Douleur chronique

Author Names: Munoz-Vergara, D.,Wilson, J.M.,Cronin, A.E.,Park, S.J.,Ma, Y.,Burton, W.M.,Yang, E.,Dubinsky, E.,Wayne, P.M.,Schreiber, K.L. Database Source: Embase Weekly Updates Journal Title: Journal of Pain Article Title: A Systematic Review of Physical Activity-Based Interventions to Prevent or Reduce Chronic Post-Surgical Pain Year: 2026 Issue: Supplement Volume: 41 Abstract: One potential risk after surgical procedures is the development of chronic post-surgical pain (CPSP). Physical activity (PA) has emerged as a potential non-pharmacological approach for treating chronic pain syndromes. This systematic review aims to synthesize and evaluate the current scientific evidence on the use of PA-based interventions for the prevention or reduction of CPSP. We conducted a systematic review of randomized controlled trials comparing PA interventions with a control group, involving surgical patients, and assessed pain >=3 months post-surgery. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and conducted a risk of bias assessment using the Cochrane risk-of-bias assessment tool. Thirteen studies met inclusion criteria, enrolling 1,155 patients (67.8% female) across four major surgery types (spine, total knee/hip arthroplasty, mastectomy, lung resection). We found that PA programs were predominantly implemented post-surgically (11 studies) and varied in terms of intervention parameters (e.g., duration). All studies assessed clinical pain using nine self-report instruments (e.g., visual analogue scale, numeric rating scale). Results suggest benefits of PA-based interventions for CPSP at 3- and 6-month post-surgery, although findings are inconsistent in terms of statistical significance. Only three studies were considered overall low risk of bias. Current evidence is insufficient to establish the efficacy of PA in preventing or reducing CPSP due to key design limitations, including the lack of more objective measures of PA adherence and the heterogeneity in control conditions. To establish efficacy, future trials need to enhance methodological rigor by incorporating more comprehensive/objective pain assessment tools (e.g., pain interference).

J Gen Intern Med. 2026 Jun 1. doi: 10.1007/s11606-026-10531-2. Online ahead of print.ABSTRACTBACKGROUND: While rates of opioid prescribing for chronic non-cancer pain have declined, long-term opioid therapy (LTOT) remains common. Current clinical guidelines emphasize the importance of continuous reassessment and weighing of harms and benefits associated with LTOT to inform treatment decisions. However, specific guidance on which harms and benefits to assess and how to weigh these factors is generally lacking. This scoping review aimed to identify and characterize clinical instruments used to assess opioid-related harms and benefits in adults receiving LTOT for chronic non-cancer pain with a focus on instrument content domains and weighing of harms and benefits.METHODS: Study selection was guided by the Population, Concept, Context (PCC) framework. Studies were included if they described clinical assessment instruments used in adults prescribed LTOT (≥ 90 days) for chronic, non-cancer pain. We searched multiple databases and screened records using a multi-coder process. Data were extracted on instrument characteristics, content domains, individual items, and scoring.RESULTS: From eight thousand, seven hundred thirty-eight records, 37 studies describing 25 instruments were included. Most instruments were self-administered by patients. All instruments assessed harms (either current or potential). Of the 448 total items contained in the 25 included instruments, 12% assessed current or potential benefits (including efficacy of analgesia, functional improvement, and quality of life) and 88% assessed harms (including misuse and safety concerns). Instruments prioritized assessment of current or potential harms over assessment of current or potential benefits of LTOT.DISCUSSION: Existing instruments for monitoring LTOT predominantly assess harms-particularly misuse-and may underrepresent current or potential therapeutic benefit. The lack of instruments to guide prescribers on harms/benefits weighing leaves a major clinical research gap.REGISTRATION: Our protocol was registered online via the Open Science Framework at https://osf.io/3ckq6 .PMID:42225871 | DOI:10.1007/s11606-026-10531-2

BMJ Open. 2026 Jun 3;16(6):e109859. doi: 10.1136/bmjopen-2025-109859.ABSTRACTOBJECTIVES: In March 2016, the Centers for Disease Control and Prevention (CDC) released the CDC Guideline for Prescribing Opioids for Chronic Pain, a set of voluntary recommendations for initiating and managing opioid treatment in the ambulatory setting. This scoping review examined guideline effects on patients, providers and health systems.METHODS: A scoping review was conducted with a preregistered protocol. Comprehensive searches of PubMed, Embase and Cumulative Index of Nursing and Allied Health Literature were conducted in April 2025. Reports published between 2016 and 2025 that explored the effects of the CDC guideline were included. No restrictions on language or country of study origin were applied, though all retrieved reports were published in the USA and in English. Two authors independently screened titles, abstracts and full-text reports. Data were extracted by healthcare setting, study aims and design, sample size, study population, participant characteristics and study findings and outcomes. Reports were characterised as empirical studies that evaluated guideline effects or implementation studies that assessed uptake. Study findings were presented descriptively and by evidence maps.RESULTS: Ninety-four studies met the inclusion criteria: 75 empirical studies and 19 implementation studies. Eighty-eight per cent measured changes in opioid prescribing; all but one found significant reductions in at least one prescribing measure, often among people receiving ≥50-90 morphine mg equivalents per day. Effects occurred across specialties and populations, including groups not targeted by the guideline. Studies found increased rates of tapering, with mixed findings on opioid-benzodiazepine coprescription. Legal analyses showed widespread policy adoption at the state level. Implementation studies described expanded risk-mitigation strategies, sometimes beyond guideline text. Few studies reported patient-centred outcomes, participant race or ethnicity or equity measures.CONCLUSIONS: This voluntary federal guideline had significant intended and unintended effects. The guideline was associated with reductions in opioid prescribing among groups targeted and not targeted by its design, with limited evidence on patient outcomes. Future work should prioritise equity-focused patient outcomes to inform implementation of the 2022 CDC guideline.PMID:42236086 | […]

J Can Chiropr Assoc. 2026 Apr;70(1):27-54. Epub 2026 Apr 30.ABSTRACTBACKGROUND: This systematic review evaluated the efficacy of SMT for chronic spinal conditions in adults aged 55 years and older.METHODS: We searched multiple databases for randomized controlled trials (RCTs) on SMT for older adults with chronic spinal conditions (≥ 12 weeks) published from February 2016 through October 2024. Additionally, studies from the prior article being updated were included as appropriate. Eligible studies compared SMT to active or inert comparators, measuring pain, function, or quality of life.RESULTS: Nine reports were included, evaluating SMT for chronic low back pain (5 RCTs, n=544), chronic neck pain (2 RCTs, n=241), lumbar spinal stenosis (1 RCT, n=259), and combined neck/back disability (1 RCT, n=182).CONCLUSION: SMT may offer comparable or modestly greater benefit than other treatments for chronic spinal conditions in older adults, particularly for neck pain and LSS. Evidence certainty remains very low to moderate.REGISTRATION: PROSPERO (CDR42024615084).PMID:42238484 | PMC:PMC13229143

J Pain. 2026 Jun 3:106342. doi: 10.1016/j.jpain.2026.106342. Online ahead of print.ABSTRACTThe co-occurrence of chronic pain and trauma symptoms is prevalent; thus treatment approaches that address both are required. This systematic review of non-randomized studies aims to describe available psychotherapeutic interventions that concurrently target chronic pain and trauma-related symptoms for adults. Five databases (MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, PsycINFO) were searched from date of inception until October 8th, 2025. Eligible studies featured a psychological intervention addressing chronic pain and trauma-related symptoms. We screened 12,597 articles at the title and abstract phase, with 23 full-text studies meeting our eligibility criteria to be included in this review. Risk of Bias was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Eight studies assessed pain as the primary outcome, with five showing a significant improvement in both pain and trauma outcomes. Seven studies assessed trauma-symptoms as the primary outcome with three finding significant improvement in both pain and trauma-related outcomes. Eight studies assessed both pain and trauma-related symptoms as primary outcomes, with six showing an improvement in both categories. Due to the heterogeneity of the interventions and inconsistency of the results, it remains unclear which intervention approach(es) are effective to manage co-morbid chronic pain and trauma-related symptoms. However, overall, the synthesis underscores that psychological therapies can improve both pain and trauma symptoms; thus, advancing the field will require rigorous study designs that can delineate which specific therapies and mechanisms of action are most effective in treating individuals living with these comorbid conditions. PERSPECTIVE: Our results highlight the inconsistency in how chronic pain, trauma-related symptoms, psychological interventions and related outcomes are assessed in the current landscape. There is a necessity to streamline and standardize trial design and reporting in this field to improve knowledge acquisition and translation.PMID:42242657 | DOI:10.1016/j.jpain.2026.106342

BMJ Open. 2026 Jun 4;16(6):e102122. doi: 10.1136/bmjopen-2025-102122.ABSTRACTOBJECTIVE: To summarise the evidence on long-term and infrequent harms following selected spinal and paraspinal injections and denervation procedures for chronic non-cancer spine pain.DESIGN: Systematic review and meta-analysis.DATA SOURCES: MEDLINE, EMBASE and Cumulative Index to Nursing and Allied Health Literature from inception to October 2023.STUDY SELECTION: Non-randomised studies reporting on harms of selected interventional procedures administered to adults living with chronic axial or radicular non-cancer spine pain with ≥4 weeks of follow-up.DATA EXTRACTION AND SYNTHESIS: A parallel guideline panel provided input on the scope, design and interpretation of this systematic review, including selection of adverse events for consideration. Systematic literature screening, data abstraction and risk of bias appraisal were conducted independently and in duplicate by pairs of reviewers. We used random-effects models for all meta-analyses and the Grading of Recommendations Assessment, Development and Evaluation approach to evaluate the certainty of evidence.RESULTS: We included 60 longitudinal studies (56 non-comparative, 4 comparative) that enrolled 4966 patients with chronic non-cancer spine-related pain. 31 studies investigated radiofrequency ablation or denervation, 22 epidural injections and 11 joint injections or nerve blocks. Low certainty evidence suggests that joint targeted steroid injection and epidural steroid injection for chronic spine pain may result in temporary altered level of consciousness (incidence: 2.1%; 95% CI 1.1% to 4.0%), joint radiofrequency nerve ablation, joint targeted steroid injection and epidural injection of local anaesthetic and steroids may result in deep infection (incidence: 0.7%; 95% CI 0.3% to 2.0%), epidural steroid injection, joint radiofrequency nerve ablation and joint targeted injection of local anaesthetic and steroids may result in dural puncture (incidence: 1.4%; 95% CI 0.5% to 4.3%), and dorsal root ganglion radiofrequency and joint radiofrequency nerve ablation with or without joint-targeted injection of steroids may result in prolonged pain or stiffness (incidence: 8.6%; 95% CI 6.3% to 11.6%). Several interventional procedures may result in metabolic complications and prolonged sensory deficits, but the supporting evidence was only very low certainty. Most complications resolved spontaneously or with conservative […]

Int J Nurs Stud. 2026 May 30;182:105607. doi: 10.1016/j.ijnurstu.2026.105607. Online ahead of print.ABSTRACTBACKGROUND: Central sensitisation is a key mechanism underlying many chronic pain conditions. Although non-pharmacological interventions such as exercise, manual therapy, and pain neuroscience education have been recommended by some experts, the comparative effectiveness of these therapies on central sensitization-specific outcomes remains unclear.OBJECTIVE: To compare and rank the efficacy of various non-pharmacological interventions on validated indices of central sensitisation in adults with chronic pain.METHODS: A systematic review and Bayesian network meta-analysis of randomized controlled trials was conducted. Databases were searched from inception to September 2025. Interventions included manual therapy, pain neuroscience education, exercise, virtual reality, electrical nerve stimulation, and their combinations. Primary outcomes were the patient-reported Central Sensitisation Inventory as a measure of subjective symptom burden, and pressure pain threshold as an objective quantitative sensory test. Standardized mean differences (SMD) with 95% credible intervals and surface under the cumulative ranking curve values were calculated. Inconsistency, heterogeneity, meta-regression, sensitivity, and publication bias analyses were performed. Confidence in evidence was evaluated using the Confidence in Network Meta-Analysis framework.RESULTS: Forty-two trials (2811 participants) were included, with a median intervention duration of 6 weeks. For the Central Sensitisation Inventory, pain neuroscience education showed the largest effect (SMD = -1.5; 95% CrI: -3.2 to 0.27), though the credible interval included the null. For pressure pain threshold, pain neuroscience education demonstrated a large, statistically significant effect (SMD = 4.0; 95% CrI: 2.7 to 5.3; high certainty). No statistically significant inconsistency or publication bias was detected. Meta-regression identified no effect modification by pain type or baseline severity. Confidence in Network Meta-Analysis indicated high-certainty evidence for pain neuroscience education on pressure pain threshold, but low-to-very-low certainty for most Central Sensitisation Inventory comparisons.CONCLUSIONS: Pain neuroscience education is effective for both subjective and objective central sensitisation indices, though evidence for patient-reported outcomes is low certainty. Exercise effects are […]

Disabil Rehabil. 2026 Jun 5:1-24. doi: 10.1080/09638288.2026.2661156. Online ahead of print.ABSTRACTPURPOSE: Chronic pain (CP) is a leading global health burden. While high-value physiotherapy (HVP) such as exercise can be effective for rehabilitation, low-value treatments such as manual therapy, remain common. We identified barriers and enablers to HVP for persons with CP, and established their alignment with the Theoretical Domains Framework (TDF) of behaviour change.MATERIALS AND METHODS: Six databases were systematically searched for studies reporting quantitative and/or qualitative data on barriers and enablers experienced by physiotherapists to the delivery of HVP for individuals with CP. Data were tabulated and narratively synthesised.RESULTS: Thirty-seven studies were included, relating to chronic low back pain [17], osteoarthritis [15], various musculoskeletal conditions [3], rotator cuff tendinopathy [1], and patellofemoral pain [1]. Barriers to HVP for chronic low back pain and osteoarthritis mapped to eight common TDF domains: knowledge, skills, social/professional role and identity, beliefs about consequences, environmental context and resources, beliefs about capabilities, intentions, and social influences. Key barrier and enabler themes included: system-level resources, knowledge/training, and professional factors.CONCLUSION: Physiotherapists face barriers to implementing HVP for the rehabilitation of individuals with CP, spanning multiple TDF domains. Findings suggest the need for multi-faceted interventions, including changes in resourcing and capacity building within healthcare systems.PMID:42248214 | DOI:10.1080/09638288.2026.2661156

J Pain Palliat Care Pharmacother. 2026 Jun 8:1-15. doi: 10.1080/15360288.2026.2678983. Online ahead of print.ABSTRACTChronic pain significantly impacts quality of life and productivity, with Integrative Pain Management (IPM) offering a potential solution. However, its cost-effectiveness compared to usual care remains unclear. This systematic review assesses the economic evaluations of IPM interventions for chronic pain. Seven randomized controlled trials (RCTs) were included, focusing on cost-effectiveness measures such as the Incremental Cost-Effectiveness Ratio (ICER) and quality-adjusted life years (QALYs). The results showed a broad range of ICER values, from $2,808 to $74,868 per QALY, depending on the intervention type and perspective. QALY gains ranged from 0.009 to 0.09, with certain studies indicating favorable cost-effectiveness for integrated care programs for chronic low back pain. However, some higher-cost interventions demonstrated limited or unfavorable cost-effectiveness, highlighting the variability in economic outcomes based on the intervention design and target population. These findings underscore the need for comprehensive economic evaluations that account for both direct and indirect costs, including productivity losses. Integrated care for chronic low back pain and multidisciplinary interventions such as cognitive behavioral therapy appear promising. Policymakers should prioritize long-term economic assessments to guide healthcare decision-making across diverse chronic pain conditions.PMID:42258429 | DOI:10.1080/15360288.2026.2678983

Eur J Phys Rehabil Med. 2026 Jun 9. doi: 10.23736/S1973-9087.26.09631-0. Online ahead of print.ABSTRACTChronic primary pain is a leading cause of disability worldwide and requires a multimodal management approach. Instrumental physical therapies are widely used in rehabilitation, although their effectiveness remains heterogeneous across conditions and modalities. The objective of this paper is to synthesize the evidence and recommendations from the 2026 Clinical Practice Guideline developed by the Italian Society of Physical and Rehabilitation Medicine (SIMFER) on the use of instrumental physical therapies in chronic primary pain (i.e., complex regional pain syndrome, fibromyalgia, and primary bone marrow edema syndromes). The guideline was developed following the GRADE methodology. Systematic searches of Medline, Embase, and Cochrane Library were performed to identify systematic reviews and randomized controlled trials. Evidence was appraised in terms of risk of bias, inconsistency, indirectness, imprecision, and publication bias. Recommendations were formulated using the Evidence-to-Decision framework. The panel issued a conditional recommendation in favor of adding instrumental physical therapies to conventional treatment in patients with fibromyalgia, complex regional pain syndrome, and primary bone marrow edema syndromes. Evidence suggests modest to large improvements in pain and disability for specific modalities such as TENS, low-level laser therapy, and electromagnetic field therapy. However, overall certainty of evidence ranged from moderate to very low due to methodological limitations and heterogeneity. Adverse events were generally mild and transient, and patient acceptability was high. Instrumental physical therapies may be considered as adjunctive interventions within a multimodal rehabilitation approach for chronic primary pain. Despite encouraging findings, the low certainty of evidence highlights the need for high-quality trials with standardized protocols and long-term follow-up to strengthen future recommendations.PMID:42262745 | DOI:10.23736/S1973-9087.26.09631-0

Pain Ther. 2026 Jun 17. doi: 10.1007/s40122-026-00849-4. Online ahead of print.ABSTRACTINTRODUCTION: Transcutaneous pulsed radiofrequency (TcPRF) is a non-invasive neuromodulation technique increasingly investigated for the management of chronic pain. However, its clinical efficacy and safety across different chronic pain conditions remains uncertain.METHODS: A systematic search of PubMed, Scopus, and Google Scholar was performed from database inception to March 2026. Randomized controlled trials (RCTs) evaluating TcPRF in chronic pain conditions were included. Pain intensity, functional outcomes, and safety data were extracted. Risk of bias was assessed using the Cochrane RoB 2 tool.RESULTS: Eight RCTs were included, encompassing both musculoskeletal and neuropathic pain conditions. TcPRF was associated with reductions in pain intensity in most studies, with more consistent effects observed in sham-controlled trials and at later follow-up time points. Functional outcomes generally improved in parallel with pain, although results varied depending on the outcome measures used. TcPRF was well tolerated, with no serious adverse events reported. However, substantial heterogeneity was noted in patient populations, comparator interventions, treatment protocols, and outcome measures.CONCLUSION: TcPRF appears to be a promising non-invasive treatment option for selected chronic pain conditions, particularly when a minimally invasive approach is preferred. Nevertheless, current evidence remains limited by heterogeneity and methodological variability. Further large-scale, well-designed RCTs with standardized treatment protocols and longer follow-up are required to clarify its clinical role.PMID:42307714 | DOI:10.1007/s40122-026-00849-4

Discov Ment Health. 2026 Jun 19;6(1):118. doi: 10.1007/s44192-026-00491-8.ABSTRACTBACKGROUND: Chronic pain presents a significant health challenge for military veterans, with a clear association with risk factors and a range of physical, emotional, cognitive, and mental health consequences. This scoping review sought to systematically synthesise studies on risk factors, cognitive and mental health effects, and interventions for chronic pain among veterans.METHOD: Four major databases (PubMed, PsycINFO, HINARI, and JSTOR) were used for the search. Records from other search engines (Google and Google Scholar) were also included. This review followed the guidelines established by Arksey and O'Malley and PRISMA-ScR.RESULTS: The study established various risk elements related to chronic pain, such as age, gender (with a more significant occurrence among females), injury, particular medical or illness conditions, accidents and injuries, and strenuous physical activities from military service. The list of identified consequences of cognitive and mental health includes PTSD, depression, anxiety and anxiety disorders, suicide and suicide ideations, poor attention and executive function, poor learning and memory, catastrophic pain, mood disorders, poor concentration, and poor coping mechanisms. Interventions adopted within chronic pain were effective when implemented early and included multidisciplinary teams.CONCLUSION: To provide effective and prompt holistic care for veterans with chronic pain, multidisciplinary interventions should be employed, with interdisciplinary healthcare professionals, including mental health and clinical health psychologists, at the centre of treatment. Their function shall be to evaluate pain and its implications for cognitive and mental health, ensuring that all facets of attention are covered.PMID:42319621 | DOI:10.1007/s44192-026-00491-8

Pain Med. 2026 Jun 22:pnag075. doi: 10.1093/pm/pnag075. Online ahead of print.ABSTRACTOBJECTIVE: Chronic pain patients experience more work disability leading to unemployment and major individual, societal and economic burden. Implanted neurostimulation has proven good results in terms of pain relief for chronic pain patients. As new stimulation techniques, paradigms and targets are being researched, a comprehensive synthesis of the effects of implanted neurostimulation on occupational outcomes remains undetermined.METHODS: MEDLINE (via PubMed), Embase, Scopus & Web of Science were systematically searched. Risk-of-bias was assessed using the modified Downs & Black checklist. Random-effects meta-analyses, including a Bayesian approach, were conducted to provide estimates of work status and return to work rates. The study protocol was prospectively registered on PROSPERO (CRD42024501152).RESULTS: 67 studies were identified for inclusion in the review; 56 were included in the meta-analysis. The paired odds to work following neurostimulator implantation increased significantly (OR 5.17; 95%CI 2.89-9.23; I2=49.0%; n = 56; P < 0.0001) and were confirmed in the conservative random-effects (OR 3.39; 95%CI 2.00-5.75; n = 56; P < 0.0001) and Bayesian model with uniform prior (OR 5.68; 95%CI 3.08-11.79; n = 56). The pooled estimate for the proportion of patients returning to work across neurostimulation modalities was 26.05% (95%CI 20.73%-32.18%; I2=68.9%; n = 55).CONCLUSIONS: Implanted electrical neurostimulation is associated with increased paired odds to work and enabled chronic pain patients to return to work. The best effects were achieved following peripheral nerve stimulation and in patients suffering head-related pain.PMID:42330362 | DOI:10.1093/pm/pnag075

Lasers Med Sci. 2026 Jun 23;41(1):125. doi: 10.1007/s10103-026-04930-4.ABSTRACTFibromyalgia Syndrome (FMS) is a chronic pain disorder characterized by widespread pain and central sensitization that significantly impacts the quality of life (QoL). For management to be effective, a multidisciplinary approach to care is typically required. Photobiomodulation therapy (PBMT), a non-pharmacological treatment, has garnered attention lately, though its clinical relevance and applications are not well defined. The objective of this review was to assess the effectiveness of PBMT in reducing FMS symptoms. This systematic review was registered at PROSPERO (CRD420251084730) and conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. A total of seven randomized controlled trials were identified following an extensive literature search across various databases, including PubMed, Scopus, Web of Science, the Cochrane Library, Embase, Ovid and ProQuest. To evaluate the methodological quality of these studies, the Cochrane Risk of Bias (RoB 2.0) tool was applied. PBMT demonstrated consistent short-term reductions in pain intensity and improvements in QoL. Additional positive effects on sleep quality and psychological well-being were observed, indicating that PBMT may provide additional therapeutic benefits beyond pain reduction, including improvements in sleep quality and psychological well-being. PBMT has shown promise as a safe, non-pharmacological adjunct therapy that may provide short-term improvements in pain levels and QoL, but substantial heterogeneity limits generalizability. Clinical trials with large samples and standardized methodologies should be conducted to better clarify the role of PBMT in multidisciplinary therapy for FMS.PMID:42334638 | DOI:10.1007/s10103-026-04930-4

J Am Coll Radiol. 2026 Jun 8:S1546-1440(26)00233-4. doi: 10.1016/j.jacr.2026.05.002. Online ahead of print.ABSTRACTChronic knee pain is prevalent in the adult population and is the most common musculoskeletal complaint in the primary care setting. Although osteoarthritis is the most common etiology of chronic knee pain, other sources include osteochondral lesion, subchondral insufficiency fracture, patellofemoral maltracking, or chronic tendon, meniscus, or ligament abnormalities. Imaging plays a key role in the evaluation of chronic knee pain, noting that the etiology cannot be reliably diagnosed or excluded via physical examination alone. Radiographs are the initial imaging modality of choice for chronic knee pain. If radiographs demonstrate osteoarthritis, this document outlines specific scenarios in which additional imaging may be warranted. This document also discusses the appropriate imaging workup for the other entities described above, including soft tissue abnormalities and subchondral insufficiency fracture. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.PMID:42340275 | DOI:10.1016/j.jacr.2026.05.002

Musculoskelet Sci Pract. 2026 Jun 16;85:103601. doi: 10.1016/j.msksp.2026.103601. Online ahead of print.ABSTRACTOBJECTIVE: Chronic musculoskeletal (MSK) pain is a leading cause of disability worldwide, and self-management is a first-line approach recommended by international clinical guidelines. Access to evidence-based information that enhances health literacy may support patients' engagement in their self-management and treatment decision-making, potentially reducing disease burden and pain. However, no tool currently exists to assess health literacy specifically in MSK pain. This study aimed to develop and describe the preliminary version of a knowledge-based questionnaire to evaluate MSK pain literacy, the Musculoskeletal Pain-Literacy questionnaire (MSK-PLq).METHODS: A systematic literature review identified existing health literacy instruments and generated a preliminary list of domains. A two-round Delphi study with 22 panellists (19 experts and three people living with chronic MSK pain), followed by consensus meetings, was used to refine domains and items (≥70% agreement). Readability was assessed using the Flesch Reading Ease (FRE) score and three stakeholders were consulted to review the questionnaire for comprehensibility, clarity, and face validity.RESULTS: Six domains were retained (Understand, Access, Appraise, Apply, Digital, Beliefs), comprising 20 items in the preliminary version of MSK-PLq. Readability was acceptable (mean FRE 74, indicating fairly easy reading), and subject feedback supported the questionnaire's clarity and face validity.CONCLUSIONS: The preliminary version of the MSK-PLq is proposed as the first knowledge-based tool to assess functional, interactive, and critical aspects of MSK pain literacy. It may have applications in clinical practice, research, education, and digital health, by informing tailored patient education and supporting self-management strategies, although further psychometric validation is required.PMID:42341408 | DOI:10.1016/j.msksp.2026.103601

Pain Physician. 2026 Jun;29(4S):S1-S228.ABSTRACTBACKGROUND: Chronic axial spinal pain is a major contributor to disability and healthcare expenditures, with facet joints recognized as one of the established sources of pain.OBJECTIVE: To provide evidence-based guidance in performing diagnostic and therapeutic facet joint interventions.METHODS: A multidisciplinary panel of experts from various medical and pharmaceutical disciplines, convened by the American Society of Interventional Pain Physicians (ASIPP), reviewed the available evidence, considered patient perspectives, and formulated recommendations for facet joint interventions in the management of chronic pain.The methodology included the development of key questions with evidence-based statements and recommendations. Grading of the evidence and recommendations followed a modified approach described by ASIPP, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and the Agency for Healthcare Research and Quality (AHRQ) methods for grading strength of recommendations. The evidence review included existing guidelines, systematic reviews, comprehensive reviews, randomized controlled trials (RCTs), and observational studies evaluating the effectiveness and safety of facet joint interventions in chronic pain management.In the development of consensus statements and guidelines, a modified Delphi technique was utilized to minimize bias related to group interactions. Panelists without a primary conflict of interest voted on approval of specific guideline statements. Each panelist was permitted to suggest revisions to guideline wording and provide additional qualifying remarks or comments regarding implementation of the guidelines in clinical practice. To achieve consensus and inclusion in the final guidelines, each guideline statement required at least 80% agreement among eligible panel members without a primary conflict of interest.RESULTS: A total of 48 authors participated in the development of these guidelines, of whom 39 participated in the voting process. A total of 37 recommendations were developed, with 100% acceptance for all items. The Summary of Recommendations is presented separately. These recommendations addressed diagnostic, therapeutic, and special considerations related to facet joint interventions. For diagnostic and therapeutic interventions, the level of evidence ranged from II to III, with moderate to strong recommendations. For special considerations […]

Pain Ther. 2026 Jun 29. doi: 10.1007/s40122-026-00853-8. Online ahead of print.ABSTRACTOpioid medications play a central role in pain management but are associated with significant risks, including dependence, opioid use disorder (OUD), and overdose. In response to rising concerns, the French National Authority for Health convened a multidisciplinary working group to develop updated guidelines on the appropriate use of opioids. These recommendations, grounded in the high-level international evidence and developed through a rigorous formal consensus method, represent the most comprehensive and recent guidelines addressing the entire opioid pharmacological class, regardless of indication. The first part focuses on the clinical use of opioid analgesics in acute and chronic pain, both cancer-related and non-cancer-related. The guidelines emphasize prudent prescribing, prioritization of non-opioid therapies, and the integration of multimodal analgesia. Specific clinical situations are addressed, including management in primary care, emergency settings, postoperative care, inpatient treatment, and the perioperative management of patients already receiving opioids or opioid agonist treatment. Practical tools such as equianalgesic conversion principles, criteria for opioid rotation, and strategies to minimize adverse effects are provided to support prescribers. By considering opioids as a single pharmacological class, these guidelines enable consistent principles to be applied across diverse clinical contexts, from the initiation of short-term opioid therapy to the safe management of patients with complex dependence profiles. Although developed in France, the recommendations are intended to have international relevance, given their reliance on global evidence and their focus on balancing effective pain relief with risk reduction. A second part, addressing the prevention and management of OUD and overdoses, complements the present manuscript.PMID:42371399 | DOI:10.1007/s40122-026-00853-8

Prog Neuropsychopharmacol Biol Psychiatry. 2026 Jun 29:111798. doi: 10.1016/j.pnpbp.2026.111798. Online ahead of print.ABSTRACTChronic pain is increasingly conceptualized within a stress-related framework. However, it remains unclear whether chronic pain and prototypical stress-related conditions-such as post-traumatic stress disorder (PTSD)-show convergence in their morphometric alterations and underlying normative functional connectivity profiles. To this end, we conducted a pre-registered transdiagnostic meta-analytic study of gray matter volume alterations in chronic pain (60 studies) and PTSD (20 studies), testing convergence at two complementary levels: direct anatomical overlap and network-level convergence within normative resting-state functional systems. Disorder-specific meta-analyses revealed that chronic pain was associated with distributed volume reductions across ventromedial prefrontal, middle cingulate, and insular cortices, whereas PTSD exhibited a single cluster of reduced volume in the anterior cingulate/dorsomedial prefrontal cortices. A direct conjunction analysis identified a spatially focal overlapping cluster of reduced volume in the bilateral medial orbitofrontal/anterior cingulate area. Importantly, using normative resting-state fMRI data (HCP 7 T dataset), we found that the disorder-specific structural abnormalities were embedded within partially overlapping large-scale systems. Specifically, chronic pain abnormalities were embedded within a distributed architecture of large-scale circuits encompassing mesocorticolimbic/reward, default mode, salience, frontoparietal, dorsal attention, and somatosensory networks. On the other hand, the PTSD focal neuroanatomical alteration was embedded in a single large-scale circuit mapping onto the mesocorticolimbic/reward, default mode, salience, and visual networks. In both conditions, the mesocorticolimbic/reward circuit emerged as the most robustly involved large-scale network. Notably, the shared cluster of reduced volume showed functional integration within the mesocorticolimbic/reward and default mode networks, with neurochemical fingerprinting revealing robust spatial correspondence with dopaminergic, serotonergic, opioid, and endocannabinoid receptor/transporter maps. Overall, these findings indicate that brain morphological alterations in chronic pain and PTSD converge in a focal medial prefrontal/anterior cingulate region and that disorder-specific abnormalities map onto partially […]