John A. Sturgeon

Commentary on: Habermann MB, Christian MB. Uncontrollability of experimental pain decreases pain intensity and relief pleasantness ratings in a between- group design. PAIN Rep 2026;11:e1448.

Background Trauma exposure is prevalent among individuals with chronic pain and is associated with poorer pain-related outcomes. Brief, scalable interventions that target overlapping trauma-pain processes are needed. This single-arm pilot study evaluated feasibility, acceptability, and changes in clinical outcomes following Stress, Trauma, and Emotional Processing for Pain (STEPP), a brief modified version of emotional awareness and expression therapy. Methods Adults (N=42) with mixed-etiology chronic pain and trauma exposure were enrolled. STEPP was delivered remotely over three weekly 1-hour individual sessions. Participants completed questionnaires at baseline, post-treatment, and 1-month, and 3-month follow-up. Feasibility benchmarks (≥70%) were prespecified for recruitment, treatment, and follow-up completion. Acceptability was assessed using the Treatment Helpfulness Questionnaire (THQ; −5 to 5) and Credibility and Expectancy Questionnaire (content credibility and expected benefit; 3–27). Linear mixed models and Hedges’ g effect sizes examined changes in pain intensity (0–10) and interference with functioning (0–100), post-traumatic stress disorder symptoms (PTSD; 0–80), pain catastrophizing (concerns about pain; 0–52), and kinesiophobia (fear of movement; 17–68). Results All feasibility benchmarks were met. 93% of eligible participants enrolled, 90% of enrolled participants initiated treatment, and 97% initiators completed treatment. Among completers, follow-up completion was 100% at post-treatment and 97% at 1 and 3 months. THQ ratings were high and met benchmarks (post M=4.0±1.2; 1-month M=3.9±1.2; 3-month M=3.8±1.3). Credibility ratings met benchmarks, whereas expectancy ratings did not. Significant improvements were observed from baseline to post-treatment: pain intensity (mean change=−0.64, SE=0.23, 95% CI −1.11 to −0.18), pain interference (−3.34, SE=0.84, 95% CI −5.00 to −1.68), PTSD (−5.60, SE=1.53, 95% CI −8.64 to −2.57), pain catastrophizing (−6.69, SE=1.34, 95% CI −9.34 to −4.03), and kinesiophobia (−5.78, SE=1.21, 95% CI −8.19 to −3.37); changes were maintained through 3 months. Effect sizes were small for pain intensity and moderate-to-large for all other outcomes. Conclusions STEPP demonstrated feasibility and acceptability, with promising improvements in pain-related and trauma-related outcomes. Randomized controlled trials are needed to establish efficacy.

Objective: Chronic migraine (CM) is a condition marked by highly frequent, intense, and disabling headaches. However, less commonly examined symptoms, such as persistent fatigue, widespread non-cephalic pain, and post-traumatic stress disorder, may also play a key role in migraine-relevant clinical outcomes. Methods: The current study utilized retrospective clinical registry data from 704 treatment-seeking patients with CM to examine longitudinal trajectories of pain intensity and pain-related life interference using linear growth modeling. Results: High levels of co-occurring non-cephalic pain (71.9% of patients) were noted in this sample. Patients endorsing more widespread pain reported higher average levels of pain intensity over time (β = 0.189 [0.103-0.275], P < .001) and less improvement in pain interference over time (β = 0.328 [0.131-0.525], P = .001). Additional findings included greater reductions in pain interference among patients with higher baseline levels of pain intensity (β = −0.185 [−0.351 to −0.020], P = .028) and fatigue (β = −0.280 [−0.493 to −0.067], P = .010) and non-significant associations between post-traumatic stress symptoms and pain intensity and pain interference in all models. Conclusions: The current findings suggest that clinical factors sometimes overlooked in headache research, such as co-occurring non-cephalic pain and fatigue, may contribute to trajectories of treatment response and psychosocial function in CM. Future research may benefit from examining these factors in headache-specific treatment settings and in the context of examining the effects of multidisciplinary care on patients with complex symptom presentations.

Objectives: This study examined the relationships among childhood trauma, central sensitization, and pain-, mood-, and opioid risk-related outcomes among adults with chronic pain (CP) on long-term opioid therapy (LTOT). We hypothesized that Adverse Childhood Experiences (ACEs) would relate to poorer outcomes, and that central sensitization would mediate the relationships between ACEs and outcomes. Methods: Adults with CP, actively prescribed opioids, were recruited via ResearchMatch.org and completed a cross-sectional electronic survey. Participants completed the Adverse Childhood Experiences (ACEs) questionnaire, the Central Sensitization Inventory (CSI), the Brief Pain Inventory (BPI), the Center for Epidemiological Studies Depression scale (CES-D-10), the Generalized Anxiety Disorders 7-item questionnaire (GAD-7), the Rapid Opioid Dependence Screen (RODS), and other substance use items. Models were estimated examining main effects of ACEs and potential mediating role of CSI between ACEs and outcome variables. Results: ACEs positively predicted higher CSI scores (β = 0.434, P<0.001), opioid dependence symptoms (β = 0.199, P<0.05), lifetime polysubstance use (β = 0.367, P<0.001), depressive symptoms (β = 0.262, P<0.001), and anxiety symptoms (β = 0.251, P = 001). As a mediator, CSI symptoms significantly mediated the association between ACEs and pain interference (LCL = 0.124, UCL = 0.303), ACEs and depressive symptoms (LCL = 0.227, UCL = 0.438), and ACEs and anxiety symptoms (LCL = 0.212, UCL = 0.387). Conclusions: Among a sample of adults with a variety of CP conditions on LTOT, ACEs emerged as a risk factor for some substance use and mood outcomes, though inconsistent effects suggest other influential factors. CSI mediated the relationship between ACEs and pain interference, depression, and anxiety, indicating childhood trauma may be especially impactful when central sensitization is higher.

Background Fibromyalgia (FM) is a common, disabling, and costly nociplastic pain condition. Most frontline treatments show modest effects in reducing pain in FM, which may be due to a mismatch between the mechanisms of existing interventions and mechanisms underlying nociplastic pain. The current study was a single-arm, open-label trial examining the feasibility, acceptability, and preliminary efficacy of a novel, three-session telehealth behavioral intervention (Brief Pain Reprocessing Therapy (BPRT)). BPRT incorporates psychological techniques specifically targeting the putative mechanisms of nociplastic pain in a brief, telehealth format. Methods 35 adults with FM initiated treatment. Participants were asked to complete three one-on-one intervention sessions via telehealth and online questionnaires at four time points (pre-intervention and at 1, 2, and 3 months post-intervention) assessing average pain intensity, pain interference, and pain-related fear. Results 33 participants (94.3%) completed the BPRT protocol. Acceptability ratings for BPRT were high (62.0 out of 70 on the Treatment Acceptability/Adherence Scale). BPRT completers reported significant reductions in average pain intensity (B=−0.645, 95% CI −0.896 to −0.395, pConclusions BPRT is feasible and acceptable, with promising preliminary efficacy for reducing pain, pain interference, and pain-related fear in FM. These findings highlight the possibility of reducing FM pain and interference using a brief telehealth intervention. Larger randomized controlled trials are needed to rigorously evaluate the efficacy and mechanisms of BPRT.

Sustained widespread deployment of clinically and cost-effective models of integrated pain care could be bolstered by optimally aligning shared stakeholder values.