European Journal of Pain最新文献

{"title":"A Significant Decline in the Number of Newly Dispensed Analgesics During the First COVID-19 Lockdown in The Netherlands","authors":"Maureen N. Zijlstra,&nbsp;Pantea Kiani,&nbsp;Pauline A. Hendriksen,&nbsp;Dana M. Dijkgraaf,&nbsp;Johan Garssen,&nbsp;Joris C. Verster","doi":"10.1002/ejp.70139","DOIUrl":"10.1002/ejp.70139","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The COVID-19 pandemic disrupted healthcare systems worldwide, including the postponement of non-urgent care and reallocation of resources toward COVID-19 patients. The aim of this study was to assess the impact of the first Dutch COVID-19 lockdown on the initiation of new analgesic prescriptions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study analysed dispensing data from 1890 Dutch pharmacies, covering approximately 96% of the population (5.46 million patients). The number of first-time prescription analgesics dispensed (ATC2 N02 class, e.g., opioids, anilides) was compared between the first halves of 2019 and 2020. First-time users were defined as patients who had not received the drug in the preceding year. Data were stratified by age group (children, adolescents, adults, elderly), sex and time periods: weeks 1–11 (pre-lockdown 2020), 12–19 (lockdown) and 20–26 (post-lockdown).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The total number of first-time dispensed analgesic drugs was significantly lower in 2020 (367,094) than in 2019 (388,973, <i>p</i> = 0.021), with a notable reduction occurring during the lockdown period (<i>p</i> = 0.003). Significant declines in first-time dispensed analgesic drugs were observed among adolescents and adults during lockdown (<i>p</i> &lt; 0.001), particularly among females. In contrast, no significant changes were found among children and the elderly. The number of first-time dispensed analgesic drugs during the pre- and post-lockdown periods was comparable between the 2 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Delayed healthcare during the lockdown was associated with a decrease in first-time dispensed analgesic drugs, especially among adolescents and adults. This may indicate untreated pain or increased reliance on over-the-counter alternatives during this period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This Nationwide Dutch study showed a significant decline in first-time dispensed analgesic drugs during the first lockdown period of the COVID-19 pandemic, especially among adolescents and adults. This may indicate untreated pain due to delayed healthcare or an increased reliance on over-the-counter alternatives during this period.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12485296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198824","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":"Multifactorial Machine Learning Algorithm Integration of Pain Mechanisms Can Predict the Efficacy of 3-Week NSAID Plus Paracetamol in Patients With Painful Knee Osteoarthritis","authors":"Rocco Giordano,&nbsp;Lars Arendt-Nielsen,&nbsp;Emma Hertel,&nbsp;Anne Estrup Olesen,&nbsp;Kristian Kjær-Staal Petersen","doi":"10.1002/ejp.70140","DOIUrl":"10.1002/ejp.70140","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Studies demonstrate that pain sensitization, epigenetic mechanisms, inflammation, and psychological factors might be predictive of treatment outcomes. Anti-inflammatory therapy is recommended, but efficacy varies among patients. This study aimed to utilise machine learning to predict the analgesic responses of 3-week NSAID plus paracetamol therapy using pre-treatment assessments of pain sensitivity, inflammation, microRNA, and psychological factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients (<i>n</i> = 101) underwent 3-week combined NSAID plus paracetamol therapy. Pain sensitivity using cuff algometry, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, EQ-5D-3L scale, and blood samples were collected before therapy. Pain relief was assessed by the Knee Injury and Osteoarthritis Outcome Score pain subscale, before and after therapy. Inflammatory biomarkers were analysed using Olink, and microRNA using Next-Generation RNA Sequencing. Data Integration Analysis for Biomarker discovery using Latent cOmponents (DIABLO) was utilised to integrate the pre-treatment data and explain the analgesic effect.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>DIABLO model identified 30 significant variables across the 4 domains. After cross-validation, model performance showed an area under the precision-recall curve of 85%, sensitivity of 83%, specificity of 87%, and balanced accuracy of 85%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study utilises a machine learning algorithm, based on pain sensitization, epigenetics, inflammatory response, and psychological factors, to predict analgesic response in osteoarthritis patients. The study demonstrates that incorporating multiple factors into a model enhances its performance, enabling the identification of patients who will benefit from therapy, advancing personalised pain management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>In this study, a machine learning algorithm, based on pain sensitization, epigenetic mechanisms, inflammatory response, and psychological factors, predicts analgesic response in osteoarthritis patients with 84% accuracy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT02967744</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12478294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185124","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":"Chronic Pain and Labour Market Affiliation: Effect of Demographic Factors and Comorbidities 5 Years Before and 2 Years After Multidisciplinary Treatment","authors":"Lea Stevnsborg,&nbsp;Magnus Pedersen,&nbsp;Lilli Kirkeskov,&nbsp;Per Føge Jensen,&nbsp;Merete Osler","doi":"10.1002/ejp.70135","DOIUrl":"https://doi.org/10.1002/ejp.70135","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study investigates the association of sociodemographic factors and comorbidities with labour market affiliation among patients with non-malignant chronic pain treated at multidisciplinary pain centres in Denmark.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This registry-based cohort study used data from the nationwide Danish Civil Registration System and Danish National Patient Registry. Patients treated at multidisciplinary pain centres in 2013–2017 were included. Labour market affiliation was assessed 5 years before and 2 years after treatment and at treatment initiation (baseline). Sequence and logistic regression analyses were used to identify associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>2375 patients (median age 47 years, female 64%, comorbidity: Mean Charlson's comorbidity score: 0.88, affective disorder: 45%, anxiety disorder: 37.0%, personality disorder: 7.8%) were included. At treatment initiation, only 34.2% of patients were employed, compared to 58.6% 5 years before treatment. Sequence analysis revealed that most patients remained in or transitioned to a ‘no labour market affiliation’ state. Factors significantly associated with labour market affiliation across timepoints included age (adjusted odd ratio [aOR] and 95% confidence interval [CI]_{age 56–65} = 0.51 [0.38–0.69]), marital status (aOR_cohabitant = 1.58 [1.30–1.92]), education level (aOR_high = 4.56 [3.51–5.93]), immigrant status (aOR_non-western = 0.35 [0.26–0.45]) and psychiatric comorbidities (aOR_{affective disorders} = 0.67 [0.56–0.87]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with high-impact, treatment-resistant chronic pain face early labour market detachment, highlighting the need for timely, equitable interventions to support employment, especially among vulnerable groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>The study offers new evidence on how socioeconomic and psychiatric comorbid vulnerabilities shape long-term labour market affiliation before relevant multidisciplinary treatment is initiated and suggests that key intervention opportunities for at-risk patients may be missed under current practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70135","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145146732","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":"The Identification of Pain Phenotypes in Individuals With Low Back Pain in Response to Dynamic Resistance Exercise","authors":"Kaitlyn M. Lyons,&nbsp;Jeffrey R. Stout,&nbsp;Matt S. Stock,&nbsp;William J. Hanney,&nbsp;Abigail W. Anderson","doi":"10.1002/ejp.70136","DOIUrl":"https://doi.org/10.1002/ejp.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Exercise-induced hypoalgesia (EIH) describes an acute reduction in pain following exercise. Individuals with low back pain (LBP) demonstrate variable EIH responses, such as increased pain sensitivity (hyperalgesia). Pain phenotyping, classifying individuals with pain sensitivity and psychological characteristics, may explain this variability. LBP phenotypes were classified using pain sensitivity, psychological variables, and EIH response to dynamic resistance exercise.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this observational cohort study, 78 individuals with LBP (mean age = 21.7 ± 2.6 years, 59% female) completed clinical pain ratings (Numeric Pain Rating Scale [NPRS]), temporal summation (TS), conditioned pain modulation (CPM), psychological questionnaires (Fear-Avoidance Beliefs Questionnaire-Physical Activity subscale [FABQ-PA]), and a 45-degree Roman chair back extension exercise. Pressure pain threshold (PPT) pre- and post-exercise determined EIH. Ward's hierarchical cluster analysis was performed with five variables (NPRS, TS, CPM, FABQ-PA, EIH). One-way ANOVA examined differences in demographic, clinical, and psychosocial factors by cluster.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three distinct clusters emerged: (1) efficient pain modulation with low fear-avoidance and high EIH (<i>n</i> = 40); (2) impaired pain modulation with moderate fear-avoidance and hyperalgesia (<i>n</i> = 19); (3) moderate pain modulation with high fear-avoidance and moderate EIH (<i>n</i> = 19). Clusters differed significantly by age (<i>p</i> = 0.02, <i>η</i>_<i>p</i>² = 0.098), disability (<i>p</i> = 0.004, <i>η</i>_<i>p</i>² = 0.138), psychosocial burden (<i>p</i> = 0.03, <i>η</i>_<i>p</i>² = 0.086), and pain catastrophizing (<i>p</i> = 0.03, <i>η</i>_<i>p</i>² = 0.09).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Individuals with LBP exhibit heterogeneous pain phenotypes. Psychological factors may diminish EIH, and impaired modulation may produce hyperalgesia post-exercise. Identifying pain phenotypes may enhance personalised rehabilitation strategies, optimising interventions for LBP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>This study provides novel evidence that biopsychosocial phenotypes influence pain responses to resistance exercise, offering a potential pathway to personalised rehabilitation for LBP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145146731","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":"Altered Topology of Brain Structural Network in Patients With Migraine Without Aura: A Structural MRI Study","authors":"Zi-Min Cao,&nbsp;Jing-Nan Jia,&nbsp;Guo-Yun Liu,&nbsp;Ze-Qiu Yang,&nbsp;Jing-Shi Zhang,&nbsp;An-qi Shi,&nbsp;Yi-Chao Chen,&nbsp;Jian-Wei Huo,&nbsp;Ya-Nan Zhang,&nbsp;Ni Liu,&nbsp;Chao-Qun Yan,&nbsp;Jun Wang","doi":"10.1002/ejp.70129","DOIUrl":"10.1002/ejp.70129","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Migraine is a neurovascular disease associated with significant morbidity and disability, but its underlying pathophysiology remains elusive. Functional alterations within the brain are frequently observed in individuals with migraine, whereas structural changes are less frequently documented. This study was primarily designed to investigate topological abnormalities in brain structural networks in patients with migraine using structural magnetic resonance imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Graph theoretical analysis was used to compare global and regional topological properties of grey matter structural networks in 37 migraine patients and 44 age-, gender-, and education-matched healthy controls. Structural correlation networks were constructed for both groups on the basis of measurements of grey matter volume.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A statistically significant difference was observed in the scores of Self-rating Anxiety Scales (SAS) and Self-rating Depression Scales (SDS) between migraine patients and healthy controls. The brain networks of patients exhibited significantly increased path length, decreased clustering coefficient, and small-worldness at the global level. At the regional level, brain regions with changes in node degree/betweenness centrality in migraine patients were predominantly located in the left cuneus, the left fusiform gyrus, the left precuneus, the right precentral gyrus, the right middle frontal gyrus, and the bilateral lingual gyrus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings of this research indicate that the topological organisation is less efficient in individuals who experience migraine. This may provide new insight into the pathogenesis of migraine from a structural perspective.</p>\u0000 \u0000 <p><b>Trial Registration:</b> Chinese Clinical Trial Registry, ChiCTR2000033995</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>The present study addresses the central pathogenesis of migraine and shows at a structural level that global brain properties are altered in migraine patients and that regional properties of specific brain regions also show abnormalities. This provides new ideas and an objective basis for the future diagnosis and treatment of migraine.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136981","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":"Performance-Related Pain Among Professional Orchestra Musicians—The First Portuguese Nationwide Study (POMPS)","authors":"A. Zão,&nbsp;E. Altennmüller,&nbsp;L. Azevedo","doi":"10.1002/ejp.70124","DOIUrl":"10.1002/ejp.70124","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;Pain is a major health problem among musicians. However, data concerning pain in a nationwide perspective are scarce, particularly among Portuguese musicians. Therefore, we aim to evaluate performance-related pain among professional orchestra musicians throughout a nationwide characterisation of all Portuguese orchestras.&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;We performed a multicenter cross-sectional study involving all Portuguese professional orchestras, which included 432 musicians (response rate of 72.1%). The main outcome was performance-related pain (evaluated by the Performance-related Pain among Musicians Questionnaire—PPAM). The secondary outcomes were: pain approach, physical activity levels, fatigue, distress, perfectionism, and health-related quality of life. We calculated the prevalence of PRP and performed a descriptive analysis of the main characteristics of our sample (distinguishing musicians with and without PRP) and of PRP, fatigue, distress, perfectionism, and health-related quality of life among musicians with pain, comparing full-time and partial-time musicians.&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;The lifetime and point prevalence of performance-related pain were 71.8% and 33.3%, respectively. Pain intensity score was 14.9 (out of 40), pain interference in general activities was 21.8 (out of 70) and pain interference in performance was even higher (28.3 out of 50). Pain intensity and interference, fatigue, and perfectionism were higher, and quality of life was lower among full-time musicians. Pain was significantly more prevalent among full-time musicians, string instrumentalists, older and more sedentary musicians, with longer careers, and those who play more hours per week. Multivariate logistic regression defined a model containing five factors significantly associated with higher probability of performance-related pain.&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;We highlight the high prevalence of pain and the significant negative impact of pain on performance and quality of life.&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 first Portuguese nationwide study demonstrated that pain is a highly disabling condition among professional orchestra musicians, particularly among full-time musicians, supporting the integration of healthcare professionals in the professional orchestra framework for a closed follow-up, early assessment and treatment,","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70124","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136966","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":"Patient Subgroups and Predictors of Improvement in Chronic Neuropathic Pain: A Trajectory-Based Analysis","authors":"Xavier Moisset,&nbsp;M. Gabrielle Pagé,&nbsp;Bruno Pereira,&nbsp;Manon Choinière","doi":"10.1002/ejp.70137","DOIUrl":"10.1002/ejp.70137","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;There is limited real-world evidence on predictive factors for good outcomes in patients with chronic neuropathic pain (NP) treated in multidisciplinary tertiary care centres. This study aimed to identify subgroups of NP patients with similar pain trajectories and evaluate associated factors.&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;We analysed data from 912 patients with chronic NP (age: 53.6 ± 13.3 years; 51.5% female) enrolled in the Quebec Pain Registry, all of whom reported a baseline pain intensity of ≥ 4/10. Patients completed standardised questionnaires prior to treatment initiation, as well as at 6 and 12 months. Pain trajectories were identified using group-based trajectory modelling (GBTM), with multiple imputation performed to address missing data. The results were confirmed using group-mixture modelling on the non-imputed dataset and using GBTM in the subgroup of patients with complete data.&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 three-class trajectory model best fitted the data for both pain intensity and interference. Only 23.1% of patients showed a clear improvement in pain intensity, while 23.5% showed improvement in pain interference. Key predictors of pain intensity improvement included lower baseline pain intensity and interference. Improvement in pain interference was associated with lower baseline interference and depression scores, as well as shorter pain duration. Notably, receiving a strong opioid significantly increased the risk (RR = 1.45 [1.17; 1.78]) of belonging to the persisting severe pain trajectory.&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;A minority of chronic NP patients demonstrated significant improvement with multidisciplinary treatment. These findings highlight the limitations of current management strategies and emphasise the need for novel therapeutic approaches to address the burden of chronic NP effectively.&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 highlights the value of trajectory analysis in identifying subgroups of patients with chronic neuropathic pain (NP) who exhibit different patterns of treatment response. Only a minority of patients—approximately 23% for both pain intensity and pain interference—demonstrated meaningful improvement. Lower baseline pain intensity and interference emerged as key predictors of better outcomes, while strong opioid use was associated with persistent severe pain. These findings undersco","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130445","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":"Mirogabalin for Treatment of Neuropathic Pain and Associated Sleep Interference: An Updated Meta-Analysis","authors":"Rafael Batista João,&nbsp;Jilly Octoria Tagore Chan,&nbsp;André Batista João,&nbsp;Luísa Mendes Araújo,&nbsp;Julyana Medeiros Dantas","doi":"10.1002/ejp.70112","DOIUrl":"10.1002/ejp.70112","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;Neuropathic pain (NeP) is a common and debilitating consequence of several neurological conditions. Gabapentinoids are used on a large scale for the treatment of both central and peripheral NeP. Mirogabalin, a novel gabapentinoid, has been proposed as a promising treatment for this condition; however, its efficacy and safety profile still need to be determined in clinical practice. In this systematic review and meta-analysis, we assessed the efficacy on pain intensity reduction, effects on sleep interference by pain, and safety of mirogabalin compared with placebo in patients affected by NeP.&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;We searched PubMed, Cochrane Library, Embase, Web of Science, and ClinicalTrials.gov databases for randomised controlled trials (RCTs) comparing mirogabalin with placebo in patients experiencing central or peripheral NeP. We computed mean differences (MD) and pooled risk ratios (RR) for continuous and binary outcomes, respectively, with 95% confidence intervals (CI). Pain was measured on a 0 to 10 numerical rating scale.&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;We included 6 RCTs involving 3048 patients. The mean age was 60.6 years, and 64.7% were male. When compared with placebo, patients treated with mirogabalin had a significant decrease in average daily pain (MD −0.60; 95% CI −0.75 to −0.45; &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and in pain-related sleep interference scores (MD −0.66; 95% CI −0.81 to −0.51; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). The mirogabalin group showed a higher rate of substantial pain relief (≥ 50%) compared with the placebo group (RR 1.27; 95% CI 1.10 to 1.46; &lt;i&gt;p&lt;/i&gt; = 0.001). Nonetheless, treatment with mirogabalin increased the risk of weight gain, peripheral oedema, somnolence and dizziness.&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;In this meta-analysis of RCTs evaluating patients with central and peripheral NeP, mirogabalin significantly improved pain and decreased sleep interference by pain, as compared with placebo; however, there was an increased risk of adverse events.&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 meta-analysis refines the current understanding of mirogabalin by demonstrating modest yet consistent benefits in reducing pain and pain-related sleep interference across neuropathic pain syndromes. The results contribute to ongoing efforts to optimise neuropathic pain management and provide more robust e","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085616","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":"Individual-Level Effects of a Digital Behavioural Treatment for Chronic Pain: Proof-of-Concept of a Single-Case Experimental Design Study","authors":"Haya Al Sharaa,&nbsp;Sara Laureen Bartels,&nbsp;Afra S. Taygar,&nbsp;Linnéa Engman,&nbsp;Suzanne Petersson,&nbsp;Ida Flink,&nbsp;Katja Boersma,&nbsp;Lance M. McCracken,&nbsp;Laura Simons,&nbsp;Johan W. S. Vlaeyen,&nbsp;Patrick Onghena,&nbsp;Rikard K. Wicksell","doi":"10.1002/ejp.70128","DOIUrl":"10.1002/ejp.70128","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 pain affects 20%–30% of the population worldwide, leading to significant distress, disability and financial burden. Pain management strategies focusing on pain reduction have shown limited effects on functioning; however, behavioural treatments aimed at enhancing resilience have demonstrated strong empirical support. Digital solutions offer new opportunities for delivering evidence-based treatments, but evaluation at the individual level is needed. The aim of this study is to examine individual-level treatment effects of a digital behavioural treatment for chronic pain in a heterogeneous sample.&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;A study with a single-case experimental design (SCED) was conducted with participants (&lt;i&gt;N&lt;/i&gt; = 11) experiencing chronic pain (&gt; 3 months) recruited through healthcare. Participants were randomised at baseline (5–10-day A-phase) and completed a 6-module digital treatment based on learning theory and well-established theories applied to chronic pain (6–8-week B-phase), with weekly therapist contact. Digital diaries, prompted twice daily, tracked psychological flexibility and acceptance, pain-related functioning, pain intensity and well-being. Data were analysed using visual analysis and effect size calculations.&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;&lt;i&gt;N&lt;/i&gt; = 11 enrolled and data from &lt;i&gt;n&lt;/i&gt; = 10 were analysed (&lt;i&gt;n&lt;/i&gt; = 1 refused digital diary, &lt;i&gt;n&lt;/i&gt; = 2 partial completers, &lt;i&gt;n&lt;/i&gt; = 8 full completers). Pain profiles varied (e.g., chronic migraine, fibromyalgia, lower back pain, etc.). Several participants benefited from the treatment, though results varied across individuals and across outcomes.&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;The digital behavioural treatment showed promise in addressing diverse pain profiles and associated functioning. The variability in responses highlights the benefit of using SCED to explore individual-level effects, thus offering a methodological proof-of-concept. Findings support further development, including tailoring to match individual needs.&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 proof-of-concept study provides support for the utility of digital behavioural interventions and individual-level evaluation of treatment effects, highlighting the potential of personalised pain treatments. The findings contribute to the growing body of support for digital solutions as effective ","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079980","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":"Differences Among Veterans With Chronic Overlapping Pain Conditions and Other Chronic Pain: Baseline Results From the LAMP Pain Management Trial","authors":"Jenna L. Adamowicz,&nbsp;Alexis Grant,&nbsp;Collin Calvert,&nbsp;Daniel Elchert,&nbsp;Katherine Hadlandsmyth,&nbsp;Mary A. Driscoll,&nbsp;Stephanie L. Taylor,&nbsp;Kelli Allen,&nbsp;Brent C. Taylor,&nbsp;Diana J. Burgess","doi":"10.1002/ejp.70125","DOIUrl":"https://doi.org/10.1002/ejp.70125","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic overlapping pain conditions (COPCs) are a constellation of disorders posited to share an underlying pain mechanism (nociplastic pain). Unfortunately, individuals with COPCs are under-represented in clinical research. The current study aimed to determine COPC prevalence among participants enrolled in a pragmatic clinical trial and compare those with COPCs to those with non-COPCs across several domains.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Learning to Apply Mindfulness to Pain (LAMP) study baseline data of veterans with chronic pain (<i>N</i> = 811) were utilised. COPC diagnoses were determined using ICD-10 codes within electronic health records. Group differences across pain and functioning-related domains were compared with and without adjustment for age and gender.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among participants with COPCs (54%), most were diagnosed with only one COPC (74%). Chronic lower back pain (71%) and migraine (28%) were the most common. Participants with COPCs were younger and more likely to be female relative to those with non-COPCs. The COPC subset was also more likely to be diagnosed with PTSD, depressive disorders and sleep disorders (<i>p</i> &lt; 0.05). Those with COPCs also reported greater pain severity and interference, more impaired health-related quality of life, greater pain catastrophising and lower pain self-efficacy than participants without COPCs (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>COPCs were common among a sample of veterans in a pragmatic clinical trial. Several baseline differences emerged indicating veterans with COPCs experience greater mental health concerns and endorse distinct pain characteristics and pain mediators. Future research is needed to further characterise this recently defined and under-represented group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Individuals with COPCs are medically complex, yet are understudied and underrepresented within pain trials research. COPCs, which predominantly impact women, are also understudied within U.S. veterans. Our findings highlight how veterans with COPCs are participating in clinical research even when interventions are not tailored to their unique characteristics. Our work also contributes to a nuanced understanding of this disease burden and is among the first to describe differences among veterans with COPCs and veterans with chronic pain but without COPCs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 9","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145062426","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}