European Journal of Pain最新文献

{"title":"Structural Reorganization of Hypothalamic Subfields in Postherpetic Neuralgia: Volumetric and Morphometric Covariance Network Analyses","authors":"Daeseok Oh, Dong Ah Lee, Ho-Joon Lee, Kang Min Park","doi":"10.1002/ejp.70434","DOIUrl":"https://doi.org/10.1002/ejp.70434","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Postherpetic neuralgia (PHN) is a chronic neuropathic pain condition associated with central nervous system reorganization, but hypothalamic alterations remain poorly understood. We investigated hypothalamic subfield volumes and morphometric covariance network organization in patients with PHN.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective cross-sectional study included 42 patients with PHN and 41 healthy controls whose hypothalamic subfield volumes were obtained from T1-weighted MRI using automated FreeSurfer segmentation. Bilateral mean raw subfield volumes were compared between groups using analysis of covariance, adjusting for age, sex and estimated total intracranial volume, with false discovery rate correction for multiple comparisons. Morphometric covariance networks were constructed from age- and sex-residualized subfield volumes and graph-theoretical measures were compared using permutation testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After adjustment for estimated total intracranial volume, age and sex, the tubular superior subfield was nominally larger in PHN (adjusted difference, 4.95 mm<sup>3</sup>; 95% CI, 0.05–9.85; <i>p</i> = 0.048), but did not survive FDR correction. No other subfield or whole-hypothalamic volume differed significantly. PHN showed reduced local efficiency and clustering coefficient and increased characteristic path length, without a significant difference in global efficiency. No pain-side-dependent lateralization or significant associations between subfield volumes and pain measures or disease duration were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PHN was associated with altered hypothalamic morphometric covariance organization, characterized by reduced local network segregation and increased characteristic path length, while regional volume differences were limited after intracranial volume correction. These findings suggest that PHN-related central reorganization may involve hypothalamic systems related to homeostatic regulation and stress adaptation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This study demonstrates altered morphometric covariance organization of hypothalamic subfields in postherpetic neuralgia, despite limited evidence of regional volumetric differences after intracranial volume adjustment. These findings suggest that hypothalamic involvement in PHN may be better reflected by altered coordinated structural organization than by regional volume changes alone.</p>\u0000 </section>\u0000 ","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 10","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149222836","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":"Response to Andrea Truini: Diagnosing a Lesion or Diagnosing Neuropathic Pain?","authors":"Didier Bouhassira, Nadine Attal","doi":"10.1002/ejp.70435","DOIUrl":"https://doi.org/10.1002/ejp.70435","url":null,"abstract":"<p>We thank Professor Andrea Truini for his thoughtful and constructive commentary (Truini <span>2026</span>) on our position paper related to the NeuPSIG diagnostic algorithm for neuropathic pain (Bouhassira and Attal <span>2026</span>). We are pleased that we share substantial common ground: diagnostic confidence in neuropathic pain should emerge from the convergence of multiple sources of information rather than from a rigid hierarchy privileging supposedly objective findings over patients' reports. Our disagreement concerns a narrower but fundamental question: should investigations demonstrating a somatosensory lesion contribute directly to the classification of pain as neuropathic?</p><p>We entirely agree that ‘imperfect tests are not uninformative tests’. We never argued otherwise. Paraclinical investigations are clinically valuable and often essential for identifying an underlying neurological lesion or disease. Our proposal is to reconsider their role in pain classification, not to dismiss their clinical utility. The critical distinction concerns what these investigations really demonstrate. Nerve conduction abnormalities establish peripheral nerve dysfunction, reduced intraepidermal nerve fibre density indicates small-fibre pathology, and imaging may identify structural lesions. However, none establishes that the identified abnormality causes the patient's pain. This distinction matters because neurological lesions are frequently painless, and structural abnormalities may also occur in conditions not conventionally classified as neuropathic pain. Even a hypothetical test with perfect sensitivity and specificity for detecting a neurological lesion would not necessarily establish whether that specific lesion causes pain. Hence, accuracy for diagnosing a lesion and accuracy for classifying pain are fundamentally different purposes.</p><p>Adrea Truini refers to the studies by Peter Dyck and colleagues to support objective anchoring when clinical examination is unreliable. However, these studies evaluated the diagnosis of diabetic polyneuropathy, not whether patients' pain was neuropathic. Nerve conduction studies provide an excellent reference for diagnosing neuropathy, but do not constitute an equivalent reference for classifying pain. The same reasoning applies to small-fibre neuropathy. Diagnostic criteria combining clinical signs, thermal thresholds and intraepidermal nerve fibre density illustrate the value of convergence for identifying neuropathy. They do not establish that these findings reliably distinguish painful from painless neuropathy. Indeed, the weak association between intraepidermal nerve fibre density and pain was a central argument in our position paper.</p><p>We acknowledge Andrea Truini's point that some laser evoked potential parameters may be less influenced by psychological modulation than response amplitude, and that methodological standardisation may improve test reliability. Nevertheless, improved reliability in d","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 10","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70435","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149222743","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":"Veratramine Alleviates Neuropathic Pain in Male Rats With Chronic Constriction Injury and Inhibits the PI3K/Akt Pathway","authors":"Yaoping Yu,&nbsp;Lijun Wang,&nbsp;Jie Cui,&nbsp;Yu Zhang,&nbsp;Fei Zhang","doi":"10.1002/ejp.70383","DOIUrl":"10.1002/ejp.70383","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Neuropathic pain (NP), a debilitating complication of chronic diseases such as diabetes and cancer, remains inadequately managed by current therapies; approximately 30% of patients are unresponsive to monotherapy. This study investigates the effects and potential mechanisms of veratramine, a natural compound, in a rodent model of chronic constriction injury (CCI)–induced neuropathic pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>NP was induced via CCI in rodents. Veratramine's effects were assessed through behavioural tests (mechanical withdrawal threshold [MWT] and thermal withdrawal latency [TWL]). Apoptosis and inflammation in the sciatic nerve were analysed. Western blotting and immunofluorescence evaluated phosphorylation of NF-κB, IκB, p38 MAPK, and spinal glial activation. Transcriptome profiling identified key pathways, validated using the PI3K/Akt agonist 740 Y-P.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Veratramine significantly increased MWT and TWL, alleviating mechanical and thermal hypersensitivity. It reduced neuronal apoptosis and inflammatory cytokine release at injury sites. Protein analysis showed suppressed phosphorylation of NF-κB, IκB, and p38 MAPK, alongside reduced numbers of Iba-1-positive and GFAP-positive cells in the spinal dorsal horn. Transcriptome data implicated PI3K/Akt signalling pathway inhibition, confirmed by 740 Y-P co-treatment reversing veratramine's anti-inflammatory and analgesic effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These findings indicate that veratramine attenuates neuropathic pain in CCI rats, and its effects may involve inhibition of the PI3K/Akt signalling pathway, leading to reduced neuroinflammation and apoptosis. This study supports a role for veratramine in the modulation of neuropathic pain and highlights the PI3K/Akt pathway as a potential target for further investigation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>The results of this study suggest that veratramine alleviates neuropathic pain in a rat model of CCI, and this effect is associated with suppression of the PI3K/Akt signalling pathway. These findings support a role for veratramine in modulating neuroinflammation and apoptosis, and may contribute to a better understanding of the molecular mechanisms involved in neuropathic pain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 9","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180197","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":"Hospital Anxiety and Depression Scale Trajectories and Risk of Complex Regional Pain Syndrome in Middle-Aged Women After Surgical Treatment of Acute Distal Radial Fracture: A Prospective Longitudinal Cohort Study","authors":"Meihui Gao,&nbsp;Jun Xiong,&nbsp;Ran Gao,&nbsp;Yun Shen,&nbsp;Shengdi Lu,&nbsp;Xiaoru Yang","doi":"10.1002/ejp.70422","DOIUrl":"10.1002/ejp.70422","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To identify Hospital Anxiety and Depression Scale–Anxiety (HADS-A) trajectories after surgical treatment of distal radius fracture (DRF) in middle-aged women, and their association with complex regional pain syndrome (CRPS).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Prospective longitudinal cohort study.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Tertiary hospital, China.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;One thousand eight hundred seventy-five consecutive women aged 40–65 years undergoing surgical fixation of acute unilateral DRF (January 2019–December 2022).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Main Outcome Measures&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Primary outcome was CRPS diagnosed by the Budapest Clinical Criteria at 3 months. HADS-A was measured at baseline and 1, 2, 3 and 6 months, with CRPS assessed at each follow-up. Latent class trajectory modelling (LCTM) defined trajectory classes; time in target range (TTR) was the proportion of assessments with HADS-A &lt; 8.&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;During 6-month follow-up, 150 women (8.0%) developed CRPS. LCTM identified four trajectories: low-stable (&lt;i&gt;n&lt;/i&gt; = 983, 52.4%), moderate-recovering (&lt;i&gt;n&lt;/i&gt; = 448, 23.9%), high-persistent (&lt;i&gt;n&lt;/i&gt; = 265, 14.1%) and delayed-onset (&lt;i&gt;n&lt;/i&gt; = 179, 9.5%). Incidence was 19.2% (high-persistent) versus 4.9% (low-stable). After adjustment, the high-persistent trajectory was associated with CRPS (odds ratio [OR] 4.85, 95% confidence interval [CI] 1.85–12.71; &lt;i&gt;p&lt;/i&gt; = 0.001). TTR showed a graded exposure–response relationship: 0% versus 100% TTR carried higher risk (adjusted OR: 4.97, 95% CI: 2.51–9.86; &lt;i&gt;p&lt;/i&gt; &lt; 0.001; &lt;i&gt;p&lt;/i&gt; for trend &lt; 0.001). Subgroup interactions were non-significant.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Persistently elevated postoperative anxiety, rather than transient distress confined to the perioperative period, was associated with CRPS after DRF surgery, with a graded exposure–response relationship between cumulative anxiety burden (HADS-A TTR) and risk. Serial psychological monitoring beyond baseline may help identify at-risk patients.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Significance Statement&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study provides the first evidence that longitudinal anxiety trajectory patterns, not single-timepoint assessments, independent","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 9","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180217","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":"Effects of Hidden Conditioning and Positive Expectations on Pain Intensity Following Spinal Manipulative Therapy: A Three-Arm Randomized Controlled Trial","authors":"Helen Cristina Nogueira Carrer,&nbsp;Thamiris Costa de Lima,&nbsp;Bianca Emanuelli Saes Campanha,&nbsp;Steven Z. George,&nbsp;Felipe J. J. Reis,&nbsp;Deise Lilian Costa Dias,&nbsp;Thais Cristina Chaves","doi":"10.1002/ejp.70414","DOIUrl":"10.1002/ejp.70414","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Conditioning and positive expectations are potential mechanisms for pain relief. However, there is a gap in the literature on the isolated or combined impact of these factors for decreasing pain intensity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study investigated whether a hidden conditioning procedure with a hidden lowering of the thermal noxious stimulus during a conditioning session combined with positive expectation would result in greater low back pain intensity reduction compared to positive and neutral expectations alone. All groups participating in the study received six sessions of spinal manipulative therapy (SMT). Patients (<i>n</i> = 264) with nonspecific chronic low back pain (CLBP), aged between 18 and 65 years, were randomly allocated to three groups: hidden conditioning with positive expectations (C-PEG), positive expectations alone (PEG), or neutral expectations alone (NEUG). Participants were submitted to a conditioning test pre- and post-first session of SMT, where heat pain stimuli were surreptitiously lowered only in the C-PEG group. The primary outcomes were low back pain intensity and global perceived effect (GPE) of improvement assessed post-first SMT session and at 6-week (primary endpoint) and 3-month follow-ups. Linear mixed-effects models were used to assess group and time effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant difference was found between the three groups at any of the follow-ups for pain intensity or GPE. Positive expectations (pre-treatment) and psychosocial variables partially mediated the relationship between baseline low back pain and disability outcomes. All groups showed a within-group reduction in low back pain and disability at follow-ups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Conditioning and positive expectation with SMT did not improve pain intensity or GPE outcomes for participants with low back pain, when compared to positive or neutral expectations alone. These findings suggest that patients did not generalize learned associations during conditioning to low back pain intensity outcome. Regardless of treatment assignment, positive expectations and psychosocial factors played a mediating role in pain intensity, GPE, and disability outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT05202704</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 9","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165650","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":"How the Brain Interprets Pain in Autistic People: Does Sex Matter?","authors":"Yelena Granovsky,&nbsp;Irit Weissman-Fogel,&nbsp;Tseela Hoffman,&nbsp;Merry Kalingel Levi,&nbsp;Eynat Gal,&nbsp;Elliot Sprecher,&nbsp;Merav Shor,&nbsp;Tami Bar-Shalita","doi":"10.1002/ejp.70411","DOIUrl":"10.1002/ejp.70411","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;While psychophysical studies suggest heightened pain sensitivity in individuals with autism spectrum disorder (ASD), the relationship between subjective pain experience and cortical neurophysiological responses and whether this relationship is sex-dependent, remains poorly understood.&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 cross-sectional two-group comparison study included 50 adults with Level 1 ASD and 52 age-, sex- and IQ-matched typically developing controls (TDC). Pain ratings and cortical contact heat-evoked potentials (CHEPs) were recorded in response to 52°C phasic heat stimuli. ANOVA and regression models assessed the effects of group, sex and pain ratings on CHEP amplitudes.&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;Compared to TDC, autistic participants reported higher pain scores (&lt;i&gt;p&lt;/i&gt; = 0.004) and had lower N&lt;sub&gt;2&lt;/sub&gt; amplitudes (&lt;i&gt;p&lt;/i&gt; = 0.02). A significant Group × Sex interaction (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) was associated with the lowest N&lt;sub&gt;2&lt;/sub&gt; amplitudes in autistic females (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Regardless of group, in females, higher N&lt;sub&gt;2&lt;/sub&gt; amplitudes were associated with higher pain scores (&lt;i&gt;p&lt;/i&gt; = 0.042; model &lt;i&gt;p&lt;/i&gt; = 0.032), whereas this association was not significant in males (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). Within-group correlation analyses in females showed a significant pain–N&lt;sub&gt;2&lt;/sub&gt; amplitude relationship in TDC (&lt;i&gt;r&lt;/i&gt; = 0.734; &lt;i&gt;p&lt;/i&gt; = 0.004) but not in autistic participants (&lt;i&gt;r&lt;/i&gt; = 0.371; &lt;i&gt;p&lt;/i&gt; = 0.192). Across groups and sexes, higher N&lt;sub&gt;2&lt;/sub&gt; amplitude values were associated with greater attention-to-detail autistic traits (&lt;i&gt;p&lt;/i&gt; = 0.009).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Our findings suggest a dissociation between subjective pain experience and cortical responses to nociceptive stimulation in autism, particularly among females, consistent with different salience-related or attentional pain processing. These results underscore the importance of considering sex and autism when interpreting pain-evoked cortical responses and challenge the assumption that pain-evoked potentials provide universally objective measures of pain.&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 identifies sex-related differences in the relationship between subjective pain ratings and cortical responses to nociceptive stimulation in autistic and typically developing individuals. Autistic females showed particularly attenua","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 9","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165127","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":"Variations in Current and Desired Limb Perception in Complex Regional Pain Syndrome","authors":"Caitlin E. Naylor,&nbsp;Gavin Buckingham,&nbsp;Christof Lutteroth,&nbsp;Janet H. Bultitude","doi":"10.1002/ejp.70401","DOIUrl":"10.1002/ejp.70401","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>People with Complex Regional Pain Syndrome (CRPS) often experience body perception disturbances, whereby features of the affected limb are perceived as distorted. However, these disturbances vary widely between individuals, as does the effectiveness of treatments aimed at altering body perception. It remains unclear whether such variation reflects distinct underlying patterns of disturbances and whether individuals differ in how they would change their limb perception.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted an exploratory online survey to examine current and desired perceptions of the affected limb in people with CRPS. 115 people with CRPS reported the severity of visual and felt disturbances in the perceived size, shape, position and definition of their affected limb, as well as any changes they would like to make to this perception.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three clusters of body perception disturbances were identified, differing in the degree of perceptual distortion from a typical limb and in the level of multimodal discrepancy. These clusters were associated with differences in the severity of other CRPS symptoms. Another three clusters were identified based on desired perceptual changes, with most respondents seeking alterations that did not simply involve returning the limb to a normal state.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings challenge the common practice of treating body perception disturbance as a single symptom in CRPS. They illustrate the value of recognising how disturbances manifest and show that individuals' desired perceptual changes often diverge from traditional rehabilitation methods aimed at normalising the limb. Future work should explore tailoring rehabilitation to individual body-perception profiles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Body-perception disturbance in CRPS is not a single construct, but comprises distinct patterns linked to clinical severity. Many individuals do not wish their limb to simply be normal, challenging core rehabilitation assumptions. These insights demonstrate substantial heterogeneity in how people with CRPS perceive their limb and how they want it to be. This highlights the need for personalised, patient-centred approaches to body-perception–focused pain management in CRPS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 9","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70401","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135574","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":"Pain Enhances the Auditory P2 but Attenuates Mismatch Response and P3a","authors":"Alexandre Lehmann,&nbsp;Marc Schönwiesner,&nbsp;Pierre Rainville","doi":"10.1002/ejp.70405","DOIUrl":"10.1002/ejp.70405","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;Auditory input is known to modulate the perception of pain, yet the reciprocal influence, how pain affects auditory processing, remains less well understood. We investigated how continuous tonic pain dynamically alters auditory cortical responses in humans.&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;Using a three-stimulus auditory oddball paradigm combined with EEG, we recorded event-related potentials (ERPs) while participants experienced thermal stimulation under three conditions: baseline, non-painful warmth, and pain. We examined multiple stages of auditory processing, including early sensory encoding (N1, P2), automatic deviance detection (MMN), and attentional reorienting (P3a).&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;Tonic pain modulated auditory ERPs in a stage- and component-specific manner. Compared to baseline and warm conditions, pain was associated with enhanced P2 responses to distractors and reduced MMN and P3a amplitudes, although no statistically significant differences in behavioural performance were observed. This pattern suggests enhanced early salience detection alongside reduced pre-attentive deviance detection and involuntary attentional shifts under pain. The warm condition selectively modulated N1 amplitude, indicating that some effects may be related to the affective and attentional demands of pain rather than somatosensory stimulation per se.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Continuous tonic pain is associated with selective modulation of auditory processing, characterized by enhanced early sensory responsiveness and reduced higher-order attentional engagement. This biphasic neural pattern, observed in the absence of measurable behavioural differences, is consistent with predictive coding and salience network accounts of pain-attention interactions and highlights the sensitivity of ERPs for detecting pain-related neural reweighting. The absence of statistically significant behavioural effects should be interpreted with caution and may reflect relatively subtle or context-dependent influences of pain under the present task conditions.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Significance Statement&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study is among the first to systematically examine how experimentally induced tonic pain modulates distinct stages of auditory processing in healthy individuals using high-resolution ERPs, with a task design and hypothesis framework capable of teasing apart the c","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 9","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70405","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135606","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":"How the Content and Referential Form of Self-Talk Influence Experimental Pain","authors":"Małgorzata M. Puchalska-Wasyl,&nbsp;Tomasz Jankowski,&nbsp;Mateusz Chwaszcz,&nbsp;Paulina Chyziak,&nbsp;Iwona Derecka,&nbsp;Anna Jankowska,&nbsp;Zuzanna Nowakowska","doi":"10.1002/ejp.70408","DOIUrl":"10.1002/ejp.70408","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;Limitations of pharmacological treatments and psychotherapeutic interventions for pain highlight the need for complementary pain-coping strategies. Although questionnaire studies suggest that self-talk may be effective in chronic pain management, experimental evidence remains scarce.&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;Our three within-subject experiments employed a cold pressor task to investigate the effects of self-talk content (self-compassionate or motivational) and its referential form (first-, second-, or third-person self-reference) on pain experience, assessed via self-reported pain intensity and high-frequency heart rate variability (HRV_HFn).&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;Experiment 1 (&lt;i&gt;N&lt;/i&gt; = 38) examined self-compassionate self-talk. Both experimental conditions (“I” and “You” self-talk) resulted in lower pain ratings than a control condition involving neutral statements; however, pain ratings did not differ between the two self-talk conditions. Experiment 2 (&lt;i&gt;N&lt;/i&gt; = 48) examined motivational self-talk. As in Experiment 1, both “I” and “You” self-talk conditions lowered pain ratings relative to the control condition, with no effect of referential form. Experiment 3 (&lt;i&gt;N&lt;/i&gt; = 81) focused exclusively on referential form, contrasting first-, second-, and third-person self-talk (the latter using participants' name). Pain ratings did not differ among the “I”, “You”, and “Name” conditions. Across three experiments, the hypothesized effects on HRV_HFn were not observed.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Although prior research has emphasized the benefits of non-first-person self-reference for reducing threat appraisal and emotional reactivity, our findings suggest that the effects of self-talk on pain depend on its content rather than its referential form. The HRV results are more consistent with studies reporting weak or absent associations between HRV indices and pain intensity.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Significance Statement&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study provides experimental evidence that self-talk content—rather than its referential form—influences pain ratings in healthy participants. Self-compassionate and motivational self-talk resulted in lower pain ratings compared with neutral control conditions, whereas first-, second- and third-person forms showed no differential effects. This work suggests that simple, content-focused self-talk strategies may offer a safe, low-cost and easily implementable adjunct to pain self-management approaches.&lt;/p&gt;\u0000 ","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 9","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148132","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 Interfering Effects of Pain on Subsequent Lexical Processing","authors":"Yuzheng Wang,&nbsp;Huizhong He,&nbsp;Yue Li,&nbsp;Wenxiao Gong","doi":"10.1002/ejp.70404","DOIUrl":"10.1002/ejp.70404","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Previous research has consistently established that the interruptive effect of painful stimuli is lasting and selective, yet investigations have primarily focused on attentional tasks. The present study investigated whether this interruptive effect extends to subsequent lexical processing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A mixed experimental design was employed, comprising two independent experiments to examine the temporal dynamics of pain's interference on different levels of lexical processing. Participants were randomly assigned to one of three conditions: pain, non-painful stimulation or no-stimulation control. In the pain and non-pain conditions, each trial began with a brief electrical stimulus, followed by a lexical task after a variable interstimulus interval (ISI; 0, 250 or 1250 ms). Two experiments were conducted: Experiment 1 (<i>N</i> = 75) employed a semantic decision task, and Experiment 2 (<i>N</i> = 75) employed a structural decision task.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In Experiment 1, semantic decision performance in the pain group was significantly impaired immediately following stimulation (0-ms delay), but this impairment subsided by 250 ms. A processing disadvantage for pain-related words was observed selectively in the semantic task. In Experiment 2, structural decision performance remained unaffected by pain at all delays.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The disruptive effect of pain on lexical processing is transient (lasting &lt; 250 ms) and selective to semantic processing, leaving structural processing intact. These findings demonstrate that pain's impact is modulated by task demands, with semantic processing being selectively vulnerable to pain-induced interference.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Pain produces a transient interruptive effect on semantic processing that dissipates within 250 ms. Structural processing remains unaffected, indicating that pain's interference is selective to deeper conceptual analysis. The disruptive effect is content-general, impairing semantic processing regardless of word type (pain-related or not).</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 9","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106143","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}