{
  "abstract": "Educational attainment is commonly used as a proxy for cognitive reserve, but whether associations between central pain-related biomarkers and acute postoperative pain differ across educational strata remains unclear. We examined associations of preoperative cerebrospinal fluid (CSF) acetylcholine (ACh), brain-derived neurotrophic factor (BDNF), and interleukin-1 beta (IL-1β) with postoperative pain and explored whether their shapes differed by educational attainment. This cross-sectional study included 160 adult male participants in China who underwent anterior cruciate ligament reconstruction between September 2014 and January 2016. Educational attainment was categorized as <15 or ≥15 years. Acute postoperative pain was assessed using a visual analog scale (VAS). CSF ACh, BDNF, and IL-1β were quantified by ELISA. Associations with VAS scores were examined using multivariable linear regression, generalized additive models (GAMs), and exploratory two-piecewise linear regression. Eighty participants were included in each educational stratum. Linear regression identified an association between IL-1β and VAS scores (P=0.003), but not ACh (P=0.313) or BDNF (P=0.086). GAMs showed significant smooth-term associations for ACh (edf=1.017, P=0.015), BDNF (edf=2.000, P=0.023), and IL-1β (edf=4.454, P=0.004). The ACh function was essentially linear, whereas BDNF and IL-1β showed greater curvature. Education-stratified curves appeared flatter in the higher-education group. Two-piecewise models did not significantly improve model fit over standard linear models within educational strata (all likelihood-ratio P>0.05), providing no robust evidence of discrete thresholds. Preoperative CSF ACh, BDNF, and IL-1β were associated with postoperative pain patterns that differed in shape, with the clearest nonlinearity observed for BDNF and IL-1β. Differences across educational strata should be considered exploratory and require confirmation in larger, prospectively powered studies.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Anesthesiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, People's Republic of China.",
    "Department of Anesthesiology, the Third Affiliated Hospital of Inner Mongolia Medical University, BaoGang Hospital, Baotou, 014010, People's Republic of China.",
    "Development and Reform Division, Xinjiang Medical University, Urumqi, 830017, People's Republic of China.",
    "Medical Neurobiology Lab, Inner Mongolia Medical University, Huhhot, 010110, People's Republic of China.",
    "Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, 361021, People's Republic of China.",
    "School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, People's Republic of China.",
    "Beijing Hui-Long-Guan Hospital, Capital Medical University, Beijing, 100096, People's Republic of China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Xiaoyu Yang"
    },
    {
      "affs": [
        1
      ],
      "name": "Lidong Su"
    },
    {
      "affs": [
        2
      ],
      "name": "Tiantian Kong"
    },
    {
      "affs": [
        3
      ],
      "name": "Ruyue Li"
    },
    {
      "affs": [
        3
      ],
      "name": "Han Wang"
    },
    {
      "affs": [
        4
      ],
      "name": "Ligang Shan"
    },
    {
      "affs": [
        5
      ],
      "name": "Yanlong Liu",
      "orcid": "0000-0001-8733-8028"
    },
    {
      "affs": [
        6
      ],
      "name": "Fan Wang",
      "orcid": "0000-0002-7048-8166"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/73adgkf4wbbs4.bib",
  "cited_by": 0,
  "doi": "10.2147/jpr.s634240",
  "fulltext_url": "https://europepmc.org/articles/PMC13715845",
  "id": "73adgkf4wbbs4",
  "issns": [
    "1178-7090"
  ],
  "landing_url": "https://europepmc.org/article/MED/42953803",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2746|Anesthesia and Pain Management"
    ]
  ],
  "openalex": "W7223389501",
  "pdf_url": "https://europepmc.org/articles/PMC13715845?pdf=render",
  "pmcid": "PMC13715845",
  "pmid": "42953803",
  "published": "2026-10-24",
  "publisher": "Dove Press",
  "ris": "https://research.draconitic.com/paper/73adgkf4wbbs4.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:20:40Z",
      "native_id": "MED:42953803",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42953803"
    },
    {
      "first_seen": "2026-11-01T12:23:02Z",
      "native_id": "PMC13715845",
      "source": "pmc",
      "url": "https://doi.org/10.2147/jpr.s634240"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Anesthesia and Pain Management",
      "subfield": "surgery"
    }
  ],
  "title": "Associations of Preoperative Cerebrospinal Fluid Acetylcholine, BDNF, and IL-1β with Acute Postoperative Pain Across Educational Strata.",
  "title_text": "Associations of Preoperative Cerebrospinal Fluid Acetylcholine, BDNF, and IL-1β with Acute Postoperative Pain Across Educational Strata.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:23:02Z",
  "url": "https://research.draconitic.com/paper/73adgkf4wbbs4",
  "venue": "Journal of pain research",
  "versions": []
}