Clinical Journal of Pain最新文献

{"title":"A Network Analysis of Fear-Avoidance Beliefs, Mood and Disability in Chronic Pain.","authors":"Gwen van der Wijk, Hanne Huygelier, Jonas Haslbeck, Andrea W M Evers, Madelon L Peters, Mathijs Teppers, Johan W S Vlaeyen","doi":"10.1097/AJP.0000000000001322","DOIUrl":"10.1097/AJP.0000000000001322","url":null,"abstract":"<p><strong>Objectives: </strong>Although the multifactorial nature of chronic pain is well established, research has predominantly examined isolated variables or singular pathways that may contribute to this condition. We use a complex systems perspective to examine the interplay of psychological factors in the context of chronic pain.</p><p><strong>Methods: </strong>We analyzed two cross-sectional datasets (N=935 and 1366) collected at a pain clinic and rehabilitation center in Belgium from individuals primarily with musculoskeletal pain. These included self-reported data on pain-related fear and avoidance beliefs, depression and anxiety symptoms, and pain intensity and pain disability. We used Gaussian Graphical Models to examine conditional associations between these variables, their relative importance (having more/stronger relationships), and how they are moderated by pain-related fear and pain intensity.</p><p><strong>Results: </strong>Our analyses revealed highly interrelated networks, with several unique, positive associations between the included factors. Depressive symptoms and pain intensity were most strongly related to pain disability. Fear-avoidance beliefs featured less prominently than previous studies looking at this concept in isolation have suggested. Apart from differences in two associations between samples, and two moderation effects of pain intensity in one sample, the network structure was similar across the two samples.</p><p><strong>Discussion: </strong>Overall, our results show that psychological factors related to pain disability have intricate interrelations, highlighting the complexity of chronic pain and the need to study its many components in relation to each other. The consistency across the two samples provides encouraging evidence that the results reflect a stable pattern within this complex system.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Procedural Pain Assessments for Neonates at Risk of Neonatal Opioid Withdrawal Syndrome: A Scoping Review.","authors":"Julianna Lavergne, Erin Langman, Deborah Mansell, Justine Dol, Britney Benoit","doi":"10.1097/AJP.0000000000001325","DOIUrl":"https://doi.org/10.1097/AJP.0000000000001325","url":null,"abstract":"<p><strong>Objectives: </strong>To identify evidence for pain assessment during acute procedures in hospitalized neonates at risk of neonatal opioid withdrawal syndrome (NOWS).</p><p><strong>Methods: </strong>This scoping review was conducted using the JBI scoping review methodology. The search strategy focused on identifying in-patient neonates undergoing acute painful procedures. Databases searched are MEDLINE, CINAHL, Embase, PsycInfo, and Scopus. The relevant data were extracted by two reviewers and the results were summarized in a narrative description and presented in a tabular format including the components of participants, concept, and context (PCC).</p><p><strong>Results: </strong>A total of 22,731 unique studies were screened, with five studies ultimately included. Of these studies, two included neonates at risk of NOWS but did not report pain responses separately. The three remaining studies observed procedural pain in opioid-exposed neonates compared to neonates without opioid exposure during heel lance. Pain assessment methods included physiologic responses and validated composite pain scores. When using composite pain tools, one study showed higher pain response in opioid-exposed neonates, while the other two studies showed the same or lower pain response. For skin conductance the findings from two studies were discrepant, with one study reporting higher pain response in opioid-exposed neonates and the other showing no statistically significant difference.</p><p><strong>Discussion: </strong>There is a need for more studies designed to examine the influence of opioid exposure and withdrawal on pain responding and management in neonates. As there is currently limited evidence to guide clinical care, clinicians should continue to use validated composite pain assessment tools and pain management strategies.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Intensive Interdisciplinary Pain Treatment (IIPT) Enhance Endogenous Pain Modulation in Youth with Chronic Pain Syndromes?","authors":"Julie Shulman, Catherine Stewart, Talia Barrett, David Zurakowski, Navil F Sethna","doi":"10.1097/AJP.0000000000001324","DOIUrl":"https://doi.org/10.1097/AJP.0000000000001324","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to investigate whether endogenous pain modulation improves after intensive interdisciplinary pain treatment (IIPT) and its relationship with clinical outcomes in youth with chronic pain syndromes. Endogenous pain modulation is a physiological process in the nervous system that inhibits pain perception. Endogenous pain modulation is often impaired in youth with chronic pain syndromes and is a potential mechanism by which IIPT interventions act.</p><p><strong>Methods: </strong>Endogenous pain modulation was measured using offset analgesia (OA) in 27 youth with primary and secondary chronic pain syndromes before and after IIPT. Test-retest reliability was measured in a subset of participants (n=12) within 5 days of IIPT admission to examine whether the observed change was meaningful and beyond the limits of error.</p><p><strong>Results: </strong>On average, OA response improved by 12.4% between admission and discharge (95% CI: 3.0, 21.8%), even after controlling for covariates using a mixed effects multivariable repeated measures ANOVA (P=0.009). OA responses demonstrated excellent test-retest reliability, intraclass correlation coefficient=0.919 (95% CI: 0.718, 0.977), and minimum detectable change (MDC95) of the OA response was 13%. Participants also demonstrated an improved ability to adapt to a constant noxious heat stimulus (P=0.044) that moderately correlated with improvements in self-reported pain intensity and sensitivity to stimuli (P<0.05).</p><p><strong>Discussion: </strong>Overall, 52% of participants demonstrated meaningful improvements (i.e., change greater than the MDC95) in endogenous pain modulation after IIPT participation. The contributions of specific IIPT interventions (e.g., exercise, desensitization, cognitive behavioral therapy) to improvements in endogenous pain modulation need further exploration.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain Self-Efficacy as a Moderator and Modifiable Factor for Health-Related Quality of Life in Preoperative Setting.","authors":"Abolfazl Jafarzadeh, Ali Mosallaei, Hossein Zare","doi":"10.1097/AJP.0000000000001323","DOIUrl":"https://doi.org/10.1097/AJP.0000000000001323","url":null,"abstract":"","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond a Diagnosis: A Qualitative Study of Women's Experiences of Painful Sexual Intercourse.","authors":"Andresa Aguiar Dos Santos, Michele Menezes, Leandro Calazans Nogueira, Ney Meziat-Filho, Felipe J J Reis","doi":"10.1097/AJP.0000000000001316","DOIUrl":"https://doi.org/10.1097/AJP.0000000000001316","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to explore the diverse aspects of sexual pain experiences among affected women.</p><p><strong>Methods: </strong>We conducted an interpretive description qualitative study and collected data using one-to-one semi-structured interviews. Participants were purposefully recruited for one-on-one semi-structured online interviews. Two independent reviewers analyzed the transcripts, and coding was finalized through consensus.</p><p><strong>Results: </strong>The study consisted of 31 women who self-identified as experiencing sexual pain with a mean age of 29 (Sd.=9.72) years and a mean pain duration of 53 (Sd.=41.93) months. We identified six main themes, including experience of living with pain, beliefs, behavior, search for help, treatments, and expectations.</p><p><strong>Discussion: </strong>This study revealed that sexual pain often begins with the first sexual encounter and may persist, deeply affecting personal and marital well-being. Pain was linked to factors such as trauma and biological dysfunctions. Participants employed various coping strategies and sought multiple treatments, though outcomes and satisfaction levels varied. Key facilitators of effective treatment were professional support and access to information, while significant barriers included shame and financial constraints. Satisfaction with healthcare largely depended on receiving a diagnosis, with future outlooks varying from hopelessness to optimism.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presence of Neuropathic-Like Symptoms in Individuals With Painful Tendinopathy/Overuse Injuries: A Systematic Review and Meta-Analysis.","authors":"Ignacio Cancela-Cilleruelo, Jorge Rodríguez-Jiménez, José L Arias-Buría, Marcos J Navarro-Santana, Lars Arendt-Nielsen, César Fernández-de-Las-Peñas","doi":"10.1097/AJP.0000000000001292","DOIUrl":"10.1097/AJP.0000000000001292","url":null,"abstract":"<p><strong>Objective: </strong>This meta-analysis evaluated the prevalence of neuropathic-like symptoms in individuals with painful tendinopathies/overuse injuries.</p><p><strong>Methods: </strong>Electronic literature searches on MEDLINE, CINAHL, PubMed, SCOPUS, and Web of Science databases were conducted up to January 20th, 2025. Studies reporting the prevalence of neuropathic-like symptoms in painful tendinopathy/overuse injury were included. The methodological quality was assessed with the Newcastle-Ottawa Quality Assessment Scale in cohort/case-control studies or the Physiotherapy Evidence Database (PEDro) in clinical trials. Random-effects models were used for meta-analytical pooled prevalence of neuropathic-like symptoms.</p><p><strong>Results: </strong>From 1285 studies identified, 8 (1 case-control, 5 cohorts, and 2 clinical trials) met inclusion criteria. The sample included 920 participants with painful tendinopathy/overuse injury (47.6% female, age: 51, SD: 12.5 y). All studies included self-reported questionnaires for evaluating neuropathic-like symptomatology. The methodological quality was moderate-high. The overall prevalence of neuropathic-like symptoms in painful tendinopathies was 30% (95% CI: 22%-38%, n=8, I2 =79%). The prevalence by each tendinopathy was: plantar heel pain (44%, 95% CI: 17%-75%, n=2, I2 =96%), lateral epicondylalgia (42%, 95% CI: 30%-56%, n=2, I2 =30%), insertional Achilles tendinopathy (38%, 95% CI: 20%-60%, n=2, I2 = 71%), greater trochanteric pain syndrome (32%, 95% CI: 26%-39%, n=2, I2 =0%), patellar-quadricipital tendinopathy (16%, 95% CI: 5%-41%, n=3, I2 =29%), noninsertional Achilles tendinopathy (11%, 95% CI: 2%-41%, n=5, I2 =86%).</p><p><strong>Conclusion: </strong>The results of this meta-analysis suggests the presence of neuropathic-like symptoms in 30% of participants with painful tendinopathy, although this prevalence rate depends on specific condition. Identification of neuropathic symptoms in musculoskeletal pain conditions is important for diagnosis as it impacts its management.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Individual Psychological Factors and Cumulative Psychological Distress on Prospective Pain Quality in Older Adults With Chronic Low Back Pain.","authors":"Patrick J Knox, Corey B Simon, Ryan T Pohlig, Jenifer M Pugliese, Peter C Coyle, Jaclyn M Sions, Gregory E Hicks","doi":"10.1097/AJP.0000000000001294","DOIUrl":"10.1097/AJP.0000000000001294","url":null,"abstract":"<p><strong>Objective: </strong>Although pain quality may be a component of the geriatric chronic pain experience that influences disability, no research has investigated the psychological underpinnings of pain quality in any geriatric chronic pain population. We sought to address this knowledge gap by examining associations between both general (ie, depressive symptoms) and pain-specific psychological risk factors (ie, fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) and prospective pain quality in older adults with chronic low back pain.</p><p><strong>Methods: </strong>Questionnaires for each psychological factor were collected at baseline, while pain quality was measured by the McGill Pain Questionnaire at baseline and 12 months. Preliminary analyses identified pain catastrophizing as the individual factor with the highest correlation to future pain quality for subsequent analyses. To assess if baseline psychological factors were cumulatively associated with 12-month pain quality, questionnaire values were entered into principal component analysis to yield a combined psychological component score. Robust regression models with HC3 standard errors were used to examine associations between baseline psychological risk factors (both individually and cumulatively) and prospective pain quality.</p><p><strong>Results: </strong>In adjusted analyses, higher baseline pain catastrophizing independently predicted worse pain quality at 12 months ( b =0.342, t =4.225, P <0.001). Similarly, higher baseline psychological component scores were independently associated with worse prospective pain quality after adjustment ( b =3.816, t =4.518, P <0.001).</p><p><strong>Discussion: </strong>The combined psychological component score had comparatively stronger predictive ability than pain catastrophizing alone; however, overall model prediction was modest, suggesting that future research is needed to identify other biopsychosocial variables that may impact pain quality in the geriatric chronic LBP population.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12369281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Engagement in Digital Self-management Interventions for Chronic Pain: A Systematic Review.","authors":"R Ross MacLean, Rachel Shor, Erin D Reilly, Lillian Reuman, Chelsey Solar, Allison M Halat, Diana M Higgins","doi":"10.1097/AJP.0000000000001289","DOIUrl":"10.1097/AJP.0000000000001289","url":null,"abstract":"<p><strong>Objectives: </strong>Digital interventions promise to increase access to non-pharmacological chronic pain treatment and reduce burden for both individuals seeking care and pain providers/clinics. Unfortunately, despite early evidence of efficacy, engagement in self-management digital interventions for chronic conditions is typically low. A comprehensive analysis into how engagement in these programs is measured and reported is warranted. The current systematic review evaluated engagement in digital self-management interventions for chronic pain and identified gaps to improve reporting of engagement data.</p><p><strong>Methods: </strong>We conducted a pre-registered systematic review using Boolean search terms to identify digital chronic pain self-management interventions that did not include clinician support. After removal of duplicates and screening, 150 full-text manuscripts were assessed, and 43 studies met inclusion criteria. Data was extracted and examined from included manuscripts.</p><p><strong>Results: </strong>Of the 43 included articles, five articles were based on 2 separate datasets, resulting in a final sample of 41 unique datasets representing 4205 participants that were mostly non-Hispanic White, female, and with at least some college education. Approximately 10% of studies did not report any data related to system use or self-reported engagement. Most engagement data consisted of mean system use variables, with a handful of studies describing self-reported use of skills and very few studies examining demographic variables associated with engagement.</p><p><strong>Discussion: </strong>To address identified gaps in the reviewed literature, we suggest guidelines for collecting and reporting engagement in digital chronic pain interventions. Consistent reporting of engagement data will improve evaluation, efficacy, and improvement of interventions designed to assist individuals who may otherwise not receive non-pharmacological pain treatment.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Psychological Factors Explain the Persistence of Symptoms in Individuals With Rotator Cuff-related Shoulder Pain? A Prospective Cohort Study.","authors":"Dayana Patricia Rosa, Marc-Olivier Dubé, Simon Beaulieu-Bonneau, Alex Scott, Hugo Masse-Alarie, Jean-Sébastien Roy","doi":"10.1097/AJP.0000000000001280","DOIUrl":"https://doi.org/10.1097/AJP.0000000000001280","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether psychosocial factors, such as resilience, perceived stress, catastrophizing, anxiety, depression, pain self-efficacy, and social support, explain the persistence of pain and disability in individuals with rotator cuff-related shoulder pain (RCRSP) following an education program.</p><p><strong>Methods: </strong>One hundred forty-three individuals with persistent RCRSP were included in this prospective cohort study. At baseline, participants completed self-reported questionnaires related to pain, disability, and psychosocial constructs, including resilience, stress, catastrophizing, anxiety and depressive symptoms, pain self-efficacy, and social support. Thereafter, participants took part in an educational program aimed at promoting self-management of RCRSP that included 2 meetings with a physiotherapist. After 12 and 24 weeks, participants filled out pain and disability questionnaires and, based on their scores, were classified as having persistent shoulder pain or as recovered.</p><p><strong>Results: </strong>A univariable modified Poisson regression showed that higher perceived stress (RR adjusted : 1.02; 95% CI: 1.01-1.04), catastrophizing (RR adjusted : 1.01; 95% CI: 1.01-1.02), symptoms of depression (RR adjusted : 1.03; 95% CI: 1.01-1.06) and anxiety (RR adjusted : 1.03; 95% CI: 1.01-1.06), along with lower resilience (RR adjusted : 0.90; 95% CI: 0.81-1.00), were associated with ongoing RCRSP at 12 weeks. In addition, reduced pain self-efficacy was associated with persistent pain at both 12 weeks (RR adjusted : 0.98; 95% CI: 0.97-0.99) and 24 weeks (RR adjusted : 0.99; 95% CI: 0.98-1.00). Multivariable regression indicated that only pain self-efficacy served as a protective factor against persistent RCRSP (RR adjusted : 0.98; 95% CI: 0.97-0.99).</p><p><strong>Discussion: </strong>This study sheds light on the impact of psychosocial factors on persistent RCRSP, underscoring the importance of positive beliefs in pain management. Importantly, pain self-efficacy emerges as a key factor in recovery.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":"41 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Effectiveness of Noninvasive Brain Stimulation for the Treatment of Pain, Fatigue, and Sleep Quality in Fibromyalgia. A Systematic Review With Network Meta-Analysis.","authors":"Ishtiaq Ahmed, Rustem Mustafaoglu, Aamir R Memon, Rubab Zafeer, Huanyu Xiong, Sofia Straudi, Nils Runge","doi":"10.1097/AJP.0000000000001282","DOIUrl":"10.1097/AJP.0000000000001282","url":null,"abstract":"<p><strong>Objectives: </strong>There is tentative evidence to support the analgesic effects of noninvasive brain stimulation (NiBS) in fibromyalgia (FM), but a comprehensive synthesis is lacking. This systematic review with network meta-analysis (NMA) aimed to determine the relative effectiveness of different NiBS techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) in FM, and to identify the optimal stimulation location and intensity/frequency.</p><p><strong>Methods: </strong>Four databases were searched until July 9, 2023 for randomized trials (RCTs) comparing NiBS in FM. Pain was the primary outcome, while fatigue and sleep were secondary outcomes. A frequentist NMA calculated standardized-mean-differences (SMDs) for pain, with pairwise meta-analysis for fatigue and sleep. Bias was assessed with the Cochrane-risk-of-bias-tool (RoB-2.0), and evidence certainty through confidence-in-NMA.</p><p><strong>Results: </strong>Forty-three RCTs with 2120 participants were included. NMA showed that low frequency (LF)-rTMS (SMD: -1.20, 95% CI: -1.82 to -0.58), dual tDCS (SMD: -0.91, 95% CI: -1.82 to -0.58), and high frequency (HF)-rTMS (SMD: -0.58, 95% CI: -1.00 to -0.17) likely results in a reduction in pain intensity at the end of intervention compared with sham stimulation. For stimulation location, right dorsolateral prefrontal cortex (DLPFC)(SMD: -1.42, 95% CI: -2.69 to -0.15), bilateral DLPFC (SMD: -0.94, 95% CI: -1.82 to -0.05), and left primary motor cortex (M1)(SMD: -0.49, 95% CI: -0.85 to -0.14) likely results in reduction in pain intensity at the end of intervention, with DLPFC maintaining effects in short-term. LF-rTMS over DLPFC (SMD: -1.42, 95% CI: -2.69 to -0.15) and HF-rTMS over M1 (SMD: -0.78, 95% CI: -1.39 to -0.18) likely results in the reduction in pain intensity at the end of intervention, with LF-rTMS over right DLPFC maintaining effects in the short term. NiBS appears to be safe and may reduce fatigue and improve sleep quality.</p><p><strong>Discussion: </strong>Excitatory stimulation like HF-rTMS over M1 and inhibitory like LF-rTMS over DLPFC may yield better results.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}