International Association For The Study Of Pain Research Articles

MANAGEMENT OF NEUROPATHIC PAIN: A REVIEW OF CURRENT TRENDS .

The International Association for the Study of Pain (IASP) defines “pain” as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Pain is a common symptom that knows no boundary. It differs with age, creed, sex, disease and specialty. Neuropathic pain is defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system. Its chronic debilitating nature and unpredictive response to medication make it a challenge to most physicians and the patient they treat. The use of treatment algorithms or guidelines have found common use in the treatment of neuropathic pain. This poses a need for periodic review. This review looked at the current trends in the management of neuropathic pain. We recommend a four-pronged approach in the evaluation and management of patients with neuropathic pain. This involved detailed review of the patient, the pain, the plan, and the pill. There is also a growing need to adopt less invasive techniques in the treatment of chronic recalcitrant pain.

Current Perspective in Mixed Pain

Pain is one of the 10 leading causes of medical consultation worldwide and is the alarm symptom of the organism in situations that threaten its integrity, however, when it becomes chronic, it loses its protective capacity and becomes, in many cases, the disease itself.
 According to the International Association for the Study of Pain (IASP) pain is classified as nociceptive, neuropathic and nociplastic. Mixed pain has been described years ago due to the coexistence of different types of pain.
 We can conclude that we do not have a screening tool and/or treatment algorithm for mixed pain, so it is preferable that pain management begins with a rigorous assessment, using the latest available tools, followed by individualized evidence-based treatment with multimodal therapy when appropriate.
 Keywords: nociceptive pain, neuropathic pain, mixed pain.

Entangled brains and the experience of pains.

The International Association for the Study of Pain (IASP) revised its definition of pain to "an unpleasant sensory and emotional experience." Three recent recommendations for understanding pain if there are no clear brain correlates include eliminativism, multiple realizability, and affordance-based approaches. I adumbrate a different path forward. Underlying each of the proposed approaches and the new IASP definition is the suspicion that there are no specific correlates for pain. I suggest that this basic assumption is misguided. As we learn more about brain function, it is becoming clear that many areas process many different types of information at the same time. In this study, I analogize how animal brains navigate in three-dimensional space with how the brain creates pain. Underlying both cases is a large-scale combinatorial system that feeds back on itself through a diversity of convergent and divergent bi-directional connections. Brains are not like combustion engines, with energy driving outputs via the structure of the machine, but are instead more like whirlpools, which are essentially dynamic patterns in some substrates. We should understand pain experiences as context-dependent, spatiotemporal trajectories that reflect heterogeneous, multiplex, and dynamically adaptive brain cells.

The deconstruction of chronic orofacial pain and a hiding inhibition pathway of orofacial pain: the trigeminal proprioceptive mesencephalic periaqueductal gray pathway.

Chronic orofacial pain has a significant negative impact that influences individuals' quality of life and our society. The prevalence is around 11.2% to 33.2% and remains high in females. Currently, there are two main diagnostic classification systems that are used internationally for chronic pain: the International Classification of Diseases, 11th Revision (ICD-11), which was published by the World Health Organization (WHO) in 2018, and the International Classification of Orofacial Pain, which was published by the International Association for the Study of Pain (IASP) in 2020. Deficits in ascending and descending pain modulation pathways may be involved in the chronic pain pathophysiology. A newly described "trigeminal proprioceptive mesencephalic periaqueductal gray pathway" is considered to be the mechanism of action of occlusal appliance in managing orofacial pain. The genetic basis of chronic orofacial pain is not yet fully understood, but a genetic susceptibility involving multiple genes among the peripheral nerves, brainstem and higher brain regions to regulate and suppress the transmission of pain signals, thereby modulating the perception of pain, is likely.

Neuropathic ocular pain: What is it and what to do about it?

Ocular surface pain (OSP) is a nonspecific symptom that can have a tremendous impact on quality of life. Individuals use various descriptors to characterize OSP including “dryness”, “burning”, “grittiness”,” shooting”, “discomfort”, “tenderness” and/or “aching”, to name a few. As feeling your eyes is “an unpleasant sensory and emotional experience”, these descriptors fit under the International Association for the Study of Pain (IASP) definition of pain.” Oftentimes, OSP is chronic in nature, lasting >3 months, although the intensity of pain can wax and wane over time. Furthermore, OSP can occur spontaneously or be triggered by stimuli such as light, wind or temperature change. In the past, OSP was placed under the umbrella term “dry eye”, as tear film abnormalities are one cause of OSP. However, it is now understood that factors beyond tear and ocular surface abnormalities may drive OSP and it is necessary to identify and address all potential contributors to pain. In general, contributors can be split across two broad categories: nociceptive contributors, defined as pain that arises directly from tissue damage at the level of the ocular surface and neuropathic contributors, defined as pain caused by a lesion or disease within peripheral or central nerves that connect the ocular surface to the brain. Or, as is the case in many individuals, pain contributors can arise from a combination of these two entities. Given the multiple potential contributors to OSP, a standardized examination and multimodal approach is necessary. In this presentation, we discuss advances in the diagnosis and management of OSP, with a focus on the diagnosis and treatment of neuropathic ocular surface pain (NOP).

Chronic Pain Management in The Basque Health Service: Starting from The Strategy

Introduction: Pain is defined by the International Association for the Study of Pain (IASP) as an "unpleasant, unpleasant, and unpleasant sensory and emotional experience of pain. (IASP) as an "unpleasant sensory and emotional experience, associated with or similar to that associated with actual or potential tissue damage". In Spain, it is estimated that 1 in 6 Spaniards (17%) suffers from chronic pain and that this disease represents the second cause of consultation in primary care (PC) and more than 50% of these interventions are related to it. Of the 10 most prevalent pathologies, half of them are related to pain, with a notably higher impact on women.
 Aims And Objectives:
 - To know the approach to pain, with special emphasis on chronic pain, in the Basque public health system.
 - To carry out an analysis of the results obtained in the survey and in the interviews with key clinical and management professionals.
 - Design and implement a pain strategy in Osakidetza.
 Material And Method: Design of an online survey with the different key areas of a strategy for pain management in a healthcare organization. 31 questions in 8 blocks.
 1.Pain management strategy or plan
 2.Resources allocated by the organization
 3.Assessment tools
 4.Pain management
 5.Training activities for professionals
 6.Information/sensitization and empowerment of the patients and families
 7.Coordination and continuity of care
 8.Evaluation indicators
 Results:
 All organizations have strategies or plans.
 67% of the Integrated care Organisation (ICO) have a Pain commission
 100% of the ICO has a Pain Unit.
 25% have specific resources for primary care.
 100% has medical protocols for referrals and 75% in infirmary.
 100% of ICO use the analog visual scale (AVS), among others.
 83% of the ICOs have drug management reconciliation activities and safety criteria in drug management, and 75% refer to non-pharmacological approach methodologies, mainly related to the neurosciences.
 58% of the OSIs consider that there are activities such as specific courses on pain and in 75% of them encourage an interdisciplinary approach with specific pain care plans such as musculoskeletal pain.
 67% believe that it promotes empowerment interventions, such as community interventions, patient empowerment, group approaches, and health education for both patients and caregivers.
 regarding continuity of care 75% have face-to-face activities and 100% have non-face-to-face activities.
 Realted to evaluation 60% uses AVS instrument and there is a high use of opioids
 Conclussion: Although there are a multitude of interventions and many agents involved in pain management, the truth is that there is great heterogeneity in the availability of the same resources in the different ICO. Pprimary care still has a residual role in the management of these patients as well as non-pharmacological treatments. the lack of psychological care for these patients is striking. Also noteworthy is the almost non-existent difference in care according to the patient's gender.
 Implications For Applicability And Limitations: A strategic plan is therefore necessary for the corporation

Research progress of nociplastic pain in the clinical treatment of chronic pain diseases

Chronic pain is increasingly developing into a worldwide health problem. Due to the money and treatment required for care and rehabilitation, as well as the complexity of the various types of pain, chronic pain sufferers often bear a huge financial burden as well as a psychological one. According to statistics, 23% of chronic pain sufferers have suicidal thoughts. In 2017, the third category pain named "nociplastic pain" was proposed for the first time by the International Association for the Study of Pain (IASP) which is disparate with the first kind nociceptive pain and the second pain neuropathic. The physiological mechanisms behind this type of pain are not known. However, it is commonly thought to be associated with a hypersensitivity response in the central nervous system and can be resulted in chronic nociceptive pain, so nociplastic pain is able to occur by itself, and can combine with other pain. At the same time, this type of pain affects the central system and produces other derived symptoms. Examples include stimulation of the limbic system, including impaired processing of emotions by the amygdala, amplified pain perception, sleep disturbances, increased fatigue and sensitivity to external environmental stimuli. There are no very clear and obvious diagnostic criteria or methods, and clinical detection is difficult. Due to the many symptoms, patients usually undergo multiple tests, with high medical costs and a poor prognosis. Patients suffer both physical and psychological distress. The disease with its complexity characteristic leads the difficulty for doctors to diagnosis it plagues patients with the condition, while increasing the difficulty of medical diagnosis and the cost of medical treatment. This article synthesizes the existing developments in outcomes in nociplastic pain from introduction and classification to diagnosis and treatment, it discusses the existing research findings.

What Interval of Daily Pain Assessment Is Required to Reliably Diagnose Chronic Pain in Sickle Cell Disease? the Pisces Study

Background: In Sickle Cell Disease (SCD), chronic pain, i.e., pain on most days over a 6 month time period, is a major complication associated with substantial morbidity and poor outcomes. In the landmark Pain in Sickle Cell Epidemiology Study (PiSCES), the largest study of pain in SCD, one-third of individuals age 16 years or older had daily or near-daily pain, and >50% had chronic pain. However, PiSCES required patients to have 5-6 months of completed diaries in order to qualify for chronic pain analysis. Practically, the International Association for the Study of Pain (IASP) has used three months as the interval upon which to base a definition of chronic pain. Shorter daily assessment intervals upon which to reliably base a definition of chronic pain would reduce respondent burden, and would improve the frequency and accuracy of pain phenotyping for clinical and research purposes. Method: We chose as the gold-standard for chronic pain definition subjects enrolled in PiSCES that had at least 5 months of daily diaries (n=127). We excluded 10 patients who had at least 182 diaries (essentially 6 months), but had at least 50% of diaries missing in any of months 1-4. We simulated daily diary assessment over less burdensome, shorter intervals, always beginning on day one of assessment, to mimic what would be done clinically. We chose the time frames of 2 weeks (2w), 4 weeks (4w), 1 month (1m), 2 months (2m), 3 months (3m), and 4 months (4m). To operationalize the definition of chronic pain, we used a definition of pain severity rated as >0 on > 50% of diary days, regardless of interval. To determine if using diaries collected over a shorter period of time would still classify patients correctly, we calculated the sensitivity and the number of false negatives, as well as the specificity and number of false positives of each simulated diary interval. Results: Within the gold standard sample, 51.3% of patients had chronic pain based on all diaries submitted. The Table shows the percent of patients diagnosed with chronic pain, the sensitivity as well as the number of false negatives, and the specificity as well as the number of false positives, for each simulated diary interval. Simulated intervals of two months or more of daily diaries yielded chronic pain percentage estimates with both high sensitivity and high specificity, compared to the gold standard estimate. Simulated intervals of two week and four weeks yielded increasingly lower specificity, i.e., increasingly more false-positive indications of chronic pain, as the interval shortened. However, each interval still yielded high sensitivity-few patients with gold-standard chronic pain were missed, even at two weeks. Results were very similar even if data from the entire 127 participants was used. Conclusion : For determining the presence of chronic SCD pain, defined as pain on more than 50% of days enrolled in PiSCES, simulated intervals of two months or more of daily diary collection yield both very good sensitivity and very good specificity, compared to intervals of 5-6 months. Clinicians and researchers may reliably choose to adopt two months of dairy collection, as a matter of practicality, to reduce respondent burden when phenotyping SCD pain as acute versus chronic.

The value of the International Association for the Study of Pain to developing countries.

Since it was founded, the International Association for the Study of Pain (IASP) has been at the forefront of improving pain research, education, and effective pain management in both developed and developing countries. As IASP activities progressed, major differences between the practice of pain management, education, and research in developed countries compared with developing countries were identified. This led to areas of focus by IASP that included pain education to address poor knowledge of pain assessment and treatment, prioritization of pain management by governments and official national legislation and programs, and availability of pain treatments (especially potent analgesics). A few pioneering IASP members from developing countries in the early years encouraged more multidisciplinary professionals to join IASP and attend conferences. Inauguration of national and regional chapters was also encouraged, and regular continuing medical education programs were held, especially on topics from IASP conferences and global pain events. Many IASP chapters in developing countries have established collaborations with groups from developed countries, whereas IASP also implemented other innovative approaches including the developing countries working group, educational grants, pain camps, and multidisciplinary pain hubs with toolkits to develop pain experts for regions in the developing world. Thus, the influence of IASP in many developing countries has had a multiplier effect on the progress made in effective pain management, education, and research. Nonetheless, challenges remain and include better integration of pain management, education, and research in national health systems and academic programs for health professionals.

Introduction and a brief historical overview of the International Association for the Study of Pain.

The mission of the International Association for the Study of Pain (IASP) is "to bring together scientists, clinicians, healthcare providers, and policymakers to stimulate and support the study of pain and to translate that knowledge into improved pain relief worldwide." The IASP will celebrate its 50th anniversary next year, and the series of articles published in this special issue of its flagship journal PAIN highlights the IASP's achievements over the past 5 decades. This article provides a brief historical overview of the IASP's 50-year journey, including the key "players," events, and initiatives leading to its formation and contributing to its progress. It complements the other articles outlining the contributions that the IASP has made and likely will continue to make to advances in pain education, research, management and advocacy, and its value to the IASP members.

The value of the International Association for the Study of Pain to career development: perspectives of trainee and early career members.

Supporting its young members has been a key priority of the International Association for the Study of Pain (IASP) for the past 5 decades. The IASP, along with its federations, chapters, and special interest groups, has provided benefits to its trainee and early career members for their career development. This article summarizes various key IASP initiatives and benefits offered to IASP members and how these benefits have positively impacted their careers, including examples from the authors of this article. Suggestions are made for future directions that the IASP could implement to enhance the value provided to its trainee and early career members, which will in turn contribute to IASP achieving its mission to stimulate and support the study of pain and to translate that knowledge into improved pain relief worldwide.

Beyond the study of pain: the evolving role of the International Association for the Study of Pain in global advocacy.

Although founded on the basis of the study of pain, the International Association for the Study of Pain (IASP) has actively advocated for improving pain relief and access to pain management in a variety of ways. The Global Year was launched in 2004 and has continued with a different theme each year, and "Pain Awareness Month" is held every September. The Declaration of Montreal (2010) emphasized that access to pain management is a fundamental human right as a result from the IASP-hosted International Pain Summit. The IASP has continued to publish timely statements related to pain and pain management. The work of IASP on the 11th version of the International Classification of Disease has ensured that chronic pain is recognized as a disease in its own right, and the establishment of the Global Alliance of Partners for Pain Advocacy Task Force recognizes the importance of engaging people with lived experience of pain in accomplishing IASP's mission. The Working Group on Global Advocacy now spearheads IASP's global efforts in capacity building to ensure that pain advocacy activities will continue to grow.

Future perspectives: the next fifty years of the International Association for the Study of Pain.

The International Association for the Study of Pain (IASP) has become the leading professional association dedicated to promoting pain research and management. Through its many activities, including research funding, educational programs, advocacy initiatives, and global collaborations, the Association has significantly contributed to the understanding and treatment of pain. Looking into the future, the IASP is determined to continue its mission of reducing the burden of pain on individuals and societies worldwide. Here, we explore how current and past activities of the IASP will shape the future of pain research, treatment, education, and advocacy as well as provide a valuable service to its members across the world.

International Association for the Study of Pain publications over the 50-year span.

The International Association for the Study of Pain (IASP) has a 50-year history of publishing educational and research materials, ranging from traditional print format books, journals, and other informational formats to online and electronic formats. Here we provide a historical overview of IASP publications and reflections from the perspective of 5 former or current Editors-in-Chief.

Discussion of International Association for the Study of Pain (IASP) pain definition: What has changed in 2020?

International Association for the Study of Pain (IASP) assigned a committee for setting a definition of pain, in year 1979. Despite many criticisms and suggestions, the definition introduced in year 1979 has been kept almost unchanged, except for the slight changes made in years 1986, 1994, and 2011. Since the criticisms from various philosophical and scientific disciplines increased in the recent period, the association assigned a team of 14 researchers and clinicians, who were at the forefront in their disciplines, in year 2018 to revise the definition. Slight modifications were suggested for the definition and explanation in year 2020. In this paper, the definition of pain suggested in year 2011 is examined first. Then, the alternative definitions and criticisms from the scientific and philosophical actors are discussed and, finally, the criticisms addressing the definition proposed in 2020 are reviewed after assessing the definition.

Glossary of key concepts and terms provided by the Іnternational association for the study of pain

The publication collects and systematizes the main definitions and concepts related to pain sensations of various genesis and their changes in pathological conditions. The work includes terminology with appropriate changes and notes, which was prepared by the working group of the International Association for the Study of Pain (IASP) and is used in numerous reports and scientific publications. The glossary deals mainly with terms and does not contain the classification of pain, which is sufficiently presented in other modern scientific publications. The presented terms and their interpretation will be useful not only to scientists, but also to clinicians and students of medical universities of Ukraine.

The Classification of Suspected Predominant Nociplastic Pain in People with Moderate and Severe Haemophilia: A Secondary Exploratory Study.

In people with haemophilia (PwH), joint pain is a major comorbidity that is often overlooked and under-treated. It is believed that, to ensure the most successful outcome, pain management should be tailored to the predominant pain phenotype (i.e., nociceptive, neuropathic and nociplastic). The 2021 clinical criteria and grading system for nociplastic pain, established by the International Association for the Study of Pain (IASP), emphasize the necessity of early-stage identification and predominant pain type classification. Consistent with findings in other chronic musculoskeletal pain conditions, studies suggest that a subgroup of PwH suffers from nociplastic pain, i.e., pain arising from altered nociception rather than structural damage, but this has not yet been explored in PwH. This study aimed to identify PwH with "unlikely", "possible" and "probable" nociplastic pain and investigate differences in anthropometric, demographic and clinical characteristics and psychological factors between subgroups of PwH and healthy individuals.: The IASP clinical criteria and grading system were used to classify pain types in adult men with moderate or severe haemophilia recruited from two Belgian haemophilia treatment centres. Statistical analyses were applied to study between-subgroup differences. Of 94 PwH, 80 PwH (85%) were classified with "unlikely" and 14 (15%) with "at least possible" nociplastic pain (including 5 PwH (5%) with "possible" and 9 PwH (10%) with "probable" nociplastic pain). PwH in both the "unlikely" and "at least possible" nociplastic pain groups showed significantly higher levels of unhelpful psychological factors compared to healthy individuals. Additionally, age may partially account for the observed differences in body height and psychological factors. Larger sample sizes may be needed to detect more subtle between-group differences. study confirmed the presence of nociplastic pain in haemophilia, categorising a notable subgroup as individuals who experience at least possible nociplastic pain. These exploratory insights may provide a starting point for future studies and the development of more effective and tailored pain management.

Urokinase-type Plasminogen Activator-induced Mouse Back Pain Model.

A model of persisting lower back pain can be induced in mice with the simple methodology described herein. Step-by-step methods for simple, rapid induction of a persisting back pain model in mice are provided here using an injection of urokinase-type plasminogen activator (urokinase), a serine protease present in humans and other animals. The methodology for induction of persisting lower back pain in mice involves a simple injection of urokinase along the ligamentous insertion region of the lumbar spine. The urokinase inflammatory agent activates plasminogen to plasmin. Typically, the model can be induced within 10 min and hypersensitivity persists for at least 8 weeks. Hypersensitivity, gait disturbance, and other standard anxiety- and depression-like measures can be tested in the persisting model.Back pain is the most prevalent type of pain. To improve awareness of back pain, the International Association for the Study of Pain (IASP) named 2021 the "Global Year about Back Pain" and 2022 the "Global Year for Translating Pain Knowledge to Practice." One limitation of the therapeutic advancement of pain therapeutics is the lack of suitable models for testing persistent and chronic pain. Thefeatures of this modelare suitable for testing potential therapeutics aimed at the reduction of back pain and its ancillary characteristics, contributing to IASP's naming 2022 as the Global Year for Translating Pain Knowledge to Practice.

TORAKAL DORSAL KÖK GANGLİYONU PULSED RADYOFREKANS UYGULAMASININ ETKİNLİĞİNİN POSTHERPETİK NEVRALJİ İLE POSTTORAKOTOMİ AĞRI SENDROMLARI ÜZERİNE ETKİLERİNİN KARŞILAŞTIRILMASI

Aim: The causative agent of herpes zoster (HZ) is the reactivated varicella-zoster virus. HZ leads to severe and painful rashes that can be accompanied by long-term pain, i.e., postherpetic neuralgia (PHN). According to the International Association for the Study of Pain (IASP), post-thoracotomy pain syndrome (PTPS) is defined as “recurrent or persistent pain along the thoracotomy incision at least two months after surgery”⁸.
 Methods: In this study, the medical records of all the patients were reviewed for age, gender, size, thoracic level, cause of pain, and visual analog scale (VAS) and DN4 scores from the patient files maintained in the archive of the Department of Algology. Two cycles of pulse radiofrequency (PRF) were administered for 2 min each. Then, a total of 5 ml of dexamethasone, lidocaine, bupivacaine, and isotonic solutions of 4 mg, 20 mg, 5 mg, and 5 mg, respectively, were added through the RF cannula at the DRG level in each application.
 Results: In total, 40 patients, including 25 men (62.5%) and 15 women (37.5%), were analyzed in this study. The mean age of the patients was 60.5 ± 12.4 years, and the median duration of pain was 2 years (0.2–15 years). When PHN and PTPS groups were compared on the basis of the pain etiology, the VAS values before treatment were not statistically different (p = 0.129), whereas the VAS values after treatment were significantly lower in the PTPS group than in the PHN group (p = 0.001).
 Conclusions: This study aimed to investigate the effectiveness of DRG PRF therapy on the causes of chronic thoracic pain and in different etiologies. The results revealed that PRF therapy is more effective in treating patients with PTPS than those with PHN. We also found that factors such as age, gender, and size did not significantly affect the treatment.
 
 Keywords: Postherpetic neuralgia, post-thoracotomy pain syndrome, pulsed radiofrequency

Nociplastic pain in research and practice : Overview of biopsychosocial principles, possibilities and difficulties

Traditionally, two mechanistic pain categories were distinguished: nociceptive and neuropathic pain. After the definitions of these two mechanistic descriptors were refined more precisely in the International Association for the Study of Pain (IASP) taxonomy in 2011, alarge group of patients remained whose pain could not be assigned to either of the two categories. Nociplastic pain was therefore proposed as athird mechanistic descriptor in 2016. This review article presents the current state of the integration of nociplastic pain into research and clinical practice. In particular, the possibilities and difficulties of applying this concept are addressed from ahuman and animal experimental research perspective.