Pain Research & Management最新文献

Postoperative pain remains a significant challenge in surgical services, which necessitates improving analgesic strategies to enhance patient outcomes. Botulinum neurotoxin (BoNT), which was primarily approved for the treatment of strabismus and blepharospasm, has demonstrated a promising impact on pain reduction through mechanisms such as neurotransmitter inhibition, receptor modulation, glial activity suppression, and interactions with opioidergic and GABAergic systems. A number of studies have investigated BoNT's impact on postsurgical pain. However, there is a lack of evaluation of its efficacy, safety, and optimal administration protocols across different surgical settings. This study aims to provide a comprehensive overview of the existing literature on the efficacy and complications of intra- and postoperative BoNT injections in managing postsurgical pain across various surgical procedures, including orthopedic and head and neck surgeries, mastectomy, hemorrhoidectomy, and fissurectomy.

Background: Multisite musculoskeletal pain is a common condition among young adults, and identifying risk factors for the experience of pain is of particular interest. During the transition from adolescence to adulthood, individuals become less physically active. The aim of this study was to investigate the long-term association between physical inactivity during adolescence and young adulthood and multisite musculoskeletal pain or discomfort later in young adulthood, with analyses conducted separately for males and females.

Methods: Data on self-reported levels of physical activity at Ages 15, 18, and 21 and multisite musculoskeletal pain or discomfort at Age 28 from The West Jutland Cohort Study (n = 1833) were used. The levels of physical activity were dichotomized into low level (< 4 h per week) and high level (> 4 h per week) of physical activity. Logistic regression analysis was conducted, stratified by sex and adjusted for depressive symptoms, smoking, parental and own educational level, equivalized childhood income, and pain status at Age 15. Results were presented as odds ratios with corresponding 95% confidence intervals.

Results: The prevalence of multisite musculoskeletal pain or discomfort was 32%, and more females reported experiencing multisite pain (37%) than males (26%). The adjusted results showed that adolescents and young adults who were physically inactive were more likely to experience multisite musculoskeletal pain or discomfort later in life than those adolescents and young adults who were physically active (OR 1.9 (1.3-2.9)).

Conclusion: Physical inactivity during adolescence and young adulthood is a risk factor for experiencing multisite musculoskeletal pain or discomfort at Age 28. This emphasizes the importance of physical activity during adolescence and young adulthood for later physical health.

Objective: Pain is one of the most common and long-lasting symptoms after lung cancer surgery, potentially impairing physical functioning. This study aims to investigate to what extent pain mediates the association between the different surgical approaches (single-port VATS versus multiport VATS or thoracotomy) and postoperative functional recovery after lung cancer surgery, with the goal of establishing clinically actionable pain score thresholds.

Methods: In a prospective cohort study including 1381 patients, pain and functional status (activity limitation and walking difficulty) were assessed daily in hospital with the Perioperative Symptom Assessment for Lung Surgery (PSA-Lung). The structural equation model (SEM) was used to investigate the mediation effect of pain in the surgery-pain-functioning pathway. The pain thresholds on postoperative day (POD) 1, 2, and 3 for optimal functional recovery were identified, corresponding to the cutoff points of pain categorization that demonstrated the largest indirect effects in the models.

Results: The surgical approach had a significant indirect effect on activity limitation and walking difficulty through pain severity (p < 0.001), with a standardized effect value of 0.039 and 0.037, respectively. According to the largest mediation effects of pain categories generated from the each day SEM, the optimal pain score cutoffs are 5 on POD1, 4 on POD2, and 3 on POD3, for both activity limitation and walking difficulty.

Conclusion: Our study quantified the partial mediating effects of pain between surgical approaches and postoperative functional status in patients with lung cancer surgery. The mediation effect-based pain thresholds support precise strategies for postoperative functional rehabilitation, which is considered the major goal of enhanced recovery after surgery. Trial Registration: Chinese Clinical Trials Registry: ChiCTR2000033016.

Pain management apps are gaining popularity for providing timely, accessible care. However, digital health intervention research is still in its infancy, with a limited understanding of how users experience and make meaning of these tools. This study explores users' experiences with the Curable app, considering its impact and the influence of contextual factors. Semi-structured interviews were conducted online with 12 Curable app users for chronic pain. Transcripts were analysed using reflexive thematic analysis through a critical realist lens. Five themes were conceptualised: (1) The space between, participants navigate a paradoxical space where trust coexists with scepticism and desperation with hope in a delicate balance. (2) Tin Man and the Invisible Women, follows the participants' journeys towards the Curable app, navigating systemic biases and cultural norms. (3) It Takes a Village, highlights the 'village' of people, resources and modalities participants needed for effective pain care, beyond a solely biomedical approach. (4) Enjoy Being in the Process of Becoming, follows participants' interoceptive journey as they reconnect with the present moment, finding peace with their pain. (5) Fiend to Friend; a story of neuroplasticity, illustrates a shift in participants' fearful and combative relationship with pain towards a more conscious and compassionate companionship. The Curable app helped to fill gaps in existing care, illustrating the potential of digital tools when woven into broader ecosystems of support. However, as with all qualitative inquiry, these findings are situated and partial, reflecting the perspectives of well-educated, cisgender, English-speaking participants who chose to engage with this research.

Objectives: This study aimed to investigate the prevalence and risk factors of mechanical pain in patients with advanced knee osteoarthritis (KOA), providing insights for targeted treatment approaches.

Methods: We conducted a cross-sectional study involving 920 patients with KOA. The sample size was determined using the formula n=(Z ²∗P∗(1 - P))/E ², assuming a 95% confidence interval (CI) and a 5% margin of error. Data on demographics and affected knee parameters, including age, sex, body mass index (BMI), affected side, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, range of motion, degree of varus, and numeric rating scale (NRS) were collected. Pain was categorized using the painDETECT questionnaire and WOMAC scores to differentiate between simple mechanical pain, mixed mechanical pain, and probable neuropathic pain (NP).

Results: Among participants, 43.48% experienced simple mechanical pain, 33.48% had mixed mechanical pain, and 23.04% reported probable NP. Significant differences were observed in the total WOMAC scores, range of motion (bend), and NRS across the three groups. Gender distribution varied significantly, with a higher proportion of female patients in each pain category. Notably, NRS on the affected side was moderately correlated with the total WOMAC pain score (r = 0.500, ^∗ p < 0.05). Moreover, female patients exhibited significantly higher WOMAC pain scores (6.28) compared with males (6.08), and women with a WOMAC pain score > 4 had an odds ratio (OR) of 2.462 (95% CI: 1.766-3.433, ^∗ p < 0.05) compared with those with a score ≤ 4.

Conclusions: Mechanical pain is highly prevalent in patients with advanced KOA. Identifying the specific type of mechanical pain and associated risk factors, such as female gender and higher NRS score, can facilitate personalized pain management.

Objectives: Opioid-free anesthesia (OFA) is a promising alternative to traditional opioid-based anesthesia. Research indicates that OFA reduces postoperative opioid consumption and related adverse effects while maintaining effective pain control and patient safety. Despite these benefits, clinical adoption of OFA remains limited, possible due to gaps in evidence. To bridge this knowledge gap, a web-based survey was used to assess Swedish healthcare professionals' (HCPs') knowledge, attitudes, and practices regarding OFA, aiming to identify barriers and facilitators for its broader integration into routine anesthesia care.

Methods: A web-based survey was sent to anesthesiology department heads at all university hospitals in Sweden and three randomly selected smaller hospitals. The department heads distributed the survey to anesthesiologists, nurse anesthetists, critical care nurses, and registered nurses involved in intraoperative care. The questionnaire had four sections: demographic data, general questions regarding intraoperative care, specific questions on OFA usage, and an open-ended question.

Results: A total of 309 HCPs responded to the survey, corresponding to a response rate of 35%. The majority of respondents (77%) had seven or more years of perioperative experience, 63% were female, and 82% worked at university hospitals. Knowledge about OFA was generally low, with 62% reporting insufficient knowledge, and 14% actively applied OFA. Self-report data demonstrated that anesthesiologists had significantly lower knowledge levels on applying OFA compared to nurse anesthetists and critical care nurses (p < 0.01). However, 85% of all HCPs expressed interest in acquiring additional theoretical knowledge about OFA. Additionally, 87% reported either absent guidelines or uncertainty about their existence, while most (57%) agreed that guidelines supporting the practice of OFA should be introduced at their clinic.

Conclusion: This survey indicated interest in OFA among Swedish perioperative HCPs while revealing key barriers to implementation, including knowledge gaps and limited guidelines. Addressing these challenges through targeted education and institutional support may facilitate broader OFA adoption, enhancing patient safety and multimodal perioperative pain management.

Introduction: Exercise-induced pain (EIP) is a transient pain phenomenon that emerges during physical exertion and resolves soon after exercise cessation. Despite being recognized as a performance-limiting variable in endurance sports, the mechanisms driving its interindividual variability remain poorly defined. We aimed to determine whether sex remains a significant predictor of EIP intensity after adjustment for performance and pain sensitivity.

Materials and methods: This cross-sectional study enrolled 122 recreational athletes (61 males and 61 females), including 48 trail runners and 74 hikers. Participants provided self-reported data on demographics and training habits. Performance was evaluated using both external and internal load metrics: external load was represented by activity duration and effort-adjusted speed, while internal load was assessed using the rating of perceived exertion (RPE). Maximum and average EIP was rated on a numeric rating scale and combined into a pain composite score (PCS). Pain threshold and tolerance were measured using the cold pressor test. Associations between variables and pain outcomes were analyzed using generalized linear models.

Results: No significant differences were observed in maximum or average EIP intensity, pain threshold, or pain tolerance between male and female athletes. Sex was not a significant predictor of the PCS after adjusting for external and internal exercise load. Neither pain threshold nor tolerance significantly predicted PCS, and these associations did not vary by gender.

Conclusion: In recreational endurance athletes, sex had no significant impact on EIP intensity when accounting for performance and pain sensitivity. These findings challenged traditional assumptions about sex-related pain differences.

Objectives: To assess perceived changes in children's understanding of the pain-damage relationship and the brain's influence on pain following exposure to sham and pain science education (PSE) books.

Methods: A series of single-case experimental designs were replicated across 17 children (8-12 years), with and without chronic pain, over six weeks. Following baseline, participants received a sham book and then a PSE book. The Concept of Pain Inventory (COPI) (total and selected items) and qualitative interviews (child and interviewer) assessed conceptual change and book acceptability.

Results: COPI scores for three targeted items fluctuated but generally increased after the PSE book for both groups, suggesting improved understanding. Discrepancies between COPI responses and interview data occurred in 88% of children, indicating varied perspectives on the nature and extent of conceptual change. The PSE book was found to be acceptable and was preferred by most children.

Discussion: Children's understanding of core pain science concepts can improve with targeted, book-based PSE. The dynamic nature of conceptual change and observed discrepancies between quantitative and qualitative assessment methods underscore the value of using multiple approaches to evaluate learning in pediatric PSE.

Objectives: A tendency to jumping to conclusions (JTCs) was described in schizophrenia, in functional movement disorders and recently in a mixed group of chronic pain patients and has been discussed to indicate prefrontal dysfunction. This study investigated the tendency to premature decisions (JTC) in patients with complex regional pain syndrome (CRPS), a severe disorder affecting predominantly the distal limb, compared to healthy individuals and those with chronic limb pain from other causes, such as nerve injury or musculoskeletal abnormalities (non-CRPS).

Methods: In the classic 'beads task', visual stimuli were used to assess evidence-based decision-making ability, followed by a variation with somatosensory stimuli. Thirty patients with CRPS were compared to 23 non-CRPS patients and 30 healthy individuals. Results were related to clinical data such as pain intensity, disease duration, CRPS phenotype based on predominant symptoms (central, peripheral and mixed) and standardized questionnaires evaluating depressive and anxiety symptoms. The main outcome was the number of draws to decision (DTD), i.e., how many beads participants requested before making a final judgement. Group differences were analysed using AN(C)OVA or Kruskal-Wallis tests with Bonferroni-corrected post hoc comparisons, unpaired t-tests and chi-squared tests as appropriate. Correlations between beads task performance and clinical parameters were examined using Pearson's or Spearman's analyses, while ANCOVA was applied to control for age, anxiety and depressive symptoms as covariates.

Results: Both CRPS and non-CRPS patients showed a significantly stronger JTC tendency, deciding at a lower DTD (2.63 ± 1.19 and 2.65 ± 1.27, respectively) than healthy controls (5.13 ± 1.92, both p < 0.001), without differences between patient groups, and the effect was independent of the CRPS phenotypes. DTD correlated with depressive or anxiety symptoms and age but not with pain intensity or disease duration.

Conclusion: Dysfunctional processes leading to JTC seem to play a role in chronic pain patients and interact with depressive and anxiety symptoms. These interactions may impact treatment outcomes and warrant further investigation.

Background: Although pain catastrophizing has been studied widely, there is no consensus on what constitutes an exaggerated response, that is, true catastrophizing, from what might be proportional unpleasant or negative responses to pain. Most available catastrophizing assessments ask respondents to consider when "in pain," with no assessment of these referent pain anchors. Thus, the influence of referent pain on catastrophic thinking remains unclear. We aimed to assess consistency across referent pain scenarios and to characterize "high" catastrophizing-representing exaggerated responses relative to referent pain intensity.

Methods: A total of 228 adults (152F) completed this observational study. The Pain Catastrophizing Scale (PCS) was completed 4 times interspersed with other assessments. First, with standard instructions, then with specific referent scenarios in a blocked order to minimize order effects. Anticipated scenario pain intensities were rated using a 0-10-cm scale. PCS cross-situational consistency was assessed with intraclass correlations. Mixed linear models evaluated the PCS-referent pain relationship, with and without covariate adjustment.

Results: PCS cross-situational consistency was high, with ICCs = 0.79-0.84. However, total scores varied significantly across referent scenarios, where catastrophizing generally increased with referent pain intensity (R = 0.74, p < 0.0001), and pain explained 40% of PCS variability. The best fit model of "high" catastrophizing, using the 75th percentile, varied with referent pain intensity, underscoring the importance of contextual anchors, without notable sex differences.

Conclusions: Trait PCS scores should not be interpreted as context-free indices of catastrophizing. The wide range of published PCS cut points may in part reflect differences in referent pain, highlighting the need to contextualize catastrophizing scores for appropriate interpretation.