fluid (CSF) were performed, revealing no significant differences between patients with FM or cLBP and controls. However, the grading of the evidence was very low. Mu-opioid receptor (MOR) dysfunction emerged as a potential feature of FM, with some evidence suggesting reduced MOR binding in the brain and decreased MOR expression in immune cells.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Current evidence does not support altered peripheral endorphin levels in FM or cLBP, while emerging PET findings indicate reduced central MOR availability in FM. These results suggest receptor-level dysregulation rather than peripheral opioid deficits. Limitations mainly arose from low sample sizes and inadequate study methodologies, underscoring the need for well-designed studies with larger sample sizes to clarify the role of endogenous opioid dysfunction in FM and cLBP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>This systematic review highlights emerging evidence of mu-opioid receptor dysfunction in fibromyalgia, despite no consistent differences in beta-endorphin levels. The findings underscore significant methodological limitations in existing studies and point to the need for rigorous, well-powered research to clarify the role of endogenous opioid dysregulation in chronic pain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145849574","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}
Marta Spinoni, Cristian Di Gesto, Maria Grazia Porpora, Caterina Grano
Background
Endometriosis is a prevalent condition characterised by chronic pelvic pain, significantly impacting women's quality of life and well-being. Pain catastrophizing is a cognitive tendency of exaggerated worrying, a sense of helplessness, and amplification of distressing thoughts in response to pain. According to the Fear-Avoidance Model, catastrophizing contributes to prolonged pain interference and mood disorders. This longitudinal study examines the relationship between pain catastrophizing, pain interference, and depressive symptoms in patients with endometriosis.
Methods
A sample of 128 cisgender women with endometriosis recruited from online patient associations completed self-report measures assessing pain catastrophizing, pain interference, and depressive symptoms at baseline (T1) and after 6 months (T2). A mediation model examining the indirect effect of pain catastrophizing on depressive symptoms through pain interference was tested. The pelvic pain level was considered as a covariate in the model.
Results
More than half of the sample reported depressive symptoms above the cut-off. Pain catastrophizing at T1 significantly predicted depressive symptoms at T2. Pain interference partially mediated this relationship.
Conclusions
Our findings indicate that heightened levels of catastrophizing correlate with increased pain interference, which, in turn, predicts elevated depressive symptoms over time. Findings suggest that by targeting catastrophizing tendencies, clinicians may help mitigate depressive symptomatology.
Significance Statement
This longitudinal study investigates for the first time the impact of pain catastrophizing on pain interference and depressive symptoms over time in cisgender women with endometriosis. Findings indicated both a direct influence of pain catastrophizing on depressive symptomatology and an indirect effect via increased pain interference, in line with the Fear-Avoidance Model. These findings underscore the importance of targeting pain catastrophizing tendencies in interventions aimed at improving the well-being of patients affected by endometriosis.
{"title":"The Role of Catastrophizing in Enhancing Pain Interference and Depressive Symptoms in Endometriosis: A Longitudinal Examination","authors":"Marta Spinoni, Cristian Di Gesto, Maria Grazia Porpora, Caterina Grano","doi":"10.1002/ejp.70198","DOIUrl":"10.1002/ejp.70198","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Endometriosis is a prevalent condition characterised by chronic pelvic pain, significantly impacting women's quality of life and well-being. Pain catastrophizing is a cognitive tendency of exaggerated worrying, a sense of helplessness, and amplification of distressing thoughts in response to pain. According to the Fear-Avoidance Model, catastrophizing contributes to prolonged pain interference and mood disorders. This longitudinal study examines the relationship between pain catastrophizing, pain interference, and depressive symptoms in patients with endometriosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A sample of 128 cisgender women with endometriosis recruited from online patient associations completed self-report measures assessing pain catastrophizing, pain interference, and depressive symptoms at baseline (T1) and after 6 months (T2). A mediation model examining the indirect effect of pain catastrophizing on depressive symptoms through pain interference was tested. The pelvic pain level was considered as a covariate in the model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>More than half of the sample reported depressive symptoms above the cut-off. Pain catastrophizing at T1 significantly predicted depressive symptoms at T2. Pain interference partially mediated this relationship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings indicate that heightened levels of catastrophizing correlate with increased pain interference, which, in turn, predicts elevated depressive symptoms over time. Findings suggest that by targeting catastrophizing tendencies, clinicians may help mitigate depressive symptomatology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This longitudinal study investigates for the first time the impact of pain catastrophizing on pain interference and depressive symptoms over time in cisgender women with endometriosis. Findings indicated both a direct influence of pain catastrophizing on depressive symptomatology and an indirect effect via increased pain interference, in line with the Fear-Avoidance Model. These findings underscore the importance of targeting pain catastrophizing tendencies in interventions aimed at improving the well-being of patients affected by endometriosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12742274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145833548","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}
Knee osteoarthritis (OA) affects approximately 10% of the general population. Of these, nearly 20% of patients undergo total knee arthroplasty (TKA). A proportion subsequently develops long-term opioid use, yet comprehensive evaluations of perioperative risk factors remain limited.
Methods
A total of 15,051 patients with knee OA who underwent TKA between 2002 and 2018 were included. Our primary analysis used a Least Absolute Shrinkage and Selection Operator (LASSO)–Elastic Net logistic regression model with a 70/30 training–validation split to identify predictors of long-term opioid use and to estimate model performance using the area under the receiver operating characteristic curve (AUC) and calibration. As supplementary analyses, hierarchical logistic regression models progressively incorporated demographic, preoperative, in-hospital, and early post-discharge variables.
Results
Overall, 1029 patients were identified as long-term opioid users. The LASSO–Elastic Net model achieved an AUC of 0.8213 (95% CI: 0.8080–0.8347). The AUCs of the hierarchical logistic models were 0.7523 (95% CI: 0.7364–0.7681) for demographic and preoperative factors (Model 1), 0.7682 (95% CI: 0.7534–0.7829) with added hospitalisation factors (Model 2), and 0.8251 (95% CI: 0.8119–0.8383) after further including post-discharge variables (Model 3).
Conclusion
This study systematically identifies risk factors for long-term opioid use across different phases of TKA care. A predictive model based on LASSO–Elastic analysis demonstrated an AUC of 0.8213, highlighting its potential for early identification of high-risk patients.
Significance Statement
Using a population-based analysis, this study identifies risk factors for prolonged opioid use following TKA, aiding clinicians in early recognition and targeted preventive strategies.
{"title":"Prediction Model for Factors Associated With Long-Term Opioid Use Following Total Knee Arthroplasty: A Retrospective Population-Based Study","authors":"Pin-Hung Yeh, Shun-Fa Yang, Jing-Yang Huang, Chao-Bin Yeh","doi":"10.1002/ejp.70195","DOIUrl":"10.1002/ejp.70195","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Knee osteoarthritis (OA) affects approximately 10% of the general population. Of these, nearly 20% of patients undergo total knee arthroplasty (TKA). A proportion subsequently develops long-term opioid use, yet comprehensive evaluations of perioperative risk factors remain limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 15,051 patients with knee OA who underwent TKA between 2002 and 2018 were included. Our primary analysis used a Least Absolute Shrinkage and Selection Operator (LASSO)–Elastic Net logistic regression model with a 70/30 training–validation split to identify predictors of long-term opioid use and to estimate model performance using the area under the receiver operating characteristic curve (AUC) and calibration. As supplementary analyses, hierarchical logistic regression models progressively incorporated demographic, preoperative, in-hospital, and early post-discharge variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 1029 patients were identified as long-term opioid users. The LASSO–Elastic Net model achieved an AUC of 0.8213 (95% CI: 0.8080–0.8347). The AUCs of the hierarchical logistic models were 0.7523 (95% CI: 0.7364–0.7681) for demographic and preoperative factors (Model 1), 0.7682 (95% CI: 0.7534–0.7829) with added hospitalisation factors (Model 2), and 0.8251 (95% CI: 0.8119–0.8383) after further including post-discharge variables (Model 3).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study systematically identifies risk factors for long-term opioid use across different phases of TKA care. A predictive model based on LASSO–Elastic analysis demonstrated an AUC of 0.8213, highlighting its potential for early identification of high-risk patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Using a population-based analysis, this study identifies risk factors for prolonged opioid use following TKA, aiding clinicians in early recognition and targeted preventive strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12740543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145833481","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}
Emma L. Karran, Aidan G. Cashin, Alessandro Chiarotto, Saurab Sharma, Trevor Barker, Mark A. Boyd, Lara J. Maxwell, Vina Mohabir, Jennifer Petkovic, Peter Tugwell, G. Lorimer Moseley
{"title":"Standardising the Collection of Socio-Demographic Data in Pain Research","authors":"Emma L. Karran, Aidan G. Cashin, Alessandro Chiarotto, Saurab Sharma, Trevor Barker, Mark A. Boyd, Lara J. Maxwell, Vina Mohabir, Jennifer Petkovic, Peter Tugwell, G. Lorimer Moseley","doi":"10.1002/ejp.70194","DOIUrl":"10.1002/ejp.70194","url":null,"abstract":"","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793515","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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