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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Rehabilitation".

Deadline for manuscript submissions: closed (20 July 2026) | Viewed by 4391

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Dr. Elena Makovac

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Department of Psychology, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
Interests: pain; autonomic nervous system; anxiety; heart rate variability; pain catastrophising; interoception; fMRI

Special Issue Information

Dear Colleagues,

The field of brain-body interactions in pain and their therapeutic interventions has made remarkable progress in recent years. Various pain conditions, previously difficult to manage or understand in a holistic context, are now being explored through an integrated approach that considers both the physiological and psychological aspects of pain. A key aspect of this interaction is interoception—the brain's ability to perceive and process internal bodily sensations. This awareness of internal bodily states influences emotional responses, pain perception, and can impact therapeutic effectiveness. The consequent development of mind-body interventions has opened new possibilities for managing chronic pain. In this Special Issue, we invite authors to submit papers exploring the clinical advances in understanding brain-body interactions in pain. We also welcome research on the application and effectiveness of mind-body interventions that target both the physiological and emotional components of pain through integrated and innovative approaches.

Dr. Elena Makovac
Guest Editor

Manuscript Submission Information

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Keywords

chronic pain
pain perception
brain-body interactions
therapeutic effectiveness
integrated approach

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Published Papers (7 papers)

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Research

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19 pages, 2019 KB

Open AccessArticle

Multimodal Non-Surgical Management for Chronic Low Back Pain: A 5-Year Cohort Study from a Tertiary Spine Center in Northwest China

by Bolong Zheng, Hua Hui, Liang Yan and Baorong He

J. Clin. Med. 2026, 15(16), 6497; https://doi.org/10.3390/jcm15166497 - 21 Aug 2026

Viewed by 177

Abstract

Background/Objectives: Chronic low back pain (CLBP) is the leading global cause of years lived with disability, but long-term real-world evidence for non-surgical management remains scarce, particularly in low- and middle-income countries. This study aimed to describe 5-year trajectories of pain, disability, healthcare utilization, patient satisfaction, and surgical conversion among patients with non-specific CLBP initially managed non-surgically at a tertiary spine center in Northwest China. We also compared long-term outcomes between unimodal therapy and multidisciplinary biopsychosocial care and examined baseline demographic, clinical, and psychosocial predictors of treatment success and conversion to surgery. Methods: We conducted a 5-year retrospective cohort study of consecutive patients with non-specific CLBP at a tertiary spine center in Northwest China. Of 485 consecutive patients screened for eligibility, 420 were enrolled and were compared on the basis of unimodal therapy with multidisciplinary biopsychosocial care. Primary outcomes were pain (Numerical Pain Rating Scale, NPRS) and disability (Oswestry Disability Index, ODI), analyzed using linear mixed-effects models; predictors of surgical conversion were identified via multivariable Cox regression. Results: Of the 420 patients, 352 (83.8% retention) completed the 5-year follow-up. Both pain and disability improved substantially during the first 12 months. Thereafter, pain intensity increased slightly (NPRS from 4.8 to 5.4), whereas functional disability continued to improve (ODI from 31.7 to 26.5). Early multidisciplinary care was associated with sustained superior outcomes (adjusted functional disability (ODI) difference: −8.2 points at 5 years) and a 42% lower observed risk of surgery (HR = 0.58). The cumulative 5-year surgical rate was 14.2%, with high pain catastrophizing as the strongest independent predictor (HR = 3.10). Conclusions: In patients with non-specific CLBP, non-surgical management yields substantial 12-month gains; function continues to improve through 5 years, while pain shows partial recurrence. Early multidisciplinary biopsychosocial care was associated with more durable outcomes and lower surgical conversion; because treatment was not randomized, these associations warrant confirmation in pragmatic trials and support routine psychosocial screening and stratified care. Full article

(This article belongs to the Special Issue Advances in Chronic Pain Research and Therapy)

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17 pages, 1009 KB

Open AccessArticle

Body Perception Disturbances in Chronic Limb Pain: Exploring Different Assessment Tools and Their Associations with Upper- and Lower-Limb Disability in a Cross-Sectional Study

by Hana Karpin, Irit Weissman-Fogel, Anatoly Livshitz, Yishai Bachar Kirshenboim and Jean Jacques Vatine

J. Clin. Med. 2026, 15(10), 3876; https://doi.org/10.3390/jcm15103876 - 18 May 2026

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Abstract

Background: Body perception disturbances (BPDs) are highly prevalent in chronic limb pain, manifesting as hostile feelings towards the limb, reduced sensory–motor function, and altered limb ownership. Various questionnaires and tests assess BPD, but their interrelation and associations with limb disability remain underexplored. This study aimed to evaluate BPD assessments, examine whether they capture overlapping or distinct aspects of BPD, and determine their associations with upper- and lower-limb disability. Methods: This observational cross-sectional study included 92 participants with chronic limb pain. Participants completed BPD questionnaires (Bath-BPD, Neurobehavioral) and tests (Laterality Recognition, Fingers/Toe Perception, Human Figure Drawing), along with clinical pain measures and the symptom severity index. Dependent outcomes were upper- and lower-limb disability. Results: Cluster analysis grouped all measures into ‘High’ and ‘Low’ BPD severity clusters, with overall cluster quality rated as fair (silhouette = 0.40). The Neurobehavioral questionnaire emerged as the primary contributor to the cluster structure (silhouette = 1). The ‘High’ BPD cluster showed significantly greater symptom severity (t(63) = −4.13, p < 0.001). Pain severity, Bath-BPD questionnaire, and symptom severity were significantly associated with upper-limb disability (p < 0.001), whereas pain intensity alone accounted for 24% of lower-limb disability variance. Conclusions: Despite the diversity of BPD assessments, the clustering pattern suggests a partial convergence between measures, though a weak cohesiveness of BPD tests indicates that they capture partially distinct aspects of body perception. BPD questionnaires were associated with upper-limb disability, whereas lower-limb disability was associated with pain intensity. These findings emphasize the importance of assessing BPDs in musculoskeletal care and suggest their potential role as indicators of symptom severity. Full article

(This article belongs to the Special Issue Advances in Chronic Pain Research and Therapy)

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18 pages, 713 KB

Open AccessArticle

Fascia-Focused Versus Conventional Physiotherapy for Chronic Low Back Pain and Comorbid Depression in Psychosomatic Inpatients

by Lea Overmann, Katharina Steinmeier, Andreas Brandl, Christoph Egner, Andrea Kreutzer, Sonia Gadea de Reckel, Petrilena-Sorina Floroiu, Silke Zimmermann, Daniel Stühn, Heike Geiß, Annette Kleeberg and Robert Schleip

J. Clin. Med. 2026, 15(10), 3698; https://doi.org/10.3390/jcm15103698 - 11 May 2026

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Abstract

Background: Chronic low back pain (CLBP) and depression often co-occur. This study compared a fascia-focused physiotherapeutic program with a conventional physiotherapeutic and relaxation-based program in psychosomatic inpatients with CLBP and comorbid depression. Methods: In this exploratory quasi-randomized study, 41 inpatients were allocated to a fascia-focused intervention group (n = 23) or a conventional active control group (n = 18). Over six weeks, the intervention group received Bowen therapy and fascia circuit training, whereas the control group received progressive muscle relaxation and strength circuit training. Outcomes were assessed at baseline and after rehabilitation. NRS pain intensity and BDI-II depressive symptom severity were the main clinically relevant outcomes; spinal function, tissue stiffness, pressure pain threshold, and craniovertebral angle were secondary or exploratory outcomes. Results: Both groups improved over time in pain intensity and depressive symptom severity. NRS scores decreased by 3.21 ± 2.61 points in the fascia-focused group and by 2.17 ± 2.34 points in the control group; BDI-II scores decreased by 9.30 ± 13.42 and 7.22 ± 8.57 points, respectively. Repeated-measures ANOVA confirmed significant time effects for NRS and BDI-II, with no significant group differences or time × group interactions. Significant time effects were also observed for thoracic tissue stiffness, lumbar and pelvic posture, thoracic and lumbar mobility, and pelvic stability. Conclusions: Fascia-focused and conventional physiotherapy showed similar observed effects in this exploratory quasi-randomized study. The absence of significant between-group differences should be interpreted cautiously because the study was not designed or powered to establish formal equivalence. Full article

(This article belongs to the Special Issue Advances in Chronic Pain Research and Therapy)

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12 pages, 527 KB

Open AccessArticle

The Effect of Intravenous Lidocaine Treatment on Sleep and Quality of Life in Fibromyalgia: An Observational Study

by Halil Ibrahim Altun and Fatma Aysen Eren

J. Clin. Med. 2026, 15(8), 2887; https://doi.org/10.3390/jcm15082887 - 10 Apr 2026

Viewed by 697

Abstract

Background/Objectives: Fibromyalgia is a painful syndrome with biopsychosocial components that predominantly affects middle-aged women. This study aimed to evaluate changes in sleep quality and quality of life following intravenous (IV) lidocaine treatment in patients with fibromyalgia (FM). Methods: This retrospective observational study included patients diagnosed with fibromyalgia who underwent intravenous lidocaine treatment at a tertiary pain clinic between June 2023 and June 2024 and had a Pittsburgh Sleep Quality Index (PSQI) score > 5. The patients’ demographic data, Fibromyalgia Impact Questionnaire (FIQ) scores at baseline and at 1 and 3 months post-treatment, Numerical Rating Scale (NRS-11) scores, Short Form-12 (SF-12) mental and physical component scores (MCS-12, PCS-12), and PSQI scores were recorded. Results: Overall, 51 patients were included. 92.2% of the patients were women, with a mean age of 41.6 ± 9.5 years. Statistically significant reductions in NRS-11, FIQ, and PSQI scores and increases in SF-12 component scores were observed at 1 and 3 months compared with baseline (p < 0.001). Negative correlations were found between NRS-11 and PCS-12 and MCS-12, and a positive correlation was found between FIQ and PSQI. Sleep quality showed a marked improvement at 1 month; however, attenuation of this benefit was observed at the 3-month follow-up. Conclusions: Sleep quality appeared to be associated with short-term functional outcomes, whereas pain intensity was associated with mid-term clinical status in patients with fibromyalgia. Prospective randomized controlled trials are required to confirm these findings and to determine optimal dosing and treatment schedules. Full article

(This article belongs to the Special Issue Advances in Chronic Pain Research and Therapy)

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10 pages, 203 KB

Open AccessArticle

Heart Rate Variability Mediates the Association Between Fear of Pain and Pain Perception: An Exploratory Study in Healthy Controls

by Alessandra Venezia, Harriet Fawsitt-Jones and Elena Makovac

J. Clin. Med. 2026, 15(5), 1705; https://doi.org/10.3390/jcm15051705 - 24 Feb 2026

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Abstract

Background/Objectives: Fear of pain (FoP) is a critical psychological factor influencing the experience of pain, yet the mechanisms behind this relationship remain unclear. HRV, indexed here by resting RMSSD, reflects individual differences in cardiac vagal tone and has been linked to pain perception and pain-related psychological processes. In this exploratory, cross-sectional study, we examined whether HRV mediates the relationship between FoP and the subjective perception of pain intensity. Methods: Twenty-two healthy participants completed several self-reported measures, including the Fear of Pain Questionnaire (FPQ-SF), and underwent an experimental cold pain induction, as well as a continuous recording of HR at rest. Mediation analysis was performed to assess the indirect effect of HRV, calculated via the Root Mean Square Successive Difference (RMSSD), on cold pain perception. Results: In correlational analyses, the Fear of Severe Pain (FoSP) subscale was associated with lower resting logRMSSD and higher cold pain ratings. In mediation models, the pattern of results was consistent with an indirect association between FoSP and cold pain ratings via logRMSSD (bootstrap 90% CI), while the direct path from FoSP to pain was not significant. Conclusions: These preliminary findings are hypothesis-generating and suggest that individual differences in resting HRV may be one physiological correlate of the fear–pain relationship in healthy controls, rather than an index of autonomic responses during pain itself. Larger longitudinal and experimental studies are needed to test temporal ordering, specificity across FoP components, and whether autonomic measures during pain better explain fear–pain coupling. Full article

(This article belongs to the Special Issue Advances in Chronic Pain Research and Therapy)

Other

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26 pages, 453 KB

Open AccessPerspective

Meditations on Methodological Issues in Clinical Investigations of “Central Sensitization” (Jonah XII)

by Shiloh Plaut

J. Clin. Med. 2026, 15(16), 6174; https://doi.org/10.3390/jcm15166174 - 9 Aug 2026

Viewed by 356

Abstract

This perspective paper addresses five methodological concerns in clinical investigations across the field of pain research and the paradigm of central sensitization. The first is the conflation of the phenomenon and the measurement tool: a patient reported outcome questionnaire called “Central Sensitization Inventory” is given as an example. Second, instruments that are used for measuring central sensitization (and its severity) are not validated to measure the phenomenon of central sensitization. The third is conceptual ambiguity regarding the theoretical framework of central sensitization and nociplastic pain, perpetuating the perception of central sensitization/nociplastic pain as both a phenomenon and a mechanism at the same time. The fourth is the conflation of clinical reasoning with scientific thinking, where in the former jumping from the mechanism to the phenomenon and vice versa is natural. The fifth is terminology issues such as “central-sensitivity syndromes” and “central sensitization-associated symptoms” when referring to fibromyalgia and similar conditions. In summary, by clinician-researchers confusing empirics with theory and theory with empirics and using clinical reasoning instead of scientific thinking, central sensitization becomes an axiom instead of a paradigm to be investigated according to hypothesis-driven studies. The failure to be aware of and clearly distinguish between these cognitive frameworks can lead to flawed research designs, inappropriate interpretations of findings, groundless mechanistic conclusions, and ultimately compromised clinical decision making. Full article

(This article belongs to the Special Issue Advances in Chronic Pain Research and Therapy)

16 pages, 1114 KB

Open AccessSystematic Review

Autonomic Dysfunction, Psychosocial Factors, and Pain Sensitivity in Persistent Spinal Pain: A Systematic Review

by Mahiques-Sanchis Alex, Alonso-Martín Mónica, Martínez-Soler Marta, Belda-Antolí Mariola, Benlloch-García Agustín, Huertas-Ramirez Borja, Yeste-Fabregat Mireia and Vicente-Mampel Juan

J. Clin. Med. 2026, 15(14), 5571; https://doi.org/10.3390/jcm15145571 - 16 Jul 2026

Viewed by 428

Abstract

Background/Objectives: Persistent spinal pain, including chronic low back pain (CLBP), chronic neck pain, and whiplash-associated disorders (WAD), is a highly prevalent musculoskeletal condition. The recent literature emphasizes a biopsychosocial framework, acknowledging that altered pain processing, psychological impairments, and autonomic nervous system dysfunction are associated with chronic pain. However, the concurrent within-sample relationships between these domains remain poorly understood and inconsistently reported. To systematically evaluate the associations among physiological autonomic measures, validated psychosocial scales, and pressure algometry in adults with persistent spinal pain. Methods: A systematic search was conducted in accordance with PRISMA guidelines. A systematic search was conducted across four electronic databases (PubMed, Web of Science, Scopus, and CINAHL) for studies evaluating all three domains within the same cohort. The search was restricted to peer-reviewed articles published in English and Spanish. Two independent blinded reviewers screened and selected the studies. Eligible studies evaluated within-sample relationships across three domains: autonomic indices (e.g., heart rate variability (HRV) and blood pressure (BP)), psychosocial factors (e.g., kinesiophobia and pain catastrophizing), and quantitative sensory testing (QST) (e.g., pressure pain threshold (PPTs)). Quality assessment was performed using the National Institutes of Health (NIH) tools. Due to significant methodological heterogeneity, the data were synthesized narratively. Results: Six studies fulfilled the eligibility criteria. The narrative synthesis revealed a preliminary pattern showing that objective functional outcomes and experimental pain processing tend to show closer associations with autonomic proxies (such as heart rate variability), whereas subjective clinical outcomes (such as perceived disability) are more consistently linked to psychosocial factors (such as kinesiophobia and catastrophizing). Conclusions: These preliminary findings suggest potentially distinct domain-specific associations rather than a uniform pathophysiological mechanism. Future specialized research and research-informed practice should incorporate multimodal assessments to better characterize individual patient profiles. Full article

(This article belongs to the Special Issue Advances in Chronic Pain Research and Therapy)

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