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Pain in vulnerable groups

Guest edited by: Dr. Line Iden BergeDr. Emily Harrop, Prof. Bettina S. Husebø, Dr. Christina Liossi, Dr. Monica Patrascu

Submission Status: Closed   |   Submission Deadline: 20 April 2024

Pain is “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage or described in terms of such damage” (IASP, 2020). Estimates suggest that at least one-quarter of people experience long-term persistent pain - an often invisible and misunderstood source of disability that affects one's ability to live, function and work. Healthcare systems are not set up or resourced to deal with such a prevalently overwhelming condition, so therapeutic advances are urgently required. 

Pain does not discriminate by age, group or sex. We know biologically that inflammatory pathways differ by sex, hormonal state, or even during pregnancy. Effective opioids are analgesic yet have contributed destructively towards addictive epidemics. The United Nations Office of Drugs and Crime World Drug Report (2019) highlights the “global paradox of too much and not enough” and describes the difficulty of ensuring appropriate access to controlled substances for medical and scientific purposes while preventing diversion and misuse.  There is also an increase in long-lasting usage of pain medication in vulnerable patient groups without proper clinical assessment. Even the use of nonsteroidal anti-inflammatory drugs may prolong recovery from acute inflammation. Psychosocial (e.g., patient education, cognitive behavioral therapy, clinical hypnosis) and non-pharmacological treatment approaches are increasingly prescribed despite limited evidence. Formerly established facts are being questioned, and the pain field faces a quandary.  

Vulnerable groups, such as children, older adults or those with life-limiting conditions, are especially at risk to this complex condition. Pain in children differs from that in adults for physiological, cognitive, developmental, and social reasons. The child’s developmental processes, cognitive ability, and education level lead to essential differences in their perceptions of and ability to express pain. Meanwhile, persons with advanced cognitive impairment, such as dementia or Parkinson’s disease, cannot report the intensity, location, and duration of pain, the effect of pain treatment or its potential side effects. In these groups, pain assessment is now performed through proxy rating, which has low validity but high placebo effect in controlled trials. Moreover, untreated pain in people with neurological conditions may trigger behavioral and psychological disturbances (such as agitation, depression, psychosis, and sleep disturbances), leading to increased psychotropic drug prescriptions.

Ethnic, gender, and socioeconomic disparities exist in pain diagnostics management too. When experiencing pain, women wait longer to be assessed, are prescribed less effective painkillers, and wait longer to receive these medications than their male counterparts. Knowledge gaps and biases are prevalent, and better research is needed to address these long-existing healthcare inequalities.

Considering current controversies and unknowns, BMC Medicine launched this Call for Papers to welcome outstanding contributions on Pain in Vulnerable Groups. Five Guest Editors with diverse backgrounds and expertise ensemble to tackle this important cross-disciplinary topic. We’ll commission content from low-middle income and vulnerable population settings, so relevant communities are heard and served.

We are particularly interested in papers that fall under the following topics:

  • Understand how internal/external factors influence pain in vulnerable populations
  • Controversies in pain research and treatment
  • Clinical interventions in at-risk groups including rheumatic, musculoskeletal, autoimmune, oncological, pediatric, neurological, and palliative care
  • Reporting of healthcare inequalities in pain diagnosis and/or management
  • Community care that humanizes and targets chronic pain
  • Psychosocial and psychological aspects of pain
  • Identifying novel mechanisms and strategies in nociception and analgesia
  • Translational innovations linking mechanisms to therapies
  • Tailored approaches to personalized medicine
  • Novel methods or technologies to recognize and estimate pain and the effect of pain treatment
  • Efficacy of non-pharmacological pain interventions based on large-scale controlled trials
  • Digital phenotyping linking clinical and/or digital biomarkers to pain
  • Systematic reduction of unnecessary pain medication investigated by controlled trials
  • Systematic placebo-controlled or blinded pain medication reduction studies

Pain in particularly vulnerable groups of children, such as:

  • vulnerable children such as those with developmental or intellectual disabilities, exposed to trauma or challenging life experiences, living in humanitarian settings, and with comorbid mental health conditions
  • children with life-limiting conditions or those requiring end-of-life pain management both in inpatient settings and in the community

BMC Medicine encourages submissions of front matter articles and original research, including clinical trials (phase I - III, randomized-controlled, either positive or negative trials), epidemiological studies (retrospective or prospective), systematic reviews and meta-analyses, medical imaging or genomics studies, biomarkers, and translational research. 

Patient perspectives and studies incorporating patient and public involvement (PPI) are particularly of interest. We also welcomed outstanding mechanistic laboratory studies that provide superb translational insights into the future of pain diagnostics and management.

We welcome the direct submission of original research within the article collection's scope. Please submit directly to BMC Medicine, indicating in your cover letter that you are targeting this collection. Alternatively, you can email a pre-submission query to the editorial team at The collection will remain open and accept submissions up to one year after launch. Articles will be published as soon as they are proofed post-acceptance.

Guest Editors provide guidance on the scope of this collection, advice on commissioned content, and editorial recommendations. However, they are not involved in the final editorial decision-making on papers submitted to this collection. All final editorial decisions are with the Editor-in-Chief, Dr. Lin Lee.

Meet the Guest Editors

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Prof Bettina S. Husebø: University of Bergen, Norway
Prof. B.S. Husebø, MD, PhD, is a specialist in anesthesiology, intensive and palliative care, nursing home medicine, and a postgraduate at Harvard University. Husebø is the leader of the Centre for Elderly and Nursing Home Medicine and head of Innovation, University of Bergen. Her research is focused on method development and randomized controlled intervention trials, including nursing home patients with complex chronic conditions and home-dwelling people with dementia. The assessment and treatment of pain, neuropsychiatric and behavioral disturbances, medication reviews, and end-of-life care are key. Her recent work involves a transdisciplinary approach on technology, smart living, and QoL. In the Lancet Commission on The Value of Death, she focused on end-of-life care in dementia.  

Prof Christina Liossi: University of Southampton, UK
Prof Christina Liossi is a paediatric psychologist and one of the world experts in paediatric pain. She has worked as an academic and clinician in the UK and abroad and has cared for children with various chronic medical conditions including cancer, cystic fibrosis, chronic kidney disease, epidermolysis bullosa, and sickle cell disease. Christina has contributed to national and international evidence-based guidelines on acute and chronic paediatric pain, pain in epidermolysis bullosa and sedation in children. She is currently Chair of the NIHR Pain and Palliative Care Clinical Studies Group. Christina’s randomized controlled clinical trials have been critical to the establishment of hypnosis as an evidenced-based intervention in the care of children with cancer.

Dr Emily Harrop: Helen & Douglas House, Oxford University Hospitals, UK
Emily has been a Consultant in Paediatric Palliative Care at Helen & Douglas House Hospices since 2010, and the Medical Director since 2019. She is also an Honorary Consultant at Oxford University Hospitals NHS Trust.  She is active in research in the field of pain & symptom management and mentors postgraduate research students in the field of palliative medicine. Emily undertook her specialist palliative care training at Great Ormond Street Hospital (including a post graduate diploma in Palliative Medicine); before this she completed a PhD in Neuroscience (Infant Pain) as well as some postgraduate training in Paediatric Clinical Pharmacology. Her other roles include Research Lead of the Association of Paediatric Palliative Medicine (APPM) and joint Chair of the Thames Valley Paediatric Palliative Care Network (TVPCN). Emily has acted as the Co-chair of the WHO Guidelines on the management of chronic pain in children (2020) and the Deputy Chair of the NICE Clinical Guideline Development Group for End-of-Life care in Babies, Children & Young People (NG61). She is currently co-Clinical Lead for CYP Palliative and End of Life Care in NHS South East England. 

Dr Line Iden Berge: University of Bergen, Norway
Line Iden Berge is (2006) and PhD in epidemiology (2014), both from UiB, and has a specialist degree in psychiatry (2017) after residency training in Helse-Bergen. In 2019 she started a 4 year 50% post-doc position at Centre for Elderly and Nursing Home Medicine (SEFAS) at Department of Global Hublic health and Primary Care, combined with 50% position as old age psychiatrist at NKS Olaviken. She works with the LIVE@Home.Path trial, a NFR funded mixed method randomized controlled trial of a municipal intervention to support home dwelling persons with dementia and their caregivers, main outcome resource utilization and caregiver burden, and she supervises two PhD candidates in this project. Main research area are neuropsychiatric symptoms and psychopharmacological treatment in dementia, and psychiatric-somatic comorbidity.

Dr Monica Patrascu: University of Bergen, Norway
Monica Patrascu received a PhD in Systems Engineering in 2012 and is specialized in intelligent systems. Currently, they are working on modeling complex biosystems, from cognitive decisional processes to agent-based models of misinformation spread. In particular, Monica works with unobtrusive wearable monitoring applied to neurodegenerative diseases, developing digital biomarkers for symptom tracking in real-world everyday life for persons Parkinson’s disease and developing digital phenotyping algorithms to recognize trajectories at the end of life, including pain detection, for persons with dementia.

  1. Cerebral palsy (CP), the most common physical disability of childhood, is often accompanied by a range of comorbidities including pain. Pain is highly prevalent in children and young people with CP, yet has be...

    Authors: Adrienne Harvey, Nadine Smith, Meredith Smith, Katarina Ostojic and Carolyn Berryman
    Citation: BMC Medicine 2024 22:238
  2. Sleep loss is a common public health problem that causes hyperalgesia, especially that after surgery, which reduces the quality of life seriously.

    Authors: Yulin Huang, Rui Xu, Qi Liu, Xiao Zhang, Yanting Mao, Yan Yang, Xiaoping Gu, Yue Liu and Zhengliang Ma
    Citation: BMC Medicine 2024 22:189
  3. The prevalence of depression among people with chronic pain remains unclear due to the heterogeneity of study samples and definitions of depression. We aimed to identify sources of variation in the prevalence ...

    Authors: Lingxiao Chen, Claire E Ashton-James, Baoyi Shi, Maja R Radojčić, David B Anderson, Yujie Chen, David B Preen, John L Hopper, Shuai Li, Minh Bui, Paula R Beckenkamp, Nigel K Arden, Paulo H Ferreira, Hengxing Zhou, Shiqing Feng and Manuela L Ferreira
    Citation: BMC Medicine 2024 22:167
  4. Chronic low back pain (CLBP) is a significant problem affecting millions of people worldwide. Three widely implemented psychological techniques used for CLBP management are cognitive therapy (CT), mindfulness ...

    Authors: Melissa A. Day, Marcia A. Ciol, M. Elena Mendoza, Jeffrey Borckardt, Dawn M. Ehde, Andrea K. Newman, Joy F. Chan, Sydney A. Drever, Janna L. Friedly, John Burns, Beverly E. Thorn and Mark P. Jensen
    Citation: BMC Medicine 2024 22:156
  5. To combat the opioid crisis, interventions targeting the opioid prescribing behaviour of physicians involved in the management of patients with chronic non-cancer pain (CNCP) have been introduced in clinical s...

    Authors: Katya Peri, Lucy Honeycutt, Erica Wennberg, Sarah B. Windle, Kristian B. Filion, Genevieve Gore, Irina Kudrina, Elena Paraskevopoulos, Areesha Moiz, Marc O. Martel and Mark J. Eisenberg
    Citation: BMC Medicine 2024 22:76
  6. Effective pain control is crucial to optimise the success of medical procedures. Immersive virtual reality (VR) technology could offer an effective non-invasive, non-pharmacological option to distract patients...

    Authors: Jhia J. Teh, Dominic J. Pascoe, Safiya Hafeji, Rohini Parchure, Adam Koczoski, Michael P. Rimmer, Khalid S. Khan and Bassel H. Al Wattar
    Citation: BMC Medicine 2024 22:64
  7. Long-term opioid use is associated with dependency, addiction, and serious adverse events. Although a framework to reduce inappropriate opioid prescribing exists, there is no consensus on prescribing indicator...

    Authors: Neetu Bansal, Stephen M. Campbell, Chiu-Yi Lin, Darren M. Ashcroft and Li-Chia Chen
    Citation: BMC Medicine 2024 22:5
  8. Vulnerable older adults living with Alzheimer’s disease or Alzheimer’s disease and related dementia (AD/ADRD) and chronic pain generally receive fewer pain medications than individuals without AD/ADRD, especia...

    Authors: Ulrike Muench, Kyung Mi Kim, Zachary Zimmer and Todd B. Monroe
    Citation: BMC Medicine 2023 21:446
  9. Infants born very and extremely premature (V/EPT) are at a significantly elevated risk for neurodevelopmental disorders and delays even in the absence of structural brain injuries. These risks may be due to ea...

    Authors: Kevin M. Cook, Josepheen De Asis-Cruz, Jung-Hoon Kim, Sudeepta K. Basu, Nickie Andescavage, Jonathan Murnick, Emma Spoehr, Melissa Liggett, Adré J. du Plessis and Catherine Limperopoulos
    Citation: BMC Medicine 2023 21:435
  10. Self-harm is an important predictor of a suicide death. Culturally appropriate strategies for the prevention of self-harm and suicide are needed but the evidence is very limited from low- and middle-income cou...

    Authors: Nusrat Husain, Tayyeba Kiran, Imran Bashir Chaudhry, Christopher Williams, Richard Emsley, Usman Arshad, Moin Ahmed Ansari, Paul Bassett, Penny Bee, Moti Ram Bhatia, Carolyn Chew-Graham, Muhammad Omair Husain, Muhammad Irfan, Ayesha Khaliq, Fareed A. Minhas, Farooq Naeem…
    Citation: BMC Medicine 2023 21:282
  11. Chronic musculoskeletal pain has been linked to dementia; however, chronic pain typically occurs in multiple sites; therefore, this study was to investigate whether greater number of chronic pain sites is asso...

    Authors: Jing Tian, Graeme Jones, Xin Lin, Yuan Zhou, Anna King, James Vickers and Feng Pan
    Citation: BMC Medicine 2023 21:169
  12. Rheumatoid arthritis (RA) is a chronic inflammatory disease that is associated with joint pain and stiffness. Biologics represent some of the most effective treatments for RA, but previous guidance from the Na...

    Authors: Peter C. Taylor, Ayman Askari, Ernest Choy, Michael R. Ehrenstein, Sara Else and Muhammad K. Nisar
    Citation: BMC Medicine 2023 21:55
  13. Understanding the relationship between chronic pain conditions and suicidal behavior—suicide attempt, other intentional self-harm, and death by suicide—is imperative for suicide prevention efforts. Although ch...

    Authors: C. Chen, E. Pettersson, A. G. Summit, K. Boersma, Z. Chang, R. Kuja-Halkola, P. Lichtenstein and P. D. Quinn
    Citation: BMC Medicine 2023 21:9
  14. Severe postoperative pain not only is a considerable burden for patients but also leads to overprescription of opioids, resulting in considerable health concerns. The remarkable development of new technologies...

    Authors: Julia Stuhlreyer, Christian Roder, Florian Krug, Christian Zöllner, Herta Flor and Regine Klinger
    Citation: BMC Medicine 2022 20:469
  15. Oral mucositis (OM) in patients receiving cancer therapy is thus far not well managed with standard approaches. We aimed to assess the safety and effectiveness of methylene blue (MB) oral rinse for OM pain in ...

    Authors: Carlos J. Roldan, Billy Huh, Juhee Song, Yago Nieto, Joyce Osei, Thomas Chai, Kent Nouri, Lakshmi Koyyalagunta and Eduardo Bruera
    Citation: BMC Medicine 2022 20:377