Pain Research & Management最新文献

Background: Coccyx morphologic features have been found to be associated with coccydynia, while coccygeal anatomical data of patients with coccydynia is scarce. The purpose of this study is to evaluate the morphological and morphometric parameters of the sacrococcyx in patients experiencing coccydynia.

Methods: Radiographic examinations of the pelvis were conducted on a cohort of 244 patients diagnosed with coccydynia. Sacrococcygeal morphological features and morphometric parameters were documented and measured.

Results: The most prevalent coccyx type was Type II (33.1%), followed by Type III (28.1%), Type IV (21.5%), Type I (12%), and Type V (5.4%), respectively. Coccygeal sacralization was present approximately one-third of cases. Around a quarter of the subjects exhibited subluxation. Bony spicule was present in 22.3% individuals. Lateral deviation of the coccyx was present in roughly one-fifth of the patients. Sacral curvature index and sacrococcygeal angles were greater in males with coccydynia than in females, while the coccygeal curvature index was smaller in males. The straight length of the coccyx, coccygeal curved index, and sacrolumbar angle all showed an increase with age.

Conclusion: Patients with coccydynia usually showed a more ventrally curved coccyx. Bony spicule, coccygeal sacralization, and lateral deviation of the coccyx were common among coccydynia patients. Coccyx alignment tended to become straighter, and the sacrolumbar angle tended to increase with age. Individuals presenting with these aforementioned anatomical features appear to be predisposed to coccydynia.

Background: Empathy for pain is a complex psychological process that enables us to understand the feelings of others experiencing pain. Personal pain experiences may shape our empathetic responses, though the precise relationship between empathy for pain and pain perception is not fully understood.

Objective: This study investigates how firsthand pain experiences influence brain responses related to empathy for pain.

Methods: We recruited 26 participants who underwent either painful or nonpainful electrical stimulation. They were then shown static pictures of hands in painful and nonpainful situations and asked to report their subjective ratings of pain empathy. Electroencephalograph activity was recorded to analyze the neural basis of their experiences.

Results: Participants who experienced painful stimulation reported higher empathy levels when viewing painful images. Electroencephalograph data revealed that painful stimulation elicited larger N1 and P2 amplitudes at the Cz electrode compared to nonpainful stimulation. It also enhanced N2 amplitudes in the frontal-central region when viewing painful pictures. Nonpainful stimulation reduced the discriminatory ability of N2 for subsequent painful and nonpainful images. Correlation analysis showed that individuals with higher pain sensitivity had greater variation in P2 responses to painful and nonpainful stimuli but less variation in N2 responses related to pain empathy.

Conclusions: These findings suggest that experiencing pain directly may enhance brain responses to others' pain, thereby increasing levels of pain empathy. This enhancement may be influenced by individual pain sensitivity and is less pronounced in those with high pain sensitivity.

Background: Mitochondria play a crucial role in various cellular processes, and their dysfunction has been increasingly recognized as a significant factor in the pathophysiology of chronic pain. Despite growing interest in this area, a comprehensive bibliometric analysis of the research trends, key themes, and influential contributions in the study of mitochondria and pain has not been conducted. This study aims to fill this gap by providing a detailed overview of the research landscape from 2004 to 2024.

Methods: A comprehensive literature search was performed using the Web of Science Core Collection database to identify relevant studies published between January 1, 2004, and June 24, 2024. A total of 1995 articles were identified and included in the analysis. Bibliometric tools, including CiteSpace, VOSviewer, and RStudio, were employed to analyze and visualize data related to cocitation networks, keyword co-occurrence, and clustering patterns. The analysis focused on identifying research trends, key authors, influential journals, and emerging themes within the field.

Results: The analysis revealed a significant increase in research activity on mitochondria and pain, particularly after 2011, with the number of publications rising from 74 in 2015 to 171 in 2020, representing a 131% growth during this period. Key themes identified include mitochondrial dysfunction, oxidative stress, neuroinflammation, autophagy, and mitochondrial biogenesis. The United States, China, Germany, and the United Kingdom emerged as leading contributors to the field, with prominent institutions such as Harvard University and the University of California playing central roles in collaborative networks. Influential authors and foundational studies were identified through cocitation analysis, highlighting the interdisciplinary nature of the research.

Conclusion: This bibliometric analysis provides a comprehensive overview of the evolving research landscape in mitochondria and pain, highlighting key trends, influential contributions, and emerging research directions. The findings underscore the growing recognition of mitochondrial dysfunction as a critical factor in pain mechanisms and suggest that future research should focus on translating basic findings into clinical practice while expanding global collaborations.

Background: Nonpharmacological interventions are necessary tools for managing chronic pain to reduce dependence on prescribed analgesic medications. myoActivation® is an innovative systematic nonpharmacological assessment and needling process to help reduce chronic pain related to myofascial dysfunction (MFD). Aim: Analyze quantitative data collected during a longitudinal mixed methods observational pilot study in patients living with social and health inequities undergoing myoActivation as part of routine clinical care to determine the impact of this treatment approach on pain intensity, enjoyment of life, general activity, and unregulated drug use. Methods: Following ethics approval, we conducted a prospective observational study of patients receiving sequential myoActivation for chronic pain. Data were collected at baseline (Week 1) and subsequently at 4, 12, and 24 weeks using validated tools, including the PEG (Pain, Enjoyment of Life, General Activity) scale as well as self-reports of substance and analgesic use. Results: There were 35 participants with a median (interquartile range) baseline PEG score of 7.7/10 (6.7-8.7/10). PEG scores improved at each follow-up, with a mean difference from baseline of -2.5 (95% CI -3.4 to -1.5, p < 0.001) at Week 24, which corresponds to a clinically significant (> 30%) and lasting improvement. At 24 weeks, 9/27 (33%) participants reported less unregulated drug use, and 8/27 (30%) reported less analgesic medication use. Discussion: This study suggests that myoActivation pain care can be an effective tool, with a lasting positive impact, to manage MFD and chronic pain in a population living with social and health inequities. Further studies are needed to examine the impact of myoActivation in the primary care setting. Trial Registration: ClinicalTrials.gov identifier: NCT04261959.

Objective: Diabetic peripheral neuropathy (DN) is a common complication of diabetes, characterized by symptoms that are milder during the day and worsen at night. This study aims to uncover the role of circadian NRF2 expression in dorsal root ganglia (DRG) in regulating pain sensitivity and explores its disruption on neuropathic pain. Method: Male BKS.Cg-Lepr^db/db/J (db/db) type 2 diabetic mice (T2DM) were used as a model for DN. Diurnal pain sensitivity in the mice was evaluated through force withdrawal threshold (FWT) and thermal withdrawal latency (TWL) at Zeitgeber Time (ZT) 2 and ZT14 from 8 to 16 weeks of age. Sciatic nerve conduction velocity (SNCV) and oxidative stress levels in DRG were evaluated. Oxidative stress levels and antioxidant activity were assessed using fluorescent probe staining. NRF2 expression was evaluated through molecular and histological methodologies. The circadian regulatory genes (Clock, Bmal1), inflammatory factors (IL-6 and IL-10), and NRF2 target gene HO-1 were all detected by qRT-PCR. To directly investigate NRF2's role, AAV-mediated intrathecal injection was used to knock down NRF2 in DRG, disrupting its circadian rhythmicity. Results: A significant diurnal variation in neuropathic pain sensitivity was observed in db/db mice, with increased pain sensitivity at ZT2 compared to ZT14. Elevated ROS levels were detected in the DRG of db/db mice, especially at ZT2. In db/+ mice, NRF2 showed diurnal rhythms with higher expression at ZT2, a pattern disrupted in db/db mice, accompanied by elevated ROS levels and inflammation in the DRG. NRF2 knockdown yielded distinct effects: in db/db mice, it further elevated ROS levels at ZT14, impaired antioxidant capacity, and imbalance between pro-inflammatory and anti-inflammatory factors without significantly altering pain sensitivity, whereas in db/+ mice, it reduced pain thresholds and induced diurnal variations in pain sensitivity. Conclusion: The circadian rhythmicity of NRF2 in nondiabetic (db/+) mice is essential for maintaining the balance between anti- and pro-ROS, as well as inflammation, thereby preventing pain exacerbation and diurnal variations. Its disruption increases oxidative stress and inflammation, associated with induced diurnal pain sensitivity. In diabetic (db/db) mice, the loss of NRF2 rhythmicity exacerbates oxidative stress but minimally affects pain sensitivity, indicating a ceiling effect in pain sensitivity. These findings highlight NRF2 rhythmicity as a potential chronotherapeutic target for managing diabetic neuropathy.

Objective: To investigate whether the tip of the spinal needle was accurately positioned within the trigeminal cistern (TC) in patients with idiopathic trigeminal neuralgia undergoing percutaneous treatments through the foramen ovale. Methods: Transovale trigeminal cisternography (TOTC) was performed to ascertain the location of the spinal needle tip within the TC in 35 patients who underwent percutaneous retrogasserian glycerol rhizotomy (PRGR) procedures and 112 patients who underwent percutaneous controlled radiofrequency trigeminal rhizotomy (PCRF-TR) where the preganglionic trigeminal rootlets (PGTRs) could not be stimulated by radiofrequency. When TOTC revealed that the needle tip was in the subtemporal subarachnoid compartments, the needle insertion site at the foramen ovale was adjusted and redirected toward the dorsum sellae under intraoperative fluoroscopy guidance. Results: In 17 (15%) patients who underwent PCRF-TR, PGTR stimulation was unsuccessful, and TOTC revealed the needle tip within the subtemporal subarachnoid space. In five (14%) patients who underwent PRGR, the needle tip was inside the subtemporal subarachnoid space, according to the TOTC evaluation. Conclusion: The findings of this study underscore the significance of TOTC in both PRGR and PCRF-TR procedures, particularly when PGTRs cannot be stimulated by the radiofrequency electrode.

Background: Opioids are a class of potent analgesics extensively utilized for the management of moderate to severe pain. They are integral to postoperative analgesia, effectively mitigating pain following surgical interventions. The present study aims to undertake a comprehensive bibliometric analysis to evaluate research trends and focal areas within the domain of opioid use and postoperative analgesia. Methods: A bibliometric analysis was conducted using the Web of Science Core Collection to gather literature from 2014 to 2024. Analysis of publication trends, research hotspots, and collaboration networks was conducted using VOSviewer, CiteSpace, and the R package "bibliometrix." Results: The search yielded 5383 relevant articles, indicating a consistent upward trend in research volume, with a significant increase commencing in 2019. The USA emerged as the leading contributor, with Harvard University identified as the foremost institution. The journal Anesthesia and Analgesia was recognized as the most prominent publication in this field, while the influential author was Meissner Winfried. Analyses of keyword identified four clusters, such as complications management, nonopioid analgesics, clinical validation of opioid-free anesthesia (OFA) and pharmacokinetics of opioids. Keywords burst analysis showed emerging interests in "enhanced recovery after surgery," "prescription," and "erector spinae plane block." Conclusion: This bibliometric analysis mapped the scientific landscape of opioids in postoperative analgesia. The research hotspots included importance of complications management, nonopioid analgesics, clinical validation of OFA, and pharmacokinetics of opioids. Future studies should improve patient outcomes through individual-based multimodal analgesia with more efficacy and safety.

Introduction: The multifactorial nature of pain complicates assessment of the validity of presenting symptoms and behaviours in people with chronic pain. Recently, the Personal Problems Questionnaire (PPQ) was developed to assess genuine and noncredible cognitive, emotional and physical complaints. Here, the PPQ was used to investigate the extent to which patients with chronic pain report noncredible complaints and the relationship with pain severity and measures of cognitive performance validity and symptom over-reporting. Materials and Methods: Seventy-five participants with chronic pain recruited from outpatient and pain management programme clinics completed the clinical and validity scales of the PPQ, the short-form McGill Pain Questionnaire (SF-MPQ) subscales and the Medical Symptom Validity Test (MSVT), and a subsample (n = 27) completed the Personality Assessment Inventory (PAI). Results: Significant mean (T-score±SD) elevations were observed across the PPQ cognitive (64.5 ± 13.1), emotional (65.1 ± 13.2) and physical (77.4 ± 11.0) clinical domains. Endorsement of implausible complaints on the PPQ was common; 35.6% of patients endorsed noncredible pain/physical complaints, while 19.2% and 33.3%, respectively, reported implausible cognitive and emotional difficulties. Multivariate analyses indicated that the odds of likely noncredible responding significantly increased in cognitive (34%) and emotional domains (26%) and in the physical domain (12%) for every point increase on the SF-MPQ affective and sensory pain subscales, respectively. Noncredible symptom reporting was elevated in those receiving disability benefits/involved in litigation (n = 27), but not significantly after controlling for pain severity. Negative impression management on the PAI was associated with implausible cognitive and emotional symptom endorsement, but there was a limited relationship between PPQ validity scales and MSVT underperformance. Conclusion: The PPQ is a potentially useful tool in the assessment of chronic pain patients, with implausible symptom endorsement found in a significant proportion, although this may not reflect intentional exaggeration.

Background: This study investigated the role of impulsivity as a personality variable predisposing to prescription opioid misuse. Pain catastrophizing, as well as anxiety, depression, and pain intensity, were postulated as potential serial mediators in this relationship. Methods: The sample comprised 366 individuals with chronic pain. We conducted correlational and serial mediation analyses to investigate the relationships between the study variables. Results: The results showed that pain catastrophizing partially mediated the relationship between impulsivity and prescription opioid misuse. Depression and anxiety also partially mediated the relationship between pain catastrophizing and prescription opioid misuse, although pain intensity did not mediate this relationship. Impulsivity was also indirectly associated with prescription opioid misuse through pain catastrophizing, anxiety, and depression. Conclusions: Our findings highlight the key role of impulsivity in prescription opioid misuse and contribute to understanding its mechanisms of action. Based on these results, clinical interventions could target emotion-related impulsivity and cognitive control deficits to reduce rumination. Future research could investigate the relationships identified in this study using the specific dimensions of impulsivity.

Objective: This study aimed to develop and validate a German version of the Treatment Expectations in Chronic Pain Scale (TEC) with the goal to provide a reliable instrument for the assessment of treatment expectations in chronic pain patients within the German healthcare context. Methods: A total of 153 chronic pain patients participated in the study. Participants were recruited from the outpatient and day clinics of the University Hospital Jena, which specialize in chronic pain treatment. The TEC scale was translated into German following the International Test Commission Guidelines. Psychometric evaluation was conducted using Mokken Scale Analysis, focusing on unidimensionality, scalability, and local independence. For construct validity, correlations were examined with optimism for convergent validity and with depression and anxiety for discriminant validity. Results: Unidimensionality was supported for the TEC scale overall, but local independence violations were observed for two item pairs on the Ideal Expectations subscale. Furthermore, strong ceiling effects were found in the Ideal Expectations subscale, limiting its discriminatory capacity. Scalability was higher for the Predicted subscale (H = 0.475) than for the Ideal subscale (H = 0.371). Reliability measures supported the internal consistency. No significant correlations with optimism were found for either subscale, contrary to previous findings. Discussion: The German TEC displayed a unidimensional structure and is appropriate for group-level analyses of treatment expectations. For individual comparisons, the Predicted subscale offers sufficient precision. Future studies with larger, more diverse samples should confirm these results and clarify how expectations shape adherence and outcomes. Trial Registration: German Clinical Trials Register (DRKS): DRKS00027071.