Pain Research & Management最新文献

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.

Objective: To compare and evaluate the effect of ProTaper Ultimate root canal instrumentation on postoperative pain level of mandibular first molars showing symptomatic irreversible pulpitis and symptomatic apical periodontitis.

Methodology: Forty patients referred to root canal treatment of the mandibular first molar were randomly divided into two equal groups according to the rotary file system used in the chemomechanical preparation: ProTaper Ultimate (n = 20) and ProTaper Gold (n = 20). After evaluating the preoperative pain score using the visual analog scale, the root canal treatment was performed in a single visit using a standardized protocol by a single operator. Postoperatively, the pain scores were recorded at 24-, 72-h, and 7-day intervals. Statistical analysis was performed at a significance of 0.05.

Results: No significant difference was shown between the ProTaper Ultimate and the ProTaper Gold groups in the intensity of postoperative pain at all time intervals. The postoperative pain score was zero at 7 days postoperatively for both groups.

Conclusion: The ProTaper Ultimate files' effect on postoperative pain is equivalent to that of the ProTaper Gold files.

Clinical relevance: The ProTaper Ultimate files' effect on postoperative pain is equivalent to that of the ProTaper Gold files. ProTaper Ultimate and ProTaper Gold rotary file systems can be equally and safely used in single-visit root canal treatment.

Trial registration: ClinicalTrials.gov identifier: NCT05747183.

Background: In childhood, assessing the history of headaches in children can be challenging due to their age and the reliance on parental reports, which may sometimes lead to under/over-reporting of symptoms. This study utilized the ID Migraine questionnaire to evaluate the presence of headaches in a sample of children and examined the correlation between the children's responses and those of their mothers.

Methods: A cohort of children aged 10-12 years and their mothers administered the ID Migraine questionnaire separately, which included questions about the children's headaches.

Results: The cohort comprised 68 children (35 females and 33 males) aged 10-12 years. Within the last 3 months, 24/68 (35.3%) reported experiencing a history of headache episodes. Headache was reported by 16/35 females (45.7%) and 8/33 males (24.2%). Of the total, only 2/68 (2.95%) met two of the three criteria for potential migraine classification, 11/68 (16.1%) met at least one criterion, and 11 reported headaches but did not meet any criteria. Discrepancies between the children's and mother's responses occurred in 23/68 cases (33.8%), of which 14 (about 61%) disagreed about the occurrence of headaches in the past 3 months and 9 (about 49%) had inconsistencies in their responses to the Migraine ID items.

Conclusions: These results highlight the challenges of collecting headache data in children under 12 years of age. Notably, there is a discrepancy between children's and mothers' reports, with underreporting headaches reported by the other in nearly 60% of the conflicting cases. Additionally, the incidence of migraine observed in this sample was lower than what is commonly suggested in the literature.

Background: This study aims to identify sociodemographic factors associated with cannabis use for chronic pain management before and after COVID-19 was declared a pandemic. Furthermore, it seeks to compare cannabis use patterns in adults with and without chronic pain.

Methods: We analyzed US-based responses from the COVID-19 Cannabis Health Study, a cross-sectional online survey administered via REDCap between March 2020 and March 2022. All respondents were cannabis consumers in the past year. Cannabis use patterns and chronic pain were self-reported via the COVID-19 Cannabis Health Questionnaire. Statistical analysis included Chi-square tests, Fisher's exact tests, t-tests, and multivariable logistic regression with a two-tailed alpha of 0.05 for significance.

Results: Among 2243 participants, 50.3% consumed cannabis to manage chronic pain. Younger age (< 40 years; aOR: 3.20, 95% CI: 2.59-3.96), Hispanic/Latino ethnicity (aOR: 2.20, 95% CI: 1.56-3.05), and higher income levels (> $100,000 annually; aOR: 1.69, 95% CI: 1.25-2.29) were associated with higher odds of consuming cannabis to manage chronic pain. Participants using cannabis for chronic pain were more likely to use a CBD/THC ratio. The pandemic led to increased dosages and changes in consumption methods: 40.5% increased their cannabis dose, smoking as the primary method declined from 62.2% before the pandemic to 34.5% afterward, while edibles rose from 7.9% to 30.9%, and tinctures from 3.2% to 8.6%. Route changes varied with chronic pain status.

Conclusion: There was a shift from smoking to nonsmoking methods to manage chronic pain. Those who were younger and those of Hispanic/Latino ethnicity had higher odds of using cannabis for chronic pain.

Background: Active physiotherapy utilizes patient-centered, sensorimotor-integrated interventions to modulate central nervous system function. This randomized controlled trial (RCT) compared the efficacy of multimodal active physiotherapy (MAP) versus multimodal passive physiotherapy (MPP) in improving physical and mental health in chronic nonspecific neck pain (CNNP) patients.

Methods: This single-blind, stratified parallel-group RCT included 54 patients with CNNP. Participants were randomly assigned to the MAP or MPP group, both receiving 16 treatment sessions (60 min/session) over 8 weeks. Primary outcomes were pain intensity (Numeric Pain Rating Scale) and emotional status (Hospital Anxiety and Depression Scale). Secondary outcomes included patient-perceived change, pain modulation, insomnia symptoms, kinesiophobia, neck function, and mental health-related quality of life (QoL). Intention-to-treat analyses were performed.

Results: Postintervention, there were no significant group-time interactions in the primary outcomes (pain intensity, anxiety, and depression; all p > 0.05), despite significant within-group improvements from baseline (all p < 0.01). Analyses adjusted for covariates confirmed no between-group differences. For secondary outcomes, the MAP group demonstrated superior improvements compared to the MPP group in conditioned pain modulation, kinesiophobia, and mental health-related QoL; no other significant differences were observed between the groups.

Conclusion: In patients with CNNP, MAP and MPP result in comparable improvements in pain and emotional status; however, MAP demonstrates superior benefits relative to MPP in pain modulation, movement-related fear, and mental health-related QoL.

Trial registration: Chinese Registry of Clinical Trials: ChiCTR2500104619.

Background: Electroacupuncture (EA) has been widely applied in treating dysmenorrhea and autonomic dysfunction. Low-level laser acupuncture (LLLA), a noninvasive acupuncture, has been used clinically, but efficacy is uncertain. This study aimed to explore the efficacy of LLLA, EA, and sham-controlled LLLA on pain, heart rate variability (HRV) activity, and symptom improvement in dysmenorrhea with autonomic imbalance.

Method: In a randomized, controlled design, a total of 114 women with dysmenorrhea and autonomic imbalance were randomly allocated to three groups: sham LLLA, LLLA, and EA. The primary outcomes are pain (VAS), and HRV parameters, and the secondary outcomes are symptom assessment (verbal multidimensional scoring system), prostaglandin E, progesterone levels, and the SF-12 quality-of-life assessment.

Results: Contrast to the sham acupuncture, LLLA and EA effectively reconciled the pain and sympathetic/parasympathetic tone significantly, no matter the vagus or sympathetic deviated status (low or high LF/HF group). LLLA was superior to EA in terms of SDNN, RMMSD, and PNN50 (p < 0.001) in the low LF/HF group in intergroup analysis. For all participants' analysis, the effects of LLLA and EA were similar for pain assessment (VAS) and quality of life (SF-12) (p < 0.05). In proinflammatory cytokine measurement, EA showed a significant decrease in prostaglandin E2 (PGE2) levels (p = 0.022).

Conclusion: This pilot study showed both LLLA and EA effectively relieve dysmenorrhea without a placebo effect, LLLA is noninferior to EA in autonomic dysfunction, and the effect is even more prominent in low LF/HF status (a relatively lower energy status). Given its noninvasiveness, LLLA could be an alternative treatment and warrants further large-scale study.

Trial registration: ClinicalTrials.gov identifier: NCT04178226.

Radiofrequency and cryoneurolysis are promising options for managing chronic and acute pain. These minimally invasive techniques target nerve structures to alleviate pain in various conditions. This narrative review aims to provide an overview of the historical development, current techniques, applications, and existing evidence for radiofrequency and cryoneurolysis in pain management. While research is ongoing, evidence suggests their effectiveness in treating conditions like postmastectomy pain, phantom limb pain, radicular pain, and trigeminal neuralgia. However, their adoption in clinical guidelines varies, and they carry potential risks. Healthcare professionals should carefully consider the benefits, risks, and current evidence base when making treatment decisions.

Objectives: Calcaneal spur is an important cause of chronic pain that is resistant to conservative treatments and reduces quality of life. Nerve ablation techniques are widely used in chronic pain. This study aimed to investigate the short- and long-term effects of radiofrequency thermocoagulation (RFT) and intralesional cryoablation (CA) on pain management, functional limitation, and ankle function in patients with calcaneal spurs.

Materials and methods: This study included 71 patients aged between 28 and 52 years (body mass index, 22.3-31.1) who were receiving chronic pain treatment. The patients were evaluated pre- and postoperatively using the visual analog scale, functional limitation, activity limitation, and American Orthopedic Foot and Ankle Society score.

Results: VAS was measured as 1.2 ± 0.1 in the RFT group and 1.3 ± 0.2 in the CA group at 6 months. RFT yielded faster and more effective results in pain management and short-term functional improvement (p=0.00002), whereas CA was superior to the former in terms of ankle function in the long term (p=0.0001).

Conclusion: RFT and CA have different advantages. Thus, personalized treatment should be provided to each patient. Although our study was conducted retrospectively, prospective studies are needed to support our findings.