European Journal of Pain最新文献

{"title":"Cognitive Function in Patients With Complex Regional Pain Syndrome: No Clear Impairment Found in a Select Patient Sample","authors":"Corinne van den Berg,&nbsp;Esther van den Berg,&nbsp;Frank J. P. M. Huygen,&nbsp;Jitske Tiemensma","doi":"10.1002/ejp.70046","DOIUrl":"https://doi.org/10.1002/ejp.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Given the impact of chronic pain on cognition, CRPS may affect specific cognitive functions. However, cognitive functioning is rarely assessed in CRPS, and previous studies have examined only limited domains. As a result, it remains unclear which cognitive functions are affected and whether impairments are CRPS-specific. This study comprehensively evaluates cognition in CRPS and compares it to carpal tunnel syndrome (CTS) to determine whether cognitive dysfunction is specific to CRPS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All patients underwent a standardised cognitive assessment consisting of ten tests, evaluating the domains of memory, concentration, executive functioning, social cognition and performance validity. Standardised z-scores and proportion of low-performing patients (&lt; −1.5 SD from age-, sex- and education adjusted normative data) were examined. Both patient groups were compared with each other and the expected population proportion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-four patients (<i>n</i> = 39 CRPS and <i>n</i> = 25 CTS) with a mean age of 52.5 (range 20–81) were included. Compared with patients with CTS, patients with CRPS had significantly higher pain scores 24 h before and during the visit (<i>p</i> &lt; 0.001). All cognitive test results were similar between the two groups. Z-scores of both groups were comparable or better than the population norm. Furthermore, proportions of patients with Z-scores below −1.5 SD were similar or better than expected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our results consistently showed no cognitive impairment in either patient group. Both groups met or exceeded population norms on all tests. However, despite our clear results, attention should be paid to factors affecting cognition, like depression, anxiety and stress.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This study explores the underexamined cognitive dysfunction in Complex Regional Pain Syndrome (CRPS). Cognitive issues, often reported by CRPS patients, can add to the burden on daily life and quality of life (QoL) but are rarely assessed. By comparing CRPS with CTS, this research examines whether cognitive impairments are specific to CRPS. Identifying these issues may lead to targeted therapies addressing both pain and cognitive challenges, ultimately improving patient outcomes and QoL.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Commitment to Trust and Integrity in Science: Implications for Pain and Anesthesiology Research","authors":"Tonya M. Palermo,&nbsp;Didier Bouhassira,&nbsp;Karen D. Davis,&nbsp;Hugh C. Hemmings Jr,&nbsp;Robert W. Hurley,&nbsp;Joel Katz,&nbsp;Jaideep J. Pandit,&nbsp;Theodore J. Price,&nbsp;Michael E. Schatman,&nbsp;Stephan K. W. Schwarz,&nbsp;Dennis C. Turk,&nbsp;Marc Van de Velde,&nbsp;Matthew D. Wiles,&nbsp;Tony L. Yaksh,&nbsp;David Yarnitsky","doi":"10.1002/ejp.70052","DOIUrl":"https://doi.org/10.1002/ejp.70052","url":null,"abstract":"&lt;p&gt;We are a group of journal editors&lt;sup&gt;1&lt;/sup&gt; dedicated to advancing discoveries and innovations in basic, translational, and clinical research across anesthesiology and pain-related disciplines, which play a crucial role in reducing the burden of pain, improving health, enhancing perioperative outcomes, and optimizing healthcare delivery. Across scientific disciplines, concerns have been raised about research quality and trustworthiness (Wallach et al. &lt;span&gt;2018&lt;/span&gt;; Ioannidis &lt;span&gt;2024&lt;/span&gt;). While these challenges are not unique to pain and anesthesiology research, we recognize this as a judicious opportunity to raise awareness and collaborate across our journals to align and strengthen initiatives to enhance research integrity, trust, and impact across our field.&lt;/p&gt;&lt;p&gt;In a 2005 landmark paper, John Ioannidis concluded with the dramatic and troubling assertion that “most published research findings are false,” stimulating a large focus in the biomedical research community on understanding issues of integrity, reproducibility, and replication that continues to be relevant to this day (Ioannidis &lt;span&gt;2005&lt;/span&gt;). Indeed, there are many instances in which authors, institutions, funders, publishers and journals have failed to embody the core values that produce trustworthy science. The trustworthiness of research is affected by both intentional actions (e.g., fabrication and falsification of data, lack of rigor, image manipulation) and unintentional actions (e.g., inadequate oversight, awareness and understanding of both technical and scientific issues). Most concerning are instances of research misconduct including fabrication, falsification, or plagiarism sometimes revealed by failure to replicate or reproduce results, duplication of publications, a rise in the number of retractions (Hemmings and Shafer &lt;span&gt;2020&lt;/span&gt;; Audisio et al. &lt;span&gt;2022&lt;/span&gt;), and calls for larger numbers of papers to be retracted (e.g., Ioannidis &lt;span&gt;2024&lt;/span&gt;). In support of Ioannidis's disquiet, some reviews (e.g., Open Science Collaboration &lt;span&gt;2015&lt;/span&gt;; Camerer et al. &lt;span&gt;2018&lt;/span&gt;) report low replication rates of positive findings in the social and life sciences across clinical trials, epidemiological research, and molecular studies.&lt;/p&gt;&lt;p&gt;In anesthesiology specifically, low agreement has been found between randomized clinical trials (RCTs) and meta-analytic findings for clinical pain interventions, where positive findings in meta-analyses were often not confirmed by subsequent large RCTs. For example, using individual patient data from RCTs published in &lt;i&gt;Anaesthesia&lt;/i&gt;, Carlisle (&lt;span&gt;2021&lt;/span&gt;) demonstrated that almost half of the databases had false data as detected from the duplication of figures, tables, and other data from published work; the duplication of data in the rows and columns of spreadsheets; impossible values; and incorrect data analytic strategies and calculations.&lt;/p&gt;&lt;p&gt;Reproducibility, clinical validity, and ","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterisation of the Oral Microbiome in Women With Fibromyalgia: An Observational Case–Control Study","authors":"Sharon Erdrich,&nbsp;Thilini Jayasinghe,&nbsp;Momchilo Vuyisich,&nbsp;Ryan Toma,&nbsp;Ingrid Gelissen,&nbsp;Joanna E. Harnett","doi":"10.1002/ejp.70051","DOIUrl":"https://doi.org/10.1002/ejp.70051","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Fibromyalgia is a complex disorder, associated with a range of symptoms, not least of which is chronic, widespread pain. Although several reports have brought the role of oral health in systemic diseases into recent focus, the oral microbiome in fibromyalgia is unexplored. The aim of this study was to compare oral health and the oral microbiome in women with fibromyalgia with that of age-matched controls.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This observational case–control study recruited adult non-smoking, non-diabetic women meeting American College of Rheumatology (ACR) 2016 fibromyalgia criteria and age-matched controls living in New Zealand. Metatranscriptomic data from salivary samples were evaluated for differences at phyla, genus and species level, with adjustment for age, BMI and added dietary sugar intake. Results were examined against self-reported oral health.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;No differences were seen in richness or diversity of oral species between the fibromyalgia (&lt;i&gt;n&lt;/i&gt; = 106) and control (&lt;i&gt;n&lt;/i&gt; = 52) groups. Women with fibromyalgia had significantly lower scores on measures of oral health, which were associated with subtle shifts in the core oral microbiome. Several oral genera were significantly correlated with oral health scores (&lt;i&gt;q&lt;/i&gt; ≤ 0.05). Higher relative abundance of the periopathogens &lt;i&gt;Prevotella denticola&lt;/i&gt; and &lt;i&gt;Solobacterium moorei&lt;/i&gt; was apparent in women with fibromyalgia.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Significant differences in oral health and the oral microbiome were seen in women with fibromyalgia. This novel discovery presents an intriguing hypothesis that invites deeper investigation into the interaction between oral health and the oral microbiome in this population, and whether these influence the aetiology and/or symptoms of fibromyalgia in women.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Significance&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study presents the first evidence of altered oral microbiome in women with fibromyalgia, revealing significant disparities in oral health and the microbiome. The observed overabundance of periopathogens and the underrepresentation of commensals compared to a control group suggest intriguing potential links between the oral microbiome and fibromyalgia symptoms. These findings indicate that enhancing oral health may have broader implications for disease management and lay a robust foundation for further exp","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Cross-Sectional Analysis of Traumatic Experiences, Post-Traumatic Stress Disorder Symptoms and Chronic Pain in Northern Ireland","authors":"Kevin E. Vowles,&nbsp;Christina Mallett,&nbsp;Jason Brooks,&nbsp;Emma Berry,&nbsp;Danielle Rainey,&nbsp;Claire Briggs,&nbsp;Maura McCarron","doi":"10.1002/ejp.70044","DOIUrl":"https://doi.org/10.1002/ejp.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic pain and post-traumatic stress disorder (PTSD) are frequently comorbid and are associated with more significant pain-related disruption than chronic pain alone. It is not clear if these disruptions are due to traumatic experience or specific symptoms related to PTSD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This issue was evaluated in a large sample (<i>N =</i> 1367) of individuals with chronic pain presenting for treatment at an interdisciplinary pain rehabilitation service. As a secondary objective, the comorbidity of chronic pain and PTSD in Northern Ireland (NI) was also examined given high regional prevalence rates. Participants completed a PTSD screening measure, along with measures of pain interference, social functioning, pain anxiety, pain self-efficacy, pain intensity and depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Screening indicated that 46.4% had never experienced a traumatic event, 22.5% had experienced a traumatic event but screened negative for PTSD and 31.1% screened positive for PTSD. Following identification of covariates, a Multivariate Analysis of Covariance examined differences in dependent measures by PTSD category, which yielded a similar pattern of results across measures. The group that screened positive for PTSD reported worse functioning and more disruptions in comparison to the other two PTSD groups, with the latter groups not differing on any measure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These analyses indicate that poorer functioning was not associated with trauma exposure alone; rather, it was experienced in association with PTSD symptoms. Further, comorbidity rates of PTSD and chronic pain in this NI dwelling sample were at the high end of the range in relation to previous work and exceeded past year regional prevalence estimates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>PTSD assessment in those with chronic pain may be best served by evaluating the impact of these experiences on function, rather than focusing on the traumatic experiences in isolation. Further, there is scope to develop integrated chronic pain and PTSD treatments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elucidating the Significance of Endogenous Hydrogen Sulfide as a Novel Candidate for Postoperative Pain Recovery in a Murine Model","authors":"Jorge Luiz Dallazen,&nbsp;Larissa Gonzaga Santos,&nbsp;Simone Aparecida Teixeira,&nbsp;Gilberto De Nucci,&nbsp;Marcelo Nicolás Muscará,&nbsp;Soraia Katia Pereira Costa","doi":"10.1002/ejp.70043","DOIUrl":"https://doi.org/10.1002/ejp.70043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hydrogen sulfide (H₂S) is proposed to be a key regulator of inflammatory diseases; however, its role in the complex and often inadequately managed pathophysiology of postoperative pain is frequently mishandled. This study was undertaken to elucidate the role of endogenous H₂S in the recovery of nociceptive thresholds using a mouse model of postoperative pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Male BALB/c mice (6–7 weeks) underwent sham or plantar incision surgery (PIS). Thermal and mechanical thresholds were assessed before surgery and 1–7 days post-PIS. At 1, 4 and 7 days post-PIS, the endogenous production of H₂S and the expression of its synthesising enzymes—cystathionine β-synthase (CBS), cystathionine γ-lyase (CSE) and 3-mercaptopyruvate sulfurtransferase (3-MPST)—were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One day post-PIS, a reduction in H₂S production was observed in the operated hindpaw, with mechanical and thermal hyperalgesia lasting 5 and 6 days, respectively. CSE expression decreased in the operated hindpaw, while that of CBS increased on day 1 in the sciatic nerve and on day 4 in the L4–L5 spinal cord segments. The expression of 3-MPST remained unchanged. Intraplantar injection of aminooxyacetic acid (AOAA) or <span>dl</span>-propargylglycine (PGly), inhibitors of CSE/CBS activity, significantly delayed nociceptive threshold recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings suggest that while H₂S signalling via CSE appears to play a limited role in postoperative pain recovery, targeting CBS activity to preserve endogenous H2S levels may offer a promising alternative for enhancing pain and accelerating recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Targeting CBS to sustain H₂S signalling offers a new strategy to enhance postoperative pain recovery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reference Values of Joint-Specific Pressure Pain Thresholds in Healthy Male Individuals: A Retrospective Study","authors":"Fabian Tomschi,&nbsp;Alexander Schmidt,&nbsp;Marius Brühl,&nbsp;Thomas Hilberg","doi":"10.1002/ejp.70050","DOIUrl":"https://doi.org/10.1002/ejp.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pressure pain thresholds (PPT) are a component of Quantitative Sensory Testing and are used to assess mechanical pain sensitivity. Joint-specific PPT measurements are relevant because many joint disorders involve altered pain processing at and around joints. This study aims to establish such reference values that might contribute to evaluate deviations in pain sensitivity in specific patient populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study retrospectively analysed PPT data from 407 healthy male individuals. Pressure was applied in a standardised manner using an algometer at eight anatomical landmarks: bilaterally at the elbow, knee and ankle joints, as well as the sternum and forehead. Percentile-based, landmark-discriminative normative data were calculated for PPT in general and segmented for age, BMI and mean subjective pain over 4 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median (IQR) PPT values (N/cm²) for anatomical landmarks are as follows: ankle = 47.2 (35.9, 63.8), knee = 65.9 (48.6, 89.1), elbow = 58.0 (40.5, 81.1), sternum = 39.8 (30.2, 53.3) and forehead = 35.5 (26.8, 45.0). Between-group analyses revealed no significant effect of BMI on PPT at any landmark assessed, no significant effect of age, except for the elbow joint (<i>p</i> = 0.035) and no effect of the presence of pain, except for the ankle (<i>p</i> = 0.020) and elbow joint (<i>p</i> = 0.010).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study provides normative joint-specific PPT values in healthy male individuals, offering reference values for both clinical and research applications. These values can assist in interpreting PPT measured in clinical settings and in identifying abnormal pain sensitivity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Pressure pain thresholds are an important measure in Quantitative Sensory Testing, yet comprehensive normative data for joint-specific PPT in healthy individuals have been lacking. This study establishes reference values across multiple anatomical landmarks, providing a critical benchmark for evaluating pain sensitivity deviations in musculoskeletal disorders. These findings enhance the interpretation of PPT measurements, supporting improved pain assessment and diagnostic accuracy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-Term Effects of Kinesio Taping on Pain and Functionality in Patients With Cervical Spine Surgery","authors":"Masoud Amir Rashedi Bonab,&nbsp;Tugba Kuru Colak,&nbsp;Ipek Yeldan,&nbsp;Deniz Konya,&nbsp;Zafer O. Toktaş","doi":"10.1002/ejp.70049","DOIUrl":"https://doi.org/10.1002/ejp.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Effective postoperative pain management following cervical spine surgery is essential for optimal recovery. This study was conducted to determine the short-term effects of Kinesio Taping (KT) on pain and functionality in patients undergoing cervical spine surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ninety patients diagnosed with cervical disc herniation, cervical stenosis or cervical spondylolisthesis who underwent posterior cervical spine surgery were randomly assigned to three groups: Group I (conventional rehabilitation [CR] + KT, <i>n</i> = 30), Group II (CR, <i>n</i> = 30) and Group III (KT, <i>n</i> = 30). The Visual Analogue Scale (VAS), pressure pain threshold (PPT), range of motion (ROM), Neck Pain and Disability Scale (NPAD), Upper Extremity Functional Index-15 (UEFI-15) and short form-36 (SF-36) were assessed at baseline, on the first and third days after intervention, and after the follow-up period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Statistically significant difference in mean changes across all scores was observed among the three groups, favouring the CR + KT group (<i>p</i> &lt; 0.001). CR + KT intervention significantly improved VAS, PTT, NPAD and SF-36 emotional scores after treatment, with improvements maintained at 2-week follow-up (<i>p</i> &lt; 0.001). In terms of treatment interaction, CR + KT intervention showed a significantly larger effect size on PPT and NPAD scores (<i>p</i> &lt; 0.001). CR + KT and CR groups demonstrated similar improvements in functionality (<i>p</i> &gt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Integrating KT into a CR programme during the early postoperative phase of cervical spine surgery may improve clinical outcomes, specifically in pain intensity, PPT, disability levels and emotional components. However, the addition of KT to the CR programme does not appear to provide any meaningful benefits in terms of functionality compared to the CR programme alone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>This study reveals that integrating the KT method into the CR programme during the early postoperative period after cervical spine surgery can serve as a supportive and complementary intervention, particularly for painful conditions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oxycodone and Morphine Use in Hospitals and Primary Care in Norway 2010–2021: A Nationwide Study","authors":"Eirik Haarr,&nbsp;Marte Handal,&nbsp;Svetlana Skurtveit,&nbsp;Torgeir Gilje Lid","doi":"10.1002/ejp.70045","DOIUrl":"https://doi.org/10.1002/ejp.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Increasing oxycodone prescribing and its association with opioid-related harms have raised concerns. In Norway, nearly 90% of opioids are prescribed in primary care, making primary care decisions important to overall opioid exposure. In-hospital use may influence primary care practices through several mechanisms. This study analyses oxycodone and morphine use in Norwegian hospitals and its association with primary care prescribing from 2010 to 2021, alongside a review of tender agreements for these medications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Morphine and oxycodone, available in all relevant formulations, served as opioid proxies to compare covariation between hospitals and their catchment areas. We analyzed 2010–2021 procurement data from hospital pharmacies and primary care dispensing data from the Norwegian Prescription Database for all hospital trusts. Correlations between hospital and primary care morphine-to-oxycodone prescribing ratios were assessed using Pearson's <i>r</i>. Annual tender agreements were obtained from the national Hospital Procurement Organization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Hospital oxycodone use increased by 67.0% and primary care prescribing rose by 86.5%. Morphine use increased by 12.6% in hospitals but decreased by 23.2% in primary care. A moderate covariation (Pearson's <i>r</i> = 0.48) between hospital use and primary care prescribing was observed. Hospital tender agreements for morphine declined by 80%, while those for oxycodone remained stable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Oxycodone use substantially increased relative to morphine in Norwegian hospitals and primary care. Prescription patterns show moderate covariation, suggesting a potential link between hospital and primary care prescribing, though causality remains uncertain. Tender agreements may contribute to prescribing trends in hospitals, with possible associations in primary care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>This study is the first to provide quantitative evidence of covariation between in-hospital use and primary care opioid prescribing across a national healthcare system. Despite recommendations favoring morphine, oxycodone prescribing continues to rise in Norway, with marked geographical variation. By linking procurement data, prescription patterns and tender agreements, our findings highlight the need to consider hospital practices and structural factors when addressing opioid prescribing. These results offer new insights into potential lever","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144140354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Mediating Role of Psychological Flexibility and Inflexibility Between Impulsivity and Opioid Misuse in People With Chronic Noncancer Pain","authors":"Victoria Barrado-Moreno,&nbsp;Rosa Esteve,&nbsp;Lance M. McCracken,&nbsp;Carmen Ramírez-Maestre","doi":"10.1002/ejp.70048","DOIUrl":"https://doi.org/10.1002/ejp.70048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The prescription of opioid medication is a frequent therapeutic approach in chronic noncancer pain, as is misuse of prescribed opioids. There is previous evidence for associations between personal variables such as impulsivity and opioid misuse. Psychological flexibility and inflexibility have also been associated with pain-related outcomes and opioid misuse. The aim of this cross-sectional study was to examine the combined role of a dispositional variable (impulsivity) along with psychological factors (Psychological Flexibility and Inflexibility) in pain outcomes and opioid misuse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The sample comprised 155 people with chronic noncancer pain. A hypothetical model was tested using correlation and structural equation modelling analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results show significant associations between impulsivity and Psychological Flexibility, Psychological Inflexibility and opioid misuse. Psychological Flexibility and Inflexibility were related to pain intensity, interference and opioid misuse. Structural equation modelling showed significant associations between impulsivity, Psychological Inflexibility and pain interference, and opioid misuse. Associations between Psychological Flexibility and pain interference and opioid misuse were nonsignificant. These results support the hypothesis that impulsivity and Psychological Inflexibility are factors that contribute to pain interference and opioid misuse, but do not support the hypothesis that Psychological Flexibility reduces opioid misuse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>It is recommended to assess these psychological aspects prior to the prescription of opioid medication, and, if necessary, offering Acceptance and Commitment and Mindfulness Based Therapies could be desirable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>The results of this study provide further evidence of the role of trait impulsivity as a transdiagnostic antecedent variable in opioid misuse, both by a direct association and through psychological inflexibility. It can be drawn from these results that psychological transdiagnostic variables, rather than pain outcomes alone, would be key factors influencing opioid misuse. These findings underscore the need for comprehensive psychological assessments prior to the prescription of opioids.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144135716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Astrocytic Inducible Nitric Oxide Synthase Upregulation Contributes to Chronic Below-Level Neuropathic Pain Following Spinal Cord Injury in Male Rats","authors":"Youngkyung Kim,&nbsp;Hyunggoo Kang,&nbsp;Young Wook Yoon","doi":"10.1002/ejp.70047","DOIUrl":"https://doi.org/10.1002/ejp.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Spinal cord injury (SCI) leads to persistent inflammation, contributing to chronic neuropathic pain. However, current treatments show limited efficacy. Three types of nitric oxide synthase (NOS) play different roles in inflammation and neuronal hyperexcitation. Therefore, this study aimed to determine the predominant NOS subtype involved in neuropathic pain after spinal contusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We investigated the effects of intrathecal NOS inhibitors on mechanical sensitivity following a moderate spinal contusion injury in male Sprague-Dawley rats. These NOS inhibitors were N(G)-nitro-L-arginine methyl ester hydrochloride (L-NAME; non-selective NOS inhibitor), 1400W (iNOS inhibitor), Nω-propyl-L-arginine hydrochloride (NPLA; nNOS inhibitor) and N5-(1-iminoethyl)-L-ornithine (L-NIO; eNOS inhibitor). Additionally, we analysed protein expression and cellular localisation of spinal NOS subtypes in rats that underwent SCI or sham procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Treatment with L-NAME significantly reduced paw withdrawal threshold in a dose-dependent manner, although motor deficits appeared at the highest dose (30 μM), while 1400W effectively alleviated mechanical hypersensitivity without motor side effects. NPLA showed limited efficacy, and L-NIO had no effect. Protein expression of iNOS increased two-fold in the L4-5 spinal segment of SCI rats compared with sham controls. After SCI, iNOS-immunoreactivity colocalized with GFAP in the superficial laminae of the L4-5 spinal segment. Treatment with 1400W reduced the hyper-reactivity of both iNOS and GFAP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings indicate that iNOS plays a significant role in below-level neuropathic pain following thoracic spinal cord contusion in rats. Specific blockade of iNOS activity may have potential as a therapeutic intervention for spinal-contusion-induced neuropathic pain with reduced risk of side effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>iNOS inhibition effectively alleviated pain without motor side effects, unlike non-selective NOS, nNOS and eNOS inhibitors. The colocalization of iNOS with astrocytes in the spinal cord suggests a key mechanism in pain maintenance. These findings highlight the potential of targeting iNOS as a therapeutic strategy for SCI-induced neuropathic pain with reduced risks of side effects.</p>\u0000 ","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}