European Journal of Pain最新文献

{"title":"Lifestyle Behaviours and Future Healthcare Utilisation for Musculoskeletal Pain in Young Adults: A Cohort Study of Norwegian University Students With Three-Year Follow-Up","authors":"Kaja Smedbråten, Margreth Grotle, Milada Hagen, Børge Sivertsen, Henriette Jahre, Kåre Rønn Richardsen, George Peat, Eva Skillgate, Britt Elin Øiestad","doi":"10.1002/ejp.70087","DOIUrl":"https://doi.org/10.1002/ejp.70087","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>It is unclear whether lifestyle behaviours influence use of healthcare for musculoskeletal pain in young adults. This study examined if lifestyle behaviours among college/university students were associated with future healthcare utilisation for musculoskeletal pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from the Students' Health and Wellbeing Study (SHoT2018) were linked with the Norwegian Registry for Primary Health Care, comprising 31,358 college/university students. We analysed associations of physical activity level, sleep duration, alcohol consumption, smoking, illicit drug use and cumulative adverse lifestyle behaviours with healthcare utilisation for musculoskeletal pain over the following three years, including ‘any use’, ‘high use’ and for back and neck pain specifically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>High physical activity levels, compared to recommended levels, were associated with a higher risk of ‘any’ healthcare utilisation for musculoskeletal pain (females: RR 1.14, 99% CI [1.04–1.25]; males: RR 1.20, 99% CI [1.07–1.36]); below recommended physical activity levels were associated with a lower risk (females: RR 0.90, 99% CI [0.85–0.96]; males: RR 0.84, 99% CI [0.76–0.93]). Illicit drug use was associated with a lower risk of healthcare utilisation for neck pain in females (RR 0.77, 99% CI [0.62–0.97]). Four or more adverse lifestyle behaviours, compared to ≤ 1, were associated with a lower risk of high healthcare utilisation for musculoskeletal pain (females: RR 0.66, 99% CI [0.48–0.90]; males: RR 0.68, 99% CI [0.48–0.97]) and a lower risk of healthcare utilisation for neck pain in females (RR 0.63, 99% CI [0.41–0.97]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Associations between college/university students' lifestyle behaviours and healthcare utilisation for musculoskeletal pain were identified, but with some unexpected patterns. Future research should explore long-term effects of these behaviours on healthcare utilisation for musculoskeletal pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>High levels of physical activity among college and university students were associated with a greater risk of seeking healthcare for musculoskeletal pain within the following three years. Illicit drug use was associated with a lower risk of seeking healthcare for neck pain in females. Surprisingly, the presence of many adverse lifestyle behaviours appeared to be associated with a lower risk of healthcare utilisation for musculoskeletal pain, particularly healthcar","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 8","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144725390","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":"Healthcare Use and Non-Recovery in Patients With Spinal Disorders","authors":"Lise Grethe Kjønø,&nbsp;Marianne Bakke Johnsen,&nbsp;Margreth Grotle,&nbsp;Jan Hartvigsen,&nbsp;Stine Clausen,&nbsp;Maja Wilhelmsen,&nbsp;Kåre Rønn Richardsen,&nbsp;Kjersti Storheim,&nbsp;Karin Magnusson","doi":"10.1002/ejp.70074","DOIUrl":"https://doi.org/10.1002/ejp.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The association between different patterns of healthcare use and non-recovery in patients with spinal disorders is unclear. We aimed to assess the association between healthcare use and non-recovery 6 months after a specialist evaluation in Norwegian secondary care and whether non-recovery was linked to adherence to specialist-recommended care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This observational registry-based cohort study includes 3745 patients aged 18–70 years (mean (SD) 46 (12) years, 59% women) from the Norwegian Neck and Back Registry (NNRR). We studied non-recovery 6 months after the specialist evaluation using the Global Perceived Effect (GPE) scale, defined as ‘slightly improved’, ‘unchanged’, ‘slightly worse’, ‘much worse’, or ‘worse than ever’. Using logistic regression, we examined the association between non-recovery and specialist-recommended healthcare (i.e., recommended follow-up in primary or secondary care) and actual healthcare use identified in national registries (visits to general practitioners, physical therapists, and chiropractors in primary care and outpatient and inpatient visits in secondary care).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 80% self-reported non-recovery at 6 months. Adherence to specialist-recommended healthcare was not associated with non-recovery (adjusted OR [aOR] 1.09, 95% CI 0.91–1.29). Highest odds for non-recovery were among patients using primary care alone (aOR 1.68, 95% CI 1.37–2.07) or no healthcare (aOR 1.81, 95% CI 1.44–2.27). Secondary care alone (aOR 0.75, 95% CI 0.59–0.96) or combined with primary care (aOR 0.49, 95% CI 0.41–0.59) was associated with recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings raise questions about the value of the specialist recommendations and also the content of healthcare services provided after a specialist evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Our findings suggest that follow-up after specialist evaluation may not adequately meet patient needs, indicating a need for improved management of spinal disorders. Given the low proportion of patients reporting recovery at 6-month follow-up, we highlight the importance of good transitions, care coordination, and coherent messages across sectors and professions. More effective healthcare and reduced sick leave could save societal costs. Moreover, this approach could improve quality of life, enabling a more active and participatory lifestyle.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144716888","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":"Influence of Social Support on Peri-Operative Pain: A Secondary Sub-Sample Analysis of a Prospective Observational Trial","authors":"Philipp Wenzel,&nbsp;Marthe Gründahl,&nbsp;Monika Fischer,&nbsp;Grit Hein,&nbsp;Fabian Fuchtmann,&nbsp;Kathrin Schnabel,&nbsp;Daniela C. Rosenberger,&nbsp;Esther M. Pogatzki-Zahn,&nbsp;Heike L. Rittner,&nbsp;Karolin Teichmüller","doi":"10.1002/ejp.70094","DOIUrl":"https://doi.org/10.1002/ejp.70094","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;Research on the role of social support in the context of acute pain is lacking, although a possible correlation between social support and acute pain might imply consequences for clinical practice. We expected perceived social support to predict the intensity of acute postsurgical pain and the dose of opioids given.&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;Within a multicentre prospective observational study, &lt;i&gt;n&lt;/i&gt; = 217 adult patients undergoing major surgery were recruited at the University Hospital of Würzburg with an additional questionnaire for assessing perceived social support using the Multidimensional Scale of Perceived Social Support (MSPSS). We also measured pre-operative pain, opioid intake and psychological factors, such as depressiveness or pain catastrophising. Main outcomes were pain intensities at rest and at movement, and morphine equivalent on Day 1 and Day 7 after surgery.&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;Perceived social support was higher in general than expected from previous studies and depended on marital status. Certain socio-demographic characteristics, pre-operative chronic pain and depressive symptoms also correlated with perceived social support. Using multiple linear regression, we could confirm known risk factors for high intensity acute postsurgical pain, for example, younger age and pre-operative pain. Perceived social support, however, was not a significant predictor of neither postsurgical pain intensity nor postsurgical opioid requirements.&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;Perceived social support measured by MSPSS does not add to the prediction of acute postsurgical pain in our study. Acute pain might be influenced more strongly by biological and psychological factors than social factors. More fine-grained measures might be necessary to record, for example, daily social support.&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;Although social interactions are known to influence pain perception, studies on the role of social support on post-operative acute pain are lacking. In a broad spectrum of surgeries, we found that perceived social support was positively related to pre-operative health measures, for example, lower average pain intensity over the past 3 months or lower morphine equivalent and opioid intake before surgery. Perceived social support, however, was not a significant predictor of neither postsurgical pain intensity no","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144714933","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":"EXPRESSION OF CONCERN: Group-Based Task-Oriented Exercises Aimed at Managing Kinesiophobia Improved Disability in Chronic Low Back Pain","authors":"","doi":"10.1002/ejp.70089","DOIUrl":"https://doi.org/10.1002/ejp.70089","url":null,"abstract":"<p><b>EXPRESSION OF CONCERN</b>: M. Monticone, E. Ambrosini, B. Rocca, D. Cazzaniga, V. Liquori, and C. Foti, “Group-Based Task-Oriented Exercises Aimed at Managing Kinesiophobia Improved Disability in Chronic Low Back Pain,” <i>European Journal of Pain</i> 20, no. 4 (2016): 541–551, https://doi.org/10.1002/ejp.756.</p><p>This Expression of Concern is for the above article, published online on 22 July 2015 in Wiley Online Library (wileyonlinelibrary.com), and has been issued by agreement between the journal Editor-in-Chief, Didier Bouhassira; the European Pain Federation; and John Wiley &amp; Sons Ltd.</p><p>The Expression of Concern has been agreed due to the apparent statistical implausibility of the effect sizes reported in this article and in other articles by the same author group [<span>1-3</span>]. These were brought to our attention by third parties and raise concerns regarding the reliability of the data. The authors provided an explanation and some original data during an investigation; however, the editorial office found that this was not sufficient to conclusively address the concerns. The original patient case report forms were no longer available due to the age of the paper. Therefore, the journal has decided to issue an Expression of Concern to inform and alert the readers.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695931","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":"Sleep Quality and Cognitive Performance in Chronic Primary Musculoskeletal Pain: An Observational Study With Healthy Controls","authors":"Alejandro Arévalo-Martínez,&nbsp;Carlos Barbosa-Torres,&nbsp;María Elena García-Baamonde,&nbsp;César Luis Díaz-Muñoz,&nbsp;Juan Manuel Moreno-Manso","doi":"10.1002/ejp.70085","DOIUrl":"https://doi.org/10.1002/ejp.70085","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 primary musculoskeletal pain (CPMP) is a recently defined diagnosis characterised by persistent pain accompanied by emotional distress and/or functional disability. Although sleep disturbances and cognitive complaints are common in individuals with chronic pain, few studies have examined their relationship in CPMP, a condition that remains underexplored. This study aimed to examine whether cognitive functioning in individuals with CPMP is affected by sleep quality, exploring its potential contribution across cognitive domains to the neuropsychological profile of this condition.&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 study included 60 adults, of whom 30 were diagnosed with CPMP and 30 were healthy controls. Participants completed the Numeric Pain Rating Scale, the Symptom Checklist-90-Revised and the Pittsburgh Sleep Quality Index, followed by a standardised neuropsychological assessment consisting of the Stroop test, the TESEN, the Rings Test and the Working Memory Index from the Wechsler Adult Intelligence 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;Patients with chronic pain exhibited mild cognitive impairment in selective and sustained attention, processing speed, working memory, planning, problem solving, inhibition and resistance to interference. Poorer sleep quality was independently associated with greater cognitive impairment, particularly in sustained attention, processing speed and working memory. Sleep quality significantly predicted performance in these cognitive domains, beyond the influence of sociodemographic factors, pain intensity and psychological distress.&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;This study contributes to characterising the neuropsychological profile of individuals with CPMP and highlights the role of sleep quality in cognitive functioning. These findings may help inform interventions aimed at improving executive performance in chronic pain populations.&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 contributes to a deeper understanding of the cognitive difficulties experienced by individuals with chronic primary musculoskeletal pain, a recently defined diagnosis in the 11th revision of the International Classification of Diseases. It highlights the importance of sleep quality as a predictor of cognitive performance—particularly in attention, processing speed and working memory—independently of p","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688267","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":"Differential Effects of Repetitive Transcranial Magnetic Stimulation on Mood and Pain Symptoms in People With Chronic Pain and Major Depressive Disorders—A Review","authors":"Daniel Ciampi de Andrade,&nbsp;Leandro Valiengo","doi":"10.1002/ejp.70077","DOIUrl":"https://doi.org/10.1002/ejp.70077","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;Chronic pain and major depressive disorder (MDD) are among the most prevalent and disabling conditions globally, often co-occurring and sharing overlapping symptoms such as fatigue, cognitive dysfunction and mood disturbances. While fibromyalgia, a primary pain syndrome, and MDD have distinct clinical manifestations, their comorbidity presents therapeutic challenges. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique, has shown efficacy in treating both pain and mood disorders when targeted at specific brain regions (motor cortex for pain, dorsolateral prefrontal cortex for mood). This review aimed to investigate whether rTMS interventions for fibromyalgia or MDD improve symptoms across both domains, particularly in comorbid cases.&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;A structured search of PubMed was conducted between January and February 2025. Clinical trials were included if they were randomised, peer-reviewed, in English and involved ≥ 30 participants. Studies included addressed rTMS effects on pain in MDD or mood in fibromyalgia, or both. Out of 143 identified articles, 36 met the inclusion criteria.&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;Evidence shows rTMS has target- and symptom-specific effects: Motor cortex stimulation improves pain without reliably affecting mood, while dorsolateral prefrontal cortex stimulation alleviates depressive symptoms but inconsistently influences pain. These outcomes suggest that symptom improvement with rTMS is not global over different symptom clusters, but rather different for specific syndromes and the respective neural networks engaged by therapy. Personalised treatment strategies guided by pre-treatment connectivity profiles and symptom clusters, already in use for psychiatric disorders, could enhance outcomes in chronic pain management. However, limitations include small sample sizes, low session numbers and potential floor effects in studies involving non-depressed fibromyalgia patients.&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;Noninvasive neuromodulation therapy with repetitive transcranial magnetic stimulation for chronic pain improves pain on fibromyalgia and neuropathic pain but does not improve mood symptoms significantly. Therapy targeting mood symptoms in people with major depressive disorder may have antinociceptive effects in experimental pain models but are not clearly detectable in instances of clinical pain. The relationship between a disease and i","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672961","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":"Conditioned Pain Modulation, Placebo and Offset Analgesia: Rates of Behavioural Expression of Inhibitory, Nonresponse and Facilitatory Pain Modulatory Effects","authors":"Lewis S. Crawford,&nbsp;Ashleigh Wake,&nbsp;Rebecca V. Robertson,&nbsp;Allan Peng,&nbsp;Noemi Meylakh,&nbsp;Damien C. Boorman,&nbsp;Leana Sattarov,&nbsp;Alister Ramachandran,&nbsp;Vaughan G. Macefield,&nbsp;Kevin A. Keay,&nbsp;Luke A. Henderson","doi":"10.1002/ejp.70088","DOIUrl":"https://doi.org/10.1002/ejp.70088","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;The brain is capable of powerfully inhibiting perceived pain intensity. Experimentally, three pain modulating phenomena have been well explored: placebo analgesia (PA), offset analgesia (OA) and conditioned pain modulation (CPM). While all three can reduce pain intensity, these paradigms are not often compared behaviourally, nor are their potentially common psychological or physiological mechanisms considered.&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;Here, we present retrospective behavioural pain rating, psychological and demographic data in 273 pain-free control participants who underwent either PA (&lt;i&gt;n&lt;/i&gt; = 100), OA (&lt;i&gt;n&lt;/i&gt; = 37) or CPM (&lt;i&gt;n&lt;/i&gt; = 136). Significant changes in pain intensities were assessed using permutation testing to derive cohorts where pain was significantly inhibited (inhibitory responders), unchanged (nonresponder) or increased (facilitatory responder) during the expression of each phenomenon. Psychological questionnaire scores, demography and pain perception variability were compared between response cohorts to all three phenomena.&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 identified largely similar proportions of individuals categorised as either inhibitory responders, nonresponders or facilitatory responders to each of PA, OA and CPM—with no sex differences identified in any phenomena nor response category. Dispositional optimism and calibrated noxious temperature demonstrated a significant effect in PA and CPM responses, respectively—with inhibitory responders recording higher scores than facilitatory responders in PA, and inhibitory responders possessing lower thermal sensitivity to nonresponders in CPM.&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;A shared mechanism was identified between PA and OA, such that perceived pain variability to repeated identical noxious stimuli related to both phenomena's expression. This warrants further investigation given the suggested neural circuit differences between these two phenomena, and only PA is presently linked with Bayesian theorem.&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;Humans are capable of inhibiting their own pain in several ways; however, the brain systems driving these analgesic mechanisms are complex and are known to diverge despite producing similar outcomes. Here we show core behavioural similarities between different forms of endogenous analgesic phenomena, with differences in psycho","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144671998","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 Role of Peripheral N-Methyl-D-Asparate (NMDA) Receptors in Itch and Pain: A Narrative Review","authors":"Ryusuke Tanaka,&nbsp;Silvia Lo Vecchio,&nbsp;Giulia Erica Aliotta,&nbsp;Lars Arendt-Nielsen","doi":"10.1002/ejp.70082","DOIUrl":"https://doi.org/10.1002/ejp.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>NMDA receptors, predominantly located in the central nervous system and known for their roles in synaptic plasticity and central sensitisation of pain and itch, are also expressed in peripheral sensory neurons. Emerging evidence suggests that peripheral NMDA receptors contribute to pathological pain and potentially itch, identifying them as promising therapeutic targets. The aim of this review is to explore the role of peripheral NMDA receptors in pain and itch and to summarise the effectiveness of topical NMDA antagonists in managing these sensations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Databases and Data Treatment</h3>\u0000 \u0000 <p>This review was conducted through a systematic search of the PubMed database using MeSH terms and keywords related to ‘peripheral NMDA receptors’, ‘pain’, ‘itch’ and ‘topical ketamine’. Additional references were included based on expert knowledge and reference tracking. Only English-language articles were considered.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Animal studies demonstrate that peripheral NMDA receptors are involved in inflammatory and certain neuropathic pain models, with antagonists showing analgesic effects. Limited studies also suggest their role in non-histaminergic itch through glutamate signalling. In humans, topical ketamine has shown mixed results for pain relief, and preliminary clinical reports suggest potential antipruritic effects. However, controlled clinical trials, particularly for itch, are lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Peripheral NMDA receptors are involved in the transmission and sensitisation of both pain and itch, especially under pathological conditions. While topical ketamine may offer therapeutic benefits, particularly for non-histaminergic itch and neuropathic pain, further clinical research is necessary to confirm its efficacy, safety and optimal use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This review highlights the underexplored role of peripheral NMDA receptors in itch, especially non-histaminergic pathways, and synthesises emerging evidence for their therapeutic potential. By comparing pain and itch mechanisms, it suggests that topical ketamine could serve as novel treatments for refractory itch and localised pain, warranting further clinical investigation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666464","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":"Nefopam Misuse: A Cross-Sectional Study in France","authors":"E. Barat,&nbsp;E. Lacroix,&nbsp;A. Gillibert,&nbsp;B. Gerard,&nbsp;P. Brevet,&nbsp;R. Leguillon,&nbsp;S. Pouplin,&nbsp;J. Grosjean,&nbsp;R. Varin","doi":"10.1002/ejp.70083","DOIUrl":"https://doi.org/10.1002/ejp.70083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Nefopam is a non-opioid analgesic. Nefopam is increasingly prescribed in contraindicated populations, raising questions about the appropriate use of nefopam. This study aimed to evaluate nefopam use in France according to age, epilepsy status and socioeconomic status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study was conducted from January 1, 2016, to December 31, 2022. Data on nefopam use in France were retrieved from the national health insurance information system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 2016 and 2022, 51.8 million boxes of nefopam were dispensed to 6.5 million patients, with a mean age of 56 years and a male-to-female sex ratio of 0.6. Nefopam use increased by 121.7%, whereas codeine use and tramadol use decreased by 7% and 17% respectively, raising the market share of nefopam from 5.0% to 11.6%. Nefopam use increased 2.8-fold in patients under 15 years and 1.7-fold in patients over 65 years, after standardisation. Nefopam use increased 1.7-fold in patients with epilepsy and 1.2-fold in patients with a disadvantaged socioeconomic status. The cost of nefopam was 4.3 times higher than alternative drugs. During the period 2016–2022, 8.23% of the general population received 1 to 4 boxes of nefopam per year, 4.68% received 6 to 19 boxes per year, and 0.91% received ≥ 20 boxes per year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study highlights a widespread inappropriate use of nefopam, especially in contraindicated populations and vulnerable groups. The recent availability of the oral form in France may worsen these patterns. Close national and European monitoring is important to assess the extent of such practices and guide future regulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This work is a snapshot of nefopam usage in France. It sheds light on contraindicated uses (in subjects under 15 years of age or with epilepsy), not recommended uses (chronic usage, or in the elderly) and reports the usage of this treatment in the most deprived patients. This article cautions against underestimating the dangers and pitfalls of this treatment, especially in light of mounting evidence of pharmacodependence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666286","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":"Well-Being, Inflammation, and Physical Activity in Acute and Chronic Back Pain: A Cross-Sectional Analysis of 22,864 UK Biobank Participants","authors":"Romina Gollan,&nbsp;Patrick J. Owen,&nbsp;Jamie L. Tait,&nbsp;Luana C. Main","doi":"10.1002/ejp.70079","DOIUrl":"https://doi.org/10.1002/ejp.70079","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;Back pain is influenced by biological, psychological, and social factors, yet is often investigated separately.&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;Cross-sectional analysis of the UK Biobank comparing well-being (Patient Health Questionnaire-4; 4–16 points; higher scores indicate greater levels of depressive and anxiety symptoms), number of stressful life events, C-reactive protein (CRP), and physical activity (International Physical Activity Questionnaire) among pain-free, acute, and chronic back pain individuals. The sample included 22,864 individuals: 5716 with acute back pain, 5716 with chronic back pain, and 11,432 pain-free controls. Group comparisons were performed using network analysis and analysis of covariance, adjusted for socioeconomic deprivation, body mass index, smoking, and alcohol consumption.&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;Well-being was poorer in acute (mean difference [95% CI]: 0.20 [0.14, 0.25] points; &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and chronic back pain (0.39 [0.34, 0.45] points; &lt;i&gt;p&lt;/i&gt; &lt; 0.001) compared to controls. More stressful life events were measured in acute (0.03 [0.01, 0.05] points; &lt;i&gt;p&lt;/i&gt; = 0.041) and chronic back pain (0.03 [0.01, 0.05] points; &lt;i&gt;p&lt;/i&gt; = 0.028) compared to controls. However, this finding was not robust to sensitivity analyses. Elevated CRP was found in acute (2.28 [0.57, 3.99]%; &lt;i&gt;p&lt;/i&gt; = 0.024; ES = very small), but not in chronic back pain, compared to controls. No significant group differences were observed for physical activity. Network structures did not differ between groups.&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;Differences in well-being and CRP among pain-free, acute, and chronic back pain individuals were identified, suggesting that variables may be affected by back pain temporality. Further prospective research incorporating additional variables is needed to explore the drivers of back pain.&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;Individuals with acute back pain showed 2% higher CRP than controls, though values remained within the normal range (&lt; 5 mg/L) across groups and below clinical relevance, suggesting limited utility of CRP in distinguishing acute from chronic back pain. Poorer well-being in both acute and chronic back pain underscores the need to explore underlying causal pathways. Moreover, similar network structures among groups indicate no neuroimmune involvement in back pain o","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666287","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}