The Clinical Journal Of Pain[JOURNAL]
Sun
200 papers
Predicting Heterogeneity of Treatment Effects to Transcranial Direct Current Stimulation for Knee Osteoarthritis Pain and Symptoms: A Machine Learning Approach.
Lee C, Kim H, Kim S … +9 more , Kim Y, Sun X, Chen CX, Park J, Pellegrini C, Garcia DO, Chen NK, Kwoh CK, Ahn H
Clin J Pain · 2026 Apr · PMID 41626992 · Publisher ↗
OBJECTIVES: We planned to identifyied key predictors of the heterogeneity of treatment effects of transcranial direct current stimulation (tDCS) in individuals with knee osteoarthritis (KOA). METHODS: This is a secondary...
OBJECTIVES: We planned to identifyied key predictors of the heterogeneity of treatment effects of transcranial direct current stimulation (tDCS) in individuals with knee osteoarthritis (KOA). METHODS: This is a secondary analysis of a randomized clinical trial involving 60 participants who underwent 15 daily sessions of 2-mA tDCS over 3 weeks. We applied group-based trajectory modeling to classify participants into distinct subgroups based on longitudinal KOA pain and symptom patterns from baseline to 3 months postintervention to examine differential responses to tDCS. Four learning-based classifiers-multilayer perceptron, ElasticNet, random forest, and gradient boosting decision trees-were then trained to predict the trajectory subgroups using demographic, clinical, and quantitative sensory testing data collected at baseline. Feature selection methods-f-regression, mutual information, and SHapley Additive exPlanations (SHAP)-were employed to identify the influential features. In addition, SHAP was used to analyze the correlation and impact of each feature on classification. RESULTS: Participants exhibited distinct response patterns to tDCS: high responders (low initial symptoms with significant improvement, n = 28) and low responders (high initial symptoms with minimal improvement, n = 32). The influential features included pain catastrophizing, conditioned pain modulation (CPM), and pressure pain thresholds (PPTh) at the trapezius. SHAP revealed that pain catastrophizing was the most influential feature. Greater pain catastrophizing, lower CPM, and lower PPTh were associated with a higher likelihood of being classified as low responders. CONCLUSION: Baseline assessments of pain catastrophizing, CPM, and PPTh may be used to stratify participants, optimize treatment allocation, or tailor stimulation parameters for individuals less likely to respond to tDCS protocols.
Effects of Preoperative Pain Education on Postoperative Pain and Postpartum Depression Following Elective Cesarean Sections: A Randomized Controlled Trial.
Fang C, Ye J, Zhang WP … +1 more , Zhu L
Clin J Pain · 2026 May · PMID 41614269 · Publisher ↗
OBJECTIVES: Postoperative pain not only causes physical discomfort for patients but may also adversely affect their rehabilitation. This study aimed to explore the effect of preoperative pain education on postoperative p...
OBJECTIVES: Postoperative pain not only causes physical discomfort for patients but may also adversely affect their rehabilitation. This study aimed to explore the effect of preoperative pain education on postoperative pain and postpartum depression after elective cesarean section. METHODS: A total of 160 women scheduled for elective cesarean section were divided into the control group and education group (80 cases in each ). The control group received routine preoperative guidance, while the education group received preoperative pain education on the basis of routine preoperative guidance. Postoperative pain intensity was assessed. Analgesics demand, time to first ambulation, and drug-related adverse reactions were recorded in both groups. RESULTS: The visual analog scale (VAS) scores in the education group at 24 hours after operation were significantly lower than those in the control group ( P <0.05). In addition, the consumption of postoperative analgesic drugs was reduced (57.8±4.5 vs. 60.2±4.7 µg, P =0.001). The time to first ambulation was earlier in the education group (4.0±0.6 vs. 4.5±0.7 h, P =0.000), and the incidence of postpartum depression was significantly decreased (2 vs. 10, odds ratio: 0.179 [95% CI: 0.038-0.847], P =0.016). DISCUSSION: This study showed that preoperative pain education could not only effectively relieve the pain after cesarean section, reduce the use of analgesic drugs, promote early ambulation, but also reduce the incidence of postpartum depression (Registration number: ChiCTR2400090909).
From Acute to Chronic: An Analysis of Neuroimaging and the Psychological Evolution of Herpes Zoster-related Pain.
Xiong J, Kuang H, Chen Y … +5 more , Zou W, Qin S, Jiang X, Gu L, Jiang J
Clin J Pain · 2026 May · PMID 41614238 · Publisher ↗
INTRODUCTION: Herpes zoster-related pain has different phases, and the changes in glymphatic function during disease development are unknown. This study investigated stage-dependent changes in glymphatic function and moo...
INTRODUCTION: Herpes zoster-related pain has different phases, and the changes in glymphatic function during disease development are unknown. This study investigated stage-dependent changes in glymphatic function and mood scale scores in patients with herpes zoster-related pain, including their interrelationships. METHODS: A total of 43 patients with herpes zoster (HZ), 54 with subacute herpetic neuralgia (SHN), 37 with postherpetic neuralgia (PHN) and 30 pain-free controls (PFC) were ultimately included in this study. Diffusion tensor imaging analysis of the perivascular space (DTI-ALPS) index was used to evaluate glymphatic function. All participants were assessed with the visual analog scale (VAS), the 90-item Symptom Checklist-90-Revised (SCL-90-R), the Hamilton Depression Scale (HAMD), and the Hamilton Anxiety Scale (HAMA). Analysis of Varivance (ANOVA) was used to determine whether there was a difference in the DTI-ALPS index among the 4 groups. Spearman correlation analysis was used to determine the correlation between the DTI-ALPS index and each clinical scale. RESULTS: DTI-ALPS indices were significantly lower on the left and right sides and mean in the PHN group than in the PFC group (left: P =0.025; right: P =0.014; mean: P =0.006). HAMA, HAMD, VAS-SCL-90-R, and HAMD-SCL-90-R scores showed significant positive/negative correlations across all 3 patient groups, whereas the HAMA-SCL-90-R correlation was significant in the SHN and PHN groups. DISCUSSION: Glymphatic dysfunction is observed in cases of zoster pain chronification, and the severity of mood disorders increases across disease stages. These findings provide both a clinical reference for how to qualify patients more comprehensively and a neuroimaging aspect to explore the mechanisms of PHN pathogenesis.
Pathophysiology of Chronic Pain.
Lyndon S
Clin J Pain · 2026 Jun · PMID 41614224 · Publisher ↗
OBJECTIVES: Chronic pain affects 1 in 5 people and persists because protective nociception is converted into maladaptive neural, immune, and psychological states. This review aimed to consolidate mechanistic and clinical...
OBJECTIVES: Chronic pain affects 1 in 5 people and persists because protective nociception is converted into maladaptive neural, immune, and psychological states. This review aimed to consolidate mechanistic and clinical evidence to clarify that transformation and identify leverage points for durable relief. METHODS: Following the Scale for the Assessment of Narrative Review Articles (SANRA) guidance, we conducted a narrative review of articles published January 1, 2000 to June 30, 2025 accessing PubMed, Embase, Web of Science, Scopus, CINAHL, PsycINFO, and the Cochrane Library, supplemented by gray literature. Eligible studies explored biological, immunologic, genetic, epigenetic, or psychosocial mechanisms or tested mechanism-targeted interventions. Data were thematically synthesized and appraised for methodological quality. RESULTS: Convergent findings reveal a multistage cascade: peripheral sensitization driven by aberrant ion channels and inflammatory mediators; spinal and supraspinal sensitization sustained by glial activation and loss of inhibition; and large-scale cortical and limbic reorganization that embeds pain within memory and emotion circuits. Neuroimmune dialogue, microbiome dysbiosis, sex-specific responses, and environment-induced epigenetic changes amplify these processes, while psychological stress and social adversity modulate their expression. Mapping these mechanisms to neuropathic, nociceptive, and nociplastic syndromes highlights therapeutic windows exploited by emerging agents such as calcitonin gene-related peptide antibodies, chemogenetic nociceptor silencing, closed-loop neuromodulation, targeted cytokine blockade, and microbiota modulation. Biomarker-informed precision approaches promise to replace empirical prescribing. DISCUSSION: Synthesizing cross-disciplinary evidence positions chronic pain as a systems disease requiring integrated, mechanism-based, and person-centered care. Defining the shared biological scaffold clarifies why traditional symptom-focused treatments frequently fail and outlines research priorities for disease-modifying analgesics and equitable delivery models.
Genetic Determinants of Analgesic Responsiveness: A Focus on CYP2D6 and COMT Polymorphisms in Chronic Pain.
Bollinger A, Stäuble CK, Urdieux IO … +8 more , Gianora J, Schüpbach T, Seibert I, Wiss FM, Jeiziner C, Hersberger KE, Allemann SS, Meyer Zu Schwabedissen HE
Clin J Pain · 2026 May · PMID 41521967 · Publisher ↗
OBJECTIVES: Interindividual variability in analgesic responsiveness often results in therapy failure (TF) or adverse drug reactions (ADR) and poses a major challenge in chronic pain management, as it is influenced by mul...
OBJECTIVES: Interindividual variability in analgesic responsiveness often results in therapy failure (TF) or adverse drug reactions (ADR) and poses a major challenge in chronic pain management, as it is influenced by multiple factors. This exploratory study investigated whether pharmacogenetic (PGx) testing could identify drug-gene interactions (DGIs) explaining variability in drug response. In addition, we explored whether genetic predispositions in CYP2D6 and COMT , indicating increased pain sensitivity, are linked to TF. METHODS: We analyzed data from chronic pain patients who underwent pharmacogenotyping due to suspected TF or ADR. PGx panel testing was carried out by a commercial provider. Additional genotyping of COMT rs6269, rs4633, and rs4818 was performed using PCR, RFLP, and Sanger sequencing. RESULTS: PGx panel testing confirmed at least one relevant genetic variant in 45% of the suspected DGIs. Notably, 41% involved the pharmacogenes CYP2D6 , CYP2C19 , and CYP2C9 . Subgroup analyses revealed that patients carrying the COMT high pain sensitivity (HPS) allele, COMT high pain phenotype, or CYP2D6 intermediate metabolizer (IM) phenotype were significantly more likely to experience TF. Logistic regression confirmed both phenotypes as significant predictors of TF. DISCUSSION: Our findings support the relevance of CYP2D6 , CYP2C19 , and CYP2C9 as key pharmacogenes for PGx testing in chronic pain management. The results suggest that a genetic predisposition in CYP2D6 and COMT , associated with increased pain sensitivity, may contribute to insufficient analgesia and subsequent TF. These insights indicate the potential value of incorporating CYP2D6 and COMT as pain-modulating genetic markers into the broader framework of PGx testing.
Interpretation of the Avoidance-Endurance Fast-Screen Questionnaire: A Qualitative Study Using Cognitive Interviews in Patients With High-Impact Chronic Pain.
Razniak LMS, Vægter HB, Aagaard A … +4 more , Andersen TE, Hasenbring MI, Rasmussen ML, Ravn SL
Clin J Pain · 2026 Jun · PMID 41502086 · Publisher ↗
OBJECTIVES: This study examined how patients with high-impact chronic pain interpreted and responded to the Danish version of the Avoidance-Endurance Fast-Screen (AE-FS) to identify potential problematic items that did n...
OBJECTIVES: This study examined how patients with high-impact chronic pain interpreted and responded to the Danish version of the Avoidance-Endurance Fast-Screen (AE-FS) to identify potential problematic items that did not correspond with item intention and causes for this. METHODS: Participants were recruited from patients referred to treatment in an interdisciplinary pain center to partake in cognitive interviews following the Three-Step Test-Interview protocol. Interview transcripts were analyzed in 2 steps. First, a coding analysis was used to code responses in relation to item intention using 4 predefined codes (congruent, incongruent, ambiguous, or confused) to identify potential problematic items (≤50% congruent responses). Second, a reflexive thematic analysis was used to uncover causes of incongruency in the problematic items as well as elements of confusion across all items. RESULTS: Thirty-four participants were included. Three items (1, 4, and 6) were identified as being problematic with items 1 and 4 having many incongruent responses. The most common causes of incongruency were related to formulations of items, and 7 elements of confusion were uncovered across all items. DISCUSSION: The current study identified potential issues with participants' interpretation of 3 items of the AE-FS. However, as interviews may be prone to the influence of social desirability bias, the interpretation of the results for item 4, where the most frequent noncongruent interpretation of making a fuss was equal to lack of pain validation, is done with caution. Therefore, a revision is suggested with reformulation of item 6 and removal of item 1, which, however, will require validation in future research.
Quantitative Sensory Testing Following Orthopedic Trauma: A Longitudinal Multisite Feasibility Study.
Aaron RV, Rassu FS, Archer KR … +8 more , Stone AL, Priest A, Bhattiprolu K, Bruehl S, Osgood G, Castillo RC, Wegener ST, Campbell CM
Clin J Pain · 2026 Apr · PMID 41502079 · Full text
OBJECTIVES: Orthopedic trauma is a major cause of disability worldwide; around half of the people who sustain orthopedic trauma develop chronic pain. Quantitative Sensory Testing (QST) is a standardized method of assessi...
OBJECTIVES: Orthopedic trauma is a major cause of disability worldwide; around half of the people who sustain orthopedic trauma develop chronic pain. Quantitative Sensory Testing (QST) is a standardized method of assessing pain sensitivity, which may be useful in characterizing pain after injury and predicting chronic pain. This primary aim of this project was to test the feasibility of a portable QST battery, administered to adults 6-weeks post major orthopedic trauma and surgery. METHODS: Twenty-nine participants (62% male; 52% black) who sustained major orthopedic trauma and surgery completed QST testing (including static measures, conditioned pain modulation, and mechanical temporal summation) at their 6-week postoperative visit and were invited to complete a 6-month follow-up survey. We examined feasibility and acceptability indices and explored associations between QST and clinical pain ratings. RESULTS: Of all eligible patients, 77% were recruited. QST procedures were feasible and tolerable. No participant declined participation, withdrew for reasons related to study procedures, or discontinued QST due to discomfort. No patient experienced increased clinical pain after QST. Exploratory analyses identified a positive association between static QST and pain interference at T1. Feasibility challenges included poor 6-month retention (57%) and difficulty administering QST to patients with upper extremity injuries. High rates of analgesic use before testing (38%) poses an additional barrier for future QST studies in this population. DISCUSSION: QST was acceptable and partially feasible; challenges included poor retention, high rates of analgesic use, and logistical barriers to accessing injury sites for testing. We pose several potential solutions for future research.
Re-Examining the Mechanistic and Translational Horizons of taVNS for Post-Thoracoscopic Pain: Commentary on Zhang et al.
La N, Rattanapitoon SK, Thanchonnang C … +1 more , Rattanapitoon NK
Clin J Pain · 2026 Mar · PMID 41490386 · Publisher ↗
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A Potential Link Between Preoperative Inflammation Biomarkers and Acute Postoperative Pain Following VATS.
Sperling PK, Petersen KK, Danielsen AV … +3 more , Rasmussen BS, Bisgaard J, Giordano R
Clin J Pain · 2026 Apr · PMID 41472465 · Publisher ↗
OBJECTIVES: Postoperative pain is common after video-assisted thoracic surgery (VATS). Recent evidence suggest that preoperative inflammatory biomarkers might be associated to chronic postoperative pain following major s...
OBJECTIVES: Postoperative pain is common after video-assisted thoracic surgery (VATS). Recent evidence suggest that preoperative inflammatory biomarkers might be associated to chronic postoperative pain following major surgery, but the association between preoperative inflammation and acute pain after VATS have not been examined. This observational cohort study aimed to investigate the association between preoperative inflammatory biomarkers and acute postoperative pain in lung cancer patients undergoing VATS. METHODS: Preoperative plasma samples from cancer patients scheduled for VATS were analyzed for 92 inflammatory markers using the Olink Bioscience inflammation panel. Postoperative pain was measured during the first 48 hours using a numerical rating scale (0 to 10 point scale). Principal component analysis and orthogonal partial least square discriminant analysis was used to identify important inflammatory markers and combined with preoperative pain and postoperative opioid usage to predict postoperative pain using a multiple linear regression model. RESULTS: The current study included 92 patients and 41 inflammatory biomarkers passing quality control. Orthogonal Partial Least Square Discriminant Analysis identified 16 important markers. An initial prediction model explained 27.2% of postoperative pain variability, while a condensed model using backwards elimination, explained 34.3% of postoperative pain variability. The condensed model included the inflammatory biomarkers 4E-BP1, STAMBP, MCP-2, VEGFA, and adjusted for postoperative opioid consumption. DISCUSSION: The current study is the first to demonstrate an association between preoperative inflammatory biomarkers, opioid consumption, and acute postoperative pain after VATS in patients with lung cancer. Future studies are needed to confirm these findings.
Using Multi-Informant Qualitative Data to Inform Adaptations to Mindfulness-Based Interventions for Adolescents With Chronic Migraine.
Clementi MA, Harmon M, Law EF … +3 more , Perzow SDE, Shomaker LB, Thompson T
Clin J Pain · 2026 Apr · PMID 41441731 · Full text
OBJECTIVES: Adolescents with chronic migraine face increased risk for comorbid anxiety and depression that, can hinder migraine self-management and coping. Mindfulness-based interventions may reduce anxiety/depression to...
OBJECTIVES: Adolescents with chronic migraine face increased risk for comorbid anxiety and depression that, can hinder migraine self-management and coping. Mindfulness-based interventions may reduce anxiety/depression to improve migraine outcomes, yet require tailoring to increase acceptability and engagement among this distinct population. The current study used qualitative methods to explore multi-informant perspectives on the illness experience and unique intervention content/delivery needs, with the goal of informing adaptations to mindfulness-based interventions for adolescents with chronic migraine. MATERIALS AND METHODS: Fifteen interest holders, representing adolescents with chronic migraine, their parents, and health care providers, completed semi-structured interviews assessing experiences with chronic migraine, the role of stress and emotions, attitudes toward mindfulness, and perspectives on a telehealth group mindfulness-based program. Interviews were transcribed and coded using a team-based thematic approach. RESULTS: Data revealed 4 major themes informing adaptations to mindfulness-based interventions for adolescents with chronic migraine: supporting engagement in mindfulness in the context of migraine pain, incorporating lived experience in intervention content, facilitating peer connections, and providing opportunities for parental involvement. Qualitative results were integrated with content expert input to develop specific adaptation recommendations for mindfulness-based interventions for adolescents with chronic migraine. DISCUSSION: Acknowledging and addressing the challenges of practicing mindfulness in the context of pain and targeting the isolating experience of chronic migraine by offering peer connection via group intervention delivery may offer unique ways to tailor mindfulness-based interventions for adolescents with chronic migraine. Adaptations may improve intervention fit, acceptability, and retention and should be tested in future clinical trials.
Somatosensory Function and Pain: Associations Over 12 Months Postinjury in Youth With Acute Musculoskeletal Pain.
Holley AL, Stoyles S, Dieckmann NF … +5 more , Heierle J, O'Brien JR, Edwards R, Palermo TM, Wilson AC
Clin J Pain · 2026 Mar · PMID 41396262 · Full text
OBJECTIVE: Acute musculoskeletal (MSK) injuries are common in youth and prior research has identified somatosensory experiences such as conditioned pain modulation (CPM) as a predictor of the transition from acute to chr...
OBJECTIVE: Acute musculoskeletal (MSK) injuries are common in youth and prior research has identified somatosensory experiences such as conditioned pain modulation (CPM) as a predictor of the transition from acute to chronic pain. Prior pediatric studies are limited by small samples, single quantitative sensory testing (QST) modalities, and short-term follow-up, so the utility of QST in predicting longer-term pain outcomes following acute injury is unknown. To fill this gap, we examined somatosensory function in the acute pain period as a predictor of pain outcomes over 12 months. METHODS: Participants were 226 youth (and a caregiver) taking part in a prospective longitudinal study. Youth completed a QST battery (pain threshold, pain tolerance, temporal summation, and CPM) at baseline (postinjury), and questionnaires assessing pain (average pain, movement-evoked pain; MEP) at 3 time points over 12 months. RESULTS: A subset of youth developed persistent pain (≥3/0 to 10 NRS) at 3 months (15% to 21% depending on pain measure). Regression models indicated CPM was the sole QST measure that predicted pain intensity and persistence at 3 months (both average and MEP). No QST measures predicted pain outcomes at 12 months. Female sex was associated with pain persistence in multiple models. DISCUSSION: CPM in the acute pain period is a potential marker for short-term pain outcomes. Future research can examine the utility of using QST in predicting pain outcomes in other pediatric pain samples (eg, non-MSK locations, more severe injuries) and can expand assessment of MEP using standardized performance tasks.
Continuing Education Articles Included in CJP.
Turk DC
Clin J Pain · 2026 Feb · PMID 41396168 · Publisher ↗
Abstract loading — click title to view on PubMed.
An Ecological Momentary Assessment Study Examining the Efficacy of Third-Wave Cognitive-Behavioral Therapies on Different Indices of Pain-Related Outcomes.
Sanabria-Mazo JP, Giné-Vázquez I, Navarrete J … +7 more , Royuela-Colomer E, Fernández-Félix BM, Suso-Ribera C, García-Palacios A, McCracken LM, Schneider S, Luciano JV
Clin J Pain · 2026 Mar · PMID 41368715 · Publisher ↗
OBJECTIVES: The average level of outcomes is the most used index for assessing the efficacy of psychological therapies; however, emerging evidence suggests that it may not fully capture the complexity of treatment effect...
OBJECTIVES: The average level of outcomes is the most used index for assessing the efficacy of psychological therapies; however, emerging evidence suggests that it may not fully capture the complexity of treatment effects. This study compared the effects of third-wave cognitive-behavioral therapy (CBT) on pain-related outcomes (pain intensity, pain interference, sleep disturbance, and depressed mood) using 6 indices: average level, variability, maximum level, minimum level, frequency in high, and frequency in low. METHODS: Ecological momentary assessment (EMA) data were collected within a randomized controlled trial (RCT) that evaluated the addition of remote-delivered third-wave CBT to treatment-as-usual (TAU) in individuals with chronic low back pain plus depressive symptoms. A total of 82 participants (CBT=50 and TAU=32) provided 4595 EMA data points over 10 weeks (70 d). RESULTS: Compared with TAU, third-wave CBT was generally associated with greater improvement across the pain-related outcomes. Frequency in low emerged as the most sensitive index for change in pain interference and depressed mood; in contrast, the average level showed limited sensitivity. The maximum level also captured some between-group differences for sleep disturbance and depressed mood. The remaining indices (variability, minimum, and frequency in high) did not consistently provide additional value. DISCUSSION: These findings suggest that the frequency of low may be a sensitive and clinically informative index for detecting treatment effects in RCTs using EMA. Nevertheless, further research is needed to establish its reliability and generalizability across clinical contexts and clinical trial designs.
Multilevel Network Meta-Analysis of Nonpharmacological Interventions for Migraine: Focusing on the Dose-Effect of Physical Exercise and Its Moderators.
Xie J, Zhang Z, Guo J
Clin J Pain · 2026 Apr · PMID 41368711 · Publisher ↗
OBJECTIVE: To compare the relative efficacy of common nonpharmacological treatments for migraine and to determine the optimal dosage for physical exercise. METHODS: We searched 4 databases up to January 2025 for randomiz...
OBJECTIVE: To compare the relative efficacy of common nonpharmacological treatments for migraine and to determine the optimal dosage for physical exercise. METHODS: We searched 4 databases up to January 2025 for randomized controlled trials of nonpharmacological interventions for migraine. A multilevel network meta-analysis, integrated with a dose-response analysis, was conducted to compare intervention efficacy and determine the optimal exercise dosage. Treatments were ranked by the Surface Under the Cumulative Ranking curve. Two independent reviewers extracted data and assessed the risk of bias. RESULTS: Fifty-nine randomized controlled trials involving 10,020 participants (78.1%, female) were included. Neuromodulation techniques were most effective (Hedges' g =-0.61, 95% credible interval: -0.89 to -0.33), followed by physical exercise (Hedges' g =-0.42, 95% credible interval: -0.67 to -0.18), and mindfulness meditation (Hedges' g =-0.38, 95% credible interval: -0.63 to -0.12). The dose-response analysis for exercise indicated that while 100 metabolic equivalent (MET)-minutes per session was statistically effective, a minimum of 110 MET-minutes per session was required to achieve the Minimal Clinically Important Difference. Efficacy reached an optimal therapeutic plateau at 250 to 300 MET-minutes per session, achievable with 3 to 5 weekly sessions of 30 to 40 minutes. DISCUSSION: Neuromodulation, physical exercise, and mindfulness meditation are promising nonpharmacological therapies for migraine. For physical exercise, a minimum dose of 110 MET-minutes per session is needed for clinically significant effects, with an optimal therapeutic window at 250 to 300 MET-minutes per session. Due to the low quality of primary evidence, these findings warrant cautious interpretation and require future validation.
Letter to the Editor Regarding: Dexmedetomidine Versus Magnesium Sulfate in Ultrasound-Guided Bilateral Bi-Level Erector Spinae Plane Block in Corrective Scoliosis Surgery: A Randomized Controlled Clinical Trial.
Lou Y, Wu J
Clin J Pain · 2026 Mar · PMID 41340428 · Publisher ↗
Abstract loading — click title to view on PubMed.
Amnesia-Related Bias in Sedation Research: Implications for Lumbar Facet Radiofrequency Ablation.
Abudayeh A, Fishchenko I
Clin J Pain · 2026 Mar · PMID 41340425 · Publisher ↗
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Optimizing Postoperative Analgesia in Total Knee Arthroplasty: A Randomized Controlled Trial on the Efficacy of Perineural Dexamethasone With iPACK and Adductor Canal Block.
Reysner T, Kowalski G, Mularski A … +3 more , Perek A, Daroszewski P, Reysner M
Clin J Pain · 2026 Feb · PMID 41305942 · Full text
OBJECTIVES: To assess the effect of perineural dexamethasone on analgesia duration and opioid consumption when used as an adjuvant to the iPACK (infiltration between the popliteal artery and capsule of the knee) block an...
OBJECTIVES: To assess the effect of perineural dexamethasone on analgesia duration and opioid consumption when used as an adjuvant to the iPACK (infiltration between the popliteal artery and capsule of the knee) block and adductor canal block in patients undergoing total knee arthroplasty. METHODS: In this double-blind, randomized controlled trial, 60 patients aged 65 years or older undergoing total knee arthroplasty under spinal anesthesia were assigned to one of 2 groups. The control group received iPACK and adductor canal block with 0.2% ropivacaine alone, while the Dexamethasone group received the same blocks with the addition of perineural dexamethasone. The primary outcome was time to first opioid rescue analgesia. Secondary outcomes included total opioid consumption over 48 hours, postoperative pain scores at defined time points, quadriceps muscle strength, and adverse effects, including neurological complications and hyperglycemia. RESULTS: Patients receiving dexamethasone experienced a significantly longer duration of analgesia (15.9±1.2 h vs. 8.8±1.6 h), lower total opioid consumption over 48 hours (1.2±1.3 mg vs. 2.3±1.4 mg morphine equivalents), and fewer patients required opioids (20% vs. 50%). Pain scores were significantly lower at 8 and 12 hours postoperatively. No differences were observed in motor function or adverse event rates. DISCUSSION: Perineural dexamethasone enhanced the duration and quality of postoperative analgesia without compromising motor function. Its inclusion in regional analgesia protocols for total knee arthroplasty may contribute to improved recovery and reduced opioid use.
Evaluating the Current Opioid Misuse Measure (COMM) as a Tool to Inform Management of Vaso-occlusive Episodes Among Hospitalized Sickle Cell Disease Patients.
Swindell WR, Johnson E, Yi M … +3 more , Joseph A, Burton M, Hong AS
Clin J Pain · 2026 Feb · PMID 41251024 · Publisher ↗
OBJECTIVES: Sickle cell disease (SCD) is associated with vaso-occlusive episodes (VOEs) that often require inpatient care. Parenteral opioids are recommended as first-line VOE treatment in hospitalized patients. The Curr...
OBJECTIVES: Sickle cell disease (SCD) is associated with vaso-occlusive episodes (VOEs) that often require inpatient care. Parenteral opioids are recommended as first-line VOE treatment in hospitalized patients. The Current Opioid Misuse Measure (COMM) survey was used to screen for aberrant opioid use in SCD patients hospitalized for VOE. Goals were to estimate the proportion of positive screens and evaluate associations with length of stay (LOS), electronic health record (EHR) data, and Prescription Drug Monitoring Program (PDMP) assessments. METHODS: SCD patients hospitalized for VOE were approached to complete COMM surveys. Descriptive statistics and multivariate modeling were used to evaluate whether COMM results were associated with LOS or secondary variables. RESULTS: A total of 111 patients were approached and 89 completed surveys. Approximately 6 in 10 (57.3%) respondents screened positive for aberrant opioid use using a sensitive COMM threshold (≥9). A more specific threshold (≥13) identified about 3 in 10 (31.7%) of respondents. Positive COMM screens were more common among younger patients and those with a higher EHR risk index (Epic general risk score). COMM score was positively correlated with LOS (Spearman r =0.25, P =0.025), although this association was nonsignificant in survival models adjusted for sex and age ( P ≥0.081). DISCUSSION: A high proportion of adults admitted for VOE screened positively using the COMM survey, which is a sensitive indicator of opioid misuse among outpatients. Our findings demonstrate feasibility of inpatient screening using the COMM survey and support further investigation of this tool for SCD patients hospitalized with VOE.
Attrition Rates in Mindfulness-Based Interventions for Chronic Pain: A Meta-Analysis With Meta-Regression.
Wang MY, Perera MPN, Fitzgerald PB … +2 more , Bailey NW, Fitzgibbon BM
Clin J Pain · 2026 Jul · PMID 41250993 · Publisher ↗
OBJECTIVE: Mindfulness-based interventions (MBIs) show promise in managing chronic pain but often require substantial time commitments, leading to high attrition and concerns about acceptability. This meta-analysis evalu...
OBJECTIVE: Mindfulness-based interventions (MBIs) show promise in managing chronic pain but often require substantial time commitments, leading to high attrition and concerns about acceptability. This meta-analysis evaluated attrition rates in MBIs for chronic pain and examined moderators contributing to participant withdrawal. METHODS: Following PRISMA guidelines, we searched relevant databases for studies of MBIs for pain. Eligible studies included randomised controlled trials, controlled trials, and quasi-experimental designs that reported attrition data for adults (≥18 y) with chronic pain lasting over 3 months. Data extraction covered attrition metrics, program characteristics, and participant demographics. Statistical analyses included random-effects meta-analyses of proportions, sensitivity analyses, meta-regression, and publication bias assessments. RESULTS: Forty-four studies (45 intervention conditions) were included. The pooled attrition rate was 30.1% (95% CI: 24.5%- 37.3%) with substantial heterogeneity ( I ²=89.0%). Attrition increased with stricter completion thresholds (minimum sessions required for programme completion status) ( P <0.001, R ²=28.1%): 18.0% (≥3 to 4 sessions), 31.6% (≥5 to 6 sessions), and 49.7% (>6 sessions). Online delivery showed higher attrition (51.0%) than in-person delivery (25.6%, P =0.002, R ²=17.1%). Individually delivered MBIs were also associated with higher attrition than group formats (β=0.216, P =0.039, R ²=5.5%). Publication bias analyses suggested minor influence on the pooled effect, which remained robust after adjustment. DISCUSSION: Attrition rates for MBIs in chronic pain vary widely. Higher attrition is associated with stricter completion criteria, online delivery, and individual formats. These findings highlight the need to optimise MBI programme structure for management of pain.
Item Reduction and Scoring of the Pediatric PainSCAN ©: A Screening Tool for Pediatric Neuropathic Pain and Complex Regional Pain Syndrome.
Mesaroli G, Davis AM, Perruccio AV … +8 more , Davidge KM, Campbell F, Sun N, Walker SM, Hess CW, Simons LE, Logan D, Stinson JN
Clin J Pain · 2026 Feb · PMID 41249025 · Publisher ↗
OBJECTIVES: The Pediatric PainSCAN© is the first screening tool specifically designed for pediatric neuropathic pain (NP) and complex regional pain syndrome (CRPS). A draft tool (37 items) was developed through a phased...
OBJECTIVES: The Pediatric PainSCAN© is the first screening tool specifically designed for pediatric neuropathic pain (NP) and complex regional pain syndrome (CRPS). A draft tool (37 items) was developed through a phased approach. This research aimed to reduce the number of items in the tool and to determine the weight of each item (ie, item scores) as it contributes to a probability of a diagnosis of NP or CRPS. METHODS: Survey 1 was administered to patients with NP or CRPS and health care professionals (HCPs). Participants rated the frequency and importance of each item in the draft tool on a 0 to 4 Likert scale; highest rated items were retained. Survey 2 was administered to a separate pool of patients (with NP, CRPS, or other pain conditions) who completed the Pediatric PainSCAN©. A logistic regression model was used to examine the relationship between item responses (yes/no) and patient diagnosis; parameter estimates were used for item scores. RESULTS: Survey 1 was completed by 43 patients (median age 15 y, 77% female) and 74 HCPs. Survey 2 was completed by 221 patients (median age 15 y, 81% female). Nineteen items remained in the final version of the tool; items were rated as important by patients and HCPs. Item scores are summed and converted to a probability score. CONCLUSION: The final set of items in the Pediatric PainSCAN© has been determined and study results provide further evidence of content validity. Additional research is needed to evaluate the tool's reliability, criterion validity, and select a cutoff score.
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