Clinical Journal of Pain最新文献

Objectives: Postoperative pain is common after Video-Assisted Thoracic Surgery (VATS). Recent evidence suggest that preoperative inflammatory biomarkers might be associated to chronic postoperative pain following major surgery, but the association between preoperative inflammation and acute pain after VATS have not been examined. This observational cohort study aimed to investigate the association between preoperative inflammatory biomarkers and acute postoperative pain in lung cancer patients undergoing VATS.

Methods: Preoperative plasma samples from cancer patients scheduled for VATS were analyzed for 92 inflammatory markers using the Olink Bioscience inflammation panel. Postoperative pain was measured during the first 48 hours using a numerical rating scale (0-10 point scale). Principal component analysis and Orthogonal Partial Least Square Discriminant Analysis (OPLS-DA) was used to identify important inflammatory markers and combined with preoperative pain and postoperative opioid usage to predict postoperative pain using a multiple linear regression model.

Results: The current study included 92 patients and 41 inflammatory biomarkers passing quality control. OPLS-DA identified 16 important markers. An initial prediction model explained 27.2% of postoperative pain variability, while a condensed model using backwards elimination, explained 34.3% of postoperative pain variability. The condensed model included the inflammatory biomarkers 4E-BP1, STAMBP, MCP-2, VEGFA, and adjusted for postoperative opioid consumption.

Discussion: The current study is the first to demonstrate an association between preoperative inflammatory biomarkers, opioid consumption, and acute postoperative pain after VATS in patients with lung cancer. Future studies are needed to confirm these findings.

Objectives: Adolescents with chronic migraine face increased risk for comorbid anxiety and depression, which can hinder migraine self-management and coping. Mindfulness-based interventions may reduce anxiety/depression to improve migraine outcomes yet require tailoring to increase acceptability and engagement among this distinct population. The current study used qualitative methods to explore multi-informant perspectives on the illness experience and unique intervention content/delivery needs, with the goal of informing adaptations to mindfulness-based interventions for adolescents with chronic migraine.

Methods: Fifteen interest holders, representing adolescents with chronic migraine, their parents, and healthcare providers, completed semi-structured interviews assessing experiences with chronic migraine, the role of stress and emotions, attitudes toward mindfulness, and perspectives on a telehealth group mindfulness-based program. Interviews were transcribed and coded using a team-based thematic approach.

Results: Data revealed four major themes informing adaptations to mindfulness-based interventions for adolescents with chronic migraine: supporting engagement in mindfulness in the context of migraine pain, incorporating lived experience in intervention content, facilitating peer connections, and providing opportunities for parental involvement. Qualitative results were integrated with content expert input to develop specific adaptation recommendations for mindfulness-based interventions for adolescents with chronic migraine.

Discussion: Acknowledging and addressing the challenges of practicing mindfulness in the context of pain and targeting the isolating experience of chronic migraine by offering peer connection via group intervention delivery may offer unique ways to tailor mindfulness-based interventions for adolescents with chronic migraine. Adaptations may improve intervention fit, acceptability, and retention and should be tested in future clinical trials.

Objective: Acute musculoskeletal (MSK) injuries are common in youth and prior research has identified somatosensory experiences such as conditioned pain modulation (CPM) as a predictor of the transition from acute to chronic pain. Prior pediatric studies are limited by small samples, single quantitative sensory testing (QST) modalities, and short-term follow-up, so the utility of QST in predicting longer-term pain outcomes following acute injury is unknown. To fill this gap, we examined somatosensory function in the acute pain period as a predictor of pain outcomes over 12 months.

Methods: Participants were 226 youth (and a caregiver) taking part in a prospective longitudinal study. Youth completed a QST battery (pain threshold, pain tolerance, temporal summation, and CPM) at baseline (post-injury), and questionnaires assessing pain (average pain, movement-evoked pain; MEP) at three timepoints over 12 months.

Results: A subset of youth developed persistent pain (≥3/0-10 NRS) at 3 months (15-21% depending on pain measure). Regression models indicated CPM was the sole QST measure that predicted pain intensity and persistence at 3 months (both average and MEP). No QST measures predicted pain outcomes at 12 months. Female sex was associated with pain persistence in multiple models.

Discussion: CPM in the acute pain period is a potential marker for short-term pain outcomes. Future research can examine the utility of using QST in predicting pain outcomes in other pediatric pain samples (e.g., non-MSK locations, more severe injuries) and can expand assessment of MEP using standardized performance tasks.

Objective: To compare the relative efficacy of common non-pharmacological treatments for migraine and to determine the optimal dosage for physical exercise.

Methods: We searched four databases up to January 2025 for randomized controlled trials of non-pharmacological interventions for migraine. A multilevel network meta-analysis, integrated with a dose-response analysis, was conducted to compare intervention efficacy and determine the optimal exercise dosage. Treatments were ranked by the Surface Under the Cumulative Ranking curve. Two independent reviewers extracted data and assessed the risk of bias.

Results: Fifty-nine randomized controlled trials involving 10,020 participants (78.1%, female) were included. Neuromodulation techniques were most effective (Hedges'g=-0.61, 95% Credible Interval: -0.89 to -0.33), followed by physical exercise (Hedges'g=-0.42, 95% Credible Interval: -0.67 to -0.18) and mindfulness meditation (Hedges'g=-0.38, 95% Credible Interval: -0.63 to -0.12). The dose-response analysis for exercise indicated that while 100 metabolic equivalent (MET)-minutes per session was statistically effective, a minimum of 110 MET-minutes per session was required to achieve the Minimal Clinically Important Difference. Efficacy reached an optimal therapeutic plateau at 250-300 MET-minutes per session, achievable with 3-5 weekly sessions of 30-40 minutes.

Discussion: Neuromodulation, physical exercise, and mindfulness meditation are promising non-pharmacological therapies for migraine. For physical exercise, a minimum dose of 110 MET-minutes per session is needed for clinically significant effects, with an optimal therapeutic window at 250-300 MET-minutes per session. Due to the low quality of primary evidence, these findings warrant cautious interpretation and require future validation.

Objectives: The average level of outcomes is the most used index for assessing the efficacy of psychological therapies; however, emerging evidence suggests that it may not fully capture the complexity of treatment effects. This study compared the effects of third-wave cognitive behavioral therapy (CBT) on pain-related outcomes (pain intensity, pain interference, sleep disturbance, and depressed mood) using six indices: average level, variability, maximum level, minimum level, frequency in high, and frequency in low.

Methods: Ecological momentary assessment (EMA) data were collected within a randomized controlled trial (RCT) that evaluated the addition of remote-delivered third-wave CBT to treatment-as-usual (TAU) in individuals with chronic low back pain plus depressive symptoms. A total of 82 participants (CBT = 50 and TAU = 32) provided 4,595 EMA data points over 10 weeks (70 days).

Results: Compared to TAU, third-wave CBT was generally associated with greater improvement across the pain-related outcomes. Frequency in low emerged as the most sensitive index for change in pain interference and depressed mood; in contrast, the average level showed limited sensitivity. The maximum level also captured some between-group differences for sleep disturbance and depressed mood. The remaining indices (variability, minimum, and frequency in high) did not consistently provide additional value.

Discussion: These findings suggest that the frequency in low may be a sensitive and clinically informative index for detecting treatment effects in RCTs using EMA. Nevertheless, further research is needed to establish its reliability and generalizability across clinical contexts and clinical trial designs.

Objective: Individuals receiving opioids for pain management are at risk for negative outcomes. However, it is not clear whether social determinants of health (SDOH) predict outcomes a year after starting a prescription opioid. The purpose was to examine associations between SDOH with psychiatric-related, pain-related, and opioid-related outcomes at a 12-month follow-up.

Methods: Participants (N=783) with a new period of 30 to 90-day opioid use completed baseline and 12-month follow-up questionnaires regarding SDOH, depressive symptoms, pain severity, pain interference, and opioid use. Multivariate adjusted models estimated the association between SDOH and outcomes.

Results: Participants had a mean age of 53.4 years (SD=11.9), 71.2% White race, and 69.9% women. Older age (OR=0.97; 0.95, 0.99) and Black race (OR=0.45; 0.27, 0.76) were inversely associated with depression, while being widowed/divorced/separated (OR=1.72; 1.01, 2.91) and lacking a college education (OR=2.43; 1.25, 4.73) were positively associated with depression. Women (OR=1.56; 1.12, 2.18) and lower income (OR=2.09; 1.14, 3.85) were associated with greater odds of opioid use, while unemployment was associated with lower odds of opioid use at 12 months (OR=0.55; 0.34, 0.89). Older age (OR=0.95; 0.91, 0.99) was inversely associated with opioid use concerns while disability (OR=4.59; 1.60, 13.11) was positively associated.

Discussion: Several SDOH variables were associated with poorer functioning at baseline and 12 months after individuals were prescribed an opioid. It may be useful for clinicians to screen for SDOH to identify higher-risk individuals.

Objectives: To identify evidence for pain assessment during acute procedures in hospitalized neonates at risk of neonatal opioid withdrawal syndrome (NOWS).

Methods: This scoping review was conducted using the JBI scoping review methodology. The search strategy focused on identifying in-patient neonates undergoing acute painful procedures. Databases searched are MEDLINE, CINAHL, Embase, PsycInfo, and Scopus. The relevant data were extracted by 2 reviewers and the results were summarized in a narrative description and presented in a tabular format, including the components of participants, concept, and context.

Results: A total of 22,731 unique studies were screened, with 5 studies ultimately included. Of these studies, 2 included neonates at risk of NOWS but did not report pain responses separately. The 3 remaining studies observed procedural pain in opioid-exposed neonates compared with neonates without opioid exposure during heel lance. Pain assessment methods included physiological responses and validated composite pain scores. When using composite pain tools, 1 study showed higher pain response in opioid-exposed neonates, while the other 2 studies showed the same or lower pain response. For skin conductance, the findings from 2 studies were discrepant, with 1 study reporting higher pain response in opioid-exposed neonates and the other showing no statistically significant difference.

Discussion: There is a need for more studies designed to examine the influence of opioid exposure and withdrawal on pain responding and management in neonates. As there is currently limited evidence to guide clinical care, clinicians should continue to use validated composite pain assessment tools and pain management strategies.