Pain Research & Management最新文献

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.

Objectives: Longus colli tendinitis (LCT) is a rare, self-limiting disease primarily characterized by neck pain. This study is to investigate and analyze the imaging and clinical features of LCT and to develop a predictive model for pain risk in LCT based on these features. Methods: This study included 35 patients with LCT enrolled between January 2017 and December 2024. Radiological features, laboratory indicators, and clinical profiles were systematically analyzed. We stratified LCT patients into high-risk (n = 20) and low-risk (n = 15) groups based on pain intensity and duration. Nomograms were developed using logistic regression models, with feature selection performed via the least absolute shrinkage and selection operator method. Model performance was evaluated through discrimination (Harrell's C-index) and calibration (calibration plots), with internal validation conducted via bootstrapping. A clinical impact curve was used to assess the model's clinical usefulness. Results: MRI features of LCT included average lesion width of 6.13 mm, length of 64.00 mm, circumference of 134.52 mm, and area of 230.64 mm². Clinically, LCT patients exhibited elevated white blood cell counts, neutrophil counts, hsCRP levels, and IL-6 levels. Feature selection revealed that the lesion area could predict pain risk in LCT patients, which was used to construct a predictive model. The model demonstrated a C-index of 0.93 (95% CI 0.84-0.99). Internal validation confirmed the model's robust performance, with a C-index of 0.93 (95% CI 0.83-0.99). Conclusion: LCT possesses distinct imaging and clinical features. Utilizing these features enables effective prediction of pain risk, thereby assisting clinical decision-making.

Background: Chronic neuropathic pain, a debilitating health condition, significantly deteriorates the quality of life. Available treatment options, mostly focusing on pain management, do not target underlying cause, resulting in suboptimal and temporary outcomes. Therefore, therapeutic targeting of the cause of neuropathic pain is necessary. This study was undertaken to assess the antineuropathic potential of the herbomineral formulation, Peedanil Gold (PN-G), which has earlier been proven effective against osteoarthritis and associated inflammatory pathophysiology. Methods: Unilateral sciatic nerve chronic constriction injury (CCI) rat model was used to assess the analgesic and anti-inflammatory potential of PN-G in managing chronic neuropathy and associated pain hypersensitivities, by monitoring cold and tactile allodynia and thermal hyperalgesia. The mRNA expression levels of various pain receptors, TRPV1, TRPV4, TRPA1, and TRPM8, and inflammatory factors, p38 MAP kinase and interleukin-6 receptor (IL-6R), were evaluated through RT-qPCR. Results: Compared to untreated study animals with CCI, PN-G treatment significantly alleviated pain hypersensitivities for cold and tactile allodynia and thermal hyperalgesia to an extent comparable to that of the reference drug, gabapentin. PN-G treatment also significantly reduced the mRNA levels of pain receptors in dorsal root ganglia, implicating a strong modulation of the pain perception. Additionally, PN-G-treated animals also exhibited noticeably reduced expressions of p38 MAP kinase and IL-6R, the crucial factors in the neuropathy-associated inflammation. Conclusions: Altogether, the outcomes from the current study prove that PN-G is an effective antineuropathic agent with potential to manage pain as well as eliminate the underlying cause of neuroinflammation behind the chronicity of neuropathic pain.

Objective: This study aimed to compare postoperative pain following the single-visit retreatment procedures of asymptomatic and symptomatic teeth using two different nickel-titanium file systems. Materials and Methods: Eighty patients were divided into symptomatic and asymptomatic groups, each further subdivided based on the use of rotary or reciprocating files. Retreatment involved removal of filling material with one flare and MicroMega REMOVER files, followed by shaping with one curve mini (rotary) or One RECI (reciprocating) files. Postoperative pain was recorded using a visual analogue scale (VAS) at 24 h, 48 h, 72 h, 7 days, and 14 days. Data were analyzed using Shapiro-Wilk, Mann-Whitney U, Kruskal-Wallis, Dunn-Bonferroni, and Pearson chi-square tests (p < 0.05). Results: No significant differences in postoperative pain were found among the four groups. Pain levels were not associated with sex, age, or tooth position. Analgesic use significantly decreased over time in all groups except the asymptomatic rotary group. Patients requiring analgesics reported higher pain scores within the first 48 h (p < 0.05). Conclusions: Postoperative pain was low and comparable across all groups. File kinematics (rotary vs. reciprocating) did not influence pain outcomes. Single-visit retreatment is a viable alternative to multivisit procedures for both symptomatic and asymptomatic cases. Clinical Relevance: This study supports the clinical feasibility of single-visit root canal retreatment, potentially improving patient comfort and reducing chair time. Trial Registration: ClinicalTrials.gov identifier: NCT06357481.

Background: Pectus excavatum is a common congenital chest wall deformity that can lead to significant cardiopulmonary compression and psychological distress. The minimally invasive Nuss procedure is the standard treatment, but it often results in severe postoperative pain. Effective perioperative pain management is essential to enhance recovery and improve patient outcomes. Objectives: This study aimed to synthesize the most effective evidence on perioperative pain management in patients with pectus excavatum and to provide evidence-based management methods for clinical teams and patients undergoing this surgery. Methods: Guided by the "6S" pyramid model, we retrieved evidence on perioperative pain management from relevant websites, databases, and unpublished gray literature. The search timeframe ranged from 2014 to December 2024. Two researchers independently evaluated the literature quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) for guidelines and the Joanna Briggs Institute (JBI) critical appraisal tool for other types of literature. Two researchers independently extracted and summarized the evidence according to the principle of high-quality evidence and newly published evidence. Results: A total of 39 articles were retrieved, of which 6 were guidelines, 6 were expert consensus, 7 were systematic reviews, 1 was a clinical decision, 11 were randomized controlled trials, and 8 were cohort studies. Overall, 35 pieces of evidence from seven dimensions-general principles, education and counseling, pain assessment, preemptive analgesia, intraoperative analgesia, postoperative pain management, and pain management after discharge-were summarized. Conclusions: This study summarized the best evidence on perioperative pain management in patients with pectus excavatum, providing a comprehensive and scientific approach to enhance recovery and patient satisfaction.

Background: Persistent pain is a complex global issue, which has a significant impact on quality of life. Poor health literacy further impacts the quality of life in people with persistent pain. It is recommended that education be provided to improve health-related knowledge. VR is an engaging learning tool and could improve health literacy. Research exploring the feasibility of physiotherapists using VR to develop health literacy is minimal. Objectives: To determine the feasibility of a VR-based pain education system among physiotherapists and understand barriers and facilitators to its adoption in clinical practice. Methods: Semistructured interviews were conducted with physiotherapists in the United Kingdom after they used a VR-based pain education system, which combines sensory-altering experiences with pain science education. Thematic analysis was used to identify considerations related to its feasibility and its potential to influence health literacy in patients with persistent pain. Results: All participants (n = 12) believed that the VR system could develop several aspects of health literacy, such as information understanding and appraisal. Challenges to clinical integration include allowing for increased clinical time and system training and ensuring the use of VR represents both personalized and evidence-based care. Conclusion: The VR pain management system was considered a feasible adjunct to address health literacy by increasing the plausibility of information and addressing health-related understanding, appraisal, and application. Future research is required to validate the effectiveness of VR-based education systems to improve health literacy.

Background: Chronic pain is one of the most common reasons for seeking medical care and is associated with depression and reduced quality of life. This study aims to explore the association of depression and quality of life with chronic pain, and medication management among patients with chronic pain. Methods: A cross-sectional study was conducted among patients visiting the outpatient departments of two tertiary care hospitals in Pokhara, Nepal. Validated questionnaires were used to collect information regarding socio-demographics, pain intensity (face pain scale), quality of life (EQ-5D-3L), depression (PROMIS depression questionnaire) and medications prescribed for pain management. Descriptive statistics, univariate analysis, correlation and multiple regression were used to analyse the data. Results: Three hundred eighty-five participants were enrolled in the study, and most were females 248 (64.4%). Low back pain (n = 96; 24.9%) was the most commonly reported pain condition. The participants' mean pain and quality of life scores were 4.5 ± 1.97 and 0.59 ± 0.37, respectively. NSAIDs were the most prescribed medication. About 25.2% of the participants had mild, 25.5% moderate and 3.4% severe depression. A significant difference in depression and quality of life score was observed between genders (p < 0.001), among participants with different education levels (p < 0.001), with comorbidity (p < 0.001) and pain duration (p < 0.001). A significant reverse association of quality of life with depression (β = -0.326, p < 0.001), pain score (β = -0.292, p < 0.001) and duration of pain (β = -0.208, p < 0.001) was observed. Conclusion: The quality of life among patients with chronic pain was correlated with the pain score, depression score and duration of pain.

Introduction: Labor pain is a well-known physiological phenomenon considered to be the most severe pain experienced by women of childbearing age. One nonpharmacological method used to alleviate labor pain is acupressure. This study aimed to examine the impact of acupressure on the BL23 points on pain intensity during the active phase of the first stage of labor. Method: This randomized, sham-controlled clinical trial took place at Tehran Baharlu Hospital in Iran from August 23 to October 21, 2023. Ninety first-time pregnant women in active labor were randomly assigned to one of three groups: acupressure on BL23 (n = 30), sham acupressure (between the seventh and eighth thoracic vertebra, 2 Cun from the midline) (n = 30), and a control group (n = 30). The sham and acupressure groups received 60 min of acupressure at three different time points during cervical dilatation at 4-5 cm, 6-7 cm, and 8-10 cm. The control group received standard labor care. Pain severity was assessed using a Numerical Rating Scale before, 10 min after, and 20 min after the intervention at each time point. Result: Pain intensity was significantly lower in the BL23 acupressure group compared to the control and sham groups at all three time points (p < 0.0001). Pain intensity decreased in the BL23 acupressure group after 10 min of intervention at all time points (p < 0.001) and continued to decrease throughout the intervention (p < 0.001). The reduction in pain in the BL23 acupressure group was evident before the start of the second and third interventions (p=0.33 and p=0.36, respectively). Twenty minutes of pressure on BL23 points at different dilatation stages were equally effective in reducing pain (p=0.13). No adverse effects on maternal and neonatal outcomes were observed in the BL23 acupressure group compared to the other groups (p > 0.05). Conclusion: This study demonstrates that applying acupressure to the BL23 points during the active phase of the first stage of labor significantly reduces labor pain. However, the pain relief provided by this intervention is temporary, with its effects diminishing over time rather than offering permanent relief. Trial Registration: Iranian Registry of Clinical Trials (IRCT): IRCT20230513058166N1.