Pub Date : 2024-12-12DOI: 10.1016/j.jpain.2024.104758
Mahsa Seydi , Kim Delbaere , Dae Uk Han , Lloyd Chan , Meghan Ambrens , Kimberley S. van Schooten
Multi-site pain is common in people aged 60 years and over and is associated with a high risk of falls. To prevent and treat pain-related disabilities, it is crucial to identify the mechanisms underlying these associations. There is some evidence that pain leads to changes in walking, such as slower gait speed and shorter walking distance, which impair mobility and may increase the risk of falls. This review evaluated evidence on the relationship between pain and gait characteristics in older people. A comprehensive search on PubMed and Embase included observational studies and clinical trials assessing objective measures of walking, such as gait speed, cadence, stride length, and double-limb support time, in older people with and without pain. Of the 1218 studies screened, thirteen met the inclusion criteria from the primary search. An additional study was identified through the secondary search, resulting in fourteen studies included in this systematic review and meta-analysis. None of these studies investigated the relationship between fear of pain and gait characteristics in older people. Results showed that older people with pain had slower gait speed than those without pain, with a small effect size (Hedge’s g = −0.30, 95% CI = −0.41 to −0.19, p < 0.0001). There were no statistically significant differences in cadence, stride length, and double-limb support time. These findings suggest that pain impacts walking speed in older people, highlighting the importance of addressing this association to manage mobility deficits and fall risk.
Perspective
This systematic review and meta-analysis show that pain is associated with reduced gait speed in older people. Recognising and addressing the impact of pain on walking may be important for preventing mobility-related disorders and falls in this population.
多部位疼痛在 60 岁及以上人群中很常见，并且与跌倒的高风险有关。为了预防和治疗与疼痛相关的残疾，确定这些关联的内在机制至关重要。有证据表明，疼痛会导致行走改变，如步速减慢和行走距离缩短，从而影响行动能力，并可能增加跌倒的风险。本综述评估了老年人疼痛与步态特征之间关系的证据。在PubMed和Embase上进行的全面搜索包括观察性研究和临床试验，这些研究评估了有疼痛和无疼痛老年人行走的客观指标，如步速、步幅、步幅长度和双肢支撑时间。在筛选出的 1218 项研究中，有 13 项符合主要搜索的纳入标准。通过二次检索又发现了一项研究，最终有 14 项研究被纳入本次系统综述和荟萃分析。这些研究均未调查老年人对疼痛的恐惧与步态特征之间的关系。结果表明，与无疼痛的老年人相比，有疼痛的老年人步速较慢，影响较小（Hedge's g = -0.30，95% CI = -0.41 to -0.19，p < 0.0001）。在步频、步幅和双肢支撑时间方面，差异无统计学意义。这些研究结果表明，疼痛会影响老年人的行走速度，强调了解决这一关联以控制行动障碍和跌倒风险的重要性。观点：本系统综述和荟萃分析表明，疼痛与老年人步速降低有关。认识并解决疼痛对行走的影响可能对预防老年人群中与行动有关的障碍和跌倒非常重要。
{"title":"The effect of pain on gait in older people: A systematic review and meta-analysis","authors":"Mahsa Seydi , Kim Delbaere , Dae Uk Han , Lloyd Chan , Meghan Ambrens , Kimberley S. van Schooten","doi":"10.1016/j.jpain.2024.104758","DOIUrl":"10.1016/j.jpain.2024.104758","url":null,"abstract":"<div><div>Multi-site pain is common in people aged 60 years and over and is associated with a high risk of falls. To prevent and treat pain-related disabilities, it is crucial to identify the mechanisms underlying these associations. There is some evidence that pain leads to changes in walking, such as slower gait speed and shorter walking distance, which impair mobility and may increase the risk of falls. This review evaluated evidence on the relationship between pain and gait characteristics in older people. A comprehensive search on PubMed and Embase included observational studies and clinical trials assessing objective measures of walking, such as gait speed, cadence, stride length, and double-limb support time, in older people with and without pain. Of the 1218 studies screened, thirteen met the inclusion criteria from the primary search. An additional study was identified through the secondary search, resulting in fourteen studies included in this systematic review and meta-analysis. None of these studies investigated the relationship between fear of pain and gait characteristics in older people. Results showed that older people with pain had slower gait speed than those without pain, with a small effect size (Hedge’s <em>g</em> = −0.30, 95% CI = −0.41 to −0.19, p < 0.0001). There were no statistically significant differences in cadence, stride length, and double-limb support time. These findings suggest that pain impacts walking speed in older people, highlighting the importance of addressing this association to manage mobility deficits and fall risk.</div></div><div><h3>Perspective</h3><div>This systematic review and meta-analysis show that pain is associated with reduced gait speed in older people. Recognising and addressing the impact of pain on walking may be important for preventing mobility-related disorders and falls in this population.</div></div>","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":"29 ","pages":"Article 104758"},"PeriodicalIF":4.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822638","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}
Pub Date : 2024-12-04DOI: 10.1016/j.jpain.2024.104753
Annie Young MRes , Simon D. French PhD , Adrian C. Traeger PhD , Mark Hancock PhD , Ben Darlow PhD , Leticia Corrêa PhD , Hazel J. Jenkins PhD
We used a scoping review design to map the available evidence describing the use of reassurance in clinical practice, interventions to increase the delivery of reassurance, and reassurance-related outcome measures. We searched CINAHL, MEDLINE, EMBASE and Cochrane Central from inception to October 2024. Publications were included if they described the use of reassurance or reassurance-related outcome measures in patients with non-specific low back pain (LBP) presenting to primary care. We did not exclude publications on the basis of study design. Data were extracted and charted in accordance with study aims. We included 88 publications describing 66 primary studies. Twenty-one papers described how clinicians used reassurance in primary care, including: information provided (n=16), frequency of use (n=6), challenges providing reassurance (n=7), and importance of individualising reassurance (n=11). Reassurance interventions were investigated in 46 trials. Reassurance interventions were delivered verbally by clinicians to individuals (n=29) or groups (n=14), or via educational materials (n=18). Only one trial measured how reassured the patient felt after the intervention using a single-item non-validated question. Thirty-six trials used indirect measurements of reassurance success, including reductions in: fear-avoidance (n=23), worry (n=8), anxiety (n=8), pain catastrophising (n=10), and further healthcare utilisation (n=12). Relatively few papers have described how clinicians use reassurance in primary care. Reassurance interventions were investigated in 46 trials; however, reassurance was rarely the primary component of the intervention and was often delivered as part of an education intervention. There are no validated measures to directly assess how reassured a patient feels after an intervention.
Perspective
This review maps the available evidence describing how patient reassurance is used and assessed in the management of low back pain. There is limited assessment of the effectiveness of reassurance interventions. Reassurance is rarely the primary component of interventions and there are no validated measures to directly assess patient reassurance.
{"title":"Reassurance use and reassurance-related outcomes for low back pain in primary care: A scoping review","authors":"Annie Young MRes , Simon D. French PhD , Adrian C. Traeger PhD , Mark Hancock PhD , Ben Darlow PhD , Leticia Corrêa PhD , Hazel J. Jenkins PhD","doi":"10.1016/j.jpain.2024.104753","DOIUrl":"10.1016/j.jpain.2024.104753","url":null,"abstract":"<div><div>We used a scoping review design to map the available evidence describing the use of reassurance in clinical practice, interventions to increase the delivery of reassurance, and reassurance-related outcome measures. We searched CINAHL, MEDLINE, EMBASE and Cochrane Central from inception to October 2024. Publications were included if they described the use of reassurance or reassurance-related outcome measures in patients with non-specific low back pain (LBP) presenting to primary care. We did not exclude publications on the basis of study design. Data were extracted and charted in accordance with study aims. We included 88 publications describing 66 primary studies. Twenty-one papers described how clinicians used reassurance in primary care, including: information provided (n=16), frequency of use (n=6), challenges providing reassurance (n=7), and importance of individualising reassurance (n=11). Reassurance interventions were investigated in 46 trials. Reassurance interventions were delivered verbally by clinicians to individuals (n=29) or groups (n=14), or via educational materials (n=18). Only one trial measured how reassured the patient felt after the intervention using a single-item non-validated question. Thirty-six trials used indirect measurements of reassurance success, including reductions in: fear-avoidance (n=23), worry (n=8), anxiety (n=8), pain catastrophising (n=10), and further healthcare utilisation (n=12). Relatively few papers have described how clinicians use reassurance in primary care. Reassurance interventions were investigated in 46 trials; however, reassurance was rarely the primary component of the intervention and was often delivered as part of an education intervention. There are no validated measures to directly assess how reassured a patient feels after an intervention.</div></div><div><h3>Perspective</h3><div>This review maps the available evidence describing how patient reassurance is used and assessed in the management of low back pain. There is limited assessment of the effectiveness of reassurance interventions. Reassurance is rarely the primary component of interventions and there are no validated measures to directly assess patient reassurance.</div></div>","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":"29 ","pages":"Article 104753"},"PeriodicalIF":4.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792723","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}
Chemotherapy-induced peripheral neuropathy (CIPN) is a type of peripheral neuropathy that develops in patients treated with certain anticancer drugs. Oxaliplatin (OXA) causes CIPN in approximately 80–90 % of patients; thus, it is necessary to elucidate its underlying mechanism and develop effective treatments and prevention methods. The purpose of this study was to determine whether the pituitary adenylate cyclase-activating polypeptide (PACAP)/PAC1 receptor system in the spinal dorsal horn is involved in OXA-induced acute cold allodynia and examine the effect of a PAC1 receptor antagonist. Administration of OXA induced acute cold allodynia in wild-type mice, but not in PACAP-/- mice. In the dorsal root ganglia, OXA upregulated PACAP expression, particularly in small-sized neurons. OXA-induced cold allodynia was ameliorated by intrathecal (i.t.) injection of PACAP6–38 (peptide antagonist for PACAP receptor) and PA-8 (small-molecule antagonist specific for PAC1 receptor). I.t. PACAP, but not vasoactive intestinal polypeptide, resulted in cold allodynia, which was blocked by PA-8. OXA induced the activation of spinal astrocytes in a PAC1 receptor-dependent manner. The results suggest that spinal PACAP/PAC1 receptor systems are involved in OXA-induced acute cold allodynia through astrocyte activation. Furthermore, we demonstrated that the systemic administration of PA-8 resulted in therapeutic and preventative effects on OXA-induced acute cold allodynia. Because PA-8 did not affect the anticancer effects of OXA, we propose PAC1 receptor inhibition as a new strategy for the treatment and prevention of CIPN.
Perspective
Cold allodynia is a hallmark of OXA-induced peripheral neuropathy. This study demonstrated the involvement of spinal PACAP/PAC1 receptors in OXA-induced acute cold allodynia. We propose PAC1 receptor inhibition as a new strategy for the treatment and prevention of OXA-induced acute cold allodynia.
{"title":"Spinal pituitary adenylate cyclase-activating polypeptide and PAC1 receptor signaling system is involved in the oxaliplatin-induced acute cold allodynia in mice","authors":"Ichiro Takasaki Ph.D. , Ryota Nagashima , Takahiro Ueda , Yuya Ashihara , Tomoya Nakamachi , Takuya Okada , Naoki Toyooka , Atsuro Miyata , Takashi Kurihara","doi":"10.1016/j.jpain.2024.104751","DOIUrl":"10.1016/j.jpain.2024.104751","url":null,"abstract":"<div><div>Chemotherapy-induced peripheral neuropathy (CIPN) is a type of peripheral neuropathy that develops in patients treated with certain anticancer drugs. Oxaliplatin (OXA) causes CIPN in approximately 80–90 % of patients; thus, it is necessary to elucidate its underlying mechanism and develop effective treatments and prevention methods. The purpose of this study was to determine whether the pituitary adenylate cyclase-activating polypeptide (PACAP)/PAC1 receptor system in the spinal dorsal horn is involved in OXA-induced acute cold allodynia and examine the effect of a PAC1 receptor antagonist. Administration of OXA induced acute cold allodynia in wild-type mice, but not in PACAP-/- mice. In the dorsal root ganglia, OXA upregulated PACAP expression, particularly in small-sized neurons. OXA-induced cold allodynia was ameliorated by intrathecal (i.t.) injection of PACAP6–38 (peptide antagonist for PACAP receptor) and PA-8 (small-molecule antagonist specific for PAC1 receptor). I.t. PACAP, but not vasoactive intestinal polypeptide, resulted in cold allodynia, which was blocked by PA-8. OXA induced the activation of spinal astrocytes in a PAC1 receptor-dependent manner. The results suggest that spinal PACAP/PAC1 receptor systems are involved in OXA-induced acute cold allodynia through astrocyte activation. Furthermore, we demonstrated that the systemic administration of PA-8 resulted in therapeutic and preventative effects on OXA-induced acute cold allodynia. Because PA-8 did not affect the anticancer effects of OXA, we propose PAC1 receptor inhibition as a new strategy for the treatment and prevention of CIPN.</div></div><div><h3>Perspective</h3><div>Cold allodynia is a hallmark of OXA-induced peripheral neuropathy. This study demonstrated the involvement of spinal PACAP/PAC1 receptors in OXA-induced acute cold allodynia. We propose PAC1 receptor inhibition as a new strategy for the treatment and prevention of OXA-induced acute cold allodynia.</div></div>","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":"27 ","pages":"Article 104751"},"PeriodicalIF":4.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142756591","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}
Pub Date : 2024-11-28DOI: 10.1016/j.jpain.2024.104749
José Luis Socorro-Cumplido , Joaquim Chaler , Miriam Almirall , Judith Sánchez-Raya , Mireia Cano , Blanca Roman-Viñas
Fibromyalgia (FM) impacts patients’ health status, functioning and quality of life. Accurate diagnosis and effective treatment planning require reliable, valid and responsive measures of these domains. This study aimed to assess the psychometric properties of performance based tests (PBTs) in FM and to quantify the availability of reliable, valid and responsive PBTs linked to key International Classification of Functioning, Disability and Health (ICF) categories related to functional impact. A systematic review was conducted following the PRISMA checklist, and four databases (PubMed, EMBASE, Cochrane Library and Web of Science) were searched. Eligible studies contained information on population, intervention (assessment), and outcomes (PBTs and their psychometric properties). The risk of bias and the methodological quality were assessed according to the COSMIN criteria. Twenty-two studies evaluating twenty-six PBTs were included. PBTs were linked to five ICF categories: exercise tolerance, muscle power and muscle endurance and changing basic body position and walking. The psychometric properties assessed were reliability, validity and responsiveness. The 6 min walking test was the most often assessed PBT with moderate quality of evidence for reliability, and very good methodological quality for validity. Overall, the methodological quality for reliability was rated as doubtful with very low to moderate evidence, for validity we found very good methodological quality with low to high evidence. No studies investigated criterion validity, and construct validity and responsiveness were seldom determined. Clinicians assessing FM patients should carefully select PBTs. Future research on PBTs psychometrics in FM should follow COSMIN recommendations, ensuring control of symptom variability.
Perspective
This review confirms that the current understanding of the psychometric properties of PBTs for FM patients is limited, hindered by heterogeneous tests and insufficient evidence, complicating outcome comparisons across studies. This gap underscores the need for future research to enhance methodological quality and address missing ICF categories related to FM.
Registered protocol at Prospero
Registration number: CRD42022380709
纤维肌痛（FM）影响患者的健康状况、功能和生活质量。准确的诊断和有效的治疗计划需要这些领域的可靠、有效和反应性措施。本研究旨在评估FM中基于表现的测试（pbt）的心理测量特性，并量化与国际功能、残疾和健康分类（ICF）中与功能影响相关的关键类别相关的可靠、有效和反应性pbt的可用性。根据PRISMA检查表进行系统评价，检索四个数据库（PubMed、EMBASE、Cochrane Library和Web of Science）。符合条件的研究包含人口、干预（评估）和结果（PBTs及其心理测量特性）的信息。根据COSMIN标准评估偏倚风险和方法学质量。纳入22项研究，评估26项pbt。PBTs与五个ICF类别有关：运动耐受性，肌肉力量和肌肉耐力以及改变基本身体姿势和步行。评估的心理测量特性包括信度、效度和反应性。6分钟步行测验是最常被评估的PBT，其信度证据质量中等，效度方法学质量非常好。总体而言，可靠性的方法学质量被评为可疑，证据非常低到中等，效度我们发现非常好的方法学质量，证据从低到高。没有研究调查标准效度，结构效度和反应性很少确定。临床医生评估FM患者应谨慎选择pbt。未来在FM中的PBTs心理测量学研究应遵循COSMIN的建议，确保症状变异性得到控制。观点：本综述证实，目前对FM患者的PBTs心理测量特性的理解是有限的，受到异质性测试和证据不足的阻碍，使研究间的结果比较复杂化。这一差距强调了未来研究的必要性，以提高方法质量并解决与FM相关的ICF缺失类别。普洛斯彼罗注册协议：注册号：CRD42022380709。
{"title":"Psychometric properties of performance based tests in patients with Fibromyalgia: A systematic review","authors":"José Luis Socorro-Cumplido , Joaquim Chaler , Miriam Almirall , Judith Sánchez-Raya , Mireia Cano , Blanca Roman-Viñas","doi":"10.1016/j.jpain.2024.104749","DOIUrl":"10.1016/j.jpain.2024.104749","url":null,"abstract":"<div><div>Fibromyalgia (FM) impacts patients’ health status, functioning and quality of life. Accurate diagnosis and effective treatment planning require reliable, valid and responsive measures of these domains. This study aimed to assess the psychometric properties of performance based tests (PBTs) in FM and to quantify the availability of reliable, valid and responsive PBTs linked to key International Classification of Functioning, Disability and Health (ICF) categories related to functional impact. A systematic review was conducted following the PRISMA checklist, and four databases (PubMed, EMBASE, Cochrane Library and Web of Science) were searched. Eligible studies contained information on population, intervention (assessment), and outcomes (PBTs and their psychometric properties). The risk of bias and the methodological quality were assessed according to the COSMIN criteria. Twenty-two studies evaluating twenty-six PBTs were included. PBTs were linked to five ICF categories: exercise tolerance, muscle power and muscle endurance and changing basic body position and walking. The psychometric properties assessed were reliability, validity and responsiveness. The 6 min walking test was the most often assessed PBT with moderate quality of evidence for reliability, and very good methodological quality for validity. Overall, the methodological quality for reliability was rated as doubtful with very low to moderate evidence, for validity we found very good methodological quality with low to high evidence. No studies investigated criterion validity, and construct validity and responsiveness were seldom determined. Clinicians assessing FM patients should carefully select PBTs. Future research on PBTs psychometrics in FM should follow COSMIN recommendations, ensuring control of symptom variability.</div></div><div><h3>Perspective</h3><div>This review confirms that the current understanding of the psychometric properties of PBTs for FM patients is limited, hindered by heterogeneous tests and insufficient evidence, complicating outcome comparisons across studies. This gap underscores the need for future research to enhance methodological quality and address missing ICF categories related to FM.</div></div><div><h3>Registered protocol at Prospero</h3><div>Registration number: CRD42022380709</div></div>","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":"29 ","pages":"Article 104749"},"PeriodicalIF":4.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774471","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}
Pub Date : 2024-11-28DOI: 10.1016/j.jpain.2024.104745
Tobias Saueressig PT, Dipl.-Vw , Patrick J. Owen PhD (A/Prof.) , Hugo Pedder PhD (Dr) , Svenja Kaczorowski PT, MSc , Clint T. Miller PhD (Dr) , Lars Donath PhD (Prof.) , Daniel L. Belavý PhD (Prof.)
Existing data suggest placebo responses to treatments are small, but some people may be more likely to respond. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) on interindividual variability in response to placebo interventions MEDLINE, EMBASE, CINAHL, Web of Science Core Collection, CENTRAL, and SPORTDiscus were searched from inception to September 2023. Trial registry searches, citation tracking, and searches for prior systematic reviews were completed. The PEDro scale assessed study quality. Random effects robust variance estimation estimated the log variability ratio (VR), identifying subgroups with varying responses. Twenty-six studies were included, comprising various musculoskeletal pain conditions. Analysis of pain intensity (VR: 1.06, 95%-confidence interval (CI):[0.97; 1.16], 95%-prediction interval (PI):[0.75; 1.51], p = 0.17, k = 26 studies, N = 52 outcomes, GRADE: low), physical function (VR: 1.14, 95%-CI:[0.97; 1.34], 95%-PI:[0.62; 2.11], p = 0.11, k = 19, N = 40, GRADE: low), and health-related quality of life (VR: 1.14, 95%-CI:[0.91; 1.41], 95%-PI:[0.72; 1.80], p = 0.19, k = 7, N = 13, GRADE: low) outcomes revealed minimal, non-statistically significant variability in placebo response compared to control. However, wide prediction intervals suggest uncertainty regarding individual response patterns. There are likely no distinct subgroups of people who are more likely to respond to placebo interventions in musculoskeletal pain; although the available data limits the certainty of this assessment. Future work should consider individual participant data meta-analyses to better elucidate potential responder subgroups and optimize treatment strategies for musculoskeletal pain.
Perspective
This study systematically reviewed and analyzed RCTs to assess interindividual variability in placebo responses for musculoskeletal pain. Findings suggest minimal variability in placebo response, with no distinct subgroups more likely to respond. Wide prediction intervals indicate uncertainty, highlighting the need for future individual participant data meta-analyses to better elucidate potential responder subgroups.
现有数据表明，安慰剂对治疗的反应很小，但有些人可能更有可能做出反应。我们对随机对照试验（rct）进行了系统回顾和荟萃分析，研究了对安慰剂干预反应的个体间变异性。MEDLINE、EMBASE、CINAHL、Web of Science Core Collection、CENTRAL和SPORTDiscus从成立到2023年9月进行了检索。完成了试验注册表检索、引文跟踪和先前系统评价的检索。PEDro量表评估研究质量。随机效应稳健方差估计估计对数变异性比率（VR），识别具有不同反应的亚组。纳入了26项研究，包括各种肌肉骨骼疼痛状况。疼痛强度分析(VR: 1.06, 95%可信区间（CI）：[0.97；1.16]， 95%预测区间（PI）：[0.75；1.51], p = 0.17, k = 26项研究，N = 52个结局，GRADE：低)，身体功能(VR: 1.14, 95% ci:[0.97；1.34], 95% -π:[0.62;2.11], p = 0.11, k = 19, N = 40， GRADE：低)，与健康相关的生活质量(VR: 1.14, 95% ci:[0.91；1.41], 95% -π:[0.72;1.80], p = 0.19, k = 7, N = 13， GRADE：低)结果显示，与对照组相比，安慰剂反应的可变性很小，无统计学意义。然而，较宽的预测间隔意味着个体反应模式的不确定性。在肌肉骨骼疼痛方面，可能没有明显的亚组更可能对安慰剂干预作出反应；尽管现有数据限制了这一评估的确定性。未来的工作应考虑个体参与者数据荟萃分析，以更好地阐明潜在的应答亚组，并优化肌肉骨骼疼痛的治疗策略。观点：本研究系统地回顾和分析了随机对照试验，以评估安慰剂对肌肉骨骼疼痛反应的个体差异。研究结果表明，安慰剂反应的可变性很小，没有明显的亚组更有可能反应。较宽的预测间隔表明不确定性，强调需要对未来的个体参与者数据进行meta分析，以更好地阐明潜在的应答者亚组。
{"title":"Are some people more susceptible to placebos? A systematic review and meta-analysis of inter-individual variability in musculoskeletal pain","authors":"Tobias Saueressig PT, Dipl.-Vw , Patrick J. Owen PhD (A/Prof.) , Hugo Pedder PhD (Dr) , Svenja Kaczorowski PT, MSc , Clint T. Miller PhD (Dr) , Lars Donath PhD (Prof.) , Daniel L. Belavý PhD (Prof.)","doi":"10.1016/j.jpain.2024.104745","DOIUrl":"10.1016/j.jpain.2024.104745","url":null,"abstract":"<div><div>Existing data suggest placebo responses to treatments are small, but some people may be more likely to respond. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) on interindividual variability in response to placebo interventions MEDLINE, EMBASE, CINAHL, Web of Science Core Collection, CENTRAL, and SPORTDiscus were searched from inception to September 2023. Trial registry searches, citation tracking, and searches for prior systematic reviews were completed. The PEDro scale assessed study quality. Random effects robust variance estimation estimated the log variability ratio (VR), identifying subgroups with varying responses. Twenty-six studies were included, comprising various musculoskeletal pain conditions. Analysis of pain intensity (VR: 1.06, 95%-confidence interval (CI):[0.97; 1.16], 95%-prediction interval (PI):[0.75; 1.51], p = 0.17, k = 26 studies, N = 52 outcomes, GRADE: low), physical function (VR: 1.14, 95%-CI:[0.97; 1.34], 95%-PI:[0.62; 2.11], p = 0.11, k = 19, N = 40, GRADE: low), and health-related quality of life (VR: 1.14, 95%-CI:[0.91; 1.41], 95%-PI:[0.72; 1.80], p = 0.19, k = 7, N = 13, GRADE: low) outcomes revealed minimal, non-statistically significant variability in placebo response compared to control. However, wide prediction intervals suggest uncertainty regarding individual response patterns. There are likely no distinct subgroups of people who are more likely to respond to placebo interventions in musculoskeletal pain; although the available data limits the certainty of this assessment. Future work should consider individual participant data meta-analyses to better elucidate potential responder subgroups and optimize treatment strategies for musculoskeletal pain.</div></div><div><h3>Perspective</h3><div>This study systematically reviewed and analyzed RCTs to assess interindividual variability in placebo responses for musculoskeletal pain. Findings suggest minimal variability in placebo response, with no distinct subgroups more likely to respond. Wide prediction intervals indicate uncertainty, highlighting the need for future individual participant data meta-analyses to better elucidate potential responder subgroups.</div></div>","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":"29 ","pages":"Article 104745"},"PeriodicalIF":4.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755776","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}
Pub Date : 2024-11-23DOI: 10.1016/j.jpain.2024.104744
Fenan S. Rassu Ph.D. , Kavya Bhattiprolu , Claudia M. Campbell , Stephen T. Wegener , Rachel V. Aaron
This study investigated the relationship between neighborhood disadvantage, measured by the Area Deprivation Index (ADI), and pain-related variables in a pain psychology clinic. We also examined the sequential mediating roles of pain catastrophizing and pain-related fear on these relationships. Participants (N = 509) completed questionnaires assessing usual pain intensity, fatigue, emotional distress, and interference with daily activities. The mean ADI score was 32.57 (SD = 22.65), with scores ranging from 1 to 100. Linear regression analysis, adjusting for age and gender, revealed that higher ADI (i.e., less advantage) was significantly associated with higher scores on pain-related variables (pain intensity: B = 0.026, p < .001; fatigue: B = 0.018, p < .001; emotional distress: B = 0.020, p < .001; interference with daily activities: B = 0.014, p = .006). Sequential mediation analysis revealed pain catastrophizing and pain-related fear mediated these relationships, with significant indirect effects for fatigue (B = 0.001, 95% CI [0.000, 0.002]) and interference with daily activities (B = 0.001, 95% CI [0.001, 0.003]) — but not pain intensity or emotional distress. Pain catastrophizing alone mediated neighborhood disadvantage-pain relationship for all variables. The results suggest that neighborhood disadvantage is associated with higher scores on pain-related experiences and that consistent with the fear avoidance model, pain catastrophizing and pain-related fear may play a role in these relationships for fatigue and interference with daily activities. These findings underscore that neighborhood disadvantage is associated with worse pain-related experiences and highlight the importance of considering neighborhood factors in chronic pain management.
Perspective
This study identifies potential pathways linking neighborhood disadvantage to chronic pain variables, highlighting the roles of pain catastrophizing and pain-related fear. The findings underscore the need for a holistic approach to pain management that recognizes both individual cognitive-emotional factors and the broader social context in which pain occurs.
{"title":"Neighborhood disadvantage and pain-related experiences in a pain psychology clinic: The mediating roles of pain catastrophizing and pain-related fear","authors":"Fenan S. Rassu Ph.D. , Kavya Bhattiprolu , Claudia M. Campbell , Stephen T. Wegener , Rachel V. Aaron","doi":"10.1016/j.jpain.2024.104744","DOIUrl":"10.1016/j.jpain.2024.104744","url":null,"abstract":"<div><div>This study investigated the relationship between neighborhood disadvantage, measured by the Area Deprivation Index (ADI), and pain-related variables in a pain psychology clinic. We also examined the sequential mediating roles of pain catastrophizing and pain-related fear on these relationships. Participants (N = 509) completed questionnaires assessing usual pain intensity, fatigue, emotional distress, and interference with daily activities. The mean ADI score was 32.57 (SD = 22.65), with scores ranging from 1 to 100. Linear regression analysis, adjusting for age and gender, revealed that higher ADI (i.e., less advantage) was significantly associated with higher scores on pain-related variables (pain intensity: B = 0.026, p < .001; fatigue: B = 0.018, p < .001; emotional distress: B = 0.020, p < .001; interference with daily activities: B = 0.014, p = .006). Sequential mediation analysis revealed pain catastrophizing and pain-related fear mediated these relationships, with significant indirect effects for fatigue (B = 0.001, 95% CI [0.000, 0.002]) and interference with daily activities (B = 0.001, 95% CI [0.001, 0.003]) — but not pain intensity or emotional distress. Pain catastrophizing alone mediated neighborhood disadvantage-pain relationship for all variables. The results suggest that neighborhood disadvantage is associated with higher scores on pain-related experiences and that consistent with the fear avoidance model, pain catastrophizing and pain-related fear may play a role in these relationships for fatigue and interference with daily activities. These findings underscore that neighborhood disadvantage is associated with worse pain-related experiences and highlight the importance of considering neighborhood factors in chronic pain management.</div></div><div><h3>Perspective</h3><div>This study identifies potential pathways linking neighborhood disadvantage to chronic pain variables, highlighting the roles of pain catastrophizing and pain-related fear. The findings underscore the need for a holistic approach to pain management that recognizes both individual cognitive-emotional factors and the broader social context in which pain occurs.</div></div>","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":"27 ","pages":"Article 104744"},"PeriodicalIF":4.0,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717349","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}
Pub Date : 2024-11-23DOI: 10.1016/j.jpain.2024.104741
Kelly N. Jahn , Sean Takamoto Kashiwagura , Muhammad Saad Yousuf
Pain hyperacusis, also known as noxacusis, causes physical pain in response to sounds that do not bother most people. How sound causes excruciating pain that can last for weeks or months is not well understood, resulting in a lack of effective treatments. To gain insight into the underlying mechanisms of the condition, 32 adults attended a virtual focus group to describe their sound-induced pain. Focus group data were used to develop three follow-up surveys that aimed to identify the most common symptoms of pain hyperacusis as well as the participants’ use of therapies for pain relief. All participants endorsed negative effects of pain hyperacusis on psychosocial and physical function. Most reported sound-induced burning (80.77%), stabbing (76.92%), throbbing (73.08%), and pinching (53.85%) sensations that occur either in the ear or elsewhere in the body. Participants have used numerous pharmaceutical and non-pharmaceutical interventions to alleviate their pain with varying degrees of pain relief. Benzodiazepines and nerve blockers emerged as the most effective analgesic options while non-pharmaceutical therapies were largely ineffective. Symptoms and therapeutic approaches were generally consistent with peripheral mechanistic theories of pain hyperacusis (e.g., trigeminal nerve involvement). An interdisciplinary approach to clinical studies and the development of animal models are needed to identify and treat the pathological mechanisms of pain hyperacusis.
Perspective
This article presents the physical and psychosocial consequences of debilitating sound-induced pain (i.e., pain hyperacusis) and the interventions that sufferers have sought for pain relief. The results are largely consistent with peripheral mechanistic theories (e.g., trigeminal nerve involvement) and will guide future work to investigate neural mechanisms and effective therapies.
{"title":"Clinical phenotype and management of sound-induced pain: Insights from adults with pain hyperacusis","authors":"Kelly N. Jahn , Sean Takamoto Kashiwagura , Muhammad Saad Yousuf","doi":"10.1016/j.jpain.2024.104741","DOIUrl":"10.1016/j.jpain.2024.104741","url":null,"abstract":"<div><div>Pain hyperacusis, also known as noxacusis, causes physical pain in response to sounds that do not bother most people. How sound causes excruciating pain that can last for weeks or months is not well understood, resulting in a lack of effective treatments. To gain insight into the underlying mechanisms of the condition, 32 adults attended a virtual focus group to describe their sound-induced pain. Focus group data were used to develop three follow-up surveys that aimed to identify the most common symptoms of pain hyperacusis as well as the participants’ use of therapies for pain relief. All participants endorsed negative effects of pain hyperacusis on psychosocial and physical function. Most reported sound-induced burning (80.77%), stabbing (76.92%), throbbing (73.08%), and pinching (53.85%) sensations that occur either in the ear or elsewhere in the body. Participants have used numerous pharmaceutical and non-pharmaceutical interventions to alleviate their pain with varying degrees of pain relief. Benzodiazepines and nerve blockers emerged as the most effective analgesic options while non-pharmaceutical therapies were largely ineffective. Symptoms and therapeutic approaches were generally consistent with peripheral mechanistic theories of pain hyperacusis (e.g., trigeminal nerve involvement). An interdisciplinary approach to clinical studies and the development of animal models are needed to identify and treat the pathological mechanisms of pain hyperacusis.</div></div><div><h3>Perspective</h3><div>This article presents the physical and psychosocial consequences of debilitating sound-induced pain (i.e., pain hyperacusis) and the interventions that sufferers have sought for pain relief. The results are largely consistent with peripheral mechanistic theories (e.g., trigeminal nerve involvement) and will guide future work to investigate neural mechanisms and effective therapies.</div></div>","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":"27 ","pages":"Article 104741"},"PeriodicalIF":4.0,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-17DOI: 10.1016/j.jpain.2024.104737
Madelyn R. Frumkin , Julie R. Brewer , Julia E. Hooker , Kate N. Jochimsen , Ana-Maria Vranceanu
Interventions aimed at preventing chronic pain after acute traumatic injury have significant potential to reduce healthcare expenditures and improve quality of life for millions of individuals. Given recent development of such interventions, limited research has examined mechanisms of change using repeated measures (e.g., session-by-session assessments). This study examines within-person relationships between pain catastrophizing and intensity during and after a four-session mind-body intervention for individuals with acute traumatic orthopedic injury (N = 76, T = 445). Random intercept cross-lagged panel models were used to examine within-person autoregressive, contemporaneous, and cross-lagged effects between pain catastrophizing and pain intensity, after accounting for stable between-person differences. Our primary hypothesis that improvements in catastrophizing would be associated with subsequent reductions in pain intensity was partially supported by a significant within-person cross-lagged effect between catastrophizing at post-test and pain with activity reported at three-month follow-up (β = 0.421, SE = 0.099, p < .001). Improvement in catastrophizing was also associated with same-session improvement in pain intensity midway through the intervention. Importantly, bidirectional within-person analyses allowed us to rule out the possibility that improvements in pain were responsible for subsequent improvements in catastrophizing, but not vice versa. Together, these findings suggest improvements in catastrophizing during psychosocial intervention may prevent transition from acute to chronic pain after injury. Future research with larger between-person sample sizes, more frequent within-person assessment, and comparable control group data is necessary to facilitate greater understanding of psychosocial mechanisms for preventing chronic pain after injury.
Perspective
This study examines within-person relationships between pain catastrophizing and intensity during and after a four-session mind-body intervention to prevent persistent pain after acute traumatic orthopedic injury. Improved catastrophizing at post-test was associated with reduced pain with activity at three-month follow-up. Within-person analyses enhance understanding of psychosocial mechanisms for preventing chronic pain after injury.
旨在预防急性创伤后慢性疼痛的干预措施在减少医疗支出和提高数百万人的生活质量方面具有巨大潜力。鉴于此类干预措施的最新发展，使用重复测量（如逐个疗程评估）来研究变化机制的研究十分有限。本研究针对急性创伤性骨科损伤患者（N = 76，T = 445）进行了为期四次的身心干预，在此期间和之后，研究了疼痛灾难化与疼痛强度之间的人际关系。在考虑了稳定的人际差异后，我们使用随机截距交叉滞后面板模型来检验疼痛灾难化和疼痛强度之间的人内自回归、同期和交叉滞后效应。我们的主要假设是，灾难化的改善将与随后疼痛强度的降低相关联，这一假设得到了测试后灾难化与三个月随访时报告的活动性疼痛之间显著的人内交叉滞后效应的部分支持（β = 0.421, SE = 0.099, p
{"title":"Within-person relationships between catastrophizing and pain intensity during a mind-body intervention to prevent persistent pain and disability after acute traumatic orthopedic injury","authors":"Madelyn R. Frumkin , Julie R. Brewer , Julia E. Hooker , Kate N. Jochimsen , Ana-Maria Vranceanu","doi":"10.1016/j.jpain.2024.104737","DOIUrl":"10.1016/j.jpain.2024.104737","url":null,"abstract":"<div><div>Interventions aimed at preventing chronic pain after acute traumatic injury have significant potential to reduce healthcare expenditures and improve quality of life for millions of individuals. Given recent development of such interventions, limited research has examined mechanisms of change using repeated measures (e.g., session-by-session assessments). This study examines <em>within-person</em> relationships between pain catastrophizing and intensity during and after a four-session mind-body intervention for individuals with acute traumatic orthopedic injury (<em>N</em> = 76, <em>T</em> = 445). Random intercept cross-lagged panel models were used to examine within-person autoregressive, contemporaneous, and cross-lagged effects between pain catastrophizing and pain intensity, after accounting for stable between-person differences. Our primary hypothesis that improvements in catastrophizing would be associated with subsequent reductions in pain intensity was partially supported by a significant within-person cross-lagged effect between catastrophizing at post-test and pain with activity reported at three-month follow-up (β = 0.421, SE = 0.099, p < .001). Improvement in catastrophizing was also associated with same-session improvement in pain intensity midway through the intervention. Importantly, bidirectional within-person analyses allowed us to rule out the possibility that improvements in pain were responsible for subsequent improvements in catastrophizing, but not vice versa. Together, these findings suggest improvements in catastrophizing during psychosocial intervention may prevent transition from acute to chronic pain after injury. Future research with larger between-person sample sizes, more frequent within-person assessment, and comparable control group data is necessary to facilitate greater understanding of psychosocial mechanisms for preventing chronic pain after injury.</div></div><div><h3>Perspective</h3><div>This study examines within-person relationships between pain catastrophizing and intensity during and after a four-session mind-body intervention to prevent persistent pain after acute traumatic orthopedic injury. Improved catastrophizing at post-test was associated with reduced pain with activity at three-month follow-up. Within-person analyses enhance understanding of psychosocial mechanisms for preventing chronic pain after injury.</div></div>","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":"26 ","pages":"Article 104737"},"PeriodicalIF":4.0,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677407","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}
Pub Date : 2024-11-14DOI: 10.1016/j.jpain.2024.104734
William Encinosa PhD , Didem Bernard PhD , R. Burciaga Valdez PhD, MHSA
{"title":"Corrigendum to “The association between smoking, chronic pain, and prescription opioid use: 2013-2021” [J Pain 26 (2025) 104707]","authors":"William Encinosa PhD , Didem Bernard PhD , R. Burciaga Valdez PhD, MHSA","doi":"10.1016/j.jpain.2024.104734","DOIUrl":"10.1016/j.jpain.2024.104734","url":null,"abstract":"","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":"26 ","pages":"Article 104734"},"PeriodicalIF":4.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640255","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}
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