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Depression, anxiety and somatization influence the recovery of people with musculoskeletal pain. A Delphi study was conducted to reach consensus on the most appropriate self-administered questionnaires to assess these psychosocial factors in people at risk of developing persistent musculoskeletal pain. A multidisciplinary panel of international experts was identified via PubReMiner. The experts (N=22) suggested 24 questionnaires in Round 1. In Round 2, experts rated the questionnaires on suitability, considering clinimetrics, content, feasibility, personal experiences and expertise. The highest ranked questionnaires were retained for Round 3, in which the experts made a final assessment of the suitability of the questionnaires. Sensitivity analyses were performed to assess the impact of (1) not all experts having participated in each round, and (2) experts having been involved in relevant questionnaire development. Consensus (i.e., ≥75% agreement) was reached for the following questionnaires. For depression: Patient Health Questionnaire-9, Beck Depression Inventory-II, Center for Epidemiological Studies-Depression Scale, and Depression Subscale of the Depression, Anxiety and Stress Scales. In the sensitivity analyses, consensus was also reached for the Depression Subscale of the Hospital Anxiety Depression Scale. For anxiety: Generalized Anxiety Disorder Scale-7, State and Trait Anxiety Inventory, and Pain Anxiety Symptoms Scale. For somatization: no recommendation could be made. Perspective This study generated a short-list of preferred questionnaires to assess depression, anxiety and somatization in people with musculoskeletal pain. Broad implementation of these questionnaires by clinicians and researchers will facilitate easier comparison and pooling of baseline and outcome data. Some of the recommended questionnaires still require validation in this population.
Learn More >Gerontological research reveals considerable interindividual variability in aging phenotypes, which has motivated research efforts to identify 'aging biomarkers.' Aging biomarkers are used to calculate biological age, which are better predictors of disease risk and residual lifespan when compared to chronological age alone. Emerging evidence using the epigenetic clock as an aging biomarker supports highly reliable individualized predictions about future health. The current study aimed to determine whether an epigenetic aging biomarker was associated with chronic pain in older adults (60-83 years old). A subset of participants (n=29) in the Neuromodulatory Examination of Pain and Mobility Across the Lifespan (NEPAL) study underwent a blood draw, demographic, psychological, cognitive and pain assessments. We estimated Horvath's epigenetic clock and calculated the difference between epigenetic age and chronological age that has been previously reported to predict overall mortality risk. Older individuals without chronic pain (n=9) had significantly "younger" epigenetic age compared to those with chronic pain (n=20, p<0.05). Older epigenetic age was associated with greater pain during daily activities (r=0.494, p=0.010) and anatomical pain sites (r=0.741, p<0.001), but not pain frequency/duration. An older epigenetic age was also associated with higher vibratory detection thresholds (r=0.490, p=0.021), heat pain thresholds (r=-0.478, p=0.028), and pressure pain thresholds at the trapezius (r=-0.571, p=0.006), but not thermal detection, pressure pain at the quadriceps or pain inhibition (p's>0.05). Epigenetic aging was associated with greater emotional stability (r=-0.461, p=0.027), conscientiousness (r=-0.549, p=0.007) and lower extraversion (r=0.414, p=0.049), but not depression or affect (p's>0.05). Epigenetic aging was also associated with lower episodic (r=-0.698, p=0.001) and working memory (r=-0.760, p<0.001). Our findings suggest that chronic pain is associated with accelerated epigenetic aging in healthy, community-dwelling older individuals and future studies with larger samples are needed to confirm our findings. An aging biomarker such as the epigenetic clock may help identify people with chronic pain at greater risk of functional decline and poorer health outcomes.
Learn More >Previous studies suggest that truncal regional anaesthesia (TRA), including techniques such as paravertebral block, may contribute significantly to analgesia after mastectomy. However, the severity and impact of postoperative pain varies markedly amongst individuals, making the identification of patients who would benefit most from TRA a potentially important step toward personalised perioperative care.
Learn More >Migraine affects over a billion people worldwide in any year and is the second most common cause of years lost due to disability. Not "just a headache", morbidity washes though society and carries a substantial economic and social cost. Understanding of migraine pathophysiology has progressed significantly. Animal models and functional neuroimaging have yielded significant insight into brain structures that mediate migraine symptoms. The role of small peptides as neurotransmitters within this network has been elucidated, allowing the generation of novel therapeutic approaches that have been validated by randomised placebo-controlled trials. Migraine is underdiagnosed and undertreated. Treatment of migraine should be proactive. An acute and, when indicated, preventive strategy should be formulated with the patient. Comorbid medication overuse must be supportively managed. Migraine-specific medications are making their way from bench to bedside. They promise an improved safety profile and ease of use in comparison to older, repurposed medications. Devices promise a non-drug alternative should patients prefer. The migraine understanding and treatment landscape is changing rapidly.
Learn More >Aim of this study was to detect the expression of miR-15a in rats following chronic constriction injury (CCI) and to investigate the regulatory functions of miR-15a during neuropathic pain (NP) development.
Learn More >This study examined whether a modified version of biofeedback (ie, Conditioned Biofeedback) that incorporated placebo analgesia-like manipulations could promote anti-nociception in healthy, pain-free participants. During Conditioned Biofeedback (n=28), sympathetic arousal level was displayed visually and participants were asked to reduce it while they received painful electric stimulations that were surreptitiously controlled by their arousal level. Thus, electric pain decreased as arousal decreased to associate successful arousal-reduction/relaxation with pain relief, and to promote expectations for future pain relief. A Biofeedback Only group (n=24) controlled for the general effects of biofeedback/relaxation. A Biofeedback+Shock group (n=21) controlled for the effects of practicing biofeedback during painful shocks. Nociceptive flexion reflex (NFR) threshold and temporal summation of pain (TS-pain) were used to assess changes in spinal nociception and pain facilitation, respectively. Results indicated all groups showed pre- to post-biofeedback increases in NFR threshold, but only the Conditioned Biofeedback group showed pre- to post-biofeedback reductions in TS-pain. Moreover, Conditioned Biofeedback resulted in a persistent (pre-biofeedback) increase in NFR threshold across sessions, whereas Biofeedback Only resulted in a persistent (pre-biofeedback) decrease in TS-pain. In sum, Conditioned Biofeedback may promote anti-nociception in healthy participants thus reducing risk for chronic pain. The study was registered prospectively on ClinicalTrials.gov (TU1560). PERSPECTIVE: A modified version of biofeedback that employs placebo analgesia manipulations was successful in increasing descending inhibition and reducing pain facilitation in healthy volunteers. As a result, it may be an effective means of reducing risk of future chronic pain onset by promoting an anti-nociceptive pain profile.
Learn More >Opioid-induced hyperalgesia (OIH) is a phenomenon whereby opioids increase patients' pain sensitivity, complicating their use in analgesia. We explored practitioners' attitudes towards, and knowledge concerning diagnosis, risk factors, and treatment of OIH.
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