Journal of Pain最新文献

Mechanical allodynia results from plastic changes in the central nervous system. Identifying the molecules involved in this plasticity is essential for understanding the mechanism of pathological pain. In a previous report, brain-enriched guanylate kinase-associated protein (BEGAIN) was identified as a protein upregulated in the spinal dorsal horn in the spared nerve injury (SNI) model. Although global BEGAIN-knockout (BEGAIN-KO) mice exhibited attenuated mechanical allodynia, it remained unclear whether BEGAIN contributes to wits development via regulatory roles in the spinal dorsal horn or supraspinal regions. To address this, spinal dorsal horn-specific BEGAIN conditional knockout (cKO) mice were generated, which showed a partial reduction in mechanical allodynia similar to that observed in global BEGAIN-KO mice in the SNI model. Next, to identify BEGAIN-expressing neuronal populations, in situ hybridization was performed; however, messenger RNA was detected throughout the spinal cord, preventing specific identification. Therefore, BEGAIN-iCre::Ai9 mice, in which BEGAIN-expressing neurons are labeled with tdTomato, were used to analyze their distribution. As a result, 15.7% of neurons in laminae I-III expressed BEGAIN, including 4.5% of Pax2-positive inhibitory neurons. A marked reduction in inflammatory pain-induced cFos-positive cells in these laminae was observed in both BEGAIN-cKO and BEGAIN-KO mice compared with wild-type mice. In addition, mechanical allodynia was almost completely attenuated in both KO mice. Based on these findings in male mice, conditional deletion of BEGAIN was shown to effectively reduce both cellular activation in laminae I-III and allodynia under pathological pain conditions.

Despite the prevalence and importance of pain for public health, little is known about how social characteristics affect the experience of pain. Though marital relationships have well documented associations on mental and physical health, research on the effects of relationship status on pain is limited. To address this limitation, we examine how changes in marital status are associated with high-impact pain, drawing on existing theoretical models of the influence of marriage on health. We use longitudinal data from the Health and Retirement Study, a nationally representative sample of American adults over 50, spanning the 1998-2016 waves of collection, capturing 157,130 person-year observations from 19,767 community-dwelling middle-aged and older adults. We estimate fixed effects models predicting the experience of high-impact pain, controlling for time-variant measures of age, socioeconomic status (income, wealth, and employment status), and health behaviors (drinking and smoking). We find that experiencing high-impact pain is significantly less likely for those who transition from marriage to either divorce (b = -0.21, 95% confidence interval: -0.35 to -0.07) or widowhood (b = -0.34, 95% confidence interval: -0.41 to -0.26). The alleviation of stress following marital dissolution and the adaptive nature of stress responses may buffer the immediate psychological impact of the transitions and protect against pain. Our findings highlight not only the relevance of social relationships for understanding pain experiences in older adults but also call for further study on how the diversifying experiences of family life in older ages affect pain. PERSPECTIVE: This study is among the first to examine the longitudinal relationship between marital status and pain at the population level. Transitions from marriage to divorce or widowhood are associated with a reduced risk of high-impact pain, suggesting that stress relief and adaptive responses following marital dissolution may buffer pain experiences.

Burnout is a concern among healthcare providers, linked to suboptimal patient care. Working as part of an integrated team has been identified as a mitigator and exacerbator of burnout, however, this relationship is not well understood in pediatric chronic pain care. This study assessed levels of burnout and perceptions of teamwork in a multidisciplinary group of pediatric chronic pain providers. A cross-sectional survey consisting of the Copenhagen Burnout Inventory and team functioning measures (i.e., communication/information sharing, team support, team effectiveness) was completed by N=195 providers. Pearson correlations were conducted to evaluate the association between burnout and teamwork. A K-means cluster analysis was used to group providers according to their level of burnout, and groupwise comparisons were conducted to examine differences in team functioning perceptions across established groups. Rates of personal (M=39.91, SD=16.97) and work-related (M=39.67, SD=17.75) burnout exceeded established norms. Team functioning ratings were generally positive; however, variability existed with poorer ratings in areas such as team coordination and productivity. Increased burnout was associated with poorer perceptions of team effectiveness and higher perceived room for improvement. K-means clustering identified three distinct provider groups: high, moderate, and low burnout, with significant differences in perceived team functioning across these groups. Elevated rates of burnout exist among multidisciplinary pediatric pain providers and are related to perceptions of team functioning. Research should explore directionality and causality of this relationship as well as provider experiences to support development of interventions to address team functioning and burnout and thus improve patient care.

This systematic review aimed at synthesizing evidence regarding the effectiveness of electrophysical resources for perineal acute pain relief after vaginal delivery in the early post-partum period. It included randomized controlled trials comparing electrophysical resources with reference groups for acute pain relief on primiparous women. Search strategy was conducted in PubMed, Embase, Lilacs, Scopus, Cochrane and Web of Science. Meta-analysis was conducted to synthesize the results. The risk of bias was assessed using PEDro scale and certainty of evidence was assessed using the GRADE approach. Seventeen studies with 1970 postpartum women were included. The evidence synthesis demonstrated high confidence in the positive effects of cryotherapy for perineal pain relief up to 4 h after its application, compared to routine care (mean difference -1.57, 95% CI: -2.18 to -0.96). Low-level laser therapy (LLLT) was found to be ineffective when compared to a placebo, with evidence showing moderate confidence (0.03, 95% CI: -0.69-0.76). The evidence for Transcutaneous Electrical Nerve Stimulation (TENS) was less conclusive: very low confidence was found regarding its positive effects compared to a placebo (MD -2.63, 95% CI: -4.85 to -0.41). Moderate confidence was found regarding TENS compared to routine care (MD -1.49, 95% CI: -1.90 to -1.09). In conclusion, high-certainty evidence on the effectiveness of cryotherapy applied after 1-4 h postpartum and moderate-certainty evidence on the effectiveness of TENS when combined with routine care. Moderate-certainty evidence indicates a lack of evidence on LLLT for perineal pain control. PERSPECTIVE: Cryotherapy can be recommended for perineal pain relief based on high and moderate confidence evidence. Applications should be performed considering patient preferences. Perineal application of LLLT, TENS and US require further studies with stronger protocol and methodological design to provide more consistent conclusions about their clinical use in postpartum period.

Chronic pain in adolescents commonly disrupts cognitive functioning, sleep, and mental health. Research suggests underdeveloped cognitive skills in adolescents may lead to poor self-management thus reinforcing pain-related disability. This study aims to examine changes across cognition, sleep, and mental health in youth with chronic pain undergoing rehabilitation in addition to identifying associations between improvements across domains of interest. A 4-week observational study was conducted in 42 adolescents (M_age=15.1 years, 76% female) diagnosed with non-cancer chronic pain syndromes and engaged in intensive interdisciplinary pain treatment (IIPT). Questionnaires assessing pain, sleep, and mental health were administered at baseline and discharge. Standardized performance-based assessments (CANTAB®) were employed to measure cognitive domains. Cognitive domains of memory, attention, and executive functioning improved over time (all ps<0.01). Significant reductions in self-reported measures related to pain, sleep disruptions, and mental health symptoms (all ps<0.001) were observed across rehabilitation. Positive associations were identified between improvements in pain, sleep, and mental health measures (all ps<0.05). No significant correlations were identified between improvements in cognition and improvements in other domains. Findings highlight the prospective gains for cognitive outcomes in adolescents with chronic pain undergoing IIPT. Further research is essential to explore mechanisms by which IIPT may directly improve cognitive functioning over the course of treatment.

Sickle cell crisis (SCC), characterized by recurrent acute pain episodes, is the most common reason for hospitalization among adolescents with sickle cell disease (SCD), a common hemoglobinopathy in Nigeria. SCC pain is challenging to manage, undertreated, and adolescents are often stigmatized and labelled as drug seekers. The combined use of analgesics and non-pharmacological interventions is highly recommended for optimal pain management. Studies indicate high usage of non-pharmacological interventions (NPIs) among adolescents, including unsafe interventions. This study aims to explore the experiences of adolescents and caregivers using NPIs to manage SCC pain at home and in Nigerian hospitals. An interpretative descriptive study was conducted, involving semi-structured interviews with 25 participants (15 caregivers and 10 adolescents). Participants were recruited across Nigeria using purposive and snowball sampling methods. Individual interviews were conducted via Zoom, and data were analyzed using constant comparison analysis. Four themes emerged: 1) Usage, 2) Perceptions, 3) Influencing Factors, and 4) Education. Participants reported using 27 NPIs, with varying impacts on the pain intensity and well-being of adolescents and caregivers. Participants held several misconceptions, including relying on NPIs and mild analgesics to manage severe pain despite their ineffectiveness and expecting their adolescents to endure the pain. They sometimes used potentially harmful NPIs such as herbal concoctions. Barriers to utilizing NPIs include the severity of SCC pain and inadequate knowledge of effective NPIs. These findings can inform the development of contextually relevant educational resources on SCC pain management for this underrepresented population in a low-middle-income country. PERSPECTIVE: This article highlights how adolescents and caregivers use non-pharmacological interventions to manage sickle cell crisis pain at home and in hospitals. It discusses challenges and participants' preferred media for receiving education on these interventions, offering valuable insights to develop effective, evidence-based educational interventions.

The central nucleus of the amygdala (CeA) is a critical regulator of nociception, and its role in pain modulation depends on factors such as hemispheric location, neuropeptide release, and experimental model. Calcitonin gene-related peptide (CGRP) is a potent neuropeptide modulator within the CeA. Previous research has demonstrated CGRPs' CeA nociceptive role in migraine, visceral, arthritic, and inflammatory pain murine models. The contribution of CeA CGRP to neuropathic pain is unclear. This study examined the effects of CGRP and its receptor antagonist, CGRP 8-37, in the CeA on mechanical and cold sensitivity in two mouse models of neuropathic pain: Chemotherapy-induced peripheral neuropathy (CIPN) mediated by paclitaxel (PTX) and injury-induced neuropathy through the spared nerve injury (SNI) model. Mechanical and cold sensitivity were measured using the hindpaw von Frey and topical acetone drop assays, respectively. Neither CGRP nor CGRP 8-37 in the CeA had any significant effect on mechanical sensitivity in either neuropathic pain model. In the SNI-treated mice, CGRP infusion into either the left or right CeA reduced cold sensitivity in the left and right SNI-treated hindpaw, while CGRP 8-37 infusion into the left or right CeA increased cold sensitivity in the right SNI-treated hindpaw only. In PTX-treated mice, CGRP infusion into the left or right CeA decreased cold sensitivity of the contralateral paw only. These results suggest that CGRP in the CeA influences pain modulation in a complex manner that depends not only on the hemisphere and injury site, but also on the underlying cause of the neuropathic condition.

Despite the widespread use and benefits of Pain Science Education, no standardized approach exists for assessing outcomes relevant to individuals with pain. This review amied to identify: (1) instruments assessing the proximal outcomes of Pain Science Education (pain-related knowledge or understanding, beliefs and attitudes), and present their psychometric properties, (2) domains that could be used to assess distal outcomes (focusing on the process and impact). In a three phase process, two series of expert panel discussions and a rapid review process were done, to identify and appraise articles reporting on instrument development and psychometric evaluation. The psychometric properties of the instruments were mapped against the COSMIN criteria. 32 instruments targeting proximal outcomes were identified. Gaps remain regarding instruments for specific populations, particularly those with low health literacy. Psychometric assessments focussed on internal consistency and structural validity, with limited exploration of content validity, reliability, responsiveness, or application of Item Response Theory methods. Distal outcomes were identified: process variables focused on pain self-efficacy, fear of movement and pain catastrophizing, and impact variables, like pain intensity, physical activity, emotional wellbeing/distress and fatigue, overlapping with core outcome sets created for chronic pain. A mixed-methods approach with qualitative and quantitative components is required to properly assess conceptual change. More psychometrically robust assessments of outcomes of PSE that are easy and quick to complete, and sufficiently flexible to use with multiple populations, would facilitate more targeted conceptual change strategies, and elucidate the nature and magnitude of impact of those strategies, in both clinical and research settings.