OBJECTIVE: Given that liposomal bupivacaine (LB) is not currently approved for thoracic surgery, this study evaluated postoperative analgesia after thoracic procedures. METHODS: This retrospective cohort study with prope...OBJECTIVE: Given that liposomal bupivacaine (LB) is not currently approved for thoracic surgery, this study evaluated postoperative analgesia after thoracic procedures. METHODS: This retrospective cohort study with propensity score matching yielded 99 matched pairs. Patients were grouped by receipt of a postoperative ultrasound-guided serratus anterior plane block with LB plus standard care versus standard care alone. The primary outcome was the area under the curve (AUC) for pain scores over the first 0 to 72 postoperative hours. Secondary endpoints included verbal response scale pain scores, opioid consumption, quality of recovery, and hospital length of stay. Statistical significance was defined as P < 0.05. RESULTS: Baseline characteristics were well balanced after matching. The LB group had a lower 0- to 72-hour pain AUC (110 ± 48 vs. 185 ± 67; P < 0.01), exceeding the prespecified threshold for clinical relevance (at least a 10% reduction), and lower early postoperative pain scores. Opioid consumption was reduced at 24 and 48 hours (both P < 0.01). Quality of recovery scores were higher at 24, 48, and 72 hours, with the 24-hour difference meeting the minimal clinically important difference. Postoperative nausea and vomiting were less frequent from 6 to 24 hours; length of stay did not differ. CONCLUSIONS: Perioperative regional block with LB was associated with reduced pain burden and opioid use after thoracic surgery. Prospective, multicenter randomized trials with longer follow-up and health economic evaluations are needed.
OBJECTIVES: Chronic overlapping pain conditions (COPCs) affect young adults and pose significant challenges in medical care. This study aimed to describe the types and number of current and past medical providers and med...OBJECTIVES: Chronic overlapping pain conditions (COPCs) affect young adults and pose significant challenges in medical care. This study aimed to describe the types and number of current and past medical providers and medications used by young adults with COPCs and to explore associations between health care utilization, clinical pain, and psychosocial factors. METHODS: Fifty young adults (mean age: 27.16 y) with COPCs were recruited and completed online questionnaires assessing demographics, pain intensity and interference, number of pain conditions, health care providers consulted, medication use, and psychosocial characteristics. Relationships among health care utilization, clinical pain measures, and psychosocial variables were analyzed using Pearson correlations and linear regression models. RESULTS: Participants reported an average of 4.40 COPCs, with fibromyalgia, chronic low back pain, and chronic fatigue syndrome being the most common. Most (72%) were currently receiving medical treatment, with primary care physicians being the most frequently consulted providers. The average number of current providers was 2.82, while the number of past providers was 4.28. Despite extensive health care engagement, 77.7% reported no improvement or worsening of their condition. No significant associations were found between the number of providers or medications and clinical or psychosocial outcomes. DISCUSSION: The findings highlight gaps in the effectiveness of health care utilization for young adults with COPCs. The high prevalence of provider visits and medication use without substantial symptom improvement suggests a need for more integrated, multidisciplinary care approaches. Future research should focus on optimizing treatment strategies and identifying opportunities for early intervention.
Terradas-Monllor M, Ullastre-Pujal M, Daüsteler C
… +8 more, Roca-Ribera R, Roca-Esteban A, Garcia Del Sol C, Cuesta-Casas M, Minobes-Molina E, Terre-Boliart R, Parés-Martínez C, Ochandorena-Acha M
OBJECTIVES: Chronic postsurgical pain (CPSP) is a common complication following total knee arthroplasty (TKA), affecting up to 30% of patients. Altered nociceptive processing may underlie the mechanisms of CPSP. The stud...OBJECTIVES: Chronic postsurgical pain (CPSP) is a common complication following total knee arthroplasty (TKA), affecting up to 30% of patients. Altered nociceptive processing may underlie the mechanisms of CPSP. The study aimed to compare conditioned pain modulation (CPM) and local and widespread sensitization between patients with and without CPSP. METHODS: A prospective case-control study was conducted among 117 patients undergoing TKA due to primary knee osteoarthritis. Participants were classified as CPSP or non-CPSP based on pain intensity (≥30 mm on the visual analog scale) at 3 months postoperatively. Quantitative sensory testing (QST) assessed CPM, local pressure pain thresholds (PPTs), and remote PPTs at tibial and forearm locations. Measures were taken at 3 and 6 months after surgery. Group comparisons and linear mixed-effects models were applied. RESULTS: Patients with CPSP (n=53) exhibited significantly lower CPM responses at both local and remote sites compared with non-CPSP patients (n=64), with differences persisting over time. Local PPTs were significantly reduced in the CPSP group across all periarticular sites, suggesting enhanced peripheral sensitization. At remote locations, lower PPTs were observed at both tibiae and at the ipsilateral forearm at 3 months; at 6 months, group differences were restricted to the ipsilateral tibia, indicating spatially selective alterations in pain modulation rather than generalized hypersensitivity. DISCUSSION: CPSP following TKA is associated with persistent differences in descending pain inhibition and increased local pressure sensitivity. These findings suggest that persistent dysfunction in descending inhibitory pathways and localized peripheral sensitization are associated with pain persistence beyond the expected healing period.
Part of the June 2026 issue supplement, to be published in its entirety on May 12, 2026.Part of the June 2026 issue supplement, to be published in its entirety on May 12, 2026.
Part of the June 2026 issue supplement, to be published in its entirety on May 12, 2026.Part of the June 2026 issue supplement, to be published in its entirety on May 12, 2026.
OBJECTIVES: Laparoscopic cholecystectomy (LC), though minimally invasive, sometimes leads to significant postoperative pain. Ketamine has shown potential in alleviating it, but small sample sizes and variability in admin...OBJECTIVES: Laparoscopic cholecystectomy (LC), though minimally invasive, sometimes leads to significant postoperative pain. Ketamine has shown potential in alleviating it, but small sample sizes and variability in administration protocols limit the generalizability of prior findings. This study evaluated the effectiveness of ketamine in reducing postoperative pain across multiple time points. METHODS: A thorough search of multiple databases was conducted, covering publications up to January 2025. Data from eligible randomized controlled trials (RCTs) were extracted and pooled to calculate mean differences (MDs) for postoperative pain scores at 30 minutes, 1, 2, 4, and 12 hours, along with opioid consumption (morphine and tramadol) and adverse events. RESULTS: The analysis included 22 RCTs with 1163 participants. Ketamine significantly reduced postoperative pain compared with placebo ( MD =-0.37, 95% CI: [-0.56 to -0.17], P =0.0002). Subgroup analyses at 30 minutes showed significant pain reduction in bolus + infusion ( MD =-0.70, 95% CI: [-1.33 to -0.07], P =0.03), bolus alone ( MD =-1.28, 95% CI: [-2.29 to -0.27], P =0.01), and propofol-based maintenance ( MD =-0.89, 95% CI: [-1.44 to -0.34], P =0.002). In addition, ketamine significantly reduced morphine ( MD =-0.46, 95% CI: [-0.91 to -0.02], P =0.04) and tramadol consumption ( MD =-1.03, 95% CI: [-1.86 to -0.21], P =0.01). DISCUSSION: Ketamine reduced opioid use and postoperative pain at 30 minutes, with efficacy varying by administration method. Future RCTs should standardize dosage, anesthesia protocols, and pain management strategies to enhance evidence consistency.
Part of the June 2026 issue supplement, to be published in its entirety on May 12, 2026.Part of the June 2026 issue supplement, to be published in its entirety on May 12, 2026.
Taddio A, Shah V, McMurtry CM
… +27 more, Lang E, MacDonald NE, Constantin K, Uleryk E, Abrams EM, Alexander S, Bucci LM, Comeau J, Cortes JM, Cranch J, Gallinger L, Girouard S, Golightly B, Guenther M, Halperin SA, Howitt L, Jensen C, Kolker S, Kryschuk E, Minhas R, Noel M, Riddell RP, Probst J, Rieder MJ, Ross K, Siamaki S, HELPinKids&Adults Collaborative
Part of the June 2026 issue supplement, to be published in its entirety on May 12, 2026.Part of the June 2026 issue supplement, to be published in its entirety on May 12, 2026.
Bogard I, Kamper SJ, Rogers K
… +1 more, Yamato TP
Clin J Pain
· 2026 Jul · PMID 41817219
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OBJECTIVE: Very few validated instruments measure a child's concept of pain. The Conceptualization of Pain Questionnaire (COPAQ) is a unidimensional instrument measuring this construct, developed in Catalan and translate...OBJECTIVE: Very few validated instruments measure a child's concept of pain. The Conceptualization of Pain Questionnaire (COPAQ) is a unidimensional instrument measuring this construct, developed in Catalan and translated into English. The clinimetric properties of the English version have not been evaluated. We conducted a Rasch analysis to evaluate its structural validity and internal consistency, and a Confirmatory Factor Analysis (CFA) to evaluate its structural validity. METHODS: We analyzed an existing data set from a previous study. Item fit was evaluated using INFIT and OUTFIT statistics, item difficulty was estimated using Rasch coefficients, and internal consistency using Cronbach alpha. Structural validity was measured using item loadings from the CFA. RESULTS: We included data from 497 adolescents (average age 14 y [SD 1.28], 51% male). There was a wide range of difficulty across items. One item demonstrated excessive positive outfit, and 2 items were close to the cutoff for excessive negative outfit. The COPAQ demonstrated poor overall fit to the unidimensional Rasch Model and did not demonstrate adequate internal consistency (Cronbach alpha=0.6). Results from the CFA suggest the items do not measure the single construct they intend to measure. DISCUSSION: The English version of the COPAQ did not have adequate internal consistency or structural validity. More work is required to assess the content validity of current instruments measuring a child's concept of pain. Developing validated instruments measuring a child's concept of pain aligned with the biopsychosocial model should be prioritized.
Part of the June 2026 issue supplement, to be published in its entirety on May 12, 2026.Part of the June 2026 issue supplement, to be published in its entirety on May 12, 2026.
BACKGROUND: Chronic musculoskeletal pain is reported by 1 of 4 adolescents worldwide. Pain-related functioning is negatively affected by pain itself but also related to depressive symptoms. Although the association betwe...BACKGROUND: Chronic musculoskeletal pain is reported by 1 of 4 adolescents worldwide. Pain-related functioning is negatively affected by pain itself but also related to depressive symptoms. Although the association between pain-related functioning and depressive symptoms is established, there is a lack of longitudinal studies that establish the direction of the association. OBJECTIVES: The aim was to analyse the temporal association between depressive symptoms and pain-related functioning among adolescents with recurrent musculoskeletal pain. METHODS: This longitudinal sample comprised 604 adolescents in seventh and eighth grade (M = 13.7 y) who reported recurrent musculoskeletal pain at baseline, defined as occurring at least every week over the previous 6 months. The adolescents were followed yearly for 2 consecutive years (T1, T2, and T3). Temporal associations of self-reported pain-related functioning and depressive symptoms were analysed. Using cross-lagged panel modelling, 4 models were estimated: autoregressive; depressive symptoms predicting pain-related functioning; pain-related functioning predicting depressive symptoms; and a bidirectional model. Pain intensity was entered as a covariate. RESULTS: The results indicate high stability of depressive symptoms and pain-related functioning over time. Although the strength of the prediction was strongest in the autoregressive paths, cross-lagged paths revealed that depressive symptoms at T1 and T2 significantly predicted pain-related functioning at T2 and T3, respectively. Conversely, pain-related functioning at T1 and T2 did not predict depressive symptoms at T2 and T3, respectively. CONCLUSIONS: The model where depressive symptoms predict pain-related functioning provided the best model fit and thus, in this general population sample, depressive symptoms drive pain-related functioning more than vice versa. Screening for and targeting depressive symptoms might be essential in affecting the functional consequences of pain.
Reece L, Mitcheson M, Donado C
… +14 more, Shulman J, Ribeiro M, Zirko K, DeFabio R, O'Donnell S, Brousseau P, Volpigno L, Daniel M, Paravalos S, Lobo K, Culpo M, Logan D, Sethna N, Greco C
Clin J Pain
· 2026 Jun · PMID 41797645
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CONTEXT: Chronic pain affects 1 in 9 young adults worldwide. Intensive interdisciplinary pain treatment (IIPT) has shown favorable outcomes in improving in pain intensity, mood, school attendance, and social and physical...CONTEXT: Chronic pain affects 1 in 9 young adults worldwide. Intensive interdisciplinary pain treatment (IIPT) has shown favorable outcomes in improving in pain intensity, mood, school attendance, and social and physical functioning in pediatric studies. However, few IIPT programs are designed for young adults (YAs), a distinctly vulnerable developmental stage. Given this limitation, we sought to study the benefits of applying an IIPT model for YAs with chronic pain and functional impairment. OBJECTIVES: This study aimed to (1) describe the design and implementation of our pilot YA-IIPT program and (2) assess outcomes of YA-IIPT on pain experience, psychological and physical functioning, disability, and quality of life, in YAs with chronic pain and functional impairment. METHODS: In this observational study, we adapted the pediatric IIPT model for YAs using a biopsychosocial approach to chronic pain treatment. Outcome measures included physical functioning, psychological functioning, disability, quality of life, and pain experience. Paired t tests and repeated-measure ANOVAs were used to compare admission, discharge, 6-week, and 6-month follow-up data. RESULTS: Patients showed clinically and statistically significant improvements across the majority of physical and psychological functioning, disability, quality of life, and pain experience measures between admission and discharge ( P <0.01). Most improvements were maintained at 6-week and 6-month follow-ups. DISCUSSION: On average, participants in our YA-IIPT program demonstrated clinically and statistically significant improvements in most areas of functioning, quality of life, and pain experience that were maintained after discharge. Further research is needed on YA pain treatment and whether outcomes after YA-IIPT are sustained long-term.
BACKGROUND: Multicomponent programs combining therapeutic exercise, cognitive-behavioral therapy, and pain neuroscience education demonstrate overall efficacy for fibromyalgia (FM). However, a substantial proportion of p...BACKGROUND: Multicomponent programs combining therapeutic exercise, cognitive-behavioral therapy, and pain neuroscience education demonstrate overall efficacy for fibromyalgia (FM). However, a substantial proportion of patients do not achieve clinically meaningful improvement. This study aimed to identify predictors of nonresponse and to develop a prognostic classifier model. METHODS: Participants (n=788) from multiple randomized controlled trials received a standardized 12-week multicomponent intervention. This secondary analysis defined nonresponse as a <20% reduction in Fibromyalgia Impact Questionnaire Revised (FIQR) scores. A machine learning approach called least absolute shrinkage and selection operator (LASSO) regularization was used to train a classifier. Model performance was assessed by external validation in a holdout sample, with the area under the curve (AUC) and mean squared error as evaluation indices. RESULTS: Higher baseline anxiety (B=0.010), depression (B=0.007), kinesiophobia (B=0.005), and FM severity (B=-0.004), along with lower physical function (B=-0.014), younger age (B=-0.005), and lower body mass index (B=-0.010), were associated with nonresponse. The model demonstrated adequate classification accuracy out-of-sample (AUC=0.657; 95% CI: 0.586-0.728). A prototype calculator incorporating these predictors was developed. CONCLUSION: Psychological, functional, and demographic factors were linked to nonresponse to multicomponent treatment in FM. Although predictive accuracy was limited, these findings support further validation of stratification approaches to inform treatment planning.
OBJECTIVES: Fentanyl, a potent μ receptor agonist, is a cornerstone of perioperative and cancer pain management due to its high efficiency and multidosage characteristics. Despite its efficacy, the risks of respiratory d...OBJECTIVES: Fentanyl, a potent μ receptor agonist, is a cornerstone of perioperative and cancer pain management due to its high efficiency and multidosage characteristics. Despite its efficacy, the risks of respiratory depression and abuse present significant global public health challenges. The development of novel drug delivery systems expands their utility but intensifies the need to balance clinical benefits with safety. This review synthesizes recent evidence on fentanyl pharmacology and clinical use, with a focus on multimodal administration strategies, dose adjustment for special populations, and the impact of antiabuse technologies and regulatory policies. METHODS: From the establishment of the database to September 2025, researchers conducted a systematic literature search in PubMed, Embase, and CNKI databases. The search terms included "fentanyl," "analgesia," "pharmacokinetics," "respiratory depression," and "abuse prevention." High-quality randomized controlled trials, meta-analysis, literature review, and the latest clinical guidelines were included. RESULTS: Analysis confirmed that fentanyl's unique pharmacokinetics and its newly discovered multivalent binding mode to the μ-receptor underpin its rapid onset and potent analgesia. Quantitative comparisons showed intravenous administration excels in rapid-onset pain relief, while mucosal routes provide superior sustained drug exposure. Critically, dose reduction is essential for elderly patients and those with hepatic impairment. DISCUSSION: The effective use of fentanyl requires an integrated strategy combining pharmacological knowledge, individual patient factors, and a robust regulatory framework. The integration of antiabuse formulation and stringent regulatory measures is vital for mitigating misuce risks while ensuring medical accessbibility.The clinical decision-making pathway proposed herein aids in optimizing analgesia and minimizing adverse outcomes. Future research should prioritize developing evidence-based guidelines for the Chinese population and exploring genomic predictors for personalized pain management.
OBJECTIVE: To investigate if psychological/cognitive aspects and executive functions can influence conditioned pain modulation (CPM) activity in elderly people with and without chronic pain. METHODS: A cross-sectional un...OBJECTIVE: To investigate if psychological/cognitive aspects and executive functions can influence conditioned pain modulation (CPM) activity in elderly people with and without chronic pain. METHODS: A cross-sectional unifactorial repeated measures case-control study with 19 adults (89.5% women, age: 73.2±5.6 y) with chronic primary musculoskeletal pain and 38 adults (74.5% women, age: 74.3±4.4 y) without chronic pain was conducted. Pain features, psychological/cognitive (anxiety, depression, pain hypervigilance, and pain catastrophizing), and 2 executive functions (working memory, mental inhibition) were assessed. Subsequently, CPM was evaluated on changes obtained in mechanical (pressure pain threshold-PPT) stimuli with the cold-pressor test paradigm. RESULTS: A significant group X time interaction after controlling all cofounders was found: PPTs were higher after the conditioned stimulus in individuals without chronic pain (CPM increase 15%±10%), whereas PPTs were lower after the conditioned stimulus in those with chronic pain (CPM decrease -11%±7%) when compared with PPTs at baseline. In elderly people with chronic pain, pain intensity and catastrophizing accounted for 28.6% of the variance of the CPM activation index. In elderly people without chronic pain, just pain catastrophizing had significant predictive value accounting for 10.6% of the variance of CPM activation index. DISCUSSION: Elderly people with chronic musculoskeletal pain exhibited impaired CPM activation as compared with adults without chronic pain. Thus, CPM activation was associated with the intensity of pain and, in a lesser extent, with pain catastrophizing, but not with anxiety/depressive levels and executive functions.
OBJECTIVES: Chronic postsurgical pain (CPSP) is a significant burden affecting ∼30% of patients after video-assisted thoracoscopic surgery (VATS). The introduction of machine learning (ML) might improve our prediction mo...OBJECTIVES: Chronic postsurgical pain (CPSP) is a significant burden affecting ∼30% of patients after video-assisted thoracoscopic surgery (VATS). The introduction of machine learning (ML) might improve our prediction models of CPSP, but studies are needed to compare the different ML models. It appears likely that a multimodal ML model would be better compared with a single-modal model, but this is yet to be explored. This study evaluated different ML prediction models for CPSP after VATS using a multivariable approach. METHODS: The study included patients scheduled to VATS. Preoperative assessments were performed within 4 domains included demographic variables, psychological factors, quantitative sensory testing, and inflammatory biomarkers. CPSP was assessed 1 year after surgery. Five ML techniques were applied: multiple logistic regression with backward elimination, Kernel k-Nearest Neighbors (kKNN), kKNN with variable elimination using Random Forest, Naive Bayesian Classifier, and Gradient Boosting. The models were applied across the 4 domains of predictors. Models were internally validated using leave-one-out cross-validation. RESULTS: This study enrolled 100 patients, with 86 completing the 12-month follow-up. Results showed varying area under the receiver operating characteristics curve (ROCAUC) across models and domains, ranging from 0.500 (95% CI: 0.500-0.500) to 0.965 (95% CI: 0.896-1.000), with Gradient Boosting demonstrating the highest ROCAUC. DISCUSSION: The study serves as a proof-of-concept, demonstrating that different ML models can yield varying results when predicting CPSP. Among these, a prediction model based on Gradient Boosting exhibited the best fit. However, the potential risk of overfitting cannot be ruled out, necessitating further validation before clinical implementation.
OBJECTIVES: Mobile health (mHealth) technology has been utilized to offer self-management tools to people with pain, including symptom tracking. Existing mobile tracking applications (apps) for chronic pain management ha...OBJECTIVES: Mobile health (mHealth) technology has been utilized to offer self-management tools to people with pain, including symptom tracking. Existing mobile tracking applications (apps) for chronic pain management have demonstrated reliability, feasibility, improved coping, and reduced health care utilization. Unfortunately, adherence in using a pain app can be problematic with many not using or discontinuing its use early. The current study aimed to investigate the impact that pain self-efficacy, pain conceptualizations, and patient perception of pain care providers, have on engagement with a mobile pain tracking app. METHODS: Seventy-six (N=76) individuals with chronic pain downloaded a pain app and completed questionnaires assessing their pain and use of a pain app 3 months after they had downloaded the app. Associations with engagement with the app, defined as the number of daily diaries completed, and demographic and self-report questionnaire data were examined. RESULTS: Results showed that engagement with the app was unrelated to self-efficacy and pain conceptualization but significantly related to positive perceptions of their pain care providers. Patients with more severe pain were found to have lower self-efficacy, less understanding of the biopsychosocial model of pain, and lower satisfaction with their involvement in their pain care decisions. Surprisingly, those who engaged more with the app demonstrated lower self-efficacy as compared with those who used the pain app less. DISCUSSION: These findings highlight the importance of the patient-provider relationship in engaging with mHealth technology for pain management. Results further imply that longer-term use of mHealth tools may not be perceived as adaptive or clinically helpful for certain individuals.
OBJECTIVES: While most adolescents display a steady recovery trajectory following surgery, some develop chronic postsurgical pain (CPSP), which can significantly impact their functioning. Psychosocial factors are known t...OBJECTIVES: While most adolescents display a steady recovery trajectory following surgery, some develop chronic postsurgical pain (CPSP), which can significantly impact their functioning. Psychosocial factors are known to play a role in the recovery from pain following surgery, but positive psychosocial factors have received little attention in the literature. This study aimed to address this gap by investigating parental and adolescent positive affect and optimism as predictors of postsurgical pain recovery and positive outcomes in adolescents. METHODS: This study uses data collected as part of a larger longitudinal project that involved administering questionnaires to adolescents and their parents over multiple timepoints. Adolescent participants aged 12 to 18 years old with a diagnosis of adolescent idiopathic scoliosis, and scheduled for spinal fusion surgery, were recruited across 4 Belgian hospitals along with their parents. Structural Equation Modelling was used to investigate how parental and adolescent positive affect and optimism predicted postsurgical outcomes, including mood, quality of life, and functional disability in adolescents. RESULTS: The study comprised 94 adolescent-parent dyads. Parental optimism before surgery predicted increased adolescent mood following surgery. Adolescent positive affect before surgery predicted increased mood and decreased pain intensity following surgery, while adolescent optimism predicted increased quality of life. None of the optimism or positive affect variables were significantly related to adolescent functional disability following surgery. DISCUSSION: Study findings identify parental and adolescent positive affect and optimism as potential predictors of postsurgical recovery and positive outcomes in adolescents. However, the multifaceted and complex nature of these relationships warrants further investigation.