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

Chronic pain is a prevalent health issue with high disability rates, and traditional pharmacological treatments often come with limitations such as dependency and side effects. Transcutaneous auricular vagus nerve stimulation (taVNS), as an emerging non-invasive neuromodulation technique, has demonstrated broad application prospects in chronic pain management in recent years. This systematic review examines the clinical efficacy of taVNS across multiple chronic pain conditions, including neuropathic pain, autoimmune disease-related pain, gastrointestinal pain, and musculoskeletal pain. It also delves into its neurobiological mechanisms, primarily involving activation of central descending pain control pathways, modulation of cholinergic anti-inflammatory pathways, balancing autonomic nervous system function, reshaping functional connectivity in brain networks, regulating neurotransmitter and neuropeptide balance, and inhibiting peripheral and central sensitization processes. Despite ongoing challenges in parameter standardization, in-depth mechanism elucidation, and personalized treatment strategies, taVNS offers an innovative therapeutic approach for chronic pain patients due to its favorable safety profile, tolerability, and multi-target regulatory advantages. Future large-scale clinical studies and multidisciplinary collaboration are needed to further advance the precision application of taVNS within comprehensive pain management systems.

Introduction: Immersive virtual reality (VR) has attracted growing interest in long-term care (LTC) as a potential tool to enhance well-being and alleviate pain. However, its effective implementation by LTC staff remains understudied. In a participatory action, mixed-methods study co-developed with knowledge users (LTC frontline staff and managers, and a VR developer), we applied the Decomposed Theory of Planned Behaviour (DTPB) to examine VR adoption in LTC and clarify barriers and facilitators to sustainable implementation.

Methods: Knowledge users were consulted to design and develop a single-phase, cross-sectional, convergent mixed-methods study. LTC staff (n = 16) were then recruited to complete an online self-report questionnaire specific to staff adoption of VR through the assessment of attitudes, social norms, perceived behavioural control and facilitating conditions. Quantitative data were analyzed descriptively. Qualitative data underwent content analysis via DTPB-guided deductive and inductive codes.

Results: LTC staff indicated overall favourable attitudes towards VR use, yet only 25% (n = 4) of participants rated VR as easy to use and 50% (n = 8) deemed it suitable for LTC settings. Staff confidence with VR use was moderate, with resident selection and troubleshooting highlighted as particular challenges. Barriers such as lacking time to learn and use VR systems, as well as potential resident discomfort, were highlighted. Facilitators included adequate activity space, organizational support, and person-centred delivery, which staff linked to residents' relaxation, positive affect, and progressive engagement. Content analysis identified four key themes explaining these patterns: (1) Barriers outweighing promise, (2) Personalization of the VR experience, (3) Enabling conditions-Environment and organization, and (4) Staff ambivalence to VR.

Discussion: VR adoption appears to be linked to alignment between compatibility, ease-of-use, facilitating conditions, and social support. Person-centred delivery and organizational support may enable consistent use and enhance residents' relaxation, positive affect and progressive engagement, relevant to pain care. Findings offer a practical roadmap for integrating VR as a low-burden intervention, while highlighting areas needing further attention to promote sustainable implementation.

Chronic pain-including both chronic primary pain (e.g., headaches, widespread musculoskeletal pain, abdominal pain) and chronic secondary pain associated with other health conditions-represents a significant yet underrecognized health concern among transgender and gender-diverse (TGD) youth. While data on the prevalence of chronic pain in TGD youth remain limited, early studies indicate higher rates compared to their cisgender peers, highlighting the need for understanding factors underlying this co-occurrence. Chronic pain arises from a complex interplay of neurobiological, psychological, and social factors, and its heightened prevalence in TGD youth may be driven by the compounded impact of biopsychosocial stressors that disproportionately affect this group. This review summarizes neurobiological vulnerabilities, psychosocial factors, and societal and systemic barriers that may contribute to increased risk of chronic pain in TGD youth. We also examine the role of gender-affirming care in addressing these biopsychosocial vulnerabilities and explore its potential to alleviate some of the factors associated with chronic pain. Additionally, we identify critical gaps in the current body of research, such as the need for longitudinal studies and deeper exploration of the effects of medical interventions like pubertal suppression and exogenous hormones on chronic pain mechanisms and outcomes. By synthesizing the available evidence, we aim to guide future research and offer actionable recommendations to enhance clinical care and support for TGD youth experiencing chronic pain.

Objective: To develop a position statement based on expert opinions for the management of medication overuse headache (MOH) in Brazil.

Method: This was an observational, prospective, descriptive, and opinion-based study. The experts were in several Brazilian states. Twelve experts who fulfilled the inclusion criteria completed a questionnaire that explored their experiences and approaches to managing MOH in both the private and public sectors.

Results: According to most experts, more than 50% of migraine patients have MOH and psychiatric comorbidities. Experts abruptly stop pain medications, prescribing a bridge treatment for more than 50% of patients. Acute treatment is administered for up to two days per week. Prophylaxis was initiated immediately, and topiramate and monoclonal antibodies were the first choices, respectively, for 36.3% and 54% of professionals. The first follow-up appointment should occur within 4 weeks.

Conclusions: Further guidelines based on evidence as well as expert opinions should be developed for the Brazilian reality, and future prospective studies can be conducted to compare the effects of different treatment regimens for MOH.

Background: Cervicogenic headache (CEH) is often refractory to monotherapies, and treatment strategies combining neuromodulation and myofascial interventions may offer additional benefits. This study evaluated the clinical effectiveness of ultrasound-guided C2 dorsal root ganglion (DRG) pulsed radiofrequency (PRF) combined with suboccipital myofascial plane block (SMPB) in subjects with CEH.

Methods: This retrospective study analyzed 67 CEH subjects treated with PRF alone (n = 28) or combined PRF + SMPB therapy (n = 39). Pain intensity (VAS), headache frequency and duration, Short-Form McGill Pain Questionnaire (SF-MPQ), and Neck Disability Index (NDI) were assessed at baseline, 1 week, 1 month, 3 months, and 6 months.

Results: The combined treatment produced significantly greater improvement in pain outcomes. At 3 months, VAS scores were 2.09 ± 1.38 in the PRF + SMPB group vs. 3.55 ± 1.11 in the PRF group (between-group difference Δ = -1.46; 95% CI -2.06 to -0.86; p < 0.001). Superior improvements were also observed in headache frequency, headache duration, SF-MPQ, and NDI at multiple timepoints. All subjects completed follow-up (attrition rate 0%), and no complications or minor adverse events were reported.

Conclusions: Ultrasound-guided C2 DRG PRF combined with SMPB demonstrated greater reductions in pain and disability than PRF alone in CEH. These findings provide preliminary, hypothesis-generating evidence supporting the feasibility and clinical utility of this multimodal approach. Prospective randomized trials with longer follow-up are warranted.

Chronic pain is an individual experience with physical and psychological dimensions. Ketamine is used in sub-anesthetic doses to treat chronic pain. We describe a proposed multidisciplinary approach with combined treatment of low-dose ketamine and pain-focused psychological and somatic therapies to benefit quality of life of disabled chronic pain patients. Beyond pain reduction, within the biopsychosocial approach, the treatment aims to achieve reduced suffering and improved pain management, functionality, and quality of life. Adopting a multidisciplinary approach can minimize exposure to ketamine and maintain a conservative ketamine dosing regimen. In this way, ketamine is not only used for the analgesic effects, but also to facilitate internal psychological processes of body-mind integration related to the pain identity and trauma. We illustrate the presented treatment approach with three cases of patients treated in a private clinic in Florida, United States. We describe the patients' original injury, ketamine and adjunct psychological and somatic therapies regimen, and short and longer-term outcomes from the patient's perspective. These results are preliminary, require replication with validated measures, and represent an opportunity for additional research and hypothesis formation. More clinical research on ketamine and adjunct therapies for chronic pain conditions is warranted to advance treatment options.

Neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory nervous system. Current algorithms for neuropathic pain diagnosis include patient history, clinical examination, and complementary tests to confirm a lesion or disease of the somatosensory nervous system, able to change the diagnosis of neuropathic pain from probable to definite. These tests include clinical neurophysiology, such as pain-related evoked potentials, quantitative sensory testing, skin biopsy to measure intraepidermal nerve fiber density, or magnetic resonance imaging. However, these tests are especially relevant to demonstrate a structural lesion of the somatosensory system leading to sensory deficit, but they cannot establish a causal link between nervous lesion and the presence of pain. Similar lesions of the somatosensory nervous system may be accompanied by pain or not, while neuropathic pain can be a matter of sensitization or hyperexcitability of somatosensory structures without overt structural lesion. Even the existence of hyperexcitability of nociceptive pathways, revealed by neurophysiological or genetic tests, may contribute to the emergence of pain, but may not be sufficient to affirm that this results in ongoing neuropathic pain. Thus, various complementary tests can be useful to identify a lesion of the somatosensory nervous system, but not to confirm the presence of associated neuropathic pain. Clinical assessment, considering disease history, symptom descriptors and a plausible neuroanatomical distribution, remains the cornerstone of the diagnosis of neuropathic pain, while paraclinical findings must be interpreted with caution in this regard.

Introduction: We present connectivity-based features associated with fibromyalgia, derived from raw EEG data at the sensor level.

Methods: These connectivity features were identified through a data-driven method, employing machine learning. We carried out some automatic, moderate pre-processing and extracted spectral connectivity features. Machine learning experiments then followed, employing feature importance analyses and feature selection techniques for building high-performing classification models; finally, based on robust cross-validation and test evaluation, we obtained the features associated with fibromyalgia. The raw EEG signals from 463 participants are used in the primary analysis. An external dataset that consists of 48 participants is used to validate the identified connectivity features.

Results: Five features in the gamma band (Fz-Cz, Pz-P4, Fz-C3, Cz-P4, and Cz-Pz) were able to objectively detect the presence or absence of fibromyalgia with an accuracy of 99.57%. The identified connectivity features associated with fibromyalgia also show promising results on EEGs that are collected using a different type of device.

Discussion: EEG-based functional connectivity features associated with fibromyalgia, identified using machine learning in the gamma band at the sensor level, can distinguish between fibromyalgia participants and healthy controls with 99.57% accuracy. These findings advance our understanding of the brain-based mechanisms of fibromyalgia and provide novel targets for future non-invasive neuromodulation and neurofeedback trials. However, future studies need to replicate these findings in independent EEG datasets in people with fibromyalgia as well as compare with other clinical populations.

Background: Research has shown substantial evidence for the effectiveness of mindfulness-based interventions in the management of chronic pain. Less evidence is available whether a one-time mindfulness intervention may also be helpful in alleviating acute procedural pain. While anticipating a potentially painful procedure, people may worry about the upcoming pain. We investigated whether the time spent in a waiting room prior to an appointment could be used for a brief mindfulness intervention.

Methods: The sample consisted of 93 female students. Experimental pain was induced with a pressure pain algometer. Subjective pain ratings were recorded with a numerical rating scale in a 3 × 2 mixed design with the factors condition (mindfulness, worry, control) and measurement time (baseline, post). A situation corresponding to a waiting room in primary care was created. Participants received an audio recording of a mindfulness meditation, a worry instruction, or an instruction to wait. In addition, participants answered the state version of the Mindful Attention Awareness Scale (State) at both measurement times.

Results: 3 × 2 mixed-design ANOVA showed no main effect for the within-subjects factor "measurement time" F(1, 89) = 0.11, p = .74, no main effect for the between-subjects factor "condition" F(2, 89) = .24; p = .98, and no interaction effect of "measurement time×condition" F(2, 89) = 2.53, p = .09. Analyses showed that worrying led to an increase in perceived pain intensity [t(31) = 1.74, p = .046 (one-tailed), d = 0.31]. No further effects were observed. State mindfulness in the mindfulness condition increased between the measurement times [t(29) = 2.00, p = .03 (one-tailed), d = 0.37].

Discussion: Mindfulness increased through the induction; it did not affect perceived pain intensity. In the worry condition, perceived pain intensity increased, which is in accordance with research on detrimental effects of worry. Regarding the aim of the study, the experiment showed that a one-shot mindfulness intervention was able to promote state mindfulness, but not decrease perceived pain intensity. Future research should investigate whether mindfulness has more impact on the affective component of the pain, rather than on its sensory component.