Chronic pain: Overview

Abstract
Objective: Intensive interdisciplinary pain treatment (IIPT), a promising approach to pediatric chronic pain treatment, focuses on functional restoration through the adoption of pain self-management. Few studies have examined the impact of motivational interviewing (MI) on preparing youth for IIPT. The Promoting Readiness and Engagement in Pain Rehabilitation (PREPaRe) intervention aims to improve IIPT efficiency and outcomes through increasing readiness to engage in pain self-management before admission.

Methods: This randomized controlled trial (RCT) investigated the effects of PREPaRe on youth and caregiver readiness to change before IIPT admission, as well as secondary pain-related and functional outcomes at IIPT discharge, including length of stay. Youth and caregivers (n=78 dyads) were randomized to receive PREPaRe alongside standard medical care (SMC) or SMC alone.

Results: Readiness ratings (e.g., willingness, importance, confidence, awareness) for youth and caregivers receiving PREPaRe significantly improved over time. However, pre-IIPT comparisons of PREPaRe versus SMC revealed main effects for time but no interactions for youth/caregiver pain acceptance and stage of change. Similarly, post-IIPT group comparisons revealed main effects for time (again, no interactions) for youth pain intensity, interference, and disability, and caregiver protective behaviors, catastrophizing, and fear. Importantly, length of IIPT admission was significantly shorter for PREPaRe versus SMC.

Discussionresults: of this clinical trial (NCT04093921) show potential promise for PREPaRe in positioning youth and families for increased readiness and more efficient success in IIPT. Future research should seek to replicate these findings, explore PREPaRe in diverse clinical contexts and demographic groups, and identify who might benefit most from the intervention.

Abstract
Chronic pain is one of the most prevalent and costly health conditions in the United States. Previous work has demonstrated that chronic pain impacts cognition and behavior. However, the impact of chronic pain on daily decisions is less well-known. This narrative review identified and synthesized findings from a literature search that yielded 18 peer-reviewed, experimental, cross-sectional studies on the effects of chronic pain on different decision-making outcomes. According to the literature, the effects of chronic pain on decision-making are evidenced by 1) reduced decision performance, 2) increased risk-taking and delay discounting, 3) altered sensitivity to outcomes, and 4) reduced cognitive flexibility and learning. Chronic pain effects on decision-making also vary by individual factors such as sex/gender, age, and affective and social factors. Guided by these findings, current limitations and future directions in the field are discussed. PERSPECTIVE: This narrative review highlights current evidence and identifies critical knowledge gaps, emphasizing a need to better understand the relationship between chronic pain and decision-making. Findings can guide future theory and shape interventions aimed at improving decision-making in chronic pain.

Purpose: Chronic neck pain (CNP) is a common but challenging symptom in clinical practice. Acupuncture is widely used in alleviating the symptoms of CNP. The main objective of this study was to evaluate the efficacy and safety of electroacupuncture (EA) in patients with CNP and to quantify the specific effects of EA by controlling for placebo effects.

Patients and methods: A randomized sham-controlled trial was conducted at the outpatient departments of single hospital in China from November 2019 to November 2020 and a total of 105 participants with CNP were enrolled. Participants were randomly assigned (1:1:1) to the EA group, sham electroacupuncture (SEA) group and waiting list (WL) group. The primary outcome was change in the Northwick Park Neck Pain Questionnaire (NPQ). Secondary outcomes included McGill Pain Questionnaire (MG), visual analogue scale (VAS) and pain threshold (PT).

Results: This randomized clinical trial included 98 patients. The EA group demonstrated a greater reduction in NPQ scores compared to the SEA group after 10 sessions (-7.2564, 95% CI=-12.2875 to -2.2253, P=0.0054) and at 3-month follow up (-7.0090, 95% CI=-10.5039 to -3.5140, P=0.0002). After 10 sessions, the EA and SEA groups exhibited greater reductions in NPQ scores compared to the WL group (EA vs WL: P <0.001, [95% CI=6.570 to 15.503]; SEA vs WL: P=0.027, [95% CI=0.578 to 9.580]). However, the EA group achieved clinically significant NPQ improvements (>25%), whereas the SEA group failed to meet this criterion.

Conclusion: This randomized clinical trial found that, in patients with CNP, EA significantly improved the symptoms compared with SEA and WL groups both immediately and cumulatively (at 5 weeks), and these benefits persisted through week 17. These comparisons demonstrated that EA's clinical benefits exceeded placebo effects.