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Pain in very preterm infants-prevalence, causes, assessment, and treatment. A nationwide cohort study.
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-21 DOI: 10.1097/j.pain.0000000000003528
Hillary Graham, Neda Razaz, Stellan Håkansson, Ylva Thernström Blomqvist, Kari Johansson, Martina Persson, Annika Nyholm, Mikael Norman

Abstract: Studies on pain in preterm infants have usually been confined to observations of painful procedures, and information from extremely preterm infants is limited. Using registry data from a Swedish nationwide cohort, this study explored the epidemiology of pain in very preterm infants, its causes, assessments, and treatment strategies. We included liveborn infants <32 weeks' gestational age (GA) discharged between January 2020 and June 2024. Proportions of infants exposed to potentially painful procedures, experiencing pain, assessed with pain scales, and receiving pharmacological treatment were calculated by each postnatal day. Among 3686 infants (mean birthweight 1176 g, GA 28.2 weeks), 11.6% had a painful condition and 84.1% were exposed to at least 1 potentially painful procedure. In total, 74.6% experienced pain, corresponding to 28,137/185,008 (15.2%) days of neonatal care. For every 2-week increase in GA, significantly lower proportions of infants experienced pain. In infants <28 weeks of GA, proportions with reported pain were approximately half the rate of painful procedures, while in infants born at 28 to 31 weeks, reported pain closely matched exposure to painful procedures. Pain scales were used in 75.0% of the infants. Pharmacological pain treatment was administered to 81.7% of infants, primarily topically or orally. Among infants with pain, proportions treated intravenously were larger at higher GAs. Despite effective analgesia/anesthesia, many very preterm infants experience pain. Visualizing pain epidemiology, procedures, conditions, and treatment by postnatal and gestational age may guide clinical management and generate research hypotheses to reduce short- and long-term adverse effects.

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引用次数: 0
Performance of baseline quartile-stratified minimal clinically important difference estimates was superior to individual minimal clinically important difference estimates when compared with a gold standard comparator of important change. 当与重要变化的金标准比较时,基线四分位分层最小临床重要差异估计的性能优于个体最小临床重要差异估计。
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-09 DOI: 10.1097/j.pain.0000000000003492
Daniel L Riddle, Levent Dumenci

Abstract: A variety of minimal clinically important difference (MCID) estimates are available to distinguish subgroups with differing outcomes. When a true gold standard is absent, latent class growth curve analysis (LCGC) has been proposed as a suitable alternative for important change. Our purpose was to evaluate the performance of individual and baseline quartile-stratified MCIDs. The current study included data from 346 persons with baseline and 12-month postoperative outcome data from KASTPain, a no-effect randomized clinical trial conducted on persons with knee arthroplasty and pain catastrophizing. Subgroup trajectories from LCGC were used as a gold standard comparator. Minimal clinically important difference-specific trajectories of recovery were calculated for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain, Disability and EuroQol-5 Dimension Visual Analogue Scale of self-reported health. The latent Kappa (Kl) chance-corrected agreement between MCIDs and LCGCs were estimated to indicate which MCID method was best at detecting important change. For all 3 outcomes, the average latent class probabilities ranged from 0.90 to 0.99, justifying the use of LCGCs as a gold standard. The Kl for LCGC and individual MCIDs ranged from 0.21 (95% CI = 0.13, 0.28) to 0.52 (95% CI = 0.41, 0.66). Baseline quartile-stratified Kl for WOMAC Pain and Disability were 0.85 (95% CI = 0.78, 0.92) and 0.74 (95% CI = 0.68, 0.83), respectively. Classification errors in individual MCID estimates most likely result from ceiling effects. Minimal clinically important differences calculated for each baseline quartile are superior to individually calculated MCIDs and should be used when latent class methods are not available. Use of individual MCIDs likely contribute substantial error and are discouraged for clinical application.

摘要:各种最小临床重要差异(MCID)估计可用于区分具有不同结果的亚组。当没有真正的黄金标准时,潜在类别增长曲线分析(LCGC)被提议作为重要变化的合适替代方案。我们的目的是评估个体和基线四分位分层MCIDs的表现。目前的研究包括346名患者的基线数据和术后12个月的预后数据,这些数据来自KASTPain,这是一项针对膝关节置换术和疼痛突变患者的无效应随机临床试验。LCGC的亚组轨迹被用作金标准比较物。对西安大略省和麦克马斯特大学骨关节炎指数(WOMAC)疼痛、残疾和自我报告健康的EuroQol-5维度视觉模拟量表计算最小临床重要差异特异性恢复轨迹。估计MCIDs和lcgc之间的潜在Kappa (Kl)机会校正一致性,以表明哪种MCID方法最适合检测重要变化。对于所有3个结果,平均潜在分类概率范围为0.90至0.99,证明lcgc作为金标准的使用是合理的。LCGC和个体mcid的Kl范围为0.21 (95% CI = 0.13, 0.28)至0.52 (95% CI = 0.41, 0.66)。WOMAC疼痛和残疾的基线四分位分层Kl分别为0.85 (95% CI = 0.78, 0.92)和0.74 (95% CI = 0.68, 0.83)。单个MCID估计的分类错误最有可能是天花板效应造成的。每个基线四分位数计算的最小临床重要差异优于单独计算的mcid,当潜在分类方法不可用时应使用。单个MCIDs的使用可能造成严重的误差,不鼓励临床应用。
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引用次数: 0
The role of pain expectancy and its confidence in placebo hypoalgesia and nocebo hyperalgesia. 疼痛预期及其信心在安慰剂低镇痛和安慰剂高镇痛中的作用。
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-09 DOI: 10.1097/j.pain.0000000000003495
Eleonora Maria Camerone, Giorgia Tosi, Daniele Romano

Abstract: Placebo hypoalgesia and nocebo hyperalgesia, which exemplify the impact of expectations on pain, have recently been conceptualised as Bayesian inferential processes, yet empirical evidence remains limited. Here, we explore whether these phenomena can be unified within the same Bayesian framework by testing the predictive role of expectations and their level of precision (ie, expectation confidence) on pain, with both predictors measured at the metacognitive level. Sixty healthy volunteers underwent a pain test (ie, 8 noxious electrical stimuli) before (Baseline) and after (T0, T1, T2) receiving a sham treatment associated with hypoalgesic (placebo), hyperalgesic (nocebo), or neutral (control) verbal suggestions, depending on group allocation. Trial-by-trial expectations, their precision, and perceived pain were measured. Skin conductance response (SCR) was also recorded as an autonomic response marker. Bayesian linear mixed models analyses revealed that, for both placebo and nocebo, pain was predicted by expectations alone and by their interaction with expectations precision. In addition, the discrepancy between expected and perceived pain was predicted by expectation precision, with greater alignment between expected and perceived pain when precision was higher. This suggests that both placebo and nocebo responses are well described from a Bayesian perspective. A main effect of time for SCR was observed, suggesting habituation to painful stimuli. Our data provide evidence indicating that both placebo hypoalgesia and nocebo hyperalgesia can be unified within the same Bayesian framework in which not only expectations but also their level of precision, both measured at the metacognitive level, are key determinants of the pain inferential process.

摘要:安慰剂痛觉减退和反安慰剂痛觉过敏是预期对疼痛影响的例证,最近被概念化为贝叶斯推理过程,但经验证据仍然有限。在这里,我们探讨这些现象是否可以统一在同一个贝叶斯框架内,通过测试预期的预测作用和他们的精度水平(即期望置信度)对疼痛,在元认知水平的预测测量。60名健康志愿者在(基线)之前和之后(T0, T1, T2)接受了疼痛测试(即8次有害电刺激),并根据组分配接受了与低痛觉(安慰剂),高痛觉(反安慰剂)或中性(对照组)口头建议相关的假治疗。每一次试验的期望、精确度和感知的痛苦都被测量。皮肤电导反应(SCR)也被记录为自主反应标志物。贝叶斯线性混合模型分析显示,对于安慰剂和反安慰剂,疼痛仅通过期望和期望精度的相互作用来预测。此外,预期疼痛与感知疼痛之间的差异可以通过期望精度来预测,当精确度越高时,预期疼痛与感知疼痛之间的一致性越强。这表明,从贝叶斯的角度来看,安慰剂和反安慰剂的反应都得到了很好的描述。观察到时间对SCR的主要影响,提示对疼痛刺激的习惯。我们的数据提供的证据表明,安慰剂痛觉减少和反安慰剂痛觉过敏可以统一在同一个贝叶斯框架内,其中不仅期望,而且精度水平,都是在元认知水平上测量的,是疼痛推理过程的关键决定因素。
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引用次数: 0
How is age at menopause and reproductive lifespan associated with chronic pain outcomes in postmenopausal women? 绝经年龄和生殖寿命与绝经后妇女的慢性疼痛结果有何关联?
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-07-26 DOI: 10.1097/j.pain.0000000000003333
Charlotte Indre Lund, Leiv Arne Rosseland, Ólöf Anna Steingrímsdóttir, Bo Lars Engdahl, Audun Stubhaug, Anne-Sofie Furberg, Christopher Sivert Nielsen

Abstract: Female sex is a prominent risk factor for chronic pain, although the underlying mechanisms are not fully understood. This cross-sectional study aimed to investigate the relationship between age at menopause, reproductive lifespan, and chronic pain in a sample of postmenopausal women aged 40 to 93 years. Data were collected from the Tromsø study conducted in Norway between 2015 and 2016 (Tromsø7). Chronic pain was assessed using a single question, which formed a sample size of 5741 participants. Chronic widespread pain was evaluated using the more comprehensive Graphical Index of Pain, resulting in a sample size of 5920 women. Premenopausal women and those who experienced menstrual cessation due to chemotherapy/radiation or hormonal intrauterine devices were excluded from the analysis. Adjusted relative risk ratios with 95% confidence intervals were calculated to determine associations. The results showed that early menopause was associated with a 1% increase in the prevalence of chronic pain for each year of earlier onset at menopause (0.992, CI 95% 0.985-0.998). This association was also observed in women who experienced natural menopause only. However, the association between menopause and chronic widespread pain did not reach statistical significance in the fully adjusted analysis (0.996, CI 95% 0.975-1.017). There were no significant associations found between reproductive lifespan and either outcome. In conclusion, the findings suggest that early menopause in postmenopausal women is linked to a higher prevalence of chronic pain. However, reproductive lifespan does not appear to have a significant impact on chronic pain or chronic widespread pain.

摘要:女性性别是慢性疼痛的一个突出风险因素,但其潜在机制尚未完全明了。这项横断面研究旨在调查40至93岁绝经后女性样本中绝经年龄、生殖寿命与慢性疼痛之间的关系。数据收集自2015年至2016年间在挪威进行的特罗姆瑟研究(Tromsø7)。慢性疼痛采用单一问题进行评估,样本量为 5741 人。慢性广泛性疼痛采用更全面的图形疼痛指数进行评估,因此样本量为 5920 名女性。绝经前妇女和因化疗/放疗或荷尔蒙宫内节育器而停经的妇女不在分析之列。通过计算调整后的相对风险比和 95% 的置信区间来确定相关性。结果显示,绝经时间每提前一年,慢性疼痛患病率就会增加 1%(0.992,CI 95% 0.985-0.998)。在仅经历自然绝经的女性中也观察到了这种关联。然而,在完全调整分析中,更年期与慢性广泛性疼痛之间的关系并未达到统计学意义(0.996,CI 95% 0.975-1.017)。生殖寿命与这两种结果之间均无明显关联。总之,研究结果表明,绝经后妇女较早绝经与较高的慢性疼痛患病率有关。然而,生育期似乎对慢性疼痛或慢性广泛性疼痛没有显著影响。
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引用次数: 0
Conceptual and historical blind spots of large language models in research on pain-related suffering. 疼痛相关痛苦研究中大语言模型的概念和历史盲点。
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-10-22 DOI: 10.1097/j.pain.0000000000003422
Charlotte Duffee
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引用次数: 0
Reply to Torta and Meyers. 答复 Torta 和 Meyers。
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-10-30 DOI: 10.1097/j.pain.0000000000003465
Delia Della Porta, Eléonore Scheirman, Valéry Legrain
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引用次数: 0
Development and validation of a home quantitative sensory testing tool-kit to assess changes in sensory and pain processing: a study in healthy young adults. 开发和验证用于评估感觉和疼痛处理变化的家庭定量感觉测试工具包:一项针对健康年轻人的研究。
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-07-09 DOI: 10.1097/j.pain.0000000000003320
Don Daniel Ocay, Kimberly Lobo, Angela Kim, Meghan Halpin, Charles B Berde

Abstract: Quantitative sensory testing (QST) is a set of methods for quantifying somatosensory functioning. Limitations of laboratory-based QST (LQST) include high cost, complexity in training, lack of portability, and time requirements for testing. Translating QST to a home setting could facilitate future research and clinical care. The objective of this study was to develop a home QST (HQST) tool-kit that is cost-effective, easy to use, and detects changes in sensory and pain processing. Thirty-two young healthy adults underwent sensory testing on their nondominant forearm using standard in-person LQST, followed by "simulated HQST" using video guidance in a separate room from the investigator before and after application of either a lidocaine or capsaicin cream. We observed good agreement between HQST and LQST scores, with significant correlations observed between the pinprick, pressure, cold and heat measures (|ρ| range = 0.36-0.54). The participants rated the HQST protocol as highly acceptable and safe but can be improved in future implementations. Home QST was able to detect hypoesthesia to vibration after lidocaine cream application ( P = 0.024, d = 0.502) and could detect hypoalgesia and hyperalgesia to pressure and heat pain sensitivity tests after application of lidocaine and capsaicin creams, respectively ( P -value range = <0.001-0.036, d -value range = 0.563-0.901). Despite limitations, HQST tool-kits may become a cost-effective, convenient, and scalable approach for improving sensory profiling in clinical care and clinical research.

摘要:定量感觉测试(QST)是一套量化躯体感觉功能的方法。基于实验室的 QST(LQST)的局限性包括成本高、训练复杂、缺乏便携性以及测试时间要求。将 QST 移植到家庭环境可促进未来的研究和临床治疗。本研究的目的是开发一种家庭 QST(HQST)工具包,它成本低廉、易于使用,并能检测感觉和疼痛处理过程的变化。32 名年轻健康的成年人在使用利多卡因或辣椒素药膏前后,使用标准的当面 LQST 对他们的非支配前臂进行了感觉测试,然后在与研究人员分开的房间里使用视频指导进行了 "模拟 HQST"。我们观察到 HQST 和 LQST 分数之间的一致性很好,针刺、压力、冷和热测量之间存在显著相关性(|ρ| 范围 = 0.36-0.54)。参与者对 HQST 方案的评价是高度可接受和安全,但在今后的实施中仍可改进。家用 QST 能够检测出涂抹利多卡因乳膏后对振动的感觉减退(P = 0.024,d = 0.502),并能检测出涂抹利多卡因乳膏和辣椒素乳膏后分别对压力和热痛敏试验的感觉减退和感觉减退(P 值范围 = 0.05-0.05)。
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引用次数: 0
Prevalence, pain trajectories, and presurgical predictors for chronic postsurgical pain in a pediatric sample in Spain with a 24-month follow-up. 西班牙儿科样本中慢性手术后疼痛的发生率、疼痛轨迹和手术前预测因素,随访 24 个月。
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-07-10 DOI: 10.1097/j.pain.0000000000003330
Guillermo Ceniza-Bordallo, Andrés Gómez Fraile, Patricia Martín-Casas, Jennifer A Rabbitts, Rui Li, Tonya M Palermo, Ibai López-de-Uralde-Villanueva

Abstract: Pediatric chronic pain, particularly chronic postsurgical pain (CPSP), poses a significant public health challenge, impacting 20% of pediatric populations. While several presurgical predictors have been identified, there is a scarcity of data on long-term outcomes, especially beyond 1 to 2 years postsurgery. Previous research primarily focuses on North American children, creating gaps in understanding CPSP outcomes in diverse health systems, such as in Spain. This study, registered as NCT04735211, investigates CPSP in 159 children and adolescents (mean age = 12.4 years, 37.1% girls, retention rate = 65%) undergoing various surgeries in Spain. The objectives include examining CPSP prevalence (Numerical Rating Scale ≥ 4) at 3, 6, 12, and 24 months, exploring postsurgical pain trajectories through group-based trajectory modeling, and identifying potential presurgical predictors for CPSP (pain intensity, pain catastrophizing, pain anxiety, fear of pain, kinesiophobia, health-related quality of life, pain interference, and physical activity), using multiple logistic regressions. Results show a CPSP prevalence of 41% at 3 months, decreasing to 14% at 24 months. Presurgical factors including pain intensity (adjusted odds ratio [aOR] = 1.25, 95% confidence interval [CI] = 1.02-1.53), pain catastrophizing (aOR = 1.06, 95% CI = 1.00-1.13), and pain anxiety (aOR = 1.06, 95% CI = 1.02-1.11) were associated with CPSP at 3 months. Group-based trajectory modeling revealed 3 postsurgical pain trajectories: Low Pain with Rapid Recovery Group (30.2%), Moderate Pain with Recovery Group (53.5%), and High Pain with Slow Recovery Group (16.3%), with group differences in presurgical predictors, excluding physical activity. This study contributes valuable insights into CPSP, emphasizing the need for long-term follow-up. The findings could inform the implementation of preventive programs for CPSP into diverse health systems.

摘要:小儿慢性疼痛,尤其是慢性手术后疼痛(CPSP)是一项重大的公共卫生挑战,影响了 20% 的小儿群体。虽然已经确定了一些手术前的预测因素,但有关长期结果的数据却很少,尤其是手术后 1 到 2 年的结果。以前的研究主要集中在北美儿童身上,因此在了解西班牙等不同卫生系统的 CPSP 结果方面存在差距。这项注册为 NCT04735211 的研究调查了在西班牙接受各种手术的 159 名儿童和青少年(平均年龄 = 12.4 岁,37.1% 为女孩,保留率 = 65%)的 CPSP 情况。研究目标包括在 3、6、12 和 24 个月时检查 CPSP 患病率(数值评定量表≥ 4),通过基于群体的轨迹建模探索手术后疼痛轨迹,并使用多重逻辑回归确定潜在的手术前 CPSP 预测因素(疼痛强度、疼痛灾难化、疼痛焦虑、疼痛恐惧、运动恐惧症、健康相关生活质量、疼痛干扰和体力活动)。结果显示,3 个月时 CPSP 患病率为 41%,24 个月时降至 14%。手术前因素包括疼痛强度(调整赔率 [aOR] = 1.25,95% 置信区间 [CI] = 1.02-1.53)、疼痛灾难化(aOR = 1.06,95% CI = 1.00-1.13)和疼痛焦虑(aOR = 1.06,95% CI = 1.02-1.11)与 3 个月时的 CPSP 相关。基于组别的轨迹模型显示了三种手术后疼痛轨迹:低度疼痛快速恢复组(30.2%)、中度疼痛恢复组(53.5%)和高度疼痛缓慢恢复组(16.3%),除体力活动外,各组在手术前预测因素上存在差异。这项研究为 CPSP 提供了宝贵的见解,强调了长期随访的必要性。研究结果可为在不同的医疗系统中实施 CPSP 预防计划提供参考。
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引用次数: 0
Prediction of the response to repetitive transcranial magnetic stimulation of the motor cortex in peripheral neuropathic pain and validation of a new algorithm. 预测外周神经病理性疼痛患者对重复经颅磁刺激运动皮层的反应并验证新算法。
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-06-14 DOI: 10.1097/j.pain.0000000000003297
Nadine Attal, Samuel Branders, Alvaro Pereira, Didier Bouhassira

Clinical trial registration: NCT02010281.

临床试验注册:NCT02010281。
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引用次数: 0
Chronic pain is specifically associated with updating working memory: a longitudinal twin study. 慢性疼痛与工作记忆的更新特别相关:一项纵向双胞胎研究。
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-08-06 DOI: 10.1097/j.pain.0000000000003347
Lydia Rader, Tor D Wager, Naomi P Friedman

Abstract: Worse executive function (EF) is associated with chronic pain and could mechanistically contribute to pain chronification. It is unclear whether there is overall impairment in EFs or whether there are impairments in specific cognitive domains. Furthermore, the possible genetic risk underlying these associations has not been tested. Participants were from the Colorado Longitudinal Twin study; 786 same-sex twins completed a battery of EF tasks at ages 23 and/or 28 and 634 of these twins self-reported chronic pain at mean age = 28.1; prevalence = 27.76% using the Brief Pain History Questionnaire. The EF tasks were used to define a Common EF factor and 2 factors specific to updating working memory and shifting mental set. We estimated the phenotypic and genetic associations of stable EF variance across ages 23 and 28, as well as EF variance unique to age 28, with pain. With respect to stable EF variance, pain phenotypically correlated with the Updating-specific factor ( r = -0.21, P = 0.008) but did not significantly correlate with the Common EF factor ( r = -0.06, P = 0.350) nor with the Shifting-specific factor ( r = -0.03, P = 0.709). There were no significant phenotypic correlations between pain and EF variance unique to age 28. A twin model indicated that pain and Updating-specific variance share genetic risk ( r A = -0.46, P = 0.005) but not environmental risk ( r E = 0.05, P = 0.844). Updating working memory shares a phenotypic and genetic relationship with pain in young adults. Impairments in gating or monitoring pain signals may play a mechanistic role in pain development.

摘要:较差的执行功能(EF)与慢性疼痛有关,并可能从机制上导致疼痛慢性化。目前尚不清楚执行功能是否存在整体损伤,还是在特定认知领域存在损伤。此外,这些关联背后可能存在的遗传风险也尚未得到检测。参与者来自科罗拉多纵向双胞胎研究;786对同性双胞胎在23岁和/或28岁时完成了一系列EF任务,其中634对双胞胎在平均年龄=28.1岁时使用简短疼痛史问卷自我报告了慢性疼痛;患病率=27.76%。EF 任务被用来定义一个通用 EF 因子和两个专门用于更新工作记忆和转换思维定势的因子。我们估算了 23 岁和 28 岁稳定 EF 变异的表型和遗传关联,以及 28 岁特有的 EF 变异与疼痛的关联。在稳定的 EF 变异方面,疼痛与更新特异因子存在表型相关性(r = -0.21,P = 0.008),但与普通 EF 因子(r = -0.06,P = 0.350)或转移特异因子(r = -0.03,P = 0.709)无显著相关性。疼痛与 28 岁特有的 EF 变异之间没有明显的表型相关性。双生子模型表明,疼痛和更新特异性变异具有遗传风险(rA = -0.46,P = 0.005),但不具有环境风险(rE = 0.05,P = 0.844)。更新工作记忆与青壮年疼痛具有表型和遗传关系。门控或监测疼痛信号的障碍可能在疼痛的发展过程中起着机理作用。
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