British Journal of Pain最新文献

Introduction: A residential pain management programme for military veterans with high medical and psychological comorbidity was adapted for remote delivery. This study evaluates the outcomes of the remote technology-delivered pain management programmes (rPMP).

Methods: Veterans with chronic pain, referred to a pain management programme, were assessed using online video calling. Veterans were suitable if they had chronic pain that affected their quality of life. Veterans were referred elsewhere when their needs were not best met by the programme. Eligible veterans attended a 9-day interactive online interdisciplinary programme and a 9-month follow-up. An experienced team of a psychologist, physiotherapist, nurse, and medical consultant, delivered the programme. Pain, mood, self-efficacy, and medication were assessed at the beginning and end of the programme and at 9-month follow-up.

Results: 107 veterans were treated in 16 rPMPs; results are from 92 complete sets of data. Statistically significant gains were observed from day 1 to day 9 (effect size Cohen's d): average pain d = 0.71, pain interference d = 0.82; mood, d = 0.99; self-efficacy, d = 0.85; reduction in catastrophic thinking, d = 1.22; overall health, d = 0.52; and changes in medication use. 72 veterans attended 9-month follow-up online; results are from 59 complete sets of data. Statistically significant gains were maintained at 9-month follow-up, effect size: mood, d = 0.71; self-efficacy, d = 0.80; reduction in catastrophic thinking, d = 0.95; and overall health, d = 0.52. Attendance was 97%, with positive feedback on programme content and delivery.

Conclusions: Veterans made significant improvements on all outcomes. Remote technology-delivered pain management for veterans with chronic pain appeared equally effective as in-person delivery, and suited veterans whose circumstances made it difficult to attend in-person treatment. Veterans who attended the 9-month follow-up largely maintained treatment gains.

Background: Pain assessment in Alzheimer's disease and related dementias (ADRD) is challenging due to cognitive decline and communication barriers, limiting the reliability of self-report and observational tools. Functional near-infrared spectroscopy (fNIRS) offers a noninvasive measure of cerebral hemodynamic responses and may serve as an objective biomarker for pain. This pilot study evaluated the feasibility of fNIRS for pain assessment in ADRD, using transcranial direct current stimulation (tDCS) solely as a controlled cortical modulation paradigm to test fNIRS sensitivity, rather than as a therapeutic intervention.

Methods: Forty older adults with mild to moderate ADRD were randomized to active (n = 20) or sham (n = 20) tDCS for 5 consecutive days to generate controlled cortical modulation. Pain was assessed using the Numerical Rating Scale (NRS), Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2), and fNIRS responses to standardized pain stimuli. Hemodynamic changes in prefrontal and somatosensory cortices were analyzed to determine whether fNIRS detected pain-related brain activity.

Results: NRS and MOBID-2 scores were significantly correlated at baseline (r = .605, p < .001) and post-intervention (r = .567, p < .001). In the active tDCS condition, pain stimulation elicited significant cortical hemodynamic changes that correlated with pain scores (p < .05), supporting fNIRS's sensitivity for detecting pain-related neural responses. In the sham group, only a few significant correlations were observed post-intervention (e.g., frontal cortex r = .44, p = .049; prefrontal cortex r = .52, p = .017), which were less consistent compared to the active condition.

Conclusion: fNIRS demonstrated feasibility as an objective pain assessment tool in ADRD. tDCS served only as a probe to induce cortical modulation for evaluating fNIRS performance. In this study, tDCS functioned as a probe to induce cortical modulation for evaluating fNIRS sensitivity, not as a therapeutic intervention. Larger trials are needed to confirm fNIRS validity for clinical application.

Introduction: The aim of this systematic literature review was to critically analyze and synthesize the current scientific literature on the effectiveness of music therapy in reducing pain among patients with rheumatic and musculoskeletal disorders (RMDs).

Methods: The literature search strategy was performed in the digital databases of MEDLINE, Scopus, and the Cochrane library to identify relevant studies published from January 2000 to December 2024, assessing the impact of music therapy on pain-related outcomes.

Results: Among the included studies (n=16), 10 were randomized controlled trials (RCTs) and 6 were non-randomized studies, including 4 prospective cohort studies and 2 prospective comparative studies. Pain was most frequently assessed using the Visual Analogue Scale (VAS), and receptive music listening was the most frequently used method, with some studies incorporating additional therapeutic interventions. A total of 11 studies out of 16 reported a statistically significant decrease in pain intensity following music therapy interventions. Conversely, 5 studies reported mixed results, emphasizing the heterogeneity of populations and interventions.

Conclusion: Music therapy appears to be a beneficial adjunct in pain management for patients with RMDs. However, well-designed randomized controlled trials, with larger sample sizes, are necessary to standardize intervention protocols and evaluate long-term effects.

Objectives: Waiting lists for pain management services globally are extensive, exacerbating the burden of chronic pain for patients and service providers. This study aimed to examine the psychological profiles of people living with chronic pain (PLwCP) during long treatment delay and use appropriate inferential analyses of waitlist data to identify potential demographic characteristics presenting at-risk subgroups.

Method: A longitudinal survey design tracked measures of psychological wellbeing (pain self-efficacy, depression, anxiety and pain catastrophizing) in PLwCP (N = 211, Males = 50, Females = 161) on the waitlist for pain management, in a major regional NHS hospital in the Southeast of the UK. Measures were collected at baseline, three-months and six-months of waiting.

Results: Regression and ANOVA models revealed that clinically significant levels of depression, anxiety, pain catastrophizing and pain self-efficacy remained high throughout the waiting period, indicating sustained psychological distress. While pain self-efficacy significantly increased over time and though the effect size was small, levels were in the clinically severe range throughout the wait-time, thus requiring intervention. Older and younger adults showed different phenotypical patterns of psychosocial wellbeing whilst waiting.

Conclusions: These findings demonstrate that clinical levels of psychological distress are persistent and entrenched throughout the waitlist for pain management. PLwCP remain an at-risk population in significant need of earlier support. Prehabilitation offers a prospective framework through which early intervention can be achieved. Subgroups identified as greater risk are younger individuals and those with worse depression, anxiety, pain catastrophizing and/or pain self-efficacy upon referral. These factors present stratification targets and direction of where prehabilitation is most urgently required. These findings have clear implications to improve pain practice.

Background: Preliminary research indicates that psychedelics may hold promise as analgesic agents. This study investigated the potential analgesic effects of lysergic acid diethylamide (LSD) microdosing on pain tolerance and subjective pain perception in healthy participants.

Methods: Utilizing a randomised, placebo-controlled design, participants received 15 μg of LSD or placebo over four administrations. Pain tolerance was assessed using the Cold Pressor Task (CPT), along with subjective ratings of painfulness, unpleasantness, and stress.

Results: No analgesic effects of LSD were found on any of these measures in the whole sample. LSD increased blood pressure and subjective ratings of drug experience on administration days. Blood pressure was positively correlated to pain tolerance in the LSD group, whereas subjective drug experience was not. To explore whether the absence of analgesic effects of LSD could be explained by ceiling effects observed in CPT performance, post-hoc analyses were conducted in a smaller subsample of individuals that did not show ceiling effects at baseline. This post-hoc analysis suggested that LSD increased pain tolerance and reduced unpleasantness, but only after the first dose.

Conclusions: Overall, the present study provided no evidence for analgesic effects of 15 µg LSD. Post-hoc analyses only revealed a marginal analgesic effect of LSD in a subsample of participants. The dose used in this study may be below the threshold dose that is needed to produce a solid and consistent analgesic effect. Future research with larger, appropriately selected samples and higher doses is recommended to further elucidate LSD's analgesic effects and its application in clinical settings.

Introduction: Sensory discrimination training has demonstrated improvements in two-point discrimination and pain reduction in people with chronic pain. We tested the feasibility and acceptability of a novel Sensory Training System (STS) device in the homes of people with Type 1 Complex Regional Pain Syndrome (CRPS).

Methods: Participants meeting CRPS diagnostic criteria were invited to use the STS for a minimum of 30 minutes per day for 30 days. Device usage data were captured by the STS. Assessments at baseline and after 30 days were: two-point discrimination ability, pain intensity and interference, sensitivity and emotions towards CRPS limb. Qualitative interviews were conducted at the end of the study to capture participants' feedback on the device.

Results: A total of 10 participants (female n = 7) completed the study. Participants' mean age was 56.4 years (range: 24-78 years), and mean disease duration was 9.37 years (range: 4.25-26.5). Eight had lower limb CRPS. The mean STS device use was 27.3 ± 3.4 days and mean daily usage of training games was 00:27:11 ± 00:07:52 (hh:mm:ss). No patterns or trends were evident between device usage and outcome data.

Conclusion: This feasibility study of a home-based STS for people with CRPS revealed key areas for improvement in the device's hardware and software and outlined the challenges of development and testing during the COVID-19 pandemic, while also capturing valuable usability insights from participant feedback. Key recommendations include early and ongoing collaboration with users, securing sufficient funding, ensuring correct device setup by participants, conducting interim analysis, and using online tools to enhance participant experience and data collection.

Study registration: The study was registered with ISRCTN registry on 28^th May 2021 (https://doi.org/10.1186/ISRCTN89099843).

Background and objective: Painful diabetic neuropathy (PDN) is a common complication of diabetes, characterized by significant pain and functional impairment. Gabapentin and duloxetine are standard treatments. This study compared their efficacy in alleviating pain, improving clinical global impression of change (CGIC), reducing sleep interference, enhancing response rates, and assessing safety.

Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. A search of Embase, Medline, ScienceDirect, Scopus, Web of Science, and Cochrane databases through May 2024 identified randomized controlled trials comparing gabapentin and duloxetine for PDN. Risk of bias was assessed using the Cochrane RoB2 tool. Data on pain, CGIC, sleep interference, responder rates, and adverse events were analyzed using a random-effects model, with results presented as standardized mean differences and risk ratios with 95% confidence intervals.

Results: Six RCTs with 526 patients (44% female) were included. There was no significant difference between duloxetine and gabapentin in relieving pain (SMD = -0.16, 95% CI [-0.36, 0.03], p = .10, I² = 66%). No significant differences were observed in the overall effect of CGIC (MD = 0.01, 95% CI [-0.07, 0.09], p = .79, I² = 0%), or sleep interference (MD = -0.07, 95% CI [-0.36, 0.23], p = .67, I² = 39%); However, duloxetine showed superiority at week 1 for CGIC (MD = 0.56, 95% CI [0.18, 0.94], p = .003), and week 8 for sleep interference (MD = -0.40, 95% CI [-0.79, -0.01], p = .04, I² = 0%), while gabapentin was superior at week 1 in sleep interference (MD = 0.75, 95% CI [0.11, 1.39], p = .02). No significant differences were observed in responder rates or adverse events.

Conclusion: Gabapentin and duloxetine are effective for PDN, with distinct advantage at different time points. Personalized treatment is recommended, and future research should assess long-term efficacy in diverse populations.

Objectives: A significant driver of low back pain (LBP) is adaptations to endogenous pain modulation (EPM). Exercise modulates pain through various mechanisms, however, there is a lack of information on its relation to EPM. The objective of this study was to evaluate the feasibility of a protocol investigating if changes in EPM occurs after exercise therapy.

Methods: Participants were recruited from an ongoing randomized controlled trial comparing graded activity to motor control exercises. Participants attended 2 in person sessions pre and post intervention to assess pain pressure threshold (PPT), temporal summation (TS), conditioned pain modulation (CPM) and exercise induced hypoalgesia (EIH). Feasibility outcomes included attrition, recruitment rate, exercise adherence, protocol burden and consistency. In total, 36 (53%) eligible participants enrolled and completed baseline assessments.

Results: A-priori thresholds for feasibility were met for attrition 32/36 (89%), recruitment rate (53% of eligible participant enrolled and 36 recruited in 6 months), exercise adherence (93.8%) and satisfaction with assessment protocols (bothersome 88.9%, future participation 97.2%), apart from discomfort with assessment (58.3%). Participants reported that the CPM caused the most discomfort. There was a trend for an increase in low back PPT, no change in TS, and a decrease in CPM and thumbnail PPT at follow up. The results demonstrated that the protocol is feasible for all pre-specified outcomes.

Discussion: This article presents a protocol for EPM using PPT, TS, CPM and EIH that is feasible in a clinical trial for LBP. A future study is needed to further investigate EPM changes after exercise therapy in this population.

Background: Knee osteoarthritis (OA) is the most common form of OA. Patients with mild-to-moderate OA, who do not respond to conservative treatment or yet warrant joint replacement, represent a significant clinical challenge. Genicular Arterial Embolisation (GAE) is a promising interventional radiological technique for OA. However, data highlight a consistent subset of patients that do not respond to GAE, despite a successful procedure. Pain Catastrophising (PC) represents a set of cognitive/affective biases to pain, linked to maladaptations in the descending pain modulatory system and has been frequently identified as a predictor of clinical outcomes. Purpose: This study aimed to investigate whether baseline pain catastrophising is associated with treatment outcomes following GAE, and to explore its neural correlates using resting-state functional magnetic resonance imaging (rs-fMRI). Research Design: A prospective, longitudinal cohort design was employed for this study. Study Sample: Thirty patients with mild-to-moderate knee OA scheduled for GAE completed a presurgical assessment including psychometric profiling and quantitative sensory testing. A neuroimaging subset of 17 patients, who met MRI safety criteria, also completed rs-fMRI. Data Collection: Participants completed outcome assessments at 6 weeks, 3 months, and 12 months post-GAE. Pain Catastrophising Scale (PCS) scores were analysed in relation to treatment outcomes and to whole-brain voxel-wise functional connectivity using the dorsolateral prefrontal cortex (DLPFC) as a seed region. PCS scores were included as regressors in rs-fMRI analyses. Results: Pain Catastrophising was associated with a myriad of psychological/lifestyle baseline variables, such as depression, anxiety and poor sleep. Surprisingly, high pain catastrophisers demonstrated the best improvements, with PC scores predicting higher reductions in pain at 6-weeks (R² = .18, p = .024), 3-months (R² = .37, p < .001) and 1-year (R² = .18, p = .027). Resting-state analyses revealed that catastrophising was associated with higher connectivity between the DLPFC and areas of the brain associated with pain processing, suggesting more frequent engagement of top-down modulatory processes. Conclusions: These results highlight that, interestingly, patients who catastrophise may benefit most from GAE. Potential explanations for this are discussed within. Overall, this data indicates GAE is an effective treatment for knee OA, and may be valuable at managing pain for high catastrophisers, who often fare worse in more invasive surgical procedures.