Background Musculoskeletal pain is a growing public health concern among school-aged children, with significant physical and psychosocial implications. Schoolbag weight and carrying style have been identified as critical ergonomic risk factors. However, evidence from developing countries, including Libya, remains limited, particularly regarding longitudinal impacts. Objective This study aimed to evaluate the association between schoolbag weight, carrying style, and musculoskeletal pain over a five-year period among elementary schoolchildren in Misrata, Libya. Methods A cohort of 443 elementary schoolchildren (grades 1–4) was followed for five years, with 421 completing all assessments. Data were collected on schoolbag weight, carrying style, walking duration, and pain characteristics. Descriptive statistics, Chi-square tests, and logistic regression were applied to explore the prevalence and predictors of pain. Repeated Measures ANOVA and Friedman tests were used to assess changes in continuous and categorical outcomes across time points. Results Musculoskeletal pain prevalence increased from 0.0% at baseline to 10.1% at the first follow-up before declining to 5.6% and 6.2% in subsequent follow-ups. Carrying style emerged as the most significant predictor of pain, with the mid-back (T12) style reducing the risk of pain by up to 98.8% compared to the low-back (L3) style. Schoolbag weight, while exceeding recommended thresholds, was not a significant predictor of pain. Gender differences were noted, with girls at higher risk during early follow-ups. Walking duration played a marginal role, influencing pain risk only in the first follow-up. Conclusion This study highlights the critical role of ergonomic carrying styles, particularly the mid-back (T12) position, in reducing musculoskeletal pain among schoolchildren. Findings challenge the conventional emphasis on bag weight alone and highlight the need for multifaceted interventions, including ergonomic education and policy changes, to promote musculoskeletal health.
Objective Experiences of trauma are common among people with chronic pain, although estimates of comorbid post-traumatic stress vary widely across contexts. Acceptance and commitment therapy (ACT), which targets psychological flexibility to improve pain-related functioning, is increasingly delivered for people with pain. To inform treatment delivery, understanding of the prevalence and correlates of post-traumatic stress among those attending ACT-based treatment for pain is needed. This study aimed to identify the prevalence of post-traumatic stress and its associations with key pain-related outcomes and other relevant psychosocial factors at the start of an ACT-based treatment. Methods This was a cross-sectional study using data collected within routine clinical care at a speciality pain management service in the UK. Four hundred and fifty-one participants completed standardized self-report questionnaires of post-traumatic stress symptoms (PTSS), pain-related outcomes (pain intensity and interference, work and social adjustment, and depression symptoms), psychological flexibility/inflexibility, and stigma at the start of an interdisciplinary ACT-based treatment for chronic pain. Results Forty-seven percent of patients ( n = 213) reported a traumatic exposure and 30% of the sample reported clinically meaningful PTSS. Greater severity of PTSS and probable post-traumatic stress disorder (PTSD) were associated with significantly worse pain-related outcomes, psychological flexibility/inflexibility, and stigma in bivariate analyses. PTSS severity and probable PTSD showed significant unique associations with poorer pain outcomes in regression models controlling for covariates and psychological flexibility/inflexibility. Conclusions Post-traumatic stress is common among people engaging in ACT-based treatment for pain and associated with adverse pain outcomes. Trauma-informed practice is therefore important when providing ACT-based treatment for pain.
Background and objective Pain affects between 80 and 95% of patients with acute pancreatitis (AP). However, despite its importance and severity, the pathophysiological mechanisms are not well understood. This narrative review aims to review current knowledge about the pathophysiological mechanisms of pain in AP. Methods, databases and data treatment A search of electronic databases (PubMed/MEDLINE, Embase, and Cochrane) was conducted from January 31 2024 to July 25 2025. Inclusion criteria included any study on acute pancreatitis and pain (management). Exclusion criteria included the absence of relevant content or specific information about pain in AP. Results We identified 11 studies. Two potential pain pathways were identified, categorised as nociceptive and neuropathic. Nociceptive signals are enhanced through the release of inflammatory mediators, such as nuclear factor-kappa B, nitric oxide and interleukin-6, in response to tissue damage. Furthermore, the characteristic visceral and referred pain is likely attributed to high levels of overlap of primary sensory afferent fibre activation and neuronal convergence. Damage of the central and peripheral nervous system through the upregulation of voltage-gated ion channels, vanilloid receptors and transmembrane proteins may cause neuropathic-like pain. This triggers neurogenic inflammation and further release of neuropeptides, inducing an auto-amplification loop between neurogenic inflammation and neuropathic pain, with one positively reinforcing the other. Conclusions Diagnostic approaches in AP should consider nociceptive and neuropathic mechanisms, which should guide specific pain management. However, the knowledge gap remains significant, for example, for specific biomarkers and mechanisms enabling the development of target-specific personalised treatments for pain in AP in the future. Significance statement In 2023, the James Lind Alliance priority-setting partnership in pancreatitis indicated that the number one priority for AP is establishing more effective ways to manage pain. 1 Therefore, a complete comprehensive understanding of the pathophysiology of pain in AP should be obtained, to advise specific pain management guidelines in AP. This review is the first of its kind, attempting to synthesise the collective knowledge on pathophysiology of pain in AP.
Background With knee osteoarthritis (OA), measures of mechanical and thermal pain sensitivity relate to both pain severity and treatment outcomes, and lower limb left/right judgement is impaired. However, little is known about these somatosensory variables in people with hip OA. Objectives Our cross-sectional study aimed to explore the differences in sensitivity to noxious mechanical and thermal stimuli, and lower limb left/right judgement, in people with hip OA compared to matched controls without hip OA. Methods Demographic variables and self-reported hip-related disability were collected using an online survey, while physical function was assessed in person using standardised procedures. Quantitative sensory testing was conducted using mechanical (pressure) and thermal pain thresholds. Left/right judgement was assessed through a lower limb left/right judgement task on an online application. Generalised linear regressions were used to analyse differences between groups and explore associations between the demographic variables and the somatosensory measures. Results 15 participants with hip osteoarthritis and 15 controls were included. Mean (SD) age was 62.1 (11.2) years, median (IQR) BMI 26.2 (4.4) kg/m 2 , and 21/30 (70%) were female. Pressure pain thresholds were lower in people with hip OA at both the hip (p = .049) and the ipsilateral elbow (p = .046). There were no differences detected between groups for thermal pain thresholds (p > .05). Left/right judgement accuracy was lower in controls compared to people with hip OA (p = .038). Associations between the somatosensory measures and demographic variables (sex, age, and BMI) varied across outcomes. Conclusions Increased mechanical, but not thermal, pain sensitivity was found in people with hip OA compared to controls. Demographic variables are associated with somatosensory measures and require consideration in any analyses using these measures.
