Chronic pain is one of the most prevalent medical conditions in the US. Besides physical symptoms, it has a profound impact on mental health and quality of life. The physiological mechanisms underlying chronic pain are complex; thus, treatments are limited. Opioid analgesics are one of the most commonly prescribed medications for the management of chronic pain; however, a major pitfall of the use of opioids is their addictive potential. Here we examine, in a mouse model, how chronic pain influences opioid addiction, with the hypothesis that chronic pain potentiates addiction due to the dual rewarding effects of opioids—euphoria and analgesia. We tested this using conditioned place preference (CPP), and find that this is not the case, as acquisition of a drug memory was attenuated under a chronic pain context. We also observe that chronic pain may facilitate extinction of the drug memory, suggesting that the mechanism of addiction under a chronic pain context is more complex than previously assumed. This complex behavioral phenotype is possibly a reflection of the underlying neural mechanisms involving multiple brain regions. In order to start understanding this mechanism, we mapped the expression of immediate early genes brain wide to identify key brain regions involved in both chronic pain and addiction. The prefrontal cortex (PFC) is one major brain region known to directly modulate circuits involved in both pain and drug addiction. However, the PFC consists of a myriad of cell types that project to distinct downstream targets, whose roles in specific behaviors are still largely unknown. A recent study classified the different subtypes of neurons in the PFC using single cell RNA sequencing (scRNA-seq), which identified a layer 5 pyramidal neuron (Pou3f1+) that is involved in pain and opioid taking. Using chemogenetic techniques, we manipulated the activity of Pou3f1+ neurons to test their response under pain and opioid use. These neurons appear to bi-directionally regulate pain perception, as activation increases mechanical sensitivity measured using von Frey filaments, and inhibition diminishes sensitivity. On the other hand, opioid administration under a chronic pain state potently activated Pou3f1+ neurons, as determined by cfos mRNA expression. These findings indicate potential interactions between the neural processing of chronic pain and opioid addiction, opening up the possibility of exploring common brain regions, and ultimately discrete cell types that can be therapeutically targeted to alleviate pain without the risk of addiction. / 2025-01-27T00:00:00Z

In the United States, 10% to 15% of newborns are admitted to the neonatal intensive care unit (NICU). Painful procedures are unavoidable during NICU care; the neonate experiences approximately 12 painful procedures per day. Inconsistent and/or inappropriate pain management in the NICU remains a problem. The purpose of this study is to identify the prevalent factors that influence the implementation of pain management strategies among nurses who work in a NICU setting in a Central Florida hospital. This study was conducted using a voluntary and anonymous electronic survey. The survey was divided into two sections; the first section designed to describe the sample, and the second section containing a Likert-type scale that assessed the nurses’ general pain knowledge, knowledge of pain assessment, and awareness of accepted pain management strategies. The survey was adapted from previously published research. Results indicate pain was more likely to be addressed when nurses collaborated closely with the attending physician. The majority of nurses were aware of current protocols for pain management on the unit but not all nurses agreed those protocols were adequate. Results also indicated pain assessment education is being provided in the NICU and the nurses feel confident in their skills to assess pain, however, not all nurses agreed that pain is being well managed in their unit. There appears to be a gap between the nurse’s knowledge/skill to assess pain and implementation of strategies to decrease pain. Although it is the nurse’s responsibility to prevent and treat newborn pain in the NICU, not all nurses agreed that newborn pain is well managed in their unit and some believe pain to be an unavoidable experience in the NICU. Nurse-physician collaboration is key to evidence based newborn pain management.

Pain assessment continues to be poorly managed in the clinical arena. A review of the communication process in pain assessment is carried out and the hierarchical approach often recommended in the literature -with self-report as its "gold-standard," is criticized as limited and simplistic. A comprehensive approach to pain assessment is recommended and a model that conceptualizes pain assessment as a complex transaction with various patient and clinician dependant factors is proposed. Attention is then focused on the pediatric patient whose pain assessment is often dependent on nonverbal communicative action. The clinical approaches to pain assessment in this population -mainly the use of behavioral/observational pain scales and facial pain scales, are explored. The primal face of pain (PFP) is identified and proposed theoretically as an important link in the function of facial pain scales. Finally, the existence of the PFP is investigated in a sample of 57 neonates across differences in sex and ethnic origin while controlling for potentially confounding factors. Facial expression to a painful stimulus is measured based on the Neonatal Facial Coding System (NFCS) and applying an innovative computer-based methodology. No statistically significant differences in facial expression were found in infant display thereby supporting the existence of the PFP.

Lower educational attainment has been linked to worse chronic pain outcomes, but the reasons for this relationship are unclear. This study analyzed the relationship between level of education and pain outcomes in patients with musculoskeletal pain, and potential psychosocial mechanisms to explain this relationship. We hypothesized that patients with lower educational attainment would report greater pain intensity and interference, and that pain catastrophizing, anxiety, and depression would mediate the relationship between educational attainment and pain. A total of 843 participants (63% female, 78% White, Mage=55.13), diagnosed with a musculoskeletal pain condition [knee osteoarthritis (29%), back pain (57%), and fibromyalgia (14%)], completed questionnaires including demographics, Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), and Hospital Anxiety and Depression Scales (HADS). Pearson correlations and bootstrapped mediation analyses were conducted to examine the relationships among education, psychosocial, and pain variables. Education was inversely correlated with pain intensity and interference, pain catastrophizing, anxiety, and depression (p < .05). Pain catastrophizing significantly mediated the relationship between education and pain intensity (95%CI [-.05, -.01]), and catastrophizing and depression mediated the effects of education on pain interference (95% CI [-.08, -.01]; 95%CI [-.06, -.01]). Anxiety did not mediate either relationship. These findings indicate that greater pain catastrophizing, and in part depression, partly drive the relationship between lower educational attainment and worse pain outcomes. This work importantly aims to reduce pain disparities and provides direction for psychosocial treatment, suggesting that pain catastrophizing may be a particularly critical target in patients with lower education level. / 2026-02-23T00:00:00Z

The purpose of this thesis is to provide a critical analysis of research findings about hydrotherapy as a means of reducing chronic pain used independently of opioids. Chronic pain is often treated with analgesics of varying potency, some with serious adverse side effects if used over a long period of time. Exploring the effectiveness of therapies other than medication to treat chronic pain is important to decrease or eliminate the amount to pain medication taken for chronic pain. Hydrotherapy is one therapy that may improve the pain experience for those with chronic pain. A literature search was conducted using the key terms chronic pain and hydrotherapy with the Cumulative Index of Nursing and Allied Health Literature database. This search yielded 5 studies that met the inclusion criteria, which were: research from 2015 or newer, studied adults over the age of 18, used hydrotherapy to reduce chronic pain who were not also using opioids, peer-reviewed, and written in the English language. The 5 studies found specifically addressed the conditions of osteoarthritis of the knee, fibromyalgia, and chronic low-back pain. All studies indicated hydrotherapy reduced chronic pain in adults. Findings of this analysis of the literature supports the recommendation to use hydrotherapy to improve chronic pain. Further research in other conditions known to cause chronic pain is needed.

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Many people around the world are impacted by some form of bodily pain. Outside factors are thought to help trigger pain, especially in those who have pain-related conditions. When it comes to human health and comfort, understanding the potential external factors that aide in triggering pain is essential. Identifying such factors makes prevention and treatment of pain more feasible. The first part of this study identified how those who suffer from various pain-related conditions (fibromyalgia, rheumatoid arthritis, osteoarthritis, and general back pain) are impacted by different air mass types. Air mass types and emergency department (ED) visits for pain in select North Carolina counties were collected over a seven-year period to determine a potential relationship. Bootstrapping analyses revealed that Moist Tropical air masses resulted in the highest number of ED visits for all pain conditions examined, while Moist Polar air masses resulted in the fewest. The barometric pressure changes associated with Transitional air masses did not have any significant relationships with pain. The second part of this study sought to determine if regional geographic characteristics impact the relationships found in first part of this study. North Carolina was separated into three geographic sections: Appalachian Mountains, Piedmont Plateau, and Coastal Plain. In the Plateau region, Moist Tropical and Moist Moderate air masses were frequently associated with the highest rates of ED visits for all the conditions examined, while Polar air masses were often associated with the fewest visits. Several conditions exhibited similar relationships with these air mass types in the Mountains, with migraine and fibromyalgia being the exceptions. Very few statistically significant relationships were found in the Coastal region. The last part of this study utilized a survey to identify impacts of weather-based migraine/pain forecasts on human behavior. When provided with different scenarios involving weather-based migraine/pain forecasts, the respondents' decision-making processes were altered. When a hypothetical forecast indicated that the weather was conducive to migraines or other types of pain, many respondents indicated that they would likely take preventative measures (e.g. medication). Additionally, as forecast severity or activity length increased, respondents were less likely to continue with a planned activity.

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