European Journal of Pain最新文献

{"title":"Development and Internal Validation of a Machine Learning Model for Predicting Long-Term Opioid Therapy After Hip Fracture Surgery in Older, Opioid-Naïve Adults.","authors":"Yasmina Maria Tudorache, Simon Storgaard Jensen, Katie Jane Sheehan, Jan-Erik Gjertsen, Alma Becic Pedersen","doi":"10.1002/ejp.70280","DOIUrl":"https://doi.org/10.1002/ejp.70280","url":null,"abstract":"<p><strong>Background: </strong>Long-term opioid therapy (LTOT) after hip fracture surgery is a common postoperative complication associated with adverse outcomes, yet tools to identify at-risk patients among opioid-naïve older adults are lacking. This study aimed to develop and internally validate a parsimonious model to predict LTOT following hip fracture surgery.</p><p><strong>Methods: </strong>Using Danish nationwide registries, we identified 26,057 opioid-naïve patients (≥ 65 years) undergoing hip fracture surgery (2010-2020) and analysed 29 predictors, covering demographics, comorbidities, medication, lifestyle, socioeconomics and surgical factors. LTOT was defined as redeeming ≥ 2 prescriptions between 31 and 365 days of surgery. Models were developed using four machine learning methods: logistic regression, backwards elimination, elastic net penalised logistic regression and random forest. Model performance was assessed using area under the receiver operating characteristic curve (AUC), calibration slope, intercept, Brier score and decision curve analysis.</p><p><strong>Results: </strong>LTOT was identified in 8095 (31.1%) patients. The backward elimination algorithm identified the best performing model, selecting 8 of 29 predictors and achieving an AUC of 0.68, calibration slope of 0.99, intercept of 0.02 and Brier score of 0.20. Predictors included age, marital status, preoperative non-opioid pain medication, preoperative novel oral anticoagulants, fracture type, surgery delay, length of hospital stay and postoperative cumulated ambulation score at discharge.</p><p><strong>Conclusions: </strong>A prediction model was developed and validated for use at discharge to identify patients at risk of LTOT 1 year after hip fracture. The model may support risk stratification at discharge, but requires external validation and evaluation of clinical implementation before routine use.</p><p><strong>Significance statement: </strong>This study presents the first internally validated prediction model for long-term opioid use in opioid-naïve older adults after hip fracture surgery. The model functions as a simple and interpretable risk stratification tool at discharge and has been incorporated in a freely available risk calculator. It addresses the lack of clinically applicable risk stratification tools in this frail population and highlights opportunities for more targeted postoperative pain management, although feasibility testing is required before clinical implementation.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 5","pages":"e70280"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766450","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":"Trauma-Informed Pain Management Among Refugees and Asylum Seekers: The Need for Integrated Care and a Human Rights Perspective.","authors":"Whitney Scott, Zoe Cricks, Gabriela Enache","doi":"10.1002/ejp.70285","DOIUrl":"https://doi.org/10.1002/ejp.70285","url":null,"abstract":"","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 5","pages":"e70285"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766459","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":"Conditioned Pain Modulation Inter-Site Variability Study: Effect Sizes and Test-Retest Reliability of Two Models.","authors":"Yi-Wun Lin, Hannah Schmidt, Niko Möller-Grell, Walter Magerl, Li-Ling Hope Pan, Shuu-Jiun Wang, Li-Wei Chou, Rolf-Detlef Treede","doi":"10.1002/ejp.70287","DOIUrl":"10.1002/ejp.70287","url":null,"abstract":"<p><strong>Background: </strong>Conditioned pain modulation (CPM) is a set of psychophysical paradigms that is increasingly used clinically to evaluate descending pain modulation pathways. Impairment is common in chronic pain, suggesting CPM may serve as a mechanistic indicator. However, the lack of protocol standardization and reference data prevents clinical use in individual patients.</p><p><strong>Methods: </strong>We compared two CPM protocols with different conditioning stimulus intensities, test stimulus types, and interaction timing. We assessed CPM effect size, test-retest reliability and sensitivity to detect loss of descending inhibition.</p><p><strong>Results: </strong>Conditioning with 0°C water led to stronger inhibition of pressure pain threshold (PPT) than conditioning with 7°C water (Cohen's d = 0.52), when tested immediately after conditioning. When tested during conditioning, effects of 7°C water immersion on heat pain sensitivity had similar magnitude (D = 0.53) and test-retest reliability (ICC = 0.77) as those on PPT (D = 0.54, ICC = 0.73). For all outcomes assessed, 95% confidence intervals (CI) of CPM effect included some facilitation instead of inhibition. The maximum degree of facilitation compatible with normal CPM (upper cutoff of CI) indicates potential sensitivity to detect individual abnormality. This was most favourable for PPT assessed after conditioning with 0°C water (decrease by more than 75 kPa or 14% of baseline PPT).</p><p><strong>Conclusions: </strong>In conclusion, testing during conditioning stimulation yields medium to large effect sizes and good test-retest reliability. PPT testing immediately after ice water immersion has the narrowest 95% CI and hence offers the potential to generalize CPM assessments beyond group-level differences and compare inhibition among individuals in clinical practice.</p><p><strong>Significance statement: </strong>Indicating the main aspects where this work adds significantly to existing knowledge in the field, and if appropriate to clinical practice. Simultaneous CPM protocols exhibit large effect sizes but are confounded by divided attention. We recommend a sequential protocol and provide model reference data for abnormal facilitation.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 5","pages":"e70287"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812637","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 Retrained: Outcomes Analysis of an Online, Interdisciplinary Chronic Pain Education Programme.","authors":"Maura McCarron, Francis Agnew, Claire Briggs, Jason Brooks, Martin Dempster, Danielle Rainey, Kevin E Vowles","doi":"10.1002/ejp.70288","DOIUrl":"10.1002/ejp.70288","url":null,"abstract":"<p><strong>Background: </strong>Videoconferencing to deliver chronic pain education offers improved accessibility and scalability. However, evidence regarding such interventions is largely absent, thus it is necessary to assess their clinical value. This study evaluated the impact of a group-based interdisciplinary chronic pain education programme, Pain Retrained, delivered via videoconferencing.</p><p><strong>Methods: </strong>This study employed a single-arm longitudinal design with measures collected at baseline, post-intervention, and 3-month follow-up. Six weekly online sessions of two hours each were delivered to groups as the first point of contact with a secondary care pain service. Changes were evaluated via multilevel Structural Equation Modelling. Indices of acceptability were assessed post-intervention.</p><p><strong>Results: </strong>In total, 261 participants (62.1% female) completed Pain Retrained. There was sustained change through follow-up for pain self-efficacy and social functioning and post-intervention only change for depression and pain-anxiety. Change was non-significant for pain intensity and pain interference. Effect sizes ranged from negligible to medium (range Cohen's d = 0.03-0.74). The majority of participants, 85.4% reported improved understanding of pain.</p><p><strong>Conclusion: </strong>There has been growing interest in advancing pain education through online modalities. This study shows that live, clinician-led online pain education is feasible and acceptable for people with chronic pain, with high satisfaction and perceived utility. These data are among the first to examine the effectiveness of this approach in relation to clinical outcomes. While outcomes were mixed, reflecting the complexity of chronic pain and limits of education alone, these findings extend existing knowledge by demonstrating this approach offers an accessible and scalable adjunct to care.</p><p><strong>Significance: </strong>The expansion of digital health interventions has outpaced evidence supporting their use in chronic pain care. By providing longitudinal, practice-based evidence from a novel large-scale programme, this study provides timely evidence to guide integration of online education into care pathways. It informs service planning while identifying key targets for optimisation, including integration with behaviour change strategies. The work also establishes priorities for further research to test efficacy and mechanisms of action in digitally delivered pain care.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 5","pages":"e70288"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812704","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":"Lesion and Disconnection Profiles of Pain Quality Subtypes After Stroke: Implications for Prognosis and Rehabilitation.","authors":"Shinji Uragami, Yuki Igawa, Yusaku Takamura, Shinya Iki, Shu Morioka, Michihiro Osumi","doi":"10.1002/ejp.70276","DOIUrl":"https://doi.org/10.1002/ejp.70276","url":null,"abstract":"<p><strong>Background: </strong>Post-stroke pain (PSP) presents with diverse pain qualities. However, the structural brain correlates underlying these distinct pain qualities remains poorly understood.</p><p><strong>Methods: </strong>We analysed PSP patients using clinical assessments, clustering based on pain qualities assessed using the Neuropathic Pain Symptom Inventory, longitudinal pain intensity evaluation and brain lesion/disconnection mapping (computed tomography/magnetic resonance imaging and Bayesian lesion-deficit inference). Pain quality-based clusters and their corresponding lesion sites and white matter tracts were identified.</p><p><strong>Results: </strong>We analysed 114 PSP patients. Cluster analysis using pain qualities classified patients into four distinct subgroups: CL1 (cold-evoked/tingling), CL2 (deep squeezing/pressure), CL3 (tingling) and CL4 (pressure-evoked). CL1 and CL3 patients predominantly exhibited features of central post-stroke pain, characterised by sensory disturbances such as allodynia and numbness. Lesion mapping revealed involvement of the thalamus, putamen and posterior insula. Disconnection analysis identified the superior thalamic radiation (Bayes factor > 70) as a common white matter tract. In contrast, CL2 and CL4 were characterised by musculoskeletal-type pain associated with joint pain, restricted range of motion and higher motor impairment. Lesions in these groups were mainly localised to the frontal lobe, with disconnection of the corticospinal and fronto-aslant tracts (Bayes factor > 50). Longitudinal analysis demonstrated pain intensity decreased over time across all clusters, with a trend towards slower improvement in Cluster 3.</p><p><strong>Conclusions: </strong>Pain quality reflects distinct pathological mechanisms of PSP and may be associated with specific patterns of brain lesions and white matter disconnections and rehabilitation prognosis. Identifying pain-quality subtypes may help inform outcomes and guide personalised rehabilitation.</p><p><strong>Significance statement: </strong>By linking distinct pain qualities with lesion and disconnection profiles, this study clarifies the neural mechanisms underlying post-stroke pain. Identifying these pain-quality subtypes provides insights into prognosis and supports the development of personalized rehabilitation strategies tailored to specific pain mechanisms.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 5","pages":"e70276"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766357","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 Effects of Lumbar Delayed Onset Muscle Soreness on Clinical, Biomechanical and Neuromuscular Outcomes: A Systematic Review and Meta-Analysis","authors":"Julien Ducas,&nbsp;Clémentine Véret,&nbsp;Émilie Gauthier-Wong,&nbsp;Martin Descarreaux,&nbsp;Jacques Abboud","doi":"10.1002/ejp.70264","DOIUrl":"10.1002/ejp.70264","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>Low back pain is multifactorial, making it difficult to isolate pain-related motor adaptations. Experimental pain models may help clarify these mechanisms. This systematic review evaluates lumbar delayed onset muscle soreness (DOMS) as a movement-evoked pain model and its effects on clinical, biomechanical and neuromuscular outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Databases and Data Treatment</h3>\u0000 \u0000 <p>The meta-analysis (PROSPERO: CRD420251051399) included studies of healthy adults with experimentally induced DOMS, with outcomes assessed within 5 days under the influence of DOMS. Databases (MEDLINE, SCOPUS, CINAH) were searched (9/12/2025), with manual screening. Independent study selection, data extraction and risk-of-bias assessment (NIH Quality Assessment Tool) were performed. Random-effects meta-analysis calculated standardized mean differences (SMDs). Sensitivity analyses and GRADE (Cochrane) assessed robustness and evidence certainty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighteen studies were included (452 participants). DOMS significantly increased low back pain intensity (SMD: Day 1 with DOMS = 1.12, Day 2 = 0.94, Day 3 = 0.69, Day 4 = 0.49) and soreness (Day 1 = 1.94, Day 2 = 1.66, Day 3 = 0.88, Day 4 = 0.59). Pressure pain thresholds decreased significantly (Day 1 = −0.47, Day 2 = −0.44). Trunk extension maximal voluntary contraction decreased significantly (Day 1 = −0.67, Day 2 = −0.95, Day 3 = −0.84, Day 4 = −0.38), while trunk flexion range of motion and flexion relaxation ratios remained unchanged.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Lumbar DOMS replicates low back pain features, movement-evoked pain, increased sensitivity and reduced muscle function, providing a non-invasive model to study short-term neuromuscular adaptations in a controlled setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This review highlights lumbar DOMS as a safe, non-invasive model to study short-term neuromuscular adaptations to pain to better understand pain mechanism. This synthesis provides foundational work for future studies using DOMS to explore LBP mechanisms. By clarifying its strengths (e.g., ecological validity for acute pain) and limitations (e.g., short duration, lack of pain-related psychological factors), we aimed to guide more standardized applications of this model in pain research.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 4","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13069876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147662559","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":"Spared Nerve Injury Induces Long-Term and Brain Region-Specific Changes in Oligodendrocyte Density in Mice","authors":"Léa J. Becker,&nbsp;Rory O'Shea,&nbsp;Gustavo Borges,&nbsp;Jordan G. McCall","doi":"10.1002/ejp.70265","DOIUrl":"10.1002/ejp.70265","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Emerging evidence suggests a role for non-neuronal cells in the pathophysiology of chronic pain. Chronic pain causes profound alterations of the transcriptomic program of oligodendroglia, but the effect of pain on the oligodendroglial cells themselves remains unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Male and female C57BL6/J mice underwent spared nerve injury (SNI). Mechanical hypersensitivity was assessed 5 weeks later using the von Frey test. Six weeks post-surgery, mice were perfused, brains dissected, and immunostained for oligodendrocyte precursor cells (OPC) and mature oligodendrocytes (OL) in four brain regions involved in pain chronification: anterior cingulate cortex (ACC), central amygdala (CeA), basolateral amygdala (BLA), and periaqueductal grey (PAG).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found OL were reduced in the ACC and CeA of both sexes 6 weeks after SNI. Conversely, BLA OL were increased in both sexes following SNI. There was a sex-dependent effect of SNI on PAG-OL, where OL were only reduced in females. SNI did not affect OPC in any of the studied brain regions, but female PAG and BLA appeared to have fewer OPC than males independent of SNI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Long-term nerve injury differentially affects OL in a brain region- and sex-dependent manner. This effect is observable 6 weeks after injury, suggesting a long-lasting impact of chronic pain on oligodendroglial cells. OPC, on the other hand, are remarkably stable. This finding aligns with previous literature showing OPC maintain homeostasis, even in pathological conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>Oligodendrocytes ensheathe axons to increase conduction speed, stabilize neuronal connections, and fine-tune neuron-to-neuron communication. Furthermore, pharmacological stimulation of myelination improves pain-induced cognitive deficits in mice, suggesting therapeutic potential in targeting oligodendrocytes in pain. A better understanding of how pain impacts oligodendroglia is thus crucial to better understand the pathophysiology of pain and identify new therapeutic targets.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 4","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147662517","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":"BACK-on-LINE™: A Digital Pain Phenotyping Tool to Personalise Early Self-Management of Low Back Pain: Reliability and Validity in Working Adults","authors":"Minghao Chen,&nbsp;Valerie Sparkes,&nbsp;Liba Sheeran","doi":"10.1002/ejp.70268","DOIUrl":"10.1002/ejp.70268","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background and Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Low back pain (LBP) is a leading cause of work-related disability. Although early tailored self-management is advocated, current approaches remain generic. Classifying LBP by predominant pain phenotype (nociceptive, neuropathic, nociplastic) may enable targeted self-management, yet practical tools for early or workplace use are limited. This study evaluated the reliability and validity of BACK-on-LINE, a self-administered digital tool differentiating nociceptive and nociplastic pain to support early mechanism-informed self-management in working populations, benchmarked against established patient-reported outcome measures (PROMs).&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;Employed adults with LBP (&lt;i&gt;n&lt;/i&gt; = 211) recruited from occupational settings completed BACK-on-LINE and PROMs assessing pain (Numeric Pain Rating Scale; NPRS), disability (Roland–Morris Disability Questionnaire; RMDQ), and psychosocial risk (STarT Back Screening Tool; SBST). Reliability was assessed using internal consistency (Cronbach's &lt;i&gt;α&lt;/i&gt;) and test–retest reliability (intraclass correlation coefficient; ICC). Validity was examined through convergent validity with PROMs, known-groups validity comparing nociceptive and nociplastic subgroups, and criterion validity using receiver operating characteristic (ROC) analyses against reference standards (pain intensity, disability, chronicity, sickness absence).&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;Data from 136 participants (64% completion) were analysed. BACK-on-LINE classified 68.4% as nociceptive and 31.6% as nociplastic. Reliability was strong (&lt;i&gt;α&lt;/i&gt; = 0.83; ICC = 0.88). Convergent validity was moderate, strongest with SBST (&lt;i&gt;r&lt;/i&gt; = 0.67). Known-groups validity was robust, with nociplastic participants reporting higher pain, disability and psychosocial risk (all &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Criterion validity was moderate (AUC = 0.67–0.77), with BACK-on-LINE demonstrating comparable or superior discrimination to SBST.&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;BACK-on-LINE shows good reliability and multi-dimensional validity for self-classifying pain phenotypes in working adults with LBP, offering a scalable approach to support early mechanism-informed self-management in occupational health pathways.&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 robust initial evidence for a self-administered digital tool BACK-on-LINE ","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 4","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13069916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147662583","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":"Postoperative Pain Management After Lumbar Discectomy. A Systematic Review With Meta-Analyses and Trial Sequential Analyses","authors":"Josephine Zachodnik,&nbsp;Rachid Bech-Azeddine,&nbsp;Magnus Sandberg,&nbsp;Rebecca Scherwin,&nbsp;Rikke Malene Hartvigsen Grønholm Jepsen,&nbsp;Louise Møller Jørgensen,&nbsp;Kasper Højgaard Thybo,&nbsp;Anja Geisler","doi":"10.1002/ejp.70261","DOIUrl":"10.1002/ejp.70261","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;Inadequate postoperative pain management after lumbar discectomy may delay recovery, increase the risk of chronic pain, and prolong hospitalization. Effective analgesic strategies must balance pain control with minimal adverse effects.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To identify the most effective postoperative analgesic interventions for patients undergoing lumbar discectomy.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Databases and Data Treatment&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This systematic review was preregistered in PROSPERO and conducted in accordance with PRISMA guidelines. Randomized controlled trials were identified through systematic searches in Medline, Embase, and the Cochrane Library. The primary outcome was opioid consumption within 24 h postoperatively. Meta-analyses were conducted using RevMan, with Trial Sequential Analysis (TSA) to adjust for random errors. Risk of bias was assessed using ROB2, and certainty of evidence was evaluated with GRADE.&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;A total of 76 RCTs comprising 5617 participants were included, covering 11 analgesic strategies. Paracetamol, NSAIDs, epidural and intrathecal anaesthetics, local infiltration, nerve blocks, gabapentin, and pregabalin significantly reduced 24-h opioid consumption. Several interventions—including paracetamol, NSAIDs, glucocorticoids, ketamine, epidural and intrathecal anaesthetics, local anaesthetics, nerve blocks, gabapentin, and pregabalin—were also associated with lower pain scores at 6 and 24 h. However, evidence certainty ranged from low to very low due to methodological limitations, small sample sizes, heterogeneity, and inconsistent baseline analgesia.&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;Multiple analgesic strategies show potential for reducing opioid use and improving early postoperative pain control after lumbar discectomy. Nevertheless, the low certainty of evidence highlights the urgent need for high-quality, standardized trials to inform clinical practice.&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;The findings demonstrate that the following analgesics significantly reduce supplemental opioid consumption and pain levels in the immediate postoperative period: PCM, NSAIDs, intrathecal anaesthetics, epidural anaesthetics, LIA/wound infiltration, nerve blockade, gabapentin, and pregabalin. Howeve","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 4","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13067818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644395","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":"Distinct Grey Matter Alterations in Untreated Mild to Moderate Chronic Low Back Pain: A Longitudinal Magnetic Resonance Imaging Study","authors":"Monica Sean,&nbsp;Samantha Cote,&nbsp;Alexia Coulombe-Lévêque,&nbsp;Julia Huck,&nbsp;Marylie Martel,&nbsp;Ze Ming Liu,&nbsp;Guillaume Léonard,&nbsp;Kevin Whittingstall,&nbsp;Pascal Tétreault","doi":"10.1002/ejp.70272","DOIUrl":"10.1002/ejp.70272","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;Chronic low back pain (CLBP) remains the leading cause of disability worldwide, yet lumbar structural abnormalities seldom account for reported symptoms. Prior neuroimaging studies often report reduced cerebral grey matter density (GMD) in CLBP but typically include patients with moderate-to-severe pain who are taking centrally acting medications, both of which can independently influence brain structure.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods and Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This longitudinal observational cohort study assessed GMD in mostly mild-to-moderate CLBP individuals not using centrally acting medications. High-resolution T1-weighted MRI scans were acquired over three timepoints (baseline, 2 months, and 4 months) from 27 CLBP participants and 25 matched healthy controls. Voxel-based morphometry revealed significantly increased GMD in CLBP participants in the right middle frontal and temporal gyri, and left orbitofrontal cortex. Additionally, GMD in regions including the right inferior parietal lobule (rIPL) showed an inverse correlation with global pain severity across all timepoints (&lt;i&gt;r&lt;/i&gt; up to −0.72, &lt;i&gt;p&lt;/i&gt; &lt; 0.0001). Participants with longer pain duration (≥ 5 years) showed lower GMD in the rIPL and reported greater symptom severity, independent of age.&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;Brain structural alterations may be present even in mild, unmedicated CLBP and may vary depending on pain duration and intensity. Structural variation in the rIPL was consistently associated with pain severity, suggesting that this region may contribute to inter-individual differences in symptom burden. Given the correlational nature of these findings, future well-controlled longitudinal studies spanning the full spectrum of chronic low back pain severity and treatment exposure are warranted to clarify the temporal dynamics and clinical relevance of these structural differences.&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 demonstrates that individuals with mild, unmedicated chronic low back pain show increased grey matter density in frontal and temporal regions and a robust inverse association between pain severity and parietal grey matter. By identifying the right inferior parietal lobule as a neural marker linked to symptom intensity, these findings refine our understanding of pain-related brain plasticity, highlight structural correlates present even in less severe clinical populations, and suggest novel targets for early intervention strategies in chronic pain.&lt;/p&gt;\u0000 ","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"30 4","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13059071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632665","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}