Culturally and linguistically diverse (CALD) populations experience disproportionate burdens of chronic disease compared to the general population; previous research demonstrated group-based interventions improve health outcomes across various chronic conditions. This umbrella review aims to summarise the available evidence concerning group-based interventions for CALD populations with chronic conditions. We conducted this umbrella review in accordance with the Cochrane Handbook for Systematic Reviews of Interventions, reported per PRISMA, and quality-assessed using AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews, version 2). We searched 11 databases (MEDLINE, Embase, Emcare, CINAHL, PsycINFO, SCOPUS, Web of Science, Cochrane, Epistemonikos, LILACS, and SciELO citation index of Web of Science) from inception to June 3, 2025, without language restrictions. All screening, data extraction, and quality assessment were carried out in duplicate. We descriptively synthesised the findings and determined the effectiveness and effect sizes of interventions as concluded by the review authors. We identified 22 systematic reviews, 271 primary studies, and over 32,320 people. Reviews originated from high-income countries; published in the last 10 years (82

Early recognition and treatment of paediatric sepsis has been shown to improve survival. Automated sepsis alerts embedded in electronic medical records (EMRs) offer real-time identification of high-risk patients and may improve timeliness of sepsis care, with possible limitations including overdiagnosis, overtreatment and alert fatigue. It is currently unclear whether automated alerts improve clinical outcomes in paediatric sepsis. We conducted a systematic review and narrative synthesis of studies evaluating clinical outcomes (mortality, PICU admission rate, length of stay), process measures (time to fluids/antibiotics, bundle adherence), and balancing measures (hospitalisation rate, antibiotic use) after implementation of EMR-based automated sepsis alerts in patients under 18 years of age. Twelve studies met inclusion criteria. Automated alerts were associated with improvements in process measures, notably reduced time to antibiotics (4/6 studies) and fluids (2/5 studies). Mortality was reduced in one study of PICU patients (29.9% vs. 17.4%, p = 0.011), and a trend towards reduced PICU admissions was observed. No significant impact on hospital or PICU length of stay was noted. Alerts did not increase hospital admission rates or antibiotic usage. Automated sepsis alerts may improve time to fluids and antibiotics in paediatric sepsis. While inconsistently reported, alerts were not found to increase hospital admission rates or antibiotic use. The impact on clinical outcomes, particularly mortality, remains uncertain. High quality randomised studies are needed to define their role in improving paediatric sepsis outcomes.

BACKGROUND:Chronic pelvic pain (CPP) affects an estimated 14.8% of UK women. Survivors of sexual violence are more likely to experience CPP, but the relationship is complex and underexplored. Shame and stigma from both experiences may interact and influence help-seeking. AIMS:To broaden understanding of how women survivors of sexual violence make personal meaning of CPP, and to consider clinical implications of findings. DESIGN & SETTING:A qualitative study of UK community-recruited women who have survived sexual violence and who experience chronic pelvic pain (CPP). METHOD:Ten participants were recruited via social media and engaged in individual, semi-structured online interviews about their experiences and understandings of sexual violence and CPP. Interviews were transcribed verbatim and analysed using reflexive Thematic Analysis. RESULTS:Three main themes were developed: (1) Healthcare professionals' attempts to silence women, who felt ignored, disbelieved or dismissed; (2) Treating the whole woman, describing the need for integrated, biopsychosocial approaches; and (3) A woman's place is in the resistance, highlighting women's active efforts to reclaim their narratives and pursue care. Shame was compounded across experiences, and women expressed frustration with fragmented care and assumptions about the psychological origins of pain. CONCLUSIONS:These results give insights into the complex meanings women survivors of sexual violence hold about their CPP, and how healthcare systems could better support them to explore and respond to those meanings. The aim should be compassionate care that recognises the complex biopsychosocial impact of sexual violence and CPP, while keeping women in control of their own care.

BACKGROUND:Whether treatment with balanced crystalloid fluid leads to better outcomes than 0.9% saline in children treated for septic shock is debated. METHODS:In this pragmatic clinical trial conducted at 47 emergency departments in five countries, patients (2 months to <18 years of age) with suspected septic shock and abnormal perfusion were randomly assigned to receive fluid resuscitation with either balanced fluid or 0.9% saline for up to 48 hours. The primary outcome was a major adverse kidney event (a composite of death, new renal-replacement therapy, or persistent kidney dysfunction) at 30 days after enrollment or hospital discharge, whichever occurred first. RESULTS:Of 9041 enrolled patients, 277 (6.1%) in the balanced-fluid group and 282 (6.2%) in the 0.9%-saline group withdrew from the trial, leaving 4235 and 4247 patients, respectively, for analysis. A primary-outcome event occurred in 137 patients (3.4%) in the balanced-fluid group and in 124 (3.0%) in the 0.9%-saline group (difference, 0.4 percentage points; 95% confidence interval [CI], -0.5 to 1.3; risk ratio, 1.10; 95% CI, 0.88 to 1.40; P = 0.85). The median number of hospital-free days during 28 days after enrollment was 23 (interquartile range, 19 to 25) in both groups. Hyperchloremia occurred in 868 patients (31.4%) in the balanced-fluid group and in 1383 (49.0%) in the 0.9%-saline group; hypernatremia in 52 (1.8%) and 89 (3.1%), respectively; and hyperlactatemia in 260 (19.8%) and 228 (16.7%). No differences in other safety outcomes or adverse events were seen. CONCLUSIONS:Among children treated for septic shock, no significant difference was seen in the incidence of death, new renal-replacement therapy, or persistent kidney dysfunction when fluid resuscitation was administered with balanced fluid as compared with 0.9% saline. (Funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development and others; PRoMPT BOLUS ClinicalTrials.gov number, NCT04102371.).

AimsThis study explored how Hong Kong Chinese cancer patients in the UK perceived their cancer experiences, and how aspects of Chinese culture influenced their access to and engagement with UK health and psychosocial services.MethodsWe conducted reflexive thematic analysis on 10 semi-structured interviews with Hong Kong Chinese individuals who had cancer during the COVID-19 pandemic.ResultsParticipants viewed cancer as a continuum that began with an overwhelming sense of death-related fear and worry, followed by physical and mental exhaustion, and frustration over the need to proactively seek help. Communication challenges due to language barriers and cultural differences hindered trust in professionals. However, support from family, friends, and spirituality aided adjustment to cancer.ConclusionsThis study highlights the cancer experiences of a small sample of Hong Kong Chinese people in the UK during the COVID-19 pandemic. Healthcare professionals should be aware of the unique cultural and language-related barriers faced by Hong Kong Chinese cancer patients in the UK. Culturally sensitive communication strategies and accessible practical support are essential to build trust and facilitate engagement with health and psychosocial services. Involving family, community, and spiritual resources in care planning may further support the wellbeing and adjustment of these patients.

Background:Opioid analgesia is frequently prescribed after surgery, with the expectation that patients will cease use within weeks, yet up to 25% of opioid-naïve patients may develop persistent postoperative opioid use. Opioid stewardship interventions are increasingly used to mitigate this risk, but little is known of the psychological factors influencing successful opioid cessation in the community after surgery in the UK. Aim:To identify psychological factors influencing opioid use and cessation after discharge following surgery in the UK. Design:Interviews with post-surgical patients 3 months after discharge; qualitative framework analysis summarised as themes. Methods:Opioid-naïve patients discharged on opioids after all-type surgery were invited three months later to a telephone interview that explored their experience of reducing opioids at home, and what influenced these decisions. Data were transcribed and qualitatively analysed. Results:48 participants were interviewed: all had ceased opioid use within one month of surgery. Four themes, comprising 15 subthemes, described diverse considerations: relationship with opioids - balance of benefits and risks; relationship with pain; relationship with clinicians; and views about addiction, including moral perspectives. Conclusion:Those interviewed made complex decisions on tapering opioids drawing on beliefs and previous experiences, relationships to healthcare, and prior experiences of pain. The themes identified lend further support, in the UK healthcare setting, to specific opioid stewardship interventions, especially patient education, pack-size limitation, and transitional pain services.

Background:Frailty increases vulnerability to adverse events (falls, illness) resulting in poorer health outcomes in later life. Persistent pain is common and impactful in older adults with frailty. Pain impact is potentially modifiable, and addressing it is important for supporting this population. The Pain in Older People with Frailty study aimed to generate evidence and develop service models to improve pain management for older adults with frailty and inform service provision for this underserved population. Objective(s):Phase 1: Map research evidence and synthesise findings from randomised controlled trials of multi-component pain management programmes and psychological therapies for community-dwelling older adults. Phase 2: In-depth qualitative interviews with community-dwelling older adults living with frailty and persistent pain, to explore pain experience and engagement with healthcare staff regarding pain. Phase 3: Service identification (four regions) including qualitative interviews with staff from pain service types (community, secondary care and specialist/tertiary) and generic community services to identify barriers and facilitators for older adults with pain and frailty to engage with pain management services. Phase 4: Co-design workshops with older adults, staff and commissioners to develop service guidance (supported by costing information) tailored to the needs of older adults with frailty and pain. Design and methods:Mixed-method, co-design study. Setting and participants:Phase 2: Community-dwelling adults (≥ 75 years) with frailty and persistent pain. Phase 3: Staff from pain services and community services, and service commissioners. Phase 4: Older adults, staff and third sector representatives. Data sources:Phase 1: Systematic review data; Phase 2: qualitative interview data (grounded theory); Phase 3: qualitative interview data (thematic analysis); Phase 4: workshop data. Results:Phase 1: Across 31 randomised controlled trials, intervention mechanisms included enhancing self-efficacy, promoting positive psychological strategies, refocusing attention to manage pain and engaging in physical activity to improve well-being and reduce pain impact. Most interventions showed potential benefits for older adults. Phase 2: Interviews with 26 older adults living with pain and frailty highlighted key themes: pain experience, pain acceptance, support seeking decisions and accessing support. Phase 3: Forty-two staff shared their perspectives on supporting older adults with frailty and pain. Phase 4: Findings were shared during workshops involving 47 stakeholders (older adults, general practices, staff and third sector representatives). Stakeholders proposed service recommendations. A health economist calculated per-patient cost estimates for different service models. Limitations:Limited representation from adults with severe frailty. Conclusions:There is no need for a dedicated pain and frailty service. Integrating pain management into existing frailty and community services should better meet the needs of frail older adults. This should include training community staff about persistent pain, referral options and establishing pathways for reporting pain and routine enquiry. Service directories, including voluntary and community organisations, could provide resources for staff and older adults. Adapting content and delivery of existing pain services will better support older adults with frailty and unmanaged pain requiring additional support. Future work:How should general practices identify older adults with frailty and pain who would most benefit from referral to pain services? How can information and awareness of pain management services be improved for this population? Funding:This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR131319.

Introduction People with inflammatory bowel disease (IBD) commonly experience pain, whether during active disease or remission, which interferes with daily life and major goals and causes distress. Current psychological methods of pain management draw from musculoskeletal pain interventions, but it has not been established that the musculoskeletal model is a good fit. We aimed to outline a psychological model of IBD pain.Methods We used qualitative methods: a very open interview (Grid Elaboration Method), conducted online and transcripts analysed for themes and subthemes. 15 men and 15 women with IBD pain, recruited from a national charity, took part in 4 months to February 2024. Participants scored their average pain 5/10 and interference by pain with activity 6/10, where 10 is maximum pain or interference.Results We extracted five inter-related themes: on the emotional impact of pain and symptoms; the challenge of pain; restrictions due to pain and other IBD symptoms; shortcomings in healthcare, particularly for pain; and poor public understanding of IBD. Although the first theme, universally endorsed, covered anxiety about the meaning of pain, we did not find the fears about physical integrity that characterise much musculoskeletal pain, nor the avoidance of physical activities based on those fears.Conclusion We propose that further exploration is warranted of the experience of IBD-related pain and how people adjust to it. This will inform the design of better psychologically-informed interventions to help people with IBD manage their pain, independently and in partnership with healthcare.

FFAME (Filtering Familiar Audio for Movement Exploration) is a novel sonification framework aiming to facilitate movement in individuals with chronic back pain. Our personalised, music-based approach contrasts and extends prior work with predetermined tonal sonification. FFAME progressively filters selected music based on angles of the trunk. Through a qualitative analysis of reported experience of 15 participants with chronic pain and 5 physiotherapists, we identify how sonification parameters and musical characteristics affect movement and meaning-making. Music-based movement sonification proved impactful across multiple dimensions: (1) encouraging movement, (2) escaping pain-related rumination, (3) externalizing pain experiences, and (4) scaffolding physical activities. Drawing on enactivism and related philosophies, the study highlights how the semantic indeterminacy of music, combined with real-time movement sonification, created a rich, open-ended environment that supported user agency and exploration. Sonification for pain management can be creative and expressive, enabling people with pain to extend challenging movements and build movement confidence.

Endometriosis is a common disorder in postpubertal women and often associated with pain in the pelvis and elsewhere. Pain and related symptoms, such as fatigue, adversely affect quality of life. Surgical and hormonal treatments have limited efficacy and can cause additional problems. There are surprisingly few studies of psychologically based interventions aimed at pain management and a better quality of life, although women with endometriosis are included within mixed chronic pain populations. As studies of pain management applied to endometriosis start to emerge, it is important to ascertain whether the assumptions of the dominant psychological model of pain, fear, and avoidance (developed mainly in musculoskeletal pain) are appropriate for the population and the problems associated with pain. We conducted a qualitative study of 16 women with endometriosis, using a very open interview technique (Grid Elaboration Method) and thematic analysis of women's accounts. We elicited 6 interrelated themes: 1 on the nature of pain; 3 on impact on everyday life, social life, and relationships, and emotions; 1 on healthcare experiences; and 1 on the burden of being female. Even when describing concerns about what was causing pain, women expressed few fears about physical integrity, nor did they avoid activities with the intention of protecting themselves from damage or increased pain. This leads us to question the applicability of the fear and avoidance model, and we encourage further exploration of the psychology of endometriosis-related pain to better design effective pain management interventions.

ABSTRACT:Pain is not experienced in isolation; it is affected by and affects other people. Interactions between parents and partners and people living with pain affect beliefs, emotions and behaviours, and pain progress and change. We searched systematically for longitudinal studies of associations between specific familial, dyadic, interpersonal factors and quantitative pain transitions. We coded studies for risk of bias. For the narrative synthesis, we grouped findings by dyads-parents and children, and people with pain and their partners (usually spouses), and then by the psychosocial mechanism/s. We described certainty of evidence for each pain transition and each mechanism. Patient and public contributors were involved throughout. Of 52 studies, 38 were of parents and children (27,814 dyads) and 14 of partners (4904 dyads). Three groups of predictive factors were identified for parent and child studies: parent mental health, parent cognitions, and parent behaviours. Parental anxiety (but not depression) predicted children's onset of pain and worsening; the evidence was of moderate certainty and almost exclusively involved mothers. Evidence that some parental behaviours, such as protective behaviours, were associated with worse child pain was of very low certainty. The evidence for partners was of poor quality, precluding synthesis. The review highlights that most interpersonal pain research fails to capture the complex dynamics of longstanding relationships and highlights the difficulty of doing so using simple models.

Pain and suffering are important to patients, and therefore, their interaction is central to clinical care. It also encompasses issues at the forefront of pain neuroscience, evolution, epidemiology, and treatment development. While Medieval Europe understood pain as a religious problem and Enlightenment theorists framed pain as a social problem, over the past 200 years, we have come to see pain as a medical problem. The medical problem of pain was originally addressed through the diagnosis and treatment of disease, but Pain Medicine has made the causation and treatment of pain a separate focus for research and clinical care. Palliative care reintroduced attention to suffering into the modern hospital. Eric Cassell argued that suffering arises from threats to the person that go beyond threats to the body. His theory of suffering has been criticized for being too focused on patients' narrative and too tied to a nociception-centered notion of pain. In general, modern medicine has promoted a unidirectional linear model of pain causing suffering in the individual patient. However, this model is not consistent with the latest pain neuroscience and is no longer adequate to guide research or clinical care. If we are to finally overcome dualism in pain theory and practice, we must begin by seeing the relationship between pain and suffering as circular rather than linear. Understanding pain and suffering as a unitary construct can advance pain research and clinical practice by providing a new framework for integrating biological, psychological, and social strategies for treating and preventing pain.

OBJECTIVES:Persistent pain is common among older people living with frailty and can impact on their daily living, mobility, social interactions and sleep. However, healthcare support to mitigate impact is lacking in this population. The Pain in Older People with Frailty (POPPY) study is a multiphase, mixed-methods study that addresses how pain management services for older people with frailty should be organised and delivered. DESIGN:For this phase (POPPY-Q), we used qualitative methods: semi-structured interviews with a grounded theory approach to analysis. SETTING AND PARTICIPANTS:Community-dwelling older people (≥75 years) with persistent pain and frailty were invited to participate in two qualitative interviews (in-person/remotely) 10 weeks apart. Interviews took place in varied geographical locations across England between July 2022 and August 2023 and explored experiences of living with pain and access to and engagement with services and healthcare professionals (HCPs) and support and treatments received for pain. RESULTS:Twenty-six people (77-91 years) with pain and frailty (from mild to severe) consented and were interviewed; 24 completed a second interview. Three interviews included a spouse/family member. Themes were general health and well-being; pain and its impact; acceptance of living with pain; support-seeking decisions; experience of accessing support; and perception/experience of pain support and treatment. This paper focuses on pain acceptance and support-seeking; other themes are used contextually, and accessing support was rare. Many participants were stoical about pain; some prioritised other health conditions; some preferred self-management; some were resigned and had lost hope of effective treatment; some expressed concern about burdening healthcare resources. CONCLUSIONS:HCPs should be aware of the stances of older people with frailty about seeking support for pain and should be proactive, asking about pain. Longer appointments for complex cases may allow general practitioners to address pain, offer reassurance, provide information or referral or arrange a follow-up consultation focused on pain management.

Observers estimate pain using multiple cues, such as verbal report or facial expression, and weighting them depending on social context. Evolutionary Social Contract Theory proposes that observers assess pain within a framework of cooperative exchanges where benefits such as care should be given only if pain is present, leading to a sensitivity to pain cues and adjustment of pain intensity estimates. Conflicting verbal and behavioral cues may affect observers' judgment difficulty, and observer characteristics may affect pain estimates. 106 participants were cued into different social contexts varying in the possibility of 'social cheating'. Next, participants were provided with verbal reports and facial expressions of women in pain based on which they had to estimate pain intensity and rate judgement difficulty. Last, participants had to judge the likeability of the women they had seen in the videos. When 'social cheating' was possible, more weight was given to facial cues and less weight to verbal cues when estimating pain. Conflicting verbal and facial pain cues were rated more difficult to judge. Women who had shown pain in their faces were perceived as less likeable. Neither observers' empathy nor their pain catastrophizing was associated with their pain estimates. The study highlights the effect of social context on pain estimates, and the dilemma associated with interpreting inconsistent verbal and facial cues of people in pain: verbal report is considered more easily manipulated and therefore taken less seriously, while the expression of facial pain elicits more negative judgements of the person with pain. PERSPECTIVE: This article shows that social context can shape how people judge others' pain. Results highlight that when 'social cheating' is possible, observers give more weight to facial expressions than to verbal reports. Awareness for these effects should be raised in health care professionals and support offered.