The Clinical Journal Of Pain[JOURNAL]
Sun
200 papers
Observer Scales of Facial Pain Expression Can Significantly Predict Acute Postoperative Pain in the Recovery Room.
Lautenbacher S, Ceynowa N, Burlakovas M … +2 more , Lang P, Kunz M
Clin J Pain · 2025 Aug · PMID 40390639 · Publisher ↗
OBJECTIVES: Immediately after surgery and general anesthesia patients may experience periods of dizziness, disorientation, and sedation, which can hinder valid pain reports. Observational pain assessment, especially focu...
OBJECTIVES: Immediately after surgery and general anesthesia patients may experience periods of dizziness, disorientation, and sedation, which can hinder valid pain reports. Observational pain assessment, especially focusing on the face, may add to the subjective pain report in the recovery room. With the present study, we wanted to test this assumption. METHODS: Sixty-three patients who had undergone a wide range of surgical procedures under general anesthesia were observed twice: 10 and 40 minutes after arrival in the recovery room. At these 2 time points, a trained examiner observed the patients' facial expression and filled out the face items of the Brief Pain Scale Non-intubated (BPS-NI) and of the Pain and Impaired Cognition-15 (PAIC-15) scale. After that, a nurse asked the patients to rate their pain on a Numerical Rating Scale (NRS). RESULTS: For both time points, the observer scales significantly predicted NRS ratings, with the BPS-NI being slightly superior (moderate/strong effect sizes) compared with the PAIC-15 (small/moderate effect sizes). On a group level, observational pain assessment showed a decrease in pain across the 2 time points, whereas NRS ratings remained stable. Despite this disparity, individual changes in pain ratings between the 2 time points were also significantly predicted by changes in both observer scales (moderate effect sizes). DISCUSSION: In the recovery room, observational pain assessment can serve as a valid predictor of subjective pain. Thus, in cases where the validity of the pain report may be hampered, especially the face item of the BPI-NI, may give substitute information about acute postoperative pain.
Dexmedetomidine Versus Magnesium Sulfate in Ultrasound-Guided Bilateral Bi-Level Erector Spinae Plane Block in Corrective Scoliosis Surgery: A Randomized Controlled Clinical Trial.
Alansary AM, Ali MM, Elshafie MA … +1 more , Elbeialy MAK
Clin J Pain · 2025 Aug · PMID 40351087 · Publisher ↗
OBJECTIVES: There is a scarcity of research regarding the effects of local anesthetic adjuvant drugs in erector spinae plane block (ESPB), especially in scoliosis surgery. This study aimed to compare dexmedetomidine (DEX...
OBJECTIVES: There is a scarcity of research regarding the effects of local anesthetic adjuvant drugs in erector spinae plane block (ESPB), especially in scoliosis surgery. This study aimed to compare dexmedetomidine (DEX) or magnesium sulfate (MgSO 4 ) as adjuvants for bupivacaine in bilateral bi-level ultrasound-guided ESPB (USG-ESPB) in patients undergoing corrective scoliosis surgery. METHODS: In this prospective, randomized study, 60 patients aged 14 to 25 years were randomly assigned to 1 of 3 groups (in a 1:1:1 ratio) after induction of general anesthesia. The DEX group [n=20] received USG-ESPB with 20 mL of bupivacaine 0.125% plus 0.25 µg/kg of DEX for each injection, whereas the MgSO 4 group [n=20] received USG-ESPB with 20 mL of bupivacaine 0.125% plus 2 mg/kg MgSO 4 for each injection. The control group [n=20] received conventional perioperative analgesia. The primary outcome was time for the first rescue analgesia. Secondary outcomes included total morphine consumption and pain scores in the first 48 postoperative hours. Hemodynamic parameters were assessed. RESULTS: The mean time to the first analgesic request was the longest among patients in the DEX group ( P <0.001). In addition, the total morphine consumption and the 48-hour time-weighted average pain score during rest and movement were significantly lower among the patients in the DEX group ( P <0.001). However, DEX was associated with a significant decrease in hemodynamic parameters ( P <0.001). CONCLUSION: Both DEX and MgSO 4 provided a satisfactory pain relief profile. However, DEX with bupivacaine provided a longer period of analgesia.
Comparison of Dexmedetomidine and Midazolam in Sedoanalgesia for Lumbar Facet Radiofrequency Ablation.
Kurçaloğlu M, Uzun Uslu P, Yilmazlar F … +4 more , Jabbarli A, Uzuner B, Özkan F, Güldoğuş F
Clin J Pain · 2025 Aug · PMID 40351058 · Full text
OBJECTIVES: Lumbar facet radiofrequency ablation (LFRA) is a painful procedure. Sedation may be applied to improve patient comfort during the procedure; however, deep sedation should be avoided to maintain the patient co...
OBJECTIVES: Lumbar facet radiofrequency ablation (LFRA) is a painful procedure. Sedation may be applied to improve patient comfort during the procedure; however, deep sedation should be avoided to maintain the patient cooperation. The purpose of this study was to compare dexmedetomidine and midazolam in sedoanalgesia for LFRA. METHODS: Patients planning to undergo LFRA were included in this cross-sectional, observational study. After a bolus dose, intravenous infusion of dexmedetomidine was administered in group D, whereas intravenous midazolam was given in group M. Intraoperative vital signs, procedural pain severity (Numerical Rating Scale-NRS), Patient Satisfaction Score (PSS), Operator Satisfaction Score (OSS), and complications were recorded. RESULTS: A total of 96 patients were included in the study. Group D consisted of 47 and group M of 49 patients. Procedural NRS, PSS, and OSS were significantly in favor of group D. Mean procedural NRS of group D was 2.91±2.03, and 4.14±2.17 in group M ( P =0.005). The rate of unsatisfactory PSS was 1 (2.1%) in group D and 7 (20%) in group M ( P =0.03). The rate of unsatisfactory OSS results was 2 (4.2%) in group D and 16 (32.6%) in group M ( P <0.001). Although over-sedation and low oxygen saturation were significantly more frequent in group M, hypotension was higher in group D. DISCUSSION: In sedoanalgesia for LFRA, dexmedetomidine is superior to midazolam with lower procedural pain, higher satisfaction scores, and improved patient cooperation. The results of this study can be considered for sedoanalgesia in other interventional pain procedures.
The Prevalence of Coexisting Motor Proficiency Delay and Chronic Pain in Children Presenting to a Tertiary Pain Service: A Cross-Sectional Observational Study.
Fechner R, Rogers K, Rogers L … +5 more , Gollan A, Alcock M, Turbitt E, Verhagen AP, Pate JW
Clin J Pain · 2025 Sep · PMID 40346837 · Publisher ↗
OBJECTIVES: Chronic pain can profoundly impact children's physical, social, and psychological functioning, with negative effects that can persist into adulthood. The prevalence of motor proficiency delay in children with...
OBJECTIVES: Chronic pain can profoundly impact children's physical, social, and psychological functioning, with negative effects that can persist into adulthood. The prevalence of motor proficiency delay in children with chronic pain is unknown. We aimed to describe the prevalence of motor proficiency delay in a sample of children and estimate potential predictive factors of delayed motor proficiency from routinely collected self-report measures. METHODS: We conducted a cross-sectional study of 94 children and adolescents (6 to 18) with chronic pain who attended a tertiary pain clinic in Australia. We assessed their motor proficiency using the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) standardised assessment tool. Participants also completed a suite of routine clinical questionnaires and a self-perception questionnaire. We described the prevalence of motor proficiency delay using descriptive statistics and estimated the extent to which routine demographic and clinical data could explain variation in BOT-2 scores using a multivariable linear model to calculate adjusted R ². RESULTS: Overall, 83% of participants presented with challenges in at least one motor-proficiency subtest (eg, coordination), and 41% had delayed total motor proficiency scores. We found that just 9% of the variance in BOT-2 scores could be explained by the covariates in the multivariable prediction model (adjusted R2 =0.09, 95% CI: 0.01-0.25). DISCUSSION: Most children presenting to a tertiary pain clinic presented with motor proficiency challenges unlikely to be identified through routinely collected self-report measures. Given that the BOT-2 can identify norm-referenced developmental targets, the use of these assessments may enhance clinical formulations and guide developmentally sensitive rehabilitation programs.
Impact of Pain Self-Efficacy on Health Outcomes in High-Impact Chronic Pain: A Longitudinal Study.
You DS, Lannon E, Kim S … +4 more , Dildine TC, Weber KA, Raney E, Mackey SC
Clin J Pain · 2025 Aug · PMID 40325564 · Full text
OBJECTIVES: High-impact chronic pain (HICP), affecting 36.4% of individuals with chronic pain, significantly limits work, social, and self-care activities. Effective treatments for HICP remain elusive. In addition to pai...
OBJECTIVES: High-impact chronic pain (HICP), affecting 36.4% of individuals with chronic pain, significantly limits work, social, and self-care activities. Effective treatments for HICP remain elusive. In addition to pain catastrophizing (PC), growing evidence suggests that pain self-efficacy (PSE) may be a treatment target for HICP. Our study examines the relative contributions of pain self-efficacy and catastrophizing to health outcomes in patients with HICP. METHODS: A total of 259 patients with chronic pain (154 with HICP; 105 without HICP) completed validated measures at baseline and 3 months later. These included the Chronic Pain Self-Efficacy Scale (CPSS), the Pain Catastrophizing Scale (PCS), and Patient-Reported Outcomes Measurement Information System (PROMIS) domains for physical health (ie, pain interference, physical function, fatigue, and sleep disturbance) and psychosocial health (ie, depression, anxiety, anger, and social isolation). RESULTS: Repeated measures MANOVA showed a significant group effect (HICP vs. No-HICP), but no significant time or group by time interaction. The HICP group reported significantly lower CPSS scores and higher PCS scores than the No-HICP group, alongside worse physical and psychosocial health outcomes (η²=0.076 to 0.445). PSE explained a greater proportion of group differences in health outcomes (52.9% to 71.7%) compared with PC (10.1% to 43.3%). Especially, SE in activity engagement accounted for the largest health disparities between the groups. DISCUSSION: Findings highlight PSE as a critical treatment target for HICP, with greater predictive utility than PC. Enhancing SE through tailored interventions may reduce the burden of HICP. Future studies should prioritize SE-based interventions and explore their scalability and long-term impact.
Effects of Individual Psychological Factors and Cumulative Psychological Distress on Prospective Pain Quality in Older Adults With Chronic Low Back Pain.
Knox PJ, Simon CB, Pohlig RT … +4 more , Pugliese JM, Coyle PC, Sions JM, Hicks GE
Clin J Pain · 2025 Jul · PMID 40296268 · Full text
OBJECTIVE: Although pain quality may be a component of the geriatric chronic pain experience that influences disability, no research has investigated the psychological underpinnings of pain quality in any geriatric chron...
OBJECTIVE: Although pain quality may be a component of the geriatric chronic pain experience that influences disability, no research has investigated the psychological underpinnings of pain quality in any geriatric chronic pain population. We sought to address this knowledge gap by examining associations between both general (ie, depressive symptoms) and pain-specific psychological risk factors (ie, fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) and prospective pain quality in older adults with chronic low back pain. METHODS: Questionnaires for each psychological factor were collected at baseline, while pain quality was measured by the McGill Pain Questionnaire at baseline and 12 months. Preliminary analyses identified pain catastrophizing as the individual factor with the highest correlation to future pain quality for subsequent analyses. To assess if baseline psychological factors were cumulatively associated with 12-month pain quality, questionnaire values were entered into principal component analysis to yield a combined psychological component score. Robust regression models with HC3 standard errors were used to examine associations between baseline psychological risk factors (both individually and cumulatively) and prospective pain quality. RESULTS: In adjusted analyses, higher baseline pain catastrophizing independently predicted worse pain quality at 12 months ( b =0.342, t =4.225, P <0.001). Similarly, higher baseline psychological component scores were independently associated with worse prospective pain quality after adjustment ( b =3.816, t =4.518, P <0.001). DISCUSSION: The combined psychological component score had comparatively stronger predictive ability than pain catastrophizing alone; however, overall model prediction was modest, suggesting that future research is needed to identify other biopsychosocial variables that may impact pain quality in the geriatric chronic LBP population.
The Relationship Between Pain Catastrophizing, Kinesiophobia, Central Sensitization, and Cognitive Function in Patients With Chronic Low Back Pain.
Alcon C, Krieger C, Neal K
Clin J Pain · 2025 Jul · PMID 40261050 · Publisher ↗
OBJECTIVES: Adverse pain behaviors and alterations in cognitive performance are shown to negatively impact the management of chronic low back pain (CLBP). Relationships between these variables are poorly recognized yet m...
OBJECTIVES: Adverse pain behaviors and alterations in cognitive performance are shown to negatively impact the management of chronic low back pain (CLBP). Relationships between these variables are poorly recognized yet may impact the efficacy of interventions that target them. This study aimed to investigate the relationship between levels of pain catastrophizing (PC), kinesiophobia, central sensitization (CS), and cognitive performance in participants with CLBP. METHODS: A sample of 60 participants aged 18 to 65 with CLBP completed pain behavior measures (Pain Catastrophizing Scale [PCS], Tampa Scale of Kinesiophobia [TSK], and the Central Sensitization Inventory [CSI]) and cognitive performance tests (Stroop Color Word Test [SCWT], Comprehensive Trail Making Test-Second Edition [CTMT2], and the Coding test). RESULTS: SCWT performance was positively correlated with PCS and TSK, whereas CTMT2 inhibitory control and set-shifting, as well as coding performance, were each negatively correlated with PCS and TSK. The high PC group demonstrated significantly larger attentional interference times on the SCWT, poorer inhibitory control and set-shifting performance on the CTMT2, and lesser performance on the coding test than the low PC group. The high kinesiophobia group performed significantly poorer on the SCWT than the low kinesiophobia group. DISCUSSION: This study demonstrates that PC and kinesiophobia have negative influences on cognitive performance in those with CLBP. Specifically, attentional interference, inhibitory control, set-shifting, and sustained working memory functions were affected. These deficits have the potential to influence how patients respond to therapeutic interventions with a cognitive focus (eg, pain neuroscience education, cognitive-behavioral therapy) and highlight an important variable that should be considered when managing CLBP.
Do Psychological Factors Explain the Persistence of Symptoms in Individuals With Rotator Cuff-related Shoulder Pain? A Prospective Cohort Study.
Rosa DP, Dubé MO, Beaulieu-Bonneau S … +3 more , Scott A, Masse-Alarie H, Roy JS
Clin J Pain · 2025 May · PMID 40232880 · Publisher ↗
OBJECTIVE: To determine whether psychosocial factors, such as resilience, perceived stress, catastrophizing, anxiety, depression, pain self-efficacy, and social support, explain the persistence of pain and disability in...
OBJECTIVE: To determine whether psychosocial factors, such as resilience, perceived stress, catastrophizing, anxiety, depression, pain self-efficacy, and social support, explain the persistence of pain and disability in individuals with rotator cuff-related shoulder pain (RCRSP) following an education program. METHODS: One hundred forty-three individuals with persistent RCRSP were included in this prospective cohort study. At baseline, participants completed self-reported questionnaires related to pain, disability, and psychosocial constructs, including resilience, stress, catastrophizing, anxiety and depressive symptoms, pain self-efficacy, and social support. Thereafter, participants took part in an educational program aimed at promoting self-management of RCRSP that included 2 meetings with a physiotherapist. After 12 and 24 weeks, participants filled out pain and disability questionnaires and, based on their scores, were classified as having persistent shoulder pain or as recovered. RESULTS: A univariable modified Poisson regression showed that higher perceived stress (RR adjusted : 1.02; 95% CI: 1.01-1.04), catastrophizing (RR adjusted : 1.01; 95% CI: 1.01-1.02), symptoms of depression (RR adjusted : 1.03; 95% CI: 1.01-1.06) and anxiety (RR adjusted : 1.03; 95% CI: 1.01-1.06), along with lower resilience (RR adjusted : 0.90; 95% CI: 0.81-1.00), were associated with ongoing RCRSP at 12 weeks. In addition, reduced pain self-efficacy was associated with persistent pain at both 12 weeks (RR adjusted : 0.98; 95% CI: 0.97-0.99) and 24 weeks (RR adjusted : 0.99; 95% CI: 0.98-1.00). Multivariable regression indicated that only pain self-efficacy served as a protective factor against persistent RCRSP (RR adjusted : 0.98; 95% CI: 0.97-0.99). DISCUSSION: This study sheds light on the impact of psychosocial factors on persistent RCRSP, underscoring the importance of positive beliefs in pain management. Importantly, pain self-efficacy emerges as a key factor in recovery.
Presence of Neuropathic-Like Symptoms in Individuals With Painful Tendinopathy/Overuse Injuries: A Systematic Review and Meta-Analysis.
Cancela-Cilleruelo I, Rodríguez-Jiménez J, Arias-Buría JL … +3 more , Navarro-Santana MJ, Arendt-Nielsen L, Fernández-de-Las-Peñas C
Clin J Pain · 2025 Jul · PMID 40211736 · Publisher ↗
OBJECTIVE: This meta-analysis evaluated the prevalence of neuropathic-like symptoms in individuals with painful tendinopathies/overuse injuries. METHODS: Electronic literature searches on MEDLINE, CINAHL, PubMed, SCOPUS,...
OBJECTIVE: This meta-analysis evaluated the prevalence of neuropathic-like symptoms in individuals with painful tendinopathies/overuse injuries. METHODS: Electronic literature searches on MEDLINE, CINAHL, PubMed, SCOPUS, and Web of Science databases were conducted up to January 20th, 2025. Studies reporting the prevalence of neuropathic-like symptoms in painful tendinopathy/overuse injury were included. The methodological quality was assessed with the Newcastle-Ottawa Quality Assessment Scale in cohort/case-control studies or the Physiotherapy Evidence Database (PEDro) in clinical trials. Random-effects models were used for meta-analytical pooled prevalence of neuropathic-like symptoms. RESULTS: From 1285 studies identified, 8 (1 case-control, 5 cohorts, and 2 clinical trials) met inclusion criteria. The sample included 920 participants with painful tendinopathy/overuse injury (47.6% female, age: 51, SD: 12.5 y). All studies included self-reported questionnaires for evaluating neuropathic-like symptomatology. The methodological quality was moderate-high. The overall prevalence of neuropathic-like symptoms in painful tendinopathies was 30% (95% CI: 22%-38%, n=8, I2 =79%). The prevalence by each tendinopathy was: plantar heel pain (44%, 95% CI: 17%-75%, n=2, I2 =96%), lateral epicondylalgia (42%, 95% CI: 30%-56%, n=2, I2 =30%), insertional Achilles tendinopathy (38%, 95% CI: 20%-60%, n=2, I2 = 71%), greater trochanteric pain syndrome (32%, 95% CI: 26%-39%, n=2, I2 =0%), patellar-quadricipital tendinopathy (16%, 95% CI: 5%-41%, n=3, I2 =29%), noninsertional Achilles tendinopathy (11%, 95% CI: 2%-41%, n=5, I2 =86%). CONCLUSION: The results of this meta-analysis suggests the presence of neuropathic-like symptoms in 30% of participants with painful tendinopathy, although this prevalence rate depends on specific condition. Identification of neuropathic symptoms in musculoskeletal pain conditions is important for diagnosis as it impacts its management.
Complex Regional Pain Syndrome: Navigating Diagnostic Complexities.
Raasveld FV, Wolff M, Luan A … +3 more , Hao D, Valerio IL, Eberlin KR
Clin J Pain · 2025 Jul · PMID 40211731 · Publisher ↗
OBJECTIVE: Complex regional pain syndrome (CRPS) presents significant diagnostic challenges due to its diverse clinical presentation. This study aimed to describe the diagnostic trajectory of patients labeled with CRPS,...
OBJECTIVE: Complex regional pain syndrome (CRPS) presents significant diagnostic challenges due to its diverse clinical presentation. This study aimed to describe the diagnostic trajectory of patients labeled with CRPS, focusing on referral patterns, application of the Budapest Criteria, and accuracy of CRPS diagnosis. METHODS: A retrospective study was conducted of 53 patients treated for CRPS at a peripheral nerve clinic within a tertiary care center (2020 to 2024). Patient demographics, referral patterns, events leading to CRPS diagnosis, and diagnostic tests were analyzed. Three clinicians (2 plastic surgeons and 1 pain medicine specialist) retrospectively assessed the validity of CRPS diagnoses using the Budapest criteria. Inter-rater reliability (IRR) for CRPS presence and type was calculated using Cohen kappa (κ). RESULTS: Among the 53 patients, the median time from the first mention of CRPS to referral to the nerve clinic was 1.3 years (IQR: 0.4 to 3.6). The Budapest Criteria had been assessed in 26% of patients pre-evaluation. In 33% of patients labeled with CRPS type I, an inciting nerve injury was identified. Following retrospective assessment, 42% of patients were determined to have CRPS by all raters, 26% were determined not to have CRPS, and 32% showed inconsistent agreement. The IRR for CRPS diagnosis and type ranged from minimal to moderate (κ=0.32 to 0.72). DISCUSSION: Our findings highlight variability in the application of the Budapest Criteria for CRPS diagnosis, as well as inconsistencies in its retrospective application. Potentially treatable peripheral nerve injuries should be addressed before CRPS diagnosis. These findings may help improve early diagnostic assessment in patients with chronic pain.
Engagement in Digital Self-management Interventions for Chronic Pain: A Systematic Review.
MacLean RR, Shor R, Reilly ED … +4 more , Reuman L, Solar C, Halat AM, Higgins DM
Clin J Pain · 2025 Jun · PMID 40145149 · Full text
OBJECTIVES: Digital interventions promise to increase access to non-pharmacological chronic pain treatment and reduce burden for both individuals seeking care and pain providers/clinics. Unfortunately, despite early evid...
OBJECTIVES: Digital interventions promise to increase access to non-pharmacological chronic pain treatment and reduce burden for both individuals seeking care and pain providers/clinics. Unfortunately, despite early evidence of efficacy, engagement in self-management digital interventions for chronic conditions is typically low. A comprehensive analysis into how engagement in these programs is measured and reported is warranted. The current systematic review evaluated engagement in digital self-management interventions for chronic pain and identified gaps to improve reporting of engagement data. METHODS: We conducted a pre-registered systematic review using Boolean search terms to identify digital chronic pain self-management interventions that did not include clinician support. After removal of duplicates and screening, 150 full-text manuscripts were assessed, and 43 studies met inclusion criteria. Data was extracted and examined from included manuscripts. RESULTS: Of the 43 included articles, five articles were based on 2 separate datasets, resulting in a final sample of 41 unique datasets representing 4205 participants that were mostly non-Hispanic White, female, and with at least some college education. Approximately 10% of studies did not report any data related to system use or self-reported engagement. Most engagement data consisted of mean system use variables, with a handful of studies describing self-reported use of skills and very few studies examining demographic variables associated with engagement. DISCUSSION: To address identified gaps in the reviewed literature, we suggest guidelines for collecting and reporting engagement in digital chronic pain interventions. Consistent reporting of engagement data will improve evaluation, efficacy, and improvement of interventions designed to assist individuals who may otherwise not receive non-pharmacological pain treatment.
The Convergent Validity of Pain Drawings and Anatomic Checklists in Individuals With Chronic Pain.
Fung J, Evans DW, Falla D … +1 more , Barbero M
Clin J Pain · 2025 Jul · PMID 40145148 · Publisher ↗
OBJECTIVES: The assessment of the spatial characteristics of pain, such as location and extent, is essential in the clinical evaluation of pain, especially when managing patient's with chronic musculoskeletal pain. This...
OBJECTIVES: The assessment of the spatial characteristics of pain, such as location and extent, is essential in the clinical evaluation of pain, especially when managing patient's with chronic musculoskeletal pain. This study evaluated the convergent validity of pain drawings (PDs) and anatomic checklists (ACLs) in measuring pain location (PL) and pain extent (PE) in individuals with chronic musculoskeletal pain. METHODS: Twenty volunteers participated, each completing a PD and an ACL in a randomized order following standardized training. PDs were digitized and analyzed using a custom algorithm on a web platform. PL was categorized across 45 anatomic areas. PE was assessed using a region-weighted approach by means of the Margolis rating scale and a pixel-based method. Statistical analyses included Spearman rho and the Jaccard Index to compare the obtained PD metrics. RESULTS: A strong correlation was found between PDs and ACLs for PE (Spearman rho=0.823), suggesting similar capabilities in quantifying the spatial distribution of pain. However, a significant discrepancy in PL measurements, with a mean Jaccard Index of 0.54, indicated poor agreement between methods. DISCUSSION: These results highlight the non-interchangeability of these instruments for PL identification and underscore the importance of each tool's unique advantages and limitations. The study also highlighted the potential benefits of incorporating innovative pain metrics into current health questionnaires to enhance their clinimetric properties. These findings advocate for continued research with larger and more diverse patient cohorts to further validate PDs and ACLs and to explore additional psychometric properties for pain assessment.
The Effect of Pain Treatment on Fatigue and Sleep Quality in Children and Adolescents-A Longitudinal Study.
Sommer A, Grothus S, Claus BB … +2 more , Höfel L, Wager J
Clin J Pain · 2025 Jul · PMID 40114271 · Publisher ↗
OBJECTIVES: Fatigue and poor sleep quality are common comorbidities in pediatric chronic pain patients and are closely related to pain characteristics. Little is known about whether fatigue and sleep quality change after...
OBJECTIVES: Fatigue and poor sleep quality are common comorbidities in pediatric chronic pain patients and are closely related to pain characteristics. Little is known about whether fatigue and sleep quality change after pain therapy or whether there are differences between various treatment intensities. METHODS: In a longitudinal study with 3 measurement points (T1-pre- treatment, T2-3 mo post-treatment, T3-6 mo post-therapy), n=248 outpatient and n=338 inpatient youth (11 to 17 y; 73.4% female) receiving pain therapy (single outpatient consultation for outpatient youth vs. intensive interdisciplinary pain treatment for inpatient youth) at 2 different pain centers were included. We examined the prevalence of fatigue and poor sleep quality in outpatient versus inpatient youth, as well as the longitudinal relationships between fatigue, sleep quality, and pain variables. Changes in fatigue and sleep quality over the course of pain therapy in outpatient and inpatient youth were also explored. RESULTS: Fatigue was highly prevalent, particularly among inpatient youth, with 44% experiencing moderate or severe fatigue symptoms. There were significant correlations between fatigue, sleep quality, and pain-related factors such as pain intensity, functional impairment, and pain-related missed school days. Fatigue symptoms and sleep quality worsened in inpatient youth but partially improved in outpatient youth from pre-therapy to post-treatment. DISCUSSION: Fatigue and sleep are relevant comorbidities in youth living with chronic pain. Addressing these issues should become an established goal of pediatric pain management, as it might further improve pain outcomes. This may require complementary interventions to explicitly target these comorbidities.
Health Professionals' Perspectives of Working With Children and Adolescents Experiencing Chronic Pain: Barriers and Facilitators.
Norton JG, Newton-John T, Alcock M … +3 more , Moore J, Southon N, Pate JW
Clin J Pain · 2025 Jun · PMID 40105747 · Publisher ↗
OBJECTIVES: To identify health professional's perceptions of barriers, facilitators, and training needs when working with children experiencing chronic pain. METHODS: Cross-sectional online survey of health professionals...
OBJECTIVES: To identify health professional's perceptions of barriers, facilitators, and training needs when working with children experiencing chronic pain. METHODS: Cross-sectional online survey of health professionals working with children experiencing chronic pain. Survey questions were a range of exploratory open and closed-ended questions, which included yes/no responses, choosing from a list, ranking options, and open responses. Quantitative data were analyzed using descriptive statistics and percentages. Qualitative data were analyzed using content analysis. RESULTS: One hundred eighty health professionals took part, of which 44% were physiotherapists. Tertiary hospitals and private practices were the most common workplaces. The most frequently reported categories of both barriers and facilitators were workforce and system factors, child factors, and parent factors. The most frequently reported confidence areas and development areas were health professional factors, approaches to care, and team structure. Of participants, 75% reported they were moderately to extremely interested in further training in pediatric chronic pain management and indicated a preference for interactive training rather than "passive" learning formats. CONCLUSION: Health professionals report a diverse range of perspectives when working with children experiencing chronic pain, including perceived barriers and facilitators to care. Most health professionals were interested in future training in pediatric chronic pain management. Future research exploring the parent and child perspective and how these factors present clinically is needed to inform future training opportunities for health professionals working with children experiencing chronic pain.
Regional Anesthesia Techniques as Perioperative Analgesia Method for Posterior Cervical Spine Surgery.
Hu J, Yang J
Clin J Pain · 2025 Jun · PMID 40105739 · Publisher ↗
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Comparing Analgesic Efficacy of Different Regional Blocks After Single-incision Video-assisted Thoracoscopic Surgery.
Liu GY, Xue FS, Jin M
Clin J Pain · 2025 May · PMID 40105737 · Publisher ↗
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Does Pain Self-efficacy Moderate the Association of Psychosocial Factors With the Health-related Quality of Life of Patients Scheduled for Lumbar Spine Surgery?
Kondo Y, Watanabe Y, Miki T … +3 more , Tsushima K, Otsuki R, Takebayashi T
Clin J Pain · 2025 Jun · PMID 40105726 · Publisher ↗
OBJECTIVES: This study aimed to investigate the moderating role of pain self-efficacy (SE) in the association of multiple psychosocial factors with the health-related quality of life (HRQOL) of patients scheduled for lu...
OBJECTIVES: This study aimed to investigate the moderating role of pain self-efficacy (SE) in the association of multiple psychosocial factors with the health-related quality of life (HRQOL) of patients scheduled for lumbar spine surgery. METHODS: This cross-sectional study analyzed 258 patients scheduled for lumbar spine surgery. Data were collected preoperatively using validated tools to measure HRQOL, pain, pain intensity, anxiety and depression, fear of movement, pain catastrophizing, and central sensitization symptoms. Hierarchical multiple regression analysis and simple slope tests were performed to assess the associations of psychosocial factors with HRQOL and the moderating effects of pain SE on these relationships. RESULTS: The final model explained 43.8% of the HRQOL variance. Significant interactions were noted between pain SE and pain intensity ( P <0.01), anxiety ( P <0.01), fear of movement ( P <0.05), and pain catastrophizing ( P <0.01). The negative associations of these psychological factors with HRQOL were significant only in the low pain self-efficacy group, whereas these associations were attenuated to nonsignificant levels in the high pain SE group. DISCUSSION: In this cross-sectional study, different associations between psychosocial factors and HRQOL were observed based on pain SE levels in patients awaiting lumbar spine surgery. This finding suggests that pain SE assessment may help identify high-risk patients who need additional preoperative psychological support.
Comparative Effectiveness of Noninvasive Brain Stimulation for the Treatment of Pain, Fatigue, and Sleep Quality in Fibromyalgia. A Systematic Review With Network Meta-Analysis.
Ahmed I, Mustafaoglu R, Memon AR … +4 more , Zafeer R, Xiong H, Straudi S, Runge N
Clin J Pain · 2025 May · PMID 40091857 · Publisher ↗
OBJECTIVES: There is tentative evidence to support the analgesic effects of noninvasive brain stimulation (NiBS) in fibromyalgia (FM), but a comprehensive synthesis is lacking. This systematic review with network meta-an...
OBJECTIVES: There is tentative evidence to support the analgesic effects of noninvasive brain stimulation (NiBS) in fibromyalgia (FM), but a comprehensive synthesis is lacking. This systematic review with network meta-analysis (NMA) aimed to determine the relative effectiveness of different NiBS techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) in FM, and to identify the optimal stimulation location and intensity/frequency. METHODS: Four databases were searched until July 9, 2023 for randomized trials (RCTs) comparing NiBS in FM. Pain was the primary outcome, while fatigue and sleep were secondary outcomes. A frequentist NMA calculated standardized-mean-differences (SMDs) for pain, with pairwise meta-analysis for fatigue and sleep. Bias was assessed with the Cochrane-risk-of-bias-tool (RoB-2.0), and evidence certainty through confidence-in-NMA. RESULTS: Forty-three RCTs with 2120 participants were included. NMA showed that low frequency (LF)-rTMS (SMD: -1.20, 95% CI: -1.82 to -0.58), dual tDCS (SMD: -0.91, 95% CI: -1.82 to -0.58), and high frequency (HF)-rTMS (SMD: -0.58, 95% CI: -1.00 to -0.17) likely results in a reduction in pain intensity at the end of intervention compared with sham stimulation. For stimulation location, right dorsolateral prefrontal cortex (DLPFC)(SMD: -1.42, 95% CI: -2.69 to -0.15), bilateral DLPFC (SMD: -0.94, 95% CI: -1.82 to -0.05), and left primary motor cortex (M1)(SMD: -0.49, 95% CI: -0.85 to -0.14) likely results in reduction in pain intensity at the end of intervention, with DLPFC maintaining effects in short-term. LF-rTMS over DLPFC (SMD: -1.42, 95% CI: -2.69 to -0.15) and HF-rTMS over M1 (SMD: -0.78, 95% CI: -1.39 to -0.18) likely results in the reduction in pain intensity at the end of intervention, with LF-rTMS over right DLPFC maintaining effects in the short term. NiBS appears to be safe and may reduce fatigue and improve sleep quality. DISCUSSION: Excitatory stimulation like HF-rTMS over M1 and inhibitory like LF-rTMS over DLPFC may yield better results.
The Impacts of Poor Sleep Quality on Knee Pain and Quality of Life in Young Adults: Insights From a Population-based Cohort.
Hertel E, Rathleff MS, Straszek CL … +2 more , Holden S, Petersen KK
Clin J Pain · 2025 Jun · PMID 40077990 · Publisher ↗
OBJECTIVES: Poor sleep is common among young adults and is often associated with pain. This study investigates the relationship between pain-related outcomes, sleep quality, and quality of life (QoL) in young adults with...
OBJECTIVES: Poor sleep is common among young adults and is often associated with pain. This study investigates the relationship between pain-related outcomes, sleep quality, and quality of life (QoL) in young adults with and without knee pain. METHODS: This study is a secondary analysis of the 5-year follow-up of a prospective cohort study. Five hundred twenty-three young adults were surveyed for knee pain in 2011 and followed up 5 years later. Respondents reporting knee pain at both points were categorized as having knee pain (n = 177), while controls did not report knee pain (n = 85). Five-year follow-up data assessed clinical pain intensity, pain-related outcomes, QoL, and physical activity. In addition, respondents were scored as having good, moderate, or poor sleep quality. RESULTS: Respondents in the knee pain group with poor sleep had worse Knee injury and Osteoarthritis Outcome Score (Knee Outcome and Osteoarthritis Score) across all domains ( P < 0.05), decreased QoL ( P < 0.001), impacted mood ( P < 0.05), and impacted everyday life ( P < 0.001) compared with those with good sleep. Respondents with poor sleep in both the knee pain and control group reported more pain sites per month ( P < 0.01) compared with those with good sleep. Finally, respondents in the knee pain group with poor sleep had increased pain medication usage compared with those with good sleep ( P < 0.05). CONCLUSION: This study emphasizes the negative association between poor sleep quality and knee pain in young adults. The results indicate a need for strategies to address sleep disturbances in young adults to alleviate pain-related suffering and to increase HRQoL.
Pain Trajectories in Pediatric Inflammatory Bowel Disease: Disease Severity, Optimism, and Pain Self-efficacy.
Nabbijohn AN, Newby-Clark IR, Mack D … +2 more , Stintzi A, McMurtry CM
Clin J Pain · 2025 May · PMID 40052200 · Publisher ↗
OBJECTIVES: This study aimed to characterize pain intensity (average, worst) and disease severity in youth with inflammatory bowel disease in the 12-month postdiagnosis, and to examine the relation between pain and risk...
OBJECTIVES: This study aimed to characterize pain intensity (average, worst) and disease severity in youth with inflammatory bowel disease in the 12-month postdiagnosis, and to examine the relation between pain and risk (disease severity) and resilience (optimism, pain self-efficacy) factors over time. METHODS: Data collection ran from February 2019 to March 2022. Newly diagnosed youth aged 8 to 17 with IBD completed numerical rating scales for average and worst pain intensity, Youth Life Orientation Test for optimism, and Pain Self-Efficacy Scale for pain self-efficacy through REDCap; weighted Pediatric Crohn's Disease Activity Index and the Pediatric Ulcerative Colitis Activity Index were used as indicators of disease severity. Descriptive statistics characterized pain and disease severity. Multilevel modeling explored relations between variables over time, including moderation effects of optimism and pain self-efficacy. RESULTS: At baseline, 83 youth ( Mage =13.9, SD=2.6; 60.2% Crohn's disease; 39.8% female) were included. Attrition rates at 4 and 12 months were 6.0% and 9.6%, respectively. Across time, at least 52% of participants reported pain. Participants in disease remission increased from 4% to 70% over 12 months. Higher disease severity predicted higher worst pain, regardless of the time since diagnosis. Higher pain self-efficacy (1) predicted lower average and worst pain, especially at later time points and (2) attenuated the association between disease severity and worst pain when included as a moderator. Higher optimism predicted lower worst pain. DISCUSSION: Pain is prevalent in pediatric inflammatory bowel disease and impacted by disease severity, pain self-efficacy, and optimism. Findings highlight modifiable intervention targets.
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