Chronic pain: Overview

Abstract
Pain is one of the primary indicators of a bone fracture and serves both a functional and practical role in guiding recovery. However, fracture pain can persist long after the fracture itself has clinically healed. The neural and molecular mechanisms that drive acute pain postfracture, and how these mechanisms are pathologically usurped to trap patients into persistent, debilitating, and often difficult to treat, chronic pain, are not well understood. The aim of this review is to provide insight into the risk factors for pain persistence after fracture, review the physiological and pathophysiological mechanisms of fracture pain, and critically evaluate the literature around fracture pain assessment techniques/models. Taken together, the concepts covered herein will provide a strong foundation to support the development of more effective treatments to better alleviate postfracture pain.

Abstract
Objectives: The aim of this systematic review was to synthesize the state-of-the-art in research on chronic pain in autistic individuals, including epidemiology, assessment, and management.

Methods: We conducted a search of the following electronic databases: PubMed/MedLine, CINHAL, PsychINFO, PubPsych, Scopus and Web of Science, from inception to 31 July 2024.

Results: A total of 5,603 citations were identified, 87 articles were deemed eligible for further assessment, and 26 articles were included in the final review. Of these, 13 provided data about the epidemiology of chronic pain, 10 were related to pain assessment, and three focused on chronic pain treatment. The most commonly studied locations of chronic pain were the abdomen and the head. The assessment tools used were frequently completed by parents or professionals/researchers and only one study used self-reported measures. Only three studies were on the management of chronic pain in autistic individuals, in particular psychological interventions.

Discussion: This study provides initial insights into chronic pain in autistic individuals, and shows that they experience conditions such as chronic abdominal pain and migraines as the general population does. It also highlights challenges to the accurate assessment and treatment of chronic pain, and emphasizes the need for heightened clinician awareness, early identification, and personalized management strategies.

Abstract
Pain and mental health symptoms frequently co-occur in adolescents, often posing physical, social, and emotional challenges. While previous research has focused on clinician perspectives on chronic pain in isolation, limited knowledge exists on the potential unique challenges these co-occurring symptoms' present to clinicians in providing appropriate support to adolescents. This study examined clinician perspectives on the challenges and barriers to treating adolescents who experience co-occurring pain and mental health symptoms. Using a cross-sectional qualitative online vignette survey, responses were collected from 40 clinicians, including psychologists, physiotherapists, and doctors involved in treating adolescents (11-19 years) who experience co-occurring chronic pain and mental health symptoms. Participants, recruited from several countries, were asked about their perceived challenges to treating adolescents with co-occurring chronic pain and mental health symptoms. Vignettes were analyzed using reflexive thematic analysis. The analysis generated two themes. The first, 'tangled threads', describes how clinicians perceive mistrust from the adolescents based on previous negative clinician encounters and a perceived need to 'undo' this anticipated harm. The second theme 'the difficult-to-pursue integrated approach' depicts how fragmentation and siloed services for pain and mental health hinder effective treatment for adolescents who experience both symptoms. Co-occurring pain and mental health symptoms in adolescents are often initially mismanaged because they do not fit the mould of the services available to treat them, resulting in a more complex presentation to clinicians. The development of a more integrated clinical approach to treating adolescents with co-occurring pain and mental health symptoms is needed. PERSPECTIVE: This study identifies that clinicians perceive they face challenges treating adolescents with co-occurring pain and mental health symptoms, often due to the adolescent's prior clinical experiences and the limited comprehensive treatment options available to them. An integrated approach is urgently needed to tailor care and reduce harm.