Frontiers in pain research (Lausanne, Switzerland)最新文献

{"title":"Combined bidirectional spinal cord stimulation for refractory neuropathic pelvic pain: a case report.","authors":"Yakov Perper, Alana Taub, Jenifer Perper","doi":"10.3389/fpain.2026.1864829","DOIUrl":"10.3389/fpain.2026.1864829","url":null,"abstract":"<p><strong>Introduction: </strong>Refractory neuropathic pelvic pain significantly impairs quality of life and is notoriously difficult to treat. We present the case of a 63-year-old woman who developed severe pelvic pain following emergency open thoracic aortic aneurysm repair. Despite extensive pharmacologic, non-pharmacologic, and interventional treatments, she experienced minimal relief.</p><p><strong>Methods: </strong>To address her pain, we attempted a novel approach termed \"Combined Bidirectional\": anterograde (thoracic) and retrograde (sacral) spinal cord stimulator (SCS) placement, accompanied by combination therapy-high-frequency stimulation (HFX) at the thoracic spine and tonic stimulation at the sacral spine.</p><p><strong>Case description: </strong>Technical difficulties complicated retrograde sacral placement, and we discussed our approach to managing these challenges. Additionally, the patient developed unexpected hip pain with tonic sacral stimulation, prompting discontinuation of this modality and continuation of HFX thoracic stimulation alone.</p><p><strong>Conclusion: </strong>This case underscores both the potential advantages and challenges of combined bidirectional SCS for pelvic pain. Further research is warranted to clarify the efficacy and optimal application of this novel approach for refractory neuropathic pelvic pain.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1864829"},"PeriodicalIF":2.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment characteristics and safety profiles of Belbuca®, buprenorphine patch, and oral schedule II opioids among chronic low back pain patients without a positive history of opioid-use disorder: a retrospective US commercial claims analysis.","authors":"Vladimir Zah, Dimitrije Grbic, Filip Stanicic","doi":"10.3389/fpain.2026.1764842","DOIUrl":"10.3389/fpain.2026.1764842","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this retrospective study was to evaluate and compare the safety characteristics of patients with chronic low back pain (cLBP) without a recent positive history of opioid use disorder (OUD).</p><p><strong>Methods: </strong>This study was conducted using the Merative MarketScan® database (January 2019-December 2023). The first date of Belbuca®, buprenorphine patch, or oral schedule II (CII) opioid prescription was designated as the index date. The observational period covered a 6-month preindex period and a follow-up period that lasted until the end of index treatment or continuous healthcare coverage. Patients were required to have two low back pain diagnoses and no OUD in the preindex period and continuous healthcare coverage during the observational period. The primary outcomes were serious treatment-emergent adverse event (TEAE) rates reported as incidence rate ratios (IRR) or absolute incidence rate difference (IRD) per 1,000 person-years for TEAEs occurring in one cohort. Propensity-score matching was employed to balance differences in patient characteristics and minimize their impact on study outcomes.</p><p><strong>Results: </strong>There were no serious TEAEs associated with higher occurrence in the Belbuca® cohort compared with oral CII opioids. Belbuca® treatment was associated with a significantly lower rate of serious opioid abuse/dependence (IRD -33.76 per 1,000 person-years, <i>p</i> = 0.032), osteoarthritis (IRD -78.77 per 1,000 person-years, <i>p</i> = 0.001), urinary discomfort (IRD -146.28 per 1,000 person-years, <i>p</i> < 0.001), seizures (IRR 0.11, <i>p</i> = 0.019), dehydration (IRR 0.13, <i>p</i> = 0.003), abdominal pain (IRR 0.25, <i>p</i> < 0.001), and nausea/vomiting (IRR 0.30, <i>p</i> = 0.001). The subanalysis compared incidence rates of serious TEAEs between Belbuca® and buprenorphine patch cohorts. Belbuca® demonstrated higher rates of serious coronary artery disease (IRD 39.01 per 1,000 person-years, <i>p</i> = 0.035), cholecystitis (IRD 39.01 per 1,000 person-years, <i>p</i> = 0.035), and headache (IRD 39.01 per 1,000 person-years, <i>p</i> = 0.035). However, the buprenorphine patch cohort had higher incidence rates of serious QT prolongation (IRD -52.78 per 1,000 person-years, <i>p</i> = 0.009), opioid abuse/dependence (IRD -184.75 per 1,000 person-years, <i>p</i> < 0.001), confusion (IRR 0.10, <i>p</i> = 0.007), hypertension (IRR 0.22, <i>p</i> = 0.043), and cellulitis (IRR 0.41, <i>p</i> = 0.011).</p><p><strong>Conclusion: </strong>The study findings suggest that Belbuca® may have a favorable safety profile relative to oral CII opioids and buprenorphine patch treatments in cLBP patients without a positive history of OUD.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1764842"},"PeriodicalIF":2.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-related associations between psychoemotional factors and health-related quality of life in patients with chronic low back pain.","authors":"Mariia Ovdii, Mykola Kondratiuk, Lilia Yaremenko, Maria Prokopiv, Kateryna Potapova, Andrii Borysenko, Olena Lazarieva, Iurii Kuchyn","doi":"10.3389/fpain.2026.1872295","DOIUrl":"10.3389/fpain.2026.1872295","url":null,"abstract":"<p><strong>Introduction: </strong>Psychoemotional Factors Are Closely Associated With Health-Related Quality Of Life (Hrqol) In Individuals With Chronic Low Back Pain (Clbp). However, It Remains Unclear Whether These Associations Differ Between Women And Men.</p><p><strong>Aim: </strong>To Evaluate Sex-Stratified Associations Between Psychoemotional Factors And Hrqol Domains In Adults With Chronic Nonspecific Clbp.</p><p><strong>Material and methods: </strong>This Cross-Sectional Study Included 223 Adults With Chronic Nonspecific Clbp (138 Women And 85 Men) Assessed Before Initiation Of Outpatient Rehabilitation. Pain Intensity, Anxiety, Depression, Perceived Stress, Kinesiophobia, And Hrqol Were Evaluated Using Standardized Questionnaires. Primary Analyses Examined Associations Between Psychoemotional Thresholds And Eight Sf-36 Domains Separately In Women And Men. Secondary Analyses Assessed Severe Pain (Vas ≥7). Exploratory Logistic Regression Models With Sex-By-Variableinteraction Terms Were Additionally Performed. Multiple Testing Was Controlled Using The Benjamini-Hochberg False Discovery Rate Procedure.</p><p><strong>Results: </strong>The Prevalence Of Clinically Significant Anxiety, Depression, High Perceived Stress, And Kinesiophobia Did Not Differ Significantly Between Women And Men. In Sex-Stratified Analyses, Elevated Psychoemotional Burden In Women Was Primarily Associated With Lower Scores In Vitality, Mental Health, Social Functioning, And General Health. In Men, Associations Involved A Broader Range Of Hrqol Domains, Including Physical Functioning, Role Limitations, Bodily Pain, And General Health. In Secondary Analyses, High Kinesiophobia Was Associated With Severe Pain In Women (Or 9.00, 95% Ci 2.01-40.32; <i>Q</i> = 0.033), Whereas No Psychoemotional Indicator Remained Significantly Associated With Severe Pain In Men After Correction For Multiple Testing. However, Exploratory Sex-By-Variableinteraction Analyses Did Not Demonstrate Statistically Robust Interaction Effects After Adjustment For Potential Confounders And Correction For Multiple Testing.</p><p><strong>Conclusions: </strong>Psychoemotional Factors Were Closely Associated With Hrqol In Adults With Chronic Nonspecific Clbp. Although Sex-Stratified Analyses Revealed Different Patterns Of Associations In Women And Men, Formal Interaction Analyses Did Not Provide Statistically Robust Evidence That These Associations Differed By Sex. The Findings Support The Importance Of Considering Psychoemotional Factors During Assessment And Rehabilitation Planning In Patients With Chronic Nonspecific Clbp And May Help Inform Future Individualized Rehabilitation Approaches.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1872295"},"PeriodicalIF":2.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Linking central sensitization to multisystemic manifestations in hypermobile Ehlers-Danlos syndrome.","authors":"Ana Paula Montemayor Zarazúa, César Vidal Elizondo Solis, Camila Ayala García, Diego Jesús Pacheco Estrella, Octavio Ilizaliturri Guerra, Ana Cecilia Arana Guajardo, Emma Purón Gonzalez, Karina Silva Luna, Luis Iván Lozano Plata, Mario Ramon García Pompermayer, Mario Alberto Garza Elizondo","doi":"10.3389/fpain.2026.1799439","DOIUrl":"10.3389/fpain.2026.1799439","url":null,"abstract":"<p><p>Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) are complex multisystemic conditions frequently associated with chronic pain. Central Sensitization (CS)-a state of neural amplification and hyperexcitability-is hypothesized to be a unifying mechanism underlying the heterogeneous symptoms in chronic pain patients. Our aim was to investigate the association between central sensitization and multisystemic symptom burden in patients with hEDS/HSD while identifying independent clinical predictors of CS. We prospectively enrolled 150 adults diagnosed with hEDS/HSD at a specialized joint hypermobility clinic. Participants were evaluated using the Central Sensitization Inventory (CSI) and the SPIDER questionnaire. Clinical CS was defined as a CSI score > 40. Statistical analyses included univariate correlations and multivariable logistic regression. Centrally sensitized patients (<i>n</i> = 76) were significantly younger and predominantly female compared to the non-CS group. While CSI scores correlated strongly with all eight SPIDER domains (<i>p</i> < 0.001), a multivariable logistic regression model (AUC 0.98) identified only three independent predictors of CS: fatigue (OR 1.089), pain (OR 1.067), and cardiac dysautonomia (OR 1.057). Central sensitization in hEDS/HSD is independently associated with a triad of fatigue, pain, and cardiac dysautonomia. Clinical management should shift toward multidisciplinary strategies to effectively address the sensitized state in this population.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1799439"},"PeriodicalIF":2.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term efficacy of physical interventions for lateral epicondylitis: a network meta-analysis based on multidimensional evaluation of pain and function.","authors":"Yu-Hong Song, Jin-Yan Lan, He-Hui Fu, Li-Xu Tang","doi":"10.3389/fpain.2026.1855508","DOIUrl":"10.3389/fpain.2026.1855508","url":null,"abstract":"<p><strong>Background: </strong>Lateral epicondylitis (LE) is a prevalent chronic tendinopathy that significantly impairs upper limb function and quality of life. This network meta-analysis (<i>N</i>MA) aims to evaluate and compare the short-term (≤3 months) efficacy of various micro-invasive and physical interventions for pain relief and functional restoration, providing an evidence-based framework for tailored clinical decision-making.</p><p><strong>Methods: </strong>A comprehensive search was performed in PubMed, Embase, the Cochrane Library, Web of Science, and CNKI for randomized controlled trials (RCTs) investigating physical interventions for LE. Primary outcomes included the Visual Analogue Scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) score, and the Patient-Rated Tennis Elbow Evaluation (PRTEE). Data synthesis, consistency testing, and Surface Under the Cumulative Ranking curve (SUCRA) calculations were performed using Stata 18.0. Two-dimensional cluster analysis was employed to concurrently assess the analgesic and functional benefits of the interventions.</p><p><strong>Results: </strong>Analysis of 38 RCTs revealed that percutaneous electrolysis (PE) was the most effective intervention for pain reduction (SUCRA = 98.5%), yielding a clinically pronounced effect size against baseline care (MD = -6.00, 95% CI: -9.75 to -2.25) and outperforming most other physical therapies. Dry needling (DN) demonstrated the highest ranking probability in functional improvement (DASH SUCRA = 79.7%; PRTEE SUCRA = 85.2%), and was the sole active treatment significantly superior to conservative care on the PRTEE scale (MD = -25.04, 95% CI: -48.29 to -1.79). In the cluster analysis, PE was localized to the \"strong analgesia\" quadrant, while DN was situated in the \"strong functional recovery\" quadrant. Other interventions, such as platelet-rich plasma and corticosteroid injections, exhibited only moderate effectiveness.</p><p><strong>Conclusion: </strong>The investigated interventions yield distinct therapeutic profiles for LE within an early temporal window. Percutaneous electrolysis shows the highest probability for rapid pain mitigation, whereas dry needling presents a favorable probability profile for restoring localized elbow function. However, given the high underlying network heterogeneity, the lack of statistical significance in DASH-related pairwise comparisons, and overlapping prediction intervals, these SUCRA-based rankings should be interpreted cautiously. We do not recommend formulating definitive long-term clinical recommendations based on these early temporal profiles; instead, clinical decisions should be tailored to the patient's predominant short-term symptoms-balancing immediate pain relief with early targeted functional recovery.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/prospero, PROSPERO CRD420251234552.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1855508"},"PeriodicalIF":2.5,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13350182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated machine learning and multi-omics analysis identifies CYP1B1 as a candidate target of orientin in intervertebral disc degeneration-associated low back pain.","authors":"Hai-E Liu, Dong-Dong Guo, Kun Liu, Xing-Jing Luo","doi":"10.3389/fpain.2026.1870398","DOIUrl":"10.3389/fpain.2026.1870398","url":null,"abstract":"<p><strong>Objectives: </strong>Orientin is a bioactive agent isolated from natural resources successfully applied for pain control. This study was to explore candidate hub gene of orientin to intervertebral disc degeneration (IDD) -associated low back pain.</p><p><strong>Methods: </strong>This study integrated the network pharmacology analysis using orientin and IDD-associated pain, machine learning and immune infiltration analysis using GSE70362 as prediction analysis. The validation was performed via molecular docking, molecular dynamics simulation, single-cell RNA sequencing (scRNA-seq) analysis and cell experiment using human annulus fibrosus cells under IL-1β stimulation.</p><p><strong>Results: </strong>Network pharmacology analysis showed that there were 368 overlapped genes between orientin and IDD-associated low back pain. Machine learning demonstrated that Cytochrome P450 1B1 (CYP1B1) was candidate hub genes with excellent diagnostic performance (AUC = 0.95). Immune infiltration analysis showed that CYP1B1 had no correlation with infiltration levels of any immune cell subset cells after Benjamini-Hochberg false discovery rate correction. Molecular Docking showed docking energies of orientin to CYP1B1 were all smaller than -9.5 kcal/mol. The molecular dynamics simulation showed a system of orientin-CYP1B1 showed a relatively stable conformational ensemble. scRNA-seq analysis revealed tissue- and cell-type specific expression of CYP1B1, with significant upregulation in annulus fibrosus fibroblasts from diseased samples. In cell experiments, orientin alleviated the decrease in cell viability induced by IL-1β stimulation, and down-regulated CYP1B1 gene expression and CYP1B1 protein levels.</p><p><strong>Conclusion: </strong>This study showed that CYP1B1 is a potential candidate hub gene for orientin to IDD-associated low back pain.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1870398"},"PeriodicalIF":2.5,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and reliability of pressure algometry for mechanical nociceptive threshold quantification in lambs in a field environment.","authors":"Charlotte Helen Johnston, Danila Marini, Stefan T Musolino, Daniel T Barratt, Mark R Hutchinson","doi":"10.3389/fpain.2026.1696631","DOIUrl":"10.3389/fpain.2026.1696631","url":null,"abstract":"<p><strong>Objective: </strong>To validate a modified algometer method for assessing mechanical nociceptive threshold (MNT) in lambs before and after husbandry procedures (marking) under field conditions by testing the precision, intra-operator reliability and agreement, and minimal detectable change (MDC).</p><p><strong>Animals: </strong>Forty-six randomly allocated Merino lambs: 6 control (sham handled), 13 hot knife tail docked, 13 rubber ring tail docked, 7 hot knife tail docked and rubber ring castrated, and 7 rubber ring tail docked and castrated.</p><p><strong>Methods: </strong>MNT (mean triplicate measurements at each replicate) was assessed at the tail base, using three replicate measurements before, and three hours after marking to assess precision, reliability, agreement, and MDC. A single operator performed all testing, with lambs restrained by one of three handlers (randomly) for each replicate. Within-animal/-occasion (pre- or post-marking) relative and absolute precision were evaluated using the coefficient of variation (CV) and a combination of standard deviation (SD) and dispersion modelling, respectively. Agreement was assessed using Bland-Altman plots, and linear mixed effects regression was used to determine the intra-class correlation coefficient (ICC) for intra-operator reliability, and any systematic effects of replicate order or handler. MDC was calculated from the standard error of measurement. Responsiveness to marking was analyzed by comparing MNT change from pre- to post-marking using linear mixed effects regression.</p><p><strong>Results: </strong>The overall median MNT was 3.07 kgf (IQR = 2.00-3.84, range = 1.23-5.00). Greater body weight was associated with significantly higher absolute imprecision (<i>p</i> = 7 × 10^-5). Median CV was 12.5% (IQR = 7.29-18.16, range = 1.5-55.4) and was significantly higher post-marking (<i>p</i> = 0.0003), likely related to lower post-marking MNT. The agreement between replicates was good with small mean differences (0.02-0.26 kgf), although there were wide Bland-Altman limits of agreement (2.27-3.51 kgf). There was good intra-operator reliability [ICC (95% CI) = 0.83 (0.81-0.94)]. The minimum detectable change was 1.38 kgf. There was a significant reduction in MNT after marking for all marking groups (<i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>Modified algometer MNT measurement in lambs around the time of marking was feasible with sufficient precision and responsiveness to demonstrate a reduction in nociceptive threshold following husbandry procedures.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1696631"},"PeriodicalIF":2.5,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic pain as a state-constrained brain network disorder: a dynamical systems model integrating physiological regulation and self-organisation.","authors":"Tim Ho, Mark Ryan","doi":"10.3389/fpain.2026.1825571","DOIUrl":"10.3389/fpain.2026.1825571","url":null,"abstract":"<p><p>Chronic pain is increasingly understood as a disorder of large-scale brain network organisation rather than a direct consequence of persistent nociceptive input. Neuroimaging studies have consistently identified alterations in the salience network (SN), default mode network (DMN), and central executive network (CEN), suggesting that persistent pain involves disturbances in the dynamic coordination of networks that integrate bodily signals, cognition, and self-related processing. However, prevailing models largely interpret these findings as intrinsic network dysfunction and provide limited explanation for the persistence and variability of pain states. In this narrative review, we propose a state-constrained triple-network model of self-organisation in which interactions among the SN, DMN, and CEN are continuously shaped by organism-level physiological regulation, including sleep organisation, autonomic balance, and interoceptive signalling. Within this framework, chronic pain may emerge when disturbances in physiological regulation bias salience processing toward bodily threat signals and stabilise network configurations that reinforce self-referential pain processing. We further interpret these dynamics within a dynamical systems framework in which persistent pain reflects a stable attractor configuration of triple-network interactions maintained by physiological regulatory constraints. Neuromodulatory interventions such as repetitive transcranial magnetic stimulation (rTMS) may act as perturbations capable of increasing network flexibility, while durable recovery may require restoration of physiological regulation and experiential integration. This framework links network neuroscience, physiological regulation, and the phenomenology of self-experience, providing a multilevel model for understanding the persistence of chronic pain and informing future approaches to integrated treatment.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1825571"},"PeriodicalIF":2.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13333776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain differences in cognitive impairment appear only during active motor tasks.","authors":"Stefan Lautenbacher, Vivien Schreiber, Clemens Grupp, Claus-Christian Carbon, Heiko Kellner, Miriam Kunz","doi":"10.3389/fpain.2026.1849507","DOIUrl":"10.3389/fpain.2026.1849507","url":null,"abstract":"<p><p>Cognitive impairment in older adults has been associated with altered pain processing and potentially increased pain vulnerability, although findings are inconsistent. We hypothesized that cognitive impairment has a stronger impact on movement-related pain in everyday contexts than on pain sensitivity assessed in passive laboratory settings. Thirty-eight cognitively healthy and 38 cognitively impaired older adults (50% women; groups age- and sex-matched), classified using the CERAD scale (Consortium to Establish a Registry for Alzheimer's Disease), completed standardized motor tasks (walking, bed mobility, lifting tasks) and experimental pressure and heat pain assessments. Pain intensity (NRS) was recorded for all tasks. Perceived exertion was assessed during motor tasks, and clinical pain status was determined via a structured interview. Groups did not differ in baseline clinical pain or experimental pain sensitivity. However, cognitively impaired participants reported significantly higher movement-related pain during motor tasks. In a blockwise regression model, movement-related pain was significantly predicted by clinical pain and experimental pain sensitivity; however cognitive status (CERAD) explained additional variance to a similar amount. In conclusion, reduced cognitive functioning significantly predicted increased pain during active, everyday motor tasks. This may reflect diminished capacities for recall, planning, and execution of pain-minimizing movement strategies. These findings underscore the importance of assessing pain in behaviorally relevant contexts where movement provokes pain, to better understand pain mechanisms in cognitively impaired older adults.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1849507"},"PeriodicalIF":2.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13333728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain sensitization as a potentially modifiable factor in people with knee osteoarthritis: insights from behavioral graded activity.","authors":"Takafumi Hattori, Takako Matsubara","doi":"10.3389/fpain.2026.1865792","DOIUrl":"10.3389/fpain.2026.1865792","url":null,"abstract":"<p><strong>Introduction: </strong>Exercise is a first-line treatment for knee osteoarthritis (KOA); however, a substantial proportion of patients show a limited response to standardized exercise programs. Pain sensitization is increasingly recognized as a contributor to poor outcomes. This study examined changes in pain, disability, and pain sensitization after a behavioral graded activity (BGA) program in people with KOA who had not responded to guideline-concordant exercise.</p><p><strong>Methods: </strong>In this single-arm trial, the pain and activities of daily living subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS) were assessed after a 12-week BGA program. Secondary outcomes included pressure pain threshold (PPT), temporal summation of pain (TSP), and step count. Baseline radiography and magnetic resonance imaging (MRI) were used to characterize structural abnormalities as potential effect modifiers.</p><p><strong>Results: </strong>Twenty-six participants completed the intervention. Linear mixed models showed significant improvements in KOOS pain and activities of daily living, exceeding the minimal important change. PPT increased at both the knee and forearm, TSP decreased, and physical activity increased. Baseline step count was positively correlated with improvement in KOOS activities of daily living, whereas structural abnormalities and pain sensitization measures were not associated with changes in KOOS outcomes.</p><p><strong>Discussion: </strong>Clinically meaningful improvements in KOOS were accompanied by concurrent changes in PPT and TSP over the 12-week BGA program in people with KOA who had not responded to guideline-concordant exercise. Future randomized controlled trials are needed to determine whether these sensory changes are attributable to BGA and to identify patient characteristics associated with treatment response.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1865792"},"PeriodicalIF":2.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13333668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}