Human Studies

Despite the existence of evidence-based psychological interventions for pain management, there are barriers that interfere with treatment engagement. A brief intervention integrated into primary care reduced barriers and showed promising benefits from pre- to post-intervention. However, it is unknown whether a brief intervention can provide long-term effects. The purpose of this study was to examine whether a brief psychological intervention offered benefits in pain severity, pain interference, pain catastrophizing, and depressive symptoms at 1- and 6-month follow-ups.

Emerging literature purports the use of basivertebral nerve ablation (BVNA) for a specific cohort of patients with chronic low back pain and Type 1 or Type 2 Modic changes from vertebral levels L3-S1. The early literature warrants further evaluation. Studies establishing the efficacy of BVNA use highly selective patient criteria. The population which fulfills these criteria in our practice is small. Our study suggests it is perhaps 3% (11/338, 95% CI 1-5%).

Fibromyalgia syndrome (FMS) is a chronic widespread pain condition with mixed peripheral and central contributions. Patients display hypersensitivities to a spectrum of stimuli. Patients' blunt pressure pain thresholds are typically reduced, and sometimes (∼15%) gentle brushstroke induces allodynia. However, after-sensations following these stimuli have not, to our knowledge, been reported. We examined the perception of blunt pressure and 'pleasant touch' in FMS. Patients were first interviewed and completed standard psychometric questionnaires. We then measured their sensitivity to blunt pressure and perception of pleasant touch including after-sensations; patients were followed for five days evaluating lingering pain from blunt pressure. We recruited 51 FMS patients and 16 pain-free controls (HC) at a UK Pain Management Centre. Forty-four patients completed the after-sensation protocol. Most patients reported pain after application of less mechanical pressure than HCs; median arm and leg thresholds were 167 kPa and 233 kPa. Eighty-four percent (31/37) of patients reported ongoing pain at the site of pressure application one day after testing, and 49% (18/37) still perceived pain at five days. After-sensations following brushstroke were common in the FMS group, reported by 77% (34/44) compared to 25% (4/16) of HCs; 34% (15/44) patients, but no HCs, perceived these after-sensations as uncomfortable. For FMS patients who experienced after-sensations, brushstroke-pleasantness ratings were reduced, and skin was often an important site of pain. Pain after blunt pressure assessment typically lingers for several days. After-sensations following brushstroke stimulation is a previously unreported FMS phenomenon. They are associated with tactile anhedonia and may identify a clinically distinct subgroup.

Although there is growing interest in medically authorized cannabis for chronic pain, little is known about patients' perspectives. We explored perceptions of people living with chronic pain regarding benefits and concerns surrounding their use of cannabis for therapeutic purposes.

Central poststroke pain (CPSP), a neuropathic pain condition, is difficult to treat. Repetitive transcranial magnetic stimulation (rTMS) targeted to the primary motor cortex (M1) can alleviate the condition, but not all patients respond. We aimed to assess a promising alternative rTMS target, the secondary somatosensory cortex (S2), for CPSP treatment.

Back pain is complex. Social support and significant other interactions influence the pain experience. To statistically derive subgroups of people with chronic low back pain based upon their interactions with significant others, and profile subgroups across multidimensional variables. Longitudinal cohort study. People with chronic axial low back pain ( = 262). Latent class analysis of significant other interaction data was used to derive subgroups of people with chronic low back pain. Subgroups were profiled across baseline multidimensional variables and one-year follow-up pain intensity, disability and bothersomeness. Three clusters were identified: Cluster 1 (7.6%) characterised by the lowest distracting, punishing and solicitous interactions. Cluster 2 (16.0%) characterised by the highest distracting and solicitous responses and social support. Cluster 3 (76.3%) characterised by the highest punishing and lowest social support. Cluster 1 reported less disability than Clusters 2 and 3. Mindfulness was significantly different across all subgroups with Cluster 1 being most mindful and Cluster 3 least mindful. Depression, anxiety and stress were significantly higher in Cluster 3 than Cluster 1. Pain catastrophising was higher for Cluster 2 than Clusters 1 and 3. Cluster 2 had lower pressure pain threshold than Clusters 1 and 3. These results support the association between significant other interactions and the experience of back pain. Considering significant other interactions in clinical practice may be important for managing some people's presentation.

Tools that are directly integrated with the electronic health record (EHR) workflow can reduce the hassle cost of certain guideline-concordant practices, such as querying a prescription drug monitoring program (PDMP) before prescribing opioids.