Isolated Mesh associated Pain Syndrome (I-MAPS) is the most common complication of continence mesh devices. The pain mechanism involved remains unknown. The aim of this study is to characterise the phenotype of women with I-MAPS related to a single continence device and to determine the pain mechanisms involved. These findings are intended to support better understanding of the management of I-MAPS. A cross-sectional study set within a quaternary-level mesh complications service. All women with I-MAPS related to a single continence device were included. Pain phenotype was determined using pain body-mapping, the Pain DETECT questionnaire (PDQ), and the Electronic Patient Assessment Questionnaire (e PAQ) to measure vagina and bladder pain. Quality of Life (QOL) and mental wellbeing were ascertained using the EuroQol group-5 Dimension (EQ5D) and WHO-5 wellbeing index. Over 5-years, 280 women presented with I-MAPS. Subjects reported high levels of pre-existing pain-inducing conditions (n = 146/280 52%). Body-mapping of pain identified localised pain suggestive of nociceptive pain and neuro-anatomically distributed pain consistent with neuropathic pain. Two percent (n = 5/280) of patients reported distant pain suggestive of a nociplastic component. PDQ identified the largest patient group had neuropathic mediated pain (n = 78/142 55%). Twenty-two percent (n = 31/142) had nociceptive pain and the remaining 23% (n = 33/142) exhibited pain of mixed origin. Trans-obturator (TOT) devices were associated with a significantly higher mean PDQ score of 20 compared to a mean of 17 in retropubic devices (p = 0.04). There was a reported, "moderate" impact in ability to perform usual activities of daily living and "moderate" rates of anxiety and depression across the study group. Poor physical and mental well-being scores were reported in patients with I-MAPS of 53/100 and 28/100 respectively. I-MAPS appears to be of neuropathic phenotype with evidence of mixed origin. Nociplastic features were identified including functional disability and reduced mood and QOL. These exemplify the multidimensional impact and burden of chronic pain.
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.
Pain is increasingly understood as a multidimensional and inferential experience shaped not only by nociceptive input but also by cognitive, emotional, and contextual factors. Among these modulators, language appears to play a central role in shaping pain perception through semantic framing, verbal suggestion, expectation, and interpersonal communication. This narrative review aimed to synthesise contemporary evidence on the relationship between language and pain perception, with particular focus on musculoskeletal rehabilitation and Pain Neuroscience Education (PNE). A structured literature search was conducted in PubMed and Scopus for English-language studies published between 2016 and 2026. Experimental studies, randomized controlled trials, neuroimaging investigations, and clinically oriented rehabilitation studies examining linguistic influences on pain perception were considered eligible. Sixteen studies met inclusion criteria and were narratively synthesised. Three interconnected domains emerged from the evidence. First, pain was consistently conceptualised as an inferential and expectation-shaped experience, in which attention, prior beliefs, and predictive processes modulate sensory interpretation. Second, verbal suggestion and semantic framing were shown to influence pain-related neural and behavioural responses. Pain-related words, threatening descriptors, and negative expectations were associated with increased pain perception and altered activity within salience and pain-regulatory networks, whereas positive framing and empathic communication appeared to facilitate adaptive modulation and placebo-related responses. Third, PNE and language-based rehabilitation approaches demonstrated potential to reduce fear, catastrophising, and maladaptive threat appraisal, particularly when integrated within multimodal rehabilitation programs including exercise, motivational interviewing, and psychologically informed physiotherapy. Overall, the evidence suggests that language is not merely descriptive but functions as an active contextual and neurocognitive component of pain experience. Clinically, communication may influence therapeutic alliance, behavioural engagement, and pain-related beliefs, with both therapeutic and ethical implications. However, current evidence remains limited by methodological heterogeneity, short-term experimental paradigms, and limited ecological validity. Language-based interventions should therefore be considered facilitators within broader biopsychosocial rehabilitation strategies rather than stand-alone treatments. Future longitudinal and clinically pragmatic studies are needed to clarify the durability, mechanisms, and translational applicability of linguistic modulation in pain rehabilitation.
Both acute and chronic pain caused by sickle cell disease (SCD) is often managed with opioid therapy despite limited evidence for long-term efficacy. Adequately managing SCD pain requires a comprehensive approach, incorporating both pharmacologic and non-pharmacologic interventions. In other conditions, peer-mentored group programs are effective in managing chronic pain; however, their role in SCD is not yet described. Our objective is to understand patients' current pharmacologic and non-pharmacologic SCD management practices as well as further exploring perspectives of pain related to SCD. Participants were interviewed using semi-structured format. Audio-recorded interviews were transcribed. Descriptive statistics and pain management modality frequencies were analyzed with Microsoft Excel. Qualitative analyses, utilizing NVIVO, identified themes through thematic analysis. Thirty-four interviews were conducted. One interview was excluded due to incomplete audio-recording. Participants described a range of coping skills including both pharmacological and non-pharmacologic pain management techniques. 81.8% (23/28) identified a relationship between stress and pain. Most patients were interested in a group intervention for pain related to SCD; 60.9% (17/28) preferred peer moderators to co-lead the intervention with medical professionals. 85.7% (24/28) preferred a fully in-person or a hybrid intervention. Pain descriptions included severe bone pain, sharp and shooting pain, and throbbing and aching body wide pain. Patients with SCD already use many non-pharmacologic methods for pain relief and endorse a desire to learn about and engage in additional techniques. There is considerable interest among patients in participating in group interventions for chronic pain related to SCD, especially if they are facilitated by peers. Future research should focus on the efficacy and benefit of various non-pharmacologic techniques for pain management in SCD.
Pain is among the most prevalent and distressing symptoms in advanced cancer, impairing physical, emotional, and social well-being. Management often requires support from family caregivers, whose own health and psychological well-being may also be adversely affected. This study examined the potential utility of digital phenotyping-moment-to-moment quantification of individual-level human behavior-to assess pain and physical quality of life (QOL) in patients with advanced cancer and their family caregivers. Patients with advanced cancer (n = 14) and their caregivers (n = 32) installed the Beiwe smartphone application, which enabled passive GPS data collection over 24 weeks. Raw GPS data were processed into daily mobility features and aggregated using biweekly moving averages and variability measures. Participants completed PROMIS measures of pain (intensity and interference) and physical QOL every 6 weeks. Within-person regression models were used to examine associations between changes in passive mobility features and changes in outcomes, with adjusted R² interpreted as effect size (small = 0.02, medium = 0.13, large = 0.26). Caregiver GPS-derived mobility features predicted a large proportion of variance in patient pain intensity (R² = 0.31) and pain interference (R² = 0.32). Combined caregiver and patient mobility data predicted large variance in caregiver physical QOL (R² = 0.43) and medium-to-large variance in patient pain intensity (R² = 0.16) and pain interference (R² = 0.33). Patient mobility features alone predicted small variance in caregiver physical QOL (R² = 0.02). When examining patient data predicting patient outcomes, mobility features were associated with small variance in physical QOL (R² = 0.03), pain intensity (R² = 0.05), and pain interference (R² = 0.08). These findings suggest that digital phenotyping may be a useful approach for predicting pain and physical QOL in advanced cancer, particularly when incorporating both patient and caregiver data. Further research is warranted to evaluate digital phenotyping as a novel method for monitoring symptoms and functional outcomes in advanced cancer care.
The complex pathogenesis of postherpetic neuralgia significantly impacts patients' quality of life. Traditional nursing models often fail to fully meet patients' individual needs, whereas the 5A nursing model emphasizes individualized and comprehensive care, providing patients with more effective pain management. This study aims to explore the impact of the 5A nursing model on the pain intensity of patients with postherpetic neuralgia, providing a scientific and effective nursing protocol for clinical practice. This study employed a prospective methodological design and enrolled patients aged 18 years and older who were admitted to the pain management department and fulfilled the diagnostic criteria for postherpetic neuralgia from July 2025 to October 2025. Participants were required to complete a demographic questionnaire and a numerical pain rating scale. Subsequently, 120 patients were randomly assigned to two groups: the conventional nursing group (n = 60) and the 5A nursing model group (n = 60). The Numeric Rating Scale (NRS) will be used to quantitatively assess pain levels in both groups at baseline, day 1, day 14, and one month post-intervention, facilitating a comparative analysis of the additional effect of the 5A nursing model on pain relief. The baseline characteristics, including age, gender, medical history (such as diabetes and hypertension), and pain location, were statistically comparable between the conventional nursing group and the 5A nursing model group, with no significant differences observed (P > 0.05). However, the Numerical Rating Scale (NRS) scores for pain in the 5A nursing model group were notably lower compared to those in the conventional nursing group, indicating a statistically significant difference (P < 0.05). Nursing interventions based on the 5A model have been demonstrated to enhance pain management for patients suffering from postherpetic neuralgia, thereby improving their overall disease condition. Consequently, clinical nursing staff are encouraged to adopt this model in managing patients' pain, and to intensify intervention measures in order to foster patients' well-being and recovery. This clinical study was registered at Chinese Clinical Trial Registry (ChiCTR2500104499) with registration date of 18/6/2025.
Neuropathic pain affects an estimated 7%-10% of the global population and imposes an annual economic burden exceeding $600 billion in the United States alone. It lacks robust objective biomarkers; current diagnosis relies heavily on subjective reporting and heterogeneous phenotypes. Currently utilized pain assessment tools include the brief pain inventory (BPI), numerical rating scales (0-10 pain scores), and the visual analog score (VAS), which depend on patient-reported outcomes and are influenced by social, psychological and contextual factors. This subjectivity contributes to heterogeneous phenotyping and variability (>30%) towards the treatment response. Emerging transcriptomic and epitranscriptomic evidence suggests that RNA-based biomarkers may offer a biologically sound and objective approach to understanding and managing pain by capturing underlying molecular mechanisms. Therefore, the present clinical review focused on RNA biomarker classes (mRNA, miRNA, lncRNA, RNA editing, RNA modifications) and proposes a clinically deployable testing system for diagnosis, stratification, and treatment monitoring, since there are no FDA-approved RNA-based biomarkers for pain. Therefore, this review synthesizes evidence from immune-cell transcriptomic meta-analysis (TCL1A/ERAP2), dorsal root ganglion (DRG) and central nervous system gene expression patterns (EFNB2, GABBR1, NCAM1, SCN11A)/brain genetic architecture via single-cell omics integration, and atlas-driven frameworks, like iPain single-cell atlas of pain chronification and nociceptor senescence. Additional sources include studies on RNA editing mediator adenosine deaminase acting on RNA2 (ADAR2), clinical and translational evidence supporting miRNA biomarkers, and lncRNA axes (NEAT1/miR-183-5p; H19/miR-141) as tissue-specific regulatory nodes. Additionally, m6A epitranscriptomic modifications regulated by the METTL3/METTL14 writer complex and FTO/ALKBH5 erasers, with site-specific methylation of GRIN2B mRNA shown to upregulate GluN2B in dorsal horn neurons and augment central sensitization. These biomarkers also demonstrate potential utility as pharmacodynamic readouts in drug and neuro-modulation trials. Additionally, an emerging RNA workflow technology pathway leveraging rapid low-input RNA based assays was also explained. All evidence supports the idea that these biomarkers can provide complementary insight into the mechanisms underlying pain. Although current evidence supports the feasibility of RNA-based biomarkers as indicators of key biological processes, however, the current pain biology score remains at the theoretical model stage and has not been validated through in vivo, in vitro or clinical trials.
As a gradual degenerative illness, knee osteoarthritis (KOA) is characterized by high rates of impairment and prevalence. Patients' quality of life is seriously jeopardized, and healthcare systems and social advancement are continuously burdened. Because it is minimally invasive, intra-articular injection treatment is frequently used to treat KOA. Among these, ozone therapy has drawn more and more clinical interest because of its ease of use, affordability, and observable symptom relief. Its scientific application in long-term management strategies is limited, nonetheless, because the exact length of its therapeutic benefits is still unknown. This study is to integrate clinical data from various follow-up time points using systematic review and meta-analysis techniques in order to comprehensively assess the temporal efficacy of intra-articular ozone therapy in reducing symptoms among patients with KOA. In order to provide evidence-based support and decision-making references for phased and continuous clinical treatment planning, the goal is to elucidate the temporal aspects of persistent therapeutic effects. Searches were conducted in PubMed, Embase, the Cochrane Library, Web of Science, and Scopus from the inception of each database up to December 3, 2025. Two reviewers independently extracted data using the Cochrane Risk of Bias Assessment Tool and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, and assessed the quality of the evidence and the certainty of the evidence for each outcome measure. Outcomes included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, WOMAC stiffness, WOMAC physical function, WOMAC Total, and Visual Analog Scale (VAS) pain. For combined outcomes, standardized mean difference (SMD) and 95% confidence interval (CI) were calculated. Statistical analysis and graphing of included information were performed using Review Manager 5.4.1, Stata 15.0, and GRADEpro GDT. A total of 16 randomized controlled trial (RCT) studies (n = 1,172) were included in this review. Meta-analysis results demonstrated that intra-articular ozone therapy exhibits a clear time-dependent effect on symptom improvement in patients with KOA. At short-term follow-up, the WOMAC total decreased at 1 month post-intervention [SMD = - 0.63, 95% CI (-1.17, -0.10), P < 0.01]; at 2 months, WOMAC pain[SMD = - 1.39, 95% CI (-1.96, -0.81), P < 0.01], WOMAC function [SMD = - 1.27, 95% CI (-2.06, -0.49), P < 0.01], and VAS[SMD = - 1.25, 95% CI (-2.10, -0.40), P < 0.01] all showed significant improvement. However, During the 3-month follow-up, no statistically significant differences were observed in any of the outcomes. At 6 and 12 months, compared with the control group, the ozone group showed statistically significantly worse scores in several outcomes, suggesting that ozone not only lacks sustained efficacy but may also be inferior to active control therapies in the long term. Intra-articular ozone therapies are effective in alleviating pain and improving joint function in patients with knee osteoarthritis in the short term (1-2 months), with effects peaking at 2 months. By 3 months, the therapeutic effect diminishes, and by 6 or 12 months, the evidence of efficacy is very weak, whereas active comparators (such as hyaluronic acid) demonstrate superior therapeutic outcomes at these time points. These findings suggest that ozone therapy may serve as a short-term treatment option but also underscore the need for placebo-controlled long-term trials and studies on repeated dosing regimens before recommending repeat injections. identifier CRD420251169941.
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.
Neonatal procedural and prolonged pain remains a frequent and clinically important problem in neonatal care, particularly among preterm and critically ill infants who undergo repeated invasive procedures. To synthesize evidence on neonatal pain assessment tools and non-pharmacological analgesic strategies, with attention to clinical implementation and emerging objective or digital assessment approaches. PubMed, CINAHL, MEDLINE, the Cochrane Library, Web of Science, Scopus, and Embase were searched for peer-reviewed English-language articles published from January 2000 to May 2025. Eligible studies included primary research, high-quality secondary evidence, and clinically relevant methodological or technological studies involving preterm or term neonates, defined as infants with a birth age of ≤28 days, or infants cared for in neonatal intensive care units. Studies were included if they addressed the development, validation, or clinical application of neonatal pain assessment tools, or the efficacy, safety, or implementation of non-pharmacological analgesic interventions. Studies limited to pharmacological analgesia, older children, or adults were excluded. Thirty-five studies were included. The evidence supports the use of validated multidimensional assessment tools for structured evaluation of neonatal pain. It indicates that family-integrated, sensory, and behavioral non-pharmacological approaches can reduce procedural pain responses. However, the strength and consistency of evidence are greater for single procedures than for repeated or prolonged pain. Artificial intelligence-based facial expression analysis, physiological monitoring, and biomarker-based approaches show potential for more objective pain detection but remain insufficiently validated for routine bedside decision-making. Standardized neonatal pain management should combine validated assessment scales, protocolized first-line non-pharmacological care, staff training, and parent involvement. Future research should prioritize repeated and prolonged pain, high-risk neonatal populations, implementation in routine neonatal intensive care practice, and the prospective validation of digital assessment systems in real-world clinical settings.
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. To Evaluate Sex-Stratified Associations Between Psychoemotional Factors And Hrqol Domains In Adults With Chronic Nonspecific Clbp. 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. 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; Q = 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. 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.
Virtual reality (VR) has shown promise for pain relief, including in cancer-related contexts, yet its underlying neurophysiological correlates remain unclear. Understanding brain-based correlates is important for evaluating VR programs and informing personalized pain management. Functional connectivity reflects coordinated activity among pain-related brain regions. This study examined associations between changes in functional connectivity and pain reduction during VR exposure using functional near-infrared spectroscopy (fNIRS) in cancer patients with chronic neuropathic and/or somatic pain. In an IRB-approved study, 41 cancer patients underwent a VR distraction session using the Oceania application on a Meta Quest® headset. Continuous fNIRS signals focused on oxygenated hemoglobin (HbO) were recorded. Pain intensity was assessed before and after VR using the FACES Pain Scale-Revised. Functional connectivity was estimated using coherence analysis, and associations with pain reduction were evaluated using Pearson correlation with false discovery rate correction. Extracted functional connectivity features showed significant negative correlations with pain reduction, particularly between channels spanning prefrontal cortex (PFC), bilateral parietal lobes [including the primary somatosensory cortex (S1)], and superior frontal gyrus (SFG). Strongest associations were observed between PFC and SFG (r = -0.43, p = 0.005), and within SFG (r = -0.42, p = 0.006). HbO activity at the PFC was significantly associated with pain reduction (r = -0.32, p = 0.044). Decreased functional connectivity in specific cortical regions was observed in association with short-term pain reduction during VR exposure. Findings suggest that functional connectivity features may represent candidate neurophysiological correlates of pain changes in immersive VR contexts.
Lateral epicondylitis (LE) is a prevalent chronic tendinopathy that significantly impairs upper limb function and quality of life. This network meta-analysis (NMA) 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. 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. 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. 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. https://www.crd.york.ac.uk/prospero, PROSPERO CRD420251234552.
In sub-Saharan Africa, the coexistence of conventional medicine and traditional healing practices creates a complex therapeutic landscape that disproportionately affects older adults. Therapeutic scarification-cutaneous incisions performed on painful body areas-remains one of the most widespread traditional approaches to chronic pain management. Its geriatric-specific complications and functional consequences remain poorly documented. With a projected 67% increase in the population aged over 60 in Cameroon by 2030 and fewer than 15% of older adults benefiting from effective social coverage, this represents a major public health priority. To analyze the prevalence, typology, and geriatric-specific complications of therapeutic scarification among older adults with chronic musculoskeletal pain in Cameroon, and to evaluate the preliminary effectiveness of a culturally integrative physiotherapy approach bridging traditional and conventional medicine. A prospective single-center mixed-methods observational study was conducted from February 2023 to May 2025 at Bafoussam Regional Hospital. Patients aged ≥65 years with chronic articular pain (≥6 months) and documented history of therapeutic scarification were included. The quantitative component involved standardized clinical assessment and statistical analysis; the qualitative component comprised semi-structured interviews (n = 92, 30-45 min) analyzed thematically following Braun and Clarke's framework (kappa = 0.78). A culturally adapted integrative physiotherapy protocol over 16 sessions was implemented, with follow-up of 6-18 months. Ninety-two patients were enrolled (mean age 73.1 ± 8.4 years; 60 women, 65.2%). Four scarification modalities were identified: parallel linear (63.0%), punctiform (20.7%), deep cruciform (12.0%), micro-scarification with cupping (4.3%). Knee osteoarthritis predominated (44.6%). Complications included infections (15.2%), keloids (34.8%), and proprioceptive impairment (35.9%) associated with a 29% increase in relative fall risk (p < 0.01). A significant age-complication gradient was observed (OR = 4.9 for >75 vs. 65-70 years; p = 0.032). Education level was inversely correlated with scarification frequency (r = -0.67; p < 0.001). Among 68 patients receiving the integrative approach, 73.5% reduced scarification use (p < 0.001), with significant functional improvements and 89.7% patient satisfaction. Five qualitative themes of adherence drivers were identified. Therapeutic scarification exposes older adults to preventable geriatric complications, including a previously unrecognized fall risk from proprioceptive disruption. The "shadow pain" mechanism-transient nociceptive inhibition by iatrogenic pain-offers a novel neurophysiological explanation for treatment adherence. The culturally integrative rehabilitation model achieved preliminary effectiveness supporting development of context-sensitive geriatric care strategies in low-resource settings. Randomized controlled trials are needed to confirm these findings.
Whilst a sizeable portion of young adults experience migraine, little is known about the unique support needs of these individuals at the critical developmental timepoint of young adulthood. In this study we aimed to identify the unmet needs for pain management in young adults (18-30 years) who experience migraine and how pain management programmes can be adjusted to better meet those needs. Individual interviews and focus groups were conducted online with seven young adults who experience migraine pain (N = 6 female, M age = 23.6 years) and eight clinicians providing pain management support to young adults with chronic pain, including migraine (representing psychology, anaesthesiology, nursing, physiotherapy & hypnotherapy). Qualitative data generated from both young adults and clinicians was jointly analysed using reflexive inductive thematic analysis. Two main themes were generated: (1) Too little too late; and (2) The challenges of finding their tribe. The first theme highlights that young adults would benefit from holistic, interdisciplinary treatment options tailored to their individual needs early on in their chronic pain journey, but access to these services is limited and offered too late in the process. The second theme represents the increased need for support in relation to social life and making vocational decisions, which could be met through peer support groups and positive representation. These insights underscore the need to improve access to holistic, interdisciplinary and personalised care for young adults living with migraine which incorporate online and peer-based support approaches to address issues related to maintaining social connection and career planning.
To explore the potential categories of pain intensity development trajectory in children with recurrent aphthous stomatitis and analyze the influencing factors of category differences. Conveniently select 200 children with recurrent aphthous stomatitis treated in our hospital from September 2023 to June 2025 as the research subjects, and retrospectively collect the pain dimension scores of the local body sign scores of oral ulcers at the time of visit (T0), as well as on the third day (T1), seventh day (T2), and fourteenth day (T3) after visit. The optimal number of categories was analyzed and named using a latent variable growth mixture model. Clinical data of the children were collected using a self-designed clinical data questionnaire. Independent influencing factors of potential category differences were analyzed by univariate analysis and multivariate logistic regression. The pain intensity development trajectory of the 200 children with recurrent aphthous stomatitis could be divided into three potential categories: high pain level relief type (68 cases, 34.00%), moderate pain level improvement type (82 cases, 41.00%), and low pain level stable type (50 cases, 25.00%). Univariate and multivariate logistic regression analyses showed that for the high pain relief type, ulcer size, number of ulcers, ulcer type, frequency of attacks, and picky eating are independent influencing factors (P < 0.05); For the moderate pain level improvement type, ulcer classification, frequency of attacks, and picky eating are independent influencing factors (P < 0.05). The development trajectory of pain severity in children with recurrent aphthous stomatitis exhibits certain heterogeneity and is influenced by factors such as ulcer size, number of ulcers, ulcer type, frequency of attacks, and picky eating habits. However, there are differences in the influencing factors of different trajectory categories. The above findings can provide reference for identifying high-risk pain trajectory children.
Musculoskeletal injuries are commonly accompanied by acute and persistent pain; the latter of which can lead to maladaptive neurophysiological changes including central sensitisation and altered pain modulation responses. Blood flow restriction (BFR) exercise uses a pneumatic tourniquet to restrict arterial blood flow into the exercising limbs and has emerged as a promising rehabilitation tool, eliciting exercise-induced hypoalgesia (EIH) and increasing muscular strength and mass, but at lower external loads/intensities. The relationship between BFR tourniquet pressure and pain response is, however, complex. This review explores the mechanisms underpinning BFR-induced hypoalgesia and hyperalgesia across clinical and healthy populations. Findings indicate that while BFR exercise can reduce pain, potentially via metabolic, vascular, neurological, and psychological pathways, higher occlusive pressures or individual susceptibility, particularly in those with persistent pain, may provoke hyperalgesia. Mechanistically, this may involve inflammatory cytokine release, upregulated conditioned pain modulation and altered endorphin or endocannabinoid signalling. Psychological factors such as catastrophising and kinesiophobia may, furthermore, exacerbate nociceptive responses. These findings collectively highlight the pleiotropic and potentially hormetic nature of BFR exercise in pain modulation. Careful prescription, pressure selection, and patient monitoring are vital to maximise analgesic benefits while minimising adverse pain responses.
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. 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. 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. 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.
In oncology, fibromyalgia (FM) is increasingly recognized as a clinically relevant comorbidity, as cancer patients frequently present overlapping symptoms such as pain, fatigue, and sleep disturbances, complicating clinical assessment and management. Moreover, anticancer treatments may trigger or exacerbate FM-like symptoms. This systematic review aimed to synthesize the available evidence on FM in oncological patients, focusing on prevalence, clinical characteristics, and its impact on pain perception, Health-Related Quality of Life (HRQoL), and treatment adherence. A comprehensive literature search was conducted in PubMed, Embase, and Scopus, including studies published from 2014 to 2024. Eligible studies, in accordance with PRISMA guidelines, included observational, cross-sectional and interventional designs involving adult patients with FM in the context of cancer or cancer-related pain. Conversely, studies not assessing FM in relation to cancer or cancer-related pain were excluded. Risk of bias was evaluated using ROBINS-I tool and the RoB 2 tool. A total of 11 studies were included, encompassing heterogeneous populations and study designs, thereby precluding a quantitative synthesis of the literature. Overall, evidence suggests that FM did not increase cancer risk but significantly contributes to pain amplification, higher symptom burden, reduced HRQoL, and impaired treatment adherence. Pre-existing nociplastic pain features were associated with premature discontinuation of oncological therapies, particularly endocrine treatments. The substantial overlap between FM-related and cancer-related symptoms may represent a major diagnostic challenge in clinical practice. This review highlights a substantial research gap, as evidence in oncology populations remains limited and is affected by moderate to high risk of bias, partly due to confounding factors. Nevertheless, FM appears to be a relevant comorbidity in oncology, warranting further investigation. High-quality longitudinal studies are needed to clarify causal associations and support evidence-based management. The protocol for this systematic review was retrospectively registered on the Open Science Framework (OSF; https://doi.org/10.17605/OSF.IO/X5N29).
Descending pain regulation has been widely studied in animals and recent studies in humans have offered new insights into this complex mechanism. This review paper aims to investigate this process in humans to better understand how pain is modulated in the body. This review included primary articles from PubMed related to pain modulation in the human brain or spinal cord. Book chapters, sources using animal models, and review papers were excluded from the paper. Findings consistently noted the periaqueductal grey and rostral medulla as central hubs of descending pain modulation, while cortical regions including the prefrontal cortex, anterior cingulate cortex, insula, and amygdala exhibited variable and context-dependent contributions. Cognitive and emotional processes, including distraction, imagery, music, catastrophizing, and anxiety, were found to modulate descending pain pathways via altered connectivity between cortical and brainstem regions. Studies also identified therapeutic applications, with transcranial direct current stimulation and spinal cord stimulation demonstrating effects on descending modulatory circuits. These studies identify exciting new progress in our understanding of pain modulation whilst also highlighting a need for further study in human populations to clarify certain inferences.