Frontiers in pain research (Lausanne, Switzerland)最新文献

Background: Pediatric patients with sickle cell disease (SCD) experience a high level of pain, which is often chronic and recurrent and results in impaired health-related quality of life (HRQOL). Patients with SCD also report a significant degree of sleep disturbance and fatigue associated with their chronic disease. The objective of the present study is to investigate the effects of pain, sleep disturbance, and general fatigue in a serial (sequential) multiple mediator model analysis predicting overall generic HRQOL in pediatric patients with SCD from their perspective.

Methods: The Pain Scale from the PedsQL Sickle Cell Disease Module, General Fatigue Scale and Sleep Disturbance Item from the PedsQL Multidimensional Fatigue Scale, and the PedsQL 4.0 Generic Core Scales were completed in a multisite national study by 227 pediatric patients with SCD aged 5-18 years. Hierarchical multiple regression and serial multiple mediator model analyses were conducted to test the percent variability accounted for and the mediating effects of sleep disturbance and general fatigue in the association between SCD pain and generic HRQOL.

Results: Pain predictive effects on generic HRQOL were serially mediated by sleep disturbance and general fatigue. In a hierarchical multiple regression analysis controlling for age and sex, pain, sleep disturbance, and general fatigue accounted for 63% of the variance in pediatric patient-reported generic HRQOL (P < 0.001), demonstrating a large effect size.

Conclusion: The mechanisms of the predictive effects of SCD-specific pain on generic HRQOL in pediatric patients with SCD are explained in part by the serial multiple mediator effects of sleep disturbance and general fatigue. Recognizing the multiple mediators of SCD-specific pain on generic HRQOL from the perspective of pediatric patients with SCD may aid future clinical research and practice to address impaired daily functioning through more comprehensive treatment approaches that include targeted symptom-specific interventions for pain, sleep disturbance, and fatigue.

Background: The Neuropathic Pain Symptom Inventory (NPSI) is a commonly used assessment in neuropathic pain (NP) trials, yet a Minimal Clinically Important Difference (MCID) has not been established. An MCID would enhance the interpretability of NPSI scores, guiding clinicians and researchers in assessing clinically important improvements in NP symptoms. The aim of this study was to calculate an MCID from the available scientific research that used the NPSI.

Methods: We conducted a systematic review and meta-analysis of NP trials reporting the NPSI. Four distributional approaches were applied to estimate the MCID: 1) meta-regression on the set of standard deviation (SD) of change scores, 2) meta-regression on the set of baseline SD scores, 3) simple aggregation on the set of SD of change scores, and 4) simple aggregation on the set of baseline SD scores. Only treatment arms within Randomized Controlled Trials (RCTs) were examined for MCID estimation. Control arms were examined separately in a sensitivity analysis using the simple aggregation method for both SD of change and baseline SD sets. Bias for each included study was assessed using the Cochrane tool for quality assessment of randomized controlled trials.

Results: 323 trials were examined, 12 were selected for inclusion with a total of 17 treatment arms. The calculated MCID estimates for the NPSI total score (range 1-100) were 6.21 for the SD of change meta-regression and 7.1 for baseline SD meta regression. The MCID values aggregated using simple aggregation methods were 7.95 using pooled SD of change scores, 7.8 using pooled baseline SD. Control arms had a MCID of 8.04 for SD of Change and 8.71 for Baseline SD.

Conclusion: This study provides preliminary MCID estimates for the NPSI. Limitations include limited data for NP subtypes, highlighting the need for additional anchor-based and etiology-specific MCID research to refine these estimates. These findings can aid in future NP trial design and the interpretation of results.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025649343, PROSEPRO CRD42025649343.

Introduction: Cannabis has been decriminalized by many states and shows promise in treating both neuropathic and non-neuropathic pain through its interaction with the endocannabinoid system and anti-inflammatory effects. This study examines differences in cannabis use for adults whose most bothersome chronic pain condition is neuropathic vs. non-neuropathic.

Materials and methods: Survey data were collected from adults receiving care at a pain clinic. Participants completed demographic questions and standardized self-report measures (PROMIS Pain Intensity/Interference and the ID-Pain tool). Participants' most bothersome pain condition(s) were categorized as neuropathic or non-neuropathic pain based on ID-Pain scores. Linear regression models assessed differences in frequency and duration of cannabis product use between groups, adjusting for age and sex.

Results: A total of 113 individuals were recruited; following exclusions and missing data, 104 participants (61.5% female) were included in the final analysis. Of these, 36.5% reported neuropathic pain as their most bothersome, and 63.5% reported non-neuropathic pain. Those with neuropathic pain reported significantly more days per month of Tetrahydrocannabinol/Cannabidiol (THC/CBD) combination (b = 5.96, p = 0.02), Cannabidiol-only (CBD-only) (b = 8.82, p = 0.03), and Tetrahydrocannabinol-only (THC-only) products (b = 7.04, p = 0.02). They also used THC-only (b = 0.97, p < 0.05) and THC/CBD (b = 1.09, p < 0.01) products more frequently per day. Neuropathic pain was positively associated with pain intensity (b = 4.10, p < 0.001) and interference (b = 4.95, p < 0.001).

Discussion: Adults whose most bothersome pain condition(s) were neuropathic used cannabis, especially THC and THC/CBD combination products, more frequently than those whose most bothersome pain was non-neuropathic. Participants with neuropathic pain also reported higher levels of pain intensity and interference. Further longitudinal research is needed to confirm whether increased use of THC-rich cannabis provides symptom relief for adults with neuropathic pain.

Background: Cancer pain is a significant public health concern worldwide, necessitating effective management strategies. This study aimed to explore the effects of patient-controlled subcutaneous analgesia (PCSA) with hydromorphone hydrochloride injection on refractory cancer pain.

Methods: We conducted a retrospective observational study involving patients who received PCSA with hydromorphone hydrochloride injection at our hospital from December 2022 to May 2023. All patients in this study were initially hospitalized to undergo dose titration and safety assessment for subcutaneous hydromorphone PCSA, ensuring drug tolerance and stable pump operation. After achieving dose stabilization, most patients continued analgesic therapy at home using the pump, with dynamic monitoring and dose adjustments conducted via telephone follow-ups and outpatient visits. Pain was assessed using the numerical rating scale (NRS), while anxiety and depression were evaluated using the Edmonton Symptom Assessment Scale (ESAS-R) and sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI). The incidence of adverse drug reactions was also documented.

Results: The treatment demonstrated significant improvement across all observed parameters. After the continuous subcutaneous injection of hydromorphone hydrochloride infusion for analgesia,the median NRS pain score decreased from 6 to 1 (p < 0.0001), the mean sleep quality score decreased from 13.85 to 7.488 (p < 0.0001), the median anxiety state score decreased from 5 to 1 (p < 0.0001), the median depression score decreased from a baseline of 3 to 0.5 (p < 0.0001), and the median equivalent oral morphine dose decreased from 140 mg to 52 mg (p < 0.0001).

Conclusions: PCSA with hydromorphone hydrochloride injection offers significant therapeutic benefits for refractory cancer pain. It effectively reduces pain intensity, decreases opioid dosage, mitigates certain adverse reactions, and is associated with reduced anxiety and depression as well as improved sleep quality.

Large, collaborative projects that combine researchers from multiple scientific disciplines have become an integral part of the scientific endeavor. While transdisciplinary team science projects hold great potential, they also come with a unique set of challenges compared to monodisciplinary projects. The Science of Team Science (SciTS) field has developed multiple conceptual models and frameworks that guide the design, implementation, and evaluation of team science initiatives to maximize their potential for making breakthrough discoveries and creating solutions for complex problems. While these conceptual models contain a trove of valuable information for successful team science, guidance on how to effectively implement them is lacking. Here, we describe our experiences with implementing conceptual SciTS models to design and establish the REstoring JOINt health and function to reduce pain (RE-JOIN) consortium, a transdisciplinary team science project aimed at elucidating the mechanisms underlying chronic joint pain, with a solution-oriented focus. We highlight our experiences and challenges with implementing existing conceptual models and provide practical tips and guidance for designing and implementing solution-oriented team science initiatives.

Background: Menstrual pain affects 45%-95% of reproductive-age females and increases the risk of other chronic pain conditions. Psychometrically sound measurement tools are essential for advancing research and clinical care in menstrual pain. Numerical rating scales (NRS) are widely used to measure pain severity. However, the minimally important difference (MID) and responsiveness to change of the NRS in the context of menstrual pain are not well understood. Understanding MID and responsiveness to change helps guide the evaluation of treatment efficacy and clinical decision-making. This study evaluated the MID and responsiveness to change in the NRS, ranging from 0 to 10, for menstrual pain severity.

Methods: Participants who were menstruating (aged 14-42, N = 100) completed two surveys 24 h apart. In both surveys, we measured menstrual pain severity (worst, least, average menstrual pain in the past 24 h, and current menstrual pain) on a 0 (no pain) to 10 (extremely severe) NRS. MIDs were estimated using distribution-based approaches (standard error of measurement and effect size) and anchor-based approaches (using symptom interference and retrospective recall of change as anchors). Responsiveness to change was evaluated using standard response means and area-under-the-curve analysis.

Results: The MID estimates were close to 1 point. The NRS of menstrual pain severity was responsive to menstrual pain improvement (standard response means ranged from 0.44 to 0.61, p < 0.001 for between-group comparisons). Area-under-the-curve estimates ranged from 0.66 to 0.70.

Conclusions: The findings can inform the design and interpretation of studies testing interventions for menstrual pain, while also guiding clinicians in monitoring and adjusting treatment.

Background: Classification attempts and treatment strategies for endometriosis have been predominantly biomedical. Symptom profiles observed in individuals with endometriosis are multidimensional and may be more effectively captured by a biopsychosocial model.

Methods: The aim of this study was to identify distinct subgroups of individuals with endometriosis based on their biopsychosocial profiles, using Latent Class Analysis. In a subsequent phase, the identified subgroups were compared in terms of sociodemographic characteristics and various indices of functioning.

Results: Two distinct subgroups were identified: Class 2, representing a high biopsychosocial burden (BPS) group characterized by both significant psychological strain and severe pain characteristics, and Class 1, representing a low BPS group with low scores on these indicators. The high BPS group reported worse control/powerlessness and greater deficits in social support.

Conclusion: Moving forward, clinical assessment of patients with endometriosis may benefit from integrating core principles from the biopsychosocial model. This approach can help identify individuals facing significant psychosocial challenges who may require multidisciplinary interventions alongside evidence-based biological treatments.

Enhanced recovery after surgery (ERAS) is a multidisciplinary collaborative diagnosis and treatment model based on evidence-based medicine. By optimizing the perioperative management strategy, we can reduce the incidence of postoperative complications, minimize the physiological and psychological trauma stress reaction of patients, shorten the hospitalization period, and promote the functional recovery of patients. The diagnosis and treatment system integrates the advantages of surgery, anesthesiology, nursing, clinical nutrition and other disciplines, and constructs a whole process optimization path through preoperative evaluation, intraoperative management and postoperative rehabilitation, which fully embodies the patient-centered medical service concept. Postoperative pain, as a key factor affecting the rehabilitation process of patients, is closely related to the long-term quality of life of patients. Therefore, the optimization of pain management has become an indispensable and important part of eras. At present, multimodal analgesia (MMA) strategy has been widely recommended as the gold standard for postoperative pain management. This paper aims to review the latest research progress, clinical application strategies and future development direction of MMA in eras. It includes the theoretical basis, core drugs and technologies, application in different surgical fields, impact on patient prognosis, current challenges and future trends of MMA, and provides evidence-based basis for optimizing perioperative pain management.

Chronic osteoarthritis (OA) pain is a complex nociplastic condition that affects humans, as well as cats and dogs. This review summarizes the physiology of pain in healthy individuals, the physiopathology of OA pain, and the use of quantitative sensory testing (QST) to objectively assess somatosensory sensitization associated with chronic OA pain. It discusses the translation of human OA pain phenotype profiles to animals, the management of neuro-sensitization with currently prescribed treatments, and complementary methods for evaluating neuro-sensitization, such as electrodiagnostic testing. Additionally, this review serves as a practical guide for standardizing QST in rats, cats, and dogs, with explanatory appendices. It was hypothesized that in translational comparison with the human condition, OA-induced rat models and naturally occurring OA in cats and dogs would exhibit similar somatosensory sensitization profiles. As observed in human OA, an imbalance between facilitatory and inhibitory endogenous controls is also evident in animal OA. This dysregulation can be characterized using QST and underlies the distinct nociceptive phenotypes. Confirming and validating OA pain profiles will promote a patient-tailored approach to effectively alleviate neuro-sensitization in humans and animals.