To evaluate the surgical outcomes of maxillary medication-related osteonecrosis of the jaw (MRONJ) at different disease stages and to analyze the comparative efficacy of different surgical techniques on the prognosis of stage Ⅲ patients. A detailed retrospective analysis was conducted on the clinical data of 136 patients with maxillary MRONJ who underwent surgical treatment in the Department of Oral and Maxillofacial Surgery of Peking University School and Hospital of Stomatology from April 2014 to February 2024. All patients were rigorously classified according to the 2022 American Association of Oral and Maxillofacial Surgeons (AAOMS) staging criteria: Stage Ⅰ (n=8), stage Ⅱ (n=30), and stage Ⅲ (n=98). The surgical interventions included local lesion resection with primary direct closure, buccal fat pad packing, and iodoform gauze packing. The patients were systematically followed up for a period of 1 year postoperatively to comprehensively assess several key outcome measures: Complete mucosal healing, resolution of pain, effective infection control, and radiological improvement of maxillary sinus inflammation based on serial computed tomography scans. Statistical analysis was performed using SPSS version 20.0. Continuous variables were expressed as mean±standard deviation and compared using the t-test, while categorical variables were expressed as numbers and percentages and compared using the χ2 test or Fisher' s exact test as appropriate. A P-value < 0.05 was considered statistically significant for all analyses. The overall short-term (3 months) cure rate was 91.2% (124/136), which improved to a long-term (1 year) cure rate of 94.9% (129/136). A stage-stratified analysis revealed excellent long-term cure rates: 100.0% (8/8) for stage Ⅰ, 96.7% (29/30) for stage Ⅱ, and 93.9% (92/98) for stage Ⅲ, with no statistically significant difference in outcomes across the different stages (P=0.611). Among the 98 stage Ⅲ patients, 34 were treated with buccal fat pad transfer (BFPT group) and 64 with iodine strip packing (ISP group), with no significant differences in baseline demographic or clinical characteristics between the two groups, ensuring comparability. The BFPT group demonstrated a statistically significant superior performance in achieving oroantral fistula closure both at the short-term (79.4% vs. 23.4%, P < 0.001) and long-term (85.3% vs. 54.7%, P=0.002) follow-up assessments. In contrast, the ISP group showed a markedly greater degree of improvement in maxillary sinus inflammation, as quantified by a standardized radiographic scoring system, with significantly greater reductions in inflammation scores at both the 3-month (P=0.029) and 12-month (P=0.014) follow-up intervals. Surgical management of maxillary MRONJ results in high rates of success with a favorable complication profile. For advanced (stage Ⅲ) disease, the choice of surgical technique entails a strategic trade-off: The buccal fat pad procedure is more conducive to achieving reliable soft tissue closure and oroantral fistula resolution, whereas iodoform gauze packing provides superior management and resolution of concomitant maxillary sinusitis. Consequently, the selection of surgical technique should be individualized, based on a careful consideration of the patient's specific anatomical defect, the extent of sinus involvement, and their overall clinical condition. 总结上颌药物相关性颌骨坏死(medication-related osteonecrosis of the jaw, MRONJ)的手术治疗效果, 比较不同手术方式治疗Ⅲ期病变患者预后的差异。 回顾性分析2014年4月至2024年2月于北京大学口腔医院颌面外科接受手术治疗的136例上颌MRONJ患者的临床资料。根据美国口腔颌面外科医师协会(American Association of Oral and Maxillofacial Surgeons, AAOMS)2022年发布的分期标准, 将患者分为Ⅰ期(8例)、Ⅱ期(30例)和Ⅲ期(98例)三组。手术方式包括局部病变切除直接缝合、颊脂垫填塞及碘条填塞。患者术后随访1年, 评估黏膜愈合、疼痛、感染控制及上颌窦炎症改善情况。采用SPSS 20.0软件进行统计学分析。 全部患者短期(3个月)总治愈率为91.2%(124/136), 长期(1年)总治愈率为94.9%(129/136)。Ⅲ期患者中, 颊脂垫填塞组在短期和长期随访中的口腔上颌窦瘘消除率均显著高于碘条填塞组(79.4% vs. 23.4%, P < 0.001;85.3% vs. 54.7%, P=0.002)。然而, 碘条填塞组在上颌窦炎症改善方面的表现更优, 其短期和长期炎症评分改善程度均显著高于颊脂垫填塞组(P=0.029, P=0.014)。 手术治疗适宜于Ⅰ~Ⅲ期的上颌MRONJ患者, 对于Ⅲ期上颌MRONJ, 颊脂垫填塞更有利于口腔上颌窦瘘的闭合, 而碘条填塞在上颌窦炎症控制方面更具优势, 临床应根据患者具体情况选择个体化手术方案。
To evaluate the short-term effectiveness of a visual treatment solution (VTS)-assisted total hip arthroplasty (THA) in patients with Crowe type Ⅲ-Ⅳ developmental dysplasia of the hip (DDH). A retrospective analysis was conducted on the clinical data of 43 patients with Crowe type Ⅲ-Ⅳ DDH who were treated between June 2023 and December 2024 and met the eligibility criteria. Of these, 22 patients underwent conventional THA (traditional group), and 21 underwent VTS-assisted THA (VTS group). There was no significant difference ( P>0.05) between the two groups in baseline data, including gender, age, side, Crowe classification, preoperative visual analogue scale (VAS) score, or Harris score. The operation time, intraoperative blood loss, postoperative drainage volume, length of hospital stay, and postoperative complications were recorded and compared between the two groups. Functional recovery and pain relief were assessed using the Harris score preoperatively and at 1 week, 3 months, and 6 months postoperatively, as well as the VAS score preoperatively and at 1 week and 1 month postoperatively. The acetabular cup anteversion and abduction angles were measured, and cup position was assessed with reference to the Lewinnek safe zone. Limb length discrepancy was measured, and acetabular coverage as well as the matching rates between the preoperatively planned and actually implanted prosthesis sizes were calculated. The operation time, intraoperative blood loss, and postoperative drainage volume were all significantly lower in the VTS group than in the traditional group ( P<0.05), whereas no significant difference was found in length of hospital stay ( P>0.05). All patients were followed up 6-9 months, with a mean time of 7.4 months. Primary wound healing was achieved in both groups, and no poor wound healing or neurovascular injury occurred. Deep venous thrombosis developed in 2 patients in the VTS group and 4 patients in the traditional group; 1 patient in the traditional group experienced prosthetic dislocation. No other complication, including dislocation or thrombosis, was observed during follow-up. There was no significant difference in the overall complication incidence between the two groups ( P>0.05). In both groups, acetabular anteversion and abduction angles were within the Lewinnek safe zone, but their distributions were more concentrated in the VTS group than in the traditional group. Compared with the traditional group, the VTS group showed significantly smaller postoperative limb length discrepancy and significantly greater anteversion angle and acetabular coverage ( P<0.05). No significant difference was found between the two groups in abduction angle, acetabular prosthesis matching rate, or femoral stem prosthesis matching rate ( P>0.05). Harris scores at 3 and 6 months postoperatively and VAS scores at 1 week and 1 month postoperatively were significantly better in the VTS group than in the traditional group ( P<0.05), whereas no significant difference was observed at the other time points ( P>0.05). VTS-assisted THA for Crowe type Ⅲ-Ⅳ DDH yields favorable short-term effectiveness by improving implant positioning accuracy, reducing surgical trauma, and promoting early pain relief and functional recovery. 验证可视化导航系统（visual treatment solution，VTS）辅助人工全髋关节置换术（total hip arthroplasty，THA）治疗CroweⅢ～Ⅳ型发育性髋关节发育不良（developmental dysplasia of the hip，DDH）患者的早期临床疗效。. 回顾性分析2023年6月—2024年12月收治且符合选择标准的43例CroweⅢ～Ⅳ型DDH患者临床资料，其中22例采用传统THA治疗（传统组）、21例采用VTS辅助下THA治疗（VTS组）。两组患者性别、年龄、侧别、Crowe分型及术前疼痛视觉模拟评分（VAS）、Harris评分等基线资料比较差异均无统计学意义（ P>0.05）。记录并比较两组患者手术时间、术中出血量、术后引流量、住院时间及术后并发症发生情况；采用术前及术后1周、3个月、6个月Harris评分，术前及术后1周、1个月VAS评分评价功能及疼痛恢复情况。测量髋臼假体的前倾角、外展角，并判断假体是否位于Lewinnek安全区；测量下肢长度差异，并计算髋臼覆盖率以及术前规划与实际应用假体匹配率。. VTS组患者手术时间、术中出血量及术后引流量均少于传统组（ P<0.05），两组患者住院时间差异无统计学意义（ P>0.05）。两组患者均获随访，随访时间6～9个月，平均7.4个月。两组切口均Ⅰ期愈合，无切口愈合不良、血管神经损伤等发生。VTS组和传统组分别有2例和4例发生下肢深静脉血栓形成，传统组1例发生假体脱位，其余患者随访期间无脱位、血栓形成等并发症发生。两组患者并发症发生率比较差异无统计学意义（ P>0.05）。两组患者的前倾角与外展角均位于Lewinnek安全区中，但VTS组患者的前倾角及外展角分布较传统组更集中。VTS组双下肢长度差异小于传统组，前倾角及髋臼覆盖率均大于传统组，差异有统计学意义（ P<0.05）；两组外展角及髋臼假体匹配率、股骨柄假体匹配率比较差异均无统计学意义（ P>0.05）。VTS组术后3、6个月Harris评分及术后1周、1个月VAS评分优于传统组，差异有统计学意义（ P<0.05）；其余时间点两组各评分差异无统计学意义（ P>0.05）。. VTS辅助治疗Crowe Ⅲ～Ⅳ型DDH的早期疗效显著，其能提高THA假体定位精度、减少创伤，有效减轻术后疼痛并促进早期功能恢复，是复杂THA的可靠技术支持。.
Acute and subacute low back pain (LBP) often progresses to a chronic impactful back problem in patients with elevated risk. The most effective way to prevent this progression is unknown. To determine the effectiveness of spinal manipulation and clinician-supported biopsychosocial self-management vs medical care for preventing chronic impactful LBP. This 2 × 2 factorial randomized clinical trial was conducted in research clinics at the University of Minnesota and the University of Pittsburgh, Pennsylvania, from November 2018 to May 2023, with follow-up concluding in June 2024. Adults with acute or subacute LBP with a moderate to high risk of chronicity were included. Four interventions were applied for 8 weeks: spinal manipulation therapy; supported self-management; combined spinal manipulation therapy and supported self-management; and guideline-based medical care. Spinal manipulation and supported self-management were provided by physical therapists and chiropractors. Mean LBP impact score per the US National Institutes of Health Task Force on Chronic LBP scale (8 [best] to 50 [worst]) during 10 to 12 months, responder analyses of group differences in the proportion of participants with at least 50% reductions. A reduction of 30% was considered the minimal clinically important within-patient difference. Secondary outcomes included measures of chronicity and LBP burden (ie, health care and medication use, productivity), important patient-reported outcomes (eg, improvement, satisfaction), biopsychosocial measures (eg, Patient-Reported Outcomes Measurement Information System), and potential mediating psychosocial measures (eg, self-efficacy, kinesiophobia, pain catastrophizing). Of the 1000 participants (mean [SD] age, 47 [16] years; 577 females [58%]) randomized, 928 (93%) completed the trial. An omnibus test of the primary outcome was statistically significant (P = .006). Group differences in mean LBP impact scores were small but statistically significant: supported self-management vs medical care, -1.7 (95% CI, -2.7 to -0.6); combined self-management and spinal manipulation vs medical care, -1.3 (95% CI, -2.5 to 0). Spinal manipulation therapy and medical care did not differ: -0.3 (95% CI, -1.5 to 1.0). Adding spinal manipulation to supported self-management did not provide additional benefit. The supported self-management group had a significantly higher proportion with at least 50% reduction in LBP impact vs medical care (64% vs 55%). Supported self-management also performed better on most secondary outcomes compared to medical care, including 12% fewer reporting chronic pain that frequently interfered with regular activities. Mediation analyses showed changes in psychosocial factors at 6 months and explained 76% of supported self-management effects at 1 year. This randomized clinical trial found that for patients with acute or subacute LBP at increased risk of chronic impactful LBP, clinician-supported biopsychosocial self-management resulted in a lower mean LBP impact score at 10 to 12 months vs medical care; spinal manipulation and medical care did not differ. While the LBP impact difference was small, the consistent results of the responder analyses and most secondary outcomes suggest differences between clinician-supported self-management and medical care are clinically relevant. ClinicalTrials.gov Identifier: NCT03581123.
Mobile health (mHealth) technology has been utilized to offer self-management tools to people with pain, including symptom tracking. Existing mobile tracking applications (apps) for chronic pain management have demonstrated reliability, feasibility, improved coping, and reduced health care utilization. Unfortunately, adherence in using a pain app can be problematic with many not using or discontinuing its use early. The current study aimed to investigate the impact that pain self-efficacy, pain conceptualizations, and patient perception of pain care providers, have on engagement with a mobile pain tracking app. Seventy-six (N=76) individuals with chronic pain downloaded a pain app and completed questionnaires assessing their pain and use of a pain app 3 months after they had downloaded the app. Associations with engagement with the app, defined as the number of daily diaries completed, and demographic and self-report questionnaire data were examined. Results showed that engagement with the app was unrelated to self-efficacy and pain conceptualization but significantly related to positive perceptions of their pain care providers. Patients with more severe pain were found to have lower self-efficacy, less understanding of the biopsychosocial model of pain, and lower satisfaction with their involvement in their pain care decisions. Surprisingly, those who engaged more with the app demonstrated lower self-efficacy as compared with those who used the pain app less. These findings highlight the importance of the patient-provider relationship in engaging with mHealth technology for pain management. Results further imply that longer-term use of mHealth tools may not be perceived as adaptive or clinically helpful for certain individuals.
Medication-related osteonecrosis of the jaw (MRONJ) represents a major clinical challenge for oral and maxillofacial surgery departments as well as dental practices. With increasing life expectancy and the more frequent use of medications associated with osteonecrosis, the incidence of MRONJ continues to rise. To date, there are no uniform treatment standards with scientifically proven effectiveness for this condition. To evaluate the impact of platelet-rich fibrin (PRF) on the outcomes of MRONJ treatment and to identify factors that may influence the effectiveness of PRF therapy, we conducted a comparative prospective study including 22 patients divided into two groups: patients treated with PRF and patients treated without PRF. PRF was prepared according to the PRF Duo Quattro Process protocol for PRF (Nice, France). The study was registered at ClinicalTrials.gov (NCT07464678). The following parameters were assessed: age, smoking status, gender, lesion location, body mass index (BMI), C-reactive protein (CRP) concentration, pain intensity, presence or absence of fistulas, soft tissue healing and radiological findings. Patients were evaluated preoperatively and postoperatively at 14 days, 6 weeks, and 6 months. The study demonstrated a reduction in pain after surgery among patients treated with PRF. In addition, the use of PRF resulted in improved healing outcomes in patients with elevated CRP. Higher BMI was associated with poorer therapeutic response to PRF. Improvements in soft tissue healing and disease stage were observed in the PRF group; however, these differences did not reach statistical significance. All findings should be interpreted with caution due to the limited sample size. There is still no standardized treatment for MRONJ. The use of platelet-rich fibrin as an inexpensive and safe adjunctive therapy may provide clinical benefits for patients, particularly through a significant reduction in pain. Further large-scale, multicenter studies are required to confirm these findings.
Comprehensive pain management in children requires a specialized skillset, with a limited number of clinicians possessing the level of expertise required to successfully navigate the complexities of holistic care. The emergence of pediatric anesthesia fellowship programs in sub-Saharan Africa presents an opportunity to embed a pediatric pain curriculum for trainees, improving the availability of specialist skill and knowledge in the field. Existing pain curricula fall short in addressing the sociocultural aspects of pediatric pain identified through research as being unique to the African context, and do not include elements of leadership and advocacy training required to navigate the complexities of resource-constrained healthcare settings. A Delphi survey including literature review, iterative rounds of surveys and expert consensus was used to establish a pediatric pain curriculum for pediatric anesthesia fellows undertaking advanced training in sub-Saharan Africa. The 22-member expert panel included anesthetists, nurses, surgeons, pharmacists, pediatricians, a physiotherapist and a patient-caregiver dyad with a lived experience of pain. After completing three rounds of surveys, a steering committee of five members was assembled to resolve outstanding items to achieve the final curriculum. The process yielded a curriculum containing 20 knowledge items and 23 skills items. Attitudes are a key component of the curriculum and were grouped into six themes. A further aspect of the process was the identification of foundational knowledge with which trainees should enter a fellowship training program. This was termed the foundational curriculum. Using a Delphi method, consensus has been achieved on a pediatric pain curriculum for pediatric anesthesia fellows in sub-Saharan Africa with potential to meet the identified need for transformative pain care in this patient population.
To explore the efficacy and safety of pulsed radiofrequency combined with sympathetic radiofrequency ablation of dorsal root ganglion in the treatment of acute herpetic neuralgia. A total of 116 patients diagnosed with acute herpetic neuralgia were randomly assigned to two groups: a dorsal root ganglion pulsed radiofrequency group (Group C) and a dorsal root ganglion pulsed radiofrequency combined with sympathetic radiofrequency ablation group (Group H). The treatment effects were evaluated using the Numerical Rating Scale, the Pittsburgh Sleep Quality Index, the proportion of patients utilizing tramadol, and the Current Perception Threshold detection. Additionally, serum levels of Galectin-3 and Interleukin-6 were measured as objective biological indicators to assess the therapeutic efficacy. The incidence of Postherpetic Neuralgia and any complications were recorded for both groups. Data showed that compared with group C, the Numerical Rating Scale, Pittsburgh Sleep Quality Index score, the proportion of patients using tramadol, and serum Galectin-3 and Interleukin-6 levels were significantly decreased, and Current Perception Threshold was significantly increased in group H (P<0.05). The incidence of Postherpetic Neuralgia in group H was significantly lower than that in group C. No serious adverse reactions occurred in the two groups after treatment. Dorsal root ganglion pulsed radiofrequency combined with sympathetic radiofrequency ablation is more effective in the treatment of acute herpetic neuralgia. Compared with PRF therapy alone, it provides patients with longer lasting pain relief, reduces the incidence of PHN, and improves the quality of life.
To validate the Patients Endorsement of the Biopsychosocial Model of Chronic Pain (PEB) Scale in young adults with chronic pain, assessing psychometric properties and associations with pain beliefs and readiness for pain self-management. A cross-sectional survey was administered to 240 young adults with chronic pain (≥3 months) via Prolific. Participants completed the PEB Scale and measures assessing readiness for pain self-management, pain beliefs, psychological variables, and pain characteristics. Reliability, factor structure, convergent/discriminant validity, and incremental validity were all assessed. In the sample, the PEB Scale had a good internal consistency (Cronbach's α=.88). Factor analysis confirmed an unifactorial structure. Convergent validity was supported through a moderate correlation between the PEB Scale and readiness for pain self-management (PSOCQ Contemplation subscale, r=.32, P=.001). The scale also showed small-moderate correlations with pain interference (r=.25, P=.001) and psychological measures. Hierarchical regression analyses revealed the PEB Scale was associated with an increased chance to be in the contemplation phase (=.042, P<.001) or action/maintenance phase (=.021, P<.05) of pain self-management, when controlling for demographics, pain characteristics, beliefs, and psychological factors. Higher PEB scores were associated with greater contemplation of and engagement in the self-management of chronic pain. The scale appears to be conceptually different from existing pain belief and psychological measures. Limitations include the use of self-report measures, limited effect sizes and demographic homogeneity of our sample. Future studies should test the scale in diverse groups, explore its sensitivity to change, and clinical utility.
Chronic musculoskeletal pain is reported by 1 of 4 adolescents worldwide. Pain-related functioning is negatively affected by pain itself but also related to depressive symptoms. Although the association between pain-related functioning and depressive symptoms is established, there is a lack of longitudinal studies that establish the direction of the association. The aim was to analyse the temporal association between depressive symptoms and pain-related functioning among adolescents with recurrent musculoskeletal pain. This longitudinal sample comprised 604 adolescents in seventh and eighth grade (M = 13.7 y) who reported recurrent musculoskeletal pain at baseline, defined as occurring at least every week over the previous 6 months. The adolescents were followed yearly for 2 consecutive years (T1, T2, and T3). Temporal associations of self-reported pain-related functioning and depressive symptoms were analysed. Using cross-lagged panel modelling, 4 models were estimated: autoregressive; depressive symptoms predicting pain-related functioning; pain-related functioning predicting depressive symptoms; and a bidirectional model. Pain intensity was entered as a covariate. The results indicate high stability of depressive symptoms and pain-related functioning over time. Although the strength of the prediction was strongest in the autoregressive paths, cross-lagged paths revealed that depressive symptoms at T1 and T2 significantly predicted pain-related functioning at T2 and T3, respectively. Conversely, pain-related functioning at T1 and T2 did not predict depressive symptoms at T2 and T3, respectively. The model where depressive symptoms predict pain-related functioning provided the best model fit and thus, in this general population sample, depressive symptoms drive pain-related functioning more than vice versa. Screening for and targeting depressive symptoms might be essential in affecting the functional consequences of pain.
People with chronic pain often experience symptoms of pain-related distress (kinesiophobia, catastrophizing) and general distress (depression, anxiety). Identifying distinct profiles of distress among patients seeking pain psychology treatment can inform personalized pain psychology interventions. Among adults seeking pain psychology treatment, the current study applied latent profile analysis (LPA) to (1) identify distinct patient symptom profiles (based on kinesiophobia, catastrophizing, depression, anxiety) and (2) characterize pain-related symptoms and demographics of each profile. Adults scheduled for a pain psychology evaluation who completed a clinical battery of patient-reported outcome measures were included. LPA was applied to identify distinct subgroups of patients based on psychological symptoms. The resulting groups were compared on pain-related and demographic factors. Participants were 548 adults (Mean Age=51.1; predominantly white [66.6%] and female [67.5%]). Two profiles were identified: "Global Distress" (67.2%, elevated clinical symptoms in all domains) and "Localized and Mild Kinesiophobia" (32.8%, sub-clinical symptoms in all domains, except mild kinesiophobia). The "Global Distress" group was younger (d=.23) and had higher levels of area deprivation (d=.23). They had higher pain intensity (d=.76), functional disability (d=.72), and opioid misuse risk (d=1.21). Among adults seeking pain psychology treatment, most experienced elevated distress across pain-specific and general domains. A minority experienced sub-clinical symptoms, with focal and mild kinesiophobia. The findings highlight a wide range of pain psychology needs among adults with chronic pain seeking psychology treatment, and highlight the value in treatment options that span intensity and breadth.
Very few validated instruments measure a child's concept of pain. The Conceptualization of Pain Questionnaire (COPAQ) is a unidimensional instrument measuring this construct, developed in Catalan and translated into English. The clinimetric properties of the English version have not been evaluated. We conducted a Rasch analysis to evaluate its structural validity and internal consistency, and a Confirmatory Factor Analysis (CFA) to evaluate its structural validity. We analyzed an existing data set from a previous study. Item fit was evaluated using INFIT and OUTFIT statistics, item difficulty was estimated using Rasch coefficients, and internal consistency using Cronbach alpha. Structural validity was measured using item loadings from the CFA. We included data from 497 adolescents (average age 14 y [SD 1.28], 51% male). There was a wide range of difficulty across items. One item demonstrated excessive positive outfit, and 2 items were close to the cutoff for excessive negative outfit. The COPAQ demonstrated poor overall fit to the unidimensional Rasch Model and did not demonstrate adequate internal consistency (Cronbach alpha=0.6). Results from the CFA suggest the items do not measure the single construct they intend to measure. The English version of the COPAQ did not have adequate internal consistency or structural validity. More work is required to assess the content validity of current instruments measuring a child's concept of pain. Developing validated instruments measuring a child's concept of pain aligned with the biopsychosocial model should be prioritized.
This article presents a Delphi consensus developed by a panel of editors-in-chief of anaesthesiology and pain medicine journals to guide the responsible use of large language models (LLMs) in academic publishing. LLMs offer potential benefits for scientific writing, including language editing, summarisation, translation, information organisation, and support for non-native English speakers, but their misuse raises concerns about accuracy, transparency, confidentiality, and research integrity. Through a three-round modified Delphi process involving 53 editors-in-chief or their delegates, 59 statements were generated and categorised into guidance for authors, editors, reviewers, and publishers with a particular attention to LLM disclosure practices and perceived risks. The consensus recognises that LLMs are useful tools in academic publishing for authors, reviewers, and editors. However, their use must be guided by ethics, legality, and principles of transparency and accountability. LLMs may assist with limited editorial and authorial tasks provided that their use is fully disclosed and all outputs are verified by humans. The consensus also emphasises the inappropriateness of using LLMs to generate original or ideative content, which should remain a strictly human responsibility. Moreover, LLMs must not generate data, references, conclusions, or entire manuscripts, nor be used for editorial decisions or peer-review reports. Editors expressed concerns about 'hallucinations', erosion of critical skills, confidentiality breaches, and the proliferation of low-quality LLM-generated manuscripts. The resulting guidance highlights transparency, human accountability, and careful verification as essential principles for integrating LLMs into scholarly workflows while preserving the integrity of scientific publishing.
Operant approach activity pacing (undertaking activities according to quotas, e.g. amount/time/goal rather than according to symptom severity) is advised for chronic pain. There is no standardised intervention that addresses all the components of operant approach activity pacing. This systematic review aimed to identify operant approach activity pacing interventions for chronic pain and explore their components, effectiveness, feasibility and acceptability. Eligible studies included any type of evaluation (e.g. randomised controlled trials, feasibility/pilot, qualitative) among adults with chronic pain. Ineligible studies included interventions based on energy conservation/envelope theory/adaptive pacing therapy/symptom-contingency, and non-English language. Databases included: MEDLINE, Embase, CINAHL, AMED, PsycINFO, Cochrane CENTRAL, PEDro, OTseeker and Web of Science (from database inception to 26th March 2025). Two independent reviewers extracted data, including descriptions of interventions (TIDieR checklist), appraised risk of bias (Joanna Briggs Institute checklists) and evaluated confidence in the research (GRADE). Findings were synthesised narratively. Nine studies (10 interventions; 11 papers) were included (873 participants). Interventions were heterogeneous in content, length (2-11 sessions) and tailored/untailored to participants' baseline behaviours. Common intervention components were pre-planning, activity-rest cycling/using rests and alternating activities/positions. Direction of effect (vote counting) was towards improved function, but mixed findings for pain/fatigue. Studies showed mixed findings across outcomes, syntheses were limited to vote counting, with very low confidence in the evidence; limiting conclusions about effectiveness. The multiple components of activity pacing can be considered to further develop and test the effectiveness of operant activity pacing for chronic pain. Funder: NIHR School for Primary Care Research. (PROSPERO:CRD42023451469).
This study aimed to evaluate pain distribution in people with acute whiplash associated disorders (WAD) and explore its association with neuropathic pain and assumed central sensitization features. Although widespread pain is common after a whiplash injury, the relationship between pain extent (the area of the body perceived as painful) and underlying pain-related mechanisms in acute WAD remains poorly understood. In this cross-sectional study, 124 individuals (mean age: 39.7±11.2 y; 67 females) with acute WAD grade II (7-30 d post-injury) completed questionnaires assessing neck pain intensity, disability, neuropathic pain (S-LANSS), and assumed central sensitization (CSI). Pain drawings were analyzed with a validated image-processing algorithm to quantify pain extent. Correlation and multiple linear regression analyses were performed to identify predictors of pain extent. Bivariate correlations showed that pain extent was significantly associated with all clinical variables, with the strongest correlation observed between pain extent and S-LANSS (ρ=0.816, P<.001). In the multiple regression model, only S-LANSS was a significant predictor of PE (β=0.705, P<.001), explaining 64% of the variance. A moderate correlation (ρ=0.437) was found between CSI and pain extent, but the CSI did not independently predict pain extent. No sex differences were observed for any clinical variable. This is the first study to show a strong association between neuropathic pain features and widespread pain in people with acute WAD. These findings highlight the potential utility of assessing pain extent and neuropathic pain features to identify pain phenotypes early after injury which may support more individualized treatment approaches.
This study aimed to identify phenotypes of people with frozen shoulder (FS) based on baseline measures including pain intensity, disability, pain-related psychological factors, and measures of central pain processing. A secondary objective was to evaluate whether these baseline phenotypes were associated with distinct longitudinal trajectories of pain intensity and disability over 9 months. People with FS were assessed at baseline for clinical (pain intensity and disability) and psychophysical variables (pain catastrophizing and hypervigilance, self-reported symptoms related to central sensitization, primary and secondary allodynia and hyperalgesia, and pain modulation). A latent profile analysis was conducted using baseline clinical and psychophysical variables. Linear mixed models were then used to examine longitudinal trajectories of pain intensity and disability across phenotypes over 3, 6, and 9 months. A total of 149 people with FS were recruited. Two distinct phenotypes were identified, of which phenotype 2 (n=70) presented higher intensity of pain, greater disability, and higher scores for pain catastrophizing, hypervigilance, and central sensitization-related symptoms at baseline compared to phenotype 1 (n=79). Over 9 months, trajectories differed by phenotype. Phenotype 2 exhibited a greater absolute reduction in both pain and disability, yet phenotype 1 remained lower at all time points, including 9 months, for both outcomes. This study highlights two distinct phenotypes in people with FS based on baseline clinical and psychophysical variables. These phenotypes showed distinct trajectories of pain and disability over 9 months, supporting the relevance of baseline phenotyping for understanding clinical heterogeneity in FS.
To investigate if psychological/cognitive aspects and executive functions can influence conditioned pain modulation (CPM) activity in elderly people with and without chronic pain. A cross-sectional unifactorial repeated measures case-control study with 19 adults (89.5% women, age: 73.2±5.6 y) with chronic primary musculoskeletal pain and 38 adults (74.5% women, age: 74.3±4.4 y) without chronic pain was conducted. Pain features, psychological/cognitive (anxiety, depression, pain hypervigilance, and pain catastrophizing), and 2 executive functions (working memory, mental inhibition) were assessed. Subsequently, CPM was evaluated on changes obtained in mechanical (pressure pain threshold-PPT) stimuli with the cold-pressor test paradigm. A significant group X time interaction after controlling all cofounders was found: PPTs were higher after the conditioned stimulus in individuals without chronic pain (CPM increase 15%±10%), whereas PPTs were lower after the conditioned stimulus in those with chronic pain (CPM decrease -11%±7%) when compared with PPTs at baseline. In elderly people with chronic pain, pain intensity and catastrophizing accounted for 28.6% of the variance of the CPM activation index. In elderly people without chronic pain, just pain catastrophizing had significant predictive value accounting for 10.6% of the variance of CPM activation index. Elderly people with chronic musculoskeletal pain exhibited impaired CPM activation as compared with adults without chronic pain. Thus, CPM activation was associated with the intensity of pain and, in a lesser extent, with pain catastrophizing, but not with anxiety/depressive levels and executive functions.
This systematic review and meta-analysis examined the efficacy of pain neuroscience education (PNE) on pain, sleep parameters and psychosocial factors in chronic musculoskeletal pain conditions in adults and adolescents. The review was conducted in accordance with PRISMA guidelines. A systematic search was performed using the databases of Medline (PubMed), Scopus, PEDro and Web of Science. The qualitative assessment was done by using Physiotherapy Evidence Database (PEDro) scale and Cochrane's risk of bias (ROB 2.0) tool. The quantitative analysis was performed using the Rev Man 5.4.1 using a random effects model, SMD with 95% confidence intervals and certainty of evidence was evaluated using GRADEpro/GDT. Twelve randomised-controlled trials (n=1485) met the inclusion criteria. The meta-analysis showed statistically significant effect in favour of PNE on reducing pain intensity (SMD: -0.27 [95% CI, -0.5 to 0.00; I2=67%]) and total sleep time with small to medium effect size (SMD: 0.42 [95% CI, 0.12 to 0.71; I2=0%]). However, no statistically significant differences were observed for other sleep parameters and psychosocial outcomes, despite some outcomes indicating a moderate clinical effect. The findings suggest that PNE alone can reduce pain intensity, but greater improvements in sleep and psychosocial outcomes are seen when it is combined with interventions such as CBT and therapeutic exercises. These results highlight the potential role of PNE within a multimodal approach to pain management, while also underscoring the need for further research on its impact on sleep parameters in a specific population.
Older adults living in residential aged care facilities (RACFs), particularly in regional and rural areas, experience a high burden of untreated dental caries, tooth sensitivity, and oral pain. Workforce shortages, limited access to dental services, and competing health priorities make the delivery of timely oral health care challenging in these settings. Poor oral health contributes to pain, impaired nutrition, reduced quality of life, and increased health service use. There is an urgent need for context-appropriate, accessible, and cost-effective interventions for RACF residents. Aqueous silver fluoride (AgF), a minimally invasive topical agent with caries-arresting and desensitizing properties, offers a pragmatic approach suitable for aged care settings. This protocol aims to test the effectiveness of an AgF intervention package in reducing tooth sensitivity and tooth pain, arresting caries, and improving oral health and well-being in older adults living in regional and rural RACFs. This study is a 2-arm, parallel-group cluster randomized controlled trial, with RACFs as the unit of randomization. The trial is conducted in public and private RACFs across regional and rural Queensland and New South Wales, Australia. Eligible participants are residents with at least 1 natural tooth. At baseline, calibrated examiners perform standardized oral examinations to assess dental caries status, lesion activity, and dentin hypersensitivity. AgF is applied to eligible carious lesions and sensitive tooth surfaces following a standardized clinical protocol. Follow-up assessments at 3 months include a repeat clinical examination to assess caries arrest and changes in hypersensitivity, along with resident-reported measures of oral pain and oral health-related quality of life collected using validated instruments. Outcomes include change in tooth sensitivity and oral pain at the 3-month follow-up, caries arrest rates, and change in oral health-related quality of life. Analyses will follow intention-to-treat principles and account for clustering using mixed-effects regression models with facility-level random effects. Models will adjust for baseline covariates and prespecified confounders. Sensitivity analyses will examine the robustness of the findings. The trial will also inform a planned economic evaluation embedded within the broader research program. This trial forms part of a broader program funded by the Medical Research Future Fund Dementia, Aging and Aged Care Grant (2024439). Recruitment and data collection commenced in May 2025 and are expected to conclude in June 2026. Recruitment is ongoing across participating RACFs. Data analysis is expected to commence in mid-2026, with primary findings anticipated for publication in early 2027. This protocol outlines a rigorous evaluation of a minimally invasive, scalable oral health intervention tailored to RACF settings. The findings will provide high-quality evidence on effectiveness to inform policy, service delivery, and economic evaluation aimed at improving oral health and well-being among older adults in residential aged care.
To develop de novo the Multidimensional Chronic Pain Self-Efficacy Scale (M-CPSES), a brief multidimensional measure of self-efficacy in chronic pain, and to examine its psychometric properties in adults with chronic pain recruited from a university-affiliated neurosurgery service. Participants (N=152) completed an initial item pool developed in Mandarin Chinese on the basis of Bandura's self-efficacy theory, Corbin and Strauss's self-management framework, clinician consultation, patient-informed refinement, and expert review. Exploratory factor analysis (EFA) was conducted on the first 100 participants, and confirmatory factor analysis (CFA) was conducted in the full sample, which included the EFA subsample. CFA supported a second-order, four-factor, nine-item model representing medical, daily life, emotional, and cognitive domains, with good model fit. Reliability for the total score was good (Cronbach's α=.84; test-retest intraclass correlation coefficient=.73). Correlations were consistent with theoretical expectations, with positive associations with general self-efficacy, self-esteem, and physical functioning and negative associations with depression, anxiety, and pain intensity. Known-groups validity was supported by lower scores in individuals with severe pain than in those with mild to moderate pain. The M-CPSES provides a concise multidimensional assessment that includes the often-overlooked cognitive aspect of chronic pain self-management. The findings support its potential utility for screening, individualized care planning, and outcome monitoring in Mandarin-speaking adults with chronic pain receiving specialty care.
Chronic overlapping pain conditions (COPCs) affect young adults and pose significant challenges in medical care. This study aimed to describe the types and number of current and past medical providers and medications used by young adults with COPCs and to explore associations between health care utilization, clinical pain, and psychosocial factors. Fifty young adults (mean age: 27.16 y) with COPCs were recruited and completed online questionnaires assessing demographics, pain intensity and interference, number of pain conditions, health care providers consulted, medication use, and psychosocial characteristics. Relationships among health care utilization, clinical pain measures, and psychosocial variables were analyzed using Pearson correlations and linear regression models. Participants reported an average of 4.40 COPCs, with fibromyalgia, chronic low back pain, and chronic fatigue syndrome being the most common. Most (72%) were currently receiving medical treatment, with primary care physicians being the most frequently consulted providers. The average number of current providers was 2.82, while the number of past providers was 4.28. Despite extensive health care engagement, 77.7% reported no improvement or worsening of their condition. No significant associations were found between the number of providers or medications and clinical or psychosocial outcomes. The findings highlight gaps in the effectiveness of health care utilization for young adults with COPCs. The high prevalence of provider visits and medication use without substantial symptom improvement suggests a need for more integrated, multidisciplinary care approaches. Future research should focus on optimizing treatment strategies and identifying opportunities for early intervention.