The Clinical Journal Of Pain[JOURNAL]
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200 papers
Pain-Related and General Distress Among Adults Seeking Pain Psychology Treatment: A Latent Profile Analysis.
Aaron RV, Pasko KM, Johnson SMS … +1 more , Rassu FS
Clin J Pain · 2026 Jun · PMID 42338250 · Publisher ↗
OBJECTIVES: People with chronic pain often experience symptoms of pain-related distress (kinesiophobia, catastrophizing) and general distress (depression, anxiety). Identifying distinct profiles of distress among patient...
OBJECTIVES: People with chronic pain often experience symptoms of pain-related distress (kinesiophobia, catastrophizing) and general distress (depression, anxiety). Identifying distinct profiles of distress among patients seeking pain psychology treatment can inform personalized pain psychology interventions. Among adults seeking pain psychology treatment, the current study applied latent profile analysis (LPA) to (1) identify distinct patient symptom profiles (based on kinesiophobia, catastrophizing, depression, anxiety) and (2) characterize pain-related symptoms and demographics of each profile. METHODS: Adults scheduled for a pain psychology evaluation who completed a clinical battery of patient-reported outcome measures were included. LPA was applied to identify distinct subgroups of patients based on psychological symptoms. The resulting groups were compared on pain-related and demographic factors. RESULTS: Participants were 548 adults (Mean Age=51.1; predominantly white [66.6%] and female [67.5%]). Two profiles were identified: "Global Distress" (67.2%, elevated clinical symptoms in all domains) and "Localized and Mild Kinesiophobia" (32.8%, sub-clinical symptoms in all domains, except mild kinesiophobia). The "Global Distress" group was younger (d=.23) and had higher levels of area deprivation (d=.23). They had higher pain intensity (d=.76), functional disability (d=.72), and opioid misuse risk (d=1.21). DISCUSSION: Among adults seeking pain psychology treatment, most experienced elevated distress across pain-specific and general domains. A minority experienced sub-clinical symptoms, with focal and mild kinesiophobia. The findings highlight a wide range of pain psychology needs among adults with chronic pain seeking psychology treatment, and highlight the value in treatment options that span intensity and breadth.
Parent Pain Catastrophizing Mediates the Relationship Between Child Pain Catastrophizing and School-Related Functioning.
Frye WS, Ward SR, Woods B … +1 more , Cucchiaro G
Clin J Pain · 2026 Jun · PMID 42332957 · Publisher ↗
OBJECTIVES: This study examined whether child and parent pain catastrophizing were associated with school functioning in youth with chronic pain. Relationships between catastrophizing and school absences, school tardines...
OBJECTIVES: This study examined whether child and parent pain catastrophizing were associated with school functioning in youth with chronic pain. Relationships between catastrophizing and school absences, school tardiness, and academic performance were evaluated, and parent catastrophizing was tested as a potential mediator between child catastrophizing and school outcomes. METHODS: Youth with chronic pain and their caregivers completed measures of pain catastrophizing and school functioning (school absences, school tardiness, grade point average [GPA]). Correlations, linear regressions, and PROCESS Model 4 mediation analyses were conducted. School functioning was also compared between youth attending in-person versus homeschool or online. RESULTS: Participants were 559 (Mage=15.2) predominantly female (76.9%) and white (90.7%) youth with chronic pain. Youth enrolled in homeschool or online had significantly higher child and parent catastrophizing than those attending in-person school. Parent pain catastrophizing was significantly associated with more absences, more tardiness, and lower GPA. Child catastrophizing was only correlated with increased absences. When both were entered into the same models, parent catastrophizing remained a significant predictor of absences and tardiness, whereas the association between child catastrophizing and absences was no longer significant. Mediation analyses demonstrated parent catastrophizing fully mediated the association between child catastrophizing and school absences; no mediation effects were observed for tardiness or GPA. DISCUSSION: Parent pain catastrophizing appears to play a critical role in school attendance for youth with chronic pain and mediates the association between child catastrophizing and school absences. Findings highlight the importance of addressing parent cognitions in interventions targeting school engagement.
Clinical Phenotypes in Frozen Shoulder Based on Psychological and Sensory Phenotypes: Associations with Pain and Disability Over Time.
Matias-Soto J, Luque-Suarez A, Dueñas L … +3 more , Struyf F, Meeus M, Mertens MGCAM
Clin J Pain · 2026 Jun · PMID 42226506 · Publisher ↗
OBJECTIVES: This study aimed to identify phenotypes of people with frozen shoulder (FS) based on baseline measures including pain intensity, disability, pain-related psychological factors, and measures of central pain pr...
OBJECTIVES: This study aimed to identify phenotypes of people with frozen shoulder (FS) based on baseline measures including pain intensity, disability, pain-related psychological factors, and measures of central pain processing. A secondary objective was to evaluate whether these baseline phenotypes were associated with distinct longitudinal trajectories of pain intensity and disability over 9 months. METHODS: People with FS were assessed at baseline for clinical (pain intensity and disability) and psychophysical variables (pain catastrophizing and hypervigilance, self-reported symptoms related to central sensitization, primary and secondary allodynia and hyperalgesia, and pain modulation). A latent profile analysis was conducted using baseline clinical and psychophysical variables. Linear mixed models were then used to examine longitudinal trajectories of pain intensity and disability across phenotypes over 3, 6, and 9 months. RESULTS: A total of 149 people with FS were recruited. Two distinct phenotypes were identified, of which phenotype 2 (n=70) presented higher intensity of pain, greater disability, and higher scores for pain catastrophizing, hypervigilance, and central sensitization-related symptoms at baseline compared to phenotype 1 (n=79). Over 9 months, trajectories differed by phenotype. Phenotype 2 exhibited a greater absolute reduction in both pain and disability, yet phenotype 1 remained lower at all time points, including 9 months, for both outcomes. DISCUSSION: This study highlights two distinct phenotypes in people with FS based on baseline clinical and psychophysical variables. These phenotypes showed distinct trajectories of pain and disability over 9 months, supporting the relevance of baseline phenotyping for understanding clinical heterogeneity in FS.
Effect of Pain Neuroscience Education on Pain, Sleep and Psychosocial factors in Chronic Musculoskeletal Pain Conditions: A Systematic Review and Meta-analysis.
Khan Z, Sehgal CA, Rehman S … +3 more , Abbas A, Iram I, Veqar Z
Clin J Pain · 2026 Jun · PMID 42219959 · Publisher ↗
OBJECTIVE: This systematic review and meta-analysis examined the efficacy of pain neuroscience education (PNE) on pain, sleep parameters and psychosocial factors in chronic musculoskeletal pain conditions in adults and a...
OBJECTIVE: This systematic review and meta-analysis examined the efficacy of pain neuroscience education (PNE) on pain, sleep parameters and psychosocial factors in chronic musculoskeletal pain conditions in adults and adolescents. METHODS: The review was conducted in accordance with PRISMA guidelines. A systematic search was performed using the databases of Medline (PubMed), Scopus, PEDro and Web of Science. The qualitative assessment was done by using Physiotherapy Evidence Database (PEDro) scale and Cochrane's risk of bias (ROB 2.0) tool. The quantitative analysis was performed using the Rev Man 5.4.1 using a random effects model, SMD with 95% confidence intervals and certainty of evidence was evaluated using GRADEpro/GDT. RESULTS: Twelve randomised-controlled trials (n=1485) met the inclusion criteria. The meta-analysis showed statistically significant effect in favour of PNE on reducing pain intensity (SMD: -0.27 [95% CI, -0.5 to 0.00; I2=67%]) and total sleep time with small to medium effect size (SMD: 0.42 [95% CI, 0.12 to 0.71; I2=0%]). However, no statistically significant differences were observed for other sleep parameters and psychosocial outcomes, despite some outcomes indicating a moderate clinical effect. DISCUSSION: The findings suggest that PNE alone can reduce pain intensity, but greater improvements in sleep and psychosocial outcomes are seen when it is combined with interventions such as CBT and therapeutic exercises. These results highlight the potential role of PNE within a multimodal approach to pain management, while also underscoring the need for further research on its impact on sleep parameters in a specific population.
Medically Unexplained Symptoms: A Systematic Umbrella Review of Current Terminology and Reported Rationales.
Myles AB, Ejova A, de Zoete RMJ … +2 more , Ghaemi Mahdavi E, Roberts RM
Clin J Pain · 2026 May · PMID 42178866 · Publisher ↗
OBJECTIVES: This review addresses current naming conventions for Medically Unexplained Symptoms (MUS) through a systematic umbrella review. Terminology used and provided rationales were considered. METHODS: Registered wi...
OBJECTIVES: This review addresses current naming conventions for Medically Unexplained Symptoms (MUS) through a systematic umbrella review. Terminology used and provided rationales were considered. METHODS: Registered with PROSPERO (CRD42024526020), this review searched eight key databases, last on January 28, 2025. Reviews including medically unexplained symptoms (or synonym or subtype) in their systematic search terms were included (N=422). RESULTS: A total of 577 references to 111 terms were made across the reviews, with numerous reviews using the same overarching terms, including "functional" (n=233), "somatic" (or variants thereof, n=51) and "medically unexplained" (n=28). Thirty percent of terms (n=179) were to specific syndromes or terms that did not group together under an overarching term, suggesting substantial variability in terms, even though over 60% of authors were primarily associated with just three disciplines - medicine, allied health, and psychology. A subset of 23 reviews provided rationales that underwent a content analysis and ROBIS risk-of-bias assessment. This analysis showed that rationales tended to (1) highlight differences between psychological, psychiatric and other medical fields (n=7), (2) focus on the patient perspective and patient-practitioner therapeutic relationship (n=10), or (3) follow broad and/or commonly used terms (n=7). DISCUSSION: The current landscape of terminology used for MUS remains varied, nuanced, and inconsistent between disciplines. Moving forward to more universal language accepted and used by both patients and practitioners would aid in the diagnosis, management, and treatment of MUS.
Impact of Early Pain Clinic Consultation and Underlying Conditions on Postherpetic Neuralgia Outcomes: A 10-Year Retrospective Cohort Study.
Yu H, Lee C, Cho Y … +1 more , Kim J
Clin J Pain · 2026 May · PMID 42178855 · Publisher ↗
OBJECTIVES: Postherpetic neuralgia (PHN) is a common and debilitating complication of herpes zoster (HZ). We evaluated whether earlier pain-clinic consultation was associated with improved PHN outcomes, including inciden...
OBJECTIVES: Postherpetic neuralgia (PHN) is a common and debilitating complication of herpes zoster (HZ). We evaluated whether earlier pain-clinic consultation was associated with improved PHN outcomes, including incident PHN, recurrence, and pain response. METHODS: In a ten-year retrospective cohort, we included adults with dermatologist-confirmed HZ referred for pain-clinic consultation. Patients were classified as having early (≤14 d from HZ diagnosis) or late/no consultation. After 1:1 propensity score matching (n=200 per group), we compared incident PHN, defined as persistent dermatomal pain at ≥90 days with numerical rating scale (NRS) ≥3, PHN recurrence, and clinically meaningful pain improvement (NRS decrease ≥2). PHN was adjudicated using structured NRS documentation and clinician notes; standardized neuropathic pain questionnaires were not routinely available. RESULTS: Compared with the late or no consultation group, the early consultation group showed lower incident PHN (RR 0.60, 95% CI 0.38-0.96, P=0.010), lower recurrence (RR 0.50, 95% CI 0.24-0.94, P=0.030), and greater pain improvement (RR 1.33, 95% CI 1.17-1.52, P <0.001). In adjusted models, late consultation (odds ratio [OR] 2.10, 95% CI 1.23-3.59) and autoimmune disease (OR 2.71, 95% CI 1.05-6.99) were associated with higher PHN risk. DISCUSSION: Earlier pain-clinic consultation was associated with lower PHN incidence and greater pain improvement, with a similar direction of effect for recurrence. These findings should be interpreted as a care-pathway association rather than a direct treatment effect, because referral timing may also reflect patient, physician, and health-system factors.
Beyond Pain Intensity: Development and Validation of the Multidimensional Chronic Pain Self-Efficacy Scale (M-CPSES).
Liang HT, Chong YB, Chang CH … +2 more , Lieu AS, Wang WH
Clin J Pain · 2026 May · PMID 42163808 · Publisher ↗
OBJECTIVES: To develop de novo the Multidimensional Chronic Pain Self-Efficacy Scale (M-CPSES), a brief multidimensional measure of self-efficacy in chronic pain, and to examine its psychometric properties in adults with...
OBJECTIVES: To develop de novo the Multidimensional Chronic Pain Self-Efficacy Scale (M-CPSES), a brief multidimensional measure of self-efficacy in chronic pain, and to examine its psychometric properties in adults with chronic pain recruited from a university-affiliated neurosurgery service. METHODS: Participants (N=152) completed an initial item pool developed in Mandarin Chinese on the basis of Bandura's self-efficacy theory, Corbin and Strauss's self-management framework, clinician consultation, patient-informed refinement, and expert review. Exploratory factor analysis (EFA) was conducted on the first 100 participants, and confirmatory factor analysis (CFA) was conducted in the full sample, which included the EFA subsample. RESULTS: CFA supported a second-order, four-factor, nine-item model representing medical, daily life, emotional, and cognitive domains, with good model fit. Reliability for the total score was good (Cronbach's α=.84; test-retest intraclass correlation coefficient=.73). Correlations were consistent with theoretical expectations, with positive associations with general self-efficacy, self-esteem, and physical functioning and negative associations with depression, anxiety, and pain intensity. Known-groups validity was supported by lower scores in individuals with severe pain than in those with mild to moderate pain. DISCUSSION: The M-CPSES provides a concise multidimensional assessment that includes the often-overlooked cognitive aspect of chronic pain self-management. The findings support its potential utility for screening, individualized care planning, and outcome monitoring in Mandarin-speaking adults with chronic pain receiving specialty care.
Continuous Ultrasound-Guided Erector Spinae Plane Block Versus Thoracic Paravertebral Block for Postoperative Analgesia in Patients Undergoing Thoracotomy.
Habeeb RM, Sultan WA, Basune ME … +1 more , Safan AG
Clin J Pain · 2026 May · PMID 42145113 · Publisher ↗
OBJECTIVES: To compare postoperative analgesia using continuous ultrasound-guided Erector spinae plane block versus Thoracic Paravertebral Block, with dynamic visual analogue scale (VAS) during coughing as the primary ou...
OBJECTIVES: To compare postoperative analgesia using continuous ultrasound-guided Erector spinae plane block versus Thoracic Paravertebral Block, with dynamic visual analogue scale (VAS) during coughing as the primary outcome. Secondary outcomes included static VAS (at rest), hemodynamic changes, side effects, total opioid consumption, time of first rescue analgesia, length of hospitalization, anesthesia recovery time, Post-Anesthesia Care Unit stay, time to first ambulation, and patient satisfaction. METHODS: The study included 40 cases scheduled for elective thoracotomy admitted to the cardiothoracic surgery unit of Menoufia University Hospital. Subjects were equally randomized into two groups 20 patients each receiving either ultrasound guided Erector Spinae Plane Block ESPB or Thoracic Paravertebral Block TPVB (control group). Both groups received 20 mL of 0.25% bupivacaine as a loading dose followed by continuous infusion of 0.125% bupivacaine at 5 mL/h, with patient-controlled boluses of 20 mL on demand. RESULTS: Dynamic Visual Analogue Scale scores were significantly lower in the ESPB group at 6, 9, 12, and 24 hours (P=0.008, 0.035, 0.001, 0.006). Morphine consumption was significantly reduced in the ESPB group (P<0.001). Hypotension was more frequent in TPVB (40% vs 10%, P=0.028). No significant differences were observed in hospital stay or patient satisfaction. DISCUSSION: The utilization of continuous ultrasound-guided ESPB demonstrated better postoperative Visual Analogue Scale scores significant decrease in opioid consumption, with fewer side effects than TPVB.
The Efficacy of Erector Spinae Plane Block Versus Subcostal Transversus Abdominis Plane Block in Laparoscopic Nephrectomy: A Randomized Clinical Trial.
Ollaek M, Aboudorra O, Goma H … +2 more , Taha A, Bakr H
Clin J Pain · 2026 May · PMID 42145106 · Publisher ↗
OBJECTIVES: This study compared the efficacy and safety of erector spinae plane block (ESPB) versus subcostal transversus abdominis plane (TAP) block in reducing postoperative pain among patients undergoing laparoscopic...
OBJECTIVES: This study compared the efficacy and safety of erector spinae plane block (ESPB) versus subcostal transversus abdominis plane (TAP) block in reducing postoperative pain among patients undergoing laparoscopic nephrectomy. METHODS: This randomized, clinical trial enrolled 70 adult patients, ASA physical status I or II, who underwent total (radical) laparoscopic nephrectomy under general anesthesia. Patients were randomly assigned to two groups. Group ESPB received an ultrasound-guided Erector Spinae Plane Block at the T7 transverse process level, while Group TAP received an ultrasound-guided subcostal TAP Block. The primary outcome was the total amount of morphine consumed at 6 and 24 hours postoperatively. Secondary outcomes included the incidence of patients requiring opioid analgesia, time to rescue analgesia, visual analogue scale, time to postoperative ambulation, intraoperative and postoperative hemodynamics, arterial partial pressure of oxygen to fraction of inspired oxygen (PaO₂/FiO₂ or P/F) ratio, and incidence of complications. RESULTS: Compared to TAP group, ESPB group exhibited significantly lower median morphine consumption at 24 hours (P=0.032), prolonged time to first analgesic rescue (P=0.049), and lower incidence of rescue morphine requirement (OR=0.23; 95% CI=0.06-0.94; P=0.031), with lower visual analogue scale scores at 12, 18, and 24 hours postoperatively (P<0.001). The mean arterial blood pressure and heart rates were comparable between groups. No significant adverse effects from either approach. DISCUSSION: In laparoscopic nephrectomy, ultrasound-guided ESPB may safely and effectively be used to improve pain management, lower pain intensity, with stable hemodynamics and comparable risk of postoperative complications to the ultrasound-guided subcostal TAP block.
The Validation of the Patients Endorsement of the Biopsychosocial Model of Chronic Pain (PEB) Scale in Young Adults with Chronic Pain.
Sanyer M, Garland EL, Barke A … +1 more , Kleinstäuber M
Clin J Pain · 2026 May · PMID 42085199 · Publisher ↗
OBJECTIVES: To validate the Patients Endorsement of the Biopsychosocial Model of Chronic Pain (PEB) Scale in young adults with chronic pain, assessing psychometric properties and associations with pain beliefs and readin...
OBJECTIVES: To validate the Patients Endorsement of the Biopsychosocial Model of Chronic Pain (PEB) Scale in young adults with chronic pain, assessing psychometric properties and associations with pain beliefs and readiness for pain self-management. METHODS: A cross-sectional survey was administered to 240 young adults with chronic pain (≥3 months) via Prolific. Participants completed the PEB Scale and measures assessing readiness for pain self-management, pain beliefs, psychological variables, and pain characteristics. Reliability, factor structure, convergent/discriminant validity, and incremental validity were all assessed. RESULTS: In the sample, the PEB Scale had a good internal consistency (Cronbach's α=.88). Factor analysis confirmed an unifactorial structure. Convergent validity was supported through a moderate correlation between the PEB Scale and readiness for pain self-management (PSOCQ Contemplation subscale, r=.32, P=.001). The scale also showed small-moderate correlations with pain interference (r=.25, P=.001) and psychological measures. Hierarchical regression analyses revealed the PEB Scale was associated with an increased chance to be in the contemplation phase (=.042, P<.001) or action/maintenance phase (=.021, P<.05) of pain self-management, when controlling for demographics, pain characteristics, beliefs, and psychological factors. DISCUSSION: Higher PEB scores were associated with greater contemplation of and engagement in the self-management of chronic pain. The scale appears to be conceptually different from existing pain belief and psychological measures. Limitations include the use of self-report measures, limited effect sizes and demographic homogeneity of our sample. Future studies should test the scale in diverse groups, explore its sensitivity to change, and clinical utility.
Operant Approach Activity Pacing Interventions for the Management of Chronic Pain: A Systematic Review.
Antcliff D, Burns L, English E … +7 more , MacKenzie R, Geraghty AWA, Marriott-Smith J, Stansfield R, Storms K, Jinks C, Holden MA
Clin J Pain · 2026 May · PMID 42085181 · Publisher ↗
OBJECTIVES: Operant approach activity pacing (undertaking activities according to quotas, e.g. amount/time/goal rather than according to symptom severity) is advised for chronic pain. There is no standardised interventio...
OBJECTIVES: Operant approach activity pacing (undertaking activities according to quotas, e.g. amount/time/goal rather than according to symptom severity) is advised for chronic pain. There is no standardised intervention that addresses all the components of operant approach activity pacing. This systematic review aimed to identify operant approach activity pacing interventions for chronic pain and explore their components, effectiveness, feasibility and acceptability. METHODS: Eligible studies included any type of evaluation (e.g. randomised controlled trials, feasibility/pilot, qualitative) among adults with chronic pain. Ineligible studies included interventions based on energy conservation/envelope theory/adaptive pacing therapy/symptom-contingency, and non-English language. Databases included: MEDLINE, Embase, CINAHL, AMED, PsycINFO, Cochrane CENTRAL, PEDro, OTseeker and Web of Science (from database inception to 26th March 2025). Two independent reviewers extracted data, including descriptions of interventions (TIDieR checklist), appraised risk of bias (Joanna Briggs Institute checklists) and evaluated confidence in the research (GRADE). Findings were synthesised narratively. RESULTS: Nine studies (10 interventions; 11 papers) were included (873 participants). Interventions were heterogeneous in content, length (2-11 sessions) and tailored/untailored to participants' baseline behaviours. Common intervention components were pre-planning, activity-rest cycling/using rests and alternating activities/positions. Direction of effect (vote counting) was towards improved function, but mixed findings for pain/fatigue. DISCUSSION: Studies showed mixed findings across outcomes, syntheses were limited to vote counting, with very low confidence in the evidence; limiting conclusions about effectiveness. The multiple components of activity pacing can be considered to further develop and test the effectiveness of operant activity pacing for chronic pain. Funder: NIHR School for Primary Care Research. (PROSPERO:CRD42023451469).
External Oblique Intercostal Plane Block for Postoperative Analgesia in Thoracoabdominal Procedures: A Systematic Review and meta-analysis.
Batista da Silva Neto E, de Carvalho JPA, Peregrino MR … +3 more , de Souza Ferreira P, de Araújo Azi LMT, Alves RL
Clin J Pain · 2026 Apr · PMID 42027023 · Publisher ↗
OBJECTIVES: The primary objective was to analyze the efficacy of EOIPB in reducing use of opioids in postoperative period. Time and need for rescue analgesia, postoperative pain scores and incidence of nausea and vomitin...
OBJECTIVES: The primary objective was to analyze the efficacy of EOIPB in reducing use of opioids in postoperative period. Time and need for rescue analgesia, postoperative pain scores and incidence of nausea and vomiting were also evaluated. METHODS: The review followed the PRISMA guidelines and was registered on PROSPERO (CRD42024622945). Randomized clinical trials that included adults undergoing thoracoabdominal surgery, comparing EOIPB with general anesthesia, multimodal anesthesia, or other regional blocks, were selected. Search was performed on May 2025 in PubMed, Embase, Scopus, and Cochrane Library databases, with no time or language restrictions. Certainty of the evidence was assessed using GRADE system. RESULTS: Fifteen studies involving 899 patients were identified. Results indicated that EOIPB significantly reduced opioid consumption in the first 24 hours postoperatively, compared with standard analgesia (MD = -19.55; 95% CI [-28.50, -10.60]; P < 0.0001, I2 = 72%) and other regional blocks (MD = -13.15; 95% CI [-24.77, -1.52]; P = 0.03, I2 = 95%). Heterogeneity was considered moderate to high among studies, related to differences in samples, anesthetic protocols, and assessment methods. Outcomes associated with postoperative pain have a low to very low quality of evidence according to the GRADE method. DISCUSSION: The findings support the clinical potential of EOIPB as an effective strategy for postoperative pain control, but without indication for adoption in clinical practice routine, limited to situations of failure of first-line techniques in analgesia, such as epidural anesthesia.
Pain Distribution and its Association With Neuropathic Pain Features and Assumed Central Sensitization in Acute Whiplash-Associated Disorders: A Cross-Sectional Study.
De-La-Rosa-Castilla F, Anarte-Lazo E, Falla D … +3 more , Bernal-Utrera C, Rodríguez-Blanco C, Barbero M
Clin J Pain · 2026 Apr · PMID 42021618 · Publisher ↗
OBJECTIVES: This study aimed to evaluate pain distribution in people with acute whiplash associated disorders (WAD) and explore its association with neuropathic pain and assumed central sensitization features. Although w...
OBJECTIVES: This study aimed to evaluate pain distribution in people with acute whiplash associated disorders (WAD) and explore its association with neuropathic pain and assumed central sensitization features. Although widespread pain is common after a whiplash injury, the relationship between pain extent (the area of the body perceived as painful) and underlying pain-related mechanisms in acute WAD remains poorly understood. METHODS: In this cross-sectional study, 124 individuals (mean age: 39.7±11.2 y; 67 females) with acute WAD grade II (7-30 d post-injury) completed questionnaires assessing neck pain intensity, disability, neuropathic pain (S-LANSS), and assumed central sensitization (CSI). Pain drawings were analyzed with a validated image-processing algorithm to quantify pain extent. Correlation and multiple linear regression analyses were performed to identify predictors of pain extent. RESULTS: Bivariate correlations showed that pain extent was significantly associated with all clinical variables, with the strongest correlation observed between pain extent and S-LANSS (ρ=0.816, P<.001). In the multiple regression model, only S-LANSS was a significant predictor of PE (β=0.705, P<.001), explaining 64% of the variance. A moderate correlation (ρ=0.437) was found between CSI and pain extent, but the CSI did not independently predict pain extent. No sex differences were observed for any clinical variable. DISCUSSION: This is the first study to show a strong association between neuropathic pain features and widespread pain in people with acute WAD. These findings highlight the potential utility of assessing pain extent and neuropathic pain features to identify pain phenotypes early after injury which may support more individualized treatment approaches.
Efficacy of a Modified Cocktail for Quadratus Lumborum Block combined With Periarticular Local Infiltration Analgesia in Total Hip Arthroplasty.
Zeng Y, Hu J, Yang J … +1 more , Ma J
Clin J Pain · 2026 Apr · PMID 42015674 · Publisher ↗
OBJECTIVES: Quadratus lumborum block(QLB) and periarticular local infiltration analgesia(LIA) are both widely used for postoperative pain control in total hip arthroplasty. The additive benefit of using a modified anesth...
OBJECTIVES: Quadratus lumborum block(QLB) and periarticular local infiltration analgesia(LIA) are both widely used for postoperative pain control in total hip arthroplasty. The additive benefit of using a modified anesthetic cocktail remains uncertain when both techniques incorporate active adjuvants. METHODS: In this randomized controlled trial, 70 patients undergoing unilateral total hip arthroplasty under general anesthesia were randomized to receive either QLB combined with LIA (QLB+LIA group) or LIA alone. Both groups received an identical modified analgesic cocktail composed of ropivacaine, dexamethasone, magnesium sulfate, and sodium bicarbonate. The primary outcome was total opioid consumption within 24 hours postoperatively. Secondary outcomes included intraoperative remifentanil usage, numerical rating scale pain scores, plasma ropivacaine concentrations, quadriceps muscle strength, daily walking distance, quality of recovery-15 score, inflammatory markers , and adverse events. RESULTS: Compared to the LIA group, the QLB+LIA group showed significantly reduced 24-hour opioid consumption (12.7±4.7 mg vs. 16.2±7.3 mg; P=0.026) and intraoperative remifentanil use (P=0.034). Numerical rating scale pain scores during mobilization at 12 and 24 hours were lower in the QLB+LIA group. No differences were observed in functional recovery or inflammatory responses. Plasma ropivacaine levels remained below toxicity thresholds in both groups. CONCLUSION: Compared with LIA alone, added LIA to QLB with a modified cocktail can reduce the use of opioids and reduce the postoperative pain score during mobilization within 24 hours after the operation.
Efficacy and Safety of Dorsal Root Ganglion Pulse Radiofrequency Combined With Sympathetic Radiofrequency Ablation in the Treatment of Acute Herpetic Neuralgia.
Xu P, Yu M, Fan H … +1 more , Fei Y
Clin J Pain · 2026 Apr · PMID 42015656 · Publisher ↗
OBJECTIVES: To explore the efficacy and safety of pulsed radiofrequency combined with sympathetic radiofrequency ablation of dorsal root ganglion in the treatment of acute herpetic neuralgia. METHODS: A total of 116 pati...
OBJECTIVES: To explore the efficacy and safety of pulsed radiofrequency combined with sympathetic radiofrequency ablation of dorsal root ganglion in the treatment of acute herpetic neuralgia. METHODS: A total of 116 patients diagnosed with acute herpetic neuralgia were randomly assigned to two groups: a dorsal root ganglion pulsed radiofrequency group (Group C) and a dorsal root ganglion pulsed radiofrequency combined with sympathetic radiofrequency ablation group (Group H). The treatment effects were evaluated using the Numerical Rating Scale, the Pittsburgh Sleep Quality Index, the proportion of patients utilizing tramadol, and the Current Perception Threshold detection. Additionally, serum levels of Galectin-3 and Interleukin-6 were measured as objective biological indicators to assess the therapeutic efficacy. The incidence of Postherpetic Neuralgia and any complications were recorded for both groups. RESULTS: Data showed that compared with group C, the Numerical Rating Scale, Pittsburgh Sleep Quality Index score, the proportion of patients using tramadol, and serum Galectin-3 and Interleukin-6 levels were significantly decreased, and Current Perception Threshold was significantly increased in group H (P<0.05). The incidence of Postherpetic Neuralgia in group H was significantly lower than that in group C. No serious adverse reactions occurred in the two groups after treatment. DISCUSSION: Dorsal root ganglion pulsed radiofrequency combined with sympathetic radiofrequency ablation is more effective in the treatment of acute herpetic neuralgia. Compared with PRF therapy alone, it provides patients with longer lasting pain relief, reduces the incidence of PHN, and improves the quality of life.
Methodological Considerations in Studies of Preoperative Pain Education for Cesarean Delivery.
Huang YP, Ku HP, Lu CW
Clin J Pain · 2026 May · PMID 41978526 · Publisher ↗
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Association Between Pain-Related Kinesiophobia and Sedentary Behavior in Older Patients with Lumbar Spine Disease.
Okawa K, Yamamoto Y, Kojima I … +12 more , Terao Y, Tanaka S, Saegusa H, Nambu M, Matsumoto H, Saito M, Soma S, Haga N, Suzuki H, Takahashi Y, Suzuki M, Yamada M
Clin J Pain · 2026 Apr · PMID 41947602 · Publisher ↗
OBJECTIVES: In older patients with lumbar spine disease, kinesiophobia caused by pain may influence SB independent of physical activity (PA). Understanding this association may lead to the development of new non-pharmaco...
OBJECTIVES: In older patients with lumbar spine disease, kinesiophobia caused by pain may influence SB independent of physical activity (PA). Understanding this association may lead to the development of new non-pharmacological strategies for managing such patients. The present study aimed to investigate whether pain-related kinesiophobia influences sedentary behavior (SB) in older patients with lumbar spine disease. METHODS: This study included 106 outpatients with lumbar spine disease, all aged > 65 years. The outcome measurements were daily step count and self-reported daily SB, calculated as the average of seven consecutive days. Kinesiophobia was assessed using the Tampa scale for kinesiophobia (TSK). Statistical analyses were performed using multiple regression analysis. RESULTS: The mean age of the participants was 77.6 ± 5.9 years, and 70 of them (77.0%) were female. The median (interquartile range) Visual Analog Scale score for pain and numbness was 23.9 (10.4-47.2) mm. The median daily step count was 3627.3 (2166.9-4419.9) steps per day, and the mean daily SB was 424.9 ± 165.6 minutes per day. The mean TSK score was 40.5 ± 4.7. Multiple regression analysis revealed that both daily step count (B=-0.01, β=-0.22, 95% confidence interval [CI]=-0.02-0.00, P=0.032) and SB (B=10.33, β=0.29, 95% CI=3.00-17.69, P=0.006) were independently associated with the TSK score. DISCUSSION: Our results suggest that increased kinesiophobia may be associated with increased SB, independent of PA. Addressing kinesiophobia in older patients with lumbar spine disease may prevent a decrease in PA and increase in SB, thereby offering a new treatment strategy.
Transversus Abdominis Plane Block With Dexmedetomidine and Local Anesthetics compared with Local Anesthetics Isolated for Patients Undergoing Cesarean Section: A Systematic Review and Meta-Analysis.
Novaes LGC, Oliveira DM, Donato AB … +2 more , Souza PFLE, Erdmann TR
Clin J Pain · 2026 Apr · PMID 41937563 · Publisher ↗
OBJECTIVES: Dexmedetomidine is a short-term sedative used for peripheral nerve blockade and spinal anesthesia. This meta-analysis evaluated efficacy and safety of dexmedetomidine in TAP block in C-section. METHODS: A sys...
OBJECTIVES: Dexmedetomidine is a short-term sedative used for peripheral nerve blockade and spinal anesthesia. This meta-analysis evaluated efficacy and safety of dexmedetomidine in TAP block in C-section. METHODS: A systematic search across online databases comparing dexmedetomidine with local anesthetics to local anesthetics isolated in TAP block for women undergoing spinal anesthesia for cesarean section. Significance was defined at P<0.05 for odds ratios (OR), mean differences (MD), and standard mean differences (SMD). Heterogeneity weas evaluated using I² statistics. Twelve randomized controlled trials (RCTs) encompassing 799 patients were included. RESULTS: Dexmedetomidine delayed the consumption of first analgesic (MD 3.69; [95% CI 2.93-4.45]; P<0.00001; I²=86%) in the postoperative period; decreased the amount of rescue intravenous tramadol consumption (MD -13.61; [95% CI -24.56--2.67]; P=0.01; I²=85%), the number of patients who required rescue analgesic (OR 0.25; [95% CI 0.13-0.49]; P<0.00001; I²=42%) and the VAS scores at 6h (MD -1.48; [95% CI -1.65--1.30]; P<0.0001; I²=70%), at 12h (MD -0.92; [95% CI -1.60--0.24]; P=0.008; I²=90%) and at 24h (MD -0.50; [95% CI -0.93--0.08]; P=0.02; I²=92%). When patient satisfaction score was analyzed, there was also a significant difference between groups (SMD 1.07; [95% CI 0.76-1.39]; P<0.00001; I²=0%). DISCUSSION: Dexmedetomidine with local anesthetics was associated with a delay in consumption of the first analgesic in the postoperative period, decrease in the amount of rescue intravenous tramadol and in the VAS scores at 6, 12 and 24 hours. However, the GRADE assessment of the quality of evidence was 'low' due to the high risk of bias and heterogeneity.
Postoperative Cognitive Dysfunction and Analgesic Outcomes in Cardiac Surgery: Evaluating the Role of Nerve Block Techniques.
Yan M, Wang K, Yan H … +1 more , Yuan S
Clin J Pain · 2026 Apr · PMID 41928696 · Publisher ↗
OBJECTIVE: Cardiac surgery frequently induces moderate to severe postoperative pain, which impedes recovery and elevates the risk of opioid dependence and postoperative cognitive dysfunction. This review aims to outline...
OBJECTIVE: Cardiac surgery frequently induces moderate to severe postoperative pain, which impedes recovery and elevates the risk of opioid dependence and postoperative cognitive dysfunction. This review aims to outline peripheral nerve block approaches in cardiac surgery and examine their analgesic efficacy and potential relationship with postoperative cognitive dysfunction. MATERIALS AND METHODS: A comprehensive literature search was performed using the electronic databases PubMed, EMBASE, and Google Scholar for publications up to September 2025. Search terms included regional anesthesia, nerve block, pain management, delirium, cognitive dysfunction, and cardiac surgery. The retrieved literature, including clinical reviews, basic research, clinical trials, and guidelines, was screened and prioritized based on thematic relevance and the strength of clinical evidence. The available evidence was synthesized into a narrative review. RESULTS: The evidence suggests that nerve blocks are an effective component of a multimodal analgesic strategy, significantly reducing postoperative opioid consumption and attenuating neuroinflammatory responses such as microglial activation. However, they have not been conclusively shown to reduce the incidence of postoperative cognitive dysfunction. Current implementation faces challenges including a lack of technique standardization and the need to adapt to heterogeneous surgical anatomies. DISCUSSION: Nerve blocks are valuable for opioid-sparing analgesia and may modulate neuroinflammation, but their role in preventing postoperative cognitive dysfunction remains unproven. Future efforts should focus on standardizing protocols and conducting mechanistic studies to clarify the relationship between nerve blocks, neuroinflammatory modulation, and long-term neurological outcomes.
Analgesic Effects of Intravenous Lidocaine in Laparoscopic Surgery: A Systematic Review and Meta-analysis With Trial Sequential Analysis.
Ng KT, Lim WE, Teoh WY … +1 more , Zainal Abidin MFB
Clin J Pain · 2026 Apr · PMID 41924854 · Publisher ↗
OBJECTIVES: Recent studies have showed that intravenous lidocaine is associated with reducing postoperative pain. However, the mechanism of action of intravenous lidocaine as a part of multi-modal analgesic regimen on pa...
OBJECTIVES: Recent studies have showed that intravenous lidocaine is associated with reducing postoperative pain. However, the mechanism of action of intravenous lidocaine as a part of multi-modal analgesic regimen on patients undergoing laparoscopic surgery remains unclear. The primary aim was to demonstrate the effects of intravenous lidocaine on postoperative pain score in adults undergoing laparoscopic surgery. METHODS: Databases of MEDLINE, EMBASE, and CENTRAL were searched since 1947 until May 2023. Randomized clinical trials (RCT) comparing intravenous lidocaine and placebo in adults undergoing surgery were included. RESULTS: Forty-five RCTs (n=2,599) were included. Intravenous lidocaine group was associated with significantly lower postoperative pain scores at rest (MD: -0.27, 95% CI: -0.45 to -0.08, P=0.005) at the 24-hour after surgery and during movement (MD: -0.58, 95% CI: -0.89 to -0.27, P<0.001). Intravenous lidocaine significantly decreased fentanyl consumption (MD: -14.46, 95% CI: -18.11 to -10.81, P<0.001) and morphine consumption (MD: -3.63, 95% CI: -5.12 to -2.13, P<0.001) postoperatively. It also significantly lowered the incidence of nausea and vomiting (RR: 0.66, 95% CI: 0.54 to 0.81, P<0.001) and reduced time to flatus (MD: -5.90, 95% CI: -8.18 to -3.62, P<0.001). DISCUSSIONS: This systematic reinforces the potential role of adding intravenous lidocaine as part of multimodal analgesia in the reduction of postoperative pain, opioid consumption, incidence of nausea and vomiting, and the time to flatus. However, our findings should be interpreted with caution owing to low level of evidence and high degree of heterogeneity.
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