Pain Assessment Research Articles

Psoriasis, a chronic inflammatory skin disorder, is often accompanied by psychological comorbidities. While the psychological effects of plaque psoriasis are well-documented, other psoriasis subtypes, such as guttate, erythrodermic, pustular, and palmoplantar psoriasis (PPP), remain less studied. This review aimed to examine psychological comorbidities in less-studied psoriasis variants. However, the available literature was limited to PPP and psoriatic arthritis (PsA). A comprehensive search of Medline, Embase, PsycINFO, and PubMed was conducted up to February 2025. Data were extracted on psychological comorbidities, disease severity, and patient demographics in patients with PPP and/or PsA. Seventeen studies (76,567 patients) were included. Depression prevalence in PsA ranged from 7.1% to 41%. In PPP, depression prevalence ranged from 5.7% in Japan to 17.1% in the United States. Anxiety prevalence ranged from 5.1% to 61.4%. Both depression and anxiety were more severe in patients with higher disease activity, with depressed patients being over 4 times more likely to report higher disease severity (AOR: 4.43, P = .001). Additional psychological comorbidities included sleep disturbances (38%) and mood disorders in PPP patients (19.6%). Functional impairment ranged from mild to moderate, with moderate but variable discomfort reported in pain assessments. Current evidence on psychological comorbidities in non-plaque psoriasis is limited to PsA and PPP. PsA and PPP can potentially be associated with an elevated risk for psychological comorbidities, particularly depression, anxiety. These findings highlight the need for comprehensive mental health screening and management in these patient populations. Further research is needed to characterize the psychological burden in other non-plaque psoriasis subtypes.

Autonomic Parameters Correlated to Acute Postoperative Pain in the Postanesthesia Care Unit: A Systematic Review.

Abstract Background Migraine is a neurological disorder and major cause of disability globally, especially in women and young adults. This study aimed to investigate the beneficial effects of polydatin (PD), a natural compound, against nitroglycerin (NTG) induced migraine like headache in mice. Materials and methods Behavioural paradigms included Von Frey filament test, tail flick test, light aversion test and assessment of migraine-associated pain like behaviour. In addition, biochemical investigations were undertaken to determine the effect of PD on migraine associated markers including oxidative stress, nitric oxide (NO) and calcitonin gene related peptide (CGRP). Integrated in vivo, in silico, and network pharmacology approaches were employed to evaluate PD’s antimigraine effects. Statistical significance was set at p < 0.05. Results Treatment with PD attenuated NTG-induced migraine like headache and related behavioural changes. PD-subjected animals exhibited enhanced levels of catalase, glutathione-S-transferase, and glutathione, as well as reduced lipid peroxidation, compared to NTG-only treated animals. Reduction in CGRP and nitrite levels along with reduced expression of neuronal nitric oxide synthase (nNOS) and inducible nitric oxide synthase (iNOS) was also observed in mouse cortex and trigeminal nucleus caudalis (TNc) after treatment with PD compared with disease controls. Histological sections from PD treated animals from these regions resembled closely with those of controls with improved cell viability. Molecular docking studies suggested that PD docked in the similar binding pocket as that of CGRP, Rimegepant (a CGRP receptor blocker) and Sumatriptan. Network pharmacology revealed potential interaction of hub genes with PD, with proteins like NOS1 (nNOS), NOS2 (iNOS), NOS3, PDE5A, GATM, ARG1 and ARG2 having significant role in network functionality and the potential mediation of PD therapeutic effect. Conclusion PD ameliorated NTG-induced migraine like headache through modulation of NO, CGRP and oxidative stress dependant mechanisms.

Exploring the relationship between joint hypermobility and chronic pain in youth: Diagnostic challenges and the Beighton Scale.

Sectio caesarean surgery is a surgical procedure that can effectively prevent ma- ternal and newborn deaths when used for reasons of medical indications. Post operative sectio caesarean can pose several risks of complications, one of which is pain and surgical wound infection. Non pharmacological approach aromatherapy as a complementary therapy to reduce postpartum pain. This case study aims to analyze the influence aromatherapy lavender on reducing pain levels in post sectio caesarean mothers by using the case study method pre and post test. The case study was carried out in 25 May 2025 – 07 June 2025. This type of case study is descriptive with the number of subjects used, namely three post partum mothers in the RSUD Batang private sector with pain assessment using a questionnaire Numeric Rating Scale (NRS). The results of the case study showed a change in pain intensity from a scale of 6-7 to a scale of 4-5. This shows an influence aromatherapy lavender on reducing pain levels in postpartum mothers caesarean section Giving innovation aromatherapy can be used as an independent nursing in- tervention so that it can be applied to patients regularly.

Wound pain continues to be challenging for health professionals and patients. Patients report that it is the most difficult part of their wound-healing journey, subsequently affecting their quality of life. Key to providing a patient-centred plan of care are robust holistic and wound pain assessments, along with the identification of factors that can impact on the wound-healing journey. This article provides some key information from research, highlighting the differences between general pain and wound pain, the categorisation of types of pain, assessment tools, what types of procedures can impact and cause trauma and further pain, along with both pharmacological and non-pharmacological pain-management techniques.

Background/Objectives: This exploratory systematic review aims to analyze the influence of isolated muscle flexibility training on the reduction of chronic pain symptoms in older adults aged 65 years or more. Articles were selected from the Web of Science, PubMed, and Scopus databases, using the EndNote software for reference management. The selection process followed the PICOS framework and the PRISMA 2020 guidelines, and the review protocol was registered in the PROSPERO database. Methods: The inclusion criteria comprised randomized controlled trials with participants aged 65 or older, evaluating the effect of flexibility training as a standalone intervention on chronic pain, and published in English or Portuguese. Studies were excluded if they involved multimodal training, did not specify participants’ ages, evaluated only acute or postoperative pain, or were not peer-reviewed articles. Results: From an initial pool of 1390 articles, only three met all criteria and were included in the final analysis. These studies—conducted in China (n = 2) and the United States (n = 1)—showed moderate methodological quality (PEDro score = 7/10). Two trials applied Proprioceptive Neuromuscular Facilitation (PNF) in participants with knee osteoarthritis, while the third compared a flexibility-based program to combined strength and aerobic training in a healthy elderly population. All studies reported significant reductions in chronic pain symptoms following flexibility training interventions. Conclusions: The reviewed evidence suggests that muscle flexibility training, particularly using techniques like PNF, may be a promising therapeutic strategy to mitigate specific chronic pain-related symptoms in older adults, particularly reductions in joint stiffness, movement discomfort, and pain intensity associated with osteoarthritis. However, the limited number of high-quality trials and heterogeneity in protocols and pain assessment tools highlight the need for further research.

BackgroundPain assessment in animal models is challenging, as behavioral tests often lack sensitivity. Particularly under analgesia, it is unclear whether pain occurs without medication. Imaging of pain-associated pathways, such as σ1 receptor (σ1R) expression, offers a promising approach to better understand underlying mechanisms. Therefore, this study evaluated [¹⁸F]fluspidine positron emission tomography/computed tomography (PET/CT) imaging for detecting σ1R-mediated pain after partial liver resection in rats.Materials and methodsPostoperative pain was assessed in eighteen female Wistar rats undergoing skin incision or partial liver resection. Nine untreated rats served as controls. Carprofen was administered for three consecutive days after surgery. PET/CT imaging was performed on postoperative days 1, 4, and 7. At each time point, organs and incision sites of three animals were harvested for histological analysis. Postoperative pain and welfare were monitored by observational score sheets, the Open Field test, Rat Grimace Scale, Von Frey test, fecal corticosterone metabolites, and hemograms.ResultsDespite analgesic treatment, PET/CT and immunohistochemistry revealed elevated σ1R expression at the abdominal incision site on day 1 after partial liver resection in comparison to the other groups, likely due to the additional peritoneal opening. σ1R expression normalized by day 4. No behavioral indicators of pain or distress were observed, though mechanical hypersensitivity was detected on day 4 in all groups, likely due to carprofen side effects.Conclusion[18F]Fluspidine PET/CT imaging sensitively detected postoperative pain-associated σ1R expression independent of analgesia. This imaging modality could remarkably refine pain monitoring, opening to further studies using different pain and analgesia models.Relevance statement[¹⁸F]Fluspidine PET/CT imaging demonstrates high sensitivity in detecting pain-associated σ1R upregulation despite non-steroidal anti-inflammatory drug administration. This approach offers valuable insights for refining pain assessment, improving severity grading, and enhancing the reliability and translational value of preclinical pain models.Key PointsPET/CT imaging with [18F]fluspidine sensitively detects pain-associated σ1R expression post-liver resection.Necessary analgesia interferes with some behavioral tests, limiting their reliability for pain assessment.[18F]Fluspidine detects peripheral σ1R upregulation despite non-steroidal anti-inflammatory drug analgesia.Imaging pain-associated receptors provides valuable insights for refining preclinical pain monitoring.Graphical

Background/Objectives: Extremity trauma represents a significant proportion of battlefield injuries and is prevalent in polytraumatized patients from accidents. Delayed antibiotic treatment and surgical intervention can lead to wound infections, contributing to preventable mortality. This preliminary study aimed to develop a conscious swine model of complex extremity trauma that induces systemic inflammatory response syndrome (SIRS). Methods: All surgical procedures were conducted under anesthesia with sufficient analgesia. All swine were instrumented with a telemetry device and catheters at least 3 days prior to any injury. In phase 1 of model development, a complex extremity injury was performed that consisted of skin and muscle loss, bone defect, severe hemorrhage, and 2 h tourniquet application. In phase 2, multi-drug resistant Gram-positive and Gram-negative bacteria were inoculated topically at the injury site to exacerbate pathophysiological changes towards SIRS. Post-injury, conscious animals were assessed a minimum of twice daily, including pain assessment, neurological response, and vital signs. Blood samples were collected for microbiological testing, complete blood cell counts, and biochemical analysis. Results: After establishing SIRS criteria for Sinclair swine, we developed a model of severe extremity trauma leading to SIRS. During phase 1, resuscitative fluids were reduced and discontinued, with animals surviving 24 h and maintaining SIRS for up to 4 h post-recovery. Phase 2 showed that Gram-negative and Gram-positive pathogens can exacerbate and prolong SIRS. After 72 h, localized infection at the injury site was observed in all animals. Conclusions: We established a new swine model of complex extremity trauma with SIRS. Our model is consistent, reproducible, and relevant to prolonged care scenarios, providing a platform for future research into the evaluation of preventative and therapeutic strategies.

To compare the efficacy and safety of picosecond lasers (PSLs) versus nanosecond lasers (NSLs) for treatment of hyperpigmented disorders and tattoos, we conducted a systematic review of literature.PubMed, Web of Science and Cochrane library (from inception to December 2024) were searched for articles. The primary outcome was the treatment success rate (≥ 75% clearance of pigment), and the secondary outcomes were the visual analogue scale (VAS) to assess pain and the rates of adverse events.We analyzed 20 randomized controlled trials and 1 retrospective comparative study comprising a total of 971 patients. For efficacy, PSLs and NSLs had comparable clearance for endogenous hyperpigmentation (RR 1.06, 95% CI [0.85, 1.31], P = 0.60), but PSLs tend to have superiority (RR 1.39, 95% CI [0.99, 1.94], P = 0.05) for exogenous hyperpigmentation. For pain assessment, the mean value of VAS for PSLs and NSLs was between 1.5 and 5.61 and 1.0 to7.9. Both lasers were tolerable and PSLs led to less pain (P < 0.01). Adverse events including post-inflammatory hyperpigmentation (PIH) and post-inflammatory hypopigmentation (PIHo) were much more obvious in Asian than European patients. Meanwhile, compared with NSLs, PSLs had significantly less rate of PIH (P = 0.02; I2 = 28%) and PIHo (P = 0.002; I2 = 13%).This systematic review suggests that PSLs had comparable efficacy with NSLs. Regarding safety, the superior profile of PSLs is currently best supported in Asian cohorts; data remain sparse for other phototypes.

Background/Objectives: Chronic pain conditions are common among older residents in long-term care facilities (LTCFs), often leading to increased demand for analgesic drugs. Despite this, pain is frequently underdiagnosed and undertreated, especially in individuals with cognitive impairments such as dementia. Both underuse and overuse of analgesics remain a challenge in LTCFs, affecting patient outcomes and quality of life. This systematic review aimed to identify patient- and facility-level factors associated with variation in analgesic use in LTCFs. Methods: This review followed PRISMA guidelines. A comprehensive literature search was conducted in PubMed, CINAHL, Cochrane Library, and Scopus for studies published between 2013 and 2024. Eligible studies were focused on adults aged ≥ 60 years in LTCFs and examined patient and facility factors related to analgesic prescription. Risk of bias was assessed independently by two reviewers using STROBE, JBI, and MMAT tools. Disagreements were resolved by a third reviewer. Results: A total of 6266 studies were retrieved; 13 papers met the eligibility criteria after screening. Dementia was the most frequently reported factor associated with lower analgesic prescribing, largely due to difficulties in assessing pain and communication barriers. Other patient-related factors included pain severity and comorbidities. Facility-level factors such as staffing levels, staff qualifications, and facility size were also associated with variation in prescribing practices. Conclusions: Dementia highly impacts pain management due to assessment and communication challenges. Improved pain assessment tools and staff training are needed to recognize pain in cognitively impaired residents and ensure appropriate analgesic use in LTCFs.

Developing an animal model that more closely represents the human multidimensional pain experience is an important step towards addressing the current chronic pain crisis. The common marmoset has potential as this model species given its biological, neurological and phylogenetic similarity to humans. Here, we developed a model of myofascial temporomandibular disorder (TMD) in the marmoset by injecting nerve growth factor (NGF) into the superficial masseter. Following injection, animals showed reduced mechanical withdrawal thresholds at 5 μg and 10 μg doses of NGF and changes in circadian rhythm and feeding initiation following injection of 10 μg of NGF. Animals did not show evidence of other TMD-related pain behaviours including jaw dysfunction, masticatory alterations, or grimace during novel behavioural assays. The model is transient, with pain resolution occurring approximately 7 days after onset, which allows for repeated testing on the same animal. This same NGF-TMD model has been previously validated in rodents and humans and presents an opportunity for forward and reverse translation to examine mechanisms, develop relevant pain assessment tools, and ultimately test novel treatments for TMD and other musculoskeletal pain conditions.

Underreporting of Pain for Short-Stay Nursing Home Residents in the Minimum Data Set 3.0?: Staff-Report, Self-Report, and the Role of Cognitive Impairment and Racial/Ethnic Identity.

Childbirth pain is a typical aspect of the delivery process and is often regarded as an unwelcome experience due to the mother's increased stress levels and the physical agony endured. This pain arises from uterine contractions that lead to the dilation and thinning of the cervix, as well as uterine ischemia stemming from the contractions of the myometrial arteries. Intense pain can trigger anxiety, which may in turn promote the production of prostaglandin hormones. Strategies to alleviate labor pain can be categorized into pharmacological methods (utilizing medication) or non-pharmacological approaches (employing non-drug techniques such as massage, physical touch, or listening to music). This research was designed as a pre-experimental study with a one-group pre-test and post-test framework. The study population consisted of all mothers who delivered at PMB Medita Kedungdung, with a sample size of 25 mothers selected through accidental sampling, adhering to inclusion criteria. Pain assessment was conducted using a behavioral observation sheet utilizing a Numeric Rating Scale (NRS). The hypothesis test applied is Wilcoxon with a value (p value &lt; 0.05). The results of the statistical analysis show a p value &lt; 0.001, indicating a significant effect between the measurements before and after the introduction of murottal Al-Qur'an therapy in reducing labor pain during the initial active phase. It is advisable to implement non-pharmacological strategies to manage labor pain for mothers in labor at PMB Medita Kedungdung.

Non-oncologic lower limb pain is a complex condition that influences patients' quality of life and is challenging to manage due to its multifactorial nature. Traditional pain assessment methods focus on intensity, overlooking broader patient experiences. The Best-Worst Scale (BWS) is an approach that is increasingly used in healthcare, particularly in understanding patient preferences. The aim of this study is to map the existing research, identify key concepts, evidence types, and gaps in the literature on the management and implications of non-oncologic lower limb pain with the goal of enhancing patients' quality of life using BWS methodology. A narrative review was performed and conducted between October and November 2024, in PubMed and the Revista Portuguesa de Medicina Geral e Familiar. The search strategy focused on chronic non-oncologic pain of the lower limb and another one on BWS and its application to the topic under study. From 124 articles, 16 were included. Regarding BWS, the studies describe it as a promising tool for improving healthcare research, highlighting its various applications, advantages, and limitations. They address the main concerns of osteoarthritis patients and their preferences regarding available treatments. Integrating BWS into clinical practice can lead to improved perception of pain assessment and greater patient satisfaction, shaping the treatment strategy based on patient preferences. The analysis suggests that BWS is a superior approach to other forms of assessing non-oncologic pain in the lower limbs. It may allow us to identify a mismatch between the goals of clinicians and the patient's goals. Best-worst scales to be used in this area must be carefully adjusted when in general application, and their validity and effectiveness thoroughly evaluated. Future research should focus on the implementation and development of BWS in holistic approaches, ensuring both patient-centered and evidence-based treatment. Bridging these gaps will contribute to an improvement in the quality of life of individuals suffering from non-oncologic pain in the lower limbs.

Subjective age-the age people feel-fluctuates considerably across days and even within days. We investigated how subjective age fluctuations are intertwined with experiences of momentary pain and how the within-person couplings of subjective age and pain are shaped by long-term changes in physical health using data from 139 older individuals participating in the Berlin Aging Study II (age 67-88, 41.3% women). After providing long-term longitudinal data across on average 7 years on central facets of physical health (pain severity, pain interference, chronic diseases) study participants completed repeated daily-life assessments of subjective age and pain up to six times per day across one full week. Results from dynamic structural equation models that combine latent change score models with location scale models of intraindividual variability indicate that in moments when individuals report pain that is 10 points above their overall average pain (on a scale from 0 = no pain to 100 = most intense pain), they feel a third of a year older than their average subjective age. Individuals who experienced steeper long-term 7-year increases in both pain severity and pain interference exhibited a stronger subjective age reactivity to momentary pain (i.e., within-person couplings of elevated momentary pain with an older subjective age) and greater subjective age systemic noise (i.e., nonpain-related momentary fluctuations in subjective age). Our findings suggest that moment-to-moment fluctuations in older adults' subjective age in daily life are shaped both by moment-to-moment fluctuations in pain and cumulative long-term physical health trajectories. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The work of recent decades has changed the idea that axial spondylitis (axSpA) is an exclusively “male” disease. However, at present, when deciding on further treatment tactics, gender differences in the course of the disease and response to treatment are not taken into account. The aim – to study gender differences in disease activity indices in patients with axial spondylitis. Material and methods. The study included 108 patients who met the 2009 ASAS (Assessment of SpondyloArthritis International Society) criteria for axSpA or the modified New York criteria for ankylosing spondylitis (AS) of 1984. The mean age of patients at inclusion in the study was 35.4±10.8 years, most of them were men – 62 (57.4%). The AS criteria were met by 67.2% of women and 88.5% of men. The remaining patients were diagnosed with non-radiographic axSpA. Results and discussion. The duration of the disease did not differ between patients of different sexes (p=0.3): 60.0 [24.0; 96.0] months in men and 42.0 [21.8; 84.0] months in women. HLA-B27 antigen positivity was detected in 36 (78.3%) women and 55 (88.7%) men. Women were more often (p=0.048) diagnosed with arthritis than men: 37 (80.4%) and 39 (62.9%), as well as dactylitis (p=0.01): 15 (32.6%) and 8 (12.9%), respectively. No differences were found between men and women in the frequency of other extraskeletal and extraaxial manifestations of axSpA. Also, no differences were found in the BASFI (Bath Ankylosing Spondylitis Functional Index), MASES (Maastrich Ankylosing Spondylitis Enthesitis Score) indices and in all domains of the BASMI (Bath Ankylosing Spondylitis Metrology Index) index. In men, the C-reactive protein level was significantly higher than in women (p=0.03). At the same time, the disease activity according to the BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) index, as well as the patient’s pain assessment indicators, global assessment of general well-being according to the numeric rating scale in women of the study group were higher than in men. The average anxiety value according to the HADS (Hospital Anxiety and Depression Scale) scale was higher in women (p=0.01) than in men – 9.0 [6.0; 10.0] and 5.0 [2.0; 8.0], respectively. The average depression value according to the HADS scale did not differ between the groups (p=0.3): 5.5 [3.0; 6.0] and 3 [1.0; 5.6], respectively. Conclusions. The revealed clinical heterogeneity of axSpA manifestations in men and women, the peculiarities in pain assessment by patients of different genders, allow us to state that gender influences the interpretation of disease activity. Further studies are needed to study gender differences in patients with axSpA to optimize treatment approaches and assess its effectiveness.

Pain diagnostics in people with haemophilia (PwH) - Pressure pain thresholds (PPT) and influence of age and joint status.

Considerable progress has been made over the past decade in the use, practicality, and clinical relevance of electroencephalography (EEG) and magnetoencephalography (MEG)-derived data, improving our understanding of cortical nociceptive processing, the transition from nociception to conscious pain, and its cognitive-emotional modulations. Multimodal responses to heat, cold, and tactile/electrical stimuli, combined with autonomic reactions, provide objective sensory tests that bypass the limitations of verbal responses, while emerging approaches to spontaneous EEG/MEG analysis are changing the game in the still elusive area of ongoing pain. We can expect that all departments involved in the assessment of chronic pain will gradually be able to access these powerful and flexible techniques.

ACR Appropriateness Criteria® Acute Left Upper Quadrant Pain.