Clinical Journal of Pain最新文献

Objectives: Chronic pain affects an estimated 8.5% of young adults in the United States. Physical activity is a promising strategy for behavioral pain management, yet research characterizing the prevalence and correlates of physical activity among young adults with chronic pain is scant. The present study sought to characterize physical activity patterns and identify psychosocial predictors of physical activity in this population.

Materials and methods: Participants were 129 young adults with self-reported chronic pain. Fear-avoidance (experiential avoidance, kinesiophobia), mental health (depression, anxiety), and energy-related (sleep disturbance, fatigue) factors were examined as correlates and predictors of moderate-to-vigorous physical activity (MVPA), walking, and sedentary behavior using generalized linear models.

Results: Participants reported an average of 51.0 (IQR=16.75, 100.75) minutes of MVPA and 90.0 (IQR=43, 153) minutes of walking per day. Nearly 3 quarters (72.9%) of participants met recommended MVPA guidelines. At baseline, experiential avoidance (95% CI [-0.019, -0.007]), depression (95% CI [-0.100, -0.017]), and fatigue (95% CI [-0.042, -0.007]) were negatively associated with MVPA; depression (95% CI [1.37, 13.71]) was positively associated with sedentary behavior. Experiential avoidance at baseline predicted MVPA at 2-week follow-up (95% CI [-0.015, -0.001]). No psychosocial factors were significantly associated with or predictive of walking.

Discussion: On average, young adults with chronic pain in our sample met recommended physical activity guidelines. Experiential avoidance was associated with MVPA at baseline and predicted less MVPA 2 weeks later. Findings suggest that while pain itself may not prevent engagement in MVPA among this population, a desire to prevent discomfort may be prohibitive.

Objectives: Non-malignant chronic pain patients are at increased risk for suicide, making it essential to identify factors associated with suicide-related outcomes (suicidal ideation, suicide attempt, and suicide death) in this population. This study aims to explore the psychopathological and psychosocial factors related to suicide-related outcomes in individuals with non-malignant chronic pain.

Method: A systematic review was conducted by searching databases including PubMed, PsycInfo, Embase, and Cochrane using predefined keywords and a systematic search strategy to identify psychopathological and psychosocial factors associated with suicide-related outcomes in adults with non-malignant chronic pain.

Results: A total of 49 studies identified 17 factors associated with suicide-related outcomes in non-malignant chronic pain: 11 psychopathological, including schizophrenia spectrum and other psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, trauma and stressor-related disorders, personality disorders, unspecified psychopathology, substance-related and addictive disorders, somatic symptom and related disorders, and sleep-wake disorders; and 6 psychosocial, including health-related quality of life, impact of pain/pain-related beliefs, coping strategies, interpersonal relationships, psychological and emotional state, and life events.

Discussion: This systematic review highlights the variety of psychopathological and psychosocial factors associated with suicide-related outcomes in non-malignant chronic pain, underscoring the necessity of integrating these aspects to improve pain management and patient care.

Objective: This meta-analysis evaluated the prevalence of neuropathic-like symptoms in individuals with painful tendinopathies/overuse injuries.

Methods: Electronic literature searches on MEDLINE, CINAHL, PubMed, SCOPUS, and Web of Science databases were conducted up to January 20th, 2025. Studies reporting the prevalence of neuropathic-like symptoms in painful tendinopathy/overuse injury were included. The methodological quality was assessed with the Newcastle-Ottawa Quality Assessment Scale in cohort/case-control studies or the Physiotherapy Evidence Database (PEDro) in clinical trials. Random-effects models were used for meta-analytical pooled prevalence of neuropathic-like symptoms.

Results: From 1285 studies identified, 8 (1 case-control, 5 cohorts, and 2 clinical trials) met inclusion criteria. The sample included 920 participants with painful tendinopathy/overuse injury (47.6% female, age: 51, SD: 12.5 y). All studies included self-reported questionnaires for evaluating neuropathic-like symptomatology. The methodological quality was moderate-high. The overall prevalence of neuropathic-like symptoms in painful tendinopathies was 30% (95% CI: 22%-38%, n=8, I2 =79%). The prevalence by each tendinopathy was: plantar heel pain (44%, 95% CI: 17%-75%, n=2, I2 =96%), lateral epicondylalgia (42%, 95% CI: 30%-56%, n=2, I2 =30%), insertional Achilles tendinopathy (38%, 95% CI: 20%-60%, n=2, I2 = 71%), greater trochanteric pain syndrome (32%, 95% CI: 26%-39%, n=2, I2 =0%), patellar-quadricipital tendinopathy (16%, 95% CI: 5%-41%, n=3, I2 =29%), noninsertional Achilles tendinopathy (11%, 95% CI: 2%-41%, n=5, I2 =86%).

Conclusion: The results of this meta-analysis suggests the presence of neuropathic-like symptoms in 30% of participants with painful tendinopathy, although this prevalence rate depends on specific condition. Identification of neuropathic symptoms in musculoskeletal pain conditions is important for diagnosis as it impacts its management.

Objective: Although pain quality may be a component of the geriatric chronic pain experience that influences disability, no research has investigated the psychological underpinnings of pain quality in any geriatric chronic pain population. We sought to address this knowledge gap by examining associations between both general (ie, depressive symptoms) and pain-specific psychological risk factors (ie, fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) and prospective pain quality in older adults with chronic low back pain.

Methods: Questionnaires for each psychological factor were collected at baseline, while pain quality was measured by the McGill Pain Questionnaire at baseline and 12 months. Preliminary analyses identified pain catastrophizing as the individual factor with the highest correlation to future pain quality for subsequent analyses. To assess if baseline psychological factors were cumulatively associated with 12-month pain quality, questionnaire values were entered into principal component analysis to yield a combined psychological component score. Robust regression models with HC3 standard errors were used to examine associations between baseline psychological risk factors (both individually and cumulatively) and prospective pain quality.

Results: In adjusted analyses, higher baseline pain catastrophizing independently predicted worse pain quality at 12 months ( b =0.342, t =4.225, P <0.001). Similarly, higher baseline psychological component scores were independently associated with worse prospective pain quality after adjustment ( b =3.816, t =4.518, P <0.001).

Discussion: The combined psychological component score had comparatively stronger predictive ability than pain catastrophizing alone; however, overall model prediction was modest, suggesting that future research is needed to identify other biopsychosocial variables that may impact pain quality in the geriatric chronic LBP population.

Objectives: Digital interventions promise to increase access to non-pharmacological chronic pain treatment and reduce burden for both individuals seeking care and pain providers/clinics. Unfortunately, despite early evidence of efficacy, engagement in self-management digital interventions for chronic conditions is typically low. A comprehensive analysis into how engagement in these programs is measured and reported is warranted. The current systematic review evaluated engagement in digital self-management interventions for chronic pain and identified gaps to improve reporting of engagement data.

Methods: We conducted a pre-registered systematic review using Boolean search terms to identify digital chronic pain self-management interventions that did not include clinician support. After removal of duplicates and screening, 150 full-text manuscripts were assessed, and 43 studies met inclusion criteria. Data was extracted and examined from included manuscripts.

Results: Of the 43 included articles, five articles were based on 2 separate datasets, resulting in a final sample of 41 unique datasets representing 4205 participants that were mostly non-Hispanic White, female, and with at least some college education. Approximately 10% of studies did not report any data related to system use or self-reported engagement. Most engagement data consisted of mean system use variables, with a handful of studies describing self-reported use of skills and very few studies examining demographic variables associated with engagement.

Discussion: To address identified gaps in the reviewed literature, we suggest guidelines for collecting and reporting engagement in digital chronic pain interventions. Consistent reporting of engagement data will improve evaluation, efficacy, and improvement of interventions designed to assist individuals who may otherwise not receive non-pharmacological pain treatment.

Objective: To determine whether psychosocial factors, such as resilience, perceived stress, catastrophizing, anxiety, depression, pain self-efficacy, and social support, explain the persistence of pain and disability in individuals with rotator cuff-related shoulder pain (RCRSP) following an education program.

Methods: One hundred forty-three individuals with persistent RCRSP were included in this prospective cohort study. At baseline, participants completed self-reported questionnaires related to pain, disability, and psychosocial constructs, including resilience, stress, catastrophizing, anxiety and depressive symptoms, pain self-efficacy, and social support. Thereafter, participants took part in an educational program aimed at promoting self-management of RCRSP that included 2 meetings with a physiotherapist. After 12 and 24 weeks, participants filled out pain and disability questionnaires and, based on their scores, were classified as having persistent shoulder pain or as recovered.

Results: A univariable modified Poisson regression showed that higher perceived stress (RR adjusted : 1.02; 95% CI: 1.01-1.04), catastrophizing (RR adjusted : 1.01; 95% CI: 1.01-1.02), symptoms of depression (RR adjusted : 1.03; 95% CI: 1.01-1.06) and anxiety (RR adjusted : 1.03; 95% CI: 1.01-1.06), along with lower resilience (RR adjusted : 0.90; 95% CI: 0.81-1.00), were associated with ongoing RCRSP at 12 weeks. In addition, reduced pain self-efficacy was associated with persistent pain at both 12 weeks (RR adjusted : 0.98; 95% CI: 0.97-0.99) and 24 weeks (RR adjusted : 0.99; 95% CI: 0.98-1.00). Multivariable regression indicated that only pain self-efficacy served as a protective factor against persistent RCRSP (RR adjusted : 0.98; 95% CI: 0.97-0.99).

Discussion: This study sheds light on the impact of psychosocial factors on persistent RCRSP, underscoring the importance of positive beliefs in pain management. Importantly, pain self-efficacy emerges as a key factor in recovery.

Objectives: There is tentative evidence to support the analgesic effects of noninvasive brain stimulation (NiBS) in fibromyalgia (FM), but a comprehensive synthesis is lacking. This systematic review with network meta-analysis (NMA) aimed to determine the relative effectiveness of different NiBS techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) in FM, and to identify the optimal stimulation location and intensity/frequency.

Methods: Four databases were searched until July 9, 2023 for randomized trials (RCTs) comparing NiBS in FM. Pain was the primary outcome, while fatigue and sleep were secondary outcomes. A frequentist NMA calculated standardized-mean-differences (SMDs) for pain, with pairwise meta-analysis for fatigue and sleep. Bias was assessed with the Cochrane-risk-of-bias-tool (RoB-2.0), and evidence certainty through confidence-in-NMA.

Results: Forty-three RCTs with 2120 participants were included. NMA showed that low frequency (LF)-rTMS (SMD: -1.20, 95% CI: -1.82 to -0.58), dual tDCS (SMD: -0.91, 95% CI: -1.82 to -0.58), and high frequency (HF)-rTMS (SMD: -0.58, 95% CI: -1.00 to -0.17) likely results in a reduction in pain intensity at the end of intervention compared with sham stimulation. For stimulation location, right dorsolateral prefrontal cortex (DLPFC)(SMD: -1.42, 95% CI: -2.69 to -0.15), bilateral DLPFC (SMD: -0.94, 95% CI: -1.82 to -0.05), and left primary motor cortex (M1)(SMD: -0.49, 95% CI: -0.85 to -0.14) likely results in reduction in pain intensity at the end of intervention, with DLPFC maintaining effects in short-term. LF-rTMS over DLPFC (SMD: -1.42, 95% CI: -2.69 to -0.15) and HF-rTMS over M1 (SMD: -0.78, 95% CI: -1.39 to -0.18) likely results in the reduction in pain intensity at the end of intervention, with LF-rTMS over right DLPFC maintaining effects in the short term. NiBS appears to be safe and may reduce fatigue and improve sleep quality.

Discussion: Excitatory stimulation like HF-rTMS over M1 and inhibitory like LF-rTMS over DLPFC may yield better results.

Objectives: The International Association for the Study of Pain defines 3 pain types presumed to involve different mechanisms-nociceptive, neuropathic, and nociplastic. Based on the hypothesis that pain types should guide the matching of patients with treatments, work has been undertaken to identify features to discriminate between them for clinical use. This study aimed to evaluate the validity of features to discriminate between pain types.

Materials and methods: Subjective and physical features were evaluated in a cohort of 350 individuals with chronic musculoskeletal pain attending a chronic pain management program. The analysis tested the hypothesis that, if features nominated for each pain type represent 3 different groups, then (1) cluster analysis should identify 3 main clusters of patients, (2) these clusters should align with the pain type allocated by an experienced clinician, (3) patients within a cluster should have high expression of the candidate features proposed to assist identification of that pain type. Supervised machine learning interrogated features with the greatest and least importance for discrimination, and probabilistic analysis probed the potential for the coexistence of multiple pain types.

Results: Results confirmed that data could be best explained by 3 clusters. Clusters were characterized by a priori specified features and agreed with the designation of the experienced clinician with 82% accuracy. Supervised analysis highlighted features that contributed most and least to the classification of pain type, and probabilistic analysis reinforced the presence of mixed pain types.

Discussion: These findings support the foundation for further refinement of a clinical tool to discriminate between pain types.

Objectives: This study aimed to characterize pain intensity (average, worst) and disease severity in youth with inflammatory bowel disease in the 12-month postdiagnosis, and to examine the relation between pain and risk (disease severity) and resilience (optimism, pain self-efficacy) factors over time.

Methods: Data collection ran from February 2019 to March 2022. Newly diagnosed youth aged 8 to 17 with IBD completed numerical rating scales for average and worst pain intensity, Youth Life Orientation Test for optimism, and Pain Self-Efficacy Scale for pain self-efficacy through REDCap; weighted Pediatric Crohn's Disease Activity Index and the Pediatric Ulcerative Colitis Activity Index were used as indicators of disease severity. Descriptive statistics characterized pain and disease severity. Multilevel modeling explored relations between variables over time, including moderation effects of optimism and pain self-efficacy.

Results: At baseline, 83 youth ( Mage =13.9, SD=2.6; 60.2% Crohn's disease; 39.8% female) were included. Attrition rates at 4 and 12 months were 6.0% and 9.6%, respectively. Across time, at least 52% of participants reported pain. Participants in disease remission increased from 4% to 70% over 12 months. Higher disease severity predicted higher worst pain, regardless of the time since diagnosis. Higher pain self-efficacy (1) predicted lower average and worst pain, especially at later time points and (2) attenuated the association between disease severity and worst pain when included as a moderator. Higher optimism predicted lower worst pain.

Discussion: Pain is prevalent in pediatric inflammatory bowel disease and impacted by disease severity, pain self-efficacy, and optimism. Findings highlight modifiable intervention targets.