European Journal of Pain最新文献_第8页

The Unserved Majority: The Urgent Need to Address the Mild-Impact Chronic Pain Population 未被服务的大多数：迫切需要解决轻度影响慢性疼痛人群。

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-12-18 DOI: 10.1002/ejp.70189

Flaminia Coluzzi

引用次数: 0

Somatosensory Abnormalities, Dysesthesia and Central Neuropathic Pain in Youth With Cerebral Palsy 青年脑瘫患者的体感异常、感觉障碍和中枢神经性疼痛。

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-12-17 DOI: 10.1002/ejp.70188

Michael Nørregaard Vinkel, Gija Rackauskaite, Mette Thorup, Andrea Truini, John Rosendahl Østergaard, Hatice Tankisi, Nanna Brix Finnerup

Background

Pain is common in people with cerebral palsy. Despite the presence of central nervous system injury, it is unknown whether central neuropathic pain occurs in cerebral palsy and whether unpleasant, abnormal sensations such as dysesthesia are present. The study aims to examine the presence of sensory abnormalities and neuropathic pain in youth with cerebral palsy and relate these findings to specific brain injuries.

Methods

This cross-sectional observational study examines 27 ambulant youth with cerebral palsy and 48 healthy controls aged 15–22 using structured interviews, detailed bedside examinations, laser evoked potentials, quantitative sensory testing and MRI.

Results

The prevalence of self-reported sensory abnormalities in the cerebral palsy group was lower than found using bedside sensory mapping (41% vs. 74%, p = 0.003) and quantitative sensory testing (41% vs. 70%, p = 0.021). Furthermore, three had evoked dysesthesia. Ongoing or recurrent pain occurred in 70% of youth with cerebral palsy, without evidence of central neuropathic pain. The relative risk of having sensory loss was 3.2 (95% CI 1.47–7.00) when an injury to the spinothalamic tract, thalamus, insula, or somatosensory cortex was present, while the relative risk of sensory gain was 5.3 (95% CI 0.78–35.85) with the presence of white matter injury from periventricular leucomalacia.

Conclusions

We recommend addressing sensory function and dysesthesia in future studies and cerebral palsy follow-up programs. Brain injury patterns may predict sensory loss or gain and distinct somatosensory topographies could clarify these mechanisms. These insights may enable earlier identification of sensory abnormalities in cerebral palsy.

Significance Statement

1) This study highlights the high prevalence yet underrecognition of sensory abnormalities and pain in individuals with cerebral palsy. 2) It explores the subjective experience and perception of sensory abnormalities and is the first to identify and characterize dysesthesia in this population. 3) The findings demonstrate that pain is common among young, ambulant individuals with cerebral palsy; however, central neuropathic pain appears to be absent despite underlying central nervous system injury.

背景：疼痛在脑瘫患者中很常见。尽管存在中枢神经系统损伤，但尚不清楚脑瘫患者是否发生中枢神经性疼痛，以及是否存在不愉快的异常感觉，如感觉不良。该研究旨在检查青少年脑瘫患者感觉异常和神经性疼痛的存在，并将这些发现与特定的脑损伤联系起来。方法：采用结构化访谈、详细床边检查、激光诱发电位、定量感觉测试和MRI对27例脑瘫青年和48例15-22岁的健康对照进行横断面观察性研究。结果：脑瘫组自我报告感觉异常的发生率低于床边感觉测图（41%比74%，p = 0.003）和定量感觉测试（41%比70%，p = 0.021）。此外，其中3例引起了感觉不良。70%的青年脑瘫患者出现持续或复发性疼痛，没有中枢神经性疼痛的证据。当脊髓丘脑束、丘脑、脑岛或体感觉皮层受到损伤时，感觉丧失的相对风险为3.2 (95% CI 1.47-7.00)，而当脑室周围白质软化造成白质损伤时，感觉获得的相对风险为5.3 （95% CI 0.78-35.85）。结论：我们建议在未来的研究和脑瘫随访计划中关注感觉功能和感觉障碍。脑损伤模式可以预测感觉丧失或获得，不同的体感地形可以阐明这些机制。这些见解可能有助于早期识别脑瘫的感觉异常。意义声明：1)本研究强调了脑瘫患者的感觉异常和疼痛的高患病率，但未被充分认识。2)它探索了感觉异常的主观体验和感知，并且是第一个识别和表征该人群的感觉障碍。3)研究结果表明，疼痛在年轻、活动的脑瘫患者中很常见；然而，尽管中枢神经系统损伤，中枢神经性疼痛似乎不存在。

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引用次数: 0

Commentary on “Phenotyping Chronic Pain and Neuropathic Pain in Population Studies” 对“人群研究中慢性疼痛和神经性疼痛的表型”的评论。

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-12-16 DOI: 10.1002/ejp.70193

Fiona M. Blyth, Saman Khalatbari-Soltani

<p>The journal recently published a position paper by Liang et al. (<span>2025</span>) titled “Phenotyping chronic pain and neuropathic pain in population studies.” There can be little argument about the central proposition of the paper—that we need to have consistent approaches to defining commonly occurring categories of chronic pain and to identifying meaningful phenotypes. The current lack of clarity and consistency undermines both our understanding of the overall population burden of chronic pain and progress on the potential of precision medicine to improve how treatment effectiveness is assessed in clinical populations.</p><p>The pyramid model for phenotyping based on chronic neuropathic pain that is proposed in the paper succinctly captures the different goals of epidemiological research spanning general population-level studies through to richly characterised clinical cohort studies, with indicative approaches to phenotyping matched to those goals. Also implicit in the pyramid model is the trade-off between generalisability and precision (breadth versus depth) required at different levels of the model, according to the primary goal at each level of the pyramid. While the paper outlines the substantial progress for neuropathic pain conditions, a significant challenge remains to replicate this for other common forms of chronic pain.</p><p>Efforts to standardise or harmonise data collection and phenotyping are essential, and will likely reduce variation in prevalence due to methodological differences between studies. When consistent definitions are used, other drivers of differences in prevalence can be identified, notably geographical and equity-related factors (Zimmer et al. <span>2022</span>). These include groups exposed to multiple, often intersecting forms of marginalisation across ethnicity, gender, disability, and socioeconomic position. Yet, perhaps paradoxically, the large-scale studies and biobanks that exist are overwhelmingly from high-income countries and settings, and even within these settings consistently under-recruit from and therefore under-represent the priority populations most at risk of high pain burden. In the rapidly developing field of clinical risk prediction modelling, there are related concerns about model fairness if models are developed from large datasets where minority populations are under-represented, and the accuracy of risk prediction in these populations is more uncertain (Riley et al. <span>2025</span>).</p><p>The authors point out that progress towards developing tailored interventions needs more clarity and consistency in identifying biopsychosocial contributors of pain, and this in turn depends on consistency in case definitions and phenotyping. Collectively, this should be underpinned by conceptually coherent models of how risk factors work together over time that can be empirically tested and refined. Cohort studies are particularly valuable in this context, as they collect longitudinal data that

该杂志最近发表了Liang等人（2025）的一篇题为“人口研究中的慢性疼痛和神经性疼痛表型”的立场论文。关于本文的中心命题，我们需要有一致的方法来定义常见的慢性疼痛类别，并确定有意义的表型，这一点几乎没有争议。目前缺乏清晰度和一致性，既破坏了我们对慢性疼痛总体人口负担的理解，也破坏了精准医学在改善临床人群治疗效果评估方面的潜力。本文提出的基于慢性神经性疼痛的表型金字塔模型简洁地捕捉了流行病学研究的不同目标，从一般人群水平的研究到特征丰富的临床队列研究，并采用与这些目标相匹配的指示性表型方法。金字塔模型中隐含的另一个问题是，根据金字塔每一层的主要目标，在模型的不同层次所需的通用性和精确性（广度与深度）之间进行权衡。虽然论文概述了神经性疼痛条件的实质性进展，但对其他常见形式的慢性疼痛复制这一重大挑战仍然存在。标准化或协调数据收集和表型的努力是必不可少的，并且可能会减少由于研究之间的方法差异而导致的患病率差异。当使用一致的定义时，可以确定患病率差异的其他驱动因素，特别是地理和公平相关因素（Zimmer et al. 2022）。这些群体包括因种族、性别、残疾和社会经济地位而面临多重、往往是交叉形式的边缘化的群体。然而，也许矛盾的是，现有的大规模研究和生物库绝大多数来自高收入国家和地区，即使在这些地区，也一直没有从高疼痛负担风险最高的优先人群中招募人员，因此代表性不足。在快速发展的临床风险预测建模领域，如果模型是从少数民族人群代表性不足的大型数据集开发的，并且这些人群的风险预测准确性更不确定，则存在与模型公平性相关的担忧（Riley et al. 2025）。作者指出，开发量身定制的干预措施的进展需要在识别疼痛的生物心理社会因素方面更加清晰和一致，而这反过来又取决于病例定义和表型的一致性。总的来说，这应该以概念上连贯的模型为基础，这些模型表明风险因素如何随着时间的推移而共同作用，这些模型可以经过经验检验和改进。在这种情况下，队列研究特别有价值，因为它们收集纵向数据，允许检查疼痛轨迹和随时间的因果关系。该立场文件还强调，形成大规模的研究联盟对于在疼痛研究的关键领域取得进展非常重要（hsambert et al. 2023）。随着大型财团和生物银行的经验积累，我们对它们潜在的好处和挑战的理解也在不断加深。其中一个挑战是评估如何在更广泛的疼痛研究领域中最好地定位大数据研究，并确保有效利用现有资源来捕获不同的人群和背景。本文链接至Liang等人的论文。要查看本文，请访问https://doi.org/10.1002/ejp.70146。

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引用次数: 0

Advancing the Prediction and Understanding of Placebo Responses in Chronic Back Pain Using Large Language Models 使用大语言模型对慢性背痛安慰剂反应的预测和理解

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-12-12 DOI: 10.1002/ejp.70184

Diogo A. P. Nunes, Dan Furrer, Sara Berger, Guillermo Cecchi, Joana Ferreira-Gomes, Fani Neto, David Martins de Matos, A. Vania Apkarian, Paulo Branco

Background

Placebo analgesia is a widely studied clinical phenomenon, yet placebo responses vary widely across individuals. Prior research has identified biopsychosocial factors that determine the likelihood of an individual to respond to placebo, yet generalizability and ecological validity in those studies have been limited due to the inability to account for dynamic personal and treatment effects.

Methods

We assessed fine-tuned large language models (LLMs) for the prediction of placebo responses in chronic low-back pain using contextual features extracted from patient interviews, as they speak about their lifestyle, pain, and treatment history. Interviews were conducted as part of two RCTs designed to study the placebo effect. These interviews were collected after treatment in the first trial (discovery cohort) and prior to treatment in the second trial (validation cohort).

Results

Semantic features extracted with LLMs can predict which individuals respond to a placebo, with an accuracy of 74% in unseen data, and validating with 70% accuracy in an independent cohort. Furthermore, in contrast to previous work, LLMs eliminated the need for pre-selecting search terms, enabling a fully data-driven approach, and provided interpretable insights into psychosocial factors underlying placebo responses.

Conclusions

These findings expand on prior research by integrating state-of-art NLP techniques to address limitations in interpretability and context sensitivity of the traditional methods in related work. This method highlights the role of language models to link language and psychological states, paving the way for a deeper quantitative exploration of biopsychosocial phenomena, and to understand how they relate to treatment outcomes.

Significance Statement

This study paves the way for a deeper yet quantitative exploration of biopsychosocial phenomena through language, and to understand how they relate to treatment outcomes, namely placebo. In this case it highlights nuanced linguistic patterns linked to responder status, which tap into semantic dimensions such as “anxiety,” “resignation,” and “hope”.

背景：安慰剂镇痛是一种被广泛研究的临床现象，然而安慰剂的反应在个体之间差异很大。先前的研究已经确定了决定个体对安慰剂反应可能性的生物心理社会因素，但由于无法解释动态的个人和治疗效果，这些研究的普遍性和生态有效性受到限制。方法：我们评估了微调的大语言模型（LLMs），利用从患者访谈中提取的背景特征来预测慢性腰痛患者的安慰剂反应，因为他们谈论他们的生活方式、疼痛和治疗史。访谈作为两项随机对照试验的一部分进行，旨在研究安慰剂效应。这些访谈是在第一次试验治疗后（发现队列）和第二次试验治疗前（验证队列）收集的。结果：用llm提取的语义特征可以预测哪些个体对安慰剂有反应，在未见数据中准确率为74%，在独立队列中准确率为70%。此外，与以前的工作相比，法学硕士消除了预先选择搜索词的需要，实现了完全数据驱动的方法，并提供了对安慰剂反应背后的社会心理因素的可解释的见解。结论：这些发现通过整合最先进的NLP技术来解决相关工作中传统方法在可解释性和上下文敏感性方面的局限性，从而扩展了先前的研究。该方法强调了语言模型在联系语言和心理状态方面的作用，为更深层次的生物心理社会现象的定量探索铺平了道路，并了解了它们与治疗结果的关系。意义声明：本研究为通过语言对生物心理社会现象进行更深入的定量探索铺平了道路，并了解了它们与治疗结果（即安慰剂）的关系。在这种情况下，它突出了与应答者状态相关的细微语言模式，这些模式利用了诸如“焦虑”、“辞职”和“希望”等语义维度。

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引用次数: 0

The Efficacy of Structured Exercise Program Versus Aerobic Exercise in Tension-Type Headache: A Randomised Clinical Trial 结构化运动方案与有氧运动对紧张性头痛的疗效：一项随机临床试验。

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-12-10 DOI: 10.1002/ejp.70186

Kübra Ataş, Ebru Kaya Mutlu

Background

Despite the widespread use of exercise in managing tension-type headache, there remains a lack of research on the effectiveness of combined structured exercise programs. The aim of this study was to investigate the effects of a structured exercise program versus aerobic exercise of equal duration on tension-type headache (TTH).

Methods

Fifty-four female participants aged between 18 and 55 years were randomised to receive a 12-week exercise program, conducted twice a week for 45 min per session. The Structured Exercise Group (SEG) participated in a combination of aerobic, strengthening, and stretching exercises, whereas the Aerobic Exercise Group (AEG) performed only aerobic exercises. The primary outcome measure was the Headache Impact Test (HIT-6), a quality-of-life questionnaire. Secondary outcome measures included headache intensity, disability level, pressure pain threshold, proprioception, muscle strength, cervical posture, exercise capacity, anxiety, and depression.

Results

Both groups showed statistically significant improvements in quality of life, pain intensity, disability, anxiety, depression, exercise capacity, pressure pain threshold, and proprioception (p < 0.05). Between-group comparisons revealed that the SEG demonstrated significantly greater improvements in quality of life, pressure pain threshold, proprioception, muscle strength, and posture (p < 0.05), whereas the AEG showed superior gains in exercise capacity (p < 0.05).

Conclusion

Both exercise programs appear similarly effective for self-reported outcomes. Based on clinical measurement results, we recommend incorporating strengthening and stretching exercises into the aerobic exercise program and extending the duration to 12 weeks for additional benefits.

Significance Statement

This study highlights the clinical value of supervised, physiotherapist-led exercise and the integration of personalised, multi-component strategies in managing tension-type headache. While both structured and aerobic programs improved pain, activity, and participation, the structured approach provided additional benefits in pressure pain threshold, proprioception, muscle strength, and posture. Tailoring interventions to individual clinical needs and extending the duration beyond 8 weeks may further enhance outcomes.

背景：尽管运动被广泛应用于治疗紧张性头痛，但关于联合有组织的运动计划的有效性的研究仍然缺乏。本研究的目的是探讨有组织的运动计划与同等持续时间的有氧运动对紧张性头痛（TTH）的影响。方法：54名年龄在18岁至55岁之间的女性参与者随机接受为期12周的锻炼计划，每周进行两次，每次45分钟。结构化运动组（SEG）参加有氧、强化和伸展运动的组合，而有氧运动组（AEG）只进行有氧运动。主要结果测量是头痛影响测试（HIT-6），这是一份生活质量问卷。次要结局指标包括头痛强度、残疾水平、压痛阈、本体感觉、肌肉力量、颈椎姿势、运动能力、焦虑和抑郁。结果：两组患者在生活质量、疼痛强度、残疾、焦虑、抑郁、运动能力、压痛阈值和本体感觉方面均有统计学上的显著改善(p结论：两种运动方案对自我报告的结果似乎同样有效。根据临床测量结果，我们建议将强化和伸展运动纳入有氧运动计划，并将持续时间延长至12周，以获得额外的好处。意义声明：本研究强调了监督，物理治疗师主导的运动和个性化，多成分策略的整合在管理紧张性头痛中的临床价值。虽然结构化和有氧方案都能改善疼痛、活动和参与，但结构化方法在压痛阈值、本体感觉、肌肉力量和姿势方面提供了额外的好处。根据个人临床需要量身定制干预措施，并将持续时间延长至8周以上，可能会进一步提高疗效。

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引用次数: 0

The Total Pain in Ukraine Study: How Does War Affect Civilians With a History of Chronic Pain? An Observational Study 乌克兰的总疼痛研究：战争如何影响有慢性疼痛史的平民？观察性研究。

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-12-10 DOI: 10.1002/ejp.70185

Iana Burmistr, Ruth Zaslansky, Dmytro Dmytriiev, Andreas Kopf

Background

Chronic pain is common and can burden individuals, families and society. This exploratory study conducted in response to the full-scale war in Ukraine from February 2022 aimed to assess the impact of war-related distress on civilians living with chronic pain.

Methods

Participants were asked to fill in an online questionnaire evaluating pain diagnoses, pain characteristics, analgesic use, screening for anxiety and depression.

Results

The cohort comprised individuals receiving care in five chronic pain centres in Ukraine before February 2022. Between December 2022 and March 2023, 952 participants accessed the survey, with data from 833 qualifying for analysis. Men represented 64% (n = 533) of the cohort; 55% of the cohort (n = 455) were aged 21–40 years; 61% reported indirect exposure to the war. The majority (80%) had received some form of psychological support before February 2022. For most (72%), economic status worsened since the onset of the war. Alcohol consumption increased in 44% of the cohort. At the time of the survey, 40% reported pain intensity scores of 0–3/10, 26% scored intensities of 4–6/10 and 34% scored intensities of ≥ 7/10; 41% described their pain as ‘distressing’ or ‘horrible’. Most participants met criteria for clinically relevant anxiety (71%) and depression (82%).

Conclusions

In this cohort, pain severity before the war is unknown; however, 70% reported moderate to severe pain at evaluation. Combined with high rates of anxiety and depression, these findings highlight significant distress among Ukrainians with chronic pain and the need for sustained, individualised pain and psychological support.

Significance Statement

We assessed the impact of war on civilians with chronic pain in Ukraine. An online survey completed by 833 patients from five clinics explored bio-psycho-social pain aspects. Most were men aged 21–40 with indirect war exposure. Economic hardship was common, and half reported increased alcohol use. Moderate to severe pain affected 59%; 41% found it distressing or horrible. Anxiety and depression were prevalent. Findings highlight major gaps in care, stressing the need for personalised pain management and integrated psychological support.

背景：慢性疼痛是一种常见的疾病，可给个人、家庭和社会带来负担。这项探索性研究是针对2022年2月乌克兰的全面战争进行的，旨在评估与战争有关的痛苦对患有慢性疼痛的平民的影响。方法：参与者被要求填写一份评估疼痛诊断、疼痛特征、止痛药使用、焦虑和抑郁筛查的在线问卷。结果：该队列包括在2022年2月之前在乌克兰的五个慢性疼痛中心接受治疗的个体。在2022年12月至2023年3月期间，952名参与者参与了这项调查，其中833名参与者的数据符合分析资格。男性占队列的64% (n = 533)；55%的队列（n = 455）年龄在21-40岁；61%的人报告间接暴露在战争中。大多数人（80%）在2022年2月之前接受过某种形式的心理支持。对大多数人（72%）来说，自战争开始以来，经济状况恶化了。44%的人饮酒增加。调查时，40%的患者报告疼痛强度评分为0-3/10,26%的患者报告疼痛强度评分为4-6/10,34%的患者报告疼痛强度评分≥7/10；41%的人形容他们的疼痛“令人痛苦”或“可怕”。大多数参与者符合临床相关焦虑（71%）和抑郁（82%）的标准。结论：在这个队列中，战前疼痛严重程度未知；然而，70%的患者在评估时报告了中度至重度疼痛。结合焦虑和抑郁的高比率，这些发现突出了乌克兰人慢性疼痛的巨大痛苦，以及对持续、个性化疼痛和心理支持的需求。意义声明：我们评估了战争对乌克兰慢性疼痛平民的影响。一项由来自5家诊所的833名患者完成的在线调查探讨了生物、心理和社会方面的疼痛。大多数是有间接战争经历的21-40岁男性。经济困难很常见，一半的人报告饮酒增加。中度至重度疼痛占59%；41%的人认为它令人痛苦或可怕。焦虑和抑郁普遍存在。研究结果强调了护理方面的主要差距，强调了个性化疼痛管理和综合心理支持的必要性。

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引用次数: 0

Exploring the Relationship Between Physical Activity and Pressure Pain Tolerance in the General Population. The Tromsø Study 2015–2016 探索一般人群体力活动与压力疼痛耐受性之间的关系。特罗姆瑟研究2015-2016。

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-12-10 DOI: 10.1002/ejp.70187

Anders Pedersen Årnes, Mats Kirkeby Fjeld, Bente Morseth, Laila Arnesdatter Hopstock, Alexander Horsch, Tom Wilsgaard, Thomas Graven-Nielsen, Audun Stubhaug, Christopher Sivert Nielsen, Ólöf Anna Steingrímsdóttir

Background

Physical activity (PA) is commonly recommended for the treatment and prevention of pain. Several small-sample studies have indicated a relationship between PA and pressure pain sensitivity.

Methods

This study used data from the seventh Tromsø Study (2015–2016) cohort to assess how questionnaire-based leisure time PA (LTPA), occupational PA (OPA), and exercise-expended metabolic equivalent of task (MET) hours per week (n = 21,083), as well as accelerometer-measured total counts and moderate-to-vigorous PA (MVPA; n = 6778) relate to pressure pain tolerance (PTol). Flexible parametric survival analysis was used to estimate hazard ratios (HR) with 95% confidence intervals (CI).

Results

Higher LTPA and MET-hours per week were associated with higher levels of PTol (p < 0.001). With sedentary LTPA as a reference group, results indicated a HR of 0.87 (95% CI: 0.83, 0.92) for light, 0.75 (0.71, 0.80) for moderate, and 0.63 (0.53, 0.73) for vigorous PA. Compared to < 7.5 MET-hours per week, HRs were 0.92 (0.88, 0.96) for 7.5–14.9 MET-hours per week, 0.84 (0.78, 0.89) for 15–22.5 MET-hours per week, and 0.86 (0.82, 0.91) for > 22.5 MET-hours per week. A similar pattern was observed for accelerometer-measured PA, with a HR of 0.91 (0.88, 0.95) for MVPA and 0.93 (0.90, 0.96) for total activity counts. No clear pattern was observed for OPA. Interaction analysis indicated generally stronger effects for men, but no differences across age groups.

Conclusion

The findings suggest that higher PA in leisure-time contexts is associated with higher pain tolerance levels in the general population.

Significance Statement

Higher physical activity levels are linked to increased pressure pain tolerance, highlighting its role in modulating pain. Notably, only leisure-time activity shows a beneficial effect, while occupational activity does not. These findings suggest that the type and combination of activity may uniquely influence pain perception, challenging the idea that all physical activity benefits pain equally. Since physical activity is widely used in clinical pain management, this distinction has key implications for tailoring exercise-based interventions to optimize outcomes.

背景：体力活动（PA）通常被推荐用于治疗和预防疼痛。几项小样本研究表明了PA与压痛敏感性之间的关系。方法：本研究使用第七届特罗姆索研究（2015-2016）队列的数据来评估基于问卷的休闲时间PA （LTPA）、职业PA （OPA）和每周运动消耗代谢当量任务（MET）小时数（n = 21083），以及加速度计测量的总计数和中至剧烈PA （MVPA; n = 6778）与压力疼痛耐受性（ptel）的关系。采用灵活参数生存分析估计95%可信区间（CI）的风险比（HR）。结果：较高的LTPA和每周MET-hours与较高的PTol水平相关（p = 22.5 MET-hours / week）。在加速度计测量的PA中也观察到类似的模式，MVPA的HR为0.91(0.88,0.95)，总活动计数的HR为0.93（0.90,0.96）。未观察到OPA的明确模式。相互作用分析表明，对男性的影响一般更大，但在不同年龄组之间没有差异。结论：研究结果表明，在普通人群中，休闲时间较高的PA与较高的疼痛耐受水平有关。意义声明：较高的体力活动水平与增加的压力疼痛耐受性有关，突出了其在调节疼痛中的作用。值得注意的是，只有休闲时间的活动显示出有益的效果，而职业活动则没有。这些发现表明，活动的类型和组合可能对疼痛感知产生独特的影响，挑战了所有体育活动都对疼痛有同样好处的观点。由于身体活动在临床疼痛管理中被广泛使用，这一区别对于调整基于运动的干预措施以优化结果具有关键意义。

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引用次数: 0

Effects of Aging on Pain Tolerance: A Comparative Study of Heat Pain Thresholds and Tonic Heat and Cold Stimuli 衰老对疼痛耐受性的影响：热痛阈与补益冷热刺激的比较研究。

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-12-02 DOI: 10.1002/ejp.70180

Julia Devanne, Louise Trocmet

Introduction

Aging is known to impact both pain perception and modulation. While sensory thresholds have been extensively studied, age-related changes in pain tolerance remain less conclusive. Additionally, limited research has explored whether thermal modality differentially affects pain tolerance in older adults. This study aimed to examine modality-specific effects of aging on pain tolerance using three experimental paradigms: thermal pain tolerance thresholds, and tolerance to tonic heat and cold stimulation.

Methods

Forty-two healthy participants were recruited. Heat pain tolerance thresholds were assessed using a contact thermode. Tonic pain tolerance was measured by exposing the hand to heat or cold air for up to 10 min in a hermetically sealed box. Outcome measures included tolerance duration, pain onset latency, and subjective pain ratings.

Results

No significant age-related differences were observed in heat pain tolerance thresholds. However, older adults exhibited significantly reduced tolerance to prolonged heat stimulation, with shorter tolerance durations and higher pain ratings. In contrast, pain responses in the cold condition did not differ between age groups.

Conclusion

Aging appears to selectively reduce tolerance to sustained heat stimulation, whereas tolerance to cold and brief stimuli is relatively preserved. This supports the existence of modality-specific changes in pain processing across the lifespan.

Significance

These results underscore the importance of stimulation characteristics in evaluating pain tolerance across the lifespan. The study highlights an underexplored heat-specific vulnerability in older adults, offering insights for refining experimental pain models, improving age-sensitive assessments, and encouraging further research into physiological mechanisms underlying altered pain processing in aging.

导读：已知衰老会影响疼痛感知和调节。虽然感觉阈值已被广泛研究，但与年龄相关的疼痛耐受性变化仍不太确定。此外，有限的研究探讨了热模式是否会对老年人的疼痛耐受性产生不同的影响。本研究采用热痛耐受阈值和补益性冷热刺激耐受三个实验范式，探讨衰老对疼痛耐受的模式特异性影响。方法：招募42名健康受试者。使用接触热模评估热痛耐受阈值。强直性疼痛耐受性是通过将手暴露在一个密封的盒子里的热或冷空气中长达10分钟来测量的。结果测量包括耐受性持续时间、疼痛发作潜伏期和主观疼痛评分。结果：热痛耐受阈值无明显的年龄相关差异。然而，老年人对长时间热刺激的耐受性明显降低，耐受性持续时间较短，疼痛评分较高。相比之下，在寒冷条件下的疼痛反应在年龄组之间没有差异。结论：衰老似乎选择性地降低了对持续热刺激的耐受性，而对寒冷和短暂刺激的耐受性则相对保持不变。这支持了在整个生命周期中疼痛处理存在模式特异性变化。意义：这些结果强调了刺激特征在整个生命周期中评估疼痛耐受性的重要性。该研究强调了老年人未被充分探索的热特异性脆弱性，为完善实验疼痛模型，改善年龄敏感性评估提供了见解，并鼓励进一步研究衰老过程中疼痛处理改变的生理机制。

{"title":"Effects of Aging on Pain Tolerance: A Comparative Study of Heat Pain Thresholds and Tonic Heat and Cold Stimuli","authors":"Julia Devanne, Louise Trocmet","doi":"10.1002/ejp.70180","DOIUrl":"10.1002/ejp.70180","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Aging is known to impact both pain perception and modulation. While sensory thresholds have been extensively studied, age-related changes in pain tolerance remain less conclusive. Additionally, limited research has explored whether thermal modality differentially affects pain tolerance in older adults. This study aimed to examine modality-specific effects of aging on pain tolerance using three experimental paradigms: thermal pain tolerance thresholds, and tolerance to tonic heat and cold stimulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Forty-two healthy participants were recruited. Heat pain tolerance thresholds were assessed using a contact thermode. Tonic pain tolerance was measured by exposing the hand to heat or cold air for up to 10 min in a hermetically sealed box. Outcome measures included tolerance duration, pain onset latency, and subjective pain ratings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant age-related differences were observed in heat pain tolerance thresholds. However, older adults exhibited significantly reduced tolerance to prolonged heat stimulation, with shorter tolerance durations and higher pain ratings. In contrast, pain responses in the cold condition did not differ between age groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Aging appears to selectively reduce tolerance to sustained heat stimulation, whereas tolerance to cold and brief stimuli is relatively preserved. This supports the existence of modality-specific changes in pain processing across the lifespan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>These results underscore the importance of stimulation characteristics in evaluating pain tolerance across the lifespan. The study highlights an underexplored heat-specific vulnerability in older adults, offering insights for refining experimental pain models, improving age-sensitive assessments, and encouraging further research into physiological mechanisms underlying altered pain processing in aging.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12670344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654035","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}

引用次数: 0

Assessing the Impact of Interdisciplinary Multimodal Pain Treatment on Health-Related Quality of Life in Chronic Pain: A Systematic Review and Meta-Analyses 评估跨学科多模式疼痛治疗对慢性疼痛患者健康相关生活质量的影响：系统回顾和荟萃分析

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-12-02 DOI: 10.1002/ejp.70176

Alistair Turvill, Frances Maratos, David Sheffield

<div> <section> <h3> Background and Objective</h3> <p>Chronic pain lowers health-related quality of life (HRQoL). This review presents the most complete examination to date of how Interdisciplinary Multimodal Pain Treatment (IMPT) affects domains of HRQoL in adults with chronic pain. We compared IMPT with treatment as usual (TAU) and active control groups (ACGs) at short, intermediate and long-term follow-up.</p> </section> <section> <h3> Databases and Data Treatment</h3> <p>We searched EBSCO, Embase, Cochrane, Google Scholar, Web of Science, ASSIA, Dimensions and CORE from inception to December 2024. We included RCTs and quasi-RCTs of IMPTs reporting HRQoL outcomes. Pre- and post-intervention means were extracted; comparable subscales were combined into amalgamated domains. Random-effects meta-analyses of standardised mean differences were conducted. Risk of bias was assessed using Cochrane ROB 1, and evidence quality was rated using GRADE. Sensitivity analyses addressed heterogeneity and study quality.</p> </section> <section> <h3> Results</h3> <p>Forty-one articles (<i>N</i> = 6613) informed 39 meta-analyses. Sample sizes ranged from <i>n</i> = 10 to <i>n</i> = 703. IMPTs showed small positive effects versus TAU for Physical Functioning at short and long follow-up, and for Pain, General Health and Emotional Functioning at all follow-up points. Exploratory analyses found benefits for Pain versus ACG at short and intermediate follow-up, Vitality versus TAU and Social Functioning versus both comparators. Heterogeneity was high and evidence quality was very low.</p> </section> <section> <h3> Conclusion</h3> <p>This study adds support and novel evidence regarding the continued use of IMPTs to improve domains of HRQoL in chronic pain. Findings suggest broader benefits than previously reported. Future research should develop methodological designs to improve evidence quality and support deeper insights going forward.</p> </section> <section> <h3> Significance Statement</h3> <p>This is the first review to compare Interprofessional Multimodal Pain Therapy (IMPT) with treatment-as-usual (TAU) and active control groups (ACG) across all Health-Related Quality of Life (HRQoL) domains for chronic pain, with short, intermediate and long-term follow-up, adjusting for intervention duration. Findings provide evidence of IMPT's superiority over TAU for physical and emotional functioning, pain and general health. Novel findings show benefits over both TAU and ACG f

背景与目的：慢性疼痛降低健康相关生活质量（HRQoL）。这篇综述提出了迄今为止最完整的跨学科多模式疼痛治疗（IMPT）如何影响成人慢性疼痛患者HRQoL领域的研究。我们在短期、中期和长期随访中将IMPT与常规治疗组（TAU）和积极对照组（acg）进行比较。数据库和数据处理：我们检索了EBSCO， Embase, Cochrane，谷歌Scholar， Web of Science， ASSIA， Dimensions和CORE从成立到2024年12月。我们纳入了报告HRQoL结果的impt的随机对照试验和准随机对照试验。提取干预前后的均值；可比较的子尺度被合并到合并域中。对标准化平均差异进行随机效应荟萃分析。采用Cochrane ROB 1评价偏倚风险，采用GRADE评价证据质量。敏感性分析解决了异质性和研究质量问题。结果：41篇文章（N = 6613）涉及39项荟萃分析。样本量从n = 10到n = 703不等。与TAU相比，IMPTs在短期和长期随访中对身体功能，以及在所有随访点对疼痛、一般健康和情绪功能显示出微小的积极影响。探索性分析发现，在短期和中期随访中，疼痛组优于ACG组，活力组优于TAU组，社会功能组优于两者。异质性高，证据质量很低。结论：本研究为持续使用IMPTs改善慢性疼痛患者HRQoL领域提供了支持和新的证据。研究结果表明，它的益处比之前报道的要广泛。未来的研究应发展方法设计，以提高证据质量，并支持更深入的见解。意义声明：这是第一个比较跨专业多模式疼痛治疗（IMPT）与常规治疗（TAU）和主动对照组（ACG）在所有与健康相关的生活质量（HRQoL）领域的慢性疼痛的综述，包括短期、中期和长期随访，调整干预持续时间。研究结果提供了IMPT在身体和情绪功能、疼痛和一般健康方面优于TAU的证据。新的研究结果显示TAU和ACG对社会功能，TAU对活力和ACG对疼痛都有好处。

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引用次数: 0

Reliable Biomarkers of Descending Pain Inhibition: A Laser-Evoked Potential and Behavioural Study 下行疼痛抑制的可靠生物标志物：激光诱发电位和行为研究。

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-12-02 DOI: 10.1002/ejp.70181

Dan Wang, Xiaohan Zhang, Shuqi Ye, Whitney Carter, Patrick Finan, Mark Quigg, Shayan Moosa, W. Jeffrey Elias, Chang-Chia Liu

<div> <section> <h3> Background</h3> <p>Conditioned pain modulation (CPM) assesses descending pain inhibition, but behavioural approaches are limited by subjectivity and variable reproducibility. We tested a CPM protocol combining nociceptive-selective laser-evoked potentials (LEPs) with a repeated-trial design to determine whether neurophysiological markers complement behavioural measures and improve reliability.</p> </section> <section> <h3> Methods</h3> <p>Twenty-seven healthy adults (mean age 24.6 years; 14 female) completed two sessions ≥ 1 week apart. Nociceptive-selective laser stimuli were applied to the left hand before and after a cold pressor task, and EEG was recorded to extract LEP-N2P2 components. Temporal LEP-N1 was measured as a secondary outcome. Behavioural CPM (B_CPM) was indexed by pain ratings; neurophysiological CPM (N_CPM) was defined by reductions in LEP-N2P2 amplitude.</p> </section> <section> <h3> Results</h3> <p>Consistent behavioural responders were observed in 92.6% of participants, and N_CPM responder rates exceeded 74% across electrodes. B_CPM and N_CPM magnitudes correlated at C3, C4, and Cz (<i>ρ</i> = 0.54–0.56; FDR-adjusted <i>p</i> < 0.05). Test–retest reliability was good to excellent for B_CPM (ICC<sub>3,1</sub> = 0.69; ICC<sub>3,2</sub> = 0.81) and for N_CPM at Cz (ICC<sub>3,1</sub> = 0.63; ICC<sub>3,2</sub> = 0.77). N1_CPM showed mean attenuation but poorer test–retest reliability (ICC<sub>3,1</sub> = −0.21; ICC<sub>3,2</sub> = −0.51) and no significant correlation with B_CPM. Psychological measures were stable across visits and unrelated to outcomes in this cohort at baseline.</p> </section> <section> <h3> Conclusion</h3> <p>The repeated-trial design enabled assessment of within-subject consistency via the B_CPM induction rate. Combining behavioural and neurophysiological measures in this dual-domain framework may improve interpretability and advance standardisation of CPM methodology. LEP-based N_CPM markers showed reproducibility across sessions and may contribute to the development of brain-based biomarkers for patient stratification and treatment selection in chronic pain.</p> </section> <section> <h3> Significance Statement</h3> <p>This study establishes a reproducible dual-domain framework for assessing descending pain inhibition by integrating behavioural conditioned pain modulation with nociceptive-specific laser-evoked potentials. Using a repeated-trial design, both behavioural and cortical measu

背景：条件疼痛调节（CPM）评估下行疼痛抑制，但行为方法受到主观性和可变可重复性的限制。我们测试了一种CPM方案，结合了伤害选择性激光诱发电位（LEPs）和重复试验设计，以确定神经生理标志物是否与行为测量相补充并提高可靠性。方法：27例健康成人（平均年龄24.6岁，女性14例），间隔≥1周完成两次治疗。在冷压任务前后分别对左手施加伤害选择性激光刺激，记录脑电图以提取LEP-N2P2成分。测量颞叶LEP-N1作为次要指标。行为CPM （B_CPM）以疼痛评分为指标；神经生理性CPM （N_CPM）通过LEP-N2P2振幅的降低来定义。结果：92.6%的参与者观察到一致的行为反应，N_CPM反应率超过74%。B_CPM和N_CPM的大小在C3、C4和Cz处相关（ρ = 0.54-0.56； fdr调整后的p = 3,1 = 0.69; ICC3,2 = 0.81）， N_CPM在Cz处相关（ICC3,1 = 0.63; ICC3,2 = 0.77）。N1_CPM平均衰减，但重测信度较差（ICC3,1 = -0.21; ICC3,2 = -0.51），与B_CPM无显著相关。心理测量在就诊期间是稳定的，与基线时的结果无关。结论：重复试验设计可以通过B_CPM诱导率来评估受试者内一致性。在这种双域框架中结合行为和神经生理测量可以提高CPM方法的可解释性和推进标准化。基于lep的N_CPM标记物在不同的治疗过程中显示出可重复性，这可能有助于发展基于脑的生物标记物，用于慢性疼痛的患者分层和治疗选择。意义声明：本研究建立了一个可重复的双域框架，通过整合行为条件疼痛调节和伤害性特异性激光诱发电位来评估下行疼痛抑制。使用重复试验设计，行为和皮层测量都显示出高反应率，强相关性和良好的测试-重测可靠性。这些发现促进了CPM方法的标准化，并证明基于lep的神经生理标志物可以客观地指标抑制功能，支持可靠的、基于大脑的生物标志物的发展，以指导机制驱动的疼痛评估和个性化神经调节疗法。

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引用次数: 0