Abstract Introduction Fibromyalgia is a chronic widespread pain disorder with incompletely understood pathogenesis. Viral infections have been proposed as potential triggers, but studies examining cytomegalovirus (CMV), a herpesvirus establishing lifelong latency, and fibromyalgia are scarce. We investigated the association between CMV infection and subsequent fibromyalgia. Methods This retrospective matched case-control study used a database of over 370,000 individuals from 01/2003 to 12/2025. Cases were defined by at least two fibromyalgia diagnoses separated by ≥ 6 months. Up to five controls per case were matched on year of birth, sex, lookback period, and neighborhood socioeconomic status. Exposure was defined as a positive CMV IgM or IgG test, with a two-year washout period. Conditional logistic regression estimated odds ratios adjusted for psychiatric disorders, sleep disorders, obesity, and smoking. Results After exclusions, 1,811 cases were matched to 8,988 controls. Prior CMV exposure was documented in 50.7% of cases versus 45.6% of controls (P < 0.001). CMV infection was significantly associated with fibromyalgia (adjusted odds ratio 1.321; 95% CI 1.173-1.488; P < 0.001). The association persisted across stricter case definitions and alternative washout periods. Conclusions CMV infection is significantly associated with increased odds of fibromyalgia. Prospective studies are warranted to establish causality and underlying mechanisms.
Abstract Background Pain in advanced cancer is a complex and multidimensional phenomenon extending beyond intensity to include biological, psychological, and social components. In women with advanced gynecologic malignancies, pain is highly prevalent yet often undercharacterized, particularly in resource-limited settings where disparities in access and delayed integration of palliative care may influence its presentation and management. Objective To characterize multidimensional pain features and identify distinct descriptive pain patterns in women with advanced gynecologic cancer receiving palliative care. Design Observational study. Setting/Subjects Electronic medical records of women aged ≥18 years with advanced gynecologic cancer and documented pain, treated at a tertiary cancer center in Mexico between 2013 and 2023, were reviewed. Measurements Sociodemographic and clinical variables were collected. Pain assessment included location, intensity, time of onset, and characteristics (somatic, visceral, neuropathic, or mixed). Psychosocial factors, including anxiety and depression, were also evaluated. Descriptive statistics were used to explore multidimensional pain patterns. Results A total of 1,015 women were included (median age 56 years; most had≤12 years of education). Cervical and ovarian cancers predominated (43.4% and 32.3%). Pain was mainly pelvic or abdominal (81.0%) and commonly mixed visceral/neuropathic. Median intensity was moderate (4/10), with higher intensity in uterine sarcoma (median 7/10). Nearly half of patients presented anxiety or depression. Conclusions Pain in advanced gynecologic cancer is heterogeneous and multidimensional, with identifiable tumor-type-specific pain patterns that may inform individualized, patient-centered management strategies, particularly in resource-limited settings
Abstract Objective This systematic scoping review examined the scope and characteristics of mobile health (mHealth) interventions for adults with chronic non-cancer pain in studies that included opioid use as an outcome. Design This study was conducted in accordance with the Joanna Briggs Institute Reviewer’s Manual and Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). This review included studies evaluating mHealth interventions for adults with chronic non-cancer pain which included opioid use as a measured outcome. Data extraction Information on study characteristics were extracted, including co-design processes, technology used, degree of human contact, theoretical basis, tailoring and engagement strategies, and key findings. Results From 4,344 records, 33 records (29 unique studies) comprising 21 published articles and 12 protocols met criteria. Interventions utilised mobile apps (n = 14), text messaging (n = 5), and telephone-based interactive voice response (n = 3). Opioid use was an eligibility criterion in 14 studies, of which seven were specifically designed to support opioid tapering. Published results indicated high acceptability and feasibility, with findings also suggesting potential efficacy. Conclusions Although most studies targeted pain management with opioid use as a secondary outcome, interventions specifically designed to support patients with tapering are emerging. There is early evidence suggesting they are acceptable, feasible, and potentially effective. Future research should evaluate efficacy, as well as examine mediating and moderating factors to better understand how and for whom mHealth interventions are effective.
Background Complementary and integrative health (CIH) therapies offer safe and effective alternatives for pain management, and use of these therapies by Veterans Health Administration (VHA) patients with pain warrants examination.Objective This study examines the patterns of CIH therapy utilization among VHA patients in a Long-Term Opioid Therapy (LTOT) cohort, identifying distinct subgroups of patients based on their CIH therapy use patterns and exploring how demographic and clinical characteristics are associated with membership in each subgroup.Methods From a national retrospective cohort of VHA patients with a documented history of LTOT between 2017 and 2021, we analyzed electronic health record data of 17 079 VHA patients who used any CIH therapy during a 12-month period (October 2021-September 2022). We assessed patterns of any use of 9 CIH therapies through latent class regression analysis and assessed covariates of latent class membership.Results A 4-class solution was identified. The largest class was Chiropractic Care (32.3%), followed by Acupuncture (29.7%), Mind-Body therapies (28.0%), and Manual Therapy (10.0%). The chiropractic care class comprised those who utilized chiropractic care with some acupuncture co-use; Acupuncture class comprised patients using almost exclusively acupuncture; Mind-Body therapies class was defined by predominant use of meditation, yoga, and tai chi; and Manual Therapy class comprised patients who used massage, acupuncture, and chiropractic care. Significant demographic and clinical differences were observed between classes.Conclusion These findings highlight distinct CIH therapy utilization patterns among VHA patients on LTOT associated with patients' demographic and clinical features. Quantifying patterns of CIH therapy use provides an effective framework for comparing pain and opioid-related outcomes across different groups. These findings suggest the need for investigating pathways to CIH that result in differences in use patterns.
Abstract Importance Despite not being recommended in treatment algorithms, people often take acetaminophen for pain relief in neuropathic pain (NP). Objective As there is no randomized clinical trial on oral acetaminophen in NP, this study aims to evaluate the efficacy of oral therapeutic-dose acetaminophen compared to placebo in patients with peripheral NP. Design This is a randomized, placebo-controlled, crossover, double-blind clinical study. The protocol and informed consent form were approved by the French Research Ethics Committee and National Drug Agency (trial number: NCT03559985). Setting It took place in University Hospital, Clermont-Ferrand, France. Participants Thirty patients with chronic post-surgery NP were randomized. Intervention Acetaminophen or placebo was taken for 7 days with a wash-out period of 7 days and treatments were compared. Main Outcomes Outcomes were 7-day mean pain intensity (numerical rating scale) after treatment, Neuropathic Pain Symptom Inventory, Patient Global Impression of Change, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and adverse events. Results Acetaminophen presents no statistical difference with the placebo for pain report (effect-size [95% CI]: −0.09 [−0.45; 0.26], P = .607) and for all secondary outcomes. Conclusions This study demonstrates no clinically meaningful analgesic benefit of short-term, 3 g/day oral acetaminophen as add-on therapy in chronic post-surgical peripheral NP, and no adverse events. Relevance Although findings should not be generalized, patients with NP using self-medicated acetaminophen should always be informed about the risks of long-term use of acetaminophen to avoid unnecessary intake and potential long-term adverse events.
