Patients suffering from fibromyalgia often report stress and pain, with both often refractory to usual drug treatment. Magnesium supplementation seems to improve fibromyalgia symptoms, but the level of evidence is still poor. This study is a randomized, controlled, double-blind trial in fibromyalgia patients that compared once a day oral magnesium 100 mg (Chronomag^®, magnesium chloride technology formula) to placebo, for 1 month. The primary endpoint was the level of stress on the DASS-42 scale, and secondary endpoints were pain, sleep, quality of life, fatigue, catastrophism, social vulnerability, and magnesium blood concentrations. After 1 month of treatment, the DASS-42 score decreased in the magnesium and placebo groups but not significantly (21.8 ± 9.6 vs. 21.6 ± 10.8, respectively, p = 0.930). Magnesium supplementation significantly reduced the mild/moderate stress subgroup (DASS-42 stress score: 22.1 ± 2.8 to 12.3 ± 7.0 in magnesium vs. 21.9 ± 11.9 to 22.9 ± 11.9 in placebo, p = 0.003). Pain severity diminished significantly (p = 0.029) with magnesium while the other parameters were not significantly different between both groups. These findings show, for the first time, that magnesium improves mild/moderate stress and reduces the pain experience in fibromyalgia patients. This suggests that daily magnesium could be a useful treatment to improve the burden of disease of fibromyalgia patients and calls for a larger clinical trial.

The impact of psychosocial vulnerability on pain in the year following breast cancer diagnosis has been little studied. To identify a score of psychosocial vulnerability (cognitive, emotional, quality of life and precariousness parameters) as a predictor of a pain trajectory, we conducted an observational prospective study and included women with newly diagnosed breast cancer. One year follow-up with 3 visits (day of breast cancer diagnosis; 6 and 12 months) aimed to identify distinct pain-time trajectories. Baseline psychosocial vulnerability was characterized by z-score transformation, a higher score representing a more vulnerable patient. A total of 89 patients were included (59.3 ± 10.7 years). Two trajectories of pain were identified—“Transient Pain trajectory” (TP) (39/89 patients) and “Persistent Pain trajectory” (PP) (50/89). A significant difference of pain over time between trajectories (PP vs. TP at 6 months: 2.23 ± 0.23 vs. 0.27 ± 0.09, p < 0.001) was observed. Psychosocial vulnerability showed a large effect size (d, −0.82; 95% CI, −1.25 to −0.38; p < 0.001) and a higher score in “Persistent pain trajectory” (PP vs. TP: 0.12 ± 0.36 vs. −0.14 ± 0.26, p < 0.001). A predictive vulnerability marker of pain development is proposed and could be used at cancer diagnosis to orientate the care pathway of patients experiencing breast cancer.

Douleur & Analgésie, première revue internationale francophone consacrée à la douleur, dont le champ de son expertise s'étend de la recherche fondamentale à la clinique tant sur le plan de l'évaluation de la douleur que de ses traitements.

Background: Ketamine use for chronic pain and depression has increased worldwide, but sex differences in its efficacy and safety have been little studied; this study examines existing evidence to address this gap. Methods: A prospective, multicenter, one-year observational study in 585 chronic pain patients was performed; 256 patients had one administration of ketamine and 329 had two or more. The primary outcome looked at was mean pain intensity (0–10), assessed every month for 1 year by telephone. Secondary outcomes included measures of depression and anxiety (assessed using the Hospital Anxiety and Depression Scale), quality of life (evaluated with the 12-item Short Form Health Survey), total ketamine dosage, reported adverse effects, and concomitant treatments. Platform of Clinical Investigation, No sex or age differences were observed in ketamine efficacy in terms of pain (mean variation in women vs. men; effect size −0.5 (95% confidence interval −0.6 to −0.4) vs. −0.5 (95% confidence interval −0.7 to −0.3), p = 0.248) or the evolution of anxiety (p = 0.135) among the 585 patients. Women reported more adverse events than men (19% vs. 13%, p = 0.002). In the subgroup of 329 patients, no differences were observed in any variables, but a single ketamine administration may be more useful in men than in women (p = 0.032), especially in younger men (p = 0.045). Conclusions: Repeated ketamine administration displayed no sex or age differences in efficacy in the treatment of pain, anxiety or depression.

Background: In older persons, pain prevalence is estimated to range between 22% and 80%. In nursing home residents, underevaluated pain is common despite pain management quality indicators. This study aims to assess neuropathic pain (NP) prevalence, NP evaluation and treatment, and healthcare professionals’ practices and needs to optimise NP management. Methods: This study received ethical approval [IRB number 2023‐CF230]. In order to obtain data from healthcare professionals working in nursing homes, an online survey was conducted on REDCap software between 4 March 2024 and 28 June 2024. The survey was divided into 3 sections: (1) prevalence of NP, (2) assessment of the four steps of the NP management algorithm (detection, evaluation, treatment and re‐evaluation), (3) awareness and needs. Results: Responses to the survey came from nine nursing homes, for a total of 841 residents, half of them aged between 75 and 85 years The prevalence of NP was 8.5% [4.2; 12.7]. The clinical pertinence of each step of the algorithm showed good satisfaction (mean ± SD, 7.9 ± 1.5). A large majority of participants (96.8%) expressed the need to receive a specific training on NP management in their care setting. Conclusion: The prevalence of NP is close to that described in the literature, but appears to be underestimated by the participants because of diagnostic issues. The decision‐making algorithm proposed to the teams has shown good results in terms of its usefulness in current practice. The survey also highlighted the need for training in this field to optimise NP management. Significance: This survey highlights the underestimated prevalence of neuropathic pain because of lack of diagnosis issues. A 4‐step algorithm (detection, evaluation, treatment and re‐evaluation) was proposed and validated by healthcare professionals for neuropathic pain management with good results in terms of its usefulness for current practice. Results unveils the still unmet needs for information and training of nursing homes healthcare professionals and medical/nursing students as regards neuropathic pain assessment and treatment.