PAIN®最新文献

Abstract: The unprecedented disruption of the COVID-19 pandemic raises crucial questions about its impact on chronic pain levels in the US population. We present a comprehensive analysis of chronic pain (CP), high-impact chronic pain (HICP), and site-specific pain prevalence before, during, and after the pandemic, and investigate key contributing factors. We analyze a nationally representative sample of 90,769 community-dwelling adults aged 18 years and older from 3 cross-sectional waves of the National Health Interview Survey (2019, 2021, and 2023). Outcomes are CP and HICP; we also present findings for 6 site-specific pain measures. We include an extensive range of covariates (demographics, socioeconomic status, health behaviors, health conditions, mental health, and health insurance type); additional analyses also explore the role of long COVID. Chronic pain prevalence increased from 20.5% (95% confidence interval: 19.9%-21.2%) in 2019 to 20.9% (20.3%-21.6%) in 2021 and 24.3% (23.7%-25.0%) in 2023, representing an 18% increase over the study period. High-impact chronic pain prevalence, which was 7.5% (7.1%-7.8%) in 2019, declined to 6.9% (6.6%-7.3%) in 2021 before rising to 8.5% (8.1%-8.9%) in 2023, a 13% overall increase. The 2023 pain increases were widespread: they occurred for all examined body sites except tooth/jaw pain and all population subgroups. Long COVID accounted for approximately 13% of the observed 2019 to 2023 increase in both CP and HICP. In 2023, an estimated 60 million Americans experienced CP and 21 million experienced HICP, the highest prevalence ever recorded in the National Health Interview Survey. These findings suggest a significant escalation in the population burden of pain, with crucial implications for public health policy.

Abstract: There are no nationally representative studies examining both the frequency and correlates of "undiagnosed pain"-pain without a formal diagnosis. To identify the magnitude of this healthcare gap, we performed cross-sectional secondary analyses of the Medical Expenditure Panel Survey (MEPS), 2016-2019 data. The primary study outcome is "being undiagnosed": the absence of diagnoses for pain-related conditions among participants reporting pain-related interference (PRI). Pain-related interference was established using the SF36 pain question embedded in MEPS, with 10,954 individuals reporting any PRI within 4 weeks of the interview and 4,902 individuals reporting at least moderate PRI. Participants with PRI were assigned as "being undiagnosed" if the following conditions were met: (1) the participant did not have medical records for any pain-related conditions in both the previous and current year of the interview and (2) did not report having any pain-related priority conditions from a list provided during the MEPS interviews. Among those reporting any PRI, about 21.1 million people (9.3%; 95% confidence interval [CI], 8.6%-10.0%) were without diagnoses for either primary pain conditions identified using MEPS clinical classification codes or conditions where pain would be a secondary symptom (eg, hypertension and immunity disorders). From multivariable logistic regression modeling, we determined that younger and middle-aged adults, males, racial and ethnic minority groups, foreign-born populations, people without insurance, and people with better perceived health are more likely to have their pain undiagnosed. Our findings underscore the need for improved access to care and better patient-provider communications in those suffering from underdiagnosed pain.

Abstract: Self-initiated actions often generate sensory signals perceived to be less intense than identical signals generated externally. This phenomenon, known as sensory attenuation, is particularly robust for nonpainful tactile sensations. For pain, however, even if the stimulation is self-generated and predictable, it remains painful, albeit sometimes slightly less intense. This difference may reflect the functional divergence between pain and nonpainful sensations, with the sense of agency playing a central role in this distinction. Across 2 experiments involving 61 pain-free adults, we investigated the attenuation of self-induced pain and nonpainful sensations across different stimulation modalities, contexts, and agency levels. We found that self-induced attenuation depended on stimulation modality rather than intensity, with significant reductions for modalities involving strong motoric components and high spatiotemporal alignment (eg, mechanical pressure), in line with the internal forward model. Individuals' trait agency played a pivotal role, with stronger agency associated with enhanced attenuation of nonpainful sensations and mild pain, but reduced attenuation of intense pain. Sex differences also emerged with stronger attenuation effects in men, who also reported higher levels of agency. This study is the first to show that trait-level agency differentially modulates attenuation for painful and nonpainful sensations and the first to explore sex differences. By comparing pain with nonpainful touch, we proposed that self-induced sensations are not attenuated uniformly but shaped by evolutionary priorities such that socially or playfully mediated sensations are more readily suppressed, while high-threat sensations like pain resist qualitative suppression to preserve their protective function.