Chronic overlapping pain conditions (COPCs) are a constellation of disorders posited to share an underlying pain mechanism (nociplastic pain). Unfortunately, individuals with COPCs are under-represented in clinical research. The current study aimed to determine COPC prevalence among participants enrolled in a pragmatic clinical trial and compare those with COPCs to those with non-COPCs across several domains.
Learning to Apply Mindfulness to Pain (LAMP) study baseline data of veterans with chronic pain (N = 811) were utilised. COPC diagnoses were determined using ICD-10 codes within electronic health records. Group differences across pain and functioning-related domains were compared with and without adjustment for age and gender.
Among participants with COPCs (54%), most were diagnosed with only one COPC (74%). Chronic lower back pain (71%) and migraine (28%) were the most common. Participants with COPCs were younger and more likely to be female relative to those with non-COPCs. The COPC subset was also more likely to be diagnosed with PTSD, depressive disorders and sleep disorders (p < 0.05). Those with COPCs also reported greater pain severity and interference, more impaired health-related quality of life, greater pain catastrophising and lower pain self-efficacy than participants without COPCs (p < 0.05).
COPCs were common among a sample of veterans in a pragmatic clinical trial. Several baseline differences emerged indicating veterans with COPCs experience greater mental health concerns and endorse distinct pain characteristics and pain mediators. Future research is needed to further characterise this recently defined and under-represented group.
Individuals with COPCs are medically complex, yet are understudied and underrepresented within pain trials research. COPCs, which predominantly impact women, are also understudied within U.S. veterans. Our findings highlight how veterans with COPCs are participating in clinical research even when interventions are not tailored to their unique characteristics. Our work also contributes to a nuanced understanding of this disease burden and is among the first to describe differences among veterans with COPCs and veterans with chronic pain but without COPCs.
Repetitive transcranial magnetic stimulation (rTMS) is recommended as a third-line treatment for chronic neuropathic pain. Because of its non-invasive nature and limited side effects, it is considered a good therapeutic option. rTMS efficacy on chronic neuropathic pain has been demonstrated in numerous quantitative studies. However, there are no qualitative studies to support these quantitative data.
Included patients presented with peripheral neuropathic pain related to polyneuropathy (n = 6), radiculopathy (n = 3) and traumatic or surgical nerve injury (n = 3). The target of the rTMS was the primary motor cortex. We conducted a longitudinal qualitative study consisting of two separate semi-structured interviews for all 12 participants from four different French multidisciplinary pain centres, one before starting treatment and the other after 2 months of rTMS treatment. Two separate manual analyses by two researchers were carried out, as were software analysis and data triangulation.
Our study revealed an overall positive impression about rTMS treatment, with improvements in pain and activities of daily living. However, most participants felt that information on this treatment was inadequate because of difficulties in understanding the treatment mechanism. These difficulties frequently led to misrepresentations about the treatment, which could result in secondary fears, particularly in relation to the fear of cognitive capacity loss.
The results suggest possible areas for improvement, both in clinical practice and in care organisation. Information provided to patients could be optimised, with a focus on more personalised care, considering preliminary representations and fears, so as to further encourage adherence to treatment. Furthermore, it is necessary to train healthcare staff in order to optimise the care pathway for patients suffering from intractable chronic pain and to limit the risks of delays in treatment.
rTMS treatment showed overall positive effects on pain and quality of life. Many participants lacked clear understanding of the treatment mechanism, leading to fear and misinformation. Improvements are needed in patient education and healthcare staff training to support therapy compliance and optimise care.
Spinal cord stimulation (SCS) is a well-established treatment for chronic neuropathic and ischaemic pain. Although patient-reported outcomes have increasingly gained recognition, the impact of SCS on informal caregivers—an equally important consideration—remains underexplored. This study aims to address this gap by evaluating multidimensional outcomes following SCS, with a particular focus on the burden experienced by informal caregivers over a one-year period.
A prospective cohort study was conducted involving 35 patient-caregiver dyads treated with SCS between January and December 2021 at AZ Delta and Jan Yperman Hospital. Inclusion required the availability of a spousal or offspring caregiver. Patients and caregivers were evaluated preoperatively and at 3, 6 and 12 months postoperatively using validated instruments including the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), EuroQuality of Life-5 Dimensions (EQ5D), Zarit Burden Index (ZBI), Modified Caregiver Strain Index (MCSI) and Relation Quality Indexes (RQI).
Patients reported significant reductions in leg and back pain (p < 0.001), leading to decreased disability (p < 0.001) and improved quality of life (p < 0.05) during follow-up. However, no significant changes were observed in caregiver burden or in the quality of the patient-caregiver relationship.
While patients reported significantly lower pain and better quality of life following SCS, these benefits do not extend to reducing caregiver burden or strengthening the patient-caregiver relationship. A holistic treatment approach that actively involves caregivers may be necessary to optimise outcomes for both patients and caregivers. Further research with a larger cohort is required.
This prospective cohort study is the first to analyze the patient-caregiver dyad in chronic pain patients treated with SCS. Although SCS effectively reduces pain and improves the quality of life of patients, these benefits do not extend to reducing caregiver burden or enhancing the patient-caregiver relationship. We argue that a more holistic approach, including caregiver involvement in the treatment process, may be necessary to improve outcomes for both patients and caregivers.
Although robust genetic markers for episodic migraine (EM) have been identified, variants associated with chronic migraine (CM) are still unknown. Given the potential pathophysiologic overlap between EM and CM, we investigated whether six single nucleotide polymorphisms (SNPs), robustly associated with EM susceptibility (LRP1 rs11172113, PRDM16 rs10797381, FHL5 rs7775721, TRPM8 rs10166942, near TSPAN2 rs2078371 and MEF2D rs1925950) also play a role in the risk of developing CM.
A total of 200 EM and 202 CM participants were prospectively included. Genotyping of selected SNPs was performed by TaqMan real-time PCR in 192 individuals with EM and 198 with CM who consented to genetic analysis. A validation group of 312 healthy individuals was used. Genetic associations were assessed by logistic regression using dominant, recessive, and allelic models.
In multivariable logistic regression analysis, LRP1 rs11172113 T>C and (near) TSPAN2 rs2078371 T>C were nominally associated with CM. However, only the association for LRP1 rs11172113 survived Bonferroni correction, with carriers of the minor C allele (genotypes T/C or C/C) having a lower risk of CM compared to wild-type homozygous subjects (OR: 0.38; 95% CI: 0.20–0.71; p-value: 0.0025). This protective effect was also observed in the analysis comparing CM participants with healthy controls.
Carriers of the minor allele of LRP1 rs11172113 have a reduced risk of CM. However, further large-scale studies, ideally with a multicentre design, are warranted to confirm the association between LRP1 rs11172113 and CM.
This study identified an association between the minor allele of LRP1 rs11172113 (low-density lipoprotein receptor-related protein 1, a receptor with key roles in lipid metabolism, vascular integrity, and inflammation control) and a reduced risk of chronic migraine. These findings support the hypothesis that episodic and chronic migraine share genetic risk factors and suggest a potential protective role for this variant.
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