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

Chronic lower back pain prevalence is greatest among older adults. Older adults (65+) often have multiple comorbidities and are more likely to have high-impact chronic pain that significantly impacts daily activities and function. Owing to greater pain burden, older adults are prime candidates for low-risk, in-home pain treatment. The goal of the present study was two-fold: (1) to examine clinical effectiveness of an FDA-Authorized Skills-Based Virtual Reality delivered therapy for chronic lower back pain in adults (18-64) and older adults (65+) by conducting a secondary analysis of a randomized controlled trial (N = 505), and (2) to examine engagement rates with the Skills-Based Virtual Reality delivered therapy in adults and older adults in the randomized controlled trial sample, and a separate real-world clinical sample (N = 2460). The clinical effectiveness analysis found that adults and older adults with chronic lower back pain showed statistically equivalent and clinically meaningful reductions in pain intensity and pain interference that were durable to 12-months post-treatment along with parallel improvements in sleep, depression, and physical disability. Adult and older adult high-impact chronic pain patients showed greater pain reductions than lower impact chronic pain patients with the majority shifting to lower impact chronic pain status at end-of-treatment that was maintained at 12-months post-treatment. VR program engagement analysis showed that older adults evidenced higher engagement in VR relative to adults in both the randomized controlled trial and real-world clinical sample. Together these results challenge common misperceptions about older adults and suggest that this Skills-Based VR therapy is an accessible solution for chronic lower back pain in older adults that leads to strong clinical outcomes and high VR program engagement.

Clinical trial registration: ClinicalTrials.gov, identifier NCT05263037.

This paper explores how existentially and religiously laden texts such as the psalms of lament can help alexithymic persons living with chronic pain to articulate their emotions. It is proposed that verbalizing emotions through psalms of lament can promote coping, and this hypothesis is exemplified by a reading of Psalm 13. The first part of Psalm 13 helps the alexithymic reader turn existential anguish into questions, expressing feelings of being forgotten, ignored, worried, and antagonized. In the second part, there is a shift towards expressing expectations using the imperative mood, highlighting assertiveness. Assertiveness, though not part of alexithymia, relates to emotional expressiveness, and learning to express requests and expectations is health-promoting. In the third part, hope is introduced. This is linked to the psalmist's ability to say "I." Self-assertion is crucial for overcoming externally-oriented thinking, empowering persons to see themselves as active agents. Trust and hope are active stances, essential for living well despite chronic pain. Hence, texts viewed as sacred by alexithymic readers can help them get a language with which to express their discomfort.

Introduction: This study evaluates the feasibility of using the Nociception Level Index (NOL) as an objective tool for assessing pain in awake patients with Complex Regional Pain Syndrome (CRPS). Traditional pain assessment methods, such as the Visual Analog Scale (VAS), are subjective and influenced by psychological and cognitive factors, limiting their accuracy in chronic pain conditions.

Methods: A single-center, prospective observational study was conducted with 26 CRPS patients. The NOL index, a multi-parameter device measuring autonomic nervous system responses, was assessed alongside VAS scores during physiotherapy exercises and intravenous lidocaine treatment. Pain levels were recorded at baseline, during painful exercises, and post-lidocaine administration. Changes in NOL and VAS scores were analyzed using the Wilcoxon signed-rank test with Bonferroni correction. Receiver operating characteristic (ROC) analysis with bootstrapped 95% confidence interval (CI) evaluated the sensitivity and specificity of NOL and VAS in discriminating painful from non-painful states.

Results: Physiotherapy exercises significantly increased both NOL (from 22.7 ± 10.7 to 30.3 ± 8.9) and VAS scores (from 5.5 ± 2.8 to 8.15 ± 1.6) (p < 0.001 for both). Lidocaine treatment led to partial pain relief, with VAS scores decreasing statistically significantly (from 7.5 ± 2.2 to 4.7 ± 2.8, p < 0.001), while NOL values trended lower (from 35.3 ± 12.2 to 29.4 ± 15.6, p = 0.26). ROC analysis showed comparable discrimination between painful and non-painful states for both tools [AUC: NOL 0.76 95% CI (0.68,0.84); VAS 0.78 95% CI (0.7,0.85)].

Conclusions: The NOL index shows promise as a complementary tool for objective pain assessment in CRPS, potentially offering insights into pain dynamics that subjective tools may miss. Further research with larger cohorts and standardized protocols is recommended to validate its clinical utility in chronic pain management.

Objectives: Our primary aim is to evaluate the agreement between subjective and objective methods of measuring sleep quality in people with musculoskeletal pain and poor sleep. Our secondary aim is to explore the relationship between subjective and objective sleep quality in people with clinical and experimental pain, as well as its impact on function.

Methods: Participants with musculoskeletal pain (intensity >5/10 most days over the preceding 3 months) and poor sleep [Pittsburgh Sleep Quality Index (PSQI) total > 5] (n = 33) completed the PSQI and wore a ring that characterizes sleep stages (i.e., Oura© ring). Responses to the PSQI over the preceding month were compared to the corresponding averaged Oura measures using zero-order correlations (primary aim). Partial Pearson correlations were used to assess sleep-pain relationships (second aim), controlling for age and sex. Statistical significance was set at α <0.05 with Bonferroni correction.

Results: PSQI responses for total bedtime (p < 0.0005), sleep duration (p < 0.0005), and the PSQI duration component (p < 0.003) significantly correlated with their Oura-derived equivalents. In contrast, Oura measures of sleep latency, efficiency, and disturbances showed no alignment with PSQI metrics. The PSQI total score and its sleep latency component were significantly associated with pain measures, including Western Ontario and McMaster Universities Osteoarthritis Index-pain (p = 0.022; latency p = 0.009), McGill Pain Questionnaire (total p = 0.026; latency p = 0.008; neuropathic p = 0.026, latency p = 0.011; continuous p = 0.026; intermittent p = 0.026, latency p = 0.008; affective-latency p = 0.008), and Graded Chronic Pain Scale pain intensity (p = 0.026; latency p = 0.012) as well as interference (latency p = 0.008). By contrast, Oura-derived sleep measures showed no significant associations with pain, except for sleep latency, which correlated with conditioned pain modulation (p = 0.049). All p-values are Bonferroni-corrected.

Conclusions: This preliminary study provides valuable insights into the complementary roles of subjective and objective sleep assessments in older adults with chronic pain. The findings underscore the importance of integrating both approaches to refine sleep evaluation in individuals with musculoskeletal pain. Future research should further examine the feasibility and clinical utility of combining subjective and objective assessments to enhance understanding of sleep- and pain-related health outcomes.

Background: Low back pain (LBP) is the leading musculoskeletal disorder worldwide and a major cause of disability, health care utilization, and economic burden. Clinical practice guidelines (CPGs) aim to optimize care but depend heavily on systematic reviews (SRs). The reporting and methodological quality of SRs underpinning LBP CPGs remain unclear.

Objectives: To conduct a meta-epidemiological assessment of the reporting and methodological quality of SRs cited in LBP CPGs and compare Cochrane vs. non-Cochrane reviews.

Methods and design: Cross-sectional meta-epidemiological study. We identified English-language LBP CPGs published between 2017 and 2021 and extracted SRs underpinning therapeutic recommendations. Reporting quality was assessed using PRISMA and methodological quality using AMSTAR-2. Two reviewers performed masked, duplicate extraction with consensus resolution. Between-group comparisons used Wilcoxon rank-sum tests; prespecified subgroup analyses (by intervention domain) and an exploratory multivariable linear regression examined factors associated with PRISMA scores.

Results: Eight CPGs cited 90 unique SRs. Mean PRISMA adherence was 83% (SD: 12.2); 39% of SRs met ≥90% of items. Mean AMSTAR-2 adherence was 79.3% (SD: 14.4); 24% were rated overall "high," while 14% were "low/critically low." Common deficits included protocol registration, justification of excluded studies, and assessment of small study/publication bias. Cochrane SRs (n = 22) had higher PRISMA (91% vs. 81%) and AMSTAR-2 (88% vs. 76%) scores than non-Cochrane SRs (both p < 0.001). Interventional technique SRs tended to have slightly lower PRISMA scores than pharmacologic SRs after adjustment, whereas noninvasive non-pharmacologic SRs were similar. In exploratory regression, higher AMSTAR-2 ratings and predominance of randomized trials were associated with higher PRISMA scores.

Conclusions: SRs informing LBP CPGs show variable reporting and methodological quality with consistent shortfalls in protocol registration, exclusion justifications, and publication-bias assessment. Cochrane SRs outperformed non-Cochrane SRs yet comprised only a minority of the evidence base. Facilitating uptake of protocol registration, complete PRISMA-aligned reporting, transparent exclusion lists, and routine small-study bias assessment, alongside greater use of methodologically stronger SRs, could strengthen the evidentiary foundation of LBP guidelines.

Objective: The current cross-sectional study retrospectively investigated associations between COVID-19-related factors and subsequent substance use in adolescents with chronic pain.

Methods: A total of 243 adolescents with diagnosed pain disorders were retrospectively surveyed from September 2021 to May 2024. Descriptive statistics summarized past-month and past-year substance use; COVID-19 exposures, impact, and distress; mental health; and pain-related indicators. Logistic regressions estimated the odds of substance use based on COVID-19 exposures, impact, and distress, controlling for demographics, mental health, and pain.

Results: Of the 243 adolescents (M _age = 16.9, SD = 1.42 years; 68.44% female), 39.9% reported past-year substance use, and 28.4% reported past-month substance use. All participants reported COVID-19 exposures (M = 9.68, SD = 3.53), impact (M = 34.00, SD = 10.11), and distress (M = 5.25, SD = 2.19). No differences in Exposures or Distress emerged between youth with vs. without substance use (p's > 0.05). Youth with past-month (U = 2,522, p < 0.001) and past-year (U = 3,998, p < 0.001) substance use reported more Impact, compared with those without use. COVID-19 social impact predicted odds of past-year (OR = 1.25, 95% CI = 1.13-1.38) and past-month (OR = 1.27, 95% CI = 1.14-1.42) substance use, controlling for gender, anxiety, depression, stress, pain intensity, pain interference, and functional disability.

Discussion: The social impact of COVID-19 uniquely predicted subsequent substance use, over and above mental and physical health symptoms in adolescents with chronic pain. Incorporating socially focused interventions into multidisciplinary pain treatment and prevention efforts may better support the health and wellness of youth with chronic pain.

Background: Non-specific low back pain (NS-LBP) is a is a highly prevalent musculoskeletal condition, with an estimated 619 million prevalent cases worldwide in 2020. Alterations in spinal and lower limb dynamics are considered as potential factors directly involved in this condition, thus we carried out a systematic review to summarize the evidence regarding walking kinematics in NS-LBP.

Methods: The reporting of this review followed the "2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis" (PRISMA 2020 checklist) and the protocol was preliminary registered in PROSPERO (ID: CRD42023431380). A search strategy was implemented in Medline, Embase, Scopus, Web of Science, and IEEE Xplore databases, up to March 2024. Inclusion criteria were: any analytical observational research instrumentally assessing the trunk and lower limbs kinematics of spontaneous walking in NS-LBP, in a comparison with healthy people. Study selection and data extraction were performed by two blinded reviewers, the methodological quality was evaluated by the Joanna Briggs Institute (JBI) Critical Appraisal Checklist and the quality of the evidence was rated through GRADE criteria.

Results: Overall, a total of 19 cross-sectional studies were included in this review and none of those was found without methodological issues. The meta-analysis showed a lower gait velocity [-15.42 (-22.78, -8.06) cm/s; p ≤ 0.0001], a lower cadence [-9.85 (-18.72, -0.99) steps/min; p = 0.03] and a lower step length [-6.30 (-11.83; -0.77) cm; p = 0.03] in NS-LBP. Regarding motion analysis, a few authors observed a less and asymmetrical motion of the lower spine in the frontal and in the transverse plane.

Conclusion: There is very-low quality evidence that gait speed, cadence and step length are reduced in patients with NS-LBP. There is proof of a movement reduction in the lower lumbar spine and in the pelvis, both in the transverse and in the frontal plane. No differences in the lower limb kinematics was consistent over the studies.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023431380.

Objective: Chronic non-cancer pain (CNCP) affects 12% of the Dutch population, with similar rates in other Western countries. CNCP not only influences the physical aspects of the body but also has a relationship with affect. Affect can be positive (PA) or negative (NA). This study investigated the relationship between pain and affect and how this relationship may have differed before and during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: In this prospective study, patients were recruited during a standard pre-consultation visit at an outpatient pain clinic. The novelty of this approach lies in the utilisation of the experience sampling method (ESM). Patients were asked to complete an ESM digital tool 10 times a day for six consecutive days. They were categorised into the pre-COVID-19 (before March 20, 2020; n = 14) and during-COVID-19 (after March 20, 2020; n = 11) groups. The study cohort consisted of females only.

Results: Patient pain levels, NA, and PA were assessed. Patients with a low PA during the pandemic experienced a significant negative impact on their daily pain levels, correlating with a 2.7-point increase on a 0-10 numeric rating scale.

Conclusions: Unlike the previous focus on the effect of high NA on pain, this study emphasises the negative influence of low PA, which can likely be attributed to reduced hedonic activities during global life events, such as the COVID-19 pandemic. Understanding the micro-level impact of low PA on individuals may provide novel targeted treatment approaches for chronic pain management.

Medication Overuse Headache (MOH) can lead to central sensitization (CS), habituation deficits (HD), shortened cortical silent period duration (CSPD), and increased pre-activation levels (PAL), all of which are quantifiable electrophysiological objective indicators related to MOH. Transcranial magnetic stimulation (TMS) is a treatment method for MOH and is primarily divided into three types: single-pulse TMS (sTMS), repetitive TMS (rTMS), and quadruple-pulse TMS (qTMS). Among these, sTMS is convenient for patients of self-administration, qTMS significantly improves the effectiveness of TMS treatment, and rTMS is suitable for widespread use in developing countries. Numerous studies have reported clinical symptom improvements in MOH patients treated with TMS, with statistically significant results. However, only a few studies have observed electrophysiological changes in MOH patients before and after treatment. Whether quantifiable objective indicators can be reversed requires further investigation.

Background: Several studies have demonstrated that veterinarians hold breed-specific beliefs about canine pain sensitivity. However, it remains unknown whether these beliefs impact how veterinarians recognize and treat pain in a clinical setting. Therefore, the objective of this study was to determine if there were differences in the assessment and treatment of pain across patients admitted to a veterinary emergency room (ER) from different breeds.

Methods: Veterinary ER records were retrospectively analyzed to evaluate the effects of breed on the assessment and treatment of pain in canine patients admitted to a single academic ER over a two-year period. Extracted data included patient signalment and information documented in medical evaluations completed by ER clinicians.

Results: The final sample included records from 3,744 patients across 69 breeds/breed types. Patient breed and the service the patient was transferred to from the ER were significantly explanatory for differences observed in pain scores and pain management plans assigned. The effect of breed and transfer service remained robust when accounting for covariates.

Conclusions and clinical relevance: Certain breeds were assigned pain scores lower than average, while other breeds were assigned higher than average pain scores despite a lack of evidence that these breeds presented with less or more painful conditions. As breed-specific beliefs do not align with experimental measures of pain sensitivity, the present findings have implications to help refine pain education and medical decision-making and ultimately improve patient care.