Journal of Pain最新文献

{"title":"Pain disparities among Medicaid beneficiaries with chronic low back pain: The differential role of psychological distress","authors":"Fenan S. Rassu ,&nbsp;Kate I. Minick ,&nbsp;Tyler Bardsley ,&nbsp;Tom H. Greene ,&nbsp;Richard L. Skolasky ,&nbsp;Julie M. Fritz","doi":"10.1016/j.jpain.2025.105550","DOIUrl":"10.1016/j.jpain.2025.105550","url":null,"abstract":"<div><div>This study examined associations between Medicaid status and pain-related experiences in adults with chronic low back pain (cLBP), and examined whether the association attenuated after adding psychological distress. This cross-sectional analysis used baseline data from 751 adults with cLBP (112 Medicaid, 639 non-Medicaid) from a multi-site clinical trial across three healthcare systems. Linear regressions were used to assess associations between Medicaid status and pain outcomes (intensity, physical function, interference), controlling for demographic and clinical covariates including race, followed by sequential regression to examine the role of psychological distress (anxiety/depression composite). In adjusted models, Medicaid beneficiaries reported significantly higher pain intensity (B = 0.906, 95% CI [0.555, 1.257]), lower physical function (B = −1.556, 95% CI [-2.642, −0.470]), and greater pain interference (B = 1.243, 95% CI [0.034, 2.452]). Independently, Black participants reported higher pain intensity than White participants. Sequential regression analyses revealed that psychological distress differentially accounted for these associations. It was associated with substantial attenuation of pain interference, such that the association with Medicaid status was no longer significant, but only partially explained the associations for pain intensity and physical function, which remained significant after accounting for distress. Pain disparities for Medicaid beneficiaries appear to reflect the dual burdens of heightened psychological distress and persistent systemic factors not fully explained by mental health. These findings underscore the need for a two-pronged approach that integrates clinical care to address psychosocial needs while advancing equitable health policy to address systemic barriers that may contribute to worse pain outcomes.</div></div><div><h3>Perspective</h3><div>Among adults with chronic low back pain, psychological distress largely accounted for the Medicaid-related disparity in pain interference, but not in pain intensity or physical function. This highlights that addressing these disparities may require both integrated mental health care for the individual and equitable health policies that target systemic barriers.</div></div>","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":"36 ","pages":"Article 105550"},"PeriodicalIF":4.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058676","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":"Neonatal pain experience and pain sensitivity trajectories in preterm infants: A longitudinal study of flexion withdrawal reflex thresholds over the first two years of age","authors":"Weizi Wu ,&nbsp;Wenxing Wang ,&nbsp;Aolan Li ,&nbsp;Jie Chen ,&nbsp;Shabnam Lainwala ,&nbsp;Adam P. Matson ,&nbsp;Ming-Hui Chen ,&nbsp;Jinlei Li ,&nbsp;Xiaomei Cong","doi":"10.1016/j.jpain.2025.105558","DOIUrl":"10.1016/j.jpain.2025.105558","url":null,"abstract":"<div><div>This study evaluated associations between early neonatal experiences during neonatal intensive care unit (NICU) hospitalization and the development of pain sensitivity, measured by flexion withdrawal reflex (FWR) thresholds, through 18–24 months corrected age in preterm infants. This longitudinal study (2017–2022) in Northeast U.S. specialized level III and IV NICUs monitored preterm infants for approximately 4–6 weeks for NICU pain/stress exposure (using the NICU Infant Stressor Scale - NISS) and analgesic use, assessing FWR thresholds post-discharge at 1, 4, 8–12, and 18–24 months of corrected age. 122 very preterm infants (63.1% male, 82.0% non-Black, 70.5% non-Hispanic) were enrolled, with a mean gestational age of 28.2 ± 2.4 weeks. The mean daily weighted NISS was 90.9 ± 19.9 (acute: 70.7; chronic: 20.2). FWR thresholds declined over time (1.11–0.7 g), suggesting increased population-level sensitivity. However, higher individual cumulative pain/stress exposure at NICU was associated with higher FWR thresholds (lower sensitivity) over time (β = 0.039, p = 0.042). The longitudinal effect of the pain/stress exposures (NISS score) on pain sensitivity (FWR) increased markedly over time in Black females, but was not observed in the Black male, Non-Black female, and Non-Black male subgroups (p &lt; 0.05). Neonatal pain/stress exposure appears to reprogram long-term pain sensitivity development. These findings underscore the critical need for optimized pain management and tailored neuroprotective strategies for all high-risk infants.</div></div><div><h3>Perspective</h3><div>The FWR thresholds reflect the maturation of the nociceptive system in preterm infants from birth through 18–24 months of age. Neonatal cumulative pain/stress exposure is associated with altered maturation of FWR thresholds.</div></div>","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":"37 ","pages":"Article 105558"},"PeriodicalIF":4.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058691","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":"Incidence and risk factors for care-induced pain in adults with physical disability: An observational study","authors":"Gwenaël Cornec ,&nbsp;Victor Plantier ,&nbsp;Arnaud Brasseur ,&nbsp;Emmanuelle Courtois-Communier ,&nbsp;Sylvain Brochard ,&nbsp;Amandine Dubois","doi":"10.1016/j.jpain.2025.105554","DOIUrl":"10.1016/j.jpain.2025.105554","url":null,"abstract":"<div><div>Care facilities for adults with physical disability provide a range of personal, medical care and rehabilitation support involving physical contact. Little is known about pain induced by these physical acts in this setting. This non interventional, observational, prospective, multicentre study aimed to measure the incidence of care-induced pain in adults with physical disability, and aimed to identify risk factors and prevention methods used. The setting was 16 randomly drawn neurological rehabilitation centres (n=5) and long-term care facilities (n=11) in 4 counties of Brittany, France. 163 adults with physical disability were randomly selected (median [IQR] age: 52 [40–62] years; sex ratio: 1.7). The main pathologies were acquired brain injury, cerebral palsy and spinal cord injury. All physical acts performed over 5 days and 1 night were recorded and pain was measured using FLACC-r. Descriptive analyses and a multivariate model predicting FLACC-r intensity were conducted. Of the 5580 acts analysed, 6% were rated as painful and 36% of the participants experienced care-induced pain at least once during the study period. Attendant care was the most frequent and frequently painful class of act. In the multivariate analysis, level of dependency, physical act class and sex predicted FLACC-r intensity (all p&lt;0.01). Pain prevention means were not routinely used (12%). Care-induced pain is frequently experienced by adults with physical disability in neurological rehabilitation centres and long-term care facilities during any act involving direct physical contact and appears to be a lifespan issue.</div></div><div><h3>Perspective</h3><div>This study measured an incidence of 6% of pain during usual physical acts in adults with physical disability. Any professional involved should be aware of this risk. Routine pain assessment and prevention are keys to improve practices, therapeutic alliance and quality of life for adults with physical disability.</div></div>","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":"37 ","pages":"Article 105554"},"PeriodicalIF":4.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058602","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":"Assessing the reliability and association of pain ratings and skin conductance responses: Insights from habituation and sensitization to pain","authors":"Maite M. van der Miesen ,&nbsp;Catherine J. Vossen ,&nbsp;Judith Eck ,&nbsp;Sophie Kühne ,&nbsp;Elbert A.J. Joosten ,&nbsp;David E.J. Linden ,&nbsp;Judith C. Peters","doi":"10.1016/j.jpain.2025.105557","DOIUrl":"10.1016/j.jpain.2025.105557","url":null,"abstract":"<div><div>Repeated painful stimulation results in substantial inter-individual differences in habituation and sensitization. The extent to which these responses reflect state versus trait characteristics remains unclear, highlighting the need to assess the reliability of these differences over time. Furthermore, the association between subjective pain ratings and skin conductance responses (SCR) has not been examined in this context. This preregistered study investigated profiles of habituation and sensitization to pain across two sessions using pain ratings and SCR. Participants underwent repeated painful electrical stimulation over two sessions separated by four weeks, receiving 75 stimuli across three runs per session. Pain intensity was rated after each stimulus, and continuous SCRs were recorded. Our results demonstrated moderate test-retest reliability of both pain ratings and SCRs, with within-run measures showing greater consistency than across-run measures. Remarkably, participants displaying sensitization exhibited higher reliability than those with habituation or no-change patterns. High test-retest reliability could suggest a trait-like response with reduced adaptability to repeated stimulation, while a higher variability (and thus low test-retest reliability) indicates state-dependent flexibility and adaptability. Our results suggest that interventions to modulate pain could be targeted at changing such sensitization patterns and promoting habituation. Furthermore, pain ratings showed diverse trajectories of habituation and sensitization, whereas SCRs predominantly habituated. This dissociation between subjective pain perception and autonomic responses challenges the prevailing view that higher pain ratings correspond to elevated SCRs. Together, these results underscore the importance of considering habituation and sensitization dynamics, with subjective and physiological measures providing complementary insights into the multidimensional pain response.</div></div><div><h3>Perspective</h3><div>Repeated painful stimulation resulted in patterns of habituation and sensitization, with large individual variability. Test-retest reliability was moderate, with higher consistency for individuals who sensitize. A dissociation between ratings and SCR was demonstrated, with diverse response patterns of ratings and mostly habituation of the SCR.</div></div>","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":"37 ","pages":"Article 105557"},"PeriodicalIF":4.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058656","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":"From fragmented services to whole-person care: Rethinking youth pain-mental health management.","authors":"Erma Pratiwi Nufi","doi":"10.1016/j.jpain.2025.105542","DOIUrl":"https://doi.org/10.1016/j.jpain.2025.105542","url":null,"abstract":"","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":" ","pages":"105542"},"PeriodicalIF":4.0,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031040","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 association of sleep-related issues with chronic pain and high-impact chronic pain incidence in U.S. adults: A 1-year representative cohort study","authors":"Alberto Herrero Babiloni ,&nbsp;Barbara Fonseca Alonso ,&nbsp;Marc O. Martel ,&nbsp;Ian A. Boggero ,&nbsp;Gilles J. Lavigne ,&nbsp;Adam P. Goode ,&nbsp;Flavia P. Kapos","doi":"10.1016/j.jpain.2025.105541","DOIUrl":"10.1016/j.jpain.2025.105541","url":null,"abstract":"<div><div>In this longitudinal cohort study, we used nationally representative data from the U.S. National Health Interview Survey (n = 7826 for chronic pain; n = 9195 for high-impact chronic pain [HICP]) to examine the association of trouble sleeping and tiredness with 1-year incidence of chronic pain and HICP in U.S. adults. We also evaluated group-specific estimates by age, sex, and race/ethnicity. The 1-year cumulative incidence of chronic pain was 10.6% (95% CI: 9.8–11.5%) and of HICP was 4.2% (95% CI: 3.7–4.8%). In adjusted models, individuals reporting trouble sleeping “more than half the days” had a 63% higher risk of chronic pain (RR = 1.63, 95% CI: 1.16–2.28) and a 101% higher risk of HICP (RR = 2.01, 95% CI: 1.29–3.13). Those reporting tiredness “nearly every day” had an 89% higher risk of chronic pain (RR = 1.89, 95% CI: 1.32–2.69) and 166% higher risk of HICP (RR = 2.66, 95% CI: 1.76–4.02). Stratified models revealed greater pain incidence in non-Hispanic/Latino (NH) Asian and NH Black or African American individuals with tiredness symptoms. Findings support addressing sleep and daily tiredness to prevent chronic pain, particularly in racially and ethnically minoritized populations.</div></div><div><h3>Perspective</h3><div>Sleep disturbances and tiredness predict the development of both chronic pain and high-impact chronic pain one year later, even after stratifying by sociodemographic characteristics. Stratified analyses revealed important racial/ethnic disparities, highlighting the potential of addressing sleep-related mechanisms to prevent pain-related disability and reduce inequities in chronic pain outcomes<strong>.</strong></div></div>","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":"36 ","pages":"Article 105541"},"PeriodicalIF":4.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016514","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 evidence for biomechanical and physiological parameters as biomarkers to discriminate between individuals with and without non-specific neck pain using sensor devices: A systematic review with meta-analysis.","authors":"Ali Cihan Dagli, Beyza Yazgan Dagli, Emad Al-Yahya, Lucas Fonseca, Praminda Caleb-Solly","doi":"10.1016/j.jpain.2025.105543","DOIUrl":"10.1016/j.jpain.2025.105543","url":null,"abstract":"<p><p>Neck pain is among the most prevalent musculoskeletal conditions worldwide. The underlying cause mostly remains unidentified, classified as non-specific neck pain. Pain can alter movement patterns and physiological responses, suggesting that certain biomechanical and physiological changes may serve as objective biomarkers for non-specific neck pain. In recent years, growing interest in sensor technologies has enabled accurate and objective measurement of these changes. This is the first review to systematically summarise current evidence on the capability of biomechanical and physiological parameters, measured via sensors, to differentiate individuals with non-specific neck pain from asymptomatic controls, and evaluate their discriminative performance. Comprehensive searches of six databases (CINAHL, MEDLINE, EMBASE, AMED, IEEE Xplore, PEDro), grey literature, and reference lists (inception to August 20, 2025) yielded 53 observational studies for qualitative synthesis, with meta-analysis on 27. Meta-analysis indicates robust evidence linking non-specific neck pain with reduced neck range of motion, impaired joint position error, decreased step length and gait speed, reduced sway area, increased electromyographic activity of the sternocleidomastoid muscle, and reduced heart rate variability. Narrative findings reported altered neck movement speed, acceleration, and smoothness during functional tasks (e.g., reach and lifting). Classification studies showed high discriminative performance using machine learning and statistical techniques, with accuracies of 71.9-90%, sensitivities of 76.3-100%, and specificities of 77.6-90%, especially for gait and electromyography parameters. The findings highlight biomechanical and physiological alterations in non-specific neck pain that can serve as objective biomarkers. Clinically, these insights could offer support to enhance assessment and inform rehabilitation strategies. PERSPECTIVE: This comprehensive review synthesises current evidence on physiological and biomechanical parameters as biomarkers in non-specific neck pain. While these parameters show promise for pain classification, their utility as biomarkers requires further evaluation and validation of their discriminative power for improved assessment and inform rehabilitation strategies.</p>","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":" ","pages":"105543"},"PeriodicalIF":4.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008524","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":"S100A12 correlates with inflammatory and pain symptoms in patients with chronic prostatitis/chronic pelvic pain syndrome","authors":"Marc Manthey ,&nbsp;Temuujin Dansranjav ,&nbsp;Hang Yan ,&nbsp;Adrian Pilatz ,&nbsp;Hans-Christian Schuppe ,&nbsp;Jens Rosellen ,&nbsp;Heidrun H. Krämer ,&nbsp;Elena Neumann ,&nbsp;Florian Wagenlehner ,&nbsp;Undraga Schagdarsurengin","doi":"10.1016/j.jpain.2025.105536","DOIUrl":"10.1016/j.jpain.2025.105536","url":null,"abstract":"<div><div>Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most prevalent urological condition in men under 50, characterized by persistent or recurrent pelvic and perineal pain, and significantly reduced quality of life. Reliable biomarkers for assessment and mechanistic understanding of pain remain limited. This retrospective case-control study consisting of 90 CP/CPPS patients (median age 29.4 years) and 90 age-matched healthy controls investigated the alarmin S100A12 as a potential biomarker linking inflammation to neurogenic pain. Seminal plasma, serum, and post-prostatic massage (PPM) urine samples were analyzed. S100A12 levels were significantly elevated in patients in seminal plasma (median 47.8 vs. 2.5 ng/ml, p&lt;0.001) and serum (median 49.2 vs. 17.4 ng/ml, p&lt;0.001). Seminal S100A12 correlated with inflammatory markers (ρ=0.551–0.686), CPSI pain scores (ρ=0.451, p&lt;0.001), and IPSS (ρ=0.342, p=0.001). Receiver operating characteristic analysis demonstrated superior diagnostic performance for seminal S100A12 (AUC=0.90, 95% CI: 0.77–0.93) compared to leukocyte count (AUC=0.60), IL-8 (AUC=0.70), and granulocyte elastase (AUC=0.50). S100A12 also correlated with sperm tail defects (ρ=0.445, p&lt;0.001), and inversely with motility (ρ=–0.306, p=0.003) and vitality (ρ=–0.273, p=0.005). In silico analysis of prostate single-cell RNA sequencing data identified <em>S100A12</em>-expressing <em>CXCR1</em>+ myeloid cells, suggesting a link to IL-8–mediated inflammation. PPM urine-derived leukocytes from patients showed increased expression of <em>RAGE</em> (p=0.006) and <em>CALCA</em> (p&lt;0.001), correlating with pain severity (ρ=0.541, p&lt;0.001). These findings implicate S100A12 in leukocyte–nerve interactions underlying pelvic pain and dysfunction, and support its use as a diagnostic biomarker and potential therapeutic target in CP/CPPS.</div></div><div><h3>Perspective</h3><div>This study identifies S100A12 as a potential biomarker of inflammation and pain in young CP/CPPS patients. The findings suggest a neuroimmune interaction involving S100A12, RAGE, and CGRP/NGF signaling, which may guide future patient stratification and therapeutic development targeting pain chronicity, inflammation, and reproductive dysfunction in CP/CPPS.</div></div>","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":"36 ","pages":"Article 105536"},"PeriodicalIF":4.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996826","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":"Letter to editor regarding DNMT3a contributes to bone cancer pain by epigenetic silencing of Kcnq2/Kcnq3 in dorsal root ganglion neurons.","authors":"Parth Aphale, Himanshu Shekhar, Shashank Dokania","doi":"10.1016/j.jpain.2025.105537","DOIUrl":"https://doi.org/10.1016/j.jpain.2025.105537","url":null,"abstract":"","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":" ","pages":"105537"},"PeriodicalIF":4.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006892","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":"Welfare policies, joint pain prevalence and educational gaps in 50 U.S. states from 2011 to 2021: A fixed effects analysis","authors":"Rui Huang ,&nbsp;Yuhang Li ,&nbsp;Feinuo Sun","doi":"10.1016/j.jpain.2025.105539","DOIUrl":"10.1016/j.jpain.2025.105539","url":null,"abstract":"<div><div>Research on geographic disparities in pain and arthritis-related outcomes is still in its infancy, with little attention to the developing trends over time and the role of state welfare policies in shaping pain disparities. This study examines 1) spatiotemporal trends of moderate/severe arthritis-related joint pain prevalence across 50 U.S. states, 2) educational disparities therein, and 3) the impact of welfare policies— i.e., Supplemental Nutrition Assistance Program, Earned Income Tax Credit, minimum wage, unemployment insurance, and Medicaid generosity. This study compiles 6-wave biennial state-level panel data using data from the Behavioral Risk Factor Surveillance System (BRFSS). Logistic regressions are conducted to estimate trends of joint pain prevalence, prevalence for different educational groups (i.e., less than high school, high school or some college, bachelor’s degree or above), and educational disparities. Incorporating policy data from the State Policy &amp; Politics Database (SPPD) and the Kaiser Family Foundation’s database (KFF), fixed effects regressions were used, with state- and year-fixed effects, to assess the impact of welfare policies. Results show that joint pain prevalence has risen in most states, with educational disparities in pain widening in over half, though both trends vary substantially across states. Colorado and North Dakota exhibit considerably sharper increases in both pain prevalence and educational inequalities. Generous Medicaid programs are associated with decreased joint pain prevalence for general population and the least-educated, and marginally linked to smaller educational inequalities therein. This study underscores the importance of state welfare policies in addressing pain disparities and calls for targeted interventions to support less-educated populations.</div></div><div><h3>Perspectives</h3><div>This article uses state-level panel data on arthritis-related pain and welfare policies to underscore the importance of studying macro-level policy determinants of pain and associated disparities.</div></div>","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":"36 ","pages":"Article 105539"},"PeriodicalIF":4.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001973","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}