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±5.6y) with chronic primary musculoskeletal pain and 38 adults (74.5% women, age: 74.3±4.4y) 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.

Carrying a double burden: The impact of pain and gender-related stigma in women with chronic pelvic pain.

The study aims to translate and cross-culturally adapt the self-compassion scale (SCS) into the Danish language and evaluate its psychometric properties. Additionally, since self-compassion (SC) is becoming as an important factor in the management of mental health in patients with chronic pain, the SCS was tested in cohort of patients with chronic non-malignant pain. A dual panel approach was applied for linguistic and cross-cultural translation. Participants were recruited through social media and multidisciplinary pain centers in Denmark. Intraclass Correlation Coefficient (ICC) verified test-retest reliability. To assess construct validity a model fit analysis was conducted through the Confirmatory Factor Analysis (CFA). Thirty-four individuals participated in the dual panel and verified that the Danish translation reflected the original English version. The test-retest (two-weeks) sample included 60 individuals and demonstrated an average ICC of 0.889 [95% CI 0.815-0.934]. The Smallest Detectable Change (SDC) revealed significant but non-clinically relevant differences between genders in both samples. Data from 761 individuals validated the SCS based on a six-factor construct. The psychometric properties verified the reliability of the Danish version. The present results suggest that an overall score can be used to describe the amount of SC in the background population, while the six subscale scores better capture nuances in patients with chronic pain. Overall, the Danish SCS was translated, cross-culturally adapted, and validated, the findings support the use of six-subscale scores in a clinical context.

The stress-pain connection in chronic primary pain: A systematic review and meta-analysis of physiological stress markers in relation to experimental pain responses.

Prevalence of Tobacco Use in Adults With Chronic Pain: Results From the National Health Interview Survey 2014-2023.

The power to adapt: How resilience and changing expectations contribute to placebo effects.

Retrospective study. To determine the prevalence of new chronic pain conditions within one year of whiplash and the factors associated with chronic pain following whiplash exposure. Whiplash is among the most common injuries that occur following motor vehicle accidents. Many have postulated that whiplash is a progenitor for the development of chronic pain. Prior research in this arena has been limited. We retrospectively identified TRICARE beneficiaries who sustained a whiplash injury between 2017 and 2023. The records of eligible beneficiaries were abstracted to obtain age at the time of injury, race, sex, US census region, sponsor rank, mental health diagnoses, environment of care, beneficiary status, time period of injury, and number of comorbidities. We considered junior enlisted sponsor rank indicative of lower socioeconomic strata. The primary outcome was the development of a chronic pain condition. We used multivariable logistic regression with reweighting to account for confounders. We examined interactions between sex/mental health conditions, sex/socioeconomic status, and sex/time period to address secular trends. The development of new chronic pain conditions occurred in 23.4%. After adjusting for confounders, we found that women (OR=1.57; 95% CI: 1.49-1.65), pre-existing mental health conditions (OR=1.35; 95% CI: 1.28-1.42) and our proxy for lower socioeconomic status (OR=1.15; 95% CI: 1.04-1.27) were significantly associated with the likelihood of developing chronic pain disorders within one year of whiplash injury. There were interactions between women and mental health conditions, as well as between women and socioeconomic status. This represents the largest study that longitudinally surveys the development of chronic pain conditions following whiplash. The incidence of chronic pain after whiplash is lower than has been previously postulated. We believe these findings can inform management during the postinjury time period and recommendations for surveillance.

The role of dual-tasking, mindfulness, and rumination on gait in older adults with chronic pain.

Impact of Iliac Vein Compression on the Outcome of Pelvic Venous Embolization in Patients with Pelvic Venous Disorder.

Clinicians often administer opioids to manage postoperative pain, but with considerable variation in chosen opioid and dosing strategies. This post hoc analysis of a Danish nationwide survey assessed how profession, length of experience, and geographical region impact dosing in the intraoperative phase (end of surgery) and the postoperative phase (PACU) for postoperative control. A 37-item online survey on opioid practice amongst anaesthesia personnel in Denmark (5 February-30 April 2024). Regression analyses compared intravenous morphine equivalent doses (MEQ) in eight clinical cases for three provider characteristics: profession (physician/nurse), length of experience (> < 10 years) and geographical region (five regions). We predefined differences ≥ 0.03 mg/kg MEQ as clinically relevant. We qualitatively described group differences in perioperative factors guiding dose adjustments, defining differences ≥ 10% as relevant. The overall response rate was 48% (2025/4187). In four intraoperative clinical cases, anaesthesiologists administered on average 0.04 mg/kg MEQ less than nurse anaesthetists (95% CI: 0.03 to 0.04, p < 0.001), considered clinically relevant. Respondents with short working experience (< 10 years) administered 0.01 mg/kg MEQ less (95% CI: 0.00 to 0.02, p = 0.001). Respondents in the North Denmark Region administered 0.07 mg/kg MEQ more than the national average of 0.32 mg/kg MEQ (p < 0.001), considered clinically relevant. In postoperative clinical cases, significant dosing differences between short versus long working experience were not considered clinically relevant. Clinically relevant differences in dose-adjusting factors existed between professions (preoperative opioid use, age, body weight, alcohol use, chronic pain, and ASA classification) and regions (chronic pain, body weight, preoperative opioid use, ASA classification, sedation, BMI, and nausea). Clinical profession and regional background contribute to variation in opioid dosing strategies. Nurse anaesthetists and respondents from the North Denmark Region administered significantly and clinically relevant higher doses of opioids. Clinically relevant differences existed between professions and regions regarding opioid dose-adjusting factors. This secondary analysis of survey results from Denmark regarding opioid choices and dosing preferences for post-surgical analgesia focused on professional categories and regions within Denmark. Some apparent dosing preference differences were described between professional groups and also between regions.

Interindividual variability in analgesic responsiveness often results in therapy failure (TF) or adverse drug reactions (ADR) and poses a major challenge in chronic pain management, as it is influenced by multiple factors. This exploratory study investigated whether pharmacogenetic (PGx) testing could identify drug-gene interactions (DGIs) explaining variability in drug response. In addition, we explored whether genetic predispositions in CYP2D6 and COMT , indicating increased pain sensitivity, are linked to TF. We analyzed data from chronic pain patients who underwent pharmacogenotyping due to suspected TF or ADR. PGx panel testing was carried out by a commercial provider. Additional genotyping of COMT rs6269, rs4633, and rs4818 was performed using PCR, RFLP, and Sanger sequencing. PGx panel testing confirmed at least one relevant genetic variant in 45% of the suspected DGIs. Notably, 41% involved the pharmacogenes CYP2D6 , CYP2C19 , and CYP2C9 . Subgroup analyses revealed that patients carrying the COMT high pain sensitivity (HPS) allele, COMT high pain phenotype, or CYP2D6 intermediate metabolizer (IM) phenotype were significantly more likely to experience TF. Logistic regression confirmed both phenotypes as significant predictors of TF. Our findings support the relevance of CYP2D6 , CYP2C19 , and CYP2C9 as key pharmacogenes for PGx testing in chronic pain management. The results suggest that a genetic predisposition in CYP2D6 and COMT , associated with increased pain sensitivity, may contribute to insufficient analgesia and subsequent TF. These insights indicate the potential value of incorporating CYP2D6 and COMT as pain-modulating genetic markers into the broader framework of PGx testing.

Pain duration as a staging variable: A conceptual framework for testing depression-pathway interventions in dementia risk.

Health care systems and insurers are expanding coverage for practitioner-delivered and self-care complementary and integrative health (CIH) therapies for chronic pain. To determine if combining practitioner-delivered and self-care CIH therapies (PD/SC-CIH) improves pain outcomes more than practitioner-delivered CIH (PD-CIH) therapies alone. Pragmatic nonrandomized trial. Structural nudges and the availability of CIH therapies were used as a surrogate to randomization. Of 3306 veterans with chronic musculoskeletal pain at 18 medical centers in the Veterans Health Administration between March 2021 and March 2023. PD-CIH therapies included acupuncture, chiropractic care, or massage therapy. Participants in the PD/SC-CIH arm also received yoga, mindfulness/meditation, and/or Tai Chi/Qigong. The primary outcome was the change in pain-related functional interference at 6 months. Pain interference improved in both arms (-0.62 and -0.70), with 39.5% and 41.1%, respectively, achieving clinically meaningful improvement with no difference between arms in improvement in pain interference: -0.12 (-0.28 to 0.05). At 6 months, more participants in the PD/SC-CIH arm reported their use of CIH therapies specifically led to perceived improvements across 4 global patient-centered measures: pain (11%; 5%-18%); fatigue (28%; 17%-40%); mental health (24%; 14%-35%); and overall well-being (27%; 18%-35%). Both approaches to offering CIH therapies were equally associated with improvements in pain interference among this large cohort with real-world CIH therapy engagement. More patients in the PD/SC-CIH arm perceived that their use of CIH therapies improved multiple health dimensions. Patients with chronic musculoskeletal pain should be encouraged to add self-care CIH therapies and health care systems should expand their availability. ClinicalTrials.gov Identifier: NCT05097521.

Effects of 8-weeks acupuncture on eyes-closed resting state natural EEG frequency components in endometriosis: AcuENDO trial sub-study.

Chronic pain is a significant health issue, particularly for women, with South Asian women being an underrepresented group in research. This study aimed to explore the needs and challenges of South Asian women living with chronic pain and develop strategies to address them. Participatory Action Research. Sixteen South Asian women in the United Kingdom, aged 30 to 78 years, participated in three rounds of data collection through focus groups, co-development of two intervention approaches and feedback sessions. Participants completed the full long-form Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) prior to phase 1 and again in phase 3. A paired-samples t-test was conducted using SPSS to determine whether there was a significant difference between pre- and post-intervention scores. Phase one identified two pain management intervention approaches: a tailored written resource and a group peer support intervention. Phase two provided insights into their design. Phase three evaluated the strategies following creation and pilot and identified key themes regarding effectiveness: resource design, effects and continued engagement. Quantitative analysis showed significant improvements in mental well-being scores across the course of the Participatory Action Research process. This study highlights barriers and facilitators to pain management among South Asian women, offering transferable insights for culturally sensitive interventions. Participatory approaches can facilitate the development of culturally tailored interventions with the potential to enhance coping, self-efficacy, empowerment and mental well-being. This study provides methodological and practical guidance for co-designing interventions for underrepresented communities, with implications for broader implementation and future research.

Normative data for the balance error scoring system for patients with chronic neck pain.

Catastrophizing contributes to the association between posttraumatic stress symptoms and pain outcomes in individuals with chronic low back pain: Differential effects as a function of sex.

From misdiagnosis to recovery: An integrative, deprescribing-led approach to fibromyalgia presenting as chronic widespread pain in an older adult.

Osteoarthritis (OA) is a leading cause of chronic pain and disability, particularly among the elderly. Despite its high global prevalence, the underlying mechanisms of OA are still not fully understood, and current treatments are largely limited to symptomatic relief. Exosomes, small extracellular vesicles involved in cell-to-cell communication, have recently gained attention for their diagnostic and therapeutic potential in OA. In particular, exosomes derived from Mesenchymal Stem Cells (MSCs) can modulate chondrocyte proliferation, apoptosis, autophagy, and inflammation. Emerging evidence also highlights the role of exosomal non-coding RNAs (ncRNAs), including miRNAs, lncRNAs, and circRNAs, in regulating cartilage degradation and subchondral bone remodeling. This review offers a comprehensive synthesis of current knowledge on the role of exosomes in OA, with a unique focus on their dual function as biomarkers and therapeutic tools. We further highlight the promise of exosome-based Drug Delivery Systems (DDSs) and propose future directions for integrating exosome technologies into OA treatment strategies. This work emphasizes the translational potential of exosomes as disease-modifying agents and regenerative tools in osteoarthritis.

Effect of Oral Opioid Prescription on Rates of Postoperative Pain among Ophthalmology Subspecialties: A Large Database Analysis.