European Journal of Pain最新文献

{"title":"Assessing signs of central sensitization: A critical review of physiological measures in experimentally induced secondary hyperalgesia.","authors":"Caterina M Leone, Cedric Lenoir, Emanuel N van den Broeke","doi":"10.1002/ejp.4733","DOIUrl":"10.1002/ejp.4733","url":null,"abstract":"<p><strong>Background and objectives: </strong>Central sensitization (CS) is believed to play a role in many chronic pain conditions. Direct non-invasive recording from single nociceptive neurons is not feasible in humans, complicating CS establishment. This review discusses how secondary hyperalgesia (SHA), considered a manifestation of CS, affects physiological measures in healthy individuals and if these measures could indicate CS. It addresses controversies about heat sensitivity changes, the role of tactile afferents in mechanical hypersensitivity and detecting SHA through electrical stimuli. Additionally, it reviews the potential of neurophysiological measures to indicate CS presence.</p><p><strong>Databases and data treatment: </strong>Four databases, PubMed, ScienceDirect, Scopus and Cochrane Library, were searched using terms linked to 'hyperalgesia'. The search was limited to research articles in English conducted in humans until 2023.</p><p><strong>Results: </strong>Evidence for heat hyperalgesia in the SHA area is sparse and seems to depend on the experimental method used. Minimal or no involvement of tactile afferents in SHA was found. At the spinal level, the threshold of the nociceptive withdrawal reflex (RIII) is consistently reduced during experimentally induced SHA. The RIII area and the spinal somatosensory potential (N13-SEP) amplitude are modulated only with long-lasting nociceptive input. At the brain level, pinprick-evoked potentials within the SHA area are increased.</p><p><strong>Conclusions: </strong>Mechanical pinprick hyperalgesia is the most reliable behavioural readout for SHA, while the RIII threshold is the most sensitive neurophysiological readout. Due to scarce data on reliability, sensitivity and specificity, none of the revised neurophysiological methods is currently suitable for CS identification at the individual level.</p><p><strong>Significance: </strong>Gathering evidence for CS in humans is a crucial research focus, especially with the increasing interest in concepts such as 'central sensitization-like pain' or 'nociplastic pain'. This review clarifies which readouts, among the different behavioural and neurophysiological proxies tested in experimental settings, can be used to infer the presence of CS in humans.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307389","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":"Increased behavioural inhibition and decreased behavioural activation in whiplash-associated disorders: Associations with health outcomes.","authors":"Ashley Smith, Susanne Becker","doi":"10.1002/ejp.4721","DOIUrl":"https://doi.org/10.1002/ejp.4721","url":null,"abstract":"<p><strong>Background: </strong>Motivation can be investigated with the BIS (Behavioural Inhibition System)/BAS (Behavioural Activation System) scale. BAS regulates the motivation to approach goal-oriented outcomes, particularly rewarding stimuli and situations, while BIS regulates escape and avoidance of unpleasant outcomes. Chronic whiplash-associated disorders (WAD) is a heterogenous pain condition with known alterations in motivated behaviour. The study aimed (1) to investigate the relationship between BIS/BAS, and pain and disability with quality of life and psychological measures in chronic WAD; (2) to determine if BIS and/or BAS mediate the relationships between pain, disability, and psychological symptoms and quality of life.</p><p><strong>Methods: </strong>254 chronic WAD patients participated in the study. Outcome measures were assessed using self-report questionnaires. BIS/BAS scores were compared to published normative data. Differences in health outcomes for participants within/outside normative 95% confidence intervals were compared and correlations with health measures tested. Mediation models explored bi-directional associations between stress, anxiety, depression, post-traumatic stress severity, pain catastrophizing, and quality of life with pain and disability.</p><p><strong>Results: </strong>Participants who exceeded normative 95% confidence intervals for BIS demonstrated higher scores for pain interference, disability and all mental health measures. No mediating role of BIS/BAS on the relation between pain and disability with quality of life and health outcomes could be confirmed.</p><p><strong>Conclusions: </strong>A comparatively large proportion of the sample exceeded the 95% confidence interval for BIS and BAS scores with associations of these scores with health outcomes, but altered motivation to approach goal-oriented outcomes appears to play only a subordinate role in chronic WAD.</p><p><strong>Significance statement: </strong>In line with current theories, we found a large proportion (30%-50%) of patients with whiplash-associated disorders (WAD) showing signs of altered function in the Behavioural Inhibition System (BIS) and Behavioural Activation System (BAS) suggesting altered reward processing and motivation in these patients. While such altered functions showed associations with pain interference, disability and all mental health measures, reward processing could no be demonstrated as a pathogenetically relevant factor in chronic WAD patients.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282511","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":"Group dynamics and therapy outcome of multimodal pain therapies: A prospective observational trial.","authors":"Lorenz Leopold Mihatsch, Benjamin Luchting, Nannette Baumann, Isabel Kiesewetter, Hans Peter Richter","doi":"10.1002/ejp.4731","DOIUrl":"https://doi.org/10.1002/ejp.4731","url":null,"abstract":"<p><strong>Background: </strong>For the treatment of chronic pain, interdisciplinary treatment programs are recommended. Despite continuous adaptation and optimization of this cost- and time-intensive and comprehensive form of therapy, it is not successful in some patients. As personality disorders have an important influence on social interaction and behaviour, the aim of our study was to identify the possible impact of patients with personality disorders on group dynamics and to analyse the influence of group dynamics on individual therapy outcomes.</p><p><strong>Methods: </strong>We conducted a prospective observational study in patients with chronic pain (N = 104) who participated in a 5-week interdisciplinary treatment program. The main outcome parameters were psychological state and pain intensity before and after the program.</p><p><strong>Results: </strong>In contrast to our clinical assumption, we found that neither the type nor the number of patients with personality accentuation or personality disorders had a clinically relevant influence on group dynamics and that even a negative group dynamic did not negatively influence the individual therapy outcome.</p><p><strong>Discussion: </strong>This trial analysed the connection between group dynamics and therapy outcome of multimodal pain therapies in chronic pain patients considering the factor of personality disorders. Our data demonstrated that neither the type nor the number of patients with personality disorders had a clinically relevant influence on group dynamics and that even a negative group dynamic did not negatively influence the individual therapy outcome. Hence, clinicians should not be afraid to include patients with personality disorders in their treatment programs.</p><p><strong>Significance statement: </strong>The study emphasizes that clinicians may include patients with personality disorders in multimodal pain treatment programs and groups, provided that the maintenance of a close therapeutic bond with the patient and within the interdisciplinary team is given.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282510","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 burden of chronic pain in transgender and gender diverse populations: Evidence from a large US clinical database.","authors":"Tomasz Tabernacki, David Gilbert, Stephen Rhodes, Kyle Scarberry, Rachel Pope, Megan McNamara, Shubham Gupta, Swagata Banik, Kirtishri Mishra","doi":"10.1002/ejp.4725","DOIUrl":"https://doi.org/10.1002/ejp.4725","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain, affecting approximately 20% of the global population, is the leading cause of disability worldwide. Transgender individuals are disproportionately exposed to chronic pain risk factors compared with the cisgender population. This study compares the incidence of chronic pain between transgender and cisgender individuals and examines the impact of gender affirming hormone therapy, anxiety, and depression on chronic pain.</p><p><strong>Methods: </strong>The study analysed medical records data of 56,470 transgender men and 41,882 transgender women in the TrinetX database. Six cohorts were created: transgender women either receiving oestrogen or no intervention, transgender men receiving testosterone or no intervention and cohorts of cisgender males and females. Unmatched age-adjusted incidence rates were calculated. Then cohorts were matched on 22 chronic pain-associated covariates and the rate of new chronic pain diagnoses was compared between those receiving hormone therapy and those without.</p><p><strong>Results: </strong>We observed significantly higher rates of chronic pain among transgender individuals compared with cisgender counterparts. Transgender men on testosterone therapy and transgender women on oestrogen therapy exhibited an increased likelihood of chronic pain diagnoses compared with those not receiving hormone therapy. Individuals with anxiety and depression were more likely to be diagnosed with chronic pain.</p><p><strong>Conclusion: </strong>This study demonstrates a significant burden of chronic pain in transgender individuals, with an increased risk among those receiving hormone therapy. Our study, the first to assess chronic pain in a large cohort of transgender patients, provides support for a potential association between hormone therapy and risk of chronic pain diagnosis. Further research is required to understand causal mechanisms and to develop improved screening and management of chronic pain in transgender populations.</p><p><strong>Significance statement: </strong>Our study, featuring the largest cohort of Transgender and Gender Diverse (TGD) individuals assembled to date, reveals critical disparities in chronic pain among TGD populations, notably those on hormone therapy, compared with the cisgender population. It highlights the urgent need for specialized screening and treatment for this vulnerable population, and research into hormone therapy's impact on pain. These insights aim to foster more effective, personalized healthcare, enhancing the well-being and quality of life for the TGD community.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282512","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":"Slow depolarizing electrical stimuli reveal differential time courses of nociceptor recovery after prolonged topical capsaicin in human skin","authors":"Divya Tumbala Gutti, Richard Carr, Martin Schmelz, Roman Rukwied","doi":"10.1002/ejp.4726","DOIUrl":"https://doi.org/10.1002/ejp.4726","url":null,"abstract":"BackgroundWe examined de‐functionalization and temporal functional recovery of C‐nociceptor evoked pain after topical 8% capsaicin applied for 4 consecutive days.MethodsCapsaicin and placebo patches were applied to human forearm skin (<jats:italic>n</jats:italic> = 14). Cold, warmth and heat pain thresholds, pain NRS to electrical and thermal (48°C, 5 s) stimuli and axon reflex flare were recorded weekly for 49 days. Mechanical and heat sensitive (‘polymodal’) nociceptors were activated by single electrical half‐period sinusoidal pulses (0.5 s, 1 Hz). Mechanical and heat <jats:italic>in</jats:italic>sensitive (‘silent’) nociceptors were activated by 4 Hz sinusoidal stimuli.ResultsCapsaicin abolished heat pain. Sensation to electrical sinusoidal stimulation was reduced but never abolished during the treatment. Pain to electrical 1 Hz ‘polymodal’ nociceptor stimulation took longer to recover than pain ratings to 4 Hz 2.5 s sinusoidal stimulation activating ‘polymodal’ and ‘silent’ nociceptors (35 vs. 21 days). Heat pain was indifferent to placebo from day 21–49. Axon reflex flare was abolished during capsaicin and only recovered to ~50% even after 49 days.ConclusionsCapsaicin abolishes heat transduction at terminal nociceptive endings, whereas small‐diameter axons sensitive to sinusoidal electrical stimulation can still be activated. 1 Hz depolarizing stimuli evoke burst discharges, as demonstrated before, and recover slower after capsaicin than single pulses induced by 4 Hz. The difference in recovery suggests differential time course of functional regeneration for C‐nociceptor sub‐types after capsaicin. All sensations recovered completely within 7 weeks in healthy subjects. Our findings contrast analgesia lasting for months in spontaneous neuropathic pain patients treated with 8% capsaicin.SignificanceSinusoidal electrical stimulation can still activate small diameter axons desensitized to heat after 4 consecutive days of topical 8% capsaicin application and reveals differential temporal functional regeneration of C‐nociceptor sub‐types. Electrical sinusoidal stimulation may detect such axons that no longer respond to heat stimuli in neuropathic skin.","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"27 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257229","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 effect of the EXOPULSE Mollii Suit on pain and fibromyalgia‐related symptoms—A randomized sham‐controlled crossover trial","authors":"Joseph G. Mattar, Moussa A. Chalah, Naoufel Ouerchefani, Marc Sorel, Johan Le Guilloux, Jean‐Pascal Lefaucheur, Georges N. Abi Lahoud, Samar S. Ayache","doi":"10.1002/ejp.4729","DOIUrl":"https://doi.org/10.1002/ejp.4729","url":null,"abstract":"BackgroundFibromyalgia pain and related symptoms are poorly managed by approved pharmacological and alternative interventions. This trial aimed to evaluate the effects of the EXOPULSE Mollii Suit—a multisite transcutaneous electrical nerve stimulation device—on fibromyalgia pain, fatigue, affective symptoms, disease impact, and quality of life.MethodsAdult patients with fibromyalgia were enrolled. Phase 1 implied a randomized, sham‐controlled, cross‐over, double‐blind trial, applying daily 1 h sessions of active or sham intervention, over 2 weeks (2‐week washout). In the open‐label phase 2, all patients received daily active intervention for 4 weeks. Comparisons on pain, fatigue, disease impact, affective symptoms, quality of life, clinical impression, and comfort ratings were performed using Friedman, Wilcoxon signed rank, and Chi2 tests.ResultsThirty‐three patients completed the study (93.9% female, mean age: 51.3 years). Pain (primary endpoint assessed via a visual analog scale) was significantly reduced after the active (pre‐active: 6.9 ± 1.4, post‐active: 5.9 ± 1.8, pre‐sham: 6.8 ± 1.4, post‐sham: 6.6 ± 1.5) versus the sham intervention (X&lt;jats:sup&gt;2&lt;/jats:sup&gt; = 10.60, &lt;jats:italic&gt;p&lt;/jats:italic&gt; = 0.014). This was also the case of other secondary endpoints (i.e., fatigue, anxiety, and disease impact), except depression and quality of life. The Clinical Global Impression of Change (CGI‐C) was significantly different between the active and sham intervention periods (X&lt;jats:sup&gt;2&lt;/jats:sup&gt; &lt;jats:italic&gt;p&lt;/jats:italic&gt; = 0.035), and the different proportions of categories were as follows: ‘worsening’ (sham: 18.2% vs. active: 0.0%), ‘improvement’ (sham: 48.5% vs. active 63.6%) or ‘no change (sham: 33.3% vs. active 36.4%) respectively. After phase 2, significant positive effects were observed for most of the outcomes, and 78.8% of patients reported improvement according to CGI‐C.ConclusionsThis study suggests the clinical benefits of the EXOPULSE Mollii Suit in alleviating pain and fibromyalgia‐related fatigue, emotional symptoms, and disease impact. It is worth noting that the study has several limitations related to the low number of participants, the short‐term analysis of effects in the first blinded and controlled phase, and the open‐label nature of phase 2. Future studies with a larger cohort and longer protocol treatment are needed, to further confirm the current results, and evaluate the long‐term effects of this technique.SignificancePatients with fibromyalgia suffer from pain as well as fatigue, sleep impairment, emotional disturbances, and altered quality of life. Transcutaneous electrical nerve stimulation might help manage those symptoms, but the available systems are limited by the fact that they could be applied at best over two sites. This randomized controlled study is the first to apply a multi‐site transcutaneous electrical nerve stimulation device, the EXOPULSE Mollii Suit, with significant effects on fibromyalgia pain and ","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"208 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269333","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":"Impaired somatosensory habituation in older adults with chronic pain during an affective oddball task","authors":"Alejandro Dorado, Carolina Sitges, Marian van der Meulen, Ana M. González‐Roldán","doi":"10.1002/ejp.4732","DOIUrl":"https://doi.org/10.1002/ejp.4732","url":null,"abstract":"BackgroundChronic pain is one of the most common health conditions among older adults, triggering various disruptions in information processing across attentional, emotional, and somatosensory domains. However, there is insufficient information about how these aspects interact and their potential contribution to the vulnerability of older adults to chronic pain. This study aimed to investigate potential alterations induced by chronic pain during aging in attentional aspects of tactile stimulation and to observe the influence of affective context.MethodTwenty‐six older adults with chronic pain (70.00 ± 5.07 years; 11 males), 28 pain‐free older adults (69.57 ± 3.96 years; 13 males) and 27 healthy younger adults (21.48 ± 1.80 years; 14 males) participated in the study. We compared the somatosensory evoked potentials elicited by frequent and deviant stimulation (probability 14%) applied when participants were viewing blocks of pleasant, unpleasant, and neutral images from the International Affective Picture System.ResultsDuring frequent stimulation, older adults with chronic pain showed higher P50 and N100 amplitudes compared to pain‐free older adults and younger individuals. Furthermore, the older group with pain exhibited higher P300 amplitude during emotional contexts compared to neutral scenarios. During deviant stimulation, older adults with chronic pain exhibited higher P50 and N100 amplitudes compared to pain‐free older adults but displayed typical age‐related flattening during P300.ConclusionsThese findings indicate that chronic pain leads to a decline in the ability to habituate to non‐painful irrelevant somatosensory stimuli, especially when it is presented in an emotional context.Significance StatementIn the present study, we have observed how older individuals suffering from chronic pain exhibit a decline in the habituation capacity of irrelevant somatosensory information. Furthermore, we have observed how the affective context in which these individuals are situated leads to an exacerbation of this deficit. Enhancing our comprehension of how aging and chronic pain interact to impact somatosensory processing could facilitate the tailoring of novel intervention strategies.","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"75 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257230","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":"Fibromyalgia in patients with non‐psychotic mental disorders: Prevalence, associated factors and validation of a brief screening instrument","authors":"Mikhail Zinchuk, Georgii Kustov, Dmitry Tumurov, Dmitry Zhuravlev, Yulia Bryzgalova, Maria Spryshkova, Alexander Yakovlev, Alla Guekht","doi":"10.1002/ejp.4730","DOIUrl":"https://doi.org/10.1002/ejp.4730","url":null,"abstract":"BackgroundFibromyalgia (FM) is a chronic pain syndrome associated with significant distress and numerous unpleasant consequences. Mental health problems in people with FM have been reported in many studies. People with mental disorders are thought to be at higher risk of FM than the general population, but the prevalence has not been established.ObjectiveWe aimed to investigate the prevalence of FM in a representative sample of inpatients with non‐psychotic mental disorders. Additionally, we aimed to assess the psychometric properties of the Fibromyalgia Rapid Screening Tool (FiRST) in the Russian‐speaking population of people with mental disorders.MethodsConsecutive inpatients admitted to the Moscow Research and Clinical Center for Neuropsychiatry for treatment of non‐psychotic mental disorders were evaluated for FM by a neurologist and completed the FiRST, Beck Depression Inventory (BDI), and State and Trait Anxiety Inventory (STAI).ResultsOf the 1168 patients evaluated 9.0% met the diagnostic criteria for FM. FM was associated with being female, having a diagnosis of unipolar depression, and having higher total scores on the BDI and STAI. The psychometric properties of the FiRST were good (McDonald's omega 0.79, corrected item‐total correlation greater than 0.45). An optimal cut‐off point with the highest Yuden's index (<jats:italic>J</jats:italic> = 0.75) was &gt;3 (AUC of 0.89).ConclusionFM is a common comorbidity in people with non‐psychotic mental disorders, associated with being female, having a diagnosis of unipolar depression, and having more severe anxiety and depression. The FiRST can be used for the FM screening with its cut‐off &gt;3 in people with non‐psychotic mental disorders.Significance StatementIt is the first study to determine the prevalence of FM in people with non‐psychotic spectrum mental disorders. The study design included a consecutive sample in a real‐life setting to avoid bias. In addition, we evaluated the psychometric properties of the FM screening instrument in a population of people with mental disorders and established the cut‐off. The specificity of this subpopulation is explained by both the high prevalence of pain symptoms and the overlap of some psychiatric and FM symptoms.","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"208 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269339","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":"Harnessing the therapeutic effects of nature for chronic Pain: A role for immersive virtual reality? A narrative review","authors":"Alexander Smith, Kayleigh J. Wyles, Sonia Medina Hernandez, Sophie Clarke, Patricia Schofield, Sam W. Hughes","doi":"10.1002/ejp.4727","DOIUrl":"https://doi.org/10.1002/ejp.4727","url":null,"abstract":"Background and ObjectiveThere is a growing interest in the relationship between nature and pain relief. Evidence from environmental psychology, neuroscience and physiology‐based studies point towards analgesic effects of nature being mediated through various cognitive, affective and/or autonomic factors. Being able to harness these therapeutic effects using immersive virtual reality (VR) could help to optimize and improve accessibility of nature‐based environments as part of chronic pain management plans. In this narrative review, we present evidence supporting a new theoretical framework for nature‐based analgesia and suggest ways for applying this through immersive VR.Databases and Data TreatmentWe provide an overview of the evidence on (1) the therapeutic effects of nature on pain, (2) environmental psychology theory that underpins the health benefits of nature, (3) key mechanistic evidence from nature neuroimaging and physiology‐based studies, (4) previous studies that have used VR‐based nature in pain research and (5) how to design effective VR interventions that can be used to integrate nature into immersive 360 environments.ResultsWe have demonstrated how environmental psychology, neuroscience and physiology‐based research can be used to form a novel theoretical framework for nature‐based analgesia. Using this framework, we identify how key aspects of nature can act as analgesic and how this can be harnessed using immersive VR.ConclusionsThrough developing this theoretical framework, we have provided a foundation on which to guide future experimental and clinical studies as well as helping to improve the accessibility of nature for chronic pain patients through immersive VR technologies.SignificanceThis review article summarizes key multidisciplinary evidence to help understand how nature exerts beneficial effects on pain processing. The use of this theoretical framework alongside advances in immersive VR technologies provides a springboard for future research and can be used to help develop new nature‐based therapeutics using VR.","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"11 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142187626","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":"Preoperative measures of pain at rest and movement-evoked pain in knee arthroplasty: Associations with pain and function outcome trajectories from a prospective multicentre longitudinal cohort study.","authors":"Daniel L Riddle, Levent Dumenci","doi":"10.1002/ejp.4723","DOIUrl":"https://doi.org/10.1002/ejp.4723","url":null,"abstract":"<p><strong>Background: </strong>The study of pain at rest (PAR) and movement-evoked pain (MEP) in persons with musculoskeletal pain has received substantial attention. Despite strong interest, relatively little attention has been directed to the psychometric development of these constructs. Our purpose was to explore the relationship between PAR and MEP and to examine the prognostic utility of these measures in persons with knee arthroplasty.</p><p><strong>Methods: </strong>We used prospectively collected data from persons scheduled for knee arthroplasty who had moderate to high levels of pain catastrophizing. Preoperative latent variables for PAR and MEP were developed and used to determine if they were associated with a binary latent variable of good versus poor pain and function outcome trajectories. Factor correlations were used to determine the extent to which the variance for PAR and MEP was overlapping.</p><p><strong>Results: </strong>PAR and MEP are significant predictors of good versus poor pain and function classes. Odds ratios ranged from 1.21 to 1.64 (p < 0.001) indicating a significant increase in the likelihood of poor outcome. Correlation between PAR and MEP latent variables was high (r = 0.89; 95% CI: 0.86-0.92) indicating substantially overlapping variance.</p><p><strong>Conclusions: </strong>PAR and MEP, as defined in our study, can be used to make prognostic judgements regarding risk of poor postoperative outcome trajectory following knee arthroplasty. However, PAR and MEP showed substantially overlapping variance indicating that measurements of both are not necessary when making prognostic assessments.</p><p><strong>Significance statement: </strong>Preoperative PAR and MEP latent variables, as defined in our study, had prognostic significance for 1 year pain and function outcome trajectories. PAR and MEP latent variables had substantially overlapping variance which suggested that only one is needed to make prognostic judgements. The prognostic significance of PAR and MEP as well as their substantially overlapping variance is new to the field prognostic research in knee arthroplasty.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153486","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}