Clinical Journal of Pain最新文献

{"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}

{"title":"Comparing Analgesic Efficacy of Different Regional Blocks After Single-incision Video-assisted Thoracoscopic Surgery.","authors":"Gu-Yue Liu, Fu-Shan Xue, Mu Jin","doi":"10.1097/AJP.0000000000001287","DOIUrl":"10.1097/AJP.0000000000001287","url":null,"abstract":"","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":"143659419","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":"Toward Validation of Clinical Measures to Discriminate Between Nociceptive, Neuropathic, and Nociplastic Pain: Cluster Analysis of a Cohort With Chronic Musculoskeletal Pain.","authors":"Paul W Hodges, Raimundo Sanchez, Shane Pritchard, Adam Turnbull, Andrew Hahne, Jon Ford","doi":"10.1097/AJP.0000000000001281","DOIUrl":"10.1097/AJP.0000000000001281","url":null,"abstract":"<p><strong>Objectives: </strong>The International Association for the Study of Pain defines 3 pain types presumed to involve different mechanisms-nociceptive, neuropathic, and nociplastic. Based on the hypothesis that pain types should guide the matching of patients with treatments, work has been undertaken to identify features to discriminate between them for clinical use. This study aimed to evaluate the validity of features to discriminate between pain types.</p><p><strong>Materials and methods: </strong>Subjective and physical features were evaluated in a cohort of 350 individuals with chronic musculoskeletal pain attending a chronic pain management program. The analysis tested the hypothesis that, if features nominated for each pain type represent 3 different groups, then (1) cluster analysis should identify 3 main clusters of patients, (2) these clusters should align with the pain type allocated by an experienced clinician, (3) patients within a cluster should have high expression of the candidate features proposed to assist identification of that pain type. Supervised machine learning interrogated features with the greatest and least importance for discrimination, and probabilistic analysis probed the potential for the coexistence of multiple pain types.</p><p><strong>Results: </strong>Results confirmed that data could be best explained by 3 clusters. Clusters were characterized by a priori specified features and agreed with the designation of the experienced clinician with 82% accuracy. Supervised analysis highlighted features that contributed most and least to the classification of pain type, and probabilistic analysis reinforced the presence of mixed pain types.</p><p><strong>Discussion: </strong>These findings support the foundation for further refinement of a clinical tool to discriminate between pain types.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544526","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":"Pain Trajectories in Pediatric Inflammatory Bowel Disease: Disease Severity, Optimism, and Pain Self-efficacy.","authors":"A Natisha Nabbijohn, Ian R Newby-Clark, David Mack, Alain Stintzi, C Meghan McMurtry","doi":"10.1097/AJP.0000000000001279","DOIUrl":"10.1097/AJP.0000000000001279","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to characterize pain intensity (average, worst) and disease severity in youth with inflammatory bowel disease in the 12-month postdiagnosis, and to examine the relation between pain and risk (disease severity) and resilience (optimism, pain self-efficacy) factors over time.</p><p><strong>Methods: </strong>Data collection ran from February 2019 to March 2022. Newly diagnosed youth aged 8 to 17 with IBD completed numerical rating scales for average and worst pain intensity, Youth Life Orientation Test for optimism, and Pain Self-Efficacy Scale for pain self-efficacy through REDCap; weighted Pediatric Crohn's Disease Activity Index and the Pediatric Ulcerative Colitis Activity Index were used as indicators of disease severity. Descriptive statistics characterized pain and disease severity. Multilevel modeling explored relations between variables over time, including moderation effects of optimism and pain self-efficacy.</p><p><strong>Results: </strong>At baseline, 83 youth ( Mage =13.9, SD=2.6; 60.2% Crohn's disease; 39.8% female) were included. Attrition rates at 4 and 12 months were 6.0% and 9.6%, respectively. Across time, at least 52% of participants reported pain. Participants in disease remission increased from 4% to 70% over 12 months. Higher disease severity predicted higher worst pain, regardless of the time since diagnosis. Higher pain self-efficacy (1) predicted lower average and worst pain, especially at later time points and (2) attenuated the association between disease severity and worst pain when included as a moderator. Higher optimism predicted lower worst pain.</p><p><strong>Discussion: </strong>Pain is prevalent in pediatric inflammatory bowel disease and impacted by disease severity, pain self-efficacy, and optimism. Findings highlight modifiable intervention targets.</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":"143574390","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":"https://doi.org/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 (i.e., depressive symptoms) and pain-specific psychological risk factors (i.e., 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":2.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship Between Pain Catastrophizing, Kinesiophobia, Central Sensitization and Cognitive Function in Patients with Chronic Low Back Pain.","authors":"Cory Alcon, Cassidy Krieger, Kaley Neal","doi":"10.1097/AJP.0000000000001293","DOIUrl":"https://doi.org/10.1097/AJP.0000000000001293","url":null,"abstract":"<p><strong>Objectives: </strong>Adverse pain behaviors and alterations in cognitive performance are shown to negatively impact the management of chronic low back pain (CLBP). Relationships between these variables are poorly recognized yet may impact the efficacy of interventions that target them. This study aimed to investigate the relationship between levels of pain catastrophizing (PC), kinesiophobia, central sensitization (CS) and cognitive performance in participants with CLBP.</p><p><strong>Methods: </strong>Participants 18-65 with CLBP completed pain behavior measures (Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK), and the Central Sensitization Inventory (CSI)) and cognitive performance tests (Stroop Color Word Test (SCWT), Comprehensive Trail Making Test - Second Edition (CTMT2), and the Coding test).</p><p><strong>Results: </strong>SCWT performance was positively correlated with PCS and TSK whereas CTMT2 inhibitory control and set-shifting, as well as coding performance were each negatively correlated with PCS and TSK. The high PC group demonstrated significantly larger attentional interference times on the SCWT, poorer inhibitory control and set-shifting performance on the CTMT2, and lesser performance on the coding test than the low PC group. The high kinesiophobia group performed significantly poorer on the SCWT than the low kinesiophobia group.</p><p><strong>Discussion: </strong>This study demonstrates that PC and kinesiophobia have negative influences on cognitive performance in those with CLBP. Specifically, attentional interference, inhibitory control, set-shifting, and sustained working memory functions were affected. These deficits have the potential to influence how patients respond to therapeutic interventions of cognitive focus (i.e., pain neuroscience education) and highlight an important variable that should be considered when managing CLBP.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052241","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":"https://doi.org/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 Newcastle-Ottawa Quality Assessment Scale in cohort/case-control studies or 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 1,285 studies identified, eight (one case-control, five cohorts and two clinical trials) met inclusion criteria. The sample included 920 subjects with painful tendinopathy/overuse injury (47.6% female, age: 51, SD: 12.5 years). 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%), non-insertional Achilles tendinopathy (11%, 95%CI 2%-41%, n=5, I2=86%).</p><p><strong>Conclusion: </strong>This meta-analysis suggests the presence of neuropathic-like symptoms in 30% of subjects 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":"2025-04-14","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":"Complex Regional Pain Syndrome: Navigating Diagnostic Complexities.","authors":"Floris V Raasveld, Margaux Wolff, Anna Luan, David Hao, Ian L Valerio, Kyle R Eberlin","doi":"10.1097/AJP.0000000000001291","DOIUrl":"https://doi.org/10.1097/AJP.0000000000001291","url":null,"abstract":"<p><strong>Objective: </strong>Complex Regional Pain Syndrome (CRPS) presents significant diagnostic challenges due to its diverse clinical presentation. This study aims to describe the diagnostic trajectory of patients labeled with CRPS, focusing on referral patterns, application of the Budapest criteria, and accuracy of CRPS diagnosis.</p><p><strong>Methods: </strong>A retrospective study was conducted of 53 patients treated for CRPS at a peripheral nerve clinic within a tertiary care center (2020-2024). Patient demographics, referral patterns, events leading to CRPS diagnosis, and diagnostic tests were analyzed. Three clinicians (two plastic surgeons, one pain medicine specialist) retrospectively assessed the validity of CRPS diagnoses using the Budapest criteria. Inter-rater reliability (IRR) for CRPS presence and type was calculated using Cohen's kappa (κ).</p><p><strong>Results: </strong>Among the 53 patients, the median time from the first mention of CRPS to referral to the nerve clinic was 1.3 years (IQR:0.4-3.6). The Budapest criteria had been assessed in 26% of patients pre-evaluation. In 33% of patients labeled with CRPS type I, an inciting nerve injury was identified. Following retrospective assessment, 42% of patients were determined to have CRPS by all raters, 26% were determined not to have CRPS, and 32% showed inconsistent agreement. The IRR for CRPS diagnosis and type ranged from minimal to moderate (κ=0.32-0.72).</p><p><strong>Discussion: </strong>Our findings highlight variability in the application of the Budapest criteria for CRPS diagnosis, as well as inconsistencies in its retrospective application. Potentially treatable peripheral nerve injuries should be addressed prior to CRPS diagnosis. These findings may help improve early diagnostic assessment in patients with chronic pain.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006618","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":"Hyperbaric Oxygen Therapy for Management of Complex Regional Pain Syndrome.","authors":"Joon Cha, Gerardo Bosco, Richard E Moon, Giorgio Melloni, Enrico M Camporesi","doi":"10.1097/AJP.0000000000001276","DOIUrl":"10.1097/AJP.0000000000001276","url":null,"abstract":"<p><strong>Objectives: </strong>Complex regional pain syndrome remains a challenging condition characterized by severe, persistent pain and a variety of inflammatory and trophic symptoms. This study aimed to analyze the current literature to evaluate hyperbaric oxygen therapy (HBOT)'s efficacy in treating complex regional pain syndrome (CRPS), focusing on both sympathetically maintained pain (SMP) and sympathetically independent pain (SIP) subtypes.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in PubMed Clinical Queries using the MeSH term \"Complex Regional Pain Syndromes\" OR the keyword \"CRPS\" AND \"Hyperbaric Oxygen Therapy\" OR the keyword \"HBOT.\" The selected publication types included a randomized controlled trial, a retrospective observational study, a comparative study, a retrospective case series, and case reports. The search was restricted to articles published in English between January 1994 and October 2024. The results from the search were used to compile this review. Patients were categorized into SMP, SIP, or indeterminate groups based on the presence of prior sympathetic nerve block history or disease duration.</p><p><strong>Results: </strong>Thirteen studies involving 280 participants were reviewed. Of the patients, 42.5% were categorized as SMP, 48.2% as SIP, and 9.3% as indeterminate. HBOT treatment ranged from 3 to 63 sessions, typically using 2.4 atmospheres absolute for 90 minutes. The results indicated significant symptom relief and functional improvement across both SMP and SIP subtypes, suggesting the broad efficacy of HBOT for CRPS management.</p><p><strong>Discussion: </strong>This review of the current literature suggests that HBOT may offer significant symptom relief, regardless of CRPS subtype or disease duration. HBOT's anti-inflammatory and neuroplasticity promoting properties make it a valuable noninvasive option for CRPS patients, potentially improving outcomes when combined with other therapeutic modalities. Further research is necessary to refine patient selection and optimize treatment protocols.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061425","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":"Measuring and Contextualizing School Refusal in Pediatric Chronic Pain: Establishing the Psychometric Properties of the SChool REfusal EvaluatioN Measure for Youth With Chronic Pain.","authors":"Catherine E Stewart, Rupa Gambhir, Sana Aladin, Deirdre E Logan","doi":"10.1097/AJP.0000000000001278","DOIUrl":"10.1097/AJP.0000000000001278","url":null,"abstract":"<p><strong>Objective: </strong>School refusal is a longstanding difficulty for youth with chronic pain. Yet, research is hindered by a lack of adequate measurement tools to assess and describe the complex interpersonal and system-level factors contributing to school refusal. This study investigates the utility of the SChool REfusal EvaluatioN (SCREEN) measure and its psychometric properties in a sample of youth with chronic pain.</p><p><strong>Materials and methods: </strong>Youth undergoing multidisciplinary evaluation at outpatient pain clinics completed self and parent-report questionnaires. Descriptive data examined school refusal. Internal consistency and construct validity were tested. Multiple regressions examined the parent and child factors related to school refusal.</p><p><strong>Results: </strong>In all, 698 youth with chronic pain participated. Two-thirds reported symptoms suggesting at-risk or clinically significant symptoms of school refusal. Cronbach alpha scores were in the acceptable to good range on the SCREEN. Convergent validity for the interpersonal discomfort subscale of the SCREEN was established. The child's fear of pain, stress, peer relationships, and parent protective behaviors significantly correlated with SCREEN total scores. Participants enrolled in fully in-person school during the study period reported significantly higher scores on the interpersonal discomfort scale than those enrolled in remote learning.</p><p><strong>Discussion: </strong>Our results provide evidence that youth with chronic pain experience significant challenges with school functioning and offer some support for the reliability and validity of the SCREEN in a sample of youth with chronic pain, a population for which few appropriate measures of school functioning have been established. The SCREEN measure may aid in assessing school refusal, with good clinical potential to quantify risk and identify modifiable factors.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257309","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}