Pain is a common, complex, and debilitating non-motor symptom of Parkinson's disease that often requires a multidisciplinary and multimodal approach to care. However, little is known about how healthcare providers experience and navigate pain care provision in Parkinson's disease, particularly within the Australian healthcare context. This study aimed to explore the perspectives of Australian healthcare providers involved in the management of pain in people with Parkinson's disease. A qualitative descriptive research methodology was used to underpin this study. Healthcare providers involved in the management of pain in people with Parkinson's disease were recruited using a quota sampling strategy. Data were collected using semi-structured interviews and analyzed thematically. Nineteen healthcare providers participated, including five from nursing, five from neurology, five from physiotherapy, three from exercise physiology, and one from general practice. Analysis of the data resulted in six themes: (1) collaborating for holistic pain management; (2) determining etiology; (3) screening and managing the non-motor symptoms of Parkinson's disease that interact with pain and its treatment; (4) provider focus drives nuanced pain therapy; (5) involving carers in the assessment and treatment of pain; and (6) educating patients and healthcare providers to achieve effective pain management. Within these themes, participants highlighted the central role of Parkinson's nurse specialists in coordinating care, facilitating communication across disciplines, and supporting both patients and healthcare providers through education and guidance. This study offers the first in-depth exploration of healthcare providers' perspectives on pain care in Parkinson's disease within Australia. The findings highlight the need for a collaborative, multidisciplinary approach supported by targeted patient and healthcare provider education to enhance communication and continuity of care, with Parkinson's nurse specialists playing a pivotal role in coordinating services and serving as a resource across the care network. Strengthening these elements presents a clear pathway for advancing the provision of pain care services in people with Parkinson's disease. Standards for Reporting Qualitative Research (SRQR) guidelines.

Independent studies demonstrate that racial biases and inferences from facial appearance impact healthcare decisions, especially in pain recognition and treatment, with such biases already detectable among medical students. To address this issue, the present research evaluated the effectiveness of a multifaceted evidence-based educational intervention aimed at mitigating implicit biases by increasing students' knowledge and awareness of these factors in clinical settings and fostering strategies for equitable pain management. A total of 100 medical students were randomly assigned to an experimental or a control group. Both groups completed a pain recognition task twice, evaluating perceived pain intensity and the likelihood of recommending treatment. Between sessions, the experimental group took part in a brief educational intervention combining theoretical input on implicit biases in pain assessment, evidence from empirical studies, and applied reflection on clinical scenarios, whereas the control group received the same lesson after completing the study. The findings reveal that repeated exposure to the pain recognition task influenced responses in both groups, suggesting a task-related learning effect. The educational intervention significantly improved response times, pain intensity ratings, and treatment recommendations across stimuli categories, irrespective of race or facial trustworthiness. This suggests that the intervention heightened students' sensitivity to pain-related cues and encouraged a re-evaluation of clinical judgements. These results underscore the value of targeted educational initiatives in addressing disparities in pain recognition and treatment driven by facial cues, providing evidence that even brief interventions may contribute to mitigating implicit biases and support more equitable healthcare decision-making. This study demonstrates the effectiveness of a brief, evidence-based educational intervention in reducing implicit racial biases in pain recognition among medical students. By enhancing students' sensitivity to pain-related cues, the intervention holds promise for improving equitable healthcare practices and reducing bias-driven disparities in pain management.

Introduction: Non-specific neck pain frequently presents in conjunction with Myofascial trigger points (MTrPs) in the upper trapezius muscle. The Strain Counter-Strain (SCS) technique is a widely recognised method for the treatment of MTrPs. Additionally, modalities such as hot packs, therapeutic ultrasound, and Transcutaneous Electrical Nerve Stimulation (TENS) have demonstrated efficacy in the management of Upper Trapezius Myofascial Pain Syndrome (UTMPS). However, there is a paucity of literature directly comparing the SCS technique with conventional physiotherapy within the same clinical trial, particularly for the treatment of acute neck pain in athletic populations. Aim: The present study aimed to compare the effectiveness of the strain counter-strain technique and conventional physiotherapy in reducing upper trapezius muscle tenderness among college amateur athletes. Materials and Methods: A single-blinded randomised controlled trial was conducted in the Department of Physiotherapy at NIMS University, Jaipur, India, from September 2024 to March 2025. A total of 66 patients with trigger points in the upper trapezius muscle were recruited and randomly allocated into two groups. Group I (n=33; males=17, females=16) received the strain counter-strain technique applied to the upper trapezius muscle, while Group II (n=33; males=15, females=18) received conventional physiotherapy. All participants were evaluated at baseline using the Numeric Pain Rating Scale (NPRS) and the Neck Disability Index (NDI). Statistical analysis was performed using paired and unpaired t-tests, with a p-value of <0.05 considered statistically significant. Results: The SCS technique was significantly more effective than conventional physiotherapy in reducing pain and disability. Statistically significant improvements were observed in NPRS scores (p-value <0.0035) and NDI scores (p-value <0.0486). Conclusion: The SCS technique demonstrated significantly greater efficacy in alleviating pain and reducing disability compared with conventional physiotherapy in individuals with acute non-specific neck pain, particularly those experiencing tenderness in the upper trapezius region. This innovative approach appears to be a valuable therapeutic option for the management of neck pain, offering improved pain relief and functional outcomes.

Peripheral nerve stimulation offers a promising alternative to pharmacological treatments for chronic pain, and recent advances in direct current stimulation enable selective inhibition of nociceptive activity. However, the safety of direct current delivery systems, particularly soft, metal-free nerve cuffs, remains poorly characterized under pathological conditions. This study evaluated the safety and biocompatibility of a silicone tripolar cuff for ionic direct current delivery in naïve rats and rodent models of neuropathic (spared nerve injury) and inflammatory (complete Freund's adjuvant) pain. The cuff was implanted around the sciatic nerve and evaluated through behavioral testing (von Frey and Hargreaves), magnetic resonance imaging, and immunohistochemistry of the sciatic nerve, dorsal root ganglia, and spinal cord. In naïve cohorts, both short- and long-term implantation did not alter behavior outcomes, and neither disease model showed worsening of pain sensitivity. Across implanted groups, markers associated with immune activation and fibrotic encapsulation were upregulated. Notably, only the implanted spared nerve injury cohort exhibited additional pathological changes, including T cell infiltration in the sciatic nerve and dorsal root ganglia, elevated satellite glial and astrocytic responses, and significant interaction between injury and implantation. Demyelination and C-fiber loss were observed in spared nerve injury cohort irrespective of cuff placement, consistent with baseline injury-driven pathology. These findings indicate that the soft, metal-free cuff is well tolerated in healthy and inflammatory pain conditions but may exacerbate local inflammation and tissue changes when implanted near nerve injury. This supports its potential use in chronic pain management when implantation is distal to local injury site. PERSPECTIVE: This study provides the first comprehensive safety assessment of a soft, metal-free nerve cuff for iDC delivery in healthy and pathological pain models. This work advances iDC as a potential treatment for chronic pain, and helps identify pathological conditions in which invasive cuff implantation could exacerbate existing nerve injury.

Dual strategy to enhance domperidone dissolution: mechanochemically synthesized multicomponent salts in orodispersible tablets.

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.

Acute and postoperative pain in children is often undertreated, with effects on patient comfort and postoperative recovery. Extended reality (XR) interventions offer non-pharmacological pain management by distracting patients from discomfort. While effective for procedural pain, its impact on prolonged pain episodes remains underexplored. To systematically review and meta-analyze findings from previous studies on the efficacy of XR interventions in managing acute and postoperative pain in children, compared to standard care. Studies involving children (≤ 18 years) with acute or postoperative pain were included if they compared XR interventions to standard care. Studies focusing on procedural or chronic pain were excluded. A systematic search was conducted on January 23, 2025, in MEDLINE, EMBASE, Web of Science, CINAHL, and PsycINFO for studies evaluating XR interventions for acute and postoperative pain in children, using validated pain measures. Pain outcomes were extracted for an exploratory meta-analysis, with self-report as the primary and observer-report as the secondary outcome. Two reviewers independently extracted data and assessed study quality using CONSORT and TREND. From 1793 records, nine studies were included, all evaluating virtual reality (VR) interventions. Seven focused on postoperative pain, two on acute pain. The primary meta-analysis (n = 6) showed a moderate but nonsignificant effect in self-reported pain (SMD = -0.61; 95% CI, -1.58 to 0.36). The secondary meta-analysis (n = 6) for observer-reported pain showed a large but nonsignificant effect (SMD = -1.04; 95% CI, -2.18 to 0.11). This meta-analysis found no significant analgesic effect of VR on acute or postoperative pain in children. However, moderate effect sizes were observed, but the lack of statistical significance indicates that XR interventions require further investigation in pediatric pain management. Future research should prioritize pain as a primary endpoint and assess the effects of VR type, timing, and age on acute pain using validated measures.

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.

Clinical and psychosocial predictors of treatment expectations in Brazilian patients with temporomandibular disorders: A retrospective cohort study.

Osteoarthritis (OA) is a prevalent musculoskeletal condition characterized by chronic pain and often accompanied by psychiatric comorbidities, such as anxiety and depression. The mesenchymal/stromal cell (MSC) secretome has emerged as promising therapy due to its immunomodulatory and regenerative properties. This study aimed to compare the therapeutic efficacy of standard (CM) and cytokine-primed conditioned media (CM+) derived from human adipose-derived MSCs in mitigating pain, mood alterations and neuroinflammation in a murine OA model. OA was induced by intra-articular injection of monoiodoacetate in male C57BL/6J mice. On day 7, mice received a single intravenous dose of CM or CM+ at two concentrations. Pain-related behavior was assessed by mechanical and thermal nociceptive tests. Anxiety- and depression-like behaviors were evaluated through open field, light/dark box, and forced swim tests. Pro- and anti-inflammatory cytokines and (neuro)inflammatory markers were analyzed in OA joint, and in the peripheral and central nervous system. Peripheral innervation and substance P were assessed in OA paw skin. Both CM and CM+ reduced painful and affective symptoms in a dose-dependent manner. However, CM (from non-primed MSCs) exhibited faster onset and longer-lasting effects, up to 17days post-injection, compared to CM+. CM also led to greater improvements in neuroinflammatory profiles, rebalancing cytokine pattern and macrophage polarization across peripheral and central tissues. MSC secretome, especially when generated without inflammatory priming, represents a safe and long-lasting therapeutic option for OA pain and associated mood disorders. These findings highlight its clinical potential as an innovative multi-targeted biological therapy.

Mental imagery-based simulations of threat can evoke "as-if-real" emotional and motivational responses, which may alter top-down pain processing. This study investigated the impact of mental imagery simulations of threat on endogenous pain modulation in n = 71 healthy participants using a cuff-pressure algometry protocol. In block one, participants were assessed on their baseline pain detection threshold (PDT), pressure pain tolerance (PTT), and their conditioned pain modulation (CPM) responses. In the second block, participants underwent the same procedures again but were randomly allocated to imagine the dominant leg cuff as being made of bubble-wrap (benign imagery condition; n = 36) or metal wire (threat imagery condition; n = 35). In between blocks, participants went to a separate room to interact with a piece of real bubble wrap or metal wire around their legs, facilitating mental imagery generation in Block 2. Partially consistent with our hypothesis, mental imagery impacted CPM effects for pain detection threshold (PDT), which was significantly reduced in the Wire relative to the Bubble-wrap condition. Mental imagery did not influence pressure pain tolerance (PPT). These results indicate that mental simulations of threat may reduce threshold-based conditioned pain modulation (CPM) responses in healthy individuals. Present findings suggest that mental simulation of threat may influence endogenous pain modulation processes. PERSPECTIVE: This study examined whether imagining physical pressure sensations as more or less threatening influenced pain perception and regulation in healthy adults. Findings suggest that threat-related mental simulation may reduce endogenous pain regulation. Results highlight mental imagery and threat appraisal as potential targets for cognitive mental imagery-based pain interventions.

Chronic pain is highly prevalent, disabling, and difficult to treat in people with spinal cord injury (SCI). Our objective was to determine whether hypnotic cognitive therapy (HYP-CT) significantly reduces average pain intensity. This single-blind, randomized, parallel-group trial investigated the efficacy of HYP-CT in treating moderate-to-severe chronic pain in community-residing adults with SCI. Participants were recruited nationwide through SCI organizations and randomized 1:1 to HYP-CT vs usual care (UC). We used computerized permuted block randomization with variable block sizes and stratified by sex and worst pain type. HYP-CT was delivered by a psychologist over the telephone or through Zoom and consisted of 6 weekly 60-minute sessions plus instructions to practice self-hypnosis daily independently by listening to session recordings. Controls were encouraged to continue current treatments or seek additional pain treatments. The primary outcome was average pain intensity assessed 4 times per week on a 0-10 numerical rating scale and averaged. The primary end point was at 6 weeks after randomization, with a follow-up assessment at 12 weeks. All outcomes were assessed through structured telephone interviews performed by blinded assessors. A total of 127 participants were randomized to HYP-CT (n = 64) vs UC (n = 63). Forty-eight percent were treated over the telephone and 52% through Zoom. The group was 42% female, had a mean age of 51.3 years (15.4 years after SCI), and had a mean baseline pain intensity of 5.93. The worst pain was neuropathic in 57% of cases. The primary outcome, average pain intensity, decreased more in the HYP-CT group compared with UC controls at 6 (-0.55, 95% CI -1.04 to -0.06) and 12 (-0.79, 95% CI -1.28 to -0.29) weeks. Depression declined significantly more in the HYP-CT vs UC groups at 6 and 12 weeks. Planned exploratory analyses suggested that the effect of HYP-CT on pain intensity was similar when delivered over the telephone vs through Zoom, and that pain intensity decreased more in those with all neuropathic pain vs those with mixed pain at 12 weeks. The study suggests that HYP-CT is an effective adjunctive treatment for SCI-related pain. Replication studies are needed. The study was registered on ClinicalTrials.gov (NCT03857672) on February 28, 2019 and study enrollment commenced on April 24, 2019. This study provides Class III evidence that, in patients with SCI, HYP-CT improves average pain intensity at 6 weeks compared with UC.

Chronic pancreatitis is a progressive inflammatory disorder marked by irreversible parenchymal injury, fibrosis, and multifactorial pain. Therapeutic endoscopy plays a central role in managing obstructive phenotypes and selected complications. This review synthesizes contemporary evidence on endoscopic management of pancreatic duct stones, main pancreatic duct strictures, benign biliary strictures (BBS), pancreatic duct leaks, pancreatic pseudocysts, and endoscopic ultrasound-guided celiac plexus block, addressing the role of endoscopy. A narrative review was performed, evaluating pain relief, ductal decompression, quality of life, adverse events, and reintervention across ERCP-based therapies, extracorporeal shock wave lithotripsy, pancreatoscopy-guided electrohydraulic or laser lithotripsy, and endoscopic management of pancreatic fluid collections and ductal leaks, and endoscopic ultrasound-guided pain interventions. In painful obstructive chronic pancreatitis, targeted endotherapy can provide symptom relief; however, randomized trials generally favor surgery drainage procedures and/or pancreatic resection over endoscopy for sustained pain control, ductal decompression, and physical quality of life, with comparable safety. ERCP alone is appropriate for small pancreatic duct stones, whereas larger stones are managed with extracorporeal shock wave lithotripsy or pancreatoscopy-guided electrohydraulic or laser lithotripsy to achieve ductal clearance. Main PD strictures are managed with dilation and stenting, with single large-caliber plastic stents preferred; routine use of fully covered self-expandable metal stents is discouraged due to higher adverse events. For chronic pancreatitis-associated BBS, fully covered metal and multiple plastic stents demonstrate similar long-term efficacy, with metal stents reducing procedural burden. Symptomatic PPCs are optimally managed endoscopically based on anatomy and ductal communication. EUS-CPB provides short-term analgesia for refractory pain. Endoscopic therapy is integral to multidisciplinary CP management, offering effective, anatomy-driven interventions, while surgery remains preferred for durable pain control in selected patients.

Neuropathic pain is a debilitating late effect among cancer survivors. This scoping review aims to provide an overview of pharmacological, psychological, and exercise interventions for neuropathic pain among cancer survivors and to identify further relevant research areas. Patient/material and methods: PubMed, PsychInfo, and EMBASE were systematically searched for studies published from January 2004 to January 2026 and abstract and full text screening was carried out. The target population was cancer survivors who had completed primary treatment and have no active disease. Neuropathic pain was defined as a) a mean pain intensity the last week/month of ≥ 3 at a numerical rating scale (0 = no pain, 10 = worst pain), and b) symptoms of neuropathy, or c) neuropathic pain diagnosed by an experienced neurologist. Of the 956 systematic reviews/guidelines and 604 original studies identified, 11 pharmacological, two psychological and three studies on exercise were eligible. Most of the studies included patients with breast cancer. Duloxetine was effective in reducing neuropathic pain from painful chemotherapy-induced neuropathy and gabapentin + concomitant morphine compared to morphine alone reduced neuropathic pain in cancer survivors with neuropathic pain due to radiation therapy, and surgery. Mindfulness-based cognitive behavioral therapy showed no effect after correction for multiple comparisons. Exercise interventions were useful in both reducing neuropathic pain as well as neuropathic symptoms. This scoping review found evidence for pharmacological treatment of neuropathic pain in cancer survivors, could not make any conclusion on psychological treatment, and exercise interventions show promising effects. Further research on interdisciplinary treatment of neuropathic pain among cancer survivors is needed.

Many people use cannabis to self-medicate for pain. Little is known about the impact of pain on tolerance and spontaneous withdrawal to delta-9-tetrahydrocannabinal (THC), the primary psychoactive compound in cannabis. Our previous research with the opioid morphine suggests persistent pain will increase the magnitude and duration of THC withdrawal. Male and female Sprague-Dawley rats were individually housed in a cage with a running wheel to provide a continuous and objective measure of well-being. All rats were injected with Complete Freund's Adjuvant (CFA) into the right hindpaw to induce inflammatory pain. Beginning 1 day later, rats received twice daily THC or vehicle injections for 7 days followed by assessment of tolerance and spontaneous withdrawal. Administration of CFA decreased wheel running. Twice daily injections of THC (3 mg/kg/injection) caused a further reduction in running in male and female rats. Tolerance to the THC-induced decrease in running was more pronounced in male compared to female rats. There was no evidence of spontaneous withdrawal to THC despite continuous assessment for 6 days. Likewise, withdrawal had no effect on body weight. The lack of spontaneous withdrawal in rats with hindpaw inflammation is consistent with our recent study showing a lack of spontaneous withdrawal to THC in pain free rats, but opposite to our opioid research showing enhancement of spontaneous withdrawal to morphine in rats with hindpaw inflammation. In sum, persistent inflammatory pain does not appear to alter the effects of repeated THC injections in male or female rats. The use of THC as a treatment for pain is limited by side effects and tolerance but not by dependence associated withdrawal symptoms.

Background and Objectives: Functional neurosurgery encompasses surgical interventions aimed at modulating the function of the central and peripheral nervous systems. Spinal cord stimulation (SCS), as a form of neuromodulation, is an established treatment for chronic pain and is increasingly utilized by both anesthesiologists and neurosurgeons. The aim of this study was to evaluate the effectiveness of SCS in patients with chronic neuropathic spinal pain. Materials and Methods: This prospective study included 42 patients who demonstrated a positive response to trial stimulation. Only patients achieving a clinically meaningful response (≥50% pain reduction) during the trial phase were included in the final analysis. Pain intensity and functional disability were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). All patients underwent a two-stage percutaneous implantation procedure using burst stimulation. A follow-up assessment was performed 3–6 months after implantation. Results: A statistically significant reduction in pain intensity was observed (p < 0.0001), with median VAS scores decreasing from 8 to 3, corresponding to a 62.5% reduction in pain intensity and exceeding the minimal clinically important difference (MCID) for VAS. Functional status improved significantly, with ODI scores decreasing from 74% to 38%, markedly surpassing the established MCID threshold. A clinically meaningful reduction in pain (≥50%) was achieved in the majority of patients. All patients requiring opioid analgesics at baseline discontinued their use following SCS implantation, and a reduction in overall analgesic consumption was observed across the cohort. Conclusions: These findings suggest that burst SCS may be an effective treatment option for carefully selected patients with chronic neuropathic spinal pain who are not candidates for conventional spine surgery. However, the results should be interpreted with caution due to the enriched study design and limited follow-up period.

Background: Gymnasts are reported as a population at high risk of low back pain. The prevention and treatment of low back pain often rely on improving the effectiveness of deep stabilizer muscles efficiency through exercises that aim to reach spinal alignment and axial lengthening. However, the scientific evidence regarding the effect of the specific instructions used during exercises on the spinopelvic complex is still lacking. To address this gap of knowledge, the aim of this pilot study was to examine the effect of specific postural and breathing instructions (spine straightening, forced expiration and perineal contraction) on the sagittal alignment of the spine before and after fifteen weeks of a specific muscle strengthening program. Methods: Sixteen gymnasts consented to participate in this study. Low-dose biplanar radiographic images were taken in neutral position and in the five specific postures before and after the program and associated skeletal 3D reconstructions were performed allowing calculation of sacral slope, pelvic tilt, lumbar lordosis and thoracic kyphosis. Results: At the end of the program, most of the postures tested led to a decrease in sacral slope, an increase in pelvic tilt, a reduction in lumbar lordosis, and a decrease in thoracic kyphosis, but with varying efficiency; the condition combining spine straightening, perineal contraction and forced expiration appeared to be the most effective in influencing all parameters simultaneously. Conclusions: The results strongly encourage combining an instruction of spine straightening with instructions of both expiration and perineal contraction, which is information of interest for coaches, physiotherapists and medical professionals.

BackgroundVagus nerve stimulation is primarily used for treating neuropsychiatric disorders, reducing inflammation, and controlling muscle tone. Nonspecific chronic neck pain is a prevalent musculoskeletal condition characterized by persistent neck pain without an identifiable structural pathology and is often associated with functional limitations, sleep disturbances, and reduced quality of life.ObjectiveThis pilot study evaluates the effectiveness of transcutaneous auricular vagus nerve stimulation (taVNS) as a non-invasive treatment for nonspecific chronic neck pain.MethodsThirty-six participants were randomly assigned to a taVNS group or a conventional treatment group. Pain intensity, muscle strength and range of motion of the neck were primary outcomes, while neck disability and sleep quality were secondary outcomes. All measures were assessed at baseline and after 15 treatment sessions. Statistical analyses included mixed-methods ANOVA, Student's t-test, and Mann-Whitney U test.ResultstaVNS significantly reduced neck pain and improved extensor muscle strength, cervical range of motion, and sleep quality compared to baseline (p < 0.05). Compared with conventional treatment, the taVNS group showed greater improvements in extensor muscle strength and neck disability (p < 0.05), while other outcomes were similar between groups.ConclusiontaVNS appears to be a safe intervention with short-term effects comparable to conventional treatments in non-specific chronic neck pain. Although greater improvements were observed in muscle strength and neck disability, overall superiority was not demonstrated. Given the short duration and small sample size, the results cannot be generalized.Clinical Trials NumberNCT05527366.

In cases of chronic non-specific neck and low back pain (CNLBP), where emotional disorders are identified, the involvement of a psychiatrist in patient management is considered. However, the effectiveness of this approach in patients with CNLBP and a confirmed anxiety or depressive disorder (F41, F33, F32) remains insufficiently studied. Objective: To conduct a comparative evaluation of the efficacy of a comprehensive approach (involving a psychiatrist, an educational programme incorporating elements of cognitive behavioural therapy (CBT), and personalised therapeutic exercise) versus a standard approach in the treatment of chronic non-specific low back pain (CNLBP) in patients diagnosed with an anxiety or depressive disorder (F41, F33, F32) by a psychiatrist. Material and methods. The study included 55 patients with CNLBP and anxiety (F41) or depressive disorder (F33, F32), who were randomized into two groups. The first group (comprehensive therapy – CT) consisted of patients (n=27) who received a comprehensive (multimodal) approach, including the involvement of a psychiatrist in patient management, 6 sessions of an individualized educational programme incorporating elements of CBT delivered by a certified specialist in chronic pain and emotional disorders, 4–5 individual sessions of therapeutic exercise (TE) with the development of a personalized exercise regimen, and recommendations on workplace ergonomics. The standard therapy (ST) group comprised patients (n = 28) who were treated using a standard therapy protocol (optimisation of drug therapy, a one-off educational programme to improve physical activity, and standard kinesiotherapy). The study protocol involved 6 months of therapy and fol-low-up with efficacy assessments at three time points – 1, 3 and 6 months after the start of treatment. A numerical rating scale (NRS) was used to assess pain intensity; the Spielberger test, which assesses state (ST) and trait (TT) anxiety, and the Beck Depression Inventory were used to assess anxiety and depressive disorders. The SF-12 questionnaire was used to assess quality of life, taking into account the division of this questionnaire into summary scales for physical (PCS-12) and mental health (MCS-12). To determine the impact of neck pain (NP), the Neck Disability Index (NDI) was used; to assess the impact of low back pain (LBP) on daily activities, the Oswestry Low Back Pain Disability Questionnaire was used. Results. Against the background of treatment, a more significant decrease in pain intensity according to the NRS was noted in the CT group than in the ST group – respectively, for NP to 1.46 ± 0.75 and 2.92 ± 1.0 after 3 months (p &lt; 0.001) and to 0.69 ± 0.72 and 3.0 ± 1.41 after 6 months (p &lt; 0.001), for LBP 2.04 ± 0.86 and 3.29 ± 1.31 after 3 months (p &lt; 0.001), and to 1.04 ± 0.91 and 3.29 ± 1.48 after 6 months (p &lt; 0.001), a decrease in functional impairment according to the Oswestry questionnaire to 15.57 ± 3.55 and 27.62 ± 3.27 after 3 months (p &lt; 0.001) and up to 10.22 ± 2.54 and 29.67 ± 4.24 after 6 months (p &lt; 0.001), a decrease in functional impairment according to the NDI to 12.54 ± 4.36 and 23.38 ± 4.5 after 3 months (p &lt; 0.001) and up to 8.08 ± 2.81 and 25.23 ± 4.95 after 6 months (p &lt; 0.001), an improvement in the quality of life according to PCS to 46.04 ± 4.31 and 43.21 ± 4.04 after 3 months (p &lt; 0.05) and up to 50.07 ± 3.27 and 43.57 ± 3.17 after 6 months (p &lt; 0.001), an improvement in the quality of life according to MCS to 47.3 ± 4.31 and 44.57 ± 3.13 after 3 months (p &lt; 0.05) and up to 50.56 ± 2.86 and 44.75 ± 2.63 after 6 months (p &lt; 0.001). During therapy, no significant differences were found between the CT and ST groups according to the Beck Depression Inventory, ST and TT, in both groups an improvement in the indicators was observed over time, however, when comparing the survey indicators after 3 and 6 months, the CT group showed a statistically significant improvement according to the Beck Depression Inventory (p = 0.04), while in the ST group no further changes were noted (p = 0.14). Conclusion. A comprehensive multidisciplinary approach (involving a psychiatrist) to the treatment of patients with chronic non-specific low back pain (CNLBP) and mental health disorders (anxiety and depressive disorders) leads to a more significant reduction in pain and an improvement in functional activity. Prescribed drug therapy for mental disorders improved the improvement in pain, functional activity and quality of life in the long term.

Advances in Pharmacologic- and Non-pharmacologic Interventions for Cancer Pain: A Narrative Review.