Chronic Pain In Adults Research Articles

Resilience as a protective factor in face of pain symptomatology, disability and psychological outcomes in adult chronic pain populations: a scoping review.

Patients suffering from chronic pain experience significant disability and disease burden. Resilience has been understood to be a protective factor in face of adversity, eventually contributing to positive outcomes. As such, the current review sought to summarize the existing literature focusing on the roles of resilience in relation to pain phenomenology, pain outcomes (including function and mental health), amongst relevant clinical correlates in a bid to promote holistic management of debilitating chronic pain conditions from a resilience-oriented psychotherapeutic approach as an adjunct to pharmacological treatment. A scoping review was conducted on empirical studies surrounding the theme of resilience in adult chronic pain populations published before 9th May 2021. The following main inclusion criteria was applied; (a)adults diagnosed with chronic pain disorders, (b)use ofquantifiable pain measures, (c)use of quantifiable resilience measures. A total of 32 studies were then selected for the review. First, higher levels of resilience were associated with a reduced likelihood of experiencing any chronic pain, fewer pain sites, better psychological response towards nociception and reduced need for analgesia. Second, higher levels of resilience correlated with better daily and physical function, quality of life, psychosocial functioning and lower likelihood of co-morbid mental health disorders. Third, resilience was an intermediary variable in the pathways from pain phenomenology leading to pain interference, depression and post-traumatic growth. The findings were contextualized using pain-disability and resilience frameworks (The Pain and Disability Drivers Model, O'Leary's Resilience models) with suggestions to enhance resilience and contextual factors in the holistic management of adult chronic pain conditions. Future research should examine the differences in resilience between pain types as well as evaluate the efficacy of streamlined resilience-oriented interventions.

The Role of Neuro-Immune Interaction in Chronic Pain Conditions; Functional Somatic Syndrome, Neurogenic Inflammation, and Peripheral Neuropathy.

Functional somatic syndromes are increasingly diagnosed in chronically ill patients presenting with an array of symptoms not attributed to physical ailments. Conditions such as chronic fatigue syndrome, fibromyalgia syndrome, or irritable bowel syndrome are common disorders that belong in this broad category. Such syndromes are characterised by the presence of one or multiple chronic symptoms including widespread musculoskeletal pain, fatigue, sleep disorders, and abdominal pain, amongst other issues. Symptoms are believed to relate to a complex interaction of biological and psychosocial factors, where a definite aetiology has not been established. Theories suggest causative pathways between the immune and nervous systems of affected individuals with several risk factors identified in patients presenting with one or more functional syndromes. Risk factors including stress and childhood trauma are now recognised as important contributors to chronic pain conditions. Emotional, physical, and sexual abuse during childhood is considered a severe stressor having a high prevalence in functional somatic syndrome suffers. Such trauma permanently alters the biological stress response of the suffers leading to neuroexcitatory and other nerve issues associated with chronic pain in adults. Traumatic and chronic stress results in epigenetic changes in stress response genes, which ultimately leads to dysregulation of the hypothalamic-pituitary axis, the autonomic nervous system, and the immune system manifesting in a broad array of symptoms. Importantly, these systems are known to be dysregulated in patients suffering from functional somatic syndrome. Functional somatic syndromes are also highly prevalent co-morbidities of psychiatric conditions, mood disorders, and anxiety. Consequently, this review aims to provide insight into the role of the nervous system and immune system in chronic pain disorders associated with the musculoskeletal system, and central and peripheral nervous systems.

Is buprenorphine an effective analgesic for treatment of chronic pain in adults?

NJ—Rutgers RWJMS at RWJUH, New Brunswick, NJ The corresponding author is Jennifer Amico, MD, MPH; [email protected]. The authors declare no conflicts of interest.

VISUAL ANALOGUE SCALE AS A TOOL FOR ASSESSING QUALITY OF LIFE (PEDSQL™) AND EMOTIONAL STRESS IN CHILDREN AFTER ANTERIOR ABDOMINAL WALL SURGERY

Introduction. The prevalence of chronic postsurgical pain can be as high as 54%. Almost 17% of adult chronic pain patients report a history of chronic pain in childhood or adolescence. Untreated chronic pain in children increases the risk of developing mental disorders later in life. Health-related quality of life (HRQoL) is a commonly used indicator of health and well-being that demonstrates the impact of health on quality of life and reflects the desirability of health states relative to perfect health. The simplicity, reliability, validity, and easy determination of visual analogue scale (VAS) scores provides for its wide-ranging application in various clinical cases. The aim of this study was to assess quality of life in children after anterior abdominal wall surgery using the PedsQL™ 3.0 Present Functioning Visual Analogue Scales. Materials and Methods. Following the inclusion and exclusion criteria, a total of 80 children undergoing treatment at the surgical department of a Communal Non-Profit Enterprise “Ivano-Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council” were enrolled in the study. Among them, 60 children underwent anterior abdominal wall surgery with various types of anesthetic regimens. The patients were asked to fill in the questionnaires repeatedly three and six months after hospital discharge. Results. According to the VAS, three and six months after surgery, quality of life was significantly lower in children who underwent anterior abdominal wall surgery under general anesthesia with opioids and were diagnosed with chronic pain syndrome (p<0.01). Their quality of life was significantly lower due to excessive emotional stress secondary to chronic pain syndrome (p<0.001). Discussion. Three months after surgery, children with chronic pain syndrome who underwent conventional anesthesia had high VAS scores experiencing reduced quality of life and elevated emotional stress as compared to the control group (p<0.001). Six months after surgery, in children who underwent regional analgesia, the levels of quality of life and emotional stress almost approached those in the control group as compared to children who underwent conventional anesthesia (p<0.001). Conclusions. Chronic pain syndrome reduced quality of life in children at the age of 7-18 years who underwent anterior abdominal wall surgery by increasing overall emotional stress. The myofascial block in conjunction with general anesthesia accelerates patient’s recovery, relieves pain, and reduces emotional stress.

Gait subgroups among older adults with chronic pain differ in cerebellum and basal ganglia gray matter volumes.

Current literature regarding morphological gray matter atrophy in chronic pain is mixed, inhibiting our ability to understand neurological mechanisms of chronic pain. The inconsistent findings may be due to the presence of subgroups within the older adult chronic pain population that differ in gait performance, as gait and gray matter have been previously associated. These gait subgroups, however, have been inadequately characterized in prior work and have not been compared across gray matter measures. Therefore, the purpose of this study was to identify and characterize gait subgroups within the older adult chronic pain population, and to evaluate differences in gray matter measures between subgroups. The present study was a secondary analysis of the Neuromodulatory Examination of Pain and Mobility Across the Lifespan (NEPAL) study. A subset of older participants (n = 40) completed assessments to evaluate psychological status, cognitive abilities, pain characteristics, and spatiotemporal gait performance using an instrumented gait mat. Gray matter measures were obtained from a T1-weighted anatomical scan using Freesurfer's recon-all function. After data reduction, a hierarchical cluster analysis identified three gait clusters: A Normal Gait cluster (n = 12), a Shuffle Gait cluster (n = 15), and an Unsteady Gait cluster (n = 13). Clusters differed in gait velocity, stride length, step width, double support percentages, and stride length variability. The Shuffle Gait cluster exhibited reduced gray matter volumes in the cerebellum, caudate, putamen, and pallidum, as well as a worse pain severity when compared to the Normal Gait cluster (p < 0.05). The Shuffle Gait cluster also had less gray matter in the cerebellum and caudate when compared to the Unsteady Gait cluster (p < 0.05). Our results confirm the existence of gait subgroups among the older adult chronic pain population and gray matter differences observed between groups support the need for the consideration of subgroups within this population for future pain, mobility, and aging studies.

Innate Immunity at the Core of Sex Differences in Osteoarthritic Pain?

Osteoarthritis (OA) is a progressive whole-joint disease; no disease-modifying drugs are currently available to stop or slow its process. Symptoms alleviation is the only treatment option. OA is the major cause of chronic pain in adults, with pain being the main symptom driving patients to seek medical help. OA pathophysiology is closely associated with the innate immune system, which is also closely linked to pain mediators leading to joint pain. Pain research has shown sex differences in the biology of pain, including sexually dimorphic responses from key cell types in the innate immune system. Not only is OA more prevalent in women than in men, but women patients also show worse OA outcomes, partially due to experiencing more pain symptoms despite having similar levels of structural damage. The cause of sex differences in OA and OA pain is poorly understood. This review provides an overview of the involvement of innate immunity in OA pain in joints and in the dorsal root ganglion. We summarize the emerging evidence of sex differences regarding innate immunity in OA pain. Our main goal with this review was to provide a scientific foundation for future research leading to alternative pain relief therapies targeting innate immunity that consider sex differences. This will ultimately lead to a more effective treatment of pain in both women and men.

The core minimum dataset for measuring pain outcomes in pain services across Scotland. Developing and testing a brief multi-dimensional questionnaire.

There is currently no agreed minimum dataset to inform specialist chronic pain service provision. We aimed to develop a Core Minimum Dataset (CMD) for pain services in Scotland and perform preliminary analysis to evaluate its psychometric properties in adults with chronic pain. The questionnaire was developed following a review of existing relevant data collection instruments and national consultation. The CMD questionnaire was completed alongside a routine pre-clinic questionnaire by patients attending two pain services over 3 months. Concurrent validity was tested by comparing scores between the CMD and pre-existing questionnaires. Reliability was assessed by test-retest and discriminative validity via receiver operating characteristic (ROC) curves. The final CMD questionnaire consisted of five questions on four domains: pain severity (Chronic Pain Grade [CPG] Q1); pain interference (CPG Q5); emotional impact (Patient Health Questionnaire-2 [PHQ-2], two questions); and quality of life (Short Form Health Survey-36 [SF-36] Q1). 530 patients completed the questionnaire. Strong correlation was found with the Hospital Anxiety and Depression Scale (rs = 0.753, p < 0.001). Moderate correlations were found with the Brief Pain Inventory for pain interference (rs = 0.585, p < 0.001) and pain severity (rs = 0.644, p < 0.001). Moderate to good reliability was demonstrated (Intra-class Correlation Coefficient = 0.572-0.845). All items indicated good discrimination for relevant health states. The findings represent initial steps towards developing an accurate questionnaire that is feasible for assessing chronic pain in adults attending specialist pain clinics and measuring service improvements in Scotland. Further validation testing, in clinical settings, is now required.

Virtual Reality and the Mediation of Acute and Chronic Pain in Adult and Pediatric Populations: Research Developments.

The use of virtual reality (VR) in the mediation of acute pain in adults has shown real benefit to patients for the past 20 years. This review of the literature provides a descriptive synthesis of the types of VR technology, the mechanisms by which VR mediates pain, and a history of early research in the area. A review of the use of VR to mediate chronic pain in adults, and both acute and chronic pain in pediatric populations follows. The studies reviewed provide mixed results and it is noted that many studies have small sample sizes, are case studies, and do not control for extraneous variables such as the dosage and type of VR technology used. Although VR is an exciting area of inquiry that promises to yield multiple applications, there is a necessity to conduct larger random controlled trials to better understand the use cases for which VR is most effective.

Added “Age-like” Brain Patterns with Increasing Pain Impact in Persons with Knee Osteoarthritis Pain: Considerations by Race

Knee osteoarthritis is a leading cause of chronic pain in adults (1, 2). Yet its impact varies (3, 4), and may be influenced by changes in the central nervous system (5, 6), similar to neuroplasticity observed in aging (7, 8), including increased brain atrophy, placing individuals at a greater risk for negative outcomes (9). We used an established brain age biomarker (brain-PAD) in a diverse cohort of middle aged and older adults with various levels of knee OA pain and related disability (10, 11). We hypothesized that 1) brain-PAD would differ between those with/without pain, 2) those with high-impact pain (i.e., pain with physical limitation) would present with a greater brain-PAD (i.e., older-appearing brain reflective of greater age-related brain atrophy), and 3) that brain-PAD would be associated with pain and psychosocial characteristics. Here, 202 adults with/without knee OA pain (mean age = 58.2 ± 8.2, 65.5% female), recruited in the UPLOAD2 study, completed clinical and experimental pain and psychosocial measures, and neuroimaging. Individuals were classified based on the presence/absence of chronic knee pain and pain-related disability. Using an established brain aging biomarker (12), we generated brain-predicted age values and subtracted chronological age to derive a brain-predicted age difference (brain-PAD) score for each participant. ANCOVAs and partial correlations determined associations between brain-PAD, pain, and psychosocial constructs adjusting for age, race, sex, and site. There was a significant pain group*race interaction for brain-PAD, (p = 0.023), and a significant main effect between pain impact groups with high-impact pain demonstrating significantly "older" brains compared to those with low-impact pain, (p = 0.036). Brain-PAD was significantly associated with pain and psychosocial variables (p's < 0.05). This study provides initial evidence for the effects of pain impact and race on brain-PAD in middle aged and older adults with knee OA-related pain. Grant support from NIH/NIA Grants R01AG059809, R01AG067757 (YCA); R37AG033906 (RBF); K02AG062498 (TB); National Science Foundation Cooperative Agreement No. DMR-1157490 and DMR-1644779 and the State of Florida for the McKnight Brain Institute.

Investigating the veracity of a sample of divergent published trial data in spinal pain.

Evidence-based medicine is replete with studies assessing quality and bias, but few evaluating research integrity or trustworthiness. A recent Cochrane review of psychological interventions for chronic pain identified trials with a shared lead author with highly divergent results. We sought to systematically identify all similar trials from this author to explore their risk of bias, governance procedures, and trustworthiness. We searched OVID MEDLINE, EMBASE, CENTRAL, and PEDro from 2010 to December 22, 2021 for trials. We contacted the authors requesting details of trial registration, ethical approval, protocol, and access to the trial data for verification. We used the Cochrane risk-of-bias tool and the Cochrane Pregnancy and Childbirth group's Trustworthiness Screening Tool to guide systematic exploration of trustworthiness. Ten trials were included: 9 compared cognitive behavioural therapy and physical exercise to usual care, exercise alone, or physiotherapy and 1 compared 2 brief cognitive behavioural therapy programmes. Eight trials reported results divergent from the evidence base. Assessment of risk of bias and participant characteristics identified no substantial concerns. Responses from the lead author did not satisfactorily explain this divergence. Trustworthiness screening identified concerns about research governance, data plausibility at baseline, the results, and apparent data duplication. We discuss the findings within the context of methods for establishing the trustworthiness of research findings generally. Important concerns regarding the trustworthiness of these trials reduce our confidence in them. They should probably not be used to inform the results and conclusions of systematic reviews, in clinical training, policy documents, or any relevant instruction regarding adult chronic pain management.

Defining Success in Transitions from Pediatric to Adult Chronic Pain Care: A Descriptive Qualitative Study of Perspectives of Young Adults Living with Chronic Pain.

To explore how young adults with chronic pain define a successful transition from pediatric to adult chronic pain care and how they would like to be empowered to achieve a successful transition. A descriptive qualitative design. Participants were recruited from a hospital-based chronic pain clinic in Toronto, Canada, and through social media. Young adults (18-25 years of age, inclusive) who received chronic pain care in a pediatric setting and continued to self-identify as having a need for chronic pain care in an adult chronic pain care setting. Semistructured interviews were used to understand the perspectives of young adults with chronic pain. Interviews were audio-recorded, transcribed verbatim, and checked for accuracy. Qualitative inductive content analysis was used to analyze the interview data. Eight young adults with chronic pain were interviewed (all women; median age=19 years). Five themes that addressed the study objectives are described: 1) Young adults value skill-building and knowledge about the transition, 2) establishment of a strong therapeutic alliance with health care providers, 3) coordinated and planned transition, 4) social and environmental support, and 5) respect for young adults' independence and autonomy. Findings suggest the need for a collaborative and individualized approach to the successful transition of young adults across the continuum of chronic pain care that addresses their unique needs. To promote successful transition, clinicians should build relationships with young adults that facilitate choice and autonomy while enhancing skill-building and education on available resources.

Applied Philosophical Hermeneutic Research: the unmethod

The purpose of this article is to provide insight into the philosophy and practice of Applied Philosophical Hermeneutics as a unique approach for research in the health sciences. While there are other research approaches grounded in hermeneutics, this article focuses on Gadamer’s modern philosophical hermeneutics. During my 18 years as a hermeneutic researcher, graduate students and I have engaged with people with a wide variety of experiences such as preventable medical error, Indigenous health, adult and adolescent chronic pain, social responsibility in higher education, oral health care for autistic children, and the experiences of people living with Thalassemia. Applied Philosophical Hermeneutics offers an approach to help bring researchers, clinicians, and patients together within a community of active partnerships in research. All these projects employed Applied Philosophical Hermeneutics as an approach to gain a deeper and personal understanding of the unique experiences of these diverse groups of people. Hermeneutics remains somewhat confusing as the unmethod which may lead to a dismissive attitude toward this research approach. Therefore, the intention of this paper is to present a risk-free insight into hermeneutics, which hopefully will open-up conversations and new learning experiences among researchers, students, patients, and colleagues.

Non-surgical treatment for adult spinal deformity: results of an intensive combined physical and psychological programme for patients with adult spinal deformity and chronic low back pain—a treatment-based cohort study

ObjectivesNo evidence-based treatment exists for adult spinal deformity (ASD) patients with chronic low back pain (CLBP). Aim of this study: evaluate a combined physical and psychological programme (CPPP) for ASD patients with CLBP and to compare this with a non-ASD-cohort with CLBP.MethodsData were extracted from the database of CLBP-patients for whom surgery is not an option and completed CPPP. Two cohorts were selected: an ASD-cohort (n = 80) based on a Cobb angle of > 10° and a consecutive age- and gender-matched non-ASD-cohort (n = 240). Primary outcome: functional status (Oswestry Disability Index; ODI). Secondary outcomes: pain intensity, self-efficacy and quality of life. Assessments: pre and post treatment, one-month and one-year follow-up (FU). Clinical relevance: minimal important clinical change (MCIC; ODI 10 points), patient acceptable symptom state (PASS; ODI ≤ 22).ResultsDemographics ASD-cohort: 79% female, mean age 50.9 (± 14.1) years, mean CLBP duration 15.5 (± 12.5) years, mean Cobb angle 21.4 (± 9.4)°. Non-ASD-cohort: not significantly different. Both cohorts improved in functional status (F[1,318] = 142.982, p < .001; r = 0.31). The ASD-cohort improved from mean ODI 39.5(± 12.0) at baseline to mean ODI 31.8(± 16.5) at one-year FU. Clinical relevance: 51% of the ASD patients reached MCIC and 33% reached a PASS. An interaction effect is shown between time and both cohorts (F[1,318] = 8.2, p = .004; r = 0.03); however, not clinically relevant. All secondary outcomes: improvement at one-year FU.ConclusionThis is the first study showing beneficial outcomes of a non-surgical treatment in selected ASD patients with longstanding CLBP. Improvement is shown in functional status, and appeared equivalent to the non-ASD cohort.Level of Evidence 1Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: a systematic review and meta-analysis of 381 studies (the meta-TENS study)

ObjectiveTo investigate the efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for relief of pain in adults.DesignSystematic review and meta-analysis.Data sourcesMedline, Cochrane Central, Embase (and others) from inception to...

Current and Emerging Approaches for Pain Management in Hemophilic Arthropathy.

IntroductionHemophilia is an inherited bleeding hematological disorder characterized by the partial or complete deficiency of clotting factor VIII or IX. Hemophilic arthropathy is the consequence of repeated joint bleeding (hemarthrosis) and its management is based on the prevention of acute bleeding through the administration of the deficient clotting factor concentrate or non-factor therapies. In addition, the management of acute and chronic pain is pivotal in hemophilic arthropathy in order to restore function and allow rehabilitation of the joint. MethodsWe conducted a qualitative review of the literature regarding current and emerging strategies for pain treatment in hemophilic arthropathy. This review considers systemic and local pharmacological and non-pharmacological interventions for acute and chronic pain management. ResultsIn hemophilic arthropathy, pain management is based on analgesics such as paracetamol, which represents the first choice for acute and chronic pain in adults and children, in association with opioids for adults. Non-steroidal anti-inflammatory drugs inhibit platelet function, so that the currently preferred drugs are short courses of cyclooxygenase 2 inhibitors. Local treatment with intra-articular injections of corticosteroids is an option for refractory cases and physiotherapy has an important role after hemarthrosis and for the long-term management of chronic pain for both pediatric and adult patients. ConclusionsThe management of pain in hemophilia requires more standardization. Meanwhile, the safest drugs should be used at the lowest effective dosage and for periods as short as possible. For the non-pharmacological management of pain in these patients, a multidisciplinary team including hematologists, orthopedic surgeons, rheumatologists, and physiotherapists is warranted.

Margaret Fuller's Physical Education

Margaret Fuller's Physical Education Jess Libow In the posthumously published Memoirs of Margaret Fuller Ossoli, Frederic Henry Hedge recalls his impression of thirteen-year-old Fuller: "I have the idea of a blooming girl of a florid complexion and vigorous health, with a tendency to robustness, of which she was painfully conscious, and which, with little regard to hygienic principles, she endeavored to suppress or conceal, thereby preparing for herself much future suffering" (91).1 Apparently presuming his readers' awareness of the adult Fuller's chronic migraines and back pain, Hedge offers an account of these ailments steeped in nineteenth-century ideas about child development and sex difference. Proposing that Fuller would have remained healthy into adulthood had she cultivated her innate vigor, Hedge cites adolescent folly as the source of her impairments, even as he praises her precocity elsewhere in his reminiscence. As an adult, however, Fuller herself proposed a slightly different narrative. While she shared Hedge's and others' concerns about young girls' precarious health, Fuller attributed her physical condition not to individual error or neglect but rather to a systemic national failure regarding female education. In this essay I argue that Fuller turned to the pedagogical science of physical education in order to redress what she perceived as a significant source of white women's interrelated physical and social limitations. Throughout her writings from the early 1840s she presents her own impairments as products of an education system that prioritized girls' sedentary, indoor pursuits over outdoor physical activity. Imagining an education system designed to cultivate female bodies as well as minds, Fuller figures white female able-bodiedness as essential to engendering a feminist future. Scholars have long recognized the centrality of embodiment to Fuller's thinking, which, as C. Michael Hurst puts it, "sutures the body and mind back together" (12). I propose that the education of girls offered Fuller an ideal arena in which to pursue this relationship between processes of mental, spiritual, and physical development on a large scale. Fuller describes herself as an extreme [End Page 1] case of disrupted development, "a youthful prodigy" whose rigorous intellectual education produced "premature development of the brain," which in turn "prevented the harmonious development of my bodily powers and checked my growth," leaving a pattern of "continual headache, weakness and nervous affections, of all kinds" (26). While critics such as Cynthia J. Davis, Deborah Manson, and Rachel A. Blumenthal have identified the significance of illness and health in Fuller's feminism, investigating her interest in physical education reveals how she leveraged her concerns about women's impairments to launch a pervasive critique of sexist systems.2 Examining Fuller's turn to physical education also helps clarify the roles of race and nation in her conception of female health. As Kyla Tompkins explains, the project of nineteenth-century health reform, of which physical education was part, "[stitched] nationalism to the individual white body" (6). Like many other health reformers, Fuller viewed cultivating individual health as inextricable from shoring up white American hegemony. She believed that the bodies of white girls—and with them, the political status of white women—could be transformed by an education system that incorporated physical activity. At the same time, because she insisted that female impairment was the result of an overly sedentary life, Fuller could extend neither her critique nor her intervention to Indigenous women, whom she suggested were impaired by the physical demands of their social roles. Ultimately, Fuller's racially differentiated theories of female development both fueled her aspirations for white women's spiritual and political capacities and established the racist limitations of her feminist vision. In what follows I begin by showing how Fuller's interest in physical education put her in direct conversation with figures in the education reform movements of the eighteenth and early nineteenth centuries as well as the emerging women's rights movement. Next, I turn to Fuller's reflections on her own early schooling, which she drew on to develop a broader critique of white women's stunted intellectual and spiritual development. I then trace the sociological turn in her thinking about physical education by examining her 1844 travel narrative Summer on the Lakes...

Implanted spinal neuromodulation interventions for chronic pain in adults.

Implanted spinal neuromodulation interventions for chronic pain in adults.

The prevalence of chronic pain in young adults: a systematic review and meta-analysis.

Previous systematic reviews have summarized the prevalence and impact of chronic pain in "average" pediatric (ie, school-age children) and adult (ie, middle-aged individuals) age groups. To the best of our knowledge, this is the first study to describe the prevalence of chronic pain in the subgroup of individuals who fall in between established boundaries of "childhood" and "adulthood"-known as young adulthood. The goal of this research was to meta-analyze prevalence data on pain in young adults based on available data published between 2008 and 2020. Searches were identified with MEDLINE, Embase, and PsycINFO. We included general population and university-based studies presenting prevalence estimates of chronic pain (pain lasting ≥3 months) in young adults. We identified 43 articles providing prevalence estimates across a combined population of 97,437 young adult respondents (age range: 15-34 years), with studies undertaken in 22 countries. Available data allowed for stratification of prevalence according to pain condition. The overall pooled random-effect prevalence rate of chronic pain in young adults was 11.6%, suggesting that 1 in every 9 young adults experience chronic pain worldwide. Prevalence rates varied considerably according to pain condition. Estimates did not vary according to sex, geographic location, and several study methodological characteristics (ie, population type, sampling area, sampling year, investigation period, and assessment method). Overall, young adult chronic pain is common and should be recognized as a major public health concern. Considering the difficulties young adults face accessing adult health care, greater attention is needed to develop transition programs and evidence-based treatments tailored to the unique needs of this age group.

Perspectives of personalized approach to prevention and treatment of anticonvulsant-induced osteoporosis via action on vitamin D exchange and VDR expression

Anticonvulsant-induced osteoporosis (AIO) and associated pain syndromes and patient disabilities are an important interdisciplinary medical problem generated by various molecular, genetic and pathophysiological mechanisms. AIO are the most important pathological processes associated with chronic pain in adults with epilepsy. Standard approaches to their prevention and treatment do not always solve the problem of the progression of the pathological process and chronicity of AIO. This is the reason for the search for new personalized strategies for the prevention and treatment of AIO. Vitamin D metabolism, expression and specificity of vitamin D receptors (VDRs) may play a key role in the development of AIO and chronic back pain in patients with epilepsy. The aim of the study was to review publications on changes in the vitamin D system in patients with AIO. We searched for articles published in e-Library, PubMed, Oxford Press, Clinical Case, Springer, Elsevier, and Google Scholar. The search was carried out by key-words and their combinations. The role of vitamin D and VDR in the development of AIO and the chronicity of back pain has been demonstrated mainly in animal models and humans. Associative genetic studies have shown that single nucleotide variants (SNVs) of the VDR gene encoding VDR may be associated with the development of osteoporosis of the spine (including those associated with the intake of an anticonvulsants). The prospects for the use of vitamin D preparations for modulating the effect of anticonvulsants used to treat epilepsy are discussed. Genetic association studies of VDR gene SNVs are important for understanding the genetic predictors of AIO and chronic back pain in patients with epilepsy, as well as for developing new personalized pharmacotherapy strategies.

Evaluation on curative effects of gabapentin for the prevention of chronic pain in adults following surgery: A protocol for systematic review and meta-analysis.

Background:Chronic pain is a common postsurgery symptom. It has an adverse impact on patients’ overall wellbeing. Chronic pain after an operation is caused by intricate mechanisms that have not been well understood. The predictability of most surgical methods has enabled scholars to conduct randomized controlled trials (RCTs) involving pharmacological interventions to prevent chronic pain after a surgery. Therefore, the present study aims to evaluate the curative effects of gabapentin to prevent chronic pain in adults after surgery.Methods:The authors will collect RCTs related to the use of gabapentin to prevent chronic pain in adults following surgery. Accordingly, a comprehensive search will be performed in 4 online databases to find English language articles, including Cochrane Library, EMBASE, Web of Science, and PubMed. In addition, the search also includes 3 Chinese language databases: VIP data, WanFang database, and China National Knowledge Infrastructure. Each of the RCT published from their inception to September 2021 will be considered. The authors will carry out a meta-analysis of RCTs after screening the studies. Subsequently, the authors will use RevMan (v 5.3) to perform an assessment of bias risk, data synthesis, and subgroup analysis, provided inclusion criteria are met.Results:The results will provide clinical evidence for the curative effects of gabapentin to prevent chronic pain in adults after surgery.Conclusion:The summary provided in this systematic review will judge whether gabapentin intervention is effective and feasible to prevent chronic pain in adults following surgery.Registration number: 10.17605/OSF.IO/XG4CK