British Journal of Pain最新文献

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.

Background: There is insufficient evidence to indicate using opioids in the management of chronic non-cancer pain (CNCP), yet ongoing prescribing is prevalent and remains a global public health matter. Inappropriate long-term prescribing of opioids is associated with side effects and adverse events. This article explores the significant barriers and enablers during opioid management indicated for CNCP within general practice, in the United Kingdom, and proposes recommendations to optimise practice.

Methods: A systematic literature review of the databases MEDLINE, EMBASE, CINAHL, Web of Science and Science Direct were searched. Titles, abstracts and full texts were screened against inclusion and exclusion criteria. Papers were evaluated using the Critical Appraisal Skills Programme qualitative appraisal tool.

Results: From 1027 citations, 6 papers were included (n practitioners = 168 and n patients = 52). Four key themes were identified: three barriers and one enabler. Barriers: general practice healthcare model constraints, relationships in primary care and attitudes towards CNCP management. Enabler: multidisciplinary team set up.

Conclusion: A change in culture from both service providers and service users is required to fully embrace the multidisciplinary team observed in general practice. Movement away from the traditional model of doctor led management needs to occur. Future policies need to prioritise reducing the long waiting times observed for specialist pain services. Non-pharmacological opportunities and services should also be developed to support patients.

Background: Complex Regional Pain Syndrome (CRPS) is a distressing pain condition that can lead to significant burdens for individuals and society. A small number of specialist CRPS-practice services exist, but access is limited; most patients are managed in local hospitals or community settings. In a series of phases, we sought to understand the needs and perspectives of therapy practitioners across the care pathway in England and to identify recommendations to improve therapy-led management of CRPS.

Methods: In phase 1, we disseminated an e-survey to physiotherapists, occupational therapists and hand therapists across a range of settings. Phase 2 comprised semi-structured interviews with therapists and patients. Online stakeholder events (phase 3) were convened to review findings and prioritise suggestions to enhance CRPS care.

Results: Seventy-seven therapists responded to the e-survey and 31 semi-structured interviews were conducted (n = 10 patients, n = 9 therapists from specialist CRPS-practice services, n = 12 therapists from other settings). N = 11 therapists and n = 5 patients participated in the stakeholder events. Findings indicated pathways of care are complex, but similarities exist in therapy approaches across settings, albeit with longer, more frequent appointments in specialist CRPS-practice services. Recommendations to improve CRPS management included: additional education provision for therapists (including better access to CRPS 'experts'), CRPS education for other clinicians, streamlining of patient pathways, and improving patient information.

Conclusions: This work highlights opportunities to improve therapy-led care for people living with CRPS. Findings will be valuable in informing UK clinical guidelines and strengthening initiatives to enhance support for therapists.

Background: Chronic pain is a common side effect of cancer treatment and is frequently cited as a top concern and unmet need for cancer survivors. This paper outlines the development of clinical recommendations to better support people with chronic pain as a long-term or late side effect of cancer and its treatment.

Method: Evidence was identified from empirical research, and new insights from cancer survivors (n = 19) and healthcare professionals (n = 135), with findings informing draft clinical recommendations. These recommendations were reviewed and refined within online stakeholder engagement events, which comprised Phase 1 researcher review (n = 5) and Phase 2 Expert Review Panels (four groups and two one-to-one discussions). Membership of expert panels included cancer survivors living with chronic pain after cancer, and clinical, research, and education experts (n = 16). Data generated from Expert Review Panels were analysed using inductive qualitative content analysis.

Results: There was shared opinion among stakeholders that the recommendations would be beneficial in this setting, the recommendations reflected the evidence and the complexity of implementation was acknowledged. Validating cancer survivors' experiences of chronic pain was seen as essential to best practice and the importance of informed patients and healthcare professionals making good decisions together was recognised.

Conclusions: Resultant clinical recommendations are summarised as: PAINS: Prepare and inform, Acknowledge and listen, Increase healthcare professional knowledge, Name and diagnose, and Services and supported self-management interventions. Implementation strategies and future research are proposed.

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.