The opioid epidemic in the United States remains a major public health concern, with opioid-related deaths increasing more than 8-fold since 1999. Chronic pain, affecting 1 in 5 US adults, is a key contributor to opioid use and misuse. While previous research has explored clinical and behavioral predictors of opioid risk, less attention has been given to large-scale linguistic patterns in public discussions of pain. Social media platforms such as X (formerly Twitter) offer real-time, population-level insights into how individuals express pain, distress, and coping strategies. Understanding these linguistic markers matters because they can reveal underlying psychological states, perceptions of health care access, and community-level opioid risk factors, offering new opportunities for early detection and targeted public health response.

This study aimed to examine linguistic markers of pain communication on the social media platform X and assess whether language patterns differ among US states with high and low opioid mortality rates. We also evaluated the predictive power of these linguistic features using machine learning and identified key thematic structures through semantic network analysis.

We collected 1,438,644 pain-related tweets posted between January and December 2021 using tweepy and snscrape. Tweets from 2 high-opioid mortality states (Ohio and Florida) and 2 low opioid mortality states (South and North Dakota) were selected, resulting in 31,994 tweets from high-death states (HDS) and 750 tweets from low-death states (LDS). Six machine learning algorithms (random forest, k-nearest neighbor, decision tree, naive Bayes, logistic regression, and support vector machine) were applied to predict state-level opioid mortality risk based on linguistic features derived from Linguistic Inquiry and Word Count. Synthetic Minority Oversampling Technique was used to address class imbalance. Semantic network analysis was conducted to visualize co-occurrence patterns and conceptual clustering.

The random forest model demonstrated the strongest predictive performance, with an accuracy of 94.69%, balanced accuracy of 94.69%, κ of 0.89, and an area under the curve of 0.95 (P<.001). Tweets from HDS contained significantly more affective pain words (t31,992=10.84; P<.001; Cohen d=0.12), health care access references, and expressions of distress. LDS tweets showed greater use of authenticity markers (t31,992=-10.04; P<.001) and proactive health-seeking language. Semantic network analysis revealed denser discourse in HDS (density=0.28) focused on distress and barriers to care, while LDS discourse emphasized recovery and optimism.

Our findings demonstrated that linguistic markers in publicly shared pain-related discourse show distinct and predictable differences across regions with varying opioid mortality risks. These linguistic patterns reflect underlying psychological, social, and structural factors that contribute to opioid vulnerability. Importantly, they offer a scalable, real-time resource for identifying at-risk communities. Harnessing social media language analytics can strengthen early detection systems, guide geographically targeted public health messaging, and inform policy efforts aimed at reducing opioid-related harm and improving pain management equity.

Access to pain management is a human right. Nevertheless, research consistently reports that children's pain is under-recognised and under-treated compared to that of adults. Additionally, younger children are less likely to receive treatment for their pain. The significance of early-life healthcare experiences is often underestimated due to constructions of young children as passive rather than active agents in healthcare. This study addresses this issue by examining how children's agency is co-constructed within the triad of children, caregivers, and healthcare professionals during childhood vaccination consultations. Field notes were collected describing vaccination consultations involving children aged two months to seven years, with an overrepresentation of children under the age of two due to the study's focus. Ethnographic observations (∼275.5 h) were held in Belgium, Italy, and Portugal, due to their diversity in healthcare system characteristics, vaccination policy, and coverage. Data were analysed using template analysis, a specific type of thematic analysis. Findings illustrate that children inherently possess agency, which can be hindered or facilitated by caregivers and healthcare professionals in the healthcare setting. Although clinical guidelines on pain mitigation for paediatric vaccinations exist, the findings show that these are not consistently applied in practice. Providing a framework for understanding the variability in paediatric pain mitigation, we highlight the socio-cultural conditions by which young children are either socialised into the patient role, or have their status as patients undermined. In pursuit of quality healthcare and pain mitigation for children during vaccination consultations, it is necessary that they are considered and treated as active, embodied healthcare agents.

Each human being experiences pain differently. In addition to the highly subjective phenomenon, only limited labeled data, mostly based on short-term pain sequences recorded in a lab setting, is available. However, human beings in a clinic might suffer from long painful time periods for which even a smaller amount of data, in comparison to the short-term pain sequences, is available. The characteristics of short-term and long-term pain sequences are different with respect to the reactions of the human body. However, for an accurate pain assessment, representative data is necessary. Although pain recognition techniques, reported in the literature, perform well on short-term pain sequences. The collection of labeled long-term pain sequences is challenging and techniques for the assessment of long-term pain episodes are still rare. To create accurate pain assessment systems for the long-term pain domain a knowledge transfer from the short-term pain domain is inevitable.

In this study, we adapt classifiers for the short-term pain domain to the long-term pain domain using pseudo-labeling techniques. We analyze the short-term and long-term pain recordings of physiological signals in combination with electric and thermal pain stimulation.

The results of the study show that it is beneficial to augment the training set with the pseudo labeled long-term domain samples. For the electric pain domain in combination with the early fusion approach, we improved the classification performance by 2.4% to 80.4% in comparison to the basic approach. For the thermal pain domain in combination with the early fusion approach, we improved the classification performance by 2.8% to 70.0% in comparison to the basic approach.

Black Americans report more intense and disabling pain than White Americans, but differences in pain behavior have rarely been studied. The Structured Pain Behavior Test (SPBT), a standardized, video-recorded series of pain-inducing movements, assesses the behavioral expression of pain. We conducted the first test of whether Black Americans with chronic low back pain (CLBP) have greater pain behavior and increased self-reported pain intensity during the SPBT, compared to White Americans. Adults (N = 267) with CLBP (174 Black, 93 White; 57% female) rated their clinical pain severity and interference (Multidimensional Pain Inventory; MPI) and their current pain intensity (Numerical Rating Scale; NRS) both before and after engaging in the SPBT, which was coded for observed pain behavior. Consistent with prior research, Black participants reported greater MPI clinical pain severity and interference (large effect). More importantly, during the SPBT, Black participants had greater pain behavior (medium effect) and reported a greater increase in pain intensity (NRS; small-medium effect) than did Whites. Racialized differences in all pain measures remained significant after controlling for multiple variables (including depressive symptoms and pain catastrophizing), and differences in observed pain behavior remained after also controlling for self-reported pain intensity (NRS) or MPI clinical pain severity. We conclude that greater self-reported pain severity and interference among Black Americans is accompanied by greater pain behavior and increased pain intensity in response to pain-inducing movements. Research should examine possible mechanisms of this racialized difference, including differential access and care, racism as pain exacerbator, and the social communication of pain. PERSPECTIVE: Black Americans with chronic back pain have greater self-reported pain severity than White Americans and greater pain behavior during the Structured Pain Behavior Test, even after controlling for self-reported pain and other variables. Black Americans' elevated pain may reflect poorer health care, racism-induced pain exacerbation, and/or social communication of need.

Although many efforts have been made to reduce racial pain disparities over decades, the pain of black patients is still undertreated. Previous work has identified a host of patient and provider factors that contribute to racial disparities in healthcare in general, and consequently, may contribute to disparities in pain care in particular. That said, there has been limited clinically meaningful progress in eliminating these disparities. This lack of progress is likely because prior research has investigated the influence of patient and provider factors in isolation, rather than examining their interaction. Successful pain care requires constructive patient-provider communication, and constructive communication is both dyadic and dynamic. One well-accepted operationalisation of such dyadic processes is behavioural coordination. We hypothesise that the pain of black patients continues to be undertreated because black patients are more likely than white patients to participate in racially discordant medical interactions (ie, seeing other-race providers) and experience disruptions in behavioural coordination. We further hypothesise that disruptions in behavioural coordination will reflect patient and provider factors identified in prior research. We propose to test these hypotheses in the planned surgical context.

Using a convergent mixed methods research design, we will collect data from at least 15 surgeons and their 150 patients (approximately equal number of black and white patients per surgeon). The data sources will include one surgeon survey, four patient surveys, video- and/or audio-recordings of preoperative consultations and medical chart reviews. The recorded preoperative consultations will be analysed both qualitatively and quantitatively to assess the magnitude and pattern of behavioural coordination between patients and surgeons. Those data will be linked to survey data and data from medical chart reviews to test our hypotheses.

Ethical approval has been obtained from the Virginia Commonwealth University Institutional Review Board (HM20023574). Findings will be disseminated through presentations at scientific conferences, publications in peer-reviewed journals and speaking engagements with clinician stakeholders. We will also share the main findings from this project with patients via a newsletter on completion of the entire project.

Burns can cause patients significant pain at the time of injury and during subsequent treatment. Other people's pain often elicits empathic responses in observers. However, effective emotion regulation strategies are needed to manage personal distress, which may otherwise inhibit helping behaviour.

This study used an interpretative qualitative approach to conduct semi-structured interviews with burns nurses. Interviews explored emotion regulation strategies used by nurses whilst causing pain to adult patients during burns dressing changes. Transcripts were analysed using Braun and Clarke's six stages of thematic analysis.

Eight burns nurses participated in the interviews. Thematic analysis developed five themes: Emotions get in the way of being a good nurse; Pain's an inevitable and justifiable part of treatment and healing; If I'm not made aware of the pain, maybe there is no pain; The pain's due to other factors, not my actions; and Sometimes it's too much.

Burns nurses' attempts at regulating their emotions were influenced by their beliefs about what makes a 'good' nurse. Gross's model of emotion regulation provides a useful framework for understanding these strategies, but further research is needed into the helpfulness thereof for nurses and patients.

Recent studies comparing behavior to different sets of facial stimuli have highlighted a need to employ more naturalistic, genuine facial expressions in cognitive research. To address this need, we identified and selected a large set of highly expressive face stimuli from the public domain, and used these stimuli to test whether participants can recognise when others are experiencing pain from their facial behaviour. After identifying 315 expressive faces to represent the kinds of facial behaviours often seen in three distinct contexts (i.e., injury-related, loss-related and victory-related), we ran six behavioural ratings tasks to characterise these faces along six dimensions; level of arousal, emotional valence, level of physical pain, attractiveness, familiarity, and perceived gender. The results indicate that injury-related expressions are recognised as lower in emotional valence than victory-related expressions, and higher in psychological arousal than both victory- and loss-related expressions. Overall, these findings suggest that the intense, energetic expressions of people in competitive situations are not rendered ambiguous to third parties by increased arousal. These results validate the use of naturalistic facial expressions in studies of non-verbal, injury-related behaviours and their recognition in forensic and clinical settings. PERSPECTIVE: Here we created and validated a large set of visual stimuli, which have been made available to the scientific community. Our results demonstrate that among high-arousal states, expressions related to feelings of intense pain and injury are visually distinct from expressions related to loss or triumph. Thus, the Wild Faces Database - High Arousal States (WFD-HAS) extension provides an important tool for understanding how we recognise injury-related facial expressions in the real world.

Painimation, a novel digital pain assessment tool, allows patients to communicate their pain quality, intensity, and location using abstract animations (painimations) and a paintable body image. This study determined the construct validity of painimations and body image measures by testing correlations with validated pain outcomes in adults with sickle cell disease (SCD). Analyses used baseline data from a multisite randomized trial of 359 adults with SCD and chronic pain. Participants completed questionnaires on demographics, pain severity, frequency and interference, catastrophizing, opioid use, mood and quality of life, plus the Painimation app. Participants were categorized by selected painimations, and were split into groups based on the proportion of painted body image. Potential confounding was evaluated by age, gender, race, education, disability, site, depression, and anxiety. The 'shooting' painimation was strongly associated with daily pain intensity, pain interference, frequency, and severity. 'Electrifying' was associated with daily pain and opioid misuse, while greater body area in pain correlated with worse outcomes across all pain measures. Both painimations and body image measures correlated with validated pain outcomes, quality of life and mental health measures. This demonstrates animations and body image data can assess SCD pain severity, potentially with more accuracy than a 0-10 scale. Future research will explore whether Painimation can differentiate biological and psychosocial pain components. PERSPECTIVE: This article presents the preliminary construct validity of Painimation in SCD by examining the associations of "painimations" and body area image data with daily e-diary and traditional self-report pain outcomes.

Children frequently encounter pain. Their pain like adults' pain is probably modulated by social-affective factors. Despite its clinical relevance, such pain modulation has not been explored experimentally in children, and little is known about specific factors accounting for it such as catastrophizing. We examined pain modulating effects of pictures varying in social-affective content and personal meaning (e.g., mothers' vs. strangers' faces) using subjective and psychophysiological measures (skin conductance, heart rate, corrugator electromyography) as outcomes.

Forty-two children (8-13 years) underwent tonic heat pain stimulation while viewing pictures (social-affective: their mothers' faces with neutral expression, strangers' neutral and happy faces; affective: positive and negative scenes). Furthermore, the contribution of children's characteristics (e.g., anxiety, catastrophizing) and facets of the parent-child relationship to pain modulation was determined.

Viewing mothers' faces or positive scenes reduced subjective pain intensity and corrugator activity in response to pain. Viewing happy strangers' faces lowered corrugator activity. Enhanced pain experience due to negative affective stimuli was primarily observed psychophysiologically. The correlation between children's tendency to catastrophize and pain relief by mothers' faces was mediated by induced arousal, likely reflecting the degree of motivational activation of seeking social support.

Pain relief by positive affective and social-affective stimuli extends previous findings in adults, especially regarding reduced pain-related facial muscle activity. Moreover, the results shed light on the interplay between catastrophizing and social context on children's pain experience. Clinically, our results imply that just looking at pictures of their mothers (or positive scenes) might help to alleviate pain in children.

Lower socioeconomic status (SES) is a risk factor for poorer pain-related outcomes. Further, the neighborhood environments of disadvantaged communities can create a milieu of increased stress and deprivation that adversely affects pain-related and other health outcomes. Socioenvironmental variables such as the Area Deprivation Index, which ranks neighborhoods based on socioeconomic factors could be used to capture environmental aspects associated with poor pain outcomes. However, it is unclear whether the ADI could be used as a risk assessment tool in addition to individual-level SES.

The current study investigated whether neighborhood-level disadvantage impacts knee pain-related outcomes above sociodemographic measures. Participants were 188 community-dwelling adults who self-identified as non-Hispanic Black or non-Hispanic White and reported knee pain. Area Deprivation Index (ADI; measure of neighborhood-level disadvantage) state deciles were derived for each participant. Participants reported educational attainment and annual household income as measures of SES, and completed several measures of pain and function: Short-form McGill Pain Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, and Graded Chronic Pain Scale were completed, and movement-evoked pain was assessed following the Short Physical Performance Battery. Hierarchical linear regression analyses were used to assess whether environmental and sociodemographic measures (i.e., ADI 80/20 [80% least disadvantaged and 20% most disadvantaged]; education/income, race) were associated with pain-related clinical outcomes.

Living in the most deprived neighborhood was associated with poorer clinical knee pain-related outcomes compared to living in less deprived neighborhoods (ps < 0.05). Study site, age, BMI, education, and income explained 11.3-28.5% of the variance across all of the individual pain-related outcomes. However, the ADI accounted for 2.5-4.2% additional variance across multiple pain-related outcomes.

The ADI accounted for a significant amount of variance in pain-related outcomes beyond the control variables including education and income. Further, the effect of ADI was similar to or higher than the effect of age and BMI. While the effect of neighborhood environment was modest, a neighborhood-level socioenvironmental variable like ADI might be used by clinicians and researchers to improve the characterization of patients' risk profile for chronic pain outcomes.

For decades, clinicians and researchers have observed bidirectional relationships between child development and the pain experience in childhood. Pain in childhood is an inherently developmental phenomenon, embedded in an iterative, time-dependent process that reflects individual biological, behavioral, social, psychological, and environmental characteristics that unfold across the early life span. Childhood pain can have wide ranging effects on brain development in ways that contribute-for better and worse-to social, emotional, and cognitive well-being in childhood and on into adulthood. Atypical trajectories of development in the context of disorders such as autism, cerebral palsy, ADHD, and mood/anxiety disorders also contribute to unique childhood pain experiences. In this paper, pain will be considered as a determinant of development, and conversely development will be considered as a key determinant of a child's pain experience. We will discuss how intersectional identities (eg, gender, race, socioeconomic status) and associated social, structural, systemic, and physical environments influence the relationship between development and pain. Finally, we will identify what might be needed to think "developmentally" in ways that extend from the "bench side" in the lab to the "curb side" in the community, integrating a developmental perspective into research and clinical practice to achieve health accessibility and equity in pain care for all children across the developmental spectrum.

Chronic pain is a common health problem worldwide that results in significant costs to society and has negative impacts on the individuals with chronic pain. In order to study and treat pain, valid and reliable pain assessment is necessary, including assessment of pain quality. However, all of the most commonly used measures of pain quality were developed in Western countries. Evidence has shown that some of these measures are not content valid for use in non-Western countries. Moreover, it remains unclear which pain descriptors are universal across people from different countries who speak different languages, and which are specific to individuals from a particular country or even from a particular region within one country.

The current study sought to: (1) identify the number and frequency of words used by native speakers of Hindi in northern India to describe their pain; (2) compare the rates of descriptor use in these individuals with samples of individuals from Nepal and the USA; and (3) investigate the content validity of the most commonly used pain quality measures for measuring pain in this Hindi-speaking population.

Two hundred and forty individuals with chronic musculoskeletal pain who speak and understand Hindi were asked to describe their pain.

The results showed overlap as well as differences in the words used to describe pain with samples of individuals with pain from other countries. Moreover, none of the pain quality measures examined were found to be content valid in the Hindi-speaking sample, suggesting that these measures need to be adapted to assess pain quality in this population.

The study findings confirm the conclusion that pain quality measures developed in one country or in one pain population are not necessarily valid for assessing pain quality in a population from another country. The findings also suggest the possibility that a measure could be developed which would allow for more valid assessment of pain quality in individuals with pain from different countries.

Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain remain rarely addressed in the context of pain prevention and management. In this review, we aim to 1) examine the broad scope of social determinants and consequences of pain and their interactions across multiple levels of organization, and 2) provide a framework synthesizing existing concepts and potential areas for future work on social aspects of pain, drawing upon socioecological, intersectional, and life course approaches. Integrating interdisciplinary theory and evidence, we outline pathways through which multilevel social factors and pain may affect each other over time. We also provide a brief summary of intrapersonal aspects of pain, which are thought to operate at the interface between individuals and the social context. Progressing from micro- to macrolevel factors, we illustrate how social determinants of pain can directly or indirectly contribute to pain experiences, expression, risk, prognosis, and impact across populations. We consider 1) at the interpersonal level, the roles of social comparison, social relatedness, social support, social exclusion, empathy, and interpersonal conflict; 2) at the group or community level, the roles of intimacy groups, task groups, social categories, and loose associations; and 3) at the societal level, the roles of political, economic, and cultural systems, as well as their policies and practices. We present examples of multilevel consequences of pain across these levels and discuss opportunities to reduce the burden and inequities of pain by expanding multilevel social approaches in pain research and practice. PERSPECTIVE: Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain are often unclearly defined, hindering their use in pain prevention, management, and research. We summarize the scope of social aspects of pain and provide a framework synthesizing existing concepts and potential areas for future work.

Peer support for chronic pain is increasingly taking place on social media via social networking communities. Several theories on the development and maintenance of chronic pain highlight how rumination, catastrophizing, and negative social interactions can contribute to poor health outcomes. However, little is known regarding the role web-based health discussions play in the development of negative versus positive health attitudes relevant to chronic pain.

This study aims to investigate how participation in online peer-to-peer support communities influenced pain expressions by examining how the sentiment of user language evolved in response to peer interactions.

We collected the comment histories of 199 randomly sampled Reddit (Reddit, Inc) users who were active in a popular peer-to-peer chronic pain support community over 10 years. A total of 2 separate natural language processing methods were compared to calculate the sentiment of user comments on the forum (N=73,876). We then modeled the trajectories of users' language sentiment using mixed-effects growth curve modeling and measured the degree to which users affectively synchronized with their peers using bivariate wavelet analysis.

In comparison to a shuffled baseline, we found evidence that users entrained their language sentiment to match the language of community members they interacted with (t198=4.02; P<.001; Cohen d=0.40). This synchrony was most apparent in low-frequency sentiment changes unfolding over hundreds of interactions as opposed to reactionary changes occurring from comment to comment (F2,198=17.70; P<.001). We also observed a significant trend in sentiment across all users (β=-.02; P=.003), with users increasingly using more negative language as they continued to interact with the community. Notably, there was a significant interaction between affective synchrony and community tenure (β=.02; P=.02), such that greater affective synchrony was associated with negative sentiment trajectories among short-term users and positive sentiment trajectories among long-term users.

Our results are consistent with the social communication model of pain, which describes how social interactions can influence the expression of pain symptoms. The difference in long-term versus short-term affective synchrony observed between community members suggests a process of emotional coregulation and social learning. Participating in health discussions on Reddit appears to be associated with both negative and positive changes in sentiment depending on how individual users interacted with their peers. Thus, in addition to characterizing the sentiment dynamics existing within online chronic pain communities, our work provides insight into the potential benefits and drawbacks of relying on support communities organized on social media platforms.

Aim: The aim of this study is to explore and compare experiences of pain management strategies for children with CP from the perspectives of children themselves and their parents. Methods: A secondary inductive analysis of previously collected qualitative data was performed. Fourteen children with CP and one parent of each child were interviewed separately about the management of the child's pain. A dyadic data analysis was used to compare parents' and children's perspectives. Findings: The main thematic categories of pain management identified were self-care, psychological strategies, physical interventions and professional treatment. Experiences described by the child and parent differed within all participating dyads but to different degrees. On a group level, children described more use of psychological strategies than parents did. Parents described more professional treatment strategies. Conclusions: Parents and children described different experiences of pain management strategies, and both perspectives are needed to understand the child's situation.

Evidence shows that patients who visit the surgical and trauma emergency units may be discharged with untreated or increased pain levels. This study explored nurses' pain assessment and management approaches at a trauma-surgical emergency unit in Ghana.

Seventeen nurses who work in the trauma department participated in this qualitative exploratory descriptive study. In-depth individual interviews were conducted, and the thematic analysis was utilized to identify emerging themes and subthemes.

Three main themes were identified: patient pain indicators, pain management, and institutional factors influencing pain management. The study revealed that nurses rely on verbal expressions, non-verbal cues, physiological changes, and the severity of pain communicated. The findings highlighted staff shortage, inadequate resources, and lack of standardized guidelines as factors affecting pain and management.

Although the study offers critical new perspectives on nurses' experiences regarding pain related issues at the trauma-surgical emergency units, its small sample size limited its generalizability.

Endometriosis is a chronic and progressive gynecological disease that affects 1 to 2 out of 10 women of childbearing age in France. The objective of this research was to understand the factors determining the quality of life of the patients who experience significant pain symptoms (75%), distinguished by the extent and depth of the lesions. The second objective was to evaluate the psychological repercussions of this pain. We will therefore assess the various psychological processes involved in explaining quality of life.

In total, 1039 women aged 18-55 years completed a self-administered questionnaire, assessing different types of pain and intensity, body image (BIS), self-esteem (Rosenberg), anxiety-depressive symptomatology (HAD), and quality of life (SF-36). Socio-biographical and medical characteristics of the patients were also assessed.

Analyses of variance showed that patients with chronic pain had lower self-esteem and body image, more anxiety-depressive symptoms, and a poorer quality of life than women with cyclic pain and those without pain. Regression analyses showed that the determinants of physical and mental quality of life differed significantly according to the type of pain experienced.

The consequences of the pain associated with endometriosis reveal multiple problems that can be considered from a new perspective. Although psychological disorders can be a response to pain phenomena they can also contribute to their increase. This is where the challenge lies in providing comprehensive care.

Children undergoing hematopoietic stem cell transplantation (HSCT) are vulnerable to pain.

This study aimed to examine how healthcare providers and parents assessed pain and what contextual factors influenced their pain assessment practices for children hospitalized after allogeneic HSCT therapy.

A qualitative case study was conducted in a tertiary level pediatric HSCT unit in 2 phases. Semistructured interviews with parents were conducted at 30 and 90 days after HSCT therapy. Healthcare providers participated in naturalistic observations of pain-related care provided to children during their hospitalization for HSCT therapy and a semistructured interview.

The assessment of pain after transplantation by healthcare providers and parents was predominantly reliant on the observation of children for behaviors indicative of pain, rather than the application of validated pain assessment tools. Without formal measures of the pain experience, judgments regarding the severity of children's pain were influenced by the context of high acuity of care posttransplantation and the emotional responses of healthcare providers and parents from bearing witness to children's pain.

Pain assessments mostly reflected children's ability to tolerate pain, rather than a genuine measurement of how significantly pain impacted the child.

This study has emphasized how the assessment of pain for children hospitalized during HSCT therapy is limited by the complexity of the clinical environment. It is recommended that validated methods of assessing pain by healthcare providers and parents be implemented into clinical practice to ensure children's pain is visible.

Pain and cognitive impairment are prevalent and often co-occur in older adults. Because pain may negatively affect cognitive test performance, identification of pain in the context of neuropsychological evaluation is important. However, pain detection based on self-report presents challenges, and pain is often under-detected in this population. Alternative methods (e.g., video-based automatic coding of facial biomarkers of pain) may facilitate pain identification and thus enhance interpretation of neuropsychological evaluation results.

The current study examined pain in the context of virtual neuropsychological assessment in 111 community-dwelling older adults, first seeking to validate the use of software developed to automatically code biomarkers of pain. Measures of pain, including self-report of acute and chronic pain and automatic coding of pain, were compared while participants completed neuropsychological testing.

Self-reported pain was negatively associated with poorer performance on a measure of executive function (both acute and chronic pain) and a global cognitive screening measure (acute pain only). However, self-reported acute and chronic pain did not correlate significantly with most neuropsychological tests. Automatic coding of pain did not predict self-report of pain or performance on neuropsychological tests beyond the influence of demographic factors and psychological symptoms.

Though results were largely not significant, correlations warrant further exploration of the influence of pain on neuropsychological test performance in this context to ensure that pain does not influence test performance in individuals with higher levels of pain and in other samples.

The drive for a more person-centred approach in the broader field of clinical medicine is also gaining traction in chronic pain treatment. Despite current advances, a further departure from 'business as usual' is required to ensure that the care offered or received is not only effective but also considers personal values, goals, abilities, and day-to-day realities. Existing work typically focuses on explaining pain symptoms and the development of standardised interventions, at the risk of overlooking the broader consequences of pain in individuals' lives and individual differences in pain responses. This review underscores the importance of considering additional factors, such as the influence of chronic pain on an individual's sense of self. It explores innovative approaches to chronic pain management that have the potential to optimise effectiveness and offer person-centred care. Furthermore, it delves into research applying hybrid and individual formulations, along with self-monitoring technologies, to enhance pain assessment and the tailoring of management strategies. In conclusion, this review advocates for chronic pain management approaches that align with an individual's priorities and realities while fostering their active involvement in self-monitoring and self-management.

Family communication about pain is an important therapeutic target when a parent lives with chronic pain. Occupational therapy literature about communication in families affected by parental chronic pain is currently lacking.

To bring an occupational perspective to communication within families affected by parental chronic pain, to generate insights for practice.

Five families (total n = 19 family members) were recruited into this collective case study. The gathered data included interviews, observations, and personal documents/artefacts. A cross-case analysis of similarities and differences between families was conducted to distil insights about the relationship between occupation and communication about parental pain.

Each family develops its own style of communicating about a parent's pain. On a day-to-day basis, pain-related communication is prompted by experienced, observed and/or anticipated occupational disruption brought about by parental pain.

Occupational disruption and occupational responses need to be components of interest, when designing assessments and interventions targeted at communication in families affected by parental chronic pain.

The findings from this study point to the importance of communication through occupation in families affected by parental chronic pain and suggest novel targets for occupational therapy intervention.

Children hospitalized following hematopoietic stem cell transplantation (HSCT) experience complex and prolonged pain in response to the intensity of this treatment.

To describe how pain was managed for children during HSCT therapy and how contextual factors related to the clinical environment influenced healthcare providers' and parents' pain management practices.

A qualitative case study was conducted and involved semi-structured interviews at two time points following transplantation (30 and 90 days) with parents (n = 10) and naturalistic observations of pain-related care provided to children (n = 29) during HSCT therapy by their healthcare providers (n = 10). Semi-structured interviews were also conducted with healthcare providers (n = 14).

The effectiveness of pain management interventions was hindered by the multifactorial nature of pain children experienced, a gap in the provision of psychosocial interventions for pain and a lack of evidence-based guidelines for the sustained, and often long-term, administration of opioids and adjuvant medications. Misconceptions were demonstrated by healthcare providers about escalating pain management according to pain severity and differentiating between opioid tolerance and addiction. Parents were active in the management of pain for children, especially the provision of nonpharmacological interventions. Collaboration with external pain services and the impact of caring for children in protective isolation delayed timely management of pain.

There is a pressing need to create evidence-based supportive care guidelines for managing pain post transplantation to optimize children's relief from pain. If parents and children are to be involved in managing pain, greater efforts must be directed toward building their capacity to make informed decisions.

According to a widely cited assertion, older adults are less likely than younger individuals to express pain complaints. Age-related differences in pain responses have been discussed in the literature despite a paucity of research involving direct comparisons of younger and older adults' pain reactions (i.e., verbal, nonverbal) in the context of a single experimental investigation. Our goal was to test the hypothesis that older adults are more stoic than younger adults in their expression of pain.

We measured trait stoicism as well as multiple responses to thermal pain.

In contrast to suggestions in the literature, equivalence testing indicated that older and younger adults displayed similar verbal and nonverbal pain responses. Our results suggest that older adults are no more stoic about their pain than are younger persons.

This is the first attempt to explore a wide array of age differences in pain expression within the context of a single experimental study.

Despite its prevalence and impact, pain is underdetected and undermanaged in persons with dementia. Family caregivers are well positioned to detect pain and facilitate its management in their care recipients, but they lack training in symptom recognition and communication. This study reports findings from a pilot trial evaluating the Pain Identification and Communication Toolkit (PICT), a multicomponent intervention that provides training in observational pain assessment and coaching in pain communication techniques.

Family caregivers of persons with comorbid pain and moderate-to-advanced dementia were randomly assigned to PICT (n = 19) or a control condition (n = 15). Caregivers in the PICT group participated in four weekly sessions delivered by telephone with a trained interventionist; caregivers in the control group received an information pamphlet about pain and dementia. All participants completed surveys at baseline and 12 weeks. Caregivers in the intervention group also completed semistructured interviews at 12 weeks. Quantitative data were analyzed using descriptive statistics and t tests; qualitative data were analyzed using content analysis.

All participants (100%) in the PICT group completed the intervention and most completed the 12-week assessment (94%). PICT randomized caregivers reported that the intervention helped them to feel more confident in their ability to recognize (67%) and communicate about pain symptoms (83%). At 12 weeks, caregivers in the PICT group showed a statistically significant improvement in self-efficacy in pain-related communication. In qualitative interviews, caregivers emphasized the utility of PICT's components, including pain assessment tools, and offered considerations for future enhancements, such as technology-based adaptations and integration within care delivery systems.

This pilot trial demonstrates that PICT is feasible to implement, acceptable to caregivers, and has the potential to improve confidence in recognizing and communicating about pain. Results support conducting a fully powered efficacy trial, an important step toward future integration into real-world care delivery.

NCT03853291.

Psychologically informed practice (PiP) includes a special focus on psychosocial obstacles to recovery, but research trials have revealed significant difficulties in implementing PiP outside of research environments. Qualitative studies have identified problems of both competence and confidence in tackling the psychosocial aspects of care, with a tendency to prefer dealing with the more mechanical aspects of care. In PiP, the distinction between assessment and management is not clear-cut. Analysis of the problem is part of the intervention, and guided self-management begins with the initial detective work by the patient, who is encouraged to develop successful and relevant behavior change. This requires a different style and focus of communication that some clinicians find difficult to enact. In this Perspective, the PiP Consultation Roadmap is offered as a guide for clinical implementation to establish a therapeutic relationship, develop patient-centered communication, and guide effective pain self-management. These strategies are illustrated through the metaphor of the patient learning to drive, with the therapist as a driving instructor and the patient as a student driver. For convenience, the Roadmap is depicted in 7 stages. Each stage represents aspects of the clinical consultation in a recommended order, although the Roadmap should be viewed as a general guide with a degree of flexibility to accommodate individual differences and optimize PiP interventions. It is anticipated that the experienced PiP clinician will find it progressively easier to implement the Roadmap as the building blocks and style of consultation become more familiar.

Providing cultural education to health professionals is essential in improving the quality of care and outcomes for Aboriginal and Torres Strait Islander patients. This study reports the evaluation of a novel training workshop used as an intervention to improve communication with Aboriginal and Torres Strait Islander patients of persistent pain services.

In this single-arm intervention study, health professionals undertook a one-day workshop, which included cultural capability and communication skills training based on a clinical yarning framework. The workshop was delivered across three adult persistent pain clinics in Queensland. At the end of the training, participants completed a retrospective pre/post evaluation questionnaire (5 points Likert scale, 1 = very low to 5 = very high), to rate their perceived importance of communication training, their knowledge, ability and confidence to communicate effectively. Participants also rated their satisfaction with the training and suggested improvements for future trainings.

Fifty-seven health professionals were trained (N = 57/111; 51% participation rate), 51 completed an evaluation questionnaire (n = 51/57; 90% response rate). Significant improvements in the perceived importance of communication training, knowledge, ability and confidence to effectively communicate with Aboriginal and Torres Strait Islander patients were identified (p < 0.001). The greatest increase was in the perceived confidence pre-training mean of 2.96 (SE = 0.11) to the post-training mean of 4.02 (SE = 0.09).

This patient-centred communication training, delivered through a novel model that combines cultural capability and the clinical yarning framework applied to the pain management setting, was highly acceptable and significantly improved participants' perceived competence. This method is transferrable to other health system sectors seeking to train their clinical workforce with culturally sensitive communication skills.

Pain assessment is a complex task largely dependent on the patient's self-report. Artificial intelligence (AI) has emerged as a promising tool for automating and objectifying pain assessment through the identification of pain-related facial expressions. However, the capabilities and potential of AI in clinical settings are still largely unknown to many medical professionals. In this literature review, we present a conceptual understanding of the application of AI to detect pain through facial expressions. We provide an overview of the current state of the art as well as the technical foundations of AI/ML techniques used in pain detection. We highlight the ethical challenges and the limitations associated with the use of AI in pain detection, such as the scarcity of databases, confounding factors, and medical conditions that affect the shape and mobility of the face. The review also highlights the potential impact of AI on pain assessment in clinical practice and lays the groundwork for further study in this area.

Pain is a complex and personal experience that presents diverse measurement challenges. Different sensing technologies can be used as a surrogate measure of pain to overcome these challenges. The objective of this review is to summarise and synthesise the published literature to: (a) identify relevant non-invasive physiological sensing technologies that can be used for the assessment of human pain, (b) describe the analytical tools used in artificial intelligence (AI) to decode pain data collected from sensing technologies, and (c) describe the main implications in the application of these technologies. A literature search was conducted in July 2022 to query PubMed, Web of Sciences, and Scopus. Papers published between January 2013 and July 2022 are considered. Forty-eight studies are included in this literature review. Two main sensing technologies (neurological and physiological) are identified in the literature. The sensing technologies and their modality (unimodal or multimodal) are presented. The literature provided numerous examples of how different analytical tools in AI have been applied to decode pain. This review identifies different non-invasive sensing technologies, their analytical tools, and the implications for their use. There are significant opportunities to leverage multimodal sensing and deep learning to improve accuracy of pain monitoring systems. This review also identifies the need for analyses and datasets that explore the inclusion of neural and physiological information together. Finally, challenges and opportunities for designing better systems for pain assessment are also presented.

Seeing others in pain can stimulate powerful socio-emotional responses. Does it also make us more moral? In two laboratory experiments, we examined the interplay between pain observation, self-reported guilt and shame, subjective perceptions of pain intensity, and subsequent honest behavior. Watching a confederate perform a moderately painful (vs. non-painful) task did not affect honest behavior in a subsequent die-roll task. Independent of pain observation, there was a positive relationship between self-reported guilt proneness and shame proneness and honesty. More specifically, individuals who are more prone to feeling guilt -and to a lesser extent shame- behaved more honestly. Furthermore, we found weak support for the hypothesis that greater perceived pain (rather than objective pain) is associated with less cheating. We call for further research in the interconnections between perceived pain, guilt, shame, and moral behavior.

Prior work suggests that people experiencing homelessness (PEH) are at heightened risk for developing pain and have a uniquely burdensome pain experience.

The aim of this scoping review was to map the current peer-reviewed, published literature on the pain experience of PEH.

In accordance with the US Annual Homeless Assessment Report, we defined homelessness as lacking shelter or a fixed address within the last year. We conceptualized the pain experience via a modified version of the Social Communication Model of Pain, which considers patient, provider, and contextual factors. Published articles were identified with CINHAL, Embase, PubMed, PsycINFO, and Web of Science databases.

Sixty-nine studies met inclusion criteria. Studies revealed that PEH have high rates of pain and experience high levels of pain intensity and interference. Substantially fewer studies examined other factors relevant to the pain experience, such as self-management, treatment-seeking behaviors, and pain management within healthcare settings. Nonetheless, initial evidence suggests that pain is undermanaged in PEH.

Future research directions to understand pain and homelessness are discussed, including factors contributing to the under-management of pain. This scoping review may inform future work to develop interventions to address the specific pain care needs of PEH.

Medical needle procedures are a common source of pain, distress, and fear for children, which can worsen over time and lead to needle noncompliance and avoidance, if unaddressed. Children's pain experience is multiply determined by external (e.g., parent behaviors) and internal (e.g., cognitive and affective) factors. Some parent behaviors (e.g., reassurance, giving control to child, empathy, apologies, criticism) have related to poor child pain experiences. No research has examined how children's internal emotion regulation, commonly measured via heart rate variability (HRV), may buffer, or strengthen this association. This study is the first to examine child HRV in relation to pain experiences, and as a moderator between a constellation of parent behaviors (reassurance, giving control, empathy) and child pain, fear, and distress.

Sixty-one children aged 7-12 years undergoing venipuncture and a parent participated. Child HRV was measured before the procedure. After venipuncture, children rated their pain and fear. Parent and child behaviors during venipuncture were coded using the "distress promoting" and "distress" composites of the Child-Adult Medical Procedure Interaction Scale-Revised.

Children with lower HRV displayed greater distress. Child HRV moderated the positive association between parent behaviors (reassurance, giving control, empathy) and child distress such that the association was strongest among children with low HRV.

Findings suggest children with lower HRV, indicative of lower emotion regulation capacity, may be at risk of experiencing higher levels of distress and may be more vulnerable to distress when facing parent reassurance, giving control, and empathy verbalizations during venipuncture.

An assessment of a teacher's concept of their student's pain could be useful to guide preventative and targeted school-based pain science education. We aimed to assess a teacher's own concept of pain against their concept of their student's pain and examine the psychometric properties of the tool. Teachers of 10-12-year-old children were invited to participate in an online survey via social media. We modified the Concept of Pain Inventory (COPI) by inserting a vignette (COPI-Proxy), and we included questions to explore teacher stigma. Overall, a sample of 233 teachers participated in the survey. The COPI-Proxy scores showed that teachers can conceptualize their student's pain separately but are influenced by their own beliefs. Only 76% affirmed the pain in the vignette as real. Teachers used potentially stigmatizing language to describe pain in their survey responses. The COPI-Proxy had acceptable internal consistency (Cronbach's alpha = 0.72) and moderate convergent validity with the COPI (r = 0.56). The results show the potential benefit of the COPI-Proxy for assessing someone's concept of another's pain, particularly for teachers who are important social influencers of children.

This study investigated clinician experience of patient use of metaphors in chronic pain communication.

Interviews were conducted with eighteen Australian clinicians working with chronic pain patients, age range 26-64 years (M=46.6), 50% female, experience working in chronic pain ranging from 2 to 27 years (M=11.16).

Thematic Analysis yielded four key themes: Metaphor as communicative tool, Metaphor as clue, Metaphor as obstacle, and Metaphor use in treatment. Clinicians identified metaphor as an important tool for patients to communicate their pain experience, whilst acknowledging that it could at times be unhelpful to patients. Metaphor was seen to contain useful information for clinicians and possess utility in assessment and treatment.

Metaphors play a significant role in chronic pain consultations, enabling clinician insight into pain type, psychopathology, and patient pain understanding. Metaphor in treatment phases may be underutilised. Clinicians should encourage patient metaphor use in chronic pain communication.

Despite growing evidence that psychopathy entails reduced emotional processing, the relationship between psychopathic traits and third-person pain perception is poorly understood. This study directly examined perception of others' pain in a sample of male and female students (N = 105) who completed the Self-Report Psychopathy scale (SRP-III) and the Toronto Empathy Questionnaire (TEQ). Participants watched a video of 60 one-second clips of other people experiencing pain. Following each clip, participants rated the perceived level of pain intensity and pain unpleasantness. Psychopathic traits were unrelated to response bias, suggesting that individuals high in psychopathic traits were no more or less likely to impute pain to others. However, higher levels of psychopathic traits, particularly callous affect and antisocial behavior, were associated with a decreased ability to discriminate others' pain. Sensitivity and response bias were unrelated to TEQ scores. These findings provide novel insights into the influence of psychopathic traits on emotional processing.

Alterations of empathy for others' pain among patients with chronic pain remained inconsistent. Here, applying a capsaicin-based ongoing pain model on healthy participants, this study investigated how ongoing first-hand pain influences empathic reactions to vicarious pain stimuli. Healthy participants were randomly treated with topical capsaicin cream (capsaicin group) or hand cream (control group) on the left forearm. Video clips showing limbs in painful and non-painful situations were used to induce empathic responses. The capsaicin group showed greater empathic neural responses in the right primary somatosensory cortex (S1) than the control group but smaller responses in the left anterior insula (AI) accompanied with smaller empathic pain-intensity ratings. Notably, the intensity of ongoing pain negatively correlated with empathy-related neural responses in the left AI. Inter-subject phase synchronization analysis was used to assess stimulus-dependent dynamic functional connectivity within or between brain regions engaged in pain empathy. The capsaicin group showed greater empathy-related neural synchronization within S1 and between S1 and AI, but less synchronization within AI and between AI and MCC. Behaviorally, the differential inter-subject pain-intensity rating alignment between painful and non-painful videos was more positive for the capsaicin group than for the control group, and this effect was partially mediated by the inter-subject neural synchronization between S1 and AI. These results suggest that ongoing first-hand pain facilitates neural activation and synchronization within brain regions associated with empathy-related somatosensory resonance at the cost of inhibiting activation and synchronization within brain regions engaged in empathy-related affective sharing.

Pain of nursing homes residents with Alzheimer's disease remains under detected compared to their cognitively intact counterparts. Communication difficulties may partly explain this poor quality of care but the influence of stigmatization on pain assessment has never been explored.

The objective of this research was to analyze whether a diagnosis label of Alzheimer's disease or the stage of the disease may bias pain assessment scores and empathic reactions of health care staff in nursing homes.

Two studies were conducted based on a similar experimental between-subjects design with a video showing an older adult woman experiencing undefined pain. Different labels and vignettes were manipulated to characterize the subject of the video. In the first study, 84 certified nursing assistants were asked to watch the video and then to assess the pain intensity and their empathic reaction. Participants were randomized in two conditions that varied the disease label (Alzheimer's disease vs no diagnosis). In the second study, 67 certified nursing assistants were enrolled who did not participate in the first study. They watched the same video as in the first study and assessed the pain intensity and their empathic reaction. They were randomized in two conditions that varied the stage of the Alzheimer's disease (mild stage vs severe stage).

Alzheimer's disease label had no influence on assessment scores. In contrast, the stage of the disease had a significant effect on the health care staff assessments with severe stage associated with lower pain intensity scores and empathic reactions.

These results confirm that the Alzheimer's disease stigma is a real phenomenon that tends to be mainly elicited by the symptoms of the acute phase of the disease. These findings are crucial to better understand the stigma related to Alzheimer's disease and to enhance the pain management of this frail population.

Pain sensation in autism spectrum disorder (ASD) has been a growing research field in the last two decades. Existing pain research has focused on pain sensitivity, suggesting either hyposensitivity or hypersensitivity to pain in individuals with ASD. However, research about other aspects of pain experience is scarce. Moreover, most pain-related research in ASD focused on quantitative measures, such as neuroimaging or parental reports. Instead, this paper aimed to illuminate the various aspects of pain experience as perceived by adults with ASD. Its descriptive qualitative research design incorporated semi-structured interviews and deductive thematic analysis. This phenomenological approach captured the subjective pain experience through the lens of people with ASD. Four primary themes emerged from the data: (a) physical pain experience, including the sequence of pain sensitivity, pain awareness, pain-related emotional aspects, and pain communication; (b) direct and indirect coping strategies; (c) function and participation outcomes; and (d) suggestions for Healthcare Providers. The findings echo the crucial role of pain awareness and communication in the pain experience of people with ASD. These two factors have been reported as profoundly influencing coping strategies, function, and participation. The results emphasize the need to expand the exploration of pain in this population, calling for greater understanding, and listening to this population's unique pain profiles and experiences to promote better-suited evaluation, diagnosis, and intervention in pain conditions.

The aim of this study was to describe how contextual factors related to the clinical setting of a pediatric HSCT unit influenced children's communication of pain to their health-care providers and parents during hospitalization.

A qualitative case study design was conducted in two-phases in a tertiary level pediatric HSCT unit. The Social Communication Model of Pain provided the conceptual framework for the study. In phase one participants were parents and phase two participants were health-care providers and children in a pediatric HSCT unit. Parents participated in semi-structured interviews at 30- and 90-days post-transplantation regarding their child's communication of pain. Naturalistic observations of children receiving clinical care were conducted and health-care providers participated in semi-structured interviews.

Children extensively denied pain to their parents and health-care providers. When children did communicate pain, they were motivated by a need to seek interventions for their pain. Children's willingness to communicate pain was influenced by the physiological impact of HSCT therapy, their previous experiences of pain, their relationship with parents and health-care providers and parents and an environment of fear and uncertainty.

There is a pressing need for child-centric approaches to support children to communicate their pain experiences to overcome the limitations imposed by the complexity of their medical treatment and the clinical environment in which they receive healthcare.

In the context of HSCT therapy children may not communicate pain until pain is severe, and no longer bearable, or outright deny the presence of pain.

To define and validate types of pain in critically ill neonates and infants by researchers and clinicians working in the neonatal intensive care unit (NICU) and high dependency unit (HDU).

A qualitative descriptive mixed-methods design.

Each stage of the study was built on and confirmed the previous stages. Stage 1 was an expert panel to develop definitions; stage 2 was a different expert panel made up of neonatal clinicians to propose clinical characteristics associated with the definitions from stage 1; stage 3 was a focus group of neonatal clinicians to provide clinical case scenarios associated with each definition and clinical characteristics; and stage 4 was a survey administered to neonatal clinicians internationally to test the validity of the definitions using the clinical case scenarios.

In stage 1, the panel (n=10) developed consensus definitions for acute episodic pain and chronic pain in neonates and infants. In stage 2, a panel (n=8) established clinical characteristics that may be associated with each definition. In stage 3, a focus group (n=11) created clinical case scenarios of neonates and infants with acute episodic pain, chronic pain and no pain using the definitions and clinical characteristics. In stage 4, the survey (n=182) revealed that the definitions allowed an excellent level of discrimination between case scenarios that described neonates and infants with acute episodic pain and chronic pain (area under the receiver operating characteristic=0.87 and 0.89, respectively).

This four-stage study enabled the development of consensus-based and clinically valid definitions of acute episodic pain and chronic pain. There is a need to define and validate other pain types to inform a taxonomy of pain experienced by neonates and infants in the NICU and HDU.