Background Chronic pain affects up to 30% of pregnant individuals globally and substantially impairs maternal well-being. The prevalence and contributing factors of de novo chronic pain in pregnancy (DNPAP) remain poorly studied, with previous chronic pain rarely distinguished from newly arising pain. We examined the prevalence and characteristics of DNPAP and its association with foetal and maternal factors, including dysmenorrhea, depressive symptoms and maternal-foetal attachment.Methods This cross-sectional study included 207 pregnant women between 30 and 34 weeks of gestation. Assessments comprised pain measures (Douleur Neuropathique-4, McGill Pain Questionnaire, Brief Pain Inventory and Pain Catastrophizing Scale) and maternal well-being measures (Edinburgh Postnatal Depression Scale, Maternal-Foetal Attachment Scale and Prenatal Psychosocial Profile). Women with DNPAP were compared with those without chronic pain to identify associated factors.Results De novo pain was reported by 20.7% of participants, with 59.6% describing it as moderate to severe. DNPAP was significantly associated with higher depressive symptoms, lower maternal-foetal attachment and a history of dysmenorrhea. Mediation analyses identified depressive symptoms as a key factor linking foetal malformations and gestational diseases to de novo pain.Conclusion Depression, reduced maternal-foetal attachment and a history of dysmenorrhea were significantly associated with de novo pain during pregnancy. Depressive symptom severity mediated the relationship between foetal malformations or gestational diseases and DNPAP. Clear characterization of pregnancy-related pain can inform preventive and therapeutic strategies to improve maternal health outcomes.Significance Statement This study is the first to report the prevalence of de novo chronic pain during pregnancy, which was found to be high affecting 20.7% of the pregnant women. De novo chronic pain in pregnancy is directly associated with depressive symptoms and is mediated by depressive symptoms in cases involving foetal malformation diagnosis and the presence of gestational diseases. A history of dysmenorrhea is significantly associated with the development of de novo chronic pain in pregnancy, suggesting potential shared underlying mechanisms that open possibilities for testing new early-detection, therapeutic, and prognostication approaches to pain across women's life-cycle.
ABSTRACT Background Chronic pain and cognitive impairment are highly prevalent among older adults and represent major contributors to disability. Although chronic pain is associated with cognitive decline, the neural mechanisms underlying this relationship in older adults remain unclear. Understanding these mechanisms is crucial for prevention and intervention, as brain connectivity offers modifiable intervention targets. This study tested whether resting‐state functional connectivity (rsFC) within the default mode (DMN), frontoparietal (FPN), and salience (SN) networks relates to cognitive performance in older adults with chronic pain. We expected greater DMN and lower FPN connectivity and examined SN connectivity without a directional prediction. Methods Fifty‐six older adults with chronic musculoskeletal pain (70.1 ± 5.81 years; 21 males), 57 pain‐free older adults (70.02 ± 5.05 years; 21 males), and 60 younger adults (20.27 ± 2.1 years; 26 males) underwent neuropsychological assessments. A subset—30 older adults with chronic pain, 29 pain‐free older adults, and 29 younger adults—underwent fMRI scanning. Results Older adults with chronic pain performed worse than pain‐free peers across verbal fluency, attention, memory, and executive function; after FDR correction, phonemic fluency and the WCST pattern remained significant. They also showed reduced FPN and increased DMN connectivity relative to younger adults (FDR; p < 0.05). Exploratory analyses linked greater DMN connectivity to poorer WCST performance within the chronic pain group (uncorrected p s < 0.05). Conclusions These findings highlight the value of integrating cognitive and brain connectivity measures to characterize cognition in the context of chronic pain and aging, while motivating longitudinal research into relationships among pain, cognition, and network organization. Significance Statement Older adults with chronic pain showed poorer executive performance than pain‐free older adults. Among older adults with chronic pain, lower frontoparietal and greater default mode connectivity emerged only relative to younger adults; the older groups did not differ significantly. Exploratory analyses linked default mode connectivity with poorer executive performance within the chronic pain group. Together, these cognitive and connectivity findings motivate longitudinal studies examining how chronic pain, executive function, and brain network organization interact during aging.
ABSTRACT Background Pain is common, and may co‐occur with suicide attempts, self‐harm and suicidal ideation. However, data on the prevalence of these outcomes across pain intensity levels is limited. Methods Cross‐sectional analysis of the 2020–2022 National Survey of Mental Health and Wellbeing. Australian residents aged 16 to 85 years were recruited over two waves: December 2020 to July 2021 ( n = 5554) and December 2021 to October 2022 ( n = 10,339). We estimated the prevalence of self‐reported self‐harm or suicidal ideation in the past year by levels of recent pain intensity (none, mild, moderate, severe) in the past four weeks. Subgroup analyses were stratified by sex assigned at birth, age, presence of mental health conditions, linguistic diversity and geographic location. Results Of the 15,880 (weighted) respondents with available data, 35% reported no pain, 41% mild pain, and 23% moderate or severe pain in the past four weeks. Past year self‐harm and suicidal ideation were reported by 2% and 3%, respectively. The prevalence of self‐harm increased with pain intensity: 0.9% (no pain), 1.9% (mild), 2.7% (moderate) and 3.5% (severe). The prevalence of suicidal ideation also increased with pain intensity: 1.6% (none), 3.0% (mild), 4.7% (moderate), 8.7% (severe). These patterns were largely consistent by sex and age group. Conclusions Greater recent pain intensity is associated with higher prevalence of self‐reported self‐harm and suicidal ideation. Monitoring mental health among people experiencing pain is important, and integrating routine suicide risk assessment into pain management and physical health care settings could support targeted suicide prevention efforts and inform policy and clinical practice. Significance Statement In this nationally representative Australian general population sample, we found a graded association between recent bodily pain and suicidal ideation and self‐harm. The consistency of this graded association across major demographic subgroups strengthens the case for pain intensity as a practical, low‐burden screening cue in primary care, pain management and physiotherapy settings. Enhanced training for general practitioners and physiotherapists should be a cornerstone of suicide prevention strategies.
ABSTRACT Background Neuropathic pain (NP) is a common and debilitating consequence of a spinal cord injury (SCI) with considerable effects on function, quality of life, and social participation. Current treatment approaches have limited effectiveness. Clinical guidelines recommend pain science education (PSE) as a first‐line intervention for persistent pain; however, the uniqueness of SCI‐related NP warrants its adaptation. Methods A four‐round modified e‐Delphi was conducted to identify and refine PSE concepts for those with SCI‐related NP. An international multidisciplinary panel of expert clinicians and researchers specialising in SCI pain and/or PSE ( n = 33) was established. The experts initially reviewed and adapted 58 concepts from general PSE (Round 1), followed by rating and iterative refinement across survey rounds (Rounds 2–4). Acceptance criteria for a concept were: rated as important (≥ 75% of responses ≥ 4 on a 1–6 Likert scale), reached consensus (interquartile range ≤ 2), and demonstrated stability (no significant change on Wilcoxon test). Results Across four rounds, experts identified 81 PSE concepts grouped under nine themes, 75 of which were accepted. All 58 established general PSE concepts required modification to align with the SCI‐related NP context, and 23 new concepts were added. Conclusions This Delphi study establishes key PSE concepts tailored to a SCI‐related NP population. The findings highlight the need to adapt general PSE for this population, including a paradigm shift from a focus on an “overprotective” to an “overactive” pain system, and the explicit inclusion of information on understanding NP, immune modulation, and medication. Significance Statement This Delphi study is the first expert‐derived framework of pain science education concepts tailored specifically for individuals with spinal cord injury‐related neuropathic pain. The findings highlight important differences from general chronic musculoskeletal PSE to those with neuropathic pain. These concepts provide a foundation for developing tailored pain science education interventions to improve self‐management and pain outcomes for people living with spinal cord injury‐related neuropathic pain.
