The journal of pain
October 1, 2022
Robert H Dworkin, Brian T Anderson, Nick Andrews et al.
22 citations
Psychedelic substances have been used historically for spiritual and mystical experiences, and recent interest focuses on their potential to treat chronic pain. Clinical trials support psychedelics' effectiveness for psychiatric conditions, but studies on chronic pain—such as cancer pain, phantom limb pain, migraine, and cluster headache—are few and mostly uncontrolled. Risks are relatively rare with careful patient screening and supervision. Key challenges include identifying mechanisms of action, selecting appropriate pain conditions, designing rigorous trials with proper control groups, minimizing unblinding bias, and accounting for patient mindset and setting. Evidence-based recommendations are needed for future research to yield informative results.
The journal of pain
July 1, 2024
Patrick H Finan, Carly Hunt, Michael L Keaser et al.
18 citations
A pilot mechanistic randomized controlled trial tested a positive emotion-enhancing intervention called Savoring Meditation against a Slow Breathing control in 44 patients with rheumatoid arthritis. Savoring significantly reduced experimental pain intensity ratings relative to rest and increased cerebral blood flow in the ventromedial prefrontal cortex, as well as connectivity between that region and the caudate during painful stimulation. Participants in the Savoring condition also reported significantly increased positive emotions and reduced anhedonic symptoms from pre- to post-intervention. The findings suggest that Savoring recruits reward-enhancing corticostriatal circuits in the face of pain, warranting future work on clinical pain outcomes.
The journal of pain
May 2, 2025
Peter Stilwell, Mael Gagnon-Mailhot, Anne Hudon et al.
8 citations
Pain-related suffering can occur through an immediate, disruptive impact on one's sense of self, even without self-reflection. Interviews with 12 adults across Canada living with various pain conditions revealed that during their worst pain episodes, the experience overwhelmed thoughts and self-reflective capacities, disrupting foundational aspects of self-experience such as agency, bodily ownership, and time. Participants described these experiences as incapacitating, dehumanizing, and dissociating. The accounts closely resemble first-hand reports of torture, supporting a new mode of pain-related suffering that does not require self-reflection. This expands traditional understandings, which have exclusively anchored suffering to self-reflective thought, to include two inter-related modes.
The journal of pain
September 1, 2024
Emily P Mills, Rachael L Bosma, Anton Rogachov et al.
5 citations
In people with neuropathic pain, white matter structure in the default mode network and a pathway connecting the medial prefrontal cortex to the periaqueductal gray is linked to how much ketamine reduces central sensitization, a key pain mechanism. Among 35 patients treated with ketamine, pretreatment fiber density in the anterior limb of the internal capsule correlated with pain relief (r = 0.48), and fiber density in the default mode network (r = 0.52) and the medial prefrontal cortex-periaqueductal gray pathway (r = 0.42) correlated with reduced temporal summation of pain, a marker of central sensitization. However, white matter structure did not distinguish responders from nonresponders.
The journal of pain
July 1, 2025
Ingrid Bindicsova, Leanne M Hides, Katherine Brain et al.
1 citation
A 4-week internet-delivered mindfulness-based cognitive therapy program for chronic pain was tested against a delayed-treatment control in 48 adults. High engagement and an 88% retention rate indicated the program was acceptable and feasible. Pain interference showed a small-to-medium improvement, while pain intensity change was small. Other secondary outcomes also showed small-to-medium improvements. The program may help overcome access barriers to pain management.
The journal of pain
May 13, 2025
Zhaochen Zhu, Tim Schouten, Rob Strijkers et al.
1 citation
A systematic review and network meta-analysis of 50 randomized controlled trials involving 4920 adults with chronic sciatica found very uncertain evidence regarding the effectiveness of non-surgical interventions. At short-term follow-up, spinal manipulative therapy, exercise combined with neural mobilization, and soft tissue anesthetic injections showed the largest reductions in leg pain intensity compared to placebo, but all were based on very low confidence evidence. Epidural magnesium injections improved physical function at short-term, and long-term improvements in physical function were seen with epidural steroid plus ketamine injections and epidural injections combined with physical therapy, again with very low confidence. No high-quality evidence confirms the superior effectiveness of any non-surgical intervention for chronic sciatica.
The journal of pain
January 6, 2026
Mark P Jensen, Marcia A Ciol, Kevin J Gertz et al.
Among 328 U.S. military veterans with chronic pain, three psychological changes helped explain why clinical hypnosis, mindfulness meditation, and pain education all reduced pain intensity and interference: greater willingness to tolerate pain, increased engagement in valued activities despite pain, and reduced catastrophizing. A fourth factor—working alliance with the therapist—was linked to pain reduction only for those receiving clinical hypnosis. Catastrophizing played a larger role in mindfulness training's effects, while pain willingness mattered more for hypnosis's effect on pain interference. The findings suggest that treatments targeting thoughts about pain, avoidance, valued activities, and therapeutic alliance may improve outcomes, but replication is needed.
The journal of pain
July 21, 2025
Nicholas P. Cherup, Patrick H. Finan
Chronic pain and functional disabilities can transform a person's identity and sense of meaning. Existing treatments often fail to provide adequate pain relief or functional recovery, and psychological issues like depression, anxiety, and fear of movement can worsen outcomes by reducing engagement in rehabilitation. Psilocybin alters consciousness by changing connectivity in brain regions involved in self-perception and movement. Early evidence suggests it helps with psychiatric disorders and unhelpful coping, but its potential for pain relief and improving rehabilitation participation through changes in self-perception and meaning-making is underexplored. This article proposes using psilocybin as a psychophysical adaptogen to reframe perceived barriers to exercise and improve both illness identity and neuromotor outcomes.
The journal of pain
November 1, 2024
Collin M Calvert, Alex Haley, Emily M Hagel Campbell et al.
Among 1,737 veterans with chronic pain, higher levels of applied mindfulness practice—especially using positive emotional regulation—were linked to less pain interference, less pain catastrophizing, and better outcomes for fatigue, sleep, anxiety, depression, post-traumatic stress, physical function, and social participation. Applied mindfulness was not significantly associated with pain intensity. The findings suggest that actively using mindfulness skills in daily life, particularly to regulate positive emotions, may improve pain-related functioning. The Applied Mindfulness Process Scale (AMPS) appears useful for measuring how people apply mindfulness outside formal sessions.