Prior neuroimaging studies and meta-analyses investigating brain correlates of placebo analgesia (PA) have yielded neuroanatomically heterogeneous findings, which may be reconciled from a connectomics perspective. The objective of this study was to examine network localization of brain functional alterations related to PA.

We initially identified PA-induced brain activation alterations (hyper-activation and hypo-activation separately) during experimental pain from 29 published studies with 674 individuals. By combining these implicated dysfunctional brain regions with large-scale discovery (N = 1113) and validation (N = 1093) resting-state functional magnetic resonance imaging datasets, we then employed a novel functional connectivity network mapping approach to construct PA hyper-activation and hypo-activation networks, respectively.

The PA hyper-activation network manifested as a pattern of circumscribed brain regions mainly involving the limbic, default, and frontoparietal networks. By contrast, the PA hypo-activation network comprised a broadly distributed set of brain regions primarily implicating the ventral attention, somatomotor, and subcortical networks.

Our findings regarding the brain network representations of PA may contribute to a deeper understanding of its action mechanisms and provide a neural framework that may inform future clinical translation.

To evaluate the feasibility and preliminary efficacy of a clinical program designed to teach informal caregivers of older Veterans with pain and mild-to-moderate dementia or mild cognitive impairment (MCI), pain management, pain coping and pain communication skills.

Twenty caregivers of older Veterans with pain and dementia or MCI and the Veterans themselves participated in a 5-session program taught by trained Veterans Affairs (VA) clinicians. All sessions were conducted remotely using video-technology, with caregivers and Veterans. Two sessions were conducted with individual Veteran-caregiver dyads, and three sessions were conducted with caregiver groups. Caregivers and Veterans completed baseline and post-intervention measures. Qualitative interviews of 10 caregivers who completed the program were also conducted and focused on identifying themes related to caregiving for their loved ones with pain and dementia and related to participating in the program.

The program was well received and almost all caregivers identified videoconferencing as the preferred venue for participating in such a program. They most valued learning about dementia and participating with other caregivers. Pre-post analyses revealed significant improvements in perceived caregiving competence and self-efficacy for managing pain. Challenges encountered included scheduling related to caregivers’ multiple competing responsibilities and lack of familiarity with tele-conferencing technology.

Patients with pain and mild to moderate dementia or MCI have been relatively ignored in current literature. Our preliminary findings suggest that a program delivered by trained healthcare professionals to caregivers and Veterans using tele-conferencing could benefit caregivers.

This study aimed to compare Merocel and Surgicel nasal packing following inferior turbinoplasty, focusing on post-operative bleeding, pain, discomfort and nasal obstruction.

A randomised controlled trial (2017–2021) was conducted in the Department of Otolaryngology, Changi General Hospital, Singapore. Sixty adults undergoing inferior turbinoplasty and/or septoplasty were randomised to receive Merocel or Surgicel packing. Standardised surgical and post-operative protocols were used. Outcomes—bleeding, pain, discomfort and nasal obstruction—were assessed on post-operative day 1 and post-operative days 5–7 using validated scales.

Fifty-eight patients completed the study (Merocel = 30; Surgicel = 28). On post-operative day 1, Surgicel had significantly lower nasal obstruction scores (1.57 ± 0.74 vs 2.10 ± 0.71; p = 0.008). By post-operative days 5–7, Merocel showed significantly less bleeding (0.77 ± 0.63 vs 1.18 ± 0.86; p = 0.044). Pain and discomfort were comparable.

Merocel provided superior sustained haemostasis, while Surgicel offered better early comfort. Both materials have comparable outcomes.

The impact of combat injury on the development of chronic pain and mental health concerns in combat-exposed populations is unknown. This study examined associations of combat injury and injury–related pain with pain-related factors and mental health outcomes, and potential mediation of the relation between combat injury and mental health outcomes by pain-related factors.

Pain interference, pain catastrophizing, pain intensity, post-traumatic stress disorder (PTSD), and major depressive episode (MDE) were assessed in (1) a probability sample of US Army soldiers and veterans cross-sectionally and (2) US Army soldiers before and 1, 3, and 9 months after deployment to Afghanistan. Associations among these variables were modeled using logistic regression and multiple mediation analyses.

Among 5003 service members with cross-sectional data, combat injury–related pain was associated with increased odds of clinically significant pain intensity (OR=2.69), pain interference (OR=3.69), MDE (OR=2.17), and PTSD (OR=3.96) relative to pain from other injuries and conditions. Among 4645 service members assessed pre- and post-deployment, combat injury was associated with increased odds of new-onset pain interference (OR=2.78), pain catastrophizing (OR=2.75), PTSD (OR=4.06), and MDE (OR=2.56) 3 months post-deployment, and PTSD (OR=2.86) and MDE (OR=1.74) 9 months post-deployment. Pain-related factors mediated the relations of combat injury with post-deployment PTSD and MDE.

Combat injury is associated with greater odds of pain interference, pain catastrophizing, PTSD, and MDE compared to other sources of pain in a cohort of US service members. Efforts to address pain-related factors following combat injury may mitigate the risk of subsequent chronic pain and mental health disorders.

Children with CHD are at risk for neurodevelopmental impairments, and though these are often mild, some children face severe developmental challenges. Both unalleviated pain and exposure to opioids in the neonatal period have detrimental effects on the developing brain.

We developed and implemented a Comfort Curriculum including a standardised sedation pathway, bedside non-pharmacologic reference, and holding guidelines. Our primary aim was to assess the effect of the Comfort Curriculum on opioid exposure. The secondary aim was to assess the effect of the Comfort Curriculum on pain scores in neonates in the first 5 days after surgery. A retrospective cohort study of all cardiac surgical patients ≤30 days of age at the time of their first operation was conducted before and at two points after implementation of the Comfort Curriculum (3 months and 15 months).

We found that initial and maximum opioid infusion rates significantly decreased between the pre-implementation and both post-implementation phases, while pain scores did not increase. The total cumulative opioid doses in the first five post-operative days showed a non-statistically significant decrease in both post-implementation phases compared to the pre-implementation phase, and median pain scores showed a trend towards decreasing in both post-implementation phases.

After implementation of the Comfort Curriculum, we found a significant decrease in the initial and maximum opioid doses and a signal towards a reduction in total opioid dose in the first 5 days after neonatal cardiac surgery.

Substance use is sustained partly through implicit associations toward drugs – i.e. automatic positive attitudes and motivational responses toward drug-related cues. Such implicit associations may be inferred by behavioral measures that capture the relative ease, speed, or priming of those associations. However, implicit opioid associations in patients with opioid use disorder (OUD) remain underexplored, and it is unknown whether mindfulness-based interventions such as Mindfulness-Oriented Recovery Enhancement (MORE) can modify implicit associations to support recovery.

We conducted secondary analyses of data from a clinical trial of adults with OUD (N = 154), randomized to either methadone treatment as usual (TAU) or TAU plus MORE. Participants completed an opioid implicit association test (IAT) at baseline. Days of opioid use were tracked over 16 weeks. Data were analyzed using logistic and zero-inflated negative binomial (ZINB) regressions to examine the impact of baseline IAT scores on future opioid use and MORE’s moderating effect.

In the TAU group, each 1-unit increase in IAT D score was associated with a 216% increase in the odds of opioid use (OR = 3.16, p = 0.049). However, in the MORE group, IAT scores were not significantly associated with future opioid use (OR = 0.58, p = 0.57). ZINB analysis revealed that each 1-unit increase in IAT D score predicted 0.96 fewer days of use in MORE relative to TAU (B = –1.25; SE = 0.58; p = 0.030).

Implicit attitudes toward opioids predicted higher opioid use among individuals receiving methadone. However, MORE attenuated this relationship and may counteract automatic cognitive biases that sustain opioid use.

Depression rates are higher in women, especially during periods of hormonal fluctuation. Reproductive system disorders (RSDs), which often disrupt hormonal balance, may contribute to this mental health burden. Despite their prevalence and significant health implications, the link between RSDs and depression remains underexplored, leaving a gap in understanding these women’s mental health risks.

Using Danish nationwide health registers (2005–2018), we conducted a cohort study of 2,295,824 women aged 15–49, examining depression outcomes in 265,891 women diagnosed with 24 RSDs, including endometriosis, polycystic ovary syndrome, and pain-related diagnoses. For each RSD, age-matched controls were selected. We calculated incidence rates, incidence rate ratios, and prevalence proportions of depression diagnoses or antidepressant use around RSD diagnosis.

Across all RSD subtypes, women demonstrated higher rates of depression both before and after diagnosis, with a peak within the year following diagnosis. Incidence rate ratios within 1 year of RSD diagnosis ranged from 1.15 (95% confidence interval [CI] 1.06–1.25) to 2.09 (95% CI 1.98–2.21), depending on RSD subtype. Elevated depression prevalence was observed 3 years before diagnosis, suggesting mental health impacts may have preceded clinical RSD identification.

This study reveals a striking association between RSDs and depression. Women with RSDs are more likely to suffer from depression, before and after RSD diagnosis, highlighting the need for integrated mental health screening and intervention. With over 10% of women affected by RSDs, addressing this overlooked mental health burden is imperative for improving well-being in a significant portion of the population.

Adult cohorts with generalised joint hypermobility (GJH) report higher rates of neurodevelopmental problems (NDPs). However, the prevalence of GJH in community-dwelling children and its association with NDPs remains unexplored.

This study aimed to (a) assess the prevalence of GJH, (b) examine its link to musculoskeletal pain and (c) explore associations with NDPs in 11-year-old Swedish children.

An in-school study was conducted as part of the 4th grade health check-up. It included a structured physical examination using the Beighton score (range 0–9) and a comprehensive neurodevelopmental assessment based on behavioural ratings, maternal interviews, medical records and academic performance.

Of 348 eligible children from eight schools, 223 (64%) participated, with Beighton scores measured in 207 (59%). The median Beighton score was 1 (interquartile range 0–2), with no significant gender differences (Wilcoxon test, P = 0.17). A Beighton score of ≥6 approximated the 95th percentile in both sexes. No significant association was found between high Beighton scores and NDPs. Few children with GJH reported weekly pain, indicating a low prevalence of hypermobility spectrum disorders in this age group.

Our findings validate the age-specific Beighton score cut-off and suggest that GJH in children of this age is not linked to NDPs, differing from findings in adults. This may reflect developmental changes during puberty. Additionally, the high prevalence of weekly pain (42%) in the cohort warrants further investigation into its causes and impact.