Clinical Journal of Pain最新文献

Objectives: Laparoscopic cholecystectomy (LC), though minimally invasive, sometimes leads to significant postoperative pain. Ketamine has shown potential in alleviating it, but small sample sizes and administration protocols variability limit prior findings generalizability. This study evaluates ketamine's effectiveness in reducing postoperative pain across multiple time points.

Methods: A thorough search of multiple databases was conducted, covering publications up to January 2025. Data from eligible randomized controlled trials (RCTs) were extracted and pooled to calculate mean differences (MDs) for postoperative pain scores at 30 minutes, 1 hour, 2 hours, 4 hours, and 12 hours, alongside opioid consumption (morphine and tramadol) and adverse events.

Results: The analysis included 22 RCTs with 1,163 participants. Ketamine significantly reduced postoperative pain compared to placebo (MD=-0.37, 95% CI [-0.56 to -0.17], P=0.0002). Subgroup analyses at 30 minutes showed significant pain reduction in bolus + infusion (MD=-0.70, 95% CI [-1.33 to -0.07], P=0.03), bolus alone (MD=-1.28, 95% CI [-2.29 to -0.27], P=0.01), and propofol-based maintenance (MD=-0.89, 95% CI [-1.44 to -0.34], P=0.002). Additionally, ketamine significantly reduced morphine (MD=-0.46, 95% CI [-0.91 to -0.02], P=0.04) and tramadol consumption (MD=-1.03, 95% CI [-1.86 to -0.21], P=0.01).

Discussion: Ketamine reduced opioid use and postoperative pain at 30 minutes, with efficacy varying by administration method. Future RCTs should standardize dosage, anesthesia protocols, and pain management strategies to enhance evidence consistency.

Part of the June 2026 issue supplement, to be published in its entirety on May 12, 2026.

Part of the June 2026 issue supplement, to be published in its entirety on May 12, 2026.

Part of the June 2026 issue supplement, to be published in its entirety on May 12, 2026.

Part of the June 2026 issue supplement, to be published in its entirety on May 12, 2026.

Objective: Very few validated instruments measure a child's concept of pain. The Conceptualization of Pain Questionnaire (COPAQ) is a unidimensional instrument measuring this construct, developed in Catalan and translated to English. The psychometric properties of the English-version have not been evaluated. We conducted a Rasch analysis to evaluate its structural validity and internal consistency and a Confirmatory Factor Analysis (CFA) to evaluate its structural validity.

Methods: We analysed an existing dataset from a previous study. Item fit was evaluated using INFIT and OUTFIT statistics, item difficulty was estimated using Rasch coefficients, and internal consistency using Cronbach's alpha. Structural validity was measured using item loadings from the CFA.

Results: We included data from 497 adolescents (average age 14 y [SD 1.28], 51% male). There was a wide range of difficulty across items. One item demonstrated excessive positive outfit, and two items were close to the cut-off for excessive negative outfit. The COPAQ demonstrated poor overall fit to the unidimensional Rasch Model and did not demonstrate adequate internal consistency (Cronbach's alpha=0.6). Results from the CFA suggest the items do not measure the single construct they intend to measure.

Discussion: The English-version of the COPAQ did not have adequate internal consistency or structural validity. More work is required to assess the content validity of current instruments measuring a child's concept of pain. Developing validated instruments measuring a child's concept of pain aligned with the biopsychosocial model should be prioritized.

Part of the June 2026 issue supplement, to be published in its entirety on May 12, 2026.

Background: Chronic musculoskeletal pain is reported by one of four adolescents worldwide. Pain-related functioning is negatively affected by pain itself but also related to depressive symptoms. While the association between pain-related functioning and depressive symptoms is established, there is a lack of longitudinal studies that establishes the direction of the association.

Objectives: The aim was to analyse the temporal association between depressive symptoms and pain-related functioning among adolescents with recurrent musculoskeletal pain.

Methods: This longitudinal sample comprised 604 adolescents in 7th and 8th grade (M = 13.7 years) who reported recurrent musculoskeletal pain at baseline, defined as occurring at least every week over the previous 6 months. The adolescents were followed yearly for two consecutive years (T1, T2 and T3). Temporal associations of self-reported pain-related functioning and depressive symptoms were analysed. Using cross-lagged panel modelling, four models were estimated: Autoregressive; Depressive symptoms predicting pain-related functioning; Pain-related functioning predicting depressive symptoms and a bidirectional model. Pain intensity was entered as a covariate.

Results: The results indicate high stability of depressive symptoms and pain-related functioning over time. While the strength of the prediction was strongest in the autoregressive paths, cross-lagged paths revealed that depressive symptoms at T1 and T2 significantly predicted pain-related functioning at T2 respectively T3. Conversely, pain-related functioning at T1 and T2 did not predict depressive symptoms at T2 respectively T3.

Conclusions: The model where depressive symptoms predict pain-related functioning provided the best model fit and thus, in this general population sample, depressive symptoms drive pain-related functioning more than vice versa. Screening for, and targeting depressive symptoms, might be essential in affecting the functional consequences of pain.

Context: Chronic pain affects 1 in 9 young adults worldwide. Intensive interdisciplinary pain treatment (IIPT) has shown favorable outcomes in pain intensity, mood, school attendance and social and physical functioning in pediatric studies.  However, few IIPT programs are designed for young adults (YAs), a distinctly vulnerable developmental stage. Given this limitation, we sought to study the benefits of applying an IIPT model for YAs with chronic pain and functional impairment.

Objectives: This study aims to 1) describe the design and implementation of our pilot YA-IIPT program and 2) assess outcomes of YA-IIPT on pain experience, psychological and physical functioning, disability, and quality of life, in YAs with chronic pain and functional impairment.

Methods: In this observational study, we adapted the pediatric IIPT model for YAs using a biopsychosocial approach to chronic pain treatment. Outcome measures included physical functioning, psychological functioning, disability and quality of life, and pain experience. Paired t-tests and repeated measure ANOVAs were used to compare admission, discharge, 6-week, and 6-month follow-up data.

Results: Patients showed clinically and statistically significant improvements across the majority of physical and psychological functioning, disability, quality of life, and pain experience measures between admission and discharge ( P values<0.01). Most improvements were maintained at 6-week and 6-month follow-up.

Discussion: On average, participants in our YA-IIPT program demonstrated clinically and statistically significant improvements in most areas of functioning, quality of life, and pain experience that were maintained after discharge. Further research is needed on YA pain treatment and whether outcomes after YA-IIPT are sustained long term.

Background: Multicomponent programs combining therapeutic exercise, cognitive-behavioral therapy, and pain neuroscience education demonstrate overall efficacy for fibromyalgia (FM). However, a substantial proportion of patients do not achieve clinically meaningful improvement. This study aimed to identify predictors of non-response and to develop a prognostic classifier model.

Methods: Participants (N=788) from multiple randomized controlled trials received a standardized 12-week multicomponent intervention. This secondary analysis defined non-response as less than a 20% reduction in Fibromyalgia Impact Questionnaire Revised (FIQR) scores. A machine learning approach called Least Absolute Shrinkage and Selection Operator (LASSO) regularization was used to train a classifier. Model performance was assessed via external validation in a hold-out sample, with the area under the curve (AUC) and mean squared error as evaluation indices.

Results: Higher baseline anxiety (B=0.010), depression (B=0.007), kinesiophobia (B=0.005), and FM severity (B=-0.004), along with lower physical function (B=-0.014), younger age (B=-0.005), and lower body mass index (B=-0.010), were associated with non-response. The model demonstrated adequate classification accuracy out-of-sample (AUC=0.657; 95% CI: 0.586-0.728). A prototype calculator incorporating these predictors was developed.

Conclusion: Psychological, functional, and demographic factors were linked to non-response to multicomponent treatment in FM. Although predictive accuracy was limited, these findings support further validation of stratification approaches to inform treatment planning.