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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

ISSN: 1877-8879

Editor-in-chief: Mads Werner

About this journal

SJPAIN will become an Open Access Journal from 2024

Scandinavian Journal of Pain will become an Open Access journal from 2024 onwards. Any new submissions made to the journal after the 10th of　December 2023 will be published Open Access under a CC-BY License and will be subject to an Article Processing charge, if they are accepted for publication. Further information can be found on the　submit tab.

For any queries relating to the change to Open Access, please contact the SJPAIN editorial office

Objective
The Scandinavian countries have a long and distinguished tradition of excellent scientific and medical contributions to pain research. Following this tradition, the Scandinavian Journal of Pain (SJPAIN) has been publishing internationally relevant articles on all aspects of pain since 2010. The journal is the official organ of the Scandinavian Association for the Study of Pain and serves as a comprehensive forum for original research on the nature of pain, pain mechanisms, and pain management. In order to bring pain-researchers and pain-clinicians up-to-date on important issues, the journal also encourages submissions of topical reviews.

Topics

Clinical Sciences: Acute Pain
Clinical Sciences: Cancer-related pain
Clinical Sciences: Chronic Pain
Clinical Sciences: Neuropathic Pain
Epidemiology, Omics and Economics of Pain
Experimental Pain
Methods, Measurements and Biostatistics
Neurobiology, Pharmacology and Basic Science
Nursing and Pain Management
Psychology of Pain and Pain Management

Article formats
Original articles (basic and clinical research), comprehensive systematic and topical reviews, hypothesis-generating case-reports and observational studies, short communications, letters to the Editor

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Benefits:

Broad and stimulating approach to pain-related research
Publication of editorial comments that put research papers into context
High quality single-blind peer-review
International and renowned editorial board

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Supplementary Materials

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Volume 23 Issue 4

October 2023

Publicly Available October 19, 2023

Frontmatter

Page range: i-iv

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Editorial Comment

December 9, 2022

What do we mean by “biopsychosocial” in pain medicine?

Emmanuel Bäckryd

Page range: 621-622

Systematic Review

June 1, 2023

The efficacy of manual therapy on HRV in those with long-standing neck pain: a systematic review

Brent Harper, Parker Price, Megan Steele

Page range: 623-637

Abstract

Objectives Long-standing neck pain (LNP) is a clinical condition frequently encountered in the physical therapy clinic. LNP is a complex, multifactorial condition affecting multiple body systems including the autonomic nervous system (ANS). Traditionally, research on the impact of physical therapy on LNP has focused on self-report measures and pain scales. Heart rate variability (HRV) is an objective measure of the ANS, allowing for quantification of effects of treatment. This systematic review is intended to evaluate if manual therapy acutely affects heart rate variability in adults with long-standing neck pain. Methods Pubmed, Medline, CINAHL, Google Scholar, Web of Science, and Cochrane library were used to retrieve the randomized controlled trials for this review between the years 2010–2021. Search terms included: chronic neck pain, neck pain, cervical pain, manual therapy, mobilization, manipulation, osteopathy, osteopathic or chiropractic. Heart rate variability, HRV, heart rate variation, effects, outcomes, benefits, impacts or effectiveness. Results Of 139 articles located and screened, three full-text articles were selected for full qualitative synthesis, with a combined population of 112 subjects, 91 of which were female, with an average age of 33.7 ± 6.8 years for all subjects. MT techniques in three studies were statistically significant in improving HRV in people with LNP; however, techniques were differed across studies, while one study showed no benefit. The studies were found to be of high quality with PEDro scores ≥6. Conclusions Although no clear cause and effect relationship can be established between improvement in HRV with manual therapy, results supported the use of MT for an acute reduction in HRV. No one particular method of MT has proven superior, MT has been found to produce a statistically significant change in HRV. These HRV changes are consistent with decreased sympathetic tone and subjective pain.

Clinical Pain Research

September 5, 2023

Development of a binary classifier model from extended facial codes toward video-based pain recognition in cancer patients

Marco Cascella, Vincenzo Norman Vitale, Fabio Mariani, Manuel Iuorio, Francesco Cutugno

Page range: 638-645

Abstract

Objectives The Automatic Pain Assessment (APA) relies on the exploitation of objective methods to evaluate the severity of pain and other pain-related characteristics. Facial expressions are the most investigated pain behavior features for APA. We constructed a binary classifier model for discriminating between the absence and presence of pain through video analysis. Methods A brief interview lasting approximately two-minute was conducted with cancer patients, and video recordings were taken during the session. The Delaware Pain Database and UNBC-McMaster Shoulder Pain dataset were used for training. A set of 17 Action Units (AUs) was adopted. For each image, the OpenFace toolkit was used to extract the considered AUs. The collected data were grouped and split into train and test sets: 80 % of the data was used as a training set and the remaining 20 % as the validation set. For continuous estimation, the entire patient video with frame prediction values of 0 (no pain) or 1 (pain), was imported into an annotator (ELAN 6.4). The developed Neural Network classifier consists of two dense layers. The first layer contains 17 nodes associated with the facial AUs extracted by OpenFace for each image. The output layer is a classification label of “pain” (1) or “no pain” (0). Results The classifier obtained an accuracy of ∼94 % after about 400 training epochs. The Area Under the ROC curve (AUROC) value was approximately 0.98. Conclusions This study demonstrated that the use of a binary classifier model developed from selected AUs can be an effective tool for evaluating cancer pain. The implementation of an APA classifier can be useful for detecting potential pain fluctuations. In the context of APA research, further investigations are necessary to refine the process and particularly to combine this data with multi-parameter analyses such as speech analysis, text analysis, and data obtained from physiological parameters.

Open Access September 11, 2023

Experience and usability of a website containing research-based knowledge and tools for pain self-management: a mixed-method study in people with high-impact chronic pain

Eva Laerkner, Laila Bendix, Madalina Jäger, Maj-Britt Hansen, Henrik Bjarke Vaegter

Page range: 646-655

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Abstract

Objectives Smerteinfo.dk is a freely accessible Danish website containing research-based, up-to-date knowledge on chronic pain, written in lay language, with a focus on information, guidance and self-management tools, developed in collaboration between health professionals and persons with high-impact chronic pain. This mixed-method study explored experiences, perceived usability, and challenges of Smerteinfo among patients with high-impact chronic pain. Methods Semi-structured interviews enabling thinking-aloud and participant observation while using Smerteinfo were performed in 11 patients with high-impact chronic pain. Survey data were collected three months after being invited to use Smerteinfo among 200 patients on waiting-list at a Pain Center in Denmark. Results Three themes captured the depth and variation in patterns of experiences, usability and challenges using Smerteinfo during interviews: 1) Appreciated easy access to new knowledge yet strived for more personalized information, 2) Experienced incentives as well as challenges when navigating the website, and 3) Suggested earlier introduction to the website. Challenges concerned the unknown update frequency of the website, information consisting of mostly text and many links, lack of material to improve self-management and too general information. Survey data revealed that 87 % found the language in the articles easy to understand and 73 % could recognize themselves and their challenges in the articles. A proportion of the respondents reported improved understanding of their pain condition (56 %), improved coping (33 %), and that they had made changes in their everyday life after reading on the website (33 %). Conclusions Patients with high-impact chronic pain found Smerteinfo valuable. The results suggest attention towards spreading knowledge of the website to general practitioners, who could introduce the site at an earlier stage of illness. Continuously improving the site and expand the applicable tools based on scientific evidence and in collaboration with end-users are crucial to ensure the usability of the website in the future.

June 19, 2023

Effect on orofacial pain in patients with chronic pain participating in a multimodal rehabilitation programme – a pilot study

Anna-Karin Holmström, Simon Vallin, Anders Wänman, Anna Lövgren, Britt-Marie Stålnacke

Page range: 656-661

Abstract

Objectives Orofacial pain in patients taking part in a multimodal rehabilitation programme (MMRP) due to chronic bodily pain is common but it is not known whether such a rehabilitation programme can also have an effect on the presence of orofacial pain. The first aim of this study was to evaluate the effect of an MMRP on orofacial pain frequency. The second aim was to evaluate differences in the effect on quality of life and on psychosocial factors related to chronic pain. Methods MMRP was evaluated through validated questionnaires from the Swedish Quality Registry for Pain Rehabilitation (SQRP). Fifty-nine patients participating in MMRP filled out the two screening questions for orofacial pain in addition to the SQRP questionnaires before and after participation in MMRP during the period August 2016 to March 2018. Results Pain intensity decreased significantly after the MMRP (p=0.005). Fifty patients (69.4 %) reported orofacial pain before MMRP and no significant decrease after the programme (p=0.228). Among individuals with orofacial pain, the self-reported level of depression decreased after participation in the programme (p=0.004). Conclusions Even though orofacial pain is common among patients with chronic bodily pain, participation in a multimodal pain programme was not enough to reduce frequent orofacial pain. This finding implies that specific orofacial pain management including information about jaw physiology could be a justified component of patient assessment prior to a multimodal rehabilitation programme for chronic bodily pain.

July 13, 2023

Analysis of Japanese nationwide health datasets: association between lifestyle habits and prevalence of neuropathic pain and fibromyalgia with reference to dementia-related diseases and Parkinson’s disease

Yukinori Nagakura, Maya Hayashi, Shunichi Kajioka

Page range: 662-669

Abstract

Objectives Chronic pain is defined as pain that persists or recurs for more than 3 months. This study focuses on neuropathic pain (NP) and fibromyalgia (FM) which are chronic pain states, and aims to identify lifestyle habits associated with their prevalence. Other neurological disorders are also analyzed as references. Methods Association between the variable referring to disease prevalence (number of claims for reimbursement of marker drugs) and the variable for lifestyle habits/health examination results (collected from insured individuals aged 40–74 years) was determined by analyzing Japanese nationwide datasets, which were collected in 2018 and aggregated by prefecture. Pregabalin, donepezil, and levodopa were used as marker drugs for the chronic pain states, dementia-related diseases (Alzheimer’s disease and Lewy body dementia) and Parkinson’s disease (PD), respectively. Pearson’s correlation analysis and multiple linear regression analysis were conducted. Results Variables showing correlation coefficient (| r |)>0.5 were put into the multiple linear regression. Exercise habits (ꞵ=−0.3182), smoking habits (0.3218), daily drinking (0.2683), and alanine aminotransferase>51 U/L (0.2309) were finally incorporated in the equation for pregabalin ( R 2 =0.7268). Walking speed (−0.4543) and daily drinking (0.5077) were incorporated in the equation for donepezil ( R 2 =0.5718). Conclusions The prevalence of chronic pain states is associated with lifestyle habits, just like the dementia-related diseases. Exercise in daily life is negatively associated with the prevalence of the chronic pain states, although excessive alcohol drinking, smoking, and high serum ALT are positively associated with it. The prevalence of PD seems less associated with lifestyle habits.

Open Access July 18, 2023

Impact of antidepressant medication on the analgetic effect of repetitive transcranial magnetic stimulation treatment of neuropathic pain. Preliminary findings from a registry study

Anu Holm, Tage Orenius, Nina Karttunen, Leena Ristolainen, Hannu Kautiainen, Heikki Hurri

Page range: 670-676

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Abstract

Objectives Repetitive transcranial magnetic stimulation (rTMS) has been found to be effective in chronic neuropathic pain conditions. However, information about the combined effects of rTMS and antidepressant treatment is scarce. We studied the outcome of rTMS and concurrent antidepressant treatment in patients with neuropathic pain. Methods In this retrospective, real-world study, 34 patients with neuropathic pain, who were considered resistant or not benefitting from conventional treatment, received rTMS treatment between 2017 and 2020. Pain-related factors were measured using the Numerical Rating Scale (NRS), Global Impression of Change (GIC), and Beck Depression Inventory. Results A decrease in pain intensity and pain interference assessed with NRS was observed after 10 treatment sessions in 16 patients. The impression of change was positive in 20 patients. Half of the patients (n=17) used antidepressant medication, while half (n=17) did not. A concurrent use of antidepressants with therapeutic rTMS was significantly linked with less pain intensity relief when compared with the nonuse of antidepressants (p=0.019). The impression of change was significantly in favor of the antidepressant nonuser group (p=0.002). No group differences in pain interference were found between the groups. Conclusions Therapeutic rTMS for neuropathic pain is plausibly sensitive to interference with antidepressant medication. The exact mechanism of our findings remains to be elucidated; confirmatory studies are warranted.

September 6, 2023

Does lumbar spinal decompression or fusion surgery influence outcome parameters in patients with intrathecal morphine treatment for persistent spinal pain syndrome type 2 (PSPS-T2)

Frank Patrick Schwarm, Raza Rehman, Jasmin Nagl, Hanna Gött, Eberhard Uhl, Malgorzata Anna Kolodziej

Page range: 677-686

Abstract

Objectives Intrathecal morphine pump (ITMP) infusion therapy is efficient in managing chronic pain refractory to standard treatment. This study evaluates pain relief and improvement of quality of life in chronic pain patients after intrathecal morphine pump implantation for treatment of persistent pain after lumbar spinal fusion surgery and lumbar spinal decompression alone. Methods Forty three chronic pain patients that received an ITMP at our department between 2009 and 2019 were retrospectively analyzed divided into 2 cohorts (lumbar spinal fusion surgery and lumbar spinal decompression alone). Pain intensity was evaluated using the numeric rating scale (NRS), quality of life was assessed by EQ-5D-3L, mental health was assessed by Beck Depression Inventory (BDI-V), and Pain Catastrophizing Scale (PCS). Morphine dosage was assessed over time. Data was collected preoperatively, 6 and 24 months postoperatively. Statistical analysis was performed using Friedman’s analysis of variance to evaluate the development of NRS, PCS, BDI and EQ-5D-3L over time and Mann-Whitney-U-test for the differences between these parameters in the different cohorts. A two-sided p-value <0.05 was considered statistically significant. Results Median age was 64 years (IQR 25–75 56–71 years). NRS, EQ-5D-3L, BDI-V, and PCS showed a significant overall improvement after 6 and 24 months compared to baseline data (p<0.001). No statistically significant differences between patients with lumbar spinal fusion surgery and lumbar spinal decompression alone were seen. Furthermore, no statistically significant differences for age and gender were seen. The initially administered median morphine dosage was significantly higher in the fusion group (3.0 mg/day; IQR 25–75 1.5–4.2 mg/day) compared to the decompression-alone group (1.5 mg/day; IQR 25–75 1.0–2.6 mg/day); (p=0.027). Conclusions This retrospective study showed that ITMP have a major long-term impact on pain relief, improve the quality of life, psychological distress, as well as pain catastrophizing in patients with chronic pain following lumbar spinal surgery independent of the previous surgical procedure. After ITMP implantation initial median morphine dosage seems to be significantly higher after spinal fusion compared to decompressive surgery alone.

Original Experimentals

September 18, 2023

Low back-pain among school-teachers in Southern Tunisia: prevalence and predictors

Mouna Baklouti, Houda Ben Ayed, Nouha Ketata, Hanen Maamri, Raouf Karray, Jihene Jdidi, Yosra Mejdoub, Mondher Kassis, Sourour Yaich, Jamel Dammak

Page range: 687-693

Abstract

Objectives In the professional environment, low back pain (LBP) is a multifactorial symptomatology, despite scientific and technological advances in the design and the arrangement of increasingly ergonomic workstations. Teachers are not exempt from this risk, due to prolonged sitting or standing. In light of this, this study aimed to estimate LBP prevalence among teachers in Southern Tunisia and to identify their determinants. Methods It was a cross-sectional study including a representative sample of teachers from secondary, middle, and primary schools in Sfax, Tunisia, conducted during the period March-April 2021. LBP intensity was assessed using a visual analog scale from 1 to 10. A severe LBP was defined as VAS≥7. Results Among the participants, 292 teachers were females (55.6 %). The median age was 48 years (Interquartile Range (IQR)=[41–53] years). Overall, 377 teachers had a severe LBP, with a global prevalence of 71.8 %. Multivariate analysis showed that independent determinants of LBP among teachers were female gender (Adjusted Odds Ratio (AOR)=2.81;p<0.001), age ≥30 (AOR=5.68;p=0.009), chronic diseases (AOR=2.52;p<0.001), working at primary schools (AOR=1.75;p=0.033), working for ≥4 h per day (AOR=2.41;p=0.005), inadequate ergonomic conditions at work (AOR=1.78;p=0.008) and distance home-school ≥10 km (AOR=2.27;p=0.003). Conclusions This study demonstrated that LBP among teachers was alarmingly high. Different individual, ergonomic, and occupational factors were predictors of this symptom. Thus, development of rational strategies for LBP prevention among teachers and the improvement of working conditions are urgently needed.

Publicly Available June 30, 2023

Economic burden of osteoarthritis – multi-country estimates of direct and indirect costs from the BISCUITS study

Sara Hallberg, Ola Rolfson, Jaro Karppinen, Berit Schiøttz-Christensen, Audun Stubhaug, Emilie Toresson Grip, Rebecca L. Robinson, Anna De Geer, Patricia Schepman

Page range: 694-704

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Abstract

Data from ‘BISCUITS’, a large Nordic cohort study linking several registries, were used to estimate differences in average direct and indirect costs between patients with osteoarthritis and controls (matched 1:1 based on birth year and sex) from the general population in Sweden, Norway, Finland and Denmark for 2017. Patients ≥18 years with ≥1 diagnosis of osteoarthritis (ICD-10: M15–M19) recorded in specialty or primary care (the latter available for a subset of patients in Sweden and for all patients in Finland) during 2011–2017 were included. Patients with a cancer diagnosis (ICD-10: C00–C43/C45–C97) were excluded. Productivity loss (sick leave and disability pension) and associated indirect costs were estimated among working-age adults (18–66 years). In 2017, average annual incremental direct costs among adults with osteoarthritis (n=1,157,236) in specialty care relative to controls ranged between €1,259 and €1,693 (p<0.001) per patient across all countries. Total average annual incremental costs were €3,224–€4,969 (p<0.001) per patient. Healthcare cost differences were mainly explained by osteoarthritis patients having more surgeries. However, among patients with both primary and secondary care data, primary care costs exceeded the costs of surgery. Primary care constituted 41 and 29 % of the difference in direct costs in Sweden and Finland, respectively. From a societal perspective, the total economic burden of osteoarthritis is substantial, and the incremental cost was estimated to €1.1–€1.3 billion yearly for patients in specialty care across the Nordic countries. When including patients in primary care, incremental costs rose to €3 billion in Sweden and €1.8 billion in Finland. Given the large economic impact, finding cost-effective and safe therapeutic strategies for these patients will be important.

July 14, 2023

Demographic and clinical factors associated with psychological wellbeing in people with chronic, non-specific musculoskeletal pain engaged in multimodal rehabilitation: –a cross-sectional study with a correlational design

Birgitta Wiitavaara, Dag Rissén, Annika Nilsson

Page range: 705-711

Abstract

Objectives To investigate which demographic and clinical factors were associated with psychological wellbeing in working-aged people in multimodal rehabilitation for musculoskeletal disorders. Methods 116 participants met the criteria for inclusion: persistent or intermittent pain for at least three months; pain that adversely impacts daily life; potential for active change despite pain; no co-morbidity or condition that will hinder participation in the rehabilitation program. Primary outcome was psychological wellbeing and independent measures were general, physical and mental health, pain intensity, limitations in daily life, depression and sleep. Results The results show decreased odds of psychological wellbeing for persons rating high on depression. The results remained significant after adjusting for sex and age. Being a woman increased the odds of high psychological wellbeing. Logistic regression showed that psychological wellbeing was not significantly associated with pain intensity; sleep; functional limitations; general, physical, or mental health. None of the other independent variables was significantly associated with high vs. low psychological wellbeing. Conclusions Depression turned out to be significantly related to psychological wellbeing, contrary to pain and limitations in daily life. If further studies with larger, random samples can confirm these results, this knowledge may be important both in clinical settings and in future research.

February 13, 2023

Interventional pathway in the management of refractory post cholecystectomy pain (PCP) syndrome: a 6-year prospective audit in 60 patients

Hayun Lee, Yuvraj Kukreja, G. Niraj

Page range: 712-719

Abstract

Objectives Post cholecystectomy pain syndrome can affect over a third of patients undergoing laparoscopic cholecystectomy. Acute exacerbations can result in recurrent emergency admission with excessive healthcare utilization. Standard surgical management appears to focus on visceral aetiology. Abdominal myofascial pain syndrome is a poorly recognised somatic pathology that can cause refractory pain in this cohort. It develops as a result of trigger points in the abdominal musculature. The report describes the pathophysiology and a novel interventional pathway in the management of post cholecystectomy pain secondary to abdominal myofascial pain syndrome. Methods The prospective longitudinal audit was performed at a tertiary pain medicine clinic in a university teaching hospital. Over a six-year period, adult patients with refractory abdominal pain following laparoscopic cholecystectomy were included in a structured interventional management pathway. The pathway included two interventions. Intervention I was a combination of abdominal plane blocks and epigastric port site trigger injection with steroids. Patients who failed to report durable relief (>50% pain relief at 12 weeks) were offered pulsed radiofrequency treatment to the abdominal planes (Intervention II). Outcomes included patient satisfaction, change in opioid consumption and impact on emergency visits. Results Sixty patients who failed to respond to standard management were offered the pathway. Four patients refused due to needle phobia. Fifty-six patients received Intervention I. Failure rate was 14% (8/56). Forty-eight patients (48/56, 86%) reported significant benefit at 12 weeks while 38 patients reported durable relief at 24 weeks (38/56, 68%). Nine patients received Intervention II and all (100%) reported durable relief. Emergency admissions and opioid consumption were reduced. Conclusions Abdominal myofascial pain syndrome is a poorly recognised cause of post cholecystectomy pain. The novel interventional management pathway could be an effective solution in patients who fail to benefit from standard management.

Original Articles

Open Access July 3, 2023

Preoperatively assessed offset analgesia predicts acute postoperative pain following orthognathic surgery

Ryoko Kono, Yuka Oono, Saori Takagi, Xenia Jørgensen Uth, Kristian Kjær Petersen, Lars Arendt-Nielsen, Hikaru Kohase

Page range: 720-728

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Abstract

Objectives High intensity and longer duration of acute postoperative pain are generally associated with a higher risk of developing chronic postoperative pain. Therefore, it is important to identify the preoperative predictors for acute postoperative pain. Preoperative evaluation of offset analgesia (OA) and the Pain Catastrophising Scale (PCS) may be potential predictors for acute postoperative pain. This study aimed to investigate the relationship between preoperative OA, PCS, and acute postoperative pain following orthognathic surgery. Methods Thirty patients (19 females) scheduled to undergo orthognathic surgery were included in this study. OA and PCS were evaluated preoperatively, and the patients reported their postoperative pain intensity using the visual analogue scale [0–100 mm] until it reached zero (number of days with pain). OA was induced on the dominant forearm via three consecutive painful heat pulses delivered for 5 s (T1=46 °C), 5 s (T2=47 °C), and 20 s (T3=46 °C). Subsequently, the associations between OA, PCS, and the number of days with pain were analysed. Results The median duration of postoperative pain was 10.3 days. Multiple linear regression analysis showed a significant (p=0.0019) predictive value of OA (p=0.008) for the number of days with pain. The PCS-magnification component was positively correlated with the number of days with pain (R=0.369, p=0.045), with no predictive values of PCS-total and PCS-subscale scores observed. Conclusions Preoperative evaluation of OA may be a new individualised, predictive tool for the number of days with acute postoperative pain following orthognathic surgery; hence, a possible biomarker for the patient’s vulnerability to developing chronic postoperative pain. Ethical committee number The study was approved by the Ethics Committee of Meikai University (A1624, A2113). Trial registry number This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) Clinical Trial (Unique ID: UMIN000026719, UMIN000046957).

August 21, 2023

Oxaliplatin causes increased offset analgesia during chemotherapy – a feasibility study

Carsten Dahl Mørch, Joanna E. Szpejewska, Laurids Ø Poulsen, Mette Nyholm Yilmaz, Ursula G. Falkmer, Lars Arendt-Nielsen

Page range: 729-734

Abstract

Objectives Offset analgesia (OA) is the phenomenon where the perceived pain intensity to heat stimulation disproportionally decreases after a slight decrease in stimulation temperature. The neural mechanisms of OA are not fully understood, but it appears that both peripheral and central temporal filtering properties are involved. Chemotherapy with oxaliplatin often causes acute peripheral sensory neuropathy, and manifests primarily as a cold induced allodynia. The aim of this exploratory patient study was to investigate if OA was affected by the neurotoxic effects of adjuvant oxaliplatin treatment. Methods OA was assessed in 17 colon cancer patients during 12 cycles of adjuvant oxaliplatin treatment. The OA response was estimated as the decrease in pain intensity caused by a temperature decrease from 46 °C to 45 °C. Changes in the OA during the treatment period was estimated using a mixed linear model and corrected for multiple comparisons by Sidak’s test. Results OA was increased significantly when assessed before the 2nd, 3rd, 5th, 6th, 9th, and 10th treatment cycle compared to the first (baseline) treatment (p<0.05). Conclusions OA is generally decreased in persons suffering from chronic pain or peripheral neuropathy as compared to healthy controls. But in the present study, OA increased during chemotherapy with oxaliplatin. The underlying mechanism of this unexpected increase should be further explored.

June 12, 2023

Effects of conditioned pain modulation on Capsaicin-induced spreading muscle hyperalgesia in humans

Jürg Schliessbach, Andreas Siegenthaler, Thomas Graven-Nielsen, Lars Arendt-Nielsen, Michele Curatolo

Page range: 735-742

Abstract

Objectives Muscle pain can be associated with hyperalgesia that may spread outside the area of primary injury due to both peripheral and central sensitization. However, the influence of endogenous pain inhibition is yet unknown. This study investigated how endogenous pain inhibition might influence spreading hyperalgesia in experimental muscle pain. Methods Conditioned pain modulation (CPM) was assessed in 30 male volunteers by cold pressor test at the non-dominant hand as conditioning and pressure pain thresholds (PPT) at the dominant 2nd toe as test stimuli. Subjects were classified as having inhibitory or facilitating CPM based on published reference values. Subsequently, muscle pain and hyperalgesia were induced by capsaicin injection into the non-dominant supraspinatus muscle. Before and 5, 10, 15, 20, 30, 40, 50 and 60 min later, PPTs were recorded at the supraspinatus, infraspinatus and deltoid muscle, ring finger and toe. Results Compared to baseline, PPTs decreased at the supraspinatus, infraspinatus and deltoid muscle (p≤0.03), and increased at the finger and toe (p<0.001). In facilitating CPM (n=10), hyperalgesia occurred at 5, 10, 15, 20 and 40 min (p≤0.026). In inhibitory CPM (n=20), hyperalgesia only occurred after 10 and 15 min (p≤0.03). At the infraspinatus muscle, groups differed after 5 and 40 min (p≤0.008). Conclusions The results suggest that facilitating CPM is associated with more spreading hyperalgesia than inhibitory CPM. This implies that poor endogenous pain modulation may predispose to muscle pain and spreading hyperalgesia after injury, and suggest that strategies to enhance endogenous pain modulation may provide clinical benefits.

September 15, 2023

Effects of oral morphine on experimentally evoked itch and pain: a randomized, double-blind, placebo-controlled trial

Hiroai Okutani, Silvia Lo Vecchio, Nadia Ammitzbøll, Asbjørn Mohr Drewes, Lars Arendt-Nielsen

Page range: 743-750

Abstract

Objectives Pain and itch share similar neuronal networks; hence, it is difficult to explain why opioids can relieve pain but provoke itching. The present human volunteer study aimed to investigate the similarities and differences in responses to experimentally provoked pain and itching to explore the underlying fundamental mechanisms. Methods Twenty-four healthy volunteers were enrolled in this single-center, randomized, double-blind, placebo-controlled, parallel-group trial. Three volar forearms and two mandibular areas were marked, and participants randomly received morphine (20 mg) or identical placebo tablets. Heat, cold, and pressure pain thresholds, and vasomotor responses were assessed at baseline and after oral morphine administration. Itch provocations were induced by intradermal application of 1 % histamine or a topical cowhage (non-histaminergic itch) to a marked area of the skin. The participants were subsequently asked to rate their itching and pain intensities. The assessments were repeated for all marked areas. Results Morphine caused analgesia, as assessed by the significant modulation of cold and pressure pain thresholds (p<0.05). There were no significant differences in histaminergic or non-histaminergic itch or pain intensity between the morphine and placebo groups. Superficial blood perfusion (vasomotor response) following histamine provocation was significantly increased by morphine (p<0.05) in both areas. No correlation was found between the provoked itch intensity and analgesic efficacy in any area or group. Conclusions Oral administration of morphine caused analgesia without modulating itch intensities but increased neurogenic inflammation in response to histamine, suggesting that different opioid mechanisms in histaminergic and non-histaminergic neurons evoke neurogenic inflammation.

September 12, 2023

The potential effect of walking on quantitative sensory testing, pain catastrophizing, and perceived stress: an exploratory study

Anna Houmøller Rasmussen, Lærke Kjeldgaard Petersen, Mette Kaasgaard Sperling, Maria Møller Bertelsen, Michael Skovdal Rathleff, Kristian Kjær-Staal Petersen

Page range: 751-758

Abstract

Objectives Studies suggest that a range of pain mechanisms, such as poor quality of sleep, perceived stress, pain catastrophizing or pain sensitivity, are likely to enhance clinical pain. Animal studies suggest that these pain mechanisms can be modulated by increasing physical activity, but human data are needed to support this hypothesis. This exploratory study aimed to investigate the changes in pain mechanisms after a simple self-directed walking program of 8-weeks. Additionally, this exploratory study investigated the interaction between changes over time in assessments of poor quality of sleep, perceived stress, pain catastrophizing or pain sensitivity and how these changes interacted with each other. Methods This prospective cohort study included 30 healthy subjects who were assessed at baseline and 4- and 8-weeks after initiating the walking program (30 min walking/day for 8 weeks). Self-report outcomes included: Pain Catastrophizing Scale (PCS), the Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index. Pressure pain thresholds, temporal summation of pain and conditioned pain modulation (CPM) were assessed using cuff algometry. Results Twenty-four subjects completed all the visits (age: 42.2, SD: 14.9, 16 females). PCS and PSS significantly decreased at the 8-week’s visit compared to baseline (p<0.05). No significant differences were seen for an improvement in quality of sleep (p=0.071) and pain sensitivity (p>0.075) when comparing the 8-week’s visit to the baseline visit. Changes in pain mechanisms comparing baseline and 8-weeks data were calculated and regression analyses found that an improvement in PCS was associated with an improvement in CPM (R 2 =0.197, p=0.017) and that a higher adherence to the walking program was associated with a larger improvement in PCS (R 2 =0.216, p=0.013). Conclusions The current exploratory study indicates that a simple self-directed walking program of 8-weeks can improve pain catastrophizing thoughts, perceived stress. Higher adherence to the walking program were associated with an improvement in pain catastrophizing and an improvement in pain catastrophizing was associated with an increase in conditioned pain modulation.

September 12, 2023

What matters to people with chronic musculoskeletal pain consulting general practice? Comparing research priorities across different sectors

Liv Nyhave Andersen, Kristian Lyndrup Kristensen, Clara Margrethe Howell, Michael Skovdal Rathleff, Kirsten Fonager, Kristian Damgaard Lyng

Page range: 759-766

Abstract

Objectives Chronic musculoskeletal pain (CMP) is a common condition, often consulted in general practice. Our previous study identified research priorities among people with CMP using a broad recruitment strategy. It is unclear whether these research priorities reflect specific settings, including the population in general practice. Potential dissimilarities may have important implications for future research. Therefore, the study aims to explore potential differences between the previously established research priorities compared to priorities of people with CMP consulting general practice. Methods Eighty-eight people living with CMP (51 females/37 males) from four regions of Denmark were recruited when they consulted their general practitioner. Participants were presented to an online survey and asked to prioritise predefined research themes (n=14) and research questions (n=38). The prioritisations were summarised into a Top-10 research priorities and compared the Top-10 from our previous study. Results Treatment (n=57), diagnosis (n=46), cross-sectoral management (n=39) and influence on daily life (n=39) were the most selected research themes. The most prioritised research questions regarded the effectiveness of treatments and cross-sectoral management, improving diagnostic approaches and how pain affects the individuals’ mental state. Four out of ten research questions aligned with our previous Top-10. Conclusions Our study identified several differences in research priorities between people living with CMP from the general population and from general practice. These findings highlight the needs for investigating how different settings influence research prioritisation. This adds important knowledge for researchers and policymakers focusing on future research within the management of CMP.

Open Access July 25, 2023

Is there a geographic and gender divide in Europe regarding the biopsychosocial approach to pain research? An evaluation of the 12th EFIC congress

Meghan A. Koop, Andrea C. Benson, Michiel F. Reneman, Gwendolyne G.M. Scholten-Peeters, Michel W. Coppieters

Page range: 767-773

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Abstract

Objectives All pain research combined advances the different domains of the biopsychosocial model and its interactions. However, there may be discrepancies between individual countries in their biomedical, psychological or social focus to pain research. As a proxy for this possible discrepancy, we analysed the biopsychosocial orientation of presentations at a recent major international pain conference. Methods The primary aim was to investigate whether there are geographical differences across Europe regarding the biopsychosocial orientation of workshop presentations at the 12th EFIC congress. The secondary aim was to investigate whether there were differences between female and male presenters regarding the biopsychosocial focus of their presentations. All available workshop abstracts were blinded and categorised by two independent reviewers as biomedical, psychosocial, biopsychosocial, or not applicable. Psychosocial and biopsychosocial were merged to non-biomedical. Results Of the 140 available abstracts, 126 abstracts could be categorised (biomedical: 51 %; non-biomedical: 49 %). Three clusters of countries emerged: (1) countries with a clear majority (≥80 %) of non-biomedical presentations (The Netherlands and Belgium); (2) countries with a balance between biomedical and non-biomedical presentations (United Kingdom, Denmark, Norway, Sweden and Finland); and (3) countries with a clear majority (71–100 %) of biomedical presentations (Italy, Germany, Switzerland and France). Overall, women delivered more presentations than men (70 vs. 56 presentations), and delivered proportionally more non-biomedical presentations (57 %) whereas men delivered proportionally more biomedical presentations (61 %). Conclusions Analysis of the 12th EFIC congress revealed geographical and gender differences in biopsychosocial orientation. Whether this reflects established differences in pain research requires further investigation.

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Journal Impact Factor	1.6	2022, Journal Citation Reports (Clarivate, 2023)
5-year Journal Impact Factor	2.2	2022, Journal Citation Reports (Clarivate, 2023)
Journal Citation Indicator	0.47	2022, Journal Citation Reports (Clarivate, 2023)
CiteScore	2.9	2022, Scopus (Elsevier B.V., 2023)
SCImago Journal Rank	0.534	2022, SJR (Scimago Lab, 2023; Data Source: Scopus)
Source Normalized Impact per Paper	0.725	2022, CWTS Journal Indicators (CWTS B.V., 2023; Data Source: Scopus)

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Editorial

Editor-in-Chief
Mads U. Werner, Copenhagen, Denmark
Email: sjpainmw@gmail.com

Founding Editor
Harald Breivik, Oslo, Norway

Honorary Editors
Lars Arendt-Nielsen, Aalborg, Denmark
Stephen Butler, Uppsala, Sweden
Torsten Gordh, Uppsala, Sweden
Per Hansson, Oslo, Norway
Eija Kalso, Helsinki, Finland
Troels Staehelin Jensen, Aarhus, Denmark
Audun Stubhaug, Oslo, Norway

SECTION EDITORS

Clinical Sciences: Acute Pain
Sohail Asghar, Copenhagen, Denmark
Daniel B. Carr, Boston, USA
Michele Curatolo, Seattle, USA
James Eisenach, Winston-Salem, USA
Katri Hamunen, Helsinki, Finland
Maja-Liisa Kalliomäki, Tampere, Finland
Vesa Kontinen, Helsinki, Finland
Gunnvald Kvarstein, Oslo, Norway
Lone Nikolajsen, Aarhus, Denmark
Johan Raeder, Oslo, Norway

Clinical Sciences: Cancer-related pain
Pål Klepstad, Trondheim, Norway
Ulf Kongsgaard, Oslo, Norway
Geana Kurita, Copenhagen, Denmark
Reino Pöyhiä, Helsinki, Finland
Märta Segerdahl, Stockholm, Sweden

Clinical Sciences: Chronic Pain
Lene Baad-Hansen, Aarhus, Denmark
Asbjørn Mohr Drewes, Aalborg, Denmark
Björn Gerdle, Linköping, Sweden
Eva Kosek, Stockholm, Sweden
Srinivasa Raja, Baltimore, USA
Andrew Rice, London, UK
Cecilia Røe, Oslo, Norway
William S. Shaw, Farmington, CT, USA
Sebastian Straube, Alberta, Canada
Henrik B. Vægter, Odense, Denmark

Clinical Sciences: Neuropathic Pain
Nanna Finnerup, Aarhus, Denmark
Hanna Harno, Helsinki, Finland
Satu Jääskeläinen, Turku, Finland
Ellen Jørum, Oslo, Norway

Epidemiology, Omics and Economics of Pain
Emmanuel Bäckryd, Linköping, Sweden
Gary MacFarlane, Aberdeen, Scotland
Christopher S. Nielsen, Oslo, Norway

Experimental Pain
Lars Arendt-Nielsen, Aalborg, Denmark
Thomas Graven-Nielsen, Aalborg, Denmark
Dagfinn Matre, Oslo, Norway

Methods, Measurements and Biostatistics
Morten Aagaard Petersen, Copenhagen, Denmark
Eva Skovlund, Trondheim, Norway

Neurobiology, Pharmacology and Basic Science
Sohail Asghar, Copenhagen, Denmark
Christian Bjerggaard-Vaegter, Aarhus, Denmark
David P. Finn, Galway, Ireland
Lene Jarlbæk, Nyborg, Denmark
Antti Pertovaara, Helsinki, Finland
Carl-Olav Stiller, Stockholm, Sweden
Camilla Svensson, Stockholm, Sweden
Bradley K. Taylor, Pittsburgh, USA

Nursing and Pain Management
Tone Rustøen, Oslo, Norway
Sigriður Zoega, Reykjavik, Iceland

Psychology of Pain and Pain Management
Katja Boersma, Örebro, Sweden
Steven Linton, Örebro, Sweden
Silje E. Reme, Oslo, Norway
Lene Vase, Aarhus, Denmark
Johan Vlaeyen, Leuven, Belgium

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(Deutsch)

Online ISSN: 1877-8879
Print ISSN: 1877-8860
Type: Journal
Language: English
Publisher: De Gruyter
First published: December 3, 2009
Publication Frequency: 4 Issues per Year
Audience: Students, researchers and health professionals in the field of pain medicine