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Re: Letter to the Editor Re: Effects of centrally acting analgesics on resting-state electroencephalography biomarker candidates of chronic pain. 回复:致编辑的信回复:中枢镇痛药对慢性疼痛静息状态脑电图生物标志物候选物的影响。
IF 4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-01-04 DOI: 10.1016/j.jpain.2026.106183
Paul Theo Zebhauser, Markus Ploner
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引用次数: 0
The effect of positive, neutral, and negative expectations about spinal manipulative therapy on pain intensity in chronic low back pain: A randomized controlled trial 一项随机对照试验:对脊椎操纵疗法的积极、中性和消极预期对慢性腰痛疼痛强度的影响。
IF 4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-31 DOI: 10.1016/j.jpain.2025.106177
Bianca Emanuelli Saes Campanha , Thamiris Costa de Lima , Helen Cristina Nogueira Carrer , Steven Z. George , Felipe J.J. Reis , Thaís Cristina Chaves
Spinal manipulative therapy (SMT) has favorable, but small effects on pain intensity to treat chronic low back pain (CLBP). However, there is the potential for these effects to be enhanced by manipulating treatment expectations. Our objective was to investigate the effect of verbally delivered treatment expectations in association with SMT on pain intensity for individuals with CLBP. Our sample consisted of sixty participants who were randomly allocated to three groups in which verbally delivered expectations (positive [PEG], neutral [NEUG], and negative [NEG]) were administered by video before one session of SMT. Pain intensity (primary outcome), global perceived effect (GPE) of improvement, disability, participants’ expectations, and empathy as secondary outcomes were assessed immediately post-treatment and pain intensity, GPE, and disability at the 3-month follow-up. Participants were interviewed about their perceptions regarding the videos. Pain intensity significantly decreased in the PEG and NEUG immediately after the SMT session (mean difference=MD), PEG - MD=-1.9 [95% CI −3.4 - −0.3] and NEUG - MD=-1.6 [95% CI −3.2 - −0.05], both when compared to the NEG. However, these findings weren’t maintained at the 3-month follow-up. No significant changes in GPE and disability were observed between groups. Our findings suggest that positive and neutral verbally delivered treatment expectations resulted in short-term SMT hypoalgesia compared to negative expectations; however, these effects did not persist at 3-month follow-up. Such results suggest that both positive and neutral SMT-related expectations should be adopted when communicating the expected treatment effects to patients.

Clinical trials registration number

NCT05996991, protocol registration: August 2023, study start date 1st October, 2023

Perspective

Our findings showed that using positive or neutral verbally delivered expectations has the potential to enhance short-term hypoalgesia associated with SMT in CLBP.
脊椎推拿疗法(SMT)治疗慢性腰痛(CLBP)对疼痛强度的影响较小,但效果较好。然而,有可能通过操纵治疗预期来增强这些效果。我们的目的是调查口头传递治疗期望与SMT对CLBP患者疼痛强度的影响。我们的样本由60名参与者组成,他们被随机分配到三组,其中口头传递期望(积极的[PEG],中性的[NEUG]和消极的[NEG])在一次SMT之前通过视频进行管理。治疗后立即评估疼痛强度(主要结局)、改善的总体感知效应(GPE)、残疾、参与者期望和共情作为次要结局,并在3个月随访时评估疼痛强度、GPE和残疾。参与者被问及他们对这些视频的看法。与NEG相比,SMT治疗后PEG和NEUG的疼痛强度立即显著降低(平均差值=MD), PEG - MD=-1.9 [95% CI -3.4 - -0.3], NEUG - MD=-1.6 [95% CI -3.2 - -0.05]。然而,这些发现在3个月的随访中没有得到维持。两组间GPE和残疾无明显变化。我们的研究结果表明,与消极预期相比,积极和中性的口头传递治疗预期导致短期SMT痛觉减退;然而,这些效果在3个月的随访中并未持续。这些结果表明,在向患者传达预期治疗效果时,应采用积极和中性的smt相关期望。临床试验注册号:NCT05996991,方案注册:2023年8月,研究开始日期2023年10月1日。观点:我们的研究结果表明,使用积极或中性的口头传递期望有可能增强CLBP患者与SMT相关的短期痛觉减退。
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引用次数: 0
Quality matters: Interpreting amputation outcomes in CRPS - Authors reply. 质量问题:解释CRPS的截肢结果-作者回复。
IF 4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-31 DOI: 10.1016/j.jpain.2025.106178
Yannick L Gilanyi, Michael C Ferraro, Andreas Goebel, Neil E O'Connell, Matthew D Jones, Saurab Sharma, Debbie Bean, Sylvia M Gustin, James H McAuley
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引用次数: 0
The efficacy and safety of repetitive transcranial magnetic stimulation for comorbid chronic low back pain and insomnia: A randomized, double-blind, sham-controlled pilot trial 重复经颅磁刺激治疗共病慢性腰痛和失眠的有效性和安全性:一项随机、双盲、假对照的试点试验
IF 4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-31 DOI: 10.1016/j.jpain.2025.106180
Jeremy R. Chang , Eliza R. Sun , Minxia Jin , Leo GH Lin , Shirley X. Li , Jannet LC Lee , Frank F. Huang , Rachel LC Kwan , Daniel KY Zheng , Dino Samartzis , Siu-Ngor Fu , Arnold YL Wong
Repetitive transcranial magnetic stimulation (rTMS) has shown efficacy in treating chronic pain or insomnia independently. Given the high prevalence of insomnia in individuals with chronic low back pain (CLBP), this pilot randomized controlled trial assessed the feasibility, acceptability, and preliminary efficacy of rTMS targeting either the left primary motor cortex (M1) or right dorsolateral prefrontal cortex (DLPFC) in individuals with comorbid CLBP and insomnia. Thirty-six participants were randomized to receive sham-rTMS, active M1-rTMS (10 Hz, 1500 pulses), or active DLPFC-rTMS (1 Hz, 1500 pulses) over 10 sessions for two weeks (five sessions per week), with a one-month follow-up. Primary outcomes were feasibility and acceptability. Secondary outcomes included pain intensity, insomnia severity, disability, psychological measures, subjective and objective sleep parameters, pain threshold, temporal summation of pain, and conditioned pain modulation. rTMS was highly feasible and acceptable, as evidenced by excellent session attendance and no participant attrition. No serious adverse events were reported. Both active M1- and DLPFC-rTMS significantly reduced pain intensity and enhanced the descending pain inhibitory pathways compared with sham stimulation. Importantly, DLPFC-rTMS was superior to sham in reducing insomnia severity, objective wake after sleep onset, and temporal summation of pain. These findings suggest that rTMS is a feasible, well-tolerated, and promising intervention for individuals with comorbid CLBP and insomnia. While both stimulation protocols yielded analgesic benefits, DLPFC-rTMS may confer additional advantages for addressing sleep disturbance. Further full-scale randomized clinical trials are warranted to validate these preliminary findings and optimize rTMS protocols for this complex clinical population.

Perspective

rTMS was feasible for comorbid chronic low back pain and insomnia, with DLPFC stimulation yielding superior effects on sleep disturbance and pain processing. Further large-scale RCTs using neuroimaging are warranted to validate and expand upon these preliminary results and elucidate the neurophysiological basis of treatment efficacy.
重复经颅磁刺激(rTMS)已显示出治疗慢性疼痛或失眠的疗效。鉴于慢性腰痛(CLBP)患者失眠的高发率,本随机对照试验评估了针对CLBP和失眠患者的左初级运动皮质(M1)或右背外侧前额叶皮质(DLPFC)的rTMS的可行性、可接受性和初步疗效。36名参与者随机接受假rtms,活跃M1-rTMS (10Hz, 1500次脉冲)或活跃DLPFC-rTMS (1Hz, 1500次脉冲),为期两周(每周5次),为期一个月的随访。主要结局是可行性和可接受性。次要结局包括疼痛强度、失眠严重程度、残疾、心理测量、主观和客观睡眠参数、痛阈、疼痛时间总和和条件性疼痛调节。rTMS是高度可行和可接受的,证明了良好的会议出席率和无参与者流失。无严重不良事件报告。与假刺激相比,活性M1-和DLPFC-rTMS均能显著降低疼痛强度,增强下行疼痛抑制通路。重要的是,DLPFC-rTMS在降低失眠严重程度、入睡后客观清醒和疼痛时间累积方面优于假手术。这些发现表明,rTMS是一种可行的、耐受性良好的、有希望的CLBP和失眠合并症患者干预方法。虽然两种刺激方案都有镇痛效果,但DLPFC-rTMS可能在解决睡眠障碍方面具有额外的优势。需要进一步的全面随机临床试验来验证这些初步发现,并优化rTMS方案,以适应这一复杂的临床人群。观点:rTMS治疗合并慢性腰痛和失眠是可行的,DLPFC刺激对睡眠障碍和疼痛加工的效果更佳。进一步使用神经影像学的大规模随机对照试验是必要的,以验证和扩展这些初步结果,并阐明治疗效果的神经生理学基础。
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引用次数: 0
How do people with fibromyalgia interpret ambiguous cues in empathy-related healthcare scenarios? 纤维肌痛患者如何在共情相关的医疗场景中解释模棱两可的线索?
IF 4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-30 DOI: 10.1016/j.jpain.2025.106181
Maria Planes Alias , David J Moore , Nicholas Fallon , Katie Herron , Charlotte Krahé
Empathic communication is essential for high-quality healthcare, yet patients must often interpret subtle and ambiguous interpersonal cues during healthcare encounters. In such contexts, prior experiences and cognitive-affective processes may shape interpretations in biased ways. In Fibromyalgia Syndrome (FMS), a frequently stigmatised and ‘invisible’ condition, such biases may influence how patients perceive unclear messages from healthcare professionals. While interpretation bias for pain-related information has been explored, bias in interpreting social-emotional information has not. This study investigated interpretations of ambiguous social-emotional cues from healthcare professionals in individuals with FMS (n = 65), compared with those with other chronic pain conditions (n = 51) and pain-free controls (n = 77). Participants completed a novel scenario-based task assessing the perceived likelihood of positive, neutral, and negative interpretations of ambiguous clinical situations. Validated self-report measures of psychological distress and perceived clinical empathy were also administered. Results showed that individuals with FMS were significantly more likely to endorse negative interpretations and less likely to endorse positive ones relative to both comparison groups, even after controlling for depression, anxiety, and stress. The FMS group also reported greater psychological distress and lower perceived empathy. Moreover, negative interpretation bias was associated with greater distress and lower perceived clinical empathy, while positive bias showed the opposite pattern. These findings suggest that individuals with FMS interpret ambiguous healthcare communication through a distinct cognitive-affective lens. This highlights that patient–provider interactions are not experienced uniformly across chronic pain populations, and that interpretative biases should be considered to improve healthcare communication.

Perspective

We explored how individuals with fibromyalgia (compared to other chronic pain and pain-free groups) interpret empathy-related ambiguous cues from healthcare professionals. Controlling for psychological distress, the fibromyalgia group showed a stronger negative interpretation bias than both comparison groups. Understanding these socio-cognitive patterns may help improve communication and empathy in fibromyalgia care.
移情沟通对于高质量的医疗保健是必不可少的,然而患者必须经常在医疗保健遭遇中解释微妙和模糊的人际关系线索。在这种情况下,先前的经验和认知-情感过程可能以有偏见的方式塑造解释。纤维肌痛综合征(FMS)是一种经常被污名化和“隐形”的疾病,这种偏见可能会影响患者如何感知来自医疗保健专业人员的不明确信息。虽然对疼痛相关信息的解释偏见已经被探索过,但对社会情绪信息的解释偏见还没有。本研究调查了FMS患者(n = 65)与其他慢性疼痛患者(n = 51)和无痛对照(n = 77)相比,医疗保健专业人员对模棱两可的社会情感线索的解释。参与者完成了一项新的基于场景的任务,评估对模棱两可的临床情况的积极、中性和消极解释的感知可能性。心理困扰的自我报告测量和临床共情感知也被执行。结果显示,即使在控制了抑郁、焦虑和压力之后,相对于两个对照组,FMS患者更有可能支持消极的解释,而更不可能支持积极的解释。FMS组还报告了更大的心理困扰和更低的感知同理心。此外,消极解释偏见与更大的痛苦和更低的临床共情感知相关,而积极偏见则呈现相反的模式。这些发现表明,FMS患者通过不同的认知-情感视角解读模棱两可的医疗保健沟通。这突出表明,在慢性疼痛人群中,患者与提供者之间的互动并不一致,应该考虑解释偏差,以改善医疗保健沟通。观点:我们探讨了纤维肌痛患者(与其他慢性疼痛和无痛组相比)如何解释医疗保健专业人员提供的与移情相关的模糊线索。控制心理困扰,纤维肌痛组表现出比两个对照组更强的负面解释偏见。了解这些社会认知模式可能有助于改善纤维肌痛护理中的沟通和同理心。
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引用次数: 0
Pain and functional disability in older adults with cardiovascular disease: A cross-national comparison of India, China, and Mexico 老年心血管疾病患者的疼痛和功能障碍:印度、中国和墨西哥的跨国比较
IF 4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-30 DOI: 10.1016/j.jpain.2025.106182
Hongtao Cheng , Huijun Wu , Lu Shao, Jie Jiang, Tingting Xie, June Zhang
Pain is highly prevalent among older adults with cardiovascular disease (CVD) and may compromise functional independence. However, the nature of this relationship in different cultural and healthcare contexts is not well understood. We examined the association between pain and functional limitations among adults aged 60 years and older with self-reported cardiovascular disease (CVD) using nationally representative data from the Longitudinal Aging Study in India (LASI, n = 11,247), the China Health and Retirement Longitudinal Study (CHARLS, n = 3733) and the Mexican Health and Aging Study (MHAS, n = 5108). Pain was assessed through self-report, and functional status was evaluated across activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility. Cross-sectional associations were estimated using multivariable logistic regression, and longitudinal analyses examined the effect of baseline pain on incident disability at 3-year follow-up in the Chinese and Mexican cohorts. Pain was reported by 43.7%, 36.2%, and 43.6% of participants in India, China, and Mexico, respectively. After adjustment for covariates, pain was significantly associated with ADL disability in all three countries (India OR=1.86, China OR=2.22, Mexico OR=2.32), with similar associations observed for IADL and mobility limitations. Strong dose–response relationships were identified between pain frequency or severity and functional limitations. Longitudinal analyses further showed that baseline pain predicted new-onset ADL and IADL disability at follow-up. These findings demonstrate that pain is consistently associated with functional decline among older adults with CVD, underscoring the importance of pain assessment and management in geriatric cardiovascular care globally.

Perspective

This study reveals consistent cross-national associations between pain and functional disability among older adults with cardiovascular disease. Pain independently predicts future functional decline, underscoring its value as a clinical marker for early intervention and as a modifiable target in integrated cardiovascular and geriatric care programs.
疼痛在患有心血管疾病(CVD)的老年人中非常普遍,并可能损害功能独立性。然而,在不同的文化和医疗背景下,这种关系的性质并没有得到很好的理解。我们使用来自印度纵向老龄化研究(LASI, n = 11,247)、中国健康与退休纵向研究(CHARLS, n = 3,733)和墨西哥健康与老龄化研究(MHAS, n = 5,108)的全国代表性数据,研究了60岁及以上自报心血管疾病(CVD)的成年人疼痛和功能限制之间的关系。通过自我报告评估疼痛,并通过日常生活活动(ADL)、日常生活工具活动(IADL)和活动能力评估功能状态。使用多变量逻辑回归估计横断面关联,并在中国和墨西哥队列中进行了3年随访,纵向分析检查了基线疼痛对事件残疾的影响。在印度、中国和墨西哥,分别有43.7%、36.2%和43.6%的参与者报告疼痛。调整协变量后,在所有三个国家(印度OR=1.86,中国OR=2.22,墨西哥OR=2.32),疼痛与ADL残疾显著相关,在IADL和活动受限方面也观察到类似的关联。疼痛频率或严重程度与功能限制之间存在强烈的剂量-反应关系。纵向分析进一步表明,基线疼痛预测了随访时新发ADL和IADL残疾。这些发现表明,疼痛一直与老年心血管疾病患者的功能下降有关,强调了全球老年心血管护理中疼痛评估和管理的重要性。观点:这项研究揭示了在患有心血管疾病的老年人中疼痛和功能障碍之间的一致的跨国关联。疼痛独立预测未来的功能衰退,强调其作为早期干预的临床标志的价值,以及作为心血管和老年综合护理计划的可修改目标。
{"title":"Pain and functional disability in older adults with cardiovascular disease: A cross-national comparison of India, China, and Mexico","authors":"Hongtao Cheng ,&nbsp;Huijun Wu ,&nbsp;Lu Shao,&nbsp;Jie Jiang,&nbsp;Tingting Xie,&nbsp;June Zhang","doi":"10.1016/j.jpain.2025.106182","DOIUrl":"10.1016/j.jpain.2025.106182","url":null,"abstract":"<div><div>Pain is highly prevalent among older adults with cardiovascular disease (CVD) and may compromise functional independence. However, the nature of this relationship in different cultural and healthcare contexts is not well understood. We examined the association between pain and functional limitations among adults aged 60 years and older with self-reported cardiovascular disease (CVD) using nationally representative data from the Longitudinal Aging Study in India (LASI, n = 11,247), the China Health and Retirement Longitudinal Study (CHARLS, n = 3733) and the Mexican Health and Aging Study (MHAS, n = 5108). Pain was assessed through self-report, and functional status was evaluated across activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility. Cross-sectional associations were estimated using multivariable logistic regression, and longitudinal analyses examined the effect of baseline pain on incident disability at 3-year follow-up in the Chinese and Mexican cohorts. Pain was reported by 43.7%, 36.2%, and 43.6% of participants in India, China, and Mexico, respectively. After adjustment for covariates, pain was significantly associated with ADL disability in all three countries (India OR=1.86, China OR=2.22, Mexico OR=2.32), with similar associations observed for IADL and mobility limitations. Strong dose–response relationships were identified between pain frequency or severity and functional limitations. Longitudinal analyses further showed that baseline pain predicted new-onset ADL and IADL disability at follow-up. These findings demonstrate that pain is consistently associated with functional decline among older adults with CVD, underscoring the importance of pain assessment and management in geriatric cardiovascular care globally.</div></div><div><h3>Perspective</h3><div>This study reveals consistent cross-national associations between pain and functional disability among older adults with cardiovascular disease. Pain independently predicts future functional decline, underscoring its value as a clinical marker for early intervention and as a modifiable target in integrated cardiovascular and geriatric care programs.</div></div>","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":"40 ","pages":"Article 106182"},"PeriodicalIF":4.0,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Are gray matter changes following pain reprocessing therapy associated with clinical improvement? A voxel-based morphometry mediation analysis 疼痛再加工治疗后灰质变化与临床改善相关吗?基于体素的形态测量中介分析。
IF 4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-23 DOI: 10.1016/j.jpain.2025.105644
Carlos Murillo , Tor D. Wager , Yoni K. Ashar
Chronic back pain (CBP) has been associated with reorganization of gray matter (GM), and treatment may reverse these GM adaptations. Prior trials testing treatment effects on GM did not included a randomized control group, found no treatment vs. control differences, or did not attempt to link treatment-induced GM changes to improvements in clinical outcomes. We addressed this gap by performing a voxel-based morphometry mediation analysis testing for effects of a psychological treatment (pain reprocessing therapy, PRT, n=44) vs. two randomized control groups (treatment as usual, n=47, and open-label placebo, n=44) on GM, and testing whether treatment-specific GM changes were associated with reductions in disability (ODI) and pain intensity (BPI). Relative to both control groups, PRT increased GM in the anterior cingulate and orbitofrontal cortex. These treatment-induced GM increases, however, did not mediate PRT effects on clinical outcomes. Instead, improvements in disability and pain were associated with GM increases in the lateral prefrontal cortex and GM decreases in the thalamus and amygdala. These findings indicate that PRT vs. control increases GM in key pain-modulatory regions, and, that clinical improvement is related to different prefrontal and subcortical GM changes in regions processing nociceptive input and regulating pain. The lack of mediation may indicate either that GM changes are not a treatment mechanism, or a lack of power to detect smaller effects. Future research is needed to better understand how treatments act on neurobiology to drive clinical improvement.
慢性背痛(CBP)与灰质重组(GM)有关,治疗可能逆转这些GM适应。先前测试转基因治疗效果的试验没有纳入随机对照组,没有发现治疗组与对照组的差异,或者没有试图将治疗诱导的转基因改变与临床结果的改善联系起来。我们通过对心理治疗(疼痛再加工治疗,PRT, n=44)和两个随机对照组(常规治疗,n=47和开放标签安慰剂,n=44)对GM的影响进行基于体素的形态测量调解分析,并测试治疗特异性GM的改变是否与残疾(ODI)和疼痛强度(BPI)的减少有关,从而解决了这一差距。与对照组相比,PRT增加了前扣带皮层和眶额皮质的GM。然而,这些治疗诱导的GM增加并没有介导PRT对临床结果的影响。相反,残疾和疼痛的改善与外侧前额皮质GM的增加和丘脑和杏仁核GM的减少有关。这些研究结果表明,PRT与对照组相比增加了关键疼痛调节区域的GM,并且临床改善与处理伤害性输入和调节疼痛的区域的前额叶和皮层下GM的不同变化有关。缺乏调解可能表明转基因变化不是一种治疗机制,或者缺乏检测较小影响的能力。未来的研究需要更好地了解治疗如何作用于神经生物学以推动临床改善。
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引用次数: 0
Standardising socio-demographic data collection in pain research: Introducing consensus recommendations for a minimum dataset 标准化疼痛研究中的社会人口统计数据收集:为最小数据集引入共识建议。
IF 4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-23 DOI: 10.1016/j.jpain.2025.105645
Emma L. Karran , Aidan G. Cashin , Alessandro Chiarotto , Saurab Sharma , Trevor Barker , Mark A. Boyd , Lara J. Maxwell , Vina Mohabir , Jennifer Petkovic , Peter Tugwell , G. Lorimer Moseley
The ‘ISSHOOs (Identifying Social factors that Stratify Health Opportunities and Outcomes) in pain research’ project has developed consensus-derived recommendations to address the inadequacy and inconsistency of socio-demographic data collection and reporting in human adult pain research. The recently published recommendations offer a highly useful, globally relevant and adaptable resource that operationalises the collection of a minimum dataset of important equity-relevant information. In this Commentary we provide a brief overview of the ISSHOOs project and the resulting recommendations – comprising Set A: the ‘minimum dataset’ and Set B: an extended dataset of optional (equity-relevant) items; and we draw attention to a separate ‘explanation and elaboration’ manuscript. We discuss the implications of routine adoption of the ISSHOOs recommendations, including limitations, implementation considerations, and the potential for both benefits and harms to be associated with their use. The overarching goal of the ISSHOOs Collaboration is to prompt a small but widespread shift in research practice that promotes research transparency, integrity and value and advances health equity for people with pain.
“疼痛研究中确定健康机会和结果分层的社会因素”项目提出了共识衍生的建议,以解决人类成人疼痛研究中社会人口统计数据收集和报告的不足和不一致。最近发布的建议提供了一个非常有用的、与全球相关的、适应性强的资源,可以对重要股票相关信息的最小数据集进行操作。在这篇评论中,我们简要概述了isshos项目和由此产生的建议——包括集合a:“最小数据集”和集合B:可选(股票相关)项目的扩展数据集;我们提请注意一个单独的“解释和阐述”手稿。我们讨论了常规采用isshos建议的含义,包括限制、实施考虑以及使用这些建议可能带来的益处和危害。isshos合作的总体目标是促使研究实践发生微小但广泛的转变,从而促进研究的透明度、完整性和价值,并促进疼痛患者的健康公平。
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引用次数: 0
Rethinking measurement of movement-evoked pain with digital technology 用数字技术测量运动诱发性疼痛的再思考。
IF 4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-19 DOI: 10.1016/j.jpain.2025.105643
Madelyn R. Frumkin , Jingwen Zhang , Ziqi Xu , Salim Yakdan , Braeden Benedict , Saad Javeed , Justin Zhang , Kathleen Botterbush , Burel R. Goodin , Chenyang Lu , Wilson Z. Ray , Jacob K. Greenberg
Movement-evoked pain (MEP) may be a useful metric for phenotyping musculoskeletal pain conditions. However, there is significant disagreement over operationalization, and no studies have assessed stability of MEP over time. Fitbit and Ecological Momentary Assessment (EMA) data were collected from adults with moderate-to-severe chronic pain schedule to receive lumbar/thoracolumbar fusion surgery (N=114). On average, participants provided 323 h of Fitbit data and 74 EMA surveys (84% completion rate). To mimic task-based assessment of MEP using the 6-minute walk test, EMA pain ratings completed within 3 h of walking at a speed ≥70spm for at least 6 min were extracted. Of the full sample, 91 individuals (80%) had any instances of pain ratings following 6-minute activity bouts (Median=6, SD=11). Post-activity pain scores exhibited good within-person consistency (ICC=.76). However, between-person differences in average pain accounted for >70% of the variance in post-activity pain. MEP change scores defined as the difference between post-activity and pre-activity pain scores had poor reliability (ICC =.08). MEP change scores were not associated with average pain or factors related to the uncontrolled nature of digital assessment (e.g., activity amount, time from activity to pain report). However, MEP change scores tended to be lower when the preceding pain rating was elevated (β = -7.96, 95% Credible Interval: -9.28, -6.66), suggesting ceiling effects. Small effects of time of day and prior activity were also observed, which could contaminate MEP assessed in the lab or clinic. Continued development of digital methodologies for assessing MEP is recommended.

Perspective

Existing movement-evoked pain assessments have limitations. Post-activity pain ratings capture overall disability and day-to-day fluctuations in pain, rather than the relationship between movement and pain. Pre-to-post activity change scores had poor reliability when assessed naturalistically and over time. Digital methodologies capture movement-evoked pain continuously across time, contexts, and real-world environments.
运动诱发疼痛(MEP)可能是一个有用的指标表型肌肉骨骼疼痛条件。然而,在操作上存在重大分歧,并且没有研究评估MEP随时间的稳定性。Fitbit和生态瞬时评估(EMA)数据收集了接受腰椎/胸腰椎融合手术的中度至重度慢性疼痛成人(N=114)。参与者平均提供了323小时的Fitbit数据和74次EMA调查(完成率84%)。为了模拟使用6分钟步行测试的基于任务的MEP评估,提取以≥70spm的速度步行至少6分钟后3小时内完成的EMA疼痛评分。在整个样本中,91人(80%)在6分钟的活动后有任何疼痛评分(中位数=6,标准差=11)。活动后疼痛评分表现出良好的人内一致性(ICC=.76)。然而,平均疼痛的个人差异占活动后疼痛差异的70%。MEP变化评分定义为活动后和活动前疼痛评分的差异,可靠性较差(ICC =.08)。MEP变化评分与平均疼痛或与数字评估不受控制性质相关的因素(例如,活动量,从活动到疼痛报告的时间)无关。然而,当先前的疼痛评分升高时,MEP变化评分倾向于降低(β = -7.96, 95%可信区间:-9.28,-6.66),提示天花板效应。还观察到一天中的时间和先前的活动的小影响,这可能会污染实验室或诊所评估的MEP。建议继续发展评估环境保护的数字方法。观点:现有的运动诱发疼痛评估有局限性。活动后疼痛评级捕捉的是整体残疾和疼痛的日常波动,而不是运动和疼痛之间的关系。当自然地和随时间评估时,前后活动变化得分的可靠性较差。数字方法在不同的时间、环境和现实环境中持续捕捉运动引起的疼痛。
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引用次数: 0
Financial status and pain in the last week of life: Insights from a nationally representative mortality follow-back survey in England and Wales 经济状况和生命最后一周的痛苦:来自英格兰和威尔士全国代表性死亡率随访调查的见解
IF 4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-19 DOI: 10.1016/j.jpain.2025.105642
Juan E. Correa-Morales , Therese Johansson , Thomas Curtis , Fliss E.M. Murtagh , Joanna M. Davies , Katherine E. Sleeman
Pain relief is a priority for patients and families living with advanced illness. There is evidence of socioeconomic inequality in palliative and end-of-life care, yet little is known about how pain might differ according to financial status. We analysed data collected in a mortality follow-back study carried out in England and Wales in 2023, to examine the association between subjective financial status and being affected by pain during the last week of life. Pain was proxy-reported by a family member using the Integrated Palliative Care Outcome Scale (IPOS). We report IPOS pain prevalence, its association with financial status, and whether this was mediated by access to care or moderated by location of care. Of 1194 decedents, 415 (37.9%) were severely or overwhelmingly affected by pain in the last week of life. Compared to decedents financially ‘living comfortably’, those ‘doing alright’ (IRR 1.20, 95%CI 1.01–1.43), and ‘just about getting by’ (IRR 1.31, 95%CI 1.04–1.65) were more affected by pain in the last week of life. Difficulty accessing care did not mediate this association. This association was moderated by location of care (F(14) =107.9, p < 0.001) and was not seen in care homes. Sensitivity analysis suggested high potential for unmeasured confounders (E-values between 1.70–1.95 for the main exposure categories). This study demonstrates that lower financial status is associated with being more severely or overwhelmingly affected by pain in the last week of life.
缓解疼痛是晚期患者及其家属的首要任务。有证据表明,在姑息治疗和临终关怀方面存在社会经济不平等,但人们对不同经济状况的疼痛有何不同知之甚少。我们分析了2023年在英格兰和威尔士进行的一项死亡率随访研究中收集的数据,以研究主观财务状况与生命最后一周疼痛程度之间的关系。疼痛由家庭成员使用综合姑息治疗结果量表(IPOS)代理报告。我们报告了IPOS疼痛患病率,其与财务状况的关系,以及这是否由获得护理介导或由护理地点调节。在1194例死者中,415例(37.9%)在生命的最后一周受到严重或压倒性的疼痛影响。与经济上“生活舒适”的死者相比,“过得还好”(IRR 1.20, 95%CI 1.01-1.43)和“勉强过得去”(IRR 1.31, 95%CI 1.04-1.65)的人在生命的最后一周更容易受到疼痛的影响。获得护理的困难并没有调解这种关联。这种关联受护理地点的影响(F(14) =107.9, p < 0.001),在养老院中未见。敏感性分析表明,未测量混杂因素的可能性很高(主要暴露类别的e值在1.70-1.95之间)。这项研究表明,经济状况较低的人在生命的最后一周更容易或压倒性地受到疼痛的影响。
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Journal of Pain
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