European Journal of Pain最新文献

{"title":"Associations Between Sum Scores or Combinations of MRI Findings in the Lumbar Spine and Low Back Pain-Related Outcomes: A Systematic Review","authors":"Line Dragsbæk,&nbsp;Tue Secher Jensen,&nbsp;Per Kjær,&nbsp;Mark Hancock,&nbsp;Stine Clausen,&nbsp;Rikke Krüger Jensen","doi":"10.1002/ejp.70076","DOIUrl":"https://doi.org/10.1002/ejp.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>Research on lumbar MRI findings has mainly focused on single MRI findings and their association with low back pain (LBP). Some studies suggest that summing or combining MRI findings may show stronger associations with LBP than single findings. This systematic review investigates how sum scores and combinations of lumbar MRI findings are associated with LBP-related outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched Embase, PubMed, CINAHL, Scopus and SPORTDiscus for studies reporting cross-sectional associations between sum scores/combinations of MRI findings and LBP. Two reviewers independently performed screening, data extraction and risk-of-bias (RoB) assessment. Study characteristics, definitions of sum scores/combinations of MRI findings and associations between sum scores of MRI findings and LBP outcomes were extracted and synthesised.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 11,537 studies and included 49 with 37 different study populations. Twelve studies had low RoB. Thirty-one studies investigated sum scores of one specific MRI finding. Ten out of 16 studies investigating disc degeneration, two out of three investigating herniation and seven out of 10 investigating endplate-related changes reported stronger associations between increasing sum scores and LBP. Additionally, seven of nine studies reported the same for disc degeneration and LBP-related disability. Sixteen studies investigated a sum score of different MRI findings. Eight of 11 studies reported stronger associations between increasing findings and LBP, and five of eight found the same for LBP-related disability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Most studies reported stronger associations between increasing sum scores of MRI findings and LBP. We recommend focusing on cumulative MRI findings when investigating the relationship with LBP outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This review emphasises the relevance of assessing MRI findings as a sum rather than as individual findings in understanding the mechanisms of low back pain. The findings offer a foundation for future research, promoting a more standardised approach to the assessment of MRI findings and their clinical relevance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144647316","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":"Assessment of Mechanical Detection Thresholds in Healthy Participants and Patients With Neuropathy: A Comparison of OptiHair2 and Aesthesiometer II","authors":"Jan D. Wandrey,&nbsp;Annika Reinecke,&nbsp;Andrea Westermann,&nbsp;Thomas Lücke,&nbsp;Elena Enax-Krumova,&nbsp;Christoph Maier,&nbsp;Jan Vollert,&nbsp;Lynn Eitner","doi":"10.1002/ejp.70078","DOIUrl":"https://doi.org/10.1002/ejp.70078","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;Mechanical detection thresholds (MDTs) are used to assess somatosensory function but can only be evaluated considering the individual sex, age and tested body region. The German Research Network on Neuropathic Pain (DFNS) provides reference values for OptiHair2, a sensitive and expensive glass filament, while nylon filaments such as the Aesthesiometer II are more durable and affordable. In this study, we compare both devices regarding their use for MDT assessment in a variety of participants, thus intending to achieve a higher range for MDT.&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;MDTs of healthy children (&lt; 18y), healthy adults (&gt; 18y) and adult patients with symptoms of suspected polyneuropathy were determined using OptiHair2 glass filaments (0.25-512mN) and Aesthesiometer II nylon filaments (0.63–235.36mN), using the method of limits according to the DFNS protocol. Testing was performed on the cheek, hand and foot in healthy participants; patients were tested on the hand and foot only. Concordance Correlation Coefficient (CCC), Pearson correlation and linear regression analysis were performed.&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 study included 55 participants (33 female, 30 healthy adults aged 22–62 years, 10 healthy children aged 9–15 years, 15 patients aged 35–86 years). There was a relevant concordance of MDTs between Aesthesiometer II and OptiHair2 at the hand (CCC children = 0.14, healthy adults = 0.56, patients = 0.66) and foot (CCC children = 0.24, healthy adults = 0.66, patients = 0.70) but not on the cheek (CCC children = 0.00, healthy adults = 0.01).&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;The Aesthesiometer II can be a viable replacement for OptiHair2 in less densely innervated areas like the feet, when screening for polyneuropathy, especially in bedside settings due to its robust materials. However, its stronger lowest force (0.63 vs. 0.25 mN) implicates poorer sensitivity for MDT assessments when testing highly innervated areas like the face.&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 suggests the use of robust Aesthesiometer II nylon filaments as an alternative to the more fragile OptiHair2 glass filaments for MDT assessments. While we find that only OptiHair2 seems to be suitable for more densely innervated areas like the face, Aesthesiometer II's durability and cost-efficiency make it a useful bedside tool, especially for asse","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70078","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144647122","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 Burden of Chronic Pain on Women: A Secondary Analysis of Data From the National Study on Disability (ENDISC) in Chile","authors":"Marina Carvalho Arruda Barreto,&nbsp;Mariana Arias Ávila,&nbsp;Ricardo Cartes-Velásquez,&nbsp;Shamyr Sulyvan de Castro","doi":"10.1002/ejp.70080","DOIUrl":"https://doi.org/10.1002/ejp.70080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic pain is a prevalent condition that disproportionately affects women, significantly impairing their functioning. Understanding its prevalence and impact is essential for designing effective interventions. This study aimed to determine the prevalence of chronic pain among women and assess its effects on functioning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional analysis utilised data from the National Study on Disability (ENDISC-2022) in Chile, focusing on women aged 18 years and older. Chronic pain was assessed through self-reported data, and functioning was evaluated using performance indicators derived from the Model Disability Survey (MDS). Generalised Linear Models (GLM) were applied to examine associations with sociodemographic and psychosocial variables, and stratified analyses compared women with and without chronic pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 30,010 participants in the ENDISC study, 14.8% reported chronic pain, with 67.1% of those affected being women. Women experiencing chronic pain exhibited significantly poorer performance scores across all evaluated domains compared to their counterparts without pain. The GLM regression analysis revealed that women with chronic pain had a significantly higher risk of worse functioning scores compared to those without chronic pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Sociodemographic factors such as age, education level, and employment status further influenced outcomes, underscoring the vulnerability of women with chronic pain. Chronic pain is a significant and pervasive issue among women in Chile, markedly impairing their functioning and well-being. Gender-sensitive approaches and policies are crucial to reducing the burden of chronic pain and improving the quality of life for affected women, particularly those in vulnerable sociodemographic groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>The findings highlight the need for targeted interventions that address the multifaceted nature of chronic pain, including its physical, psychological, and social dimensions in women with pain and a more sensitive look at the difficulties encountered by this population, such as work issues.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624848","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":"Cognitive Function in Patients With Complex Regional Pain Syndrome (CRPS)","authors":"S. Liesto,&nbsp;T. Aho,&nbsp;S. K. Jääskeläinen,&nbsp;M. Hietanen,&nbsp;E. Kalso","doi":"10.1002/ejp.70070","DOIUrl":"https://doi.org/10.1002/ejp.70070","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;Complex Regional Pain Syndrome (CRPS) is characterised by pain, sensory, vasomotor, sudomotor, motor, and trophic symptoms, with cognitive symptoms also reported. This study aimed to examine the neuropsychological profile of patients with meticulously diagnosed CRPS 1 and 2.&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 neuropsychological examination was conducted in 54 CRPS patients. The test battery included Block Design and Similarities from Wechsler Adult Intelligence-IV, word list learning and delayed recall, and Digit Span from Wechsler Memory Scale-III, Trail Making Test (TMT), verbal and drawing fluency, Brixton, Manikin and Bourdon–Wiersma tests. Patients performing below −0.67 SD of the performance of a healthy Finnish population in ≥ 3 tests were classified as having cognitive decline. Questionnaires included Insomnia Severity Index, Beck Depression Inventory-II, CRPS Severity Scale, Disabilities of the Arm, Shoulder and Hand, Pain Catastrophizing Scale, Resilience Scale-14, Brief Pain Inventory, Insomnia Severity Index and State Trait Anxiety Inventory. Patients were asked about subjective cognitive difficulties.&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 subgroup comprising 30% of the CRPS patients showed cognitive decline. Higher pain catastrophising was associated with poorer test performance in TMT Part A. There were no differences between left and right sides on the visual attention test. Subjective cognitive difficulties were not associated with objective cognitive test performance. Cognitive functioning did not differ between CRPS 1 and 2 patients.&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 elucidates how CRPS affects cognitive functioning, important information when tailoring multidisciplinary rehabilitation to CRPS patients. Psychological factors may have a stronger impact on subjective cognitive difficulties than on objective test performances.&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;CRPS is an enigmatic syndrome with multifactorial origins, leading to chronic, disabling pain due to progressing neuroplastic alterations in the central nervous system. This study adds comprehensive novel information about cognitive function in CRPS, as, except for lateralised cognitions and body perception, cognitive domains have not previously been extensively studied in CRPS patients. Cognitive decline in 30% of patients indicates that neuropsychological asses","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574042","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":"Physical and Mental Health of Fibromyalgia Patients Following October 7th Attack and the Ensuing Military Conflict: A Cross-Sectional Analysis","authors":"Valerie Aloush,&nbsp;Avital Gurfinkel,&nbsp;Jacob N. Ablin,&nbsp;Odelia Elkana","doi":"10.1002/ejp.70075","DOIUrl":"https://doi.org/10.1002/ejp.70075","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;Fibromyalgia symptoms can be exacerbated by acute or chronic stress. Although military conflicts have been associated with increased rates of PTSD and fibromyalgia in military personnel, civilian populations exposed to such conflicts are also at a higher risk of chronic pain and somatic symptoms.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aim&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study aims to assess the physical and mental health of fibromyalgia patients in Israel following the October 7th attacks and to identify key risk and protective 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;An online survey conducted in January 2024 gathered data from fibromyalgia patients across Israel, a population exposed to intense conflict-related stressors, including missile attacks, mass evacuations and widespread military mobilisation. The survey addressed demographics, health behaviours, access to medical services, anxiety, depression, coping mechanisms, social support and fibromyalgia-specific indices like the Widespread Pain Index (WPI) and Symptom Severity Scale (SSS).&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;Among 246 respondents, nearly 70% ceased complementary treatments and psychotherapy, and 83.3% reduced or stopped physical exercise. These patients reported heightened pain, anxiety, depression and perceived deterioration. Strong correlations were found between higher anxiety/depression levels and increased pain and somatic symptoms (&lt;i&gt;p&lt;/i&gt; &lt; 0.01). Social support was associated with reduced anxiety and depression but not pain. Positive life orientation was linked to lower pain, somatic symptoms and mental distress (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Avoidant coping strategies worsened outcomes, whereas problem-focused coping and acceptance had protective effects.&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 war has negatively affected the mental and physical health of fibromyalgia patients. Cessation of physical activity and therapy may contribute, whereas positive coping and life orientation can offer protection.&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 is the first to comprehensively examine the wellness of fibromyalgia patients during the war in Israel, highlighting the profound mental and physical deterioration in this population. By identifying key risk factors, such as cessation of physical activity and psychother","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582201","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":"Cluster-Randomised Controlled Trial of At-Home Virtual Reality for People With Chronic Musculoskeletal Pain on the Waiting List","authors":"Syl Slatman,&nbsp;Lieke Heesink,&nbsp;Reinoud Achterkamp,&nbsp;José Broeks,&nbsp;Bram Lemans,&nbsp;Nelson Monteiro de Oliveira,&nbsp;Leonie Brinckate-Oolbekkink,&nbsp;Diede Paarlberg,&nbsp;Heleen Reinders-Messelink,&nbsp;Remko ter Riet,&nbsp;Marjolein Stegeman,&nbsp;Jesper Knoop,&nbsp;Monique Tabak","doi":"10.1002/ejp.70073","DOIUrl":"https://doi.org/10.1002/ejp.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Virtual reality (VR) has been introduced as a novel intervention in chronic musculoskeletal pain (CMP) rehabilitation. However, much remains unknown about the effectiveness of VR for CMP. The aim of this study was to examine the effectiveness of VR in daily life versus no treatment for people with CMP who were on a waiting list to receive secondary pain treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study employed a cluster-randomised, controlled design. The intervention group received a novel VR application that offers pain education and pain management techniques. This home-based, stand-alone, immersive VR intervention was advised to be used daily for four weeks. The control group received no treatment. Primary outcome measure was health-related quality of life at four weeks; secondary outcome measures included various pain-related variables (e.g., pain self-efficacy). Intervention effectiveness was analysed using linear mixed models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-three participants were included in this trial (mean age: 55.5 (SD: 15)) of which 70% were women. No significant between-group differences were found at four weeks on physical (mean difference (95% CI): 0.039 (−2.810 to 2.889), <i>p</i> = 0.978) or mental (3.590 (−1.640 to 8.819), <i>p</i> = 0.172) health-related quality of life or any of the secondary outcome measures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The pain education VR intervention showed no effect in improving outcomes for people with CMP who were on a waiting list, compared to a no-intervention control group. Future research should investigate for which patients, settings, and timing this VR intervention could be beneficial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Prior research showed that VR could be beneficial for people with CMP. However, the results of this study showed that VR is ineffective as stand-alone therapy for people with CMP who were on a waiting list to receive secondary pain treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558261","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":"Varying Analgesic Effectiveness of Systemic and Central Intrathecal Administration of Cyclooxygenase-2 Inhibitors in Different Phases of Osteoarthritic Pain in Rats","authors":"Chun-Sung Sung,&nbsp;Shi-Ying Huang,&nbsp;Hao-Jung Cheng,&nbsp;Sung-Chun Lin,&nbsp;Zong-Sheng Wu,&nbsp;Zhi-Kang Yao,&nbsp;Nan-Fu Chen,&nbsp;Yen-Hsuan Jean,&nbsp;Zhi-Hong Wen","doi":"10.1002/ejp.70068","DOIUrl":"https://doi.org/10.1002/ejp.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Osteoarthritis (OA) contributes to heightened pain perception by disrupting the normal function of peripheral nerves and spinal nociceptive circuits. Although selective cyclooxygenase-2 (COX-2) inhibitors reduce OA-associated pain, the distinct roles of spinal COX-2 and glial cell activity in this context remain poorly defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The effects of two COX-2 inhibitors, etoricoxib and celecoxib, were examined using an anterior cruciate ligament transection (ACLT) rat model of OA. Mechanical allodynia was assessed behaviorally using the von Frey filament test. COX-2 protein expression and glial cell (astrocyte and microglia) activation in the lumbar spinal cord were analysed via immunohistochemistry.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Spinal COX-2 expression was significantly increased, mainly in neurons and astrocytes, at the 16th week after ACLT (<i>p</i> = 0.026). Microglia and astrocytes were activated from the 2nd to 16th week and from the 6th to 16th week after ACLT, respectively. The intrathecal median effective dose (ED₅₀) of COX-2 inhibitors, etoricoxib and celecoxib, required for reducing mechanical allodynia was lower at the 16th week than at the 2nd week after ACLT surgery (<i>p</i> = 0.0448 and 0.046, respectively). In contrast, the oral ED₅₀ values of etoricoxib and celecoxib for relieving mechanical allodynia were slightly higher at the 16th week than at the 2nd week after ACLT surgery (<i>p</i> = 0.097 and 0.227, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study shows that the efficacy of COX-2 inhibitors in ALCT-induced OA rats depends on the timing and route of administration. In the later phase, spinal glia cells exhibited increased activity and elevated COX-2 expression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>This study characterises the complex mechanisms underlying OA pain, involving both peripheral and central components, and highlights the stage-specific involvement of COX-2, particularly in the spinal cord. It provides experimental evidence linking central COX-2 activity and glial cell responses to OA pain, offering insights into the temporal dynamics of pain processing and guiding the development of therapeutic strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558309","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":"What a Sham(e): Sham-Controlled Conditioned Pain Modulation Effects on Pressure but Not Heat Pain Thresholds in Healthy Volunteers","authors":"Madeleine Hau,&nbsp;Laura Sirucek,&nbsp;Iara De Schoenmacker,&nbsp;Robin Lütolf,&nbsp;Lindsay Gorrell,&nbsp;Michèle Hubli,&nbsp;Petra Schweinhardt","doi":"10.1002/ejp.70067","DOIUrl":"https://doi.org/10.1002/ejp.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Conditioned pain modulation (CPM) is a well-established experimental paradigm to study descending pain modulation in humans, measuring the pain modulatory effect of a painful conditioning stimulus (CS) on a painful test stimulus (TS). Control conditions using a non-painful CS accounting for modulatory effects not attributable to the painfulness of the CS are seldom included. Thus, this study aimed to differentiate CPM effects from perceived changes of the TS unrelated to the painfulness of the CS by comparing effects of a painful and a control CS on four different TS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Forty-nine healthy participants underwent a combined parallel and sequential CPM paradigm with a cold water bath (median NRS 8/10) as painful and an ambient-temperature sham water bath (median NRS 0/10) as non-painful control CS. TS were pressure and heat pain thresholds (PPT, HPT) (parallel and sequential) and temporal summation of pain (TSP, sequential) (pressure and heat). Larger TS changes with the painful compared to the control CS were interpreted as sham-controlled CPM effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A parallel sham-controlled CPM effect was only detected for PPT (significantly larger PPT increases during the painful compared to the control condition (<i>p</i> = 0.009)). HPT increased for both conditions without a significant difference between conditions (<i>p</i> = 0.152). TSP was successfully induced but not modulated by either CS (<i>p</i> &gt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates sham-controlled CPM effects on PPT, but not on HPT, most likely due to heat adaptation or habituation. This challenges the interpretation of prior studies using CPM paradigms with HPT as TS without a control condition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>This study highlights the importance of including control conditions in CPM paradigms using HPT as TS. HPT increased similarly during a painful and a control condition, most likely due to adaptation and habituation. Although these are known effects, CPM studies rarely control for them. Pressure pain thresholds increased more during the painful than during the control condition, making it a more suitable TS, especially when a control condition is absent.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520096","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":"Is Lifting Technique Related to Pain and Functional Limitation? A Replicated Single-Case Design Study of Five People With Lifting-Related Chronic Low Back Pain","authors":"Ivan Pui Hung Au,&nbsp;Nic Saraceni,&nbsp;Anne Smith,&nbsp;Peter O'Sullivan,&nbsp;Leo Ng,&nbsp;Amity Campbell","doi":"10.1002/ejp.70071","DOIUrl":"https://doi.org/10.1002/ejp.70071","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Chronic low back pain (CLBP) is often provoked by lifting activities, but the relationship between changes in lifting technique and clinical outcomes while undergoing intervention remains unclear. This study examined the within-person relationships between changes in lifting technique and changes in pain and functional limitation in people with lifting-related CLBP.&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;Five participants with lifting-related CLBP completed repeated measures of their lifting techniques, pain and functional limitation across baseline (4–6 weeks), intervention (12 weeks) and follow-up periods (3 months). Participants received up to 10 sessions of Cognitive Functional Therapy (CFT) during the intervention period. Wearable sensors measured the spinal and lower extremities' range of motion (ROM) and velocity during a repeated lift task. Pain and functional limitation were assessed via online questionnaires. Within-person relationships were estimated using cross-correlation analyses.&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;All participants demonstrated changes in lifting technique throughout the study, though with varied timing and direction. Changes in lifting technique were frequently related to changes in functional limitation (18/25 relationships, 72%) and sometimes to changes in pain (13/25 relationships, 52%). When relationships were observed, reductions in pain and functional limitation were predominantly (27/31 relationships, 87%) associated with a transition along a continuum from squat-like towards semi-squat-like and stoop-like lifting techniques with faster lifting movements.&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;Within-person changes in lifting technique varied among individuals. Greater trunk ROM and velocity, lower knee ROM and velocity, and faster lifting movements often co-occurred with lower levels of pain and functional limitation. This reflects a transition along a continuum from squat-like towards semi-squat-like and stoop-like lifting techniques.&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;Our study reveals that changes in lifting technique may relate to clinical improvements in people with lifting-related CLBP on an individual basis. Contrary to conventional clinical and ergonomic advice promoting ‘safe’ squat lifting techniques, our findings suggest that transition from squat-like towards semi-squat-like and stoop-like lifting techni","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524873","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 Characteristics and Changes in Long-Term Opioid Use Among Patients With Non-Cancer Pain in Dutch Primary Care 2013–2022: A Population-Based Cohort Study","authors":"Loes de Kleijn,&nbsp;Laura Struik,&nbsp;Hanneke J. B. M. Rijkels-Otters,&nbsp;Alessandro Chiarotto,&nbsp;Bart W. Koes,&nbsp;Jacoline J. van den Driest","doi":"10.1002/ejp.70061","DOIUrl":"https://doi.org/10.1002/ejp.70061","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pain guidelines recommend de-prescribing long-term opioid treatment (LTOT) in non-cancer pain for reasons of risk–benefit balance. However, the prevalence and changes over time with regard to LTOT in patients with chronic non-cancer pain in Dutch primary care are unknown. Hence, we examined the prevalence and characteristics and investigated associated diagnoses, comorbidities, co-medications and changes in prescription numbers between 2013 and 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective population-based cohort study was conducted using the Rijnmond Primary Care Database, which includes over 500,000 patient records from at least 240 GPs within the greater region of Rotterdam. All episodes of LTOT (&gt; 3 months) in patients &gt; 18 years from 2013 to 2022 were included. Descriptive statistics were adopted to characterise the study cohort. The prevalence of LTOT from 2013 to 2022 was calculated per 100 patient years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Musculoskeletal complaints were the main registered indication by the first prescription of opioids. Patients were more frequently female (66.9%), with a mean age of 62.6 years. Most common comorbidities included diabetes mellitus and depressive disorder. The prevalence of LTOT increased twofold from 0.54% (95% CI: 0.51–0.58) per 100 patient years in 2013 to 1.04% (95% CI: 1.00–1.07) in 2022. The proportion of LTOT episodes solely involving potent opioids slightly increased between 2013 and 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study demonstrated a twofold increase in the prevalence of LTOT for chronic non-cancer pain in Dutch primary care from 2013 to 2022. Musculoskeletal pain complaints were the main indication. From 2013 to 2022 potent opioids assumed a more prominent role in LTOT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>The about twofold increase in long-term opioid therapy for chronic non-cancer pain between 2013 and 2022, along with the specific rise in potent opioid prescriptions in Dutch primary care, highlights an urgent need for future studies. These studies should focus on developing strategies to accelerate the implementation of revised primary care pain guidelines, especially given the limited effectiveness of long-term opioid treatment in non-cancer pain and the anticipated rise in chronic non-cancer pain due to Europe's ageing population.</p>\u0000 </section","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511182","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}