British Journal of Pain最新文献

Objective: Chronic pain has been shown to be more prevalent among women than men. However, each person's experience of pain is shaped by a complex interplay of biological, psychological and social factors. The aim of this study was to summarise a comprehensive 'experience of pain' questionnaire in the UK Biobank and identify differences in the experience of chronic pain between females and males.

Methods: This was an exploratory analysis of an online self-assessment questionnaire consisting of 128 questions related to UK Biobank participant's experience of pain that was administered in 2019. Data were summarised by sex, and chi-squared and t-tests were used to determine whether there were statistically significant differences between females and males.

Results: About one-third of UK Biobank participants (167,183, 57% female) responded to the questionnaire. More females than males reported suffering from chronic pain (60.0% vs 51.5%). There was female predominance in 11 out of 14 medical conditions, particularly in osteoarthritis (35.6% females vs 24.5% males), migraine (25.0% vs 12.3%) and fibromyalgia (2.7% vs 0.7%). Female participants tended to report pain of greater severity and longer duration that more profoundly impairs their everyday functioning when compared to their male counterparts.

Conclusion: A significant strength of our study is the large sample size, and the high detail of information captured about pain phenotypes, in which we found sex differences in chronic pain persist. We recommend future pain surveys collect sex-based pain conditions to enable better recognition of why sex differences in pain persist.

Introduction: Optimal pain control after pediatric hip surgery enhances recovery, minimizes opioid needs, and improves comfort. The pericapsular nerve group (PENG) block, a unique regional intervention, has advantages over the standard caudal epidural block (CEB). This study compares the analgesic efficacy of ultrasound-guided PENG and CEB blocks in children having hip surgery.

Methods: This study included 80 pediatric patients, aged 1 to 7 years, who received general anesthesia for hip surgery. Patients were randomly allocated to receive either a PENG block (Group P) using 0.5 mL/kg of 0.25% bupivacaine, or a CEB (Group C) using equivalent bupivacaine volume. The primary outcome was postoperative pain assessed by the FLACC scale at predefined timepoints. Secondary measured outcomes were the time until the first rescue analgesic, total morphine usage, occurrence of adverse effects, and parental satisfaction.

Results: Pain scores were generally comparable, but Group C showed significantly lower FLACC scores at 30 min (p = .047), while Group P had lower scores at 6 h (p = .024). Group P demonstrated a significantly longer time to first rescue analgesic (10.68 ± 7.03 vs 7.85 ± 4.77 h, p = .039) and lower morphine consumption (p = .047). Block performance time was greater in Group P (p < .001), but higher parental satisfaction was noted (p = .03). The safety profile was equivalent between groups, with no significant disparity in adverse effect frequency.

Conclusion: For pediatric hip surgery, ultrasound-guided PENG block provides long-lasting postoperative analgesia compared to CEB, while reducing opioid needs and enhancing parent satisfaction.

Background: The Scottish Service Model for Chronic Pain advocates multidisciplinary provision of care, stratified across sectors. However, there is lack of transparency over staffing capacities and provisions.

Method: We submitted Freedom of Information requests to the 14 regional Scottish Health Boards in September 2024. We conducted descriptive quantitative and qualitative analysis of responses.

Findings: We received 13 responses from 14 Health Boards with varying levels of detail. We found that staff groups most commonly reported to provide dedicated care for chronic pain are: medicine, physiotherapy, psychology and nursing, with lower levels of occupational therapy and pharmacy provision. Six Boards reported at least 1.0 whole-time equivalent medical, physiotherapy and psychology staffing capacity per 500,000 population, with sparse provisions by some populous Boards, showing considerable variation. A variety of pain groups were reported. Boards with higher levels of multidisciplinary staffing and group provision tended to report a dedicated management resource. We found several examples of cross-sectoral connections, potentially improving access to pain care according to need at the local level. The most variable and least well-developed responses were to the question on equitable delivery of care, demonstrating need to improve delivery of equitable approaches and strategies to pain care.

Conclusions: We used FOI requests to collect data on chronic pain staffing capacity showing considerable variation across Scotland. There are limitations to this method; it is likely that our findings do not show a complete picture, rather useful insights into activities and provisions of services for pain care across Scotland.

Background: Despite an increasingly biopsychosocial approach to pain management in healthcare, limited research exists on psychological features in dentistry including endodontic-related pain. This study aimed to identify the scope of evidence on the relationship of psychological variables to pain associated with dentistry specifically endodontics, as a first step towards addressing them for treatment.

Methods: This scoping review was conducted according to the JBI Manual for Evidence Synthesis. Literature searches were performed in MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, Cochrane, and CINAHL, alongside grey literature sources, including ProQuest, ClinicalTrials.gov, and conference materials, reference lists, medRxiv pre-prints, EBSCO theses, and data from clinical trial registers such as ClinicalTrials.gov and Cochrane trials (via Ovid) (from inception to February 2025). Two independent reviewers screened records, and data extraction was cross-verified. The protocol was registered on Open Science Framework (DOI: 10.17605/OSF.IO/FSRJP).

Results: Forty eight studies were included. Twelve broad psychological constructs were evaluated in relation to pre, during, and post-endodontic pain: pain expectancies, positive treatment expectancies, depression, anxiety, positive and negative mood (affect), beliefs about pain, desire for control of dental treatments, perceptions of dentists, somatic focus or awareness, pain coping strategies, personality, and psychiatric diagnoses. Pre-procedural pain was most frequently linked to anxiety. Procedural and post-procedural pain was consistently associated with anxiety, pain expectations, depression, and pain beliefs.

Conclusion: A variety of psychological factors have been investigated in relation to endodontic pain at different time-frames. Whilst associations between endodontic pain and psychological constructs were found, further research is needed to evaluate the strength of these associations, and the scope of evidence for interventions designed to address these psychological contributors to pain in dental practice. Identifying psychological contributors to endodontic pain can enhance pain prediction, patient communication, and clinical care strategies.

This study explored the psychological sense-making of people with amputations towards their phantom limb pain. Interviews with eight participants were analysed using interpretative phenomenological analysis. Four themes were developed: (1) 'Everybody just thinks you're some kind of freak': Making personal and social sense of phantom limb pain; (2) 'If you talk about them, they seem to come': Perceiving phantom limb pain as an externalised threat; (3) 'The sooner you accept things, truthfully accept things, then life becomes better': Achieving acceptance; and (4) The unrecognised role of psychology in managing phantom limb pain. The findings indicate the importance of (1) education and validation for those who experience phantom limb pain, (2) education around the role psychology can have in managing with the pain, and (3) psychological interventions being available and offered to those with phantom limb pain.

Background: Young patients who suffer from a pediatric condition are typically submitted to diverse and often repeated painful procedures. Theory and empirical studies suggest that communication styles used by healthcare professionals could mitigate such procedural pain. Recently, a hypnotic communication training (Rel@x) was developed with promising results. The present study aimed to describe how healthcare professionals change the words they use with patients after training.

Methods: A nine-hour training in hypnosis-derived communication was offered to 78 volunteer healthcare professionals from a tertiary pediatric hospital, and 58 participated in the evaluative study. Participants were evaluated at baseline, immediately after the training, and 5 months later (39 ± 10 yrs, 52 women, 54 nurses). We used a video-recorded standardized simulation protocol of venipuncture, and five categories of words were derived. Word categories were corroborated in a validity study with 10 independent judges. We modeled pre-post-follow-up changes over time with latent growth curve models.

Results: Following training, healthcare professionals used fewer words related to negative experiences (-51%) or medical procedures (-73%) and used more words referring to the relaxing and analgesic experience (+20%), and the specific techniques they had learned (Pleasant place +260%, Magic glove +582%). These changes were maintained at a proportion of 45-81% 5 months later. More change was observed among women and less experienced healthcare professionals.

Conclusion: Results suggest that healthcare professionals exposed to a short, structured communication training aiming to mitigate pediatric pain durably adjust the language they use when performing a painful procedure. This is encouraging for future testing and implementation of hypnosis-derived communication training in healthcare providers.

Background: Chronic postoperative neuropathic pain is a common and sometimes disabling problem. Mainstay pharmacological management involves gabapentinoids, tricyclic anti-depressants and serotonin and norepinephrine reuptake inhibitors. Past this, guidance is limited. There is good evidence for the use of high-concentration capsaicin patch in non-operative causes of neuropathic pain. This systematic review aimed to evaluate the evidence base for the high-concentration (8%) capsaicin patch for postoperative neuropathic pain.

Methods: We carried out a systematic search of 4 databases (Ovid MEDLINE, Embase, Cochrane Library and https://ClinicalTrials.gov) from inception to 3rd July 2025 to identify randomised controlled trials investigating the effectiveness of high-concentration capsaicin patch for postoperative neuropathic pain. The primary outcome was pain improvement, with adverse events being the secondary outcome. Study selection was performed independently by two reviewers using the Rayyan platform.

Results: 487 studies were identified. After screening, only one randomised controlled trial on 46 participants met inclusion criteria. The high-concentration capsaicin patch did not significantly improve postoperative neuropathic pain compared to an inactive placebo patch. However, the certainty of evidence was graded as very low using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We also found 2 ongoing trials without published results.

Conclusion: This systematic review identified a clear gap in the literature regarding the use of high-concentration capsaicin patches for chronic postoperative neuropathic pain. High-quality studies are needed to expand the existing evidence base. Based on our findings, we propose several recommendations to guide future research in this area.

Objective: To compare three therapeutic strategies in the management of acute post-traumatic pain at emergency department (ED) discharge.

Methods: We conducted a prospective, randomized, controlled trial including patients ≥18 years with acute post-traumatic pain. They were randomized to receive oral paracetamol (n = 506), paracetamol-codeine (P-Cod group; n = 489) and paracetamol-caffeine (P-Caf group; n = 505) for 7 days. The primary endpoint was the rate of participants achieving at least 50% reduction in Numerical Rating Scale (NRS) from baseline by the 7th day after ED discharge. Secondary endpoints included the need for rescue analgesics, adverse effects, and patient satisfaction.

Results: At day-7, success rate were 85.8%, 93.9%, and 90.1% in paracetamol, P-Cod, and P-Caf groups, respectively. The differences were statistically significant between the paracetamol and P-Caf groups (p = .02), the paracetamol and P-Cod groups (p ≤ .001); and the P-Cod and P-Caf groups (p = .04). The need for rescue analgesics was significantly higher in paracetamol group (47.6%) compared to P-Caf (7.5%) and P-Cod group (7.4%); whereas, no significant difference was found between P-Cod and P-Caf groups. Most of the adverse effects (95.7%) were observed in P-Cod group. Finally, patients treated with paracetamol alone were the least satisfied.

Conclusion: The combination of codeine or caffeine with paracetamol was equally effective and superior to paracetamol alone. If we consider the better tolerance, paracetamol combined with caffeine appears to be a suitable analgesic option for post trauma patients.