The Clinical Journal Of Pain[JOURNAL]
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200 papers
A Multisite Implementation of the Comfort Ability Program Telehealth Intervention for Pediatric Chronic Pain: Insights From Patients, Caregivers, and Providers.
Hale AE, Bhandari R, Vassilopoulos A … +3 more , Fussner LM, Collins J, Coakley R
Clin J Pain · 2026 Feb · PMID 41230636 · Publisher ↗
OBJECTIVE: The primary aim of this multisite study was to evaluate the feasibility and acceptability of a telehealth adaptation of the Comfort Ability Program (CAP) workshop, a group-based and family-based, in-person, be...
OBJECTIVE: The primary aim of this multisite study was to evaluate the feasibility and acceptability of a telehealth adaptation of the Comfort Ability Program (CAP) workshop, a group-based and family-based, in-person, behavioral health intervention for pediatric pain and related symptoms. METHODS: Four pediatric medical centers recruited patients (ages: 10 to 17; n=137) and their caregivers (n=139) for CAP-Virtual (CAP-V), a 6-session telehealth intervention. Families completed acceptability, feasibility, and clinical assessments at 4 time points: (1) pretreatment, (2) postsession, (3) immediately post-treatment, and (4) 1-week post-treatment. Clinicians also completed ratings of telehealth engagement. RESULTS: Patients, caregivers, and clinicians overwhelmingly rated CAP-V as a highly feasible and acceptable intervention. The overwhelming majority (95%+) completed 75% or more of the multisession intervention, and 58% were able to have multiple caregivers from the same household participate. There were a few technological issues that significantly impacted either the content or social connectedness of group participants. DISCUSSION: The CAP intervention can be delivered through telehealth with rates of acceptability and feasibility that are analogous to the in-person intervention. Cross-site and aggregate participant responses from this investigation helped to further refine virtual intervention content and structure. Overall, findings from this study support the maintenance and expansion of access to telehealth care-specifically for specialized behavioral health interventions that may be difficult to access-by demonstrating high rates of patient participation, satisfaction with intervention and technology, and successful attainment of intervention goals as rated by patients and providers. Additional research is needed to assess long-term clinical outcomes.
Cardiovascular Risks of Nonsteroidal Anti-Inflammatory Drugs: A Narrative Review.
Elliott A, Juresic S, Siegel L … +1 more , Smith NT
Clin J Pain · 2026 Feb · PMID 41230625 · Publisher ↗
OBJECTIVES: The primary objective of this article was to examine literature from the last 10 years surrounding cardiovascular risks associated with NSAID use. METHODS: A systematic search was developed to include randomi...
OBJECTIVES: The primary objective of this article was to examine literature from the last 10 years surrounding cardiovascular risks associated with NSAID use. METHODS: A systematic search was developed to include randomized control trials and systematic review meta-analyses that focused on the cardiovascular effects associated with NSAID use. RESULTS: The search and screen identified 10 articles published in the last 10 years to be included in the review. DISCUSSION: The most common cardiovascular risks studied in the included literature were hemodynamic effects and myocardial infarction. The evidence in the included studies suggests that concerns of adverse hemodynamic effects may be overstated with short-term NSAID use. Myocardial infarction was shown to be a very serious, but rare, side effect associated with NSAID use. Practitioners should weigh this risk when using NSAIDs in patients with an increased risk of MI at baseline. Other included studies described risks of Kounis syndrome, QTc prolongation, and potential reversal of right ventricular dysfunction in patients using NSAIDs.
Effects of Ultrasound-Guided Oblique Subcostal Transversus Abdominis Block Combined With Patient-Controlled Intravenous Analgesia on Analgesia and Early Recovery After Open Hepatectomy: A Randomized Controlled Clinical Trial.
Wang C, Xu W, Li Y … +4 more , Sun Y, Chen W, Yang W, An K
Clin J Pain · 2026 Feb · PMID 41208188 · Full text
OBJECTIVES: Open hepatectomy is associated with acute severe postoperative pain. The oblique subcostal transversus abdominis plane (OSTAP) block combined with patient-controlled intravenous analgesia (PCIA) has gained at...
OBJECTIVES: Open hepatectomy is associated with acute severe postoperative pain. The oblique subcostal transversus abdominis plane (OSTAP) block combined with patient-controlled intravenous analgesia (PCIA) has gained attention as a multimodal analgesic strategy, but evidence for its synergistic efficacy remains limited. Therefore, we conducted a randomized controlled trial to assess the effect of ultrasound-guided bilateral OSTAP blockade combined with PCIA in open hepatectomy. METHODS: This study is a single-center, prospective, randomized controlled trial. All participants were randomized to receive either the OSTAP+PCIA (OSTAP group) or PCIA alone (PCIA group) (1:1). Primary endpoints were mean postoperative visual analog scale (VAS) scores at rest and on movement. Secondary endpoints included pain scores at different time points postoperatively, cumulative opioid consumption, hemodynamic parameters, adverse events, time to functional recovery, postoperative hospitalization duration, and total costs. RESULTS: A total of 74 patients underwent randomization. The mean VAS scores of the OSTAP group were significantly lower than the PCIA group in both rest and movement ( P <0.001), with a statistically significant difference in the postoperative period of 6 hours ( P <0.001 and 0.001) and 24 hours ( P =0.001 and 0.046). The OSTAP group significantly reduced perioperative opioid consumption ( P <0.001 and 0.032). The hemodynamic parameters in the OSTAP group showed more stability. The time to first ambulation and oral intake was earlier in the OSTAP group ( P =0.040 and 0.028). No statistically significant differences in other measurements were observed. DISCUSSION: The combination of OSTAP and PCIA provided effective pain relief and reduces perioperative opioid consumption for patients undergoing open hepatectomy without increasing adverse events and costs.
The Role of Psychological Stress in the Relationship Between Chronic Pain and School Functioning.
Koike C, Logan DE, Nestor BA … +2 more , Greco C, Kossowsky J
Clin J Pain · 2026 Jan · PMID 41104954 · Publisher ↗
INTRODUCTION: Pediatric chronic pain is linked to higher school absenteeism, academic struggles, and social stressors, which may further exacerbate pain. Stress is thought to be a key mechanism in this relationship. This...
INTRODUCTION: Pediatric chronic pain is linked to higher school absenteeism, academic struggles, and social stressors, which may further exacerbate pain. Stress is thought to be a key mechanism in this relationship. This study tested whether psychological stress mediates the association between chronic pain and school functioning. METHODS: Adolescents with chronic pain (ACP) at a tertiary hospital in the northeastern United States and adolescents without chronic pain (AWCP) completed self-report measures of psychological stress and school functioning. Analyses included t tests, Spearman's correlations, and mediation models controlling for age, gender, and race. RESULTS: The sample comprised 488 adolescents (63.11% female, M age =16.05, SD=1.23): 274 (56.14%) ACP and 214 (43.85%) AWCP. ACP reported significantly higher psychological stress ( P <0.001) and greater school-related interpersonal discomfort ( P =0.013) com p ared to AWCP. After covariate adjustment, the difference in interpersonal discomfort was no longer significant. Psychological stress correlated with poorer school functioning across all subscales ( r =0.4-0.52, P < 0.05). In the mediation model, chronic pain strongly predicted higher stress (a=9.70, P <0.001), stress predicted poorer school functioning (b=0.99, P <0.001), and the indirect effect was large and statistically significant (ab=9.62, 95% CI [7.06,12.45], P <0.001). After accounting for stress, the direct link between chronic pain and school functioning became negative and statistically significant (c'=-12.61, 95% CI [-16.09,-9.13], P <0.001), while the total effect remained not statistically significant (c=-2.99, P =0.14), consistent with a suppression pattern. DISCUSSION: Psychological stress mediates the relationship between chronic pain and school functioning. Interventions targeting stress may improve school outcomes for adolescents with chronic pain even if pain symptoms persist.
Complications Associated With Use of Peripheral Nerve Stimulators for Pain Management.
Andrassy B, Harris M, Mukhdomi T
Clin J Pain · 2026 Mar · PMID 41097862 · Publisher ↗
OBJECTIVE: Peripheral nerve stimulators (PNS) are neuromodulation devices indicated for pain management. PNS advancements including miniaturized and partially externalized devices have led to increased utilization. Sound...
OBJECTIVE: Peripheral nerve stimulators (PNS) are neuromodulation devices indicated for pain management. PNS advancements including miniaturized and partially externalized devices have led to increased utilization. Sound evidence supports PNS for pain management, and associated complications are typically modest. However, few studies have examined which PNS-related complications arise most frequently, or relative complication type frequencies between PNS devices. We characterized the most common complications that emerged from PNS use, for 4 commercially available PNS devices. METHODS: We queried the FDA Manufacturer and User Device Experience (MAUDE) database for adverse event reports related to SPRINT PNS, Nalu Neurostimulation System, StimQ PNS/Freedom PNS, and Stimrouter from 3/14 to 3/24. Duplicate entries were removed, then entries were categorized using event descriptions. Analyses were performed using Microsoft Excel and RStudio. RESULTS: Of 1149 unique reports, procedural complications were most common (31.3%), followed by device-related complications (30.9%), and patient complaints (24.02%). Reports that did not fit the categories described were "Other" complications (10.97%). The most common procedural complications were infections (26.8%), and the most common device-related complications were lead migration (10.5%), erosion (8.09%), and electric shock (4.53%). Explant was the most common management technique (46.3%). Other nonsurgical management (22.9%) and surgical revision (17.7%) were also common. DISCUSSION: This analysis aimed to inform the safe utilization of PNS for pain management. Infections made up a larger proportion of complications than previously reported, revealing a need for stricter patient selection and infection prevention techniques.
Efficacy and Safety of Serratus Anterior Plane Block and Erector Spinae Plane Block for Rib Fracture Pain: A Systematic Review and Meta-analysis.
Lin BH, Huang HM, Lin SF
Clin J Pain · 2026 Feb · PMID 41097841 · Publisher ↗
OBJECTIVES: Fascial plane blocks (FPBs), including serratus anterior plane block (SAPB) and erector spinae plane block (ESPB), are regional anesthesia techniques targeting the plane between fascial layers. We aimed to ev...
OBJECTIVES: Fascial plane blocks (FPBs), including serratus anterior plane block (SAPB) and erector spinae plane block (ESPB), are regional anesthesia techniques targeting the plane between fascial layers. We aimed to evaluate the analgesic efficacy and safety of FPBs in patients with rib fractures. METHODS: PubMed, EMBASE, Cochrane Library, and Google Scholar were searched through August 2025. We included prospective studies comparing the pain-relieving efficacy of FPBs with that of standard care (no block) or thoracic epidural analgesia. SAPB and ESPB were analyzed collectively to assess overall analgesic efficacy, with subgroup analyses performed to examine their individual effects. Bayesian analysis was performed for validation. RESULTS: This review included 9 studies (600 patients). The results indicated that FPBs outperformed standard care in relieving pain for up to 6 hours postblock (standardized mean difference [SMD]: -0.58; 95% CI: -0.99 to -0.17). The analgesic efficacy of FPBs was similar to that of thoracic epidural analgesia for up to 48 hours (SMD: -0.13; 95% CI:-0.45 to 0.2). FPBs reduced in-hospital opioid use (SMD: -0.81; 95% CI: -1.72 to 0.11) and stabilized hemodynamic parameters. In subgroup analyses, both SAPB and ESPB demonstrated consistent trends in analgesic efficacy. These findings were corroborated in Bayesian analyses. Regarding safety, FPBs were associated with lower risks of hypotension (risk difference: -0.24; 95% CI: -0.36 to -0.12) and nausea and vomiting (risk difference: -0.19; 95% CI: -0.39 to 0.01). DISCUSSION: SAPB and ESPB can be promising options for rib fracture analgesia, particularly in emergency settings. Further studies are warranted to validate our findings.
Exploring the Relationship Between Central Sensitization, Pain Characteristics, and Function in a Cross-Sectional Study of Individuals With Lateral Elbow Tendinopathy.
Keating C, Puentedura E, Lucado A … +1 more , Cleland J
Clin J Pain · 2026 Jan · PMID 41084876 · Publisher ↗
OBJECTIVE: To investigate the relationship between central sensitization (CS), pain intensity, pain interference, and function in individuals with lateral elbow tendinopathy, and to determine the influence of psychologic...
OBJECTIVE: To investigate the relationship between central sensitization (CS), pain intensity, pain interference, and function in individuals with lateral elbow tendinopathy, and to determine the influence of psychological factors such as anxiety and depression. A cohort study involving comprehensive assessments to explore associations between neurophysiological and psychological factors in individuals with lateral elbow tendinopathy. METHODS: Participants diagnosed with lateral elbow tendinopathy underwent evaluations including the Central Sensitization Inventory, neurophysiological measures, and psychological assessments (anxiety and depression scales). Pain intensity and interference were measured, along with patient-specific functional scores to assess functional ability. RESULTS: Elevated Central Sensitization Inventory scores were significantly associated with increased continuous pain intensity, highlighting the role of CS in pain perception. Psychological factors, particularly anxiety and depression, correlated closely with higher pain intensity. Two-point discrimination emerged as a statistically significant predictor of functional ability, suggesting that functional impairment may involve multifaceted factors including neurophysiological measures. DISCUSSION: The findings underscore the importance of identifying CS and psychological factors to develop targeted, biopsychosocial interventions for lateral elbow tendinopathy. Recognizing the contribution of central mechanisms and emotional health can improve personalized treatment strategies, ultimately enhancing recovery and quality of life. The study emphasizes the necessity for comprehensive assessments that extend beyond pain severity to include psychological evaluations.
Mid-Life Social and Health Outcomes Associated With Early-Onset Chronic Noncancer Pain: Findings from the Victorian Adolescent Health Cohort Study.
Campbell G, Husin HM, Kerr JA … +7 more , Dashti SG, Olsson CA, Patton GC, Santo T, Hopkins RE, Degenhardt L, Sawyer SM
Clin J Pain · 2026 Jan · PMID 41084870 · Publisher ↗
OBJECTIVES: Little is known about how those with early life experiences of chronic pain fare in middle adulthood. The current study examines the association of adolescent, young adult, and adult chronic pain onset with m...
OBJECTIVES: Little is known about how those with early life experiences of chronic pain fare in middle adulthood. The current study examines the association of adolescent, young adult, and adult chronic pain onset with middle-aged sociodemographic, physical and mental health, and substance use profiles. METHODS: The Victorian Adolescent Health Cohort Study (VAHCS) commenced in 1992 as a population-representative sample of 1943 14 to 15-year-old adolescents who have been followed across 11 waves into middle adulthood. We analysed data from Wave 11 (2019 to 2021, n=1412, age 43 years [mid-life]) to describe the midlife sociodemographic, physical and mental health, and substance use profiles of those who retrospectively reported adolescent (10 to 24 y), young adult (25 to 34 y), and adult (35 to 44 y) onset chronic pain. We also describe associations by sex at birth. RESULTS: Two in 5 participants (41%) reported experiencing chronic pain by age 43 years. This was higher in females than in males (44.6% vs. 36.4%, respectively). Of these, just under half (45%) reported adolescent-onset chronic pain, 30% reported young adult-onset, and 25% reported adult-onset chronic pain. Compared with later onset pain, adolescent-onset was associated with a greater risk for financial hardship (particularly in males), past 12-month major illness, generalised anxiety disorder (among males), and more frequent cannabis use in mid-adult life. DISCUSSION: Our findings suggest that chronic pain in midlife commonly starts early, across adolescence and young adulthood, and that many with earlier life histories of chronic pain are not faring well across a range of indicators in middle adult life, particularly those with the onset of chronic pain in adolescence.
Longitudinal Outcomes for a 10-Week Interdisciplinary Pain Rehabilitation Program.
Craner JR, Fromson AJ, Moore KB … +3 more , Lake ES, Perra AEA, Holwerda T
Clin J Pain · 2026 Jan · PMID 41081341 · Publisher ↗
OBJECTIVES: Chronic pain is an important public health problem. Interdisciplinary pain rehabilitation programs (IPRPs) demonstrate immediate and long-term improvements in pain, functioning, and overall quality of life fo...
OBJECTIVES: Chronic pain is an important public health problem. Interdisciplinary pain rehabilitation programs (IPRPs) demonstrate immediate and long-term improvements in pain, functioning, and overall quality of life for individuals with chronic pain. However, data on treatment durability for different program models and patient populations are limited. The purpose of this study was to examine long-term outcomes of a 10-week IPRP. METHODS: Three hundred ninety-eight adults with chronic pain were treated at a rehabilitation hospital between February 2019 and May 2021 in an intensive 10-week outpatient IPRP consisting of physical therapy, occupational therapy, pain psychology, and medical management. Participants completed measures of pain intensity, pain interference, depressed mood, anxiety, physical functioning and pain catastrophizing at intake, discharge, and 3-month, 6-month, 9-month, and 12-month post-treatment. RESULTS: A total of 34.7% of participants returned postprogram surveys at 3 months, 26.9% at 6 months, 17.6% at 9 months, and 15.6% at 12 months. Participants were primarily female (79.1%), White/Caucasian (79.4%) and married (51.5%) with an average age of 49.30±15.29 years. The results demonstrated statistically and clinically significant improvement across all outcome measures comparing intake to discharge. While there was some deterioration of treatment gains over time, all measures remained improved at all time points compared with intake. DISCUSSION: A 10-week IPRP model can improve pain and functioning in a population of patients with heterogenous chronic pain conditions in a community setting, providing durable improvements over time. These results add to the body of literature supporting IPRPs as an effective intervention for patients with chronic pain.
Letter to the Editor regarding "Hyperbaric Oxygen Therapy (HBOT) for Management of Complex Regional Pain Syndrome (CRPS)".
Hajek M, Klugar M
Clin J Pain · 2026 Jan · PMID 41069040 · Publisher ↗
Abstract loading — click title to view on PubMed.
Social Determinants of Health Among Individuals Receiving Opioids for Pain Management.
Miller-Matero LR, Morris EP, Christopher B … +10 more , Pappas C, Chrusciel T, Salas J, Wilson L, Secrest S, Sullivan MD, Carpenter RW, Lustman PJ, Ahmedani BK, Scherrer JF
Clin J Pain · 2025 Dec · PMID 41017040 · Full text
OBJECTIVE: Individuals receiving opioids for pain management are at risk for negative outcomes. However, it is not clear whether social determinants of health (SDOH) predict outcomes a year after starting a prescription...
OBJECTIVE: Individuals receiving opioids for pain management are at risk for negative outcomes. However, it is not clear whether social determinants of health (SDOH) predict outcomes a year after starting a prescription opioid. The purpose was to examine associations between SDOH with psychiatric-related, pain-related, and opioid-related outcomes at a 12-month follow-up. METHODS: Participants (N=783) with a new period of 30 to 90-day opioid use completed baseline and 12-month follow-up questionnaires regarding SDOH, depressive symptoms, pain severity, pain interference, and opioid use. Multivariate adjusted models estimated the association between SDOH and outcomes. RESULTS: Participants had a mean age of 53.4 years (SD=11.9), 71.2% White race, and 69.9% women. Older age (OR=0.97; 0.95, 0.99) and Black race (OR=0.45; 0.27, 0.76) were inversely associated with depression, while being widowed/divorced/separated (OR=1.72; 1.01, 2.91) and lacking a college education (OR=2.43; 1.25, 4.73) were positively associated with depression. Women (OR=1.56; 1.12, 2.18) and lower income (OR=2.09; 1.14, 3.85) were associated with greater odds of opioid use, while unemployment was associated with lower odds of opioid use at 12 months (OR=0.55; 0.34, 0.89). Older age (OR=0.95; 0.91, 0.99) was inversely associated with opioid use concerns while disability (OR=4.59; 1.60, 13.11) was positively associated. DISCUSSION: Several SDOH variables were associated with poorer functioning at baseline and 12 months after individuals were prescribed an opioid. It may be useful for clinicians to screen for SDOH to identify higher-risk individuals.
Psychopathological and Psychosocial Factors Associated With Suicide-Related Outcomes in Individuals with Chronic Non-Cancer Pain: A Systematic Review.
Forget J, Kalisch L, Attali D … +4 more , Calati R, Torino G, Courtet P, Baeza-Velasco C
Clin J Pain · 2026 Apr · PMID 40999625 · Publisher ↗
OBJECTIVES: Individuals with chronic noncancer-related pain (CNCP) are at increased risk for suicide, making it essential to identify factors associated with suicide-related outcomes (suicidal ideation, suicide attempt,...
OBJECTIVES: Individuals with chronic noncancer-related pain (CNCP) are at increased risk for suicide, making it essential to identify factors associated with suicide-related outcomes (suicidal ideation, suicide attempt, and suicide death) in this population. This study aims to explore the psychopathological and psychosocial factors related to suicide-related outcomes in individuals with CNCP. METHOD: A systematic review was conducted by searching databases including PubMed, PsycInfo, Embase, and Cochrane using predefined keywords and a systematic search strategy to identify psychopathological and psychosocial factors associated with suicide-related outcomes in adults with chronic CNCP. RESULTS: A total of 49 studies identified 17 factors associated with suicide-related outcomes in CNCP: 11 psychopathological, including schizophrenia spectrum and other psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, trauma and stressor-related disorders, personality disorders, unspecified psychopathology, substance-related and addictive disorders, somatic symptom and related disorders, and sleep-wake disorders; and 6 psychosocial, including health-related quality of life, impact of pain/pain-related beliefs, coping strategies, interpersonal relationships, psychological and emotional state, and life events. DISCUSSION: This systematic review highlights the variety of psychopathological and psychosocial factors associated with suicide-related outcomes in CNCP, underscoring the necessity of integrating these aspects to improve pain management and patient care.
Pain Sensitization and Descending Pain Inhibition in Fibromyalgia.
Garcia-Hernandez A, de la Coba P, Bruehl S … +2 more , Duschek S, Reyes Del Paso GA
Clin J Pain · 2025 Dec · PMID 40977392 · Publisher ↗
BACKGROUND: Both facilitation of ascending nociceptive pathways and impaired inhibition of descending ones may contribute to pain sensitization in fibromyalgia (FM). The slowly repeated evoked pain (SREP) protocol is a p...
BACKGROUND: Both facilitation of ascending nociceptive pathways and impaired inhibition of descending ones may contribute to pain sensitization in fibromyalgia (FM). The slowly repeated evoked pain (SREP) protocol is a potential diagnostic marker for assessing this sensitization. Though its mechanisms are unclear, SREP appears linked to ascending facilitation, while the role of descending inhibitory dysfunction in SREP sensitization remains to be clarified. OBJECTIVE: To quantify descending pain inhibition in FM compared with healthy individuals and to assess its relationship with pain sensitization via SREP. In addition, associations between descending pain inhibition and clinical symptoms were examined. METHODS: In 55 women with FM and 45 pain-free women, descending pain inhibition was estimated using the conditioned pain modulation (CPM) paradigm, with interdigital web pinching as the conditioning stimulus. The use of the SREP protocol consisted of applying pressure stimuli to the nail of the third finger of the nondominant hand. Clinical symptoms were assessed using self-report questionnaires. RESULTS: SREP sensitization was stronger and CPM smaller in FM patients than in pain-free women. In individuals with FM , SREP sensitization was inversely associated with CPM, and both were related to clinical symptoms. Individuals with FM who did not show CPM reported greater severity of FM symptoms and higher anxiety and fatigue levels than those who showed CPM. CONCLUSIONS: Impaired endogenous pain inhibition contributes to pain sensitization in FM and may partly explain SREP sensitization. This reduced pain inhibition could also underlie the clinical symptoms commonly seen in FM. Future research may clarify the altered balance between ascending and descending pain processes in FM.
Diagnostic Criteria for Centralized Pain Following Peripheral Nerve Injury: A Systematic Review.
Raasveld FV, Tiems MRA, Johnston BR … +5 more , Moussa O, Valerio IL, Hao D, Coert JH, Eberlin KR
Clin J Pain · 2026 Jan · PMID 40977364 · Publisher ↗
INTRODUCTION: Peripheral nerve injuries (PNIs) resulting from trauma or surgery can lead to neuropathic pain and, in some cases progress to centralized pain. This condition significantly affects patients' quality of life...
INTRODUCTION: Peripheral nerve injuries (PNIs) resulting from trauma or surgery can lead to neuropathic pain and, in some cases progress to centralized pain. This condition significantly affects patients' quality of life and functional abilities. However, diagnostic criteria for centralized pain after PNI remain poorly defined, complicating patient identification and treatment. This systematic review aimede to assess current diagnostic approaches and propose evidence-based criteria for clinical diagnosis. METHODS: A systematic search of MEDLINE, Embase, Web of Science, and CENTRAL was conducted for studies assessing diagnostic approaches for centralized pain after PNI. Included studies addressed clinical characteristics, diagnostic tests, or signs of centralized pain after PNI. Exclusion criteria included acute pain studies (<3 mo), pediatric patients, and non-English articles. RESULTS: From 950 citations screened, 28 studies (6189 patients) were included. On the basis of the synthesized evidence, we propose the following diagnostic criteria for centralized pain after PNI: (1) documented peripheral nervous system injury or compression; (2) neuropathic pain persisting for 3 months; (3) hyperalgesia, allodynia, or other forms of hypersensitivity extending beyond the primary zone of injury; (4) associated mood/cognitive disturbances; and (5) limited response to peripheral nerve blocks, defined as <50% pain reduction, if performed. CONCLUSIONS: This study proposes a comprehensive, evidence-based diagnostic framework for centralized pain after PNI. The algorithm combines clinical criteria with optional diagnostic testing, providing a practical approach for diagnosis that accounts for variability in access to advanced diagnostic tools. By standardizing the diagnostic process, the framework aims to enhance patient identification and support appropriate treatment selection in clinical practice. LEVEL OF EVIDENCE: Level III-systematic reviews.
Procedural Pain Assessments for Neonates at Risk of Neonatal Opioid Withdrawal Syndrome: A Scoping Review.
Lavergne J, Langman E, Mansell D … +2 more , Dol J, Benoit B
Clin J Pain · 2025 Dec · PMID 40968465 · Publisher ↗
OBJECTIVES: To identify evidence for pain assessment during acute procedures in hospitalized neonates at risk of neonatal opioid withdrawal syndrome (NOWS). METHODS: This scoping review was conducted using the JBI scopin...
OBJECTIVES: To identify evidence for pain assessment during acute procedures in hospitalized neonates at risk of neonatal opioid withdrawal syndrome (NOWS). METHODS: This scoping review was conducted using the JBI scoping review methodology. The search strategy focused on identifying in-patient neonates undergoing acute painful procedures. Databases searched are MEDLINE, CINAHL, Embase, PsycInfo, and Scopus. The relevant data were extracted by 2 reviewers and the results were summarized in a narrative description and presented in a tabular format, including the components of participants, concept, and context. RESULTS: A total of 22,731 unique studies were screened, with 5 studies ultimately included. Of these studies, 2 included neonates at risk of NOWS but did not report pain responses separately. The 3 remaining studies observed procedural pain in opioid-exposed neonates compared with neonates without opioid exposure during heel lance. Pain assessment methods included physiological responses and validated composite pain scores. When using composite pain tools, 1 study showed higher pain response in opioid-exposed neonates, while the other 2 studies showed the same or lower pain response. For skin conductance, the findings from 2 studies were discrepant, with 1 study reporting higher pain response in opioid-exposed neonates and the other showing no statistically significant difference. DISCUSSION: There is a need for more studies designed to examine the influence of opioid exposure and withdrawal on pain responding and management in neonates. As there is currently limited evidence to guide clinical care, clinicians should continue to use validated composite pain assessment tools and pain management strategies.
Does Intensive Interdisciplinary Pain Treatment (IIPT) Enhance Endogenous Pain Modulation in Youth With Chronic Pain Syndromes?
Shulman J, Stewart C, Barrett T … +2 more , Zurakowski D, Sethna NF
Clin J Pain · 2025 Dec · PMID 40965100 · Publisher ↗
OBJECTIVES: This study aimed to investigate whether endogenous pain modulation (EPM) improves after intensive interdisciplinary pain treatment (IIPT) and its relationship with clinical outcomes in youth with chronic pain...
OBJECTIVES: This study aimed to investigate whether endogenous pain modulation (EPM) improves after intensive interdisciplinary pain treatment (IIPT) and its relationship with clinical outcomes in youth with chronic pain syndromes. EPM is a physiological process in the nervous system that inhibits pain perception. EPM is often impaired in youth with chronic pain syndromes and is a potential mechanism by which IIPT interventions act. METHODS: EPM was measured using offset analgesia (OA) in 27 youth with primary and secondary chronic pain syndromes before and after IIPT. Test-retest reliability was measured in a subset of participants (n=12) within 5 days of IIPT admission to examine whether the observed change was meaningful and beyond the limits of error. RESULTS: On average, OA response improved by 12.4% between admission and discharge (95% CI: 3.0, 21.8%), even after controlling for covariates using a mixed effects multivariable repeated measures ANOVA ( P =0.009). OA responses demonstrated excellent test-retest reliability, intraclass correlation coefficient=0.919 (95% CI: 0.718, 0.977), and minimum detectable change (MDC 95 ) of the OA response was 13%. Participants also demonstrated an improved ability to adapt to a constant noxious heat stimulus ( P =0.044) that moderately correlated with improvements in self-reported pain intensity and sensitivity to stimuli ( P <0.05). DISCUSSION: Overall, 52% of participants demonstrated meaningful improvements (ie, change greater than the MDC 95 ) in EPM after IIPT participation. The contributions of specific IIPT interventions (eg, exercise, desensitization, cognitive-behavioral therapy) to improvements in EPM need further exploration.
A Network Analysis of Fear-Avoidance Beliefs, Mood, and Disability in Chronic Pain.
van der Wijk G, Huygelier H, Haslbeck J … +4 more , Evers AWM, Peters ML, Teppers M, Vlaeyen JWS
Clin J Pain · 2025 Dec · PMID 40926587 · Publisher ↗
OBJECTIVES: Although the multifactorial nature of chronic pain is well established, research has predominantly examined isolated variables or singular pathways that may contribute to this condition. We use a complex syst...
OBJECTIVES: Although the multifactorial nature of chronic pain is well established, research has predominantly examined isolated variables or singular pathways that may contribute to this condition. We use a complex systems perspective to examine the interplay of psychological factors in the context of chronic pain. METHODS: We analyzed 2 cross-sectional data sets (N=935 and 1366) collected at a pain clinic and rehabilitation center in Belgium from individuals primarily with musculoskeletal pain. These included self-reported data on pain-related fear and avoidance beliefs, depression and anxiety symptoms, pain intensity, and disability. We used Gaussian Graphical Models to examine conditional associations between these variables, their relative importance (having more/stronger relationships), and how they are moderated by pain-related fear and pain intensity. RESULTS: Our analyses revealed highly interrelated networks, with several unique, positive associations between the included factors. Depressive symptoms and pain intensity were most strongly related to pain disability. Fear-avoidance beliefs featured less prominently than previous studies looking at this concept in isolation have suggested. Apart from differences in 2 associations between samples, and 2 moderation effects of pain intensity in 1 sample, the network structure was similar across the 2 samples. DISCUSSION: Overall, our results show that psychological factors related to disability have intricate interrelations, highlighting the complexity of chronic pain and the need to study its many components in relation to each other. The consistency across the 2 samples provides encouraging evidence that the results reflect a stable pattern within this complex system.
Pain Self-Efficacy as a Moderator and Modifiable Factor for Health-Related Quality of Life in Preoperative Setting.
Jafarzadeh A, Mosallaei A, Zare H
Clin J Pain · 2026 Jan · PMID 40919840 · Publisher ↗
Abstract loading — click title to view on PubMed.
Evaluating PREPaRe (Promoting Readiness and Engagement in Pain Rehabilitation): A Randomized Controlled Trial of a Telehealth Motivational Interviewing Intervention for Youth and Families With Chronic Pain.
Smith AM, Rogan H, Logan DE
Clin J Pain · 2025 Nov · PMID 40851376 · Full text
OBJECTIVE: Intensive interdisciplinary pain treatment (IIPT), a promising approach to pediatric chronic pain treatment, focuses on functional restoration through the adoption of pain self-management. Few studies have exa...
OBJECTIVE: Intensive interdisciplinary pain treatment (IIPT), a promising approach to pediatric chronic pain treatment, focuses on functional restoration through the adoption of pain self-management. Few studies have examined the impact of motivational interviewing (MI) on preparing youth for IIPT. The Promoting Readiness and Engagement in Pain Rehabilitation (PREPaRe) intervention aims to improve IIPT efficiency and outcomes through increasing readiness to engage in pain self-management before admission. METHODS: This randomized controlled trial (RCT) investigated the effects of PREPaRe on youth and caregiver readiness to change before IIPT admission, as well as secondary pain-related and functional outcomes at IIPT discharge, including length of stay. Youth and caregivers (n=78 dyads) were randomized to receive PREPaRe alongside standard medical care (SMC) or SMC alone. RESULTS: Readiness ratings (eg, willingness, importance, confidence, awareness) for youth and caregivers receiving PREPaRe significantly improved over time. However, pre-IIPT comparisons of PREPaRe versus SMC revealed main effects for time but no interactions for youth/caregiver pain acceptance and stage of change. Similarly, post-IIPT group comparisons revealed main effects for time (again, no interactions) for youth pain intensity, interference, and disability, and caregiver protective behaviors, catastrophizing, and fear. Importantly, length of IIPT admission was significantly shorter for PREPaRe versus SMC. DISCUSSION: Results of this clinical trial (NCT04093921) show potential promise for PREPaRe in positioning youth and families for increased readiness and more efficient success in IIPT. Future research should seek to replicate these findings, explore PREPaRe in diverse clinical contexts and demographic groups, and identify who might benefit most from the intervention.
Modeling Temporal Summation and Conditioned Pain Modulation in Individuals With and Without Chronic Pain.
Vincenot M, Lévesque S, Gendron L … +3 more , Camirand Lemyre F, Marchand S, Léonard G
Clin J Pain · 2025 Nov · PMID 40808589 · Full text
OBJECTIVES: Although significant progress has been made in recent years in the field of pain modulation, information regarding patients' pain modulation profiles remains largely research-bound and is not yet easily acces...
OBJECTIVES: Although significant progress has been made in recent years in the field of pain modulation, information regarding patients' pain modulation profiles remains largely research-bound and is not yet easily accessible in clinical settings. The aim of this study was to develop and validate a model for estimating pain modulation profiles-including temporal summation of pain (TSP) and conditioned pain modulation (CPM)-using easily accessible measures. METHODS: This study included 347 pain-free individuals and 108 with chronic pain. TSP was induced through tonic heat pain stimulations, whereas CPM was evaluated using pressure pain thresholds (CPM-PPT) and tonic heat pain stimulations (CPM-HPS) as test stimuli, with the cold pressor test as the conditioning stimulus. Independent variables included demographic, psychological, and physiological measures. A LASSO regression with cross-validation was used to identify key independent. RESULTS: For TSP, the model explained 40% of the variance, incorporating factors such as monoamines and blood pressure. For CPM, the CPM-HPS model performed best, accounting for 35% of the variance, with blood pressure, sex, and pain catastrophizing identified as important predictors. DISCUSSION: Overall, these results indicate that TSP and CPM can be partially estimated using readily accessible measures, but high prediction error currently limits their clinical applicability.
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