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

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.

Objective: Non-odontogenic toothache, which is characterized by tooth pain without corresponding dental abnormality, is occasionally indeterminate due to its complicated persistent teeth, dentoalveolar and/or facial pain, specifically between patients with persistent idiopathic dentoalveolar pain (PIDAP) and those with trigeminal neuralgia (TN), accompanied by atypical sensations. This study aimed to clarify clinical characteristics in this patient population and to identify clinical real-world factors for differentiation.

Methods: All clinical data were retrospectively collected. Totally 340 patients, who were referred to our department with undiagnosed complicated persistent pain, were involved in the comparative analysis, depending on symptoms' laterality, and 149 patients with unilateral symptoms were involved, depending on the presence of neurovascular compression (NVC) of trigeminal nerves and final diagnosis of PIDAP or TN.

Results: Patients with bilateral symptoms (n = 105) presented more severe affected pain sensations with higher pain catastrophizing compared to patients with unilateral symptoms (n = 234, p = 0.022). NVC was observed in 84 patients (56.4%); however, no significant difference in clinical features was observed depending on the presence of NVC. While patients with TN (n = 26) presented significantly stronger "shooting" and "stabbing" pain (p = 0.004, p = 0.006, respectively) with more severe NVC condition (p = 0.033), patients with PIDAP (n = 123) showed significantly higher scores in the central sensitization inventory (p < 0.001) and somatic symptom scales-8 (p = 0.004).

Conclusion: These results suggest that relying solely on examining the presence of NVC is insufficient to distinguish PIDAP and TN in this patient population, but careful assessment of pain quality, pain catastrophizing, central sensitization, and somatic symptoms, besides detailed neurovascular conditions, is crucial.

Pain resulting from tissue damage, including surgical incision, is often only partially responsive to anti-inflammatory drugs, suggesting the contribution of a neuropathic mechanism. Tissue damage leads to expression in dorsal root ganglion (DRG) sensory neurons of activating transcription factor 3 (Atf3), a known injury-induced transcription factor. Atf3 expression is associated with sensitization of cellular physiology and enhanced amplitude/duration of a nociceptive reflex. It is unclear how tissue damage leads to these changes in the sensory neurons, but it could include direct damage to the tissue-innervating axons and inflammation-associated retrograde biochemical signalling. We examined the necessity and sufficiency of incision, inflammation, and axonal conduction for induction of Atf3 in response to skin incision in rat. Incision outside of a single dermatome, but close enough to induce inflammation inside the dermatome, was not sufficient to induce Atf3 expression in the corresponding DRG. Incision inside the dermatome led to strong expression of Atf3. An anti-inflammatory drug did not prevent this induction of Atf3. In a mouse model of repeated injury - a major etiological factor for chronic pain - a second plantar incision induced a significant extension in the duration of mechanical hypersensitivity as compared to a single plantar incision. This corresponded with a remarkable increase in Atf3 expression in a rat model of repeated incision. Together, these results suggest that damage to axons innervating the skin is both necessary and sufficient for induction of Atf3 expression in sensory neurons. This is dramatically increased by repeated injury. Further, pre-treatment of the nerves innervating the incised skin with bupivacaine, a local anesthetic commonly used to reduce surgical pain, did not prevent induction of Atf3, indicating that conduction of action potentials is not necessary for induction of Atf3. Closure of incision with surgical glue or treatment with polyethylene glycol, known to enhance membrane integrity after injury, reduced incision-associated regulation of Atf3, Growth-Associated Protein-43 (Gap43), and electrophysiological changes. We conclude that tissue damage-induced pain arises from a mix of Atf3-independent inflammation-related mechanisms and axonal damage-associated mechanisms and therefore requires a mix of approaches to prevent/treat persistent post-surgical pain.

Chronic pain patients (CPPs) often face complex, multifactorial challenges, with many reporting that their pain management lacks comprehensiveness. Spiritual care has emerged as a potential resource in addressing the diverse needs of CPPs, but remains underutilized due to healthcare professionals' (HCPs) uncertainty about how to integrate it into clinical practice. This study aimed to develop a best practice guide for integrating spiritual care into chronic pain therapy using a qualitative Delphi study. Three rounds of data collection, involving a panel of CPPs and HCPs with expertise in chronic pain from various disciplines, were conducted. Participants shared their experiences and suggestions for addressing spiritual aspects in pain therapy. The process led to the formulation of a consensus-based best practice guide, outlining practical strategies for HCPs to engage with spiritual care in a way that is respectful and sensitive to individual patient needs. Results indicated that incorporating spiritual care in chronic pain therapy can enhance therapeutic relationships, foster more meaningful patient interactions, and provide additional coping mechanisms. The guide was rated as clinically applicable, and offers a structured yet flexible framework for integrating spiritual care into multimodal pain treatment and is expected to improve patient outcomes by addressing existential aspects of chronic pain.

Objective: This study aimed to evaluate the effectiveness of ultrasound-guided acupotomy (UgA) in treating Cervical spondylosis (CS), particularly in pain relief, improvement in cervical range of motion (CROM), and overall clinical efficacy, through a systematic review and meta-analysis based on GRADE quality assessment.

Methods: Following PRISMA guidelines, we searched databases including PubMed, Embase, Cochrane Library, Web of Science, and CNKI, Wanfang, Weipu, and Sinomed, identifying 33 randomized controlled trials (RCTs). Inclusion criteria were: patients aged 18-70 with a diagnosis of CS, intervention with UgA, and control groups receiving placebo, physical therapy, or other conventional treatments. Primary outcomes included clinical effective rate and Visual Analog Scale (VAS) for pain, while secondary outcomes encompassed Neck Disability Index (NDI), CROM, and mean flow velocity of vertebral and basilar arteries (MFV-VA/BA). Study quality was assessed using the Cochrane Risk of Bias 2.0 tool, and meta-analysis was conducted using Stata 15.0. The GRADE approach was used to evaluate evidence quality.

Results: Meta-analysis revealed that UgA significantly improved the clinical effective rate compared to control treatments (RR = 1.17, 95% CI: 1.13-1.21), with low heterogeneity (I ² = 12%). UgA also demonstrated significant pain reduction (WMD = -0.96, 95% CI: -1.25 to -0.67), albeit with high heterogeneity (I ² = 91.6%). For secondary outcomes such as NDI, CROM, and MFV-VA/BA, UgA showed moderate improvements, but with considerable heterogeneity. GRADE assessment indicated high-quality evidence for the clinical effective rate, while evidence for VAS, NDI, and CROM was rated as low or very low due to heterogeneity and publication bias.

Conclusion: UgA shows superior efficacy for pain and disability in cervical spondylosis compared to non-UgA and other acupuncture related therapies. However, heterogeneity and potential publication bias exist. It requires skilled practitioners and real-time ultrasound guidance for treatment. Future multinational randomized trials with standardized protocols are needed.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/PROSPERO, PROSPERO CRD42025649835.

Conditioned pain modulation (CPM) is a behavioral measure of diffuse noxious inhibitory control (DNIC), an endogenous central pain modulatory mechanism in which one pain stimulus suppresses the perception of another. CPM efficiency is reduced in individuals with chronic pain and serves as a potential predictor for the development of chronic pain conditions. Current research indicates that CPM, traditionally viewed as a static metric, may exhibit protocol-dependent variability in its effects on pain sensitivity, potentially through neuroplastic mechanisms and central pain processing pathways. This randomized controlled trial (NCT05783362) investigated whether repeated activation of central pain modulatory systems enhances CPM efficiency. The secondary aim examined associations between repeated CPM exposure and pain-related psychological factors. Sixty healthy participants (52% female; ages 18-75) were randomly allocated to High Exposure (HE), Low Exposure (LE), or No Exposure (NE) CPM intervention groups. Pre- and post-intervention measures included CPM efficiency and pain sensitivity across thermal and pressure pain tests. Two-way ANOVA analyses revealed significant main effects for both time (p < 0.001, η ² = 0.23) and intervention (p = 0.030, η ² = 0.107) on CPM efficiency when comparing HE and LE groups from pre- to post-intervention. One-way ANOVA analysis at the final visit showed that HE demonstrated significantly higher CPM efficiency compared to LE (p = 0.02, Cohen's d = 0.73), while comparisons between HE and NE approached but did not reach statistical significance (p = 0.053-0.060; medium-to-large effect sizes, Cohen's d > 0.70). This was supported by increased heat threshold pain intensity ratings (p < 0.001, η ² = 0.13), suggesting broader adaptations in pain processing that strengthen descending pain control mechanisms. Other QST measures and psychological variables remained unchanged, suggesting the specificity of the modulatory enhancement. Results support the plasticity of endogenous pain modulation and suggest potential therapeutic applications for pain management interventions.

Clinical trial registration: https://clinicaltrials.gov/study/NCT05783362, identifier NCT05783362.