Pain Research & Management最新文献

Background: A supportive healthcare experience that implements a biopsychosocial model of care can empower a person with chronic pain to make informed decisions and engage in self-management behaviours. Despite the positive influence of supportive healthcare, little is known about the presence of healthcare support in under-resourced chronic pain services. This idiographic study explores the lived experience of service users and providers participating in chronic pain services with a specific focus on autonomy support and self-management skills. Methods: Semistructured interviews were conducted on service users (n = 7) self-reporting a diagnosis of chronic pain (pain > 3 months) and service providers (n = 5), defined as healthcare professionals with > 3 years of experience in clinical healthcare settings managing pain conditions. All interviews took place online (mean 47 ± 11 min). Interview transcripts were analysed using interpretative phenomenological analysis. Results: Analyses generated four themes: 'biomedical model leads care'; 'lost in a system'; 'I need support' and 'the essentials of self-management'. Both service users and providers described regular experiences of invalidation and biomedical approaches to pain management. Long waitlists, a lack of multidisciplinary services, short appointment times and a lack of educational resources all impacted the development of self-management skills in service users. Conclusion: Despite clinical guidelines recommending a biopsychosocial model of care, the biomedical model remains the dominant approach in chronic pain management, reflecting a persistent gap between evidence and practice. Service users and providers desire access to multidisciplinary services that support a biopsychosocial model of care. Healthcare professionals cannot deliver what service users expect due to macro-, meso- and microlevel factors. Future research is needed to explore practical solutions to deliver pain services that optimise the development of self-management skills where existing infrastructure and resources negatively impact service delivery. Suggested approaches include enhancing autonomy-supportive communication by healthcare providers and ensuring early access to high-quality educational materials.

Background: Nurses play a crucial role in pain management through adherence to protocols, accurate pain assessment, and personalized pain relief strategies. However, a gap exists between nurses' ability to perceive pain and patients' actual needs. In Ethiopia, postoperative pain management practices are inadequate, and there is limited research on nurses' pain cognition. Aim: To evaluate the knowledge, attitudes, practices, and associated factors regarding postoperative pain management among nurses at Wolaita Sodo Comprehensive Specialized Hospital in Ethiopia. Methods: A cross-sectional study design involving 124 nurses was utilized. Data were collected using the Knowledge Attitude Survey regarding pain and the Nurses Carrying Behaviors Checklist. Statistical analysis was conducted using SPSS Version 28, employing descriptive statistics, one-way ANOVA, independent sample t-tests, and Pearson correlation coefficients. Multiple linear regressions were used to identify factors associated with pain management practices, with statistical significance set at a p value below 0.05. Results: The mean knowledge, attitude, and practice scores were 49.51 ± 9.51, 43.04 ± 14.72, and 71.05 ± 10.53, respectively. Positive correlations were found between knowledge and practices (r = 0.348, p < 0.001) and between attitudes and practices (r = 0.247, p=0.006). Training on pain, pain experience, work experience, and marital status were independent influencing factors for practice toward postoperative pain management. Conclusion: The study highlights critical gaps in nurses' knowledge and practices regarding postoperative pain management, particularly in opioid safety, dose conversion, and withdrawal symptoms. Over half of the nurses had inadequate knowledge, and most exhibited poor practices. Although negative attitudes were prevalent, training, experience, and personal pain exposure contributed to improved practices. Enhancing structured education, clinical mentoring, and institutional support is essential to improve postoperative pain care.

Background: Trigeminal neuralgia (TN) is a prevalent neurological disorder characterized by recurrent acute pain localized within the distribution area of the trigeminal nerve. This condition places a severe psychological and emotional burden on patients. Although lipids are associated with many diseases, their relationship with TN remains unclear. This study aims to investigate the causal association between plasma lipidome and TN using a bidirectional two-sample Mendelian randomization (MR) approach, with the ultimate goal of informing potential therapeutic strategies for TN management. Methods: We conducted a bidirectional two-sample MR analysis to systematically assess the causal relationship between plasma lipidome and TN. Genome-wide association study (GWAS) summary statistics for plasma lipidome and TN were obtained from publicly available datasets. The primary causal inference was performed using inverse variance weighted (IVW) regression, with complementary analyses including MR-Egger regression, weighted mode, simple mode, weighted median, and MR pleiotropy residuals and outliers (MR-PRESSO) to test for and adjust potential pleiotropy. Comprehensive sensitivity analyses were implemented to verify the robustness of our findings, including heterogeneity testing, leave-one-out analysis, and examination of directional pleiotropy. This multianalytical approach provides a rigorous framework for elucidating the potential role of plasma lipidome dysregulation in TN pathogenesis. Results: Our forward MR analysis results demonstrated that genetically predicted glycerophospholipids (GP) and glycerolipid family (GL) exert significant causal effects on TN risk. More specifically, phosphatidylinositol (PI) in the GP, as well as diacylglycerol and triacylglycerol in the GL, were significantly associated with reduced TN risk (p < 0.05, OR < 1). However, distinct molecular configurations of phosphatidylcholine (PC) and phosphatidylethanolamine (PE) within the GP class exhibited differential impacts on TN susceptibility. The reverse MR analysis identified eight configurations of PC reduced TN risk (p < 0.05, OR < 1), with PC (18:0_18:2) showing a particularly notable bidirectional causal relationship with TN. Rigorous sensitivity analyses confirmed the absence of both heterogeneity (Cochran's Qp > 0.05) and horizontal pleiotropy (MR-Egger intercept p > 0.05) across all examined lipid species, supporting the robustness of these findings. Conclusions: This MR study establishes causal links between specific plasma lipidomes and TN risk, identifying protective lipid species and revealing a bidirectional relationship for PC, offering potential therapeutic targets for TN management.

Background: Dysmenorrhea is a common gynecological symptom among reproductive-aged women, associated with substantial pain and decreased quality of life. Previous studies have suggested that inflammatory and hormonal fluctuations linked to dysmenorrhea may influence endometrial cancer (EC) risk though causality remains uncertain. This study aimed to investigate potential causal relationships between dysmenorrhea (including pain severity, analgesic use, endometriosis, and related pelvic pain) and EC risk using a Mendelian randomization (MR) approach. Methods: A two-sample MR analysis was conducted using genome-wide association study (GWAS) data, selecting single nucleotide polymorphisms (SNPs) significantly associated with dysmenorrhea to assess EC risk. Primary analysis was performed with the inverse-variance weighted (IVW) method, while weighted median and MR-Egger analyses were conducted to enhance robustness. Results: The IVW analysis showed a significant inverse association between dysmenorrhea and EC risk (OR = 0.883; 95% CI: 0.794-0.983; and p=0.023), which remained significant after adjusting for confounders (OR = 0.868; 95% CI: 0.775-0.971; and p=0.0136). Sensitivity analyses supported this protective association. Other factors, including pain severity, analgesic use, endometriosis, and related pelvic pain, showed no significant association with EC. Conclusion: This study indicates a potential inverse relationship between dysmenorrhea and EC risk. These findings provide novel causal evidence for understanding complex associations in female reproductive health, underscoring the need for further research on dysmenorrhea in EC prevention.

Background: Paracetamol is one of the most commonly used analgesic and antipyretic drug, available as a single or a combined formulation. Caffeine is an adjuvant analgesic to several drugs such as paracetamol. The goal of combining paracetamol with caffeine is to achieve a higher analgesic efficacy of paracetamol while lowering its dose and thus reducing side effects. Objective: This narrative literature review aims to provide an overview of the cumulative analgesic effects of this combination and the mechanisms underlying the potentiation by caffeine of the antinociceptive effect of paracetamol. Methods: The search was conducted in PubMed, MEDLINE, ClinicalTrials.gov, and Cochrane Database. For the clinical efficacy and safety, only randomized controlled trials and meta-analysis assessing paracetamol 1000 mg in combination with caffeine 130 mg were considered. Results: As emphasized by the data presented in this review, there is a potentiation of paracetamol-induced analgesia by caffeine with synergistic interactions observed in preclinical and clinical studies. Caffeine enhances the antinociceptive effect of paracetamol and accelerates the absorption of associated paracetamol, which explains the significant faster analgesics' effect with the combination. In clinical trials in patients with mild to moderate acute pain, the combination demonstrates a higher pain relief compared with paracetamol alone with a significant improvement of pain relief in patients with primary headaches without added safety issues. Conclusions: This combination is effective and safe in the treatment of acute mild and moderate pain. Prescribing physicians might consider using paracetamol and caffeine combination among other options in treating these types of pain.

Objective: Mental imagery involves forming internal sensory representations, while osteoarthritis is a degenerative joint disease characterized by cartilage loss. This study explores how mental imagery can modulate pain perception and enhance visual processing in individuals with knee osteoarthritis. Methods: Forty-eight participants were randomly assigned to a mental imagery group or a treatment group. The treatment group received conventional physiotherapy interventions, including ultrasound, transcutaneous electrical nerve stimulation, hot pack application, and isometric knee exercises, while the mental imagery group mentally imagined the same treatments. Both groups underwent interventions for 10 days, with assessments before and after. Pain intensity was measured using the visual analog scale (VAS), and visual processing was assessed through the digital pareidolia test. Results: Both groups exhibited significant reductions in VAS scores, with the mental imagery group demonstrating a more substantial decrease. Notably, the mental imagery group had faster reaction times to face pareidolia images, indicating improved visual processing. In contrast, the treatment group's reaction times to face pareidolia images remained unchanged. Conclusion: These findings highlight that mental imagery could serve as an alternative approach to pain management and cognitive enhancement, potentially influencing top-down mechanisms in facial pattern recognition. This highlights the potential for mental imagery to be integrated into therapeutic strategies for pain-related conditions, promoting personalized, innovative treatments.

Exposing the skin to high levels of ultraviolet B (UVB) radiation induces an inflammatory response that upregulates local nociceptive processing; this, in turn, facilitates protective responses to limit further injury. In this study, the UVB model was used to explore additional effects of inflammation on supraspinal nociceptive processing. Thirty-one healthy participants attended two sessions approximately 24 h apart. In each session, pressure-pain thresholds and sensitivity to sharp stimulation and heat were assessed in both forearms, and pressure-pain thresholds and sensitivity to sharp stimulation were assessed on each side of the forehead. In a novel paradigm, supraspinal nociceptive processing was explored by assessing pain and blink reflexes to electrical stimulation of the forehead, paired with acoustic startle stimuli. At the end of the first session, UVB radiation at a dose sufficient to induce erythema at the most exposed site was administered to one forearm. Consistent with local sensitization, sensitivity to heat and sharp stimulation had increased at the maximally exposed site 24 h later. This local response was accompanied by changes in supraspinal nociceptive processing-pressure-pain thresholds were lower on the ipsilateral than contralateral side of the forehead, and acoustic startle stimuli augmented electrically evoked pain. Blink reflexes weakened from the first to the second session, but decreases were smaller on the UVB-treated than contralateral side. Together, these findings suggest that acoustic startle stimuli facilitated activity in sensitized supraspinal nociceptive pathways. Potentially, this supraspinal mechanism adds to the burden of chronic nociplastic pain during states of heightened arousal and stress.

Background: Pain status is a common concern among older adults and has been linked to functional limitations. This study aimed to examine the association between pain status and disabilities risk in basic activities of daily living (BADL) and instrumental activities of daily living (IADL) in older adults in China, using data from the 2020 China Health and Retirement Longitudinal Study (CHARLS). Methods: A cross-sectional analysis was conducted using data from 8102 participants aged 60 and older from the 2020 CHARLS. Univariate and multivariate binary logistic regression analyses were performed to assess the association between pain status and BADL/IADL disabilities. We further examined the contribution of each covariate and categorized participants by pain location and number of pain sites. Subgroup analyses were conducted to examine the consistency of findings across demographic and health-related factors. Results: Pain status was significantly associated with higher odds of both BADL and IADL disabilities (p < 0.05), even after adjusting for covariates. Self-rated health and depressive symptoms exerted the greatest influence on the OR values. Pain in any anatomical region, particularly when present at multiple sites, was associated with increased odds of disability. Head and neck pain was specifically associated with IADL disability, while pain in the upper limbs, torso, and lower limbs was associated with both BADL and IADL disabilities. Subgroup analyses confirmed the robustness of these associations. Conclusions: Pain status, especially multisite pain, is significantly associated with BADL and IADL disabilities in older Chinese adults. Although causality cannot be inferred due to the study's cross-sectional design, these findings underscore the importance of addressing pain alongside other health and psychological factors when developing strategies to support functional independence in aging populations.

Background: Chronic nonspecific low back pain (CNLBP) is often associated with impaired mobility, functional limitations, and psychological distress. While myofascial release (MFR) and capacitive-resistive therapy (TECAR) have individually shown potential benefits, evidence regarding their combined application is limited. Methods: This assessor-blinded, three-arm randomized controlled trial included 67 patients with CNLBP. Participants were assigned to MFR alone, resistive-mode TECAR (R-TECAR) alone, or MFR plus R-TECAR. Interventions were administered twice weekly for 4 weeks, with each session lasting 20 min. Primary outcomes included the Numeric Pain Rating Scale (NPRS) and the Roland-Morris Disability Questionnaire (RMDQ), assessed at the baseline, 4 weeks, and one-and-a-half-month follow-up. Secondary outcomes encompassed thoracolumbar fascia (TLF) thickness, pressure pain threshold (PPT), trunk mobility, quality of life, anxiety, and depression. Intention-to-treat analyses were performed. Results: All interventions yielded significant improvements in pain and disability over time, although the combined MFR + R-TECAR therapy did not achieve statistically significant additional benefits compared with single therapies. Notably, a significant interaction effect emerged for PPT in the right quadratus lumborum muscle (p=0.01), with the MFR + R-TECAR group demonstrating greater improvement than R-TECAR alone. Other secondary outcomes, including TLF thickness and psychometric measures, improved over time but showed no significant between-group differences. Conclusions: Combining MFR with R-TECAR for CNLBP did not produce superior outcomes compared with individual treatments though certain muscle-specific benefits were observed. Future research should focus on optimizing treatment parameters, extending intervention and follow-up periods, and exploring individualized approaches to maximize therapeutic efficacy. Trial Registration: Chinese Registry of Clinical Trials: ChiCTR2400087961.

Objective: The objective was to compare the effectiveness of a combined pain neuroscience education and resistance training program (PNE + RT) with that of a combined aerobic and flexibility exercise program (AE + FE). Design: A randomized pilot study was conducted in women with fibromyalgia. Methods: Thirty-one women with fibromyalgia were randomized into the experimental group (PNE + RT, n = 15) and the usual care group (AE + FE, n = 16). Both groups carried out the intervention 3 days a week for 12 weeks. Primary outcomes were pain intensity, disability, and symptoms related to central sensitization (CS). Among them, pain intensity was considered the main primary endpoint for statistical analysis and interpretation. Secondary outcomes were pressure pain threshold (PPT), maximum handgrip strength (MHS), and stiffness. Results: Statistically significant between-group differences were found in favor of PNE + RT group for short-term pain intensity (p < 0.05) and PPT trapezius (p < 0.05). PNE + RT also showed statistically significant within-group improvements in pain intensity (p < 0.01), CS-related symptoms (p < 0.01), PPT quadriceps (p < 0.01), and MHS of the left hand (p < 0.01). Disability improved significantly in both groups (p < 0.01). There were no significant changes in stiffness. Conclusion: The PNE + RT program is more effective than the AE + FE program in improving pain intensity in the short term and PPT in the trapezius muscle in the long term. PNE + RT is also effective in improving disability, pain intensity, CS-related symptoms (short and long term), and left MHS and PPT in the quadriceps muscle (long term), although it is not more effective than AE + FE. The AE + FE program is only effective in improving disability. These findings are preliminary, and larger studies are needed to confirm the results. Trial Registration: ClinicalTrials.gov identifier: NCT04855851.