IntroductionSurgery using polypropylene mesh devices was the gold-standard procedure for stress urinary incontinence (SUI). Use of vaginally placed mesh devices has been restricted due to rising rates of complications of which pain is the most prevalent. The aetiology of Isolated Mesh Associated Pain Syndrome (I-MAPS) remains elusive. There is growing evidence to support the involvement of a neuropathically-mediated process with the possibility of systemic effects.ObjectivesTo objectively identify small nerve fibre injury in patients with I-MAPS and correlate this against women with painless devices and a healthy control group.Study designForty-six women with continence mesh devices were enrolled of which 26 had I-MAPS and 22 were pain-free. These were compared against 22 healthy, mesh and pain-free controls. Participants underwent nerve fibre assessment using Corneal Confocal Microscopy (CCM), Including Corneal Nerve Fibre Density (CNFD), Corneal Nerve Branch Density (CNBD) and Corneal Nerve Fibre Length (CNFL). Neuropathic pain was assessed using the Pain DETECT questionnaire (PDQ). Functional and mental well-being was ascertained using the EuroQol 5-Dimension (EQ5D) and WHO-5 wellbeing questionnaires.ResultsWomen with I-MAPS had significant reductions in corneal nerve fibre health across all 3 morphological parameters compared to pain-free women with mesh and healthy pain and mesh-free controls. This included CNFD (15.85 ± 4.23 vs. 27.46 ± 6.84 fibres/mm2, p < 0.0001) (15.85 ± 4.23 vs. 29.43 ± 6.30 fibres/mm2, p < 0.0001), CNBD (14.77 ± 6.69 vs. 32.41 ± 14.53 branches/mm2, p = 0.0002) (14.77 ± 6.69 vs. 39.68 ± 18.92 branches/mm2, p < 0.0001) and CNFL (9.88 ± 2.49 vs. 15.67 ± 3.41 mm/mm2, p < 0.0001) (9.88 ± 2.49 vs. 17.21 ± 3.46 mm/mm2, p < 0.0001).ConclusionsSmall nerve fibre injury potentially contributes to the symptomatology of I-MAPS and may highlight a systemic effect of polypropylene mesh implants. These findings warrant further investigation in larger study groups.
Annually, millions of humans and animals suffer from chronic and acute pain, creating welfare and quality of life concerns for both humans and animals. There is a need to develop new and effective analgesic options as alternatives to opioids and non-steroidal anti-inflammatories (NSAIDs) for humans and animals. A major challenge in developing novel therapeutic approaches is accurately measuring the impact of pain in animal models in a way that is clinically relevant and predictive of clinical efficacy. The Pain in Animals Workshop (PAW) meetings are held every other year in partnership with the National Institutes of Health (NIH), bringing key stakeholders together to improve our understanding of the impact of pain in humans and animals and determine how best to measure this impact. The 2025 workshop explored the following topics: - Current perspectives on non-rodent models, - Artificial intelligence applied to the measurement of pain, - Evolutionary clues to pain mechanisms and novel measures, - Breed and sex differences in pain sensitivity (perceptions and reality). The workshop brought together academic, government, and industry experts. Under the topic of ‘Current perspectives on non-rodent models’, current views regarding such models were discussed, whilst also showcasing and discussing recent NIH funded/ongoing programs involving these models. With the current interest in non-rodent models and spontaneous disease models, the discussion on successes and challenges was timely. Given the topic's importance and the meeting's uniqueness, this narrative summarizes the presentations and discussions on the topic of current perspectives on spontaneous and other non-rodent disease models.
BackgroundDiffusion tensor image analysis along the perivascular space (DTI-ALPS) provides a local diffusion index in periventricular white matter. We examined adjusted bilateral patient-control differences and whether reported migraine duration related differently to left and right ALPS.MethodsThe study included 25 healthy controls and 64 participants with migraine. Generalized estimating equations (GEE) accounted for paired left and right measurements. The patient model included disease duration, age, baseline monthly migraine days (MMD), sex and body mass index, with each allowed a side-specific association. Sensitivity analyses evaluated tensor reorientation and alternative periventricular regions of interest (ROIs).ResultsThere was no evidence of an average bilateral patient-control difference. The duration-by-side interaction was positive (β=0.0053 per year, 95% confidence interval 0.0022 to 0.0084; P < 0.001). The left-sided duration slope was negative; the right-sided slope was near zero and was not statistically significant. The interaction remained positive with an external literature-derived local ROI definition but was not reproduced by broader atlas sampling.ConclusionsLonger reported migraine duration was associated with a less leftward ALPS profile in sampled periventricular white matter, with no evidence of an average bilateral patient-control shift. The spatial sensitivity results support a local interpretation of this cross-sectional association.
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) presents with variable pelvic pain, urinary and sexual symptoms, and functional impairment. Psychological factors are established components of assessment, and UPOINT has brought psychosocial involvement into phenotype-directed care. The unresolved question is whether modelling shared psychopathology improves on the combined use of established assessments. The general factor of psychopathology (p) is a candidate representation of shared covariance across broad psychiatric domains; its clinical utility in CP/CPPS is unestablished. A single latent score does not inherently distinguish severe symptoms within one domain from moderate symptoms across several domains. We separate measurement indicators, p, specific psychological processes, contextual information and future outcomes. A four-stage roadmap addresses measurement development, longitudinal interpretation, incremental prediction and clinical translation. Comparisons must distinguish the contribution of additional assessment content from that of a p representation using identical information. Direct assessment of actionable problems and individualized clinical formulation remain essential. Predictive improvement would not itself establish that using p improves care, and a single output score does not reduce assessment burden. If p adds little reproducible and clinically meaningful value, simpler established measures should remain preferred.
ObjectivesPsychosocial risk and resilience factors are powerful determinants of chronic pain trajectories and lived experiences. Yet, a key source of support or stress for most people—close family relationships—remains a relatively untapped area of pain intervention, particularly for midlife and aging adults. In this article, we discuss methodological approaches to advance research identifying family-specific impacts on chronic pain in later life.MethodsWe present two persistent measurement challenges in studying family-specific contributors to pain: (1) linear and traditional notions of family conceptualization marked by limited considerations of community and intergenerational context, particularly in regards to aging families; and (2) a broad operationalization of ’social support,' which is defined ambiguously and inconsistently across the literature and which often prioritizes marital or intimate partner relationships as having overriding importance for determining health (including pain) for adults. These consistent gaps prevent the formulation of testable family-pain hypotheses and limit our ability to build a solid body of evidence explicating how rich and dynamic family environments may protect against, or worsen, pain outcomes in older adulthood.ResultsWe propose measurement solutions, including a theoretically-driven approach to conceptualizing family emotional. We outline potential analytic strategies for testing family-pain pathways and consider potential statistical challenges.DiscussionInnovative research to identify family contributors to chronic pain may be limited by methodological challenges often inherent to family research. The proposed measurement solutions have the potential to contribute to advancing pain research and the optimization of family-based pain management interventions particularly for aging adults.
