European journal of pain : EJP
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Dysregulation of the μ-opioid receptor has been reported in fibromyalgia (FM) and was linked to pain severity. Here, we investigated the effect of the functional genetic polymorphism of the μ-opioid receptor gene (OPRM1) (rs1799971) on symptom severity, pain sensitivity and cerebral pain processing in FM subjects and healthy controls (HC). ⋯ We show that the functional polymorphism of the μ-opioid receptor gene OPRM1 was associated with alterations in the fronto-parietal network as well as with increased activation of posterior cingulum during evoked pain in FM. Thus, the OPRM1 polymorphism affects cerebral processing in brain regions implicated in salience, attention, and the default mode network. This finding is discussed in the light of pain and the opioid system, providing further evidence for a functional role of OPRM1 in cerebral pain processing.
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In pain research and clinics, it is common practice to subgroup subjects according to shared pain characteristics. This is often achieved by computer-aided clustering. In response to a recent EU recommendation that computer-aided decision making should be transparent, we propose an approach that uses machine learning to provide (1) an understandable interpretation of a cluster structure to (2) enable a transparent decision process about why a person concerned is placed in a particular cluster. ⋯ Assessing the variables importance in clustering is important for understanding any cluster structure. XAI models are able to provide a human-understandable interpretation of the cluster structure. Model selection must be adapted individually to the clustering problem. The advantage of comprehensibility comes at an expense of accuracy.
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Individuals vary in their temperature and pungency preferences; whereas some individuals prefer to bath in, or consume food and beverages at very high temperatures, others prefer lukewarm temperatures. Similarly, pungent food may be preferred by some, but not by others. The aim was to investigate, for the first time whether temperature and pungency preferences are associated with variations in thermal sensitivity or ethnic origin related to pungency consumption. ⋯ People vary with regard to their temperature and spiciness preferences for reasons yet unknown. The study revealed that these preferences correlate with one another and were associated with the sensitivity to noxious heat but not with age, gender and cultural background, which suggests that they may be innate.
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Despite evidence that intensive interdisciplinary pain treatment (IIPT) is effective in facilitating functional recovery in adolescents with chronic pain, engagement with IIPT is suboptimal among adolescents. A key aspect of IIPT is to support functional recovery via (re)engagement with age-appropriate daily activities. The aim of this study was to gain a comprehensive insight into adolescents' perceptions of the barriers they need to overcome to engage with age-appropriate activities in order to achieve functional recovery. ⋯ The findings reveal a variety of barriers that were perceived to hinder functional recovery through reduced engagement with age-appropriate activities and thereby hamper progress within IIPT. The Passenger on the bus metaphor can be used to identify similar barriers faced by adolescents in an individualized treatment approach, thereby making it possible for clinicians to target their IIPT more precisely.
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Observational Study
Six-year trends in postoperative prescribing and use of multimodal analgesics following total hip and knee arthroplasty: A single-site observational study of pain management.
Guidelines for acute postoperative pain management recommend administering analgesics in multimodal combination to facilitate synergistic benefit, reduce opioid requirements and decrease side-effects. However, limited observational research has examined the extent to which multimodal analgesics are prescribed and administered postoperatively following joint replacement. ⋯ Evaluation of 6-year trends in a large Australian metropolitan private hospital indicated substantial growth in postoperative multimodal analgesic prescribing. In the context of growing global awareness concerning multimodal analgesia, findings suggested diffusion of best-evidence prescribing into clinical practice. Findings indicated the effects of postoperative multimodal analgesia in real-world conditions outside of experimental trials. Postoperative multimodal analgesia in the clinical setting was only associated with a modest reduction in rest pain, but substantially reduced interference from pain on activities and sleep.