Prevalence and interference of chronic pain among people with haemophilia: A systematic review and meta-analysis

Haemophilia is an X-linked rare congenital bleeding disorder, characterized by a deficiency in blood clotting factor VIII (haemophilia A) or IX (haemophilia B). As a consequence, the main clinical manifestation of the disease are spontaneous bleeding episodes that most frequently occur in the joints and muscles28,41. Haemophilia severity is graded according to plasma levels of clotting factor activity as mild (5–40% of normal), moderate (1–5% of normal) or severe (<1% of normal), and is generally associated with a corresponding increase in bleeding frequency3.

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Shifting the National Consciousness about Pain Treatment: The Critical Need for a National Public Education Campaign

The failure of past practices and policies related to opioid prescribing for chronic pain has led federal agencies and professional organizations to recommend multimodal approaches that prioritize evidence-based nonpharmacological pain treatments (NPTs). These multimodal approaches, which include both traditional and complementary/integrative approaches, hold great promise for reducing the burden of chronic pain and reducing opioid use. Unfortunately, NPT approaches are underutilized due to a daunting array of interrelated barriers including the public's attitudes and beliefs about chronic pain and its treatment.

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The prevalence, characteristics and impact of chronic pain in people with muscular dystrophies: A systematic review and meta-analysis

Muscular dystrophies (MDs) are a heterogeneous group of genetic diseases that are among the most common forms of neuromuscular diseases (NMDs). Clinically, MDs manifest as progressive muscle weakness related to loss of mobility, agility and physical movements as a consequence of defects in genes responsible for muscle protein synthesis 14, 29. According to the National Institute of Neurological Disorders and Stroke (NINDS), there are nine major groups of MDs40: Duchenne muscular dystrophy (DMD), Becker muscular dystrophy (BMD), Myotonic dystrophy (DM), Facioscapulohumeral muscular dystrophy (FSHD), Congenital muscular dystrophy (CMD), Limb-girdle muscular dystrophy (LGMD), Emery-Dreifuss Muscular Dystrophy (EDMD), Occulopharyngeal Muscular Dystrophy (OPMD), and Distal Muscular Dystrophies (Distal MDs or Distal myopathies).

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Partha Kar: “Phir Bhi Dil Hai Hindustani”—the anguish of the Indian diaspora

I have a strong sense of déjà vu, witnessing the scenes of carnage in India as covid rips through the country. Perhaps I’m feeling the pain more intensely because, having seen the impact that covid...

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Effectiveness of Dry Needling Therapy on Pain, Hip Muscle Strength, and Physical Function in Patients With Hip Osteoarthritis: A Randomized Controlled Trial

Publication date: May 2021

Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 5

Author(s): Luis Ceballos-Laita, Sandra Jiménez-del-Barrio, Javier Marín-Zurdo, Alejandro Moreno-Calvo, Javier Marín-Boné, María Isabel Albarova-Corral, Elena Estébanez-de-Miguel

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Shoulder Pain Is Associated With Rate of Rise and Jerk of the Applied Forces During Wheelchair Propulsion in Individuals With Paraplegic Spinal Cord Injury

Publication date: May 2021

Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 5

Author(s): Benjamin J.H. Beirens, Fransiska M. Bossuyt, Ursina Arnet, Lucas H.V. van der Woude, Wiebe H.K. de Vries

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STAR SHAPE KINESIO TAPING IS NOT BETTER THAN A MINIMAL INTERVENTION OR SHAM KINESIO TAPING FOR PAIN INTENSITY AND POSTURAL CONTROL IN CHRONIC LOW BACK PAIN: A RANDOMIZED CLINICAL TRIAL

Publication date: Available online 2 April 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Fabrício José Jassi, Tiago Tsunoda Del Antônio, Beatriz Oliveira Azevedo, Renato Moraes, Steven Z. George, Thais Cristina Chaves

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Rehabilitative Interventions for Central Neuropathic Pain: A Systematic Review With Meta-Analysis

Publication date: April 2021

Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4

Author(s): Stanley Winser, Umar Bello, Priya Kannan

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Physiotherapy Management for Central Neuropathic Pain (cNeP) Secondary to Spinal Cord Injury: A Systematic Review With Meta-Analysis

Publication date: April 2021

Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4

Author(s): Stanley Winser, Umar Bello

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Comments on ‘a systematic review and meta‐analysis of radiofrequency procedures on innervation to the shoulder joint for relieving chronic pain’ by Pushparaj et al

Abstract

We read with great interest the paper “A Systematic Review and Meta‐analysis of Radiofrequency Procedures on Innervation to the Shoulder Joint for relieving Chronic Pain” by Pushparaj and colleagues (2021). This is an excellent and timely systematic assessment of predominately pulsed radiofrequency neurotomy (pRF) of the suprascapular nerve and we commend the authors for their robust methodology and willingness to hold up a commonly accepted pain clinic treatment to appropriate scientific scrutiny.

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Anti‐Nociceptive Effects of Oxytocin Receptor Modulation in Healthy Volunteers – a Randomized, Double‐Blinded, Placebo‐Controlled Study

ABSTRACT

Background

There is increasing evidence for oxytocin as a neurotransmitter in spinal nociceptive processes. Hypothalamic oxytocinergic neurons project to the spinal dorsal horn, where they activate GABA‐ergic inhibitory interneurons. The present study tested whether the long‐acting oxytocin‐analogue carbetocin has anti‐nociceptive effects in multi‐modal experimental pain in humans.

Methods

Twenty‐five male volunteers received carbetocin 100 mcg and placebo (0.9% NaCl) on two different sessions in a randomized, double‐blinded, cross‐over design. Multi‐modal quantitative sensory testing (QST) including a model of capsaicin‐induced hyperalgesia and allodynia were performed at baseline and at 10, 60 and 120 minutes after drug administration. QST data were analyzed using mixed linear and logistic regression models. Carbetocin plasma concentrations and oxytocin receptor genotypes were quantified and assessed in an exploratory fashion.

Results

An anti‐nociceptive effect of carbetocin was observed on intramuscular electrical temporal summation (estimated difference: 1.26 mA, 95%‐CI 1.01 to 1.56 mA, p = 0.04) and single‐stimulus electrical pain thresholds (estimated difference: 1.21 mA, 95%‐CI 1.0 to 1.47 mA, p = 0.05). Furthermore, the area of capsaicin‐induced allodynia was reduced after carbetocin compared to placebo (estimated difference: ‐6.5 cm², 95%‐CI ‐9.8 to ‐3.2 cm², p < 0.001).

Conclusions

This study provides evidence of an anti‐nociceptive effect of carbetocin on experimental pain in humans.

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Effectiveness of Dry Needling Therapy on Pain, Hip Muscle Strength, and Physical Function in Patients With Hip Osteoarthritis: A Randomized Controlled Trial

Publication date: May 2021

Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 5

Author(s): Luis Ceballos-Laita, Sandra Jiménez-del-Barrio, Javier Marín-Zurdo, Alejandro Moreno-Calvo, Javier Marín-Boné, María Isabel Albarova-Corral, Elena Estébanez-de-Miguel

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Shoulder Pain Is Associated With Rate of Rise and Jerk of the Applied Forces During Wheelchair Propulsion in Individuals With Paraplegic Spinal Cord Injury

Publication date: May 2021

Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 5

Author(s): Benjamin J.H. Beirens, Fransiska M. Bossuyt, Ursina Arnet, Lucas H.V. van der Woude, Wiebe H.K. de Vries

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STAR SHAPE KINESIO TAPING IS NOT BETTER THAN A MINIMAL INTERVENTION OR SHAM KINESIO TAPING FOR PAIN INTENSITY AND POSTURAL CONTROL IN CHRONIC LOW BACK PAIN: A RANDOMIZED CLINICAL TRIAL

Publication date: Available online 2 April 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Fabrício José Jassi, Tiago Tsunoda Del Antônio, Beatriz Oliveira Azevedo, Renato Moraes, Steven Z. George, Thais Cristina Chaves

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Rehabilitative Interventions for Central Neuropathic Pain: A Systematic Review With Meta-Analysis

Publication date: April 2021

Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4

Author(s): Stanley Winser, Umar Bello, Priya Kannan

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Physiotherapy Management for Central Neuropathic Pain (cNeP) Secondary to Spinal Cord Injury: A Systematic Review With Meta-Analysis

Publication date: April 2021

Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4

Author(s): Stanley Winser, Umar Bello

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Effectiveness of Dry Needling Therapy on Pain, Hip Muscle Strength, and Physical Function in Patients With Hip Osteoarthritis: A Randomized Controlled Trial

Publication date: May 2021

Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 5

Author(s): Luis Ceballos-Laita, Sandra Jiménez-del-Barrio, Javier Marín-Zurdo, Alejandro Moreno-Calvo, Javier Marín-Boné, María Isabel Albarova-Corral, Elena Estébanez-de-Miguel

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Shoulder Pain Is Associated With Rate of Rise and Jerk of the Applied Forces During Wheelchair Propulsion in Individuals With Paraplegic Spinal Cord Injury

Publication date: May 2021

Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 5

Author(s): Benjamin J.H. Beirens, Fransiska M. Bossuyt, Ursina Arnet, Lucas H.V. van der Woude, Wiebe H.K. de Vries

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Chronic pain (primary and secondary) in over 16s: summary of NICE guidance

What you need to knowA collaborative and supportive relationship between healthcare professional and person with chronic pain and a comprehensive person-centred assessment are central to good...

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The persistent pain transcriptome: identification of cells and molecules activated by hyperalgesia.

The underlying neurobiological and behavioral modifications needed to promote healing of an organism provide an empirical framework for understanding normal and pathological pain states. At a minimum, there is a dualistic modulation of pain sensitivity to promote resumption of physical activity yet prevent tissue re-injury. Throughout the post-injury persistent pain state, opponent neural processes participate in modulation of a sensory set-point to balance acute and tonic incoming nociceptive information to control resolution of the hyperalgesic state as the organism heals.

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Yoga, Eurythmy Therapy and Standard Physiotherapy (YES-Trial) for Patients with Chronic Non-specific Low Back Pain: a Three-Armed Randomized Controlled Trial

Chronic back pain is a major public health problem of global relevance. According to current surveys, about 22% of the German population aged between 18 and 79 suffer from back pain, 62% were affected by episodes of back pain within the last 12 months, and 19% suffered from chronic back pain during the past 12 months. Only 50% of those suffering from back pain for longer than six months can be re-integrated into work; over 60% of all applications for invalidity and disability are made due to back pain.

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Patients describe their lived experiences of battling to live with Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS) is a condition which is difficult to diagnose, difficult to treat, and unlike other chronic pain conditions, it can spread to encompass other parts of the body 8, 32, 48. It is reputed to be the most painful condition known to man as measured by the McGill Pain scale, rating higher than amputation of a digit, childbirth and cancer pain 8, 32, 59. Previously known as reflex sympathetic dystrophy (RSD), causalgia and shoulder-hand syndrome, CRPS is largely unknown in the general public and many health professionals will not encounter or recognise it in clinical practice 8, 38.

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Efficacy of online-based Acceptance and Commitment Therapy for chronic pain: A systematic review and meta-analysis

Chronic pain, defined as pain or discomfort lasting more than 3 months15,48, is considered a major health problem40. Highly prevalent26, chronic pain is also linked to psychological problems, impaired social functioning, low quality of life, and high economic cost5,6,32. As chronic pain is considered to result from an interplay between physiological states and psychosocial factors19, it is recognized that the psychological aspects of pain should be addressed during treatment14.

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Sexually Dimorphic Role of Toll-like Receptor 4 (TLR4) in High Molecular Weight Hyaluronan (HMWH)-induced Anti-hyperalgesia

Hyaluronan (HA), a negatively charged linear disaccharide polymer, is an integral component of the extracellular matrix 44,46 that plays a role in several physiological processes. High molecular weight hyaluronan (HMWH) has been used extensively to treat osteoarthritis pain 3,16,19,29,47 and has been shown to have anti-inflammatory and immunosuppressive effects 17,25,30,34,51. We have shown that HMWH is anti-hyperalgesic against several pro-inflammatory mediators and in chemotherapy-induced neuropathic pain 10,21,23.

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Differential activation of colonic afferents and dorsal horn neurons underlie stress-induced and comorbid visceral hypersensitivity in female rats

Chronic pain is a major health problem affecting 50-100 million people in the United States 30. Ten chronic pain conditions including irritable bowel syndrome (IBS) and temporomandibular disorder (TMD) are collectively known as Chronic Overlapping Pain Conditions and have minimal basis in underlying injury or disease 38, 61. One characteristic that sets these conditions apart is the propensity to overlap; having one condition significantly increases the odds of having multiple conditions 14, 54, 64, 65.

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Local and systemic expression pattern of MMP-2 and MMP-9 in complex regional pain syndrome

Matrix metalloproteinases (MMP) are endopeptidases which contribute to trauma reaction after tissue injury. Among MMPs, MMP-2 and MMP-9 are also known as gelatinases. MMPs play an important role in neuropathic pain and mechanical allodynia but also in inflammation and edema in various tissues.39,53,66 These proteins seem to be significantly involved in bone repair after fracture7 and in physiological wound healing,37 while they are also upregulated in chronic wounds.49

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Should exercises be painful or not? Effects on clinical and experimental pain in individuals with shoulder pain

Shoulder pain is the third most common musculoskeletal disorder29 with the rotator cuff tendons and associated structures around the sub-acromial space most commonly involved, also known as rotator cuff-related shoulder pain (RCRSP).6 Exercise can reduce pain and improve functional disability in RCRSP,27 although the influence of exercise prescription parameters are not fully understood.28 In particular, there is a paucity of research regarding the acute pain modulatory response to exercise in individuals with chronic pain conditions.

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Cognitive Agency in Music Interventions: Increased perceived control of music predicts increased pain tolerance

Abstract

Background

Self‐selected music is consistently found to be the strongest predictor for successful music listening interventions in pain management contexts, but the specific cognitive mechanisms that mediate these effects are currently unknown.

Objectives

The aim of this study was to isolate the role of cognitive agency on pain tolerance in music listening interventions, independently from parallel effects related to enjoyment. Additionally the study examines the role of intramusical features, and individual attributes related to musical engagement.Methods Fifty‐two participants completed a repeated measures experiment which involved listening to six different pieces of music while completing the cold pressor task. Cognitive agency was operationalised by giving participants different degrees of perceived control over the music selection, when in fact it was pre‐determined by the experimenter.

Results

A generalised linear mixed model was used to analyse the impact of perceived choice and intramusical features on pain tolerance measured in terms of duration on the cold pressor task, pain intensity and pain unpleasantness. Increased levels of perceived choice predicted increases in pain tolerance when enjoyment was accounted for. Individual levels of trait empathy and sophisticated emotional engagement with music also contributed to the effects. Intramusical features did not predict increases in pain tolerance.

Conclusions

This study demonstrates that the reason self‐selected music is particularly effective in reducing pain is related to the act of making a choice over the music itself. This study provides support for the cognitive vitality model and emphasises the importance of giving people as much control as possible in music interventions.

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Self‐reported prognostic factors in adults reporting neck or low back pain: An umbrella review

Abstract

Numerous systematic reviews have attempted to synthesise evidence on prognostic factors for predicting future outcomes such as pain, disability and return‐to‐work/work absence in neck and low back pain populations. An umbrella review of systematic reviews was conducted to summarise the magnitude and quality of the evidence for each prognostic factor investigated. Searches were limited to the last 10 years (2008‐11th April 2018, updated 28th September 2020). A two‐stage approach was undertaken: in stage one, data on prognostic factors was extracted from systematic reviews identified from the systematic search that met the inclusion criteria. Where a prognostic factor was investigated in ≥1 systematic review and where 50% or more of those reviews found an association between the prognostic factor and one of the outcomes of interest, it was taken forward to stage two. In stage two, additional information extracted included the strength of association found, consistency of effects, and risk of bias. The GRADE approach was used to grade confidence in the evidence. Stage one identified 41 reviews (90 prognostic factors), with 35 reviews (25 prognostic factors) taken forward to stage two. Seven prognostic factors (disability/activity limitation, mental health; pain intensity; pain severity; coping; expectation of outcome/recovery; and fear‐avoidance) were judged as having moderate confidence for robust findings. Although there was conflicting evidence for the strength of association with outcome, these factors may be used for identifying vulnerable subgroups or people able to self‐manage. Further research can investigate the impact of using such prognostic information on treatment/referral decisions and patient outcomes.

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The effect of acute‐experimental pain models on offset analgesia

Abstract

Background

Offset analgesia (OA) is characterized by a disproportionately large decrease in pain perception after a slight decrease in noxious stimulation. In patients with ongoing pain, this response is reduced. The effect is pronounced in painful body areas. The influence of acute pain has not been sufficiently investigated. The aim of this study was to investigate the influence of two experimental acute pain models, measured within the area of acute pain and on the non‐affected opposite side, thereby considering the possible somatotopic nature of OA.

Methods

Healthy, pain‐free volunteers (n = 75) were randomly assigned to one of three groups (cold water, exercise and control group). The ‘cold water group’ immersed one hand into cold water for 3 min (Cold Pressor Task), while the ‘exercise group’ performed an isometric grip exercise for 3 min. There was no manipulation in the control group. Each experimental pain stimulus was performed at both (dominant, non‐dominant) forearms. The individualized OA paradigm consisted of offset and constant temperature trials. Offset analgesia was measured immediately before, during and after the experimental pain stimuli.

Results

A significant difference in OA was shown during experimental pain when compared to the control condition (exercise vs. control: p < 0.001, cold vs. control: p = 0.001), with no difference between the experimental conditions (p > 0.05). Immediately following the pain stimulation, results were marginally non‐significant (p = 0.05).

Conclusions

Experimental painful stimulation reduced OA. This result should be interpreted with caution due to potential influences of conditioned pain modulation or exercise‐induced hypoalgesia as well as possible floor effects.

Significance

Temporal contrast of pain perception is inhibited in acute pain states. This study showed that reduced offset analgesia is observed when pain is experimentally induced using noxious cold and exercise stimuli.

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Factors associated with seeking medical care for low back pain in a twin adult sample

Abstract

Background

Previous studies have only investigated how symptom presentation and socio‐demographic factors influence care‐seeking for low back pain (LBP). However, the influence of health and lifestyle factors remains unclear, and the potential confounding effects of aggregated familial factors (including genetics and the early shared environment) has not been considered extensively.

Methods

A cross‐sectional analysis was performed on 1605 twins enrolled in the Murcia Twin Registry (Spain). The outcome was seeking medical care for LBP and various self‐reported demographic, health and lifestyle factors were considered predictors. All variables except sleep quality and diabetes were collected in 2013, which were cross‐referenced from 2009 to 2010. A multivariate logistic regression model was performed on the total sample, followed by a co‐twin case–control analysis.

Results

The only significant factor found to increase the odds of seeking medical care for LBP without being affected by familial factors was poor sleep quality (total sample OR = 1.58, 95%CI 1.24–2.01; case–control OR = 1.75, 95%CI 1.14–2.69). The factors that were associated with reduced odds of seeking medical care for LBP and not confounded by familial factors were male sex (case–control OR = 0.55, 95%CI 0.33–0.93), alcohol intake (case–control OR = 0.90, 95%CI 0.82–0.99) and a history of diabetes (case–control OR = 0.50, 95%CI 0.25–0.97). No other factors significantly influenced medical care‐seeking for LBP.

Conclusions

People reporting poor sleep quality are more likely to seek medical care for LBP in the long term, with this relationship being independent from aggregated familial factors. Conversely, males, people reporting higher alcohol intake, and people with a history of diabetes are less likely to seek medical care for LBP.

Significance

This is the first study investigating the factors that influence seeking medical care for LBP, while adjusting for the influence of familial factors using a co‐twin control design. Poor sleep quality is associated with seeking medical care for LBP in the long term and does not appear to be confounded by familial factors. Early screening for indicators of poor sleep quality and appropriate referral to interventions for improving sleep quality or reducing pain in sleep may improve LBP management.

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P2X7‐induced nociception in the temporomandibular joint of rats depends on inflammatory mechanisms and C‐fibres sensitization

Abstract

Background

P2X7 receptors are responsible for triggering inflammatory responses contributing to processes of pain in articular tissues. This study aimed to investigate whether the activation of the P2X7 receptor located in the temporomandibular joint (TMJ) tissues induces nociception through an inflammatory mechanisms and/or the activation of C‐fibres (small‐diameter primary afferents) of rats’ TMJ.

Methods

The TMJ hypernociception induced by the activation of P2X7 receptor was assessed by measuring the behavioural nociceptive responses. After behavioural experiments, the animals were terminally anaesthetized and periarticular tissues were removed and homogenate for enzyme‐linked immunosorbent assay, leukocyte infiltration and western blotting analysis.

Results

The nonselective P2X7 receptor agonist BzATP induced a dose‐dependent TMJ nociception, which was blocked by the selective P2X7 receptor antagonist A‐438079. The co‐administration of the selective β2‐adrenoceptor antagonist (ICI‐118,551) and the pre‐treatment with cyclooxygenase inhibitor indomethacin or with the nonspecific selectin inhibitor Fucoidan significantly reduced BzATP‐induced TMJ nociception. BzATP also induced an increase of pro‐inflammatory cytokines TNFα, IL‐1β and CINC‐1 levels, as well as leukocyte recruitment in TMJ tissue, effects that were reduced by A‐438079. Moreover BzATP‐induced TMJ nociception was inhibited in rats neonatal‐treated with Capsaicin (depleting C‐fibers). Finally, BzATP‐induced an increase in TRPV1 expression in TMJ tissue.

Conclusions

These findings suggest that P2X7 receptor activation in TMJ of rats induces nociceptive responses mediated by sympathomimetic amines, prostaglandins, leukocyte migration and increased levels of pro‐inflammatory cytokines. Furthermore, the P2X7 receptor activation induces nociceptive responses dependent on the activation of the primary afferent nociceptors of rats’ TMJ.

Significance

The activation of P2X7 receptors has an essential role in TMJ nociception and could be an interesting target to control the inflammatory pain in temporomandibular disorders.

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Pain after a motor vehicle crash: The role of socio‐demographics, crash characteristics and peri‐traumatic stress symptoms

Abstract

Background

The vast majority of individuals who come to the emergency department (ED) for care after a motor vehicle collision (MVC) are diagnosed with musculoskeletal strain only and are discharged to home. A significant subset of this population will still develop persistent pain and posttraumatic psychological sequelae may play an important role in pain persistence.

Methods

We conducted a multisite longitudinal cohort study of adverse post‐traumatic neuropsychiatric sequelae among patients seeking ED treatment in the aftermath of a traumatic life experience. We report on a sub‐group of patients (n = 666) presenting after an MVC, the most common type of trauma and we examine associations of socio‐demographic and MVC characteristics, and persistent pain 8 weeks after MVC. We also examine the degree to which these associations are related to peritraumatic psychological symptoms and 2‐week acute stress reactions using an applied approach.

Results

Eight‐week prevalence of persistent moderate or severe pain was high (67.4%) and positively associated with patient sex (female), older age, low socioeconomic status (education and income) and pain severity in the ED. Peritraumatic stress symptoms (distress and dissociation) appear to exert some influence on both acute pain and the transition from acute to persistent pain.

Discussion and Conclusions

The early aftermath of an MVC may be an important time period for intervening to prevent and reduce persistent pain. Substantial variation in mediating pathways across predictors also suggests potential diverse and complex underlying biological and psychological pathogenic processes are at work in the early weeks following trauma.

Significance

The first several days after trauma may dictate recovery trajectories. Persistent pain, pain lasting beyond the expected time of recovery, is associated with pain early in the recovery period, but also mediated through other pathways. Future work is needed to understand the complex neurobiological processes in involved in the development of persistent and acute post‐traumatic pain.

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Associations between biased threat interpretations, fear and avoidance of pain and pain‐linked disability in adolescent chronic pain patients

Abstract

Background

Biased interpretations of ambiguous bodily threat situations characterize youth with chronic pain, and have been associated with functional disability for this population. Despite predictions by the fear‐avoidance model of chronic pain, that fear and avoidance of pain explain the association between threat perceptions and disability, this has not yet been explored in youth with chronic pain. This study aimed to address this gap by investigating these proposed relationships, in addition to the association between bodily threat interpretations and daily aspects of disability (as well as social, and emotional impairments).

Method

Sixty‐eight adolescents aged 11–18 years old with a clinical diagnosis of chronic pain completed an extended version of the Adolescent Interpretations of Bodily Threat task to assess interpretations of bodily and social threat situations, alongside measures of disability and fear and avoidance of pain.

Results

Using mediation analysis, fear and avoidance of pain statistically accounted for the relationship between negative bodily threat interpretations and functional disability. Significant associations were also demonstrated between negative bodily threat interpretations and adolescent‐reported impairments in daily, emotional and social impairments. Data revealed a significant relationship between negative social interpretations and daily functional disability.

Conclusions

Findings indicate the clinical relevance of bodily and social threat interpretations, and fear and avoidance of pain, for this population and raise further questions regarding the content‐specificity of threat interpretations.

Significance

Psychological theories of pain‐associated impact and disability point to fear and avoidance of pain, as well as information‐processing biases. Here, we present novel data showing the clinical relevance of bodily and social threat interpretations in explaining pain‐related disability amongst youth with chronic pain, potentially by shaping fear and avoidance of pain. Longitudinal designs will be required to assess these temporally sensitive mediation pathways.

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Age differences in cognitive–affective processes in adults with chronic pain

Abstract

Background

Chronic pain is associated with significant physical and psychological impairments across the adult lifespan. However, there is a relative gap in knowledge on individual differences that predict pain‐related functioning. The current study highlights one important source of individual variation: age.

Methods

We used cross‐sectional data from a large treatment‐seeking cohort of 2,905 adults (M age = 46.6 [13.1]; 71.8% women) presenting to a tertiary pain centre in the United Kingdom to determine age differences in cognitive‐affective processes (catastrophizing, acceptance, self‐efficacy), including their differential patterns and effects on disability and depression.

Results

Older adults (ages 65–75) were found to experience higher pain acceptance and pain self‐efficacy compared to both middle‐aged (ages 40–64) and young adult (ages 18–39) age groups. Older adults also experienced lower levels of catasophizing compared to middle‐age adults. Testing age as a moderator, we found that the relationships of pain self‐efficacy and acceptance with depression as well as the relationship between pain self‐efficacy and disability were comparatively weakest among older adults and strongest among young adults. Similarly, the relationship between pain catastrophizing and depression was relatively stronger for young and middle‐aged adults compared to older adults.

Conclusions

Age‐related differences in psychological mechanisms that influence pain‐related functioning present unique challenges and opportunities for scientists and clinicians to improve our understanding and treatment of pain across the lifespan. Additional work is needed to refine our knowledge of age‐related differences in cognitive‐affective, biopsychosocial dimensions of chronic pain and to develop and test the efficacy of age‐tailored interventions.

Significance

Our cross‐sectional analysis of 2,905 treatment‐seeking adults with chronic pain presenting to a tertiary care center in the United Kingdom revealed distinct age differences in cognitive‐affective linked to disability and depression. This study contributes to the limited knowledge on age‐related variance in psychological mechanisms underlying adjustment to chronic pain. Promising avenues for future research include refining our understanding of age‐related differences in cognitive–affective, biopsychosocial dimensions of chronic pain and elucidating the most salient treatment targets among different age groups.

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Real‐world effectiveness and tolerability of carbamazepine and oxcarbazepine in 354 patients with trigeminal neuralgia

Abstract

Background

It is widely agreed that carbamazepine and oxcarbazepine are highly effective in the long‐term treatment of trigeminal neuralgia. However, the tolerability of these drugs across the different aetiologies of trigeminal neuralgia is still undetermined.

Methods

In this retrospective, real‐world study, we assessed the effectiveness and tolerability of carbamazepine and oxcarbazepine in a large cohort of patients with classical (254 patients), secondary (60 patients) and idiopathic (40 patients) trigeminal neuralgia. We analysed data using a propensity score analysis to account for selection bias; frequencies of side effects associated with carbamazepine and oxcarbazepine were calculated by adjusting data with the inverse probability of treatment weighting.

Results

The initial proportion of responders was 88.3% with carbamazepine, and 90.9% with oxcarbazepine. The number of refractory patients was significantly higher in idiopathic (15%) and secondary forms (27%) than in classical trigeminal neuralgia (6%; p < .05). In 53 patients treated with carbamazepine (29.6%) and in 22 treated with oxcarbazepine (12.6%), major side effects caused treatment interruption or dosage reduction to an unsatisfactory level. Side effects occurred more frequently in patients treated with carbamazepine (43.6%) than with oxcarbazepine (30.3%, p < .0001). The frequency of treatment discontinuation was higher in patients with secondary and idiopathic forms than in those with classical trigeminal neuralgia (p < .05).

Conclusions

Our real‐world study shows that carbamazepine and oxcarbazepine are effective in most patients with trigeminal neuralgia; nevertheless, side effects are still a major issue, particularly in patients with secondary and idiopathic trigeminal neuralgia.

Significance

Although carbamazepine and oxcarbazepine are effective in most patients with trigeminal neuralgia, their side effects are still a major issue, thus necessitating the development of better‐tolerated drugs.

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Is Europe facing an opioid epidemic: What does European monitoring data tell us?

Abstract

This paper addresses the question of whether Europe is facing an opioid epidemic and utilizes data from the European monitoring system on opioid use, harms and availability, to help assess the situation. Data sources covering the last decade on overdose deaths, drug treatment entrants and drug‐related emergencies suggest that the health burden associated with opioid use is mostly related to the consumption of heroin – and to a lesser extent diverted opioid substitution treatment medications – and that it is primarily affecting an ageing cohort of vulnerable users, with little evidence of an increase in initiation. While opioid‐related deaths are currently at much lower levels than in the United States, they still represent a large preventable health burden with differences across EU countries. There is also increasing concern related to the high availability of heroin, illicitly produced synthetic opioids and diverted opioid pain medications on the European drugs market. Trends in the latter categories are poorly monitored and we may miss signs of emerging problems. Moreover, the economic recession following the COVID‐19 pandemic has a potential to lead to resurgence in opioid use and harms.

Significance

This paper looks at data from the European monitoring system to address the question of whether Europe is facing an opioid epidemic. It reviews available health and supply side indicators, considering the limitations of each data source. A summary of the available evidence would suggest that while opioid‐related deaths in Europe represent a large preventable health burden with differences across EU countries, Europe as a whole is not facing an opioid crisis of the size and nature seen in the US.

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Mechanisms of recovery after neck‐specific or general exercises in patients with cervical radiculopathy

Abstract

Background

The mechanisms of action that facilitate improved outcomes after conservative rehabilitation are unclear in individuals with cervical radiculopathy (CR). This study aims to determine the pathways of recovery of disability with different exercise programs in individuals with CR.

Methods

We analysed a dataset of 144 individuals with CR undergoing conservative rehabilitation. Eleven variables collected at baseline, 3, 6 and 12 months follow‐up were used to build a Bayesian Network (BN) model: treatment group (neck‐specific vs. general exercises), age, sex, self‐efficacy, catastrophizing, kinesiophobia, anxiety, neck–arm pain intensity, headache pain intensity and disability. The model was used to quantify the contribution of different mediating pathways on the outcome of disability at 12th months.

Results

All modelled variables were conditionally independent from treatment groups. A one‐point increase in anxiety at 3rd month was associated with a 2.45‐point increase in 12th month disability (p <.001). A one‐point increase in head pain at 3rd month was associated with a 0.08‐point increase in 12th month disability (p <.001). Approximately 83% of the effect of anxiety on disability was attributable to self‐efficacy. Approximately 88% of the effect of head pain on disability was attributable to neck–arm pain.

Conclusions

No psychological or pain‐related variables mediated the different treatment programs with respect to the outcome of disability. Thus, the specific characteristics investigated in this study did not explain the differences in mechanisms of effect between neck‐specific training and prescribed physical activity. The present study provides candidate modifiable mediators that could be the target of future intervention trials.

Significance

Psychological and pain characteristics did not differentially explain the mechanism of effect that two exercise regimes had on disability in individuals with cervical radiculopathy. In addition, we found that improvements in self‐efficacy was approximately five times more important than that of neck–arm pain intensity in mediating the anxiety‐disability relationship. A mechanistic understanding of recovery provides candidate modifiable mediators that could be the target of future intervention trials.

Trials registration

ClinicalTrials.gov identifier: NCT01547611.

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Internet‐delivered acceptance and commitment therapy as microlearning for chronic pain: A randomized controlled trial with 1‐year follow‐up

Abstract

Background

Studies of Internet‐delivered acceptance and commitment therapy (ACT) for chronic pain have shown small to moderate positive effects for pain interference and pain acceptance. Effects on pain intensity, depression, anxiety and quality of life (QoL) have been less favourable, and improvements for values and sleep are lacking. In this randomized controlled trial iACT – a novel format of Internet‐ACT using daily microlearning exercises – was examined for efficacy compared to a waitlist condition.

Methods

Adult participants (mean age 49.5 years, pain duration 18.1 years) with diverse chronic pain conditions were recruited via self‐referral, and randomized to iACT (n = 57) or waitlist (n = 56). The primary outcome was pain interference. The secondary outcomes were QoL, depression, anxiety, insomnia and pain intensity. The process variables included psychological inflexibility and values. Post‐assessments were completed by 88% (n = 100) of participants. Twelve‐month follow‐up assessments were completed by 65% (iACT only, n = 37). Treatment efficacy was analysed using linear mixed models and an intention‐to‐treat‐approach.

Results

Significant improvements in favour of iACT were seen for pain interference, depression, anxiety, pain intensity and insomnia, as well as process variables psychological inflexibility and values. Between‐group effect sizes were large for pain interference (d = 0.99) and pain intensity (d = 1.2), moderate for anxiety and depressive symptoms and small for QoL and insomnia. For the process variables, the between‐group effect size was large for psychological inflexibility (d = 1.0) and moderate for values. All improvements were maintained at 1‐year follow‐up.

Conclusions

Internet‐ACT as microlearning may improve a broad range of outcomes in chronic pain.

Significance

The study evaluates a novel behavioral treatment with positive results on pain interference, mood as well as pain intensity for longtime chronic pain sufferers. The innovative format of a digital ACT intervention delivered in short and experiential daily learnings may be a promising way forward.

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Impaired exercise‐induced hypoalgesia in individuals reporting an increase in low back pain during acute exercise

Abstract

Objectives

Exercise therapy is recommended for low back pain (LBP) although the immediate effects on pain are highly variable. In 96 individuals with LBP this cross‐sectional study explored (a) the magnitude of exercise‐induced hypoalgesia (EIH) and (b) measures of pain sensitivity and clinical pain manifestations in individuals reporting a clinical relevant increase in back pain during physical activity compared with individuals reporting low or no increase in back pain during physical activity.

Methods

Cuff algometry was performed at baseline on the leg to assess pressure pain threshold (cPPT), tolerance (cPTT) and temporal summation of pain (cTSP). Manual PPTs were assessed on the back and leg before and after a 6‐min walk test (6MWT). Back pain was scored on a numerical rating scale (NRS) after each minute of walking. The EIH‐effect was estimated as the increase in PPTs after the walk exercise.

Results

Twenty‐seven individuals reported an increase of ≥2/10 in pain NRS scores during walking and compared with the individuals with <2/10 NRS scores: cPPT and EIH‐effects were lower whereas cTSP, pain intensity and disability were increased (p < 0.03). Baseline NRS scores, EIH and pain thresholds were associated with the likelihood of an increase of ≥2/10 in back pain intensity during walking (p < 0.05).

Conclusions

Pain flares in response to physical activity in individuals with LBP seem to be linked with baseline pain sensitivity and pain intensity, and impair the beneficial EIH. Such information may better inform when individuals with LBP will have a beneficial effect of physical activity.

Significance

Pain flares in response to physical activity in individuals with LBP seem to be linked with baseline pain sensitivity and pain intensity, and impair the beneficial exercise‐induced hypoalgesia. Such information may better inform when individuals with LBP will have a beneficial effect of physical activity.

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Effectiveness of a structured group intervention based on pain neuroscience education for patients with fibromyalgia in primary care: A multicentre randomized open‐label controlled trial

Abstract

Background

There has been increased interest in pain neuroscience education (PNE) as a therapeutic approach for the management of fibromyalgia (FM).

Methods

A multicentre randomized, open‐label, controlled trial was conducted to assess the effectiveness of a structured group intervention based on PNE in patients with FM. A total of 139 patients were included in the study and randomized to the intervention group (7 group sessions of education in neurobiology of pain) or to the control group (treatment as usual only). The primary outcome was the improvement of functional status and pain measured with the Fibromyalgia Impact Questionnaire (FIQ), and secondary outcomes were the reduction in the impact of pain and other symptoms (catastrophizing, anxiety and depression) and number of patients reaching no worse than moderate functional impairment (FIQ score <39). Differences between groups were calculated by linear mixed‐effects (intention‐to‐treat approach) and mediational models through path analyses.

Results

At 1 year, improvements in FIQ scores were higher in the intervention group with moderate or high effect size, and decreases of ≥20% in 69.1% of patients (20.9% in the control group) and of ≥50% in 39.7% (4.5% in the control group). Also, 52.9% of patients had a FIQ <39 points (13.4% in the control group).

Conclusions

In this sample of patients with FM, the improvement in quality of life and control of symptoms obtained by adding a PNE intervention showed promising results, equalling or surpassing previously reported outcomes.

Significance

A structured group intervention based on pain neuroscience education for 1 year in patients with fibromyalgia was associated with significant amelioration of the impact of the disease on scores of the Fibromyalgia Impact Questionnaire, the Health Assessment Questionnaire, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale and the Polysymptomatic Distress Scale as compared with only treatment as usual. These findings are clinically relevant considering the challenges posed by fibromyalgia to clinicians and patients alike.

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Facial expressions of pain in daily clinical practice to assess postoperative pain in children: Reliability and validity of the facial action summary score

Abstract

Background

Behavioural pain scales are recommended to assess postoperative pain for children who are too young to use self‐report tools. Their main limitation is underestimation of pain in the days following an intervention. Although relevant, facial expression is not used in daily clinical practice. This prospective study aimed to assess the validity and reliability of the Facial Action Summary Score (FASS), a five‐item scale, to assess postoperative pain until hospital discharge in children <7 years.

Methods

Assessments of pain and anxiety of 123 children using FASS and validated scales were used to study the psychometric validity of the FASS in clinical practice.

Results

The content validity was previously investigated in a development study. The internal validity of the FASS was high with excellent reliability (intraclass coefficient = 0.94) and a high Cronbach α (0.89). Convergent validity with pain scales (FLACC [Face, Legs, Activity, Cry, Consoling] and FPS‐R [Faces Pain Scale – Revised]) was high (r > 0.8). Sensitivity to change was verified by a significant decrease in the score after rescue analgesia. For a threshold of 2/5, the FASS shows excellent specificity (97%) and sensitivity (82%). The low number of false negatives is the main strength of this tool.

Conclusions

This work highlights the interest in using facial expression in daily clinical practice to manage postoperative pain. The FASS is easy to use with excellent psychometric properties and is particularly sensitive to measure pain in the days following surgery.

Significance

The aim of this study was to prove that facial expression of pain can be used in clinical practice to measure postoperative pain in children. The reduced number of false negatives is the main strength of this tool.

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European clinical practice recommendations on opioids for chronic noncancer pain – Part 2: Special situations*

Abstract

Background

Opioid use for chronic non‐cancer pain (CNCP) is under debate. In the absence of pan‐European guidance on this issue, a position paper was commissioned by the European Pain Federation (EFIC).

Methods

The clinical practice recommendations were developed by eight scientific societies and one patient self‐help organization under the coordination of EFIC. A systematic literature search in MEDLINE (up until January 2020) was performed. Two categories of guidance are given: Evidence‐based recommendations (supported by evidence from systematic reviews of randomized controlled trials or of observational studies) and Good Clinical Practice (GCP) statements (supported either by indirect evidence or by case‐series, case–control studies and clinical experience). The GRADE system was applied to move from evidence to recommendations. The recommendations and GCP statements were developed by a multiprofessional task force (including nursing, service users, physicians, physiotherapy and psychology) and formal multistep procedures to reach a set of consensus recommendations. The clinical practice recommendations were reviewed by five external reviewers from North America and Europe and were also posted for public comment.

Results

The European Clinical Practice Recommendations give guidance for combination with other medications, the management of frequent (e.g. nausea, constipation) and rare (e.g. hyperalgesia) side effects, for special clinical populations (e.g. children and adolescents, pregnancy) and for special situations (e.g. liver cirrhosis).

Conclusion

If a trial with opioids for chronic noncancer pain is conducted, detailed knowledge and experience are needed to adapt the opioid treatment to a special patient group and/or clinical situation and to manage side effects effectively.

Significance

If a trial with opioids for chronic noncancer pain is conducted, detailed knowledge and experience are needed to adapt the opioid treatment to a special patient group and/or clinical situation and to manage side effects effectively. A collaboration of medical specialties and of all health care professionals is needed for some special populations and clinical situations.

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Issue Information

European Journal of Pain, Volume 25, Issue 5, Page 947-948, May 2021.

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A systematic review and meta‐analysis of radiofrequency procedures on innervation to the shoulder joint for relieving chronic pain

Abstract

Background and Objective

Studies have reported relief of chronic shoulder pain with non‐ablative pulsed neuromodulatory (pRF) or ablative radiofrequency (aRF) procedures on innervation of the shoulder joint but interpretation of these reports is hampered by inconsistent indications, anatomic targets and follow‐up. This systematic review was conducted to synthesize the existing literature on procedures employing pRF or aRF for treating chronic shoulder pain.

Databases and Data Treatment

MEDLINE and other medical literature databases were reviewed up to 31 December 2019 for publications on pRF or aRF procedures on shoulder joint innervation to relieve chronic pain. Data on analgesic and functional outcomes measured at any time point following the interventions were extracted. Existing knowledge on innervation of the shoulder joint with relevance to RF procedures was also synthesized.

Results

In all, 42 publications, 7 randomized controlled trials (RCTs) and 35 observational studies, case series or reports were identified. Thirty‐six of these publications were on pRF procedure and 29 of these reported procedures exclusively targeting the suprascapular nerve. A meta‐analysis of the seven RCTs evaluating pRF indicated no analgesic benefit or functional improvement with this treatment over conventional medical management. Case series and reports on aRF indicate a potential for analgesic benefit but the quality of this evidence was low.

Conclusions

RF treatments targeting the sensory innervation of the shoulder joint affected by degenerative conditions have the potential to reduce pain but the current evidence does not suggest analgesic or functional benefit (GRADE certainty of evidence—low). Studies of high methodological quality are required to further investigate the role of these interventions.

Significance

This is a comprehensive review of literature on pulsed (non‐ablative) and ablative radiofrequency (RF) procedures for chronic shoulder pain. The systematic review and meta‐analysis of 7 trials found that pulsed RF for chronic shoulder pain provided similar analgesia and functional improvement as conservative medical management at three months after the procedures. The case series and reports on ablative RF for shoulder pain indicate possible analgesic benefit but their quality was low. This review highlights the need for studies of a high quality on ablative RF treatments for chronic shoulder pain.

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Inhibition of ferroptosis‐like cell death attenuates neuropathic pain reactions induced by peripheral nerve injury in rats

Abstract

Background

Relationships between iron‐dependent ferroptosis and nerve system diseases have been recently revealed. However, the role of ferroptosis in neuropathic pain (NeP) remains to be elucidated. Thus, we aimed to investigate whether ferroptosis in spinal cord contributes to NeP induced by a chronic constriction injury (CCI) of the sciatic nerve.

Methods

Forty Sprague‐Dawley rats received CCI or sham surgery, and were randomly assigned to the following four groups: sham group; CCI + LIP group; CCI + Veh group; and CCI group. Liproxstatin‐1 or corn oil were separately injected intraperitoneally for three consecutive days after surgery in the CCI + LIP or CCI + Veh group. The mechanical and thermal hypersensitivities were tested after surgery. Biochemical and morphological changes related to ferroptosis in the spinal cord were also assessed. These included iron content, glutathione peroxidase 4 (GPX4) and anti‐acyl‐CoA synthetase long‐chain family member 4 (ACSL4) expression, lipid peroxidation assays, as well as mitochondrial morphology.

Results

CCI‐induced NeP was followed by iron accumulation, increased lipid peroxidation and dysregulation of ACSL4 and GPX4. Moreover transmission electron microscopy confirmed the presence of aberrant morphological changes on mitochondrial, such as mitochondria shrinkage and membrane rupture. Furthermore, the administration of liproxstatin‐1 on CCI rats attenuated hypersensitivities, lowered the iron level, decreased spinal lipid peroxidation, restored the dysregulations in GPX4 and ACSL4 levels, and protected against CCI induced morphological changes in mitochondria.

Conclusions

Our findings indicated the involvement of ferroptosis in CCI induced NeP, and point to ferroptosis inhibitors such as liproxstatin‐1 as potential therapies for hypersensitivity induced by peripheral nerve injury.

Significance

The spinal ferroptosis‐like cell death was involved in the development of neuropathic pain resulted from peripheral nerve injury, and inhibition of ferroptosis by liproxstatin‐1 could alleviate mechanical and thermal hypersensitivities. This knowledge suggested that ferroptosis could represent a potential therapeutic target for neuropathic pain.

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Development and validation of the Brief Assessment of Distress about Pain

Abstract

Background

The experience of pain is a complex interaction of somatic, behavioural, affective and cognitive components. Negative psychological states (e.g., anxiety, fear and depression) are intertwined with pain and contribute to poorer outcomes for individuals suffering from chronic and acute pain by exacerbating the overall experience of pain and leading to increased dysfunction, disability, and distress. A need exists for efficient assessment of aversive emotional states that are associated with pain.

Methods

A multistage developmental process included expert judges, two undergraduate samples, and a chronic pain patient sample. The 4‐item Brief Assessment of Distress about Pain (BADP) scale was developed to assess anxiety, fear, and depression related to pain, as well as an overall evaluation of distress about pain.

Results

Principal components analyses indicated that the BADP consisted of one factor. Inter‐scale correlation coefficients revealed that the BADP was highly related to other measures that assess similar constructs, suggesting evidence for convergent validity. Intra‐scale correlation coefficients indicated that the items of the BADP were only moderately associated with each other. Findings also supported evidence for discriminative validity, test–retest reliability, and internal consistency of the BADP.

Conclusions

The BADP has good psychometric properties as a measure of negative affectivity related to pain. The scale's single negative affectivity item may be useful for screening. The BADP helps address a gap in the literature with regard to a brief measure assessing fear, anxiety, depression, and negative affect in relation to pain. Demonstrated utility in a patient sample indicates the measure is suitable for further clinical study.

Significance

The BADP provides an efficient, psychometrically‐supported means to assess affective distress (i.e., anxiety, fear, depression, and negative affect) associated with pain.

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Inhibition of ferroptosis‐like cell death attenuates neuropathic pain reactions induced by peripheral nerve injury in rats

Abstract

Background

Relationships between iron‐dependent ferroptosis and nerve system diseases have been recently revealed. However, the role of ferroptosis in neuropathic pain (NeP) remains to be elucidated. Thus, we aimed to investigate whether ferroptosis in spinal cord contributes to NeP induced by a chronic constriction injury (CCI) of the sciatic nerve.

Methods

Forty Sprague‐Dawley rats received CCI or sham surgery, and were randomly assigned to the following four groups: sham group; CCI + LIP group; CCI + Veh group; and CCI group. Liproxstatin‐1 or corn oil were separately injected intraperitoneally for three consecutive days after surgery in the CCI + LIP or CCI + Veh group. The mechanical and thermal hypersensitivities were tested after surgery. Biochemical and morphological changes related to ferroptosis in the spinal cord were also assessed. These included iron content, glutathione peroxidase 4 (GPX4) and anti‐acyl‐CoA synthetase long‐chain family member 4 (ACSL4) expression, lipid peroxidation assays, as well as mitochondrial morphology.

Results

CCI‐induced NeP was followed by iron accumulation, increased lipid peroxidation and dysregulation of ACSL4 and GPX4. Moreover transmission electron microscopy confirmed the presence of aberrant morphological changes on mitochondrial, such as mitochondria shrinkage and membrane rupture. Furthermore, the administration of liproxstatin‐1 on CCI rats attenuated hypersensitivities, lowered the iron level, decreased spinal lipid peroxidation, restored the dysregulations in GPX4 and ACSL4 levels, and protected against CCI induced morphological changes in mitochondria.

Conclusions

Our findings indicated the involvement of ferroptosis in CCI induced NeP, and point to ferroptosis inhibitors such as liproxstatin‐1 as potential therapies for hypersensitivity induced by peripheral nerve injury.

Significance

The spinal ferroptosis‐like cell death was involved in the development of neuropathic pain resulted from peripheral nerve injury, and inhibition of ferroptosis by liproxstatin‐1 could alleviate mechanical and thermal hypersensitivities. This knowledge suggested that ferroptosis could represent a potential therapeutic target for neuropathic pain.

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Development and validation of the Brief Assessment of Distress about Pain

Abstract

Background

The experience of pain is a complex interaction of somatic, behavioural, affective and cognitive components. Negative psychological states (e.g., anxiety, fear and depression) are intertwined with pain and contribute to poorer outcomes for individuals suffering from chronic and acute pain by exacerbating the overall experience of pain and leading to increased dysfunction, disability, and distress. A need exists for efficient assessment of aversive emotional states that are associated with pain.

Methods

A multistage developmental process included expert judges, two undergraduate samples, and a chronic pain patient sample. The 4‐item Brief Assessment of Distress about Pain (BADP) scale was developed to assess anxiety, fear, and depression related to pain, as well as an overall evaluation of distress about pain.

Results

Principal components analyses indicated that the BADP consisted of one factor. Inter‐scale correlation coefficients revealed that the BADP was highly related to other measures that assess similar constructs, suggesting evidence for convergent validity. Intra‐scale correlation coefficients indicated that the items of the BADP were only moderately associated with each other. Findings also supported evidence for discriminative validity, test–retest reliability, and internal consistency of the BADP.

Conclusions

The BADP has good psychometric properties as a measure of negative affectivity related to pain. The scale's single negative affectivity item may be useful for screening. The BADP helps address a gap in the literature with regard to a brief measure assessing fear, anxiety, depression, and negative affect in relation to pain. Demonstrated utility in a patient sample indicates the measure is suitable for further clinical study.

Significance

The BADP provides an efficient, psychometrically‐supported means to assess affective distress (i.e., anxiety, fear, depression, and negative affect) associated with pain.

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Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical practice guideline.

Lumbar spinal stenosis (LSS) causing neurogenic claudication (NC) is increasingly common with an aging population and can be associated with significant symptoms and functional limitations. We developed this guideline to present the evidence and provide clinical recommendations on non-surgical management of patients with LSS causing NC.Using the GRADE approach, a multidisciplinary guidelines panel based recommendations on evidence from a systematic review of randomized controlled trials and systematic reviews published through June 2019, or expert consensus.

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When do we not face our fears? Investigating the boundary conditions of costly pain-related avoidance generalization

Avoidance of objectively safe movements and activities is central to chronic pain disability55, which often profits from psychological treatments, such as Cognitive Behavioral Therapy39, rather than purely biomedical ones14, 15. Avoidance of pain-associated movements/activities after healing prevents disconfirmation of threat, leading to a self-sustaining cycle of fear and avoidance55. Furthermore, avoidance often spreads to movements resembling the original pain-associated movement, that were never paired with pain themselves (avoidance generalization)12.

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AAAPT Diagnostic Criteria for Acute Thoracic Surgery Pain

An expert panel involving the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), American Pain Society (APS), and American Academy of Pain Medicine (AAPM) established an initiative to develop a pain taxonomy (AAAPT) for the multidimensional classification of acute pain55,56. Within the AAAPT framework, acute pain was generally defined as pain experienced up to 7 days after the inciting event55. AAAPT defined the following five dimensions to broadly categorize acute pain conditions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/ functional consequences, and 5) putative pathophysiologic mechanisms55.

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Modulating Brain Rhythms of Pain using Transcranial Alternating Current Stimulation (tACS) - A Sham-controlled Study in Healthy Human Participants

Pain is a vital protective phenomenon but can also occur for extended time periods without protecting the body. In such chronic pain conditions, pain represents a highly disabling disorder and is a leading cause of disability worldwide20, 47. Current treatment approaches are often insufficient and can cause serious side effects as indicated by the current Opioid crisis42. Moreover, the development of pain therapeutics is stagnating52. Thus, novel approaches for the treatment of chronic pain are urgently needed28, 45, 52.

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Prevalence and characteristics of new‐onset pain in COVID‐19 survivours, a controlled study

Abstract

Background

We assessed whether COVID‐19 is associated with de novo pain and de novo chronic pain (CP).

Methods

This controlled cross‐sectional study was based on phone interviews of patients discharged from hospital after COVID‐19 compared to the control group composed of individuals hospitalized during the same period due to non‐COVID‐19 causes. Patients were classified as having previous CP based on the ICD‐11/IASP criteria, de novo pain (i.e. any new type of pain, irrespective of the pain status before hospital stay), and de novo CP (i.e. persistent or recurring de novo pain, lasting more than 3 months) after COVID‐19. We assessed pain prevalence and its characteristics, including headache profile, pain location, intensity, interference, and its relationship with fatigue, and persistent anosmia. Forty‐six COVID‐19 and 73 control patients were included. Both groups had similar sociodemographic characteristics and past medical history.

Results

Length of in‐hospital‐stay and ICU admission rates were significantly higher amongst COVID‐19 survivours, while mechanical ventilation requirement was similar between groups. Pre‐hospitalisation pain was lower in COVID‐19 compared to control group (10.9% vs. 42.5%; p = 0.001). However, the COVID‐19 group had a significantly higher prevalence of de novo pain (65.2% vs. 11.0%, p = 0.001), as well as more de novo headache (39.1%) compared to controls (2.7%, p = 0.001). New‐onset CP was 19.6% in COVID‐19 patients and 1.4% (p = 0.002) in controls. These differences remained significant (p = 0.001) even after analysing exclusively (COVID: n = 40; controls: n = 34) patients who did not report previous pain before the hospital stay. No statistically significant differences were found for mean new‐onset pain intensity and interference with daily activities between both groups. COVID‐19 pain was more frequently located in the head/neck and lower limbs (p < 0.05). New‐onset fatigue was more common in COVID‐19 survivours necessitating inpatient hospital care (66.8%) compared to controls (2.5%, p = 0.001). COVID‐19 patients who reported anosmia had more new‐onset pain (83.3%) compared to those who did not (48.0%, p = 0.024).

Conclusion

COVID‐19 was associated with a significantly higher prevalence of de novo CP, chronic daily headache, and new‐onset pain in general, which was associated with persistent anosmia.

Significance

There exists de novo pain in a substantial number of COVID‐19 survivours, and some develop chronic pain. New‐onset pain after the infection was more common in patients who reported anosmia after hospital discharge.

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Prevalence and characteristics of new‐onset pain in COVID‐19 survivours, a controlled study

Abstract

Background

We assessed whether COVID‐19 is associated with de novo pain and de novo chronic pain (CP).

Methods

This controlled cross‐sectional study was based on phone interviews of patients discharged from hospital after COVID‐19 compared to the control group composed of individuals hospitalized during the same period due to non‐COVID‐19 causes. Patients were classified as having previous CP based on the ICD‐11/IASP criteria, de novo pain (i.e. any new type of pain, irrespective of the pain status before hospital stay), and de novo CP (i.e. persistent or recurring de novo pain, lasting more than 3 months) after COVID‐19. We assessed pain prevalence and its characteristics, including headache profile, pain location, intensity, interference, and its relationship with fatigue, and persistent anosmia. Forty‐six COVID‐19 and 73 control patients were included. Both groups had similar sociodemographic characteristics and past medical history.

Results

Length of in‐hospital‐stay and ICU admission rates were significantly higher amongst COVID‐19 survivours, while mechanical ventilation requirement was similar between groups. Pre‐hospitalisation pain was lower in COVID‐19 compared to control group (10.9% vs. 42.5%; p = 0.001). However, the COVID‐19 group had a significantly higher prevalence of de novo pain (65.2% vs. 11.0%, p = 0.001), as well as more de novo headache (39.1%) compared to controls (2.7%, p = 0.001). New‐onset CP was 19.6% in COVID‐19 patients and 1.4% (p = 0.002) in controls. These differences remained significant (p = 0.001) even after analysing exclusively (COVID: n = 40; controls: n = 34) patients who did not report previous pain before the hospital stay. No statistically significant differences were found for mean new‐onset pain intensity and interference with daily activities between both groups. COVID‐19 pain was more frequently located in the head/neck and lower limbs (p < 0.05). New‐onset fatigue was more common in COVID‐19 survivours necessitating inpatient hospital care (66.8%) compared to controls (2.5%, p = 0.001). COVID‐19 patients who reported anosmia had more new‐onset pain (83.3%) compared to those who did not (48.0%, p = 0.024).

Conclusion

COVID‐19 was associated with a significantly higher prevalence of de novo CP, chronic daily headache, and new‐onset pain in general, which was associated with persistent anosmia.

Significance

There exists de novo pain in a substantial number of COVID‐19 survivours, and some develop chronic pain. New‐onset pain after the infection was more common in patients who reported anosmia after hospital discharge.

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Doctors raise concerns about NICE guidelines on chronic primary pain

Doctors in pain management have raised concerns about the National Institute of Health and Care Excellence’s guidance on treating chronic primary pain,1 which they said do not reflect clinical...

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[Clinical Picture] Bilateral elongated styloid processes: Eagle syndrome

A 40-year-old-woman presented to our outpatient clinic with a 6-month history of pain in her throat and a feeling that she had a foreign body in the submandibular region. She said the pain was pricking, intermittent, bilateral, non-radiating, aggravated by eating solid food, and moderate to severe in intensity. She reported no history of trauma or previous operations—specifically a tonsillectomy. The patient was previously fit and well and had no medical history.

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The Effect of a Psychologically-Informed Intervention to Treat Adolescents with Patellofemoral Pain: A Randomized Controlled Trial.

Publication date: Available online 7 April 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Mitchell Selhorst, Alicia Fernandez-Fernandez, Laura Schmitt, Jessica Hoehn

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The Effect of a Psychologically-Informed Intervention to Treat Adolescents with Patellofemoral Pain: A Randomized Controlled Trial.

Publication date: Available online 7 April 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Mitchell Selhorst, Alicia Fernandez-Fernandez, Laura Schmitt, Jessica Hoehn

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The Effect of a Psychologically-Informed Intervention to Treat Adolescents with Patellofemoral Pain: A Randomized Controlled Trial.

Publication date: Available online 7 April 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Mitchell Selhorst, Alicia Fernandez-Fernandez, Laura Schmitt, Jessica Hoehn

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The Effect of a Psychologically-Informed Intervention to Treat Adolescents with Patellofemoral Pain: A Randomized Controlled Trial.

Publication date: Available online 7 April 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Mitchell Selhorst, Alicia Fernandez-Fernandez, Laura Schmitt, Jessica Hoehn

from ScienceDirect Publication: Archives of Physical Medicine and Rehabilitation https://ift.tt/3s9JMFP
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The Effect of a Psychologically-Informed Intervention to Treat Adolescents with Patellofemoral Pain: A Randomized Controlled Trial.

Publication date: Available online 7 April 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Mitchell Selhorst, Alicia Fernandez-Fernandez, Laura Schmitt, Jessica Hoehn

from ScienceDirect Publication: Archives of Physical Medicine and Rehabilitation https://ift.tt/3s9JMFP
via IFTTT

The Effect of a Psychologically-Informed Intervention to Treat Adolescents with Patellofemoral Pain: A Randomized Controlled Trial.

Publication date: Available online 7 April 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Mitchell Selhorst, Alicia Fernandez-Fernandez, Laura Schmitt, Jessica Hoehn

from ScienceDirect Publication: Archives of Physical Medicine and Rehabilitation https://ift.tt/3s9JMFP
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The Effect of a Psychologically-Informed Intervention to Treat Adolescents with Patellofemoral Pain: A Randomized Controlled Trial.

Publication date: Available online 7 April 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Mitchell Selhorst, Alicia Fernandez-Fernandez, Laura Schmitt, Jessica Hoehn

from ScienceDirect Publication: Archives of Physical Medicine and Rehabilitation https://ift.tt/3s9JMFP
via IFTTT

The Effect of a Psychologically-Informed Intervention to Treat Adolescents with Patellofemoral Pain: A Randomized Controlled Trial.

Publication date: Available online 7 April 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Mitchell Selhorst, Alicia Fernandez-Fernandez, Laura Schmitt, Jessica Hoehn

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Broadening the scope of pediatric intensive interdisciplinary pain treatment to promote future resilience and psychological flexibility

Abstract

This journal recently published a paper by Wager and colleagues, entitled "Long‐term outcomes of children with severe chronic pain: Comparison of former patients with a community sample” (Wager et al., in press). This paper demonstrates the lasting positive effects of intensive interdisciplinary pain treatment (IIPT) in children, and adds confidence in the duration of treatment effects through its unprecedented, controlled, 7‐year follow‐up design. Youth treated in IIPT are those with the most impairing pain; thus, these results are particularly encouraging, with almost 60% of the clinical sample no longer experiencing chronic pain.

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Perception of repeated pain relief with controllable and uncontrollable pain

Abstract

Background

The ultimate goal of pain research is to provide effective routes for pain relief. Nevertheless, the perception pain relief as a change in pain intensity and un‐/pleasantness has only been rarely investigated. It has been demonstrated that pain relief has rewarding and reinforcing properties, but it remains unknow whether the perception of pain relief changes when pain reductions occur repeatedly. Further, it remains an open question whether the perception of pain relief depends on the controllability of the preceding pain.

Methods

In the present study, healthy volunteers (N=38) received 5 cycles of painful heat stimulation and reduction of this stimulation to a non‐painful warm stimulation once in a condition with control of the stimulation and once without control. Participants rated perceived intensity and un‐/pleasantness on visual analogue scales during the heat stimulation and immediately after its reduction.

Results

Results showed that perceived pain relief, estimated by the difference in ratings during ongoing heat stimulation and after its reduction, increased with repetitions. However, this increase leveled off after two to four repetitions. Further, perceived pain relief was larger in the condition without control compared to the condition with control.

Conclusion

The perception of pain relief can be modulated similar to the perception of pain by stimulus characteristics and psychological factors. Mechanistic knowledge about such modulating factors is important, because they can determine, for example, the amount of requested pain killers in clinical settings and the efficacy of pain relief as a reinforcing stimulus.

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The Effect of a Psychologically-Informed Intervention to Treat Adolescents with Patellofemoral Pain: A Randomized Controlled Trial.

Publication date: Available online 7 April 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Mitchell Selhorst, Alicia Fernandez-Fernandez, Laura Schmitt, Jessica Hoehn

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High‐frequency spinal cord stimulation as rescue therapy for chronic pain patients with failure of conventional spinal cord stimulation

Abstract

Background

This study aims to evaluate the efficacy of 10‐kHz high‐frequency (HF10) devices as a rescue treatment in patients with failure of conventional spinal cord stimulation (SCS) therapy for chronic pain without the need to change the spinal hardware.

Methods

In this real‐world prospective study, patients with neuropathic pain treated with conventional tonic SCS in whom the therapy had failed, either during the trial phase or after a period of optimal functioning, were recruited throughout 2 years for HF10‐SCS therapy. Data on analgesia, functionality, analgesics use and treatment safety were collected 12 months after treatment.

Results

Eleven of the 18 (61%) patients included in the study were successfully rescued with HF10‐SCS. Of them, 5 out of 12 (45%) were in the trial phase and 6 out of 6 (100%) had previously functioning implants. A significant improvement in low‐back and limb pain was obtained (p = .003 and p = .0001, respectively). Treatment success was significantly associated with gender (p = .037), weight (p = .014), body mass index (BMI) (p = .007) and time of rescue (p = .015). A linear regression test confirmed a significant association between treatment failure and BMI and gender (p = .004).

Conclusions

Our results suggest that analgesic rescue with HF10‐SCS is an effective therapeutic option for non‐responders to conventional SCS, although obesity might be a limiting factor for treatment success. Nevertheless, more comprehensive studies are needed to corroborate our findings.

Significance

This study shows that high‐frequency stimulation may be useful in patients with failure of conventional tonic stimulation for chronic pain, both in the trial phase and in previously implanted subjects. The novelty of this study lies in the use of the implanted epidural electrodes, which avoids the need for further surgery. The results in terms of pain control and recovery of functionality are satisfactory. In addition, variables such as male gender and high body mass index could be predictors of therapy failure.

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Offer exercise, therapy, acupuncture, or antidepressants for chronic primary pain, says NICE

Chronic primary pain should be managed with exercise programmes, cognitive behavioural therapy, acceptance and commitment therapy, and acupuncture, NICE has said in guidance on the assessment and...

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Opioids: A ‘crisis’ of too much or not enough – or simply how rich you are and where you live?

Abstract

The ‘Opioid Crisis’, which originated in Western countries, has been misrepresented and is misinforming the global public. For 20 years, since the advent of the synthetic opioids, 25,000 Americans, on average, have died annually from opioid‐related overdoses. The United States produces and consumes by far the greatest amounts of opioids. National regulations introduced to curb overdoses and restrict opioid availability have condemned many Americans, such as cancer patients or those in need of palliative care, to a life of extreme pain due to lack of access to adequate pain management. As is often the case, US‐driven laws have informed and guided international regulations. Worldwide, 83% of countries have low or non‐existent access to opioids for pain relief. Over 25 million people are at the end‐of‐life stage, with eight million people dying annually in unnecessary pain and distress. Ineffectively controlled pain is a global public health issue blighting the lives of billions of people worldwide with immeasurable human and socioeconomic costs. International conventions regulate the trade and use of controlled medications, including many opioids. The goal is to balance widespread access to optimal forms of pain management with restrictions to govern the use and prevent the misuse of controlled substances. Those conventions are failing to meet their goals. International guidelines to inform national legislation have been compromised and withdrawn, thanks to undue interference from US‐based opioid manufacturers. The new goal must be to ensure equitable access, for all, to opioids and ensure that optimal pain management becomes a central component of Universal Health Coverage.

Significance

The opioid crisis is, more accurately, a multicomponent global crisis and one that is not fully apparent or well understood. Regulations of the wealthy and powerful to control a surfeit of opioids, which encourages misuse, cannot be allowed to govern legislation in the majority of countries worldwide where citizens have little or no access to opioids to reduce pain and suffering. International conventions must be revised to ensure an optimal balance that allows access to opioids for all those who need them.

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Opioids: A ‘crisis’ of too much or not enough – or simply how rich you are and where you live?

Abstract

The ‘Opioid Crisis’, which originated in Western countries, has been misrepresented and is misinforming the global public. For 20 years, since the advent of the synthetic opioids, 25,000 Americans, on average, have died annually from opioid‐related overdoses. The United States produces and consumes by far the greatest amounts of opioids. National regulations introduced to curb overdoses and restrict opioid availability have condemned many Americans, such as cancer patients or those in need of palliative care, to a life of extreme pain due to lack of access to adequate pain management. As is often the case, US‐driven laws have informed and guided international regulations. Worldwide, 83% of countries have low or non‐existent access to opioids for pain relief. Over 25 million people are at the end‐of‐life stage, with eight million people dying annually in unnecessary pain and distress. Ineffectively controlled pain is a global public health issue blighting the lives of billions of people worldwide with immeasurable human and socioeconomic costs. International conventions regulate the trade and use of controlled medications, including many opioids. The goal is to balance widespread access to optimal forms of pain management with restrictions to govern the use and prevent the misuse of controlled substances. Those conventions are failing to meet their goals. International guidelines to inform national legislation have been compromised and withdrawn, thanks to undue interference from US‐based opioid manufacturers. The new goal must be to ensure equitable access, for all, to opioids and ensure that optimal pain management becomes a central component of Universal Health Coverage.

Significance

The opioid crisis is, more accurately, a multicomponent global crisis and one that is not fully apparent or well understood. Regulations of the wealthy and powerful to control a surfeit of opioids, which encourages misuse, cannot be allowed to govern legislation in the majority of countries worldwide where citizens have little or no access to opioids to reduce pain and suffering. International conventions must be revised to ensure an optimal balance that allows access to opioids for all those who need them.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3mnNJFz
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Opioids: A ‘crisis’ of too much or not enough – or simply how rich you are and where you live?

Abstract

The ‘Opioid Crisis’, which originated in Western countries, has been misrepresented and is misinforming the global public. For 20 years, since the advent of the synthetic opioids, 25,000 Americans, on average, have died annually from opioid‐related overdoses. The United States produces and consumes by far the greatest amounts of opioids. National regulations introduced to curb overdoses and restrict opioid availability have condemned many Americans, such as cancer patients or those in need of palliative care, to a life of extreme pain due to lack of access to adequate pain management. As is often the case, US‐driven laws have informed and guided international regulations. Worldwide, 83% of countries have low or non‐existent access to opioids for pain relief. Over 25 million people are at the end‐of‐life stage, with eight million people dying annually in unnecessary pain and distress. Ineffectively controlled pain is a global public health issue blighting the lives of billions of people worldwide with immeasurable human and socioeconomic costs. International conventions regulate the trade and use of controlled medications, including many opioids. The goal is to balance widespread access to optimal forms of pain management with restrictions to govern the use and prevent the misuse of controlled substances. Those conventions are failing to meet their goals. International guidelines to inform national legislation have been compromised and withdrawn, thanks to undue interference from US‐based opioid manufacturers. The new goal must be to ensure equitable access, for all, to opioids and ensure that optimal pain management becomes a central component of Universal Health Coverage.

Significance

The opioid crisis is, more accurately, a multicomponent global crisis and one that is not fully apparent or well understood. Regulations of the wealthy and powerful to control a surfeit of opioids, which encourages misuse, cannot be allowed to govern legislation in the majority of countries worldwide where citizens have little or no access to opioids to reduce pain and suffering. International conventions must be revised to ensure an optimal balance that allows access to opioids for all those who need them.

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Pain regulation during mindfulness meditation: phenomenological fingerprints in novices and experts practitioners

Abstract

Background

The way people respond to pain is based on psychological mechanisms, beliefs and expectations. Mindfulness meditation (MM) has been shown to regulate pain and mental suffering through different mechanisms such as positive reappraisal, attentional and emotional regulation. Yet, subjective experience and meaning of pain in connection with MM are still largely unexplored.

Methods

The present mixed‐methods study combined an interpretative‐phenomenological qualitative approach with an experimental thermal pain paradigm to explore and compare the meaning of experiencing pain in 32 novices who received short meditation training and 30 experts in meditation practice (more than 10, 000 hours in life). We collected the qualitative data during in‐depth semi‐structured interviews where we probed participants’ response strategies. During the pain task, we collected self‐reports of intensity and unpleasantness, while after the task we collected self‐reports of avoidance, openness, vividness and blissfulness.

Results

Five phenomenological clusters (PhC) emerged from the interviews, including three which described pain as an unpleasant sensation calling for: 1) experiential avoidance‐suppression, 2) volitional agency‐distanciation, or 3) a positive cognitive reappraisal and flexibility. Two additional clusters (4‐5), containing mostly expert meditators, thematized pain sensation as an opportunity to gain metacognitive insights about mental processes, and to deconstruct one’s suffering through these insights. PhC5 further integrates these insights with the recognition that suffering is part of the shared human experience and with the aspiration to relieve others from suffering. Each PhC was correlated to a unique profile of self‐reports during the pain paradigm.

Conclusion

These findings need to be replicated in patients with severe and chronic pain and practicing MM. They also warrant the integration of this mixed‐method approach with brain imaging data to refine the experiential neuroscience of pain.

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