Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain

Problem Adaptation Therapy for Older Adults with Chronic Pain and Negative Emotions in Primary Care (PATH-Pain): A Randomized Clinical Trial

OBJECTIVE

To test the efficacy of Problem Adaptation Therapy for Pain (PATH-Pain) versus Usual Care (UC) in reducing pain-related disability, pain intensity, and depression among older adults with chronic pain and negative emotions.

DESIGN

RCT assessing the between-group differences during the acute (0-10 weeks) and follow-up (weeks 11-24) phase of treatment.

SETTING

A geriatrics primary care site.

PARTICIPANTS

100 participants (80 % females, Mean Age = 75.5) with chronic pain, negative emotions, and varying cognition (56 % had cognitive impairment) were randomly assigned to PATH-Pain (N = 49) or UC (N = 51).

INTERVENTIONS

PATH-Pain is a collaborative program which includes a psychosocial intervention designed to improve emotion regulation. UC participants received a booklet that described evidence-based self-management pain strategies.

MEASUREMENTS

Primary outcomes: Pain-related disability (Modified Roland-Morris Disability Questionnaire), and pain intensity.

SECONDARY OUTCOMES

Depression (Montgomery-Asberg Depression Rating Scale), emotion regulation (Emotion Regulation Questionnaire), and treatment satisfaction (Client Satisfaction Questionnaire).

RESULTS

During acute treatment (by Week 10), PATH-Pain vs. UC participants showed a significant decrease in pain-related disability [contrast mean difference (CMD) = -1.96, P = 0.02), CI [-0.47, -3.44]] and in depression severity (CMD = -2.50, P = 0.03, CI [-.0.23, -4.76]), but not in pain intensity. PATH-Pain (vs. UC) participants also demonstrated a significant improvement in expressive suppression, an aspect of emotion regulation (CMD = 2.120, P = 0.010, CI [.085, 4.155]). During follow-up (Week 11 to 24), there were no significant between-group differences in pain-related disability, pain intensity, or depression severity.

CONCLUSIONS

This primarycarebased study demonstrates the short-term efficacy of PATH-Pain versus UC in reducing pain-related disability and depression in older adults with comorbid chronic pain and negative emotions, as well as varying degrees of cognitive functioning.

Closed-Loop Infraslow Brain-Computer Interface can Modulate Cortical Activity and Connectivity in Individuals With Chronic Painful Knee Osteoarthritis: A Secondary Analysis of a Randomized Placebo-Controlled Clinical Trial

Introduction. Chronic pain is a percept due to an imbalance in the activity between sensory-discriminative, motivational-affective, and descending pain-inhibitory brain regions. Evidence suggests that electroencephalography (EEG) infraslow fluctuation neurofeedback (ISF-NF) training can improve clinical outcomes. It is unknown whether such training can induce EEG activity and functional connectivity (FC) changes. A secondary data analysis of a feasibility clinical trial was conducted to determine whether EEG ISF-NF training can significantly alter EEG activity and FC between the targeted cortical regions in people with chronic painful knee osteoarthritis (OA). Methods. A parallel, two-arm, double-blind, randomized, sham-controlled clinical trial was conducted. People with chronic knee pain associated with OA were randomized to receive sham NF training or source-localized ratio ISF-NF training protocol to down-train ISF bands at the somatosensory (SSC), dorsal anterior cingulate (dACC), and uptrain pregenual anterior cingulate cortices (pgACC). Resting state EEG was recorded at baseline and immediate post-training. Results. The source localization mapping demonstrated a reduction (P = .04) in the ISF band activity at the left dorsolateral prefrontal cortex (LdlPFC) in the active NF group. Region of interest analysis yielded significant differences for ISF (P = .008), slow (P = .007), beta (P = .043), and gamma (P = .012) band activities at LdlPFC, dACC, and bilateral SSC. The FC between pgACC and left SSC in the delta band was negatively correlated with pain bothersomeness in the ISF-NF group. Conclusion. The EEG ISF-NF training can modulate EEG activity and connectivity in individuals with chronic painful knee osteoarthritis, and the observed EEG changes correlate with clinical pain measures.

Informal caregivers' burden and chronic pain in older adults: a dyadic study unveiling the correlation and its impact

BACKGROUND AND AIMS

Older adults' chronic pain care includes assisting with daily activities and exercise. But the informal caregivers have stated different challenges in the caring process. This study aims to explore the chronic pain situations of older adults, the burden of their informal caregivers, and the correlation between the severity of chronic pain in older adults and the level of burden experienced by their caregivers.

METHODS

A total of 150 older adults (mean age: 65.44) with chronic pain and 150 informal caregivers (mean age: 41.06) were recruited for this study. Older adults completed the brief pain inventory and pain self-efficacy questionnaire. Depression, anxiety, stress, and activities of daily living were assessed. Informal caregivers also completed the caregiver burden inventory.

RESULTS

150 informal caregivers completed the questionnaire. The mean caregiver burden score was 3.73, positively associated with pain conditions and emotional tolls in older adults.

CONCLUSION

The findings highlight the need for healthcare professionals to address the physical and emotional burdens experienced by informal caregivers. Healthcare professionals should investigate the caregiver burden. Comprehensive support strategies should be developed to enhance the well-being of both older adults and their caregivers, ultimately improving pain management and quality of life.

Buprenorphine, Pain, and Opioid Use in Patients Taking High-Dose Long-Term Opioids: A Randomized Clinical Trial

Importance

Guidelines recommend dose reduction or discontinuation of long-term opioid therapy when harm outweighs benefit, but strategies to help patients do so are limited.

Objective

To test optionally switching to buprenorphine as a strategy for improving pain and reducing opioids among patients prescribed high-dose, full agonist long-term opioid therapy.

Design, Setting, and Participants

In this pragmatic, multisite, 12-month randomized clinical trial with masked outcome assessment, patients treated at Veterans Affairs primary care clinics were recruited from October 2017 to March 2021, with follow-up completed June 2022. Eligible patients had moderate to severe chronic pain despite high-dose opioid therapy (≥70 mg/d for at least 3 months). Patients were randomized to having the option to switch to buprenorphine or not having the option to switch.

Interventions

The buprenorphine option was discussed with eligible patients as part of a larger trial of collaborative pain care interventions. Those who switched had structured follow-up to optimize dosing and address adverse effects.

Main Outcomes and Measures

The primary outcome was Brief Pain Inventory total score at 12 months. The main secondary outcome was opioid dose in morphine milligram equivalents at 12 months.

Results

Of 207 included participants, 185 (89.4%) were male, and the mean (SD) age was 60.9 (10.2) years. A total of 104 were randomized to the buprenorphine option and 103 to the no buprenorphine option. In the buprenorphine option arm, 27 participants (26.0%) switched. Over 12 months, the mean (SD) Brief Pain Inventory score improved from 6.8 (1.5) to 6.1 (1.9; adjusted mean difference [AMD], -0.59; 95% CI, -0.89 to -0.29) in the buprenorphine option arm and from 6.8 (1.6) to 6.3 (1.7; AMD, -0.50; 95% CI, -0.81 to 0.20) in the no option arm (between-group AMD, -0.09; 95% CI, -0.52 to 0.34). Over 12 months, mean (SD) opioid dosage decreased from 157 (75) mg/d to 94 (98) mg/d in the buprenorphine option arm (AMD, -61.0 mg/d; 95% CI, -74.1 to -47.9) and from 165 (88) mg/d to 107 (89) mg/d (AMD, -58.5 mg/d; 95% CI, -71.6 to -45.4) in the no option arm (between-group AMD, -2.5 mg/d; 95% CI, -21.1 to 16.0).

Conclusions and Relevance

In this trial, outcomes did not differ between groups; both had small improvements in pain and substantial reductions in opioid dosage, but the proportion of participants who switched to buprenorphine was low.

Trial Registration

ClinicalTrials.gov Identifier: NCT03026790.

Development and Psychometric Evaluation of the Swallowing Satisfaction Scale (SSS)

The purpose of the current study was to develop a new scale to assess a level of satisfaction associated directly with swallowing ability. First, by interviewing 10 adults with dysphagia, 10 experts, as well as reviewing literature, the initial version of the swallowing satisfaction scale (SSS) was developed. The content validity of the SSS was evaluated using two qualitative and quantitative methods and expert opinions. The qualitative method was also used to determine face validity through interviews with 10 adults with dysphagia. Finally, the reliability of the scale was assessed by determining the values of internal consistency and test-retest reliability. Interviews with patients with swallowing disorders and experts in the field of dysphagia, as well as a literature review, led to the development of an initial version of the SSS with 36 items. After determining content and face validity, the number of items in the scale was reduced to 24. The calculation of Cronbach's alpha coefficient with participation of 53 patients with dysphagia showed the appropriate internal consistency of the SSS (0.968). Moreover, the ICC coefficient of the scale score in the test-retest phase was 0.983 and the ICC of each scale item was between 0.87 and 0.98. In this study, a suitable tool was developed to evaluate the level of satisfaction associated directly with swallowing ability in individuals with dysphagia, and its psychometric properties were investigated. The SSS is a valid and reliable tool with 24 items that can be used by therapists and researchers for clinical or research purposes.

Exploring the associations between the biomechanical and psychological mechanistic pathways of lower back pain development amongst persons with lower-limb amputation: A study protocol

INTRODUCTION

The global rise in lower-limb amputations is mainly due to diabetes and vascular complications. Amputations cause serious physical and psycho-social disabilities which impair locomotion and compromise patients quality of life. Biopsychosocial factors such as altered gait parameters, poor prosthetic fit, depression, fear avoidance behaviours and stigma increase the risk of individuals incurring lower back pain; the leading cause of secondary disability amongst persons with lower-limb amputation. Exploring the potential mechanistic pathways of lower back pain development is important to inform timely patient-centred programmes of care. Currently, limited information exists to inform the design of such programmes. Thus, there is a pressing need to understand the bio-behavioural, psychological, and social features of individuals with lower-limb amputation in the presence of lower back pain.

METHODS AND ANALYSIS

This proposed study protocol employs a prospective longitudinal study design that aims to explore the determinants of lower back pain amongst 30 adults with unilateral lower-limb amputation over 12-months. Biomechanical gait variables, trunk and lower-limb muscle activations, and objective pain measurements will be monitored every 3-months, and their relationship will be investigated. This information can be used to explore the characteristics of lower back pain and will inform future care management and rehabilitation processes. A data repository will be created and will be accessible through the University of Bath library website (https://library.bath.ac.uk/home).

TRIAL REFERENCE NUMBER

The study is registered at IRAS ID: 321729 and at ClinicalTrials.gov: NCT06243549.

Exploring the causal paths and longitudinal impact of telework on health: the TeleHealth survey-data linkage study protocol

BACKGROUND

The transition from traditional office work to telework has accelerated significantly since the late 20th century, especially in light of the COVID-19 pandemic. Despite its widespread adoption, the long-term health impacts of telework remain unclear. This study seeks to clarify the telework-health relationship by integrating longitudinal self-reported health data with health-related administrative records.

METHODS AND ANALYSIS

An online self-reported longitudinal survey with four follow-ups of 6 months each, starting in November 2024, will be set up and linked with administrative data sources. In total, a non-probabilistic sample of 5000 non-teleworkers and teleworkers will be recruited. This survey will mainly assess the effect of teleworking on mental (eg, depression and anxiety) and physical (eg, pain) health. Administrative data (eg, healthcare consumption contacts and socioeconomic status) will be extracted from Belgian administrative data sources (Statistics Belgium and the InterMutualistic Agency) for the same period. This administrative data will be linked to the survey data using the Social Security ID. The underlying relationships between telework and health will be analysed via regression models and mediation models embedded in the natural effects framework. The analysis will aim to (1) identify the impact of telework on self-reported health and administrative data, (2) identify the moderators and mediators between the telework-health relationship, (3) understand the long-term patterns of telework and health interaction and (4) predict the health outcomes of teleworkers. To mitigate biases associated with non-probabilistic samples and attrition, standardised probability weights scoring will be derived from the data.

ETHICS AND DISSEMINATION

This study involves human participants and has been approved by the Ethics Committee of Universitair Ziekenhuis Gent (Nr°. ONZ-2023-0630). The participants will participate in the study after signing an informed consent form. The study will be disseminated in academic journals, on (social) media and on the project website.

Validity and reliability of the Danish version of the Short Form Brief Pain Inventory

BACKGROUND

Pain is impacted by bio-psycho-social factors and is closely related to disability and poor quality of life. Therefore, a patient-reported outcome measure (PROM) is needed to capture these aspects effectively. The Short Form Brief Pain Inventory (SF-BPI) serves this purpose as a tool for pain assessment. However, the Danish translation (SFBPI-DK) has not undergone validation.

OBJECTIVE

Assess the validity and reliability of SFBPI-DK.

METHODS

In patients with spine-related pain, construct validity was tested using Confirmatory Factor Analysis (CFA) and convergent validity through correlations with EuroQol 5-domain 5-level (EQ-5D-5L), EQ-5D-5L VAS, Work Ability Score (WAS), and Insomnia Severity Index (ISI-7). Internal consistency was assessed with Cronbach's alpha. In individuals with musculoskeletal pain, test-retest reliability and Minimal Detectable Change (MDC) were evaluated. Floor and ceiling effects were reported for both groups.

RESULTS

In patients with spine-related pain (n = 329), construct validity of the SFBPI-DK was confirmed through CFA of a modified 3-factor structure. Convergent validity showed "fair" to "moderate strong" associations with EQ-5D-5L, EQ-5D-5L VAS, WAS, and ISI-7. Internal consistency was satisfactory (Cronbach's alpha 0.89-0.91). In individuals with musculoskeletal pain (n = 119), good temporal stability was demonstrated with ICCs of 0.76-0.88. The MDC for the Severity score, Interference score, and the Physical- and Affective Interference subscores were 3.37, 2.41, 3.57, and 4.01, respectively.

CONCLUSION

The SFBPI-DK is a valid tool for assessing pain in patients with persistent spine-related pain and a reliable tool for individuals with persistent musculoskeletal pain among Danish-speaking populations.

Care Models to Improve Pain and Reduce Opioids Among Patients Prescribed Long-Term Opioid Therapy: The VOICE Randomized Clinical Trial

Importance

Patients prescribed long-term opioid therapy for chronic pain often experience unrelieved pain, poor quality of life, and serious adverse events.

Objective

To compare the effects of integrated pain team (IPT) vs pharmacist collaborative management (PCM) on pain and opioid dosage.

Design, Setting, and Participants

This study was a pragmatic multisite 12-month randomized comparative effectiveness trial with masked outcome assessment. Patients were recruited from October 2017 to March 2021; follow-up was completed June 2022. The study sites were Veterans Affairs primary care clinics. Eligible patients had moderate to severe chronic pain despite long-term opioid therapy (≥20 mg/d for at least 3 months).

Interventions

IPT involved interdisciplinary pain care planning, visits throughout 12 months with medical and mental health clinicians, and emphasis on nondrug therapies and motivational interviewing. PCM was a collaborative care intervention involving visits throughout 12 months with a clinical pharmacist care manager who conducted structured monitoring and medication optimization. Both interventions provided individualized pain care and opioid tapering recommendations to patients.

Main Outcomes and Measures

The primary outcome was pain response (≥30% decrease in Brief Pain Inventory total score) at 12 months. The main secondary outcome was 50% or greater reduction in opioid daily dosage at 12 months.

Results

A total of 820 patients were randomized to IPT (n = 411) or PCM (n = 409). Participants' mean (SD) age was 62.2 (10.6) years, and 709 (86.5%) were male. A pain response was achieved in 58/350 patients in the IPT group (16.4%) vs 54/362 patients in the PCM group (14.9%) (odds ratio, 1.11 [95% CI, 0.74-1.67]; P = .61). A 50% opioid dose reduction was achieved in 102/403 patients in the IPT group (25.3%) vs 98/399 patients in the PCM group (24.6%) (odds ratio, 1.03 [95% CI, 0.75-1.42]; P = .85). Over 12 months, the mean (SD) Brief Pain Inventory total score improved from 6.7 (1.5) points to 6.1 (1.8) points (P < .001) in IPT and from 6.6 (1.6) points to 6.0 (1.9) points (P < .001) in PCM (between-group P = .82). Over 12 months, mean (SD) opioid daily dosage decreased from 80.8 (74.2) mg/d to 54.2 (65.0) mg/d in IPT (P < .001) and from 74.5 (56.9) mg/d to 52.8 (51.9) mg/d (P < .001) in PCM (between-group P = .22).

Conclusions and Relevance

Outcomes in this randomized clinical trial did not differ between groups; both had small improvements in pain and substantial reductions in opioid dosage.

Trial Registration

ClinicalTrials.gov Identifier: NCT03026790.

Assessing alexithymia in chronic pain: psychometric properties of the Toronto Alexithymia Scale-20 and Perth Alexithymia Questionnaire

Introduction

Alexithymia is elevated in chronic pain and relates to poor pain-related outcomes. However, despite concerns from other clinical populations, the psychometric properties of alexithymia measures have not been rigorously established in chronic pain.

Objective

This study examined the psychometric properties of the Toronto Alexithymia Scale-20 Item (TAS-20) and the Perth Alexithymia Questionnaire (PAQ) in adults with chronic pain.

Methods

An online sample of adults with chronic pain across the United States (N = 1453) completed the TAS-20, PAQ, and related questionnaires at baseline, 3-month follow-up, and 12-month follow-up.

Results

Both measures showed good temporal stability, convergent validity (with emotion regulation scores), divergent validity (with depression and anxiety scores), and criterion validity. Some concerns were raised about the TAS-20: the original 3-factor structure showed a poor model fit; the Externally Oriented Thinking subscale of the TAS-20 had poor factor loadings and unacceptable internal consistency; and, we identified several TAS-20 items that may slightly inflate the predictive validity of the TAS-20 on pain-related outcomes. The original 5-factor structure of the PAQ showed a good fit; each PAQ subscale had good factor loadings and excellent internal consistency.

Conclusions

Both the TAS-20 and PAQ had psychometric strengths. Our data raised some concern for the use of TAS-20 subscales; the PAQ may be a psychometrically stronger option, particularly for investigators interested in alexithymia subscale analysis in people with chronic pain.

Cognitive considerations for adults with sickle cell disease completing the brief pain inventory

Introduction

Accurate assessment of pain severity is important for caring for patients with sickle cell disease (SCD). The Brief Pain Inventory was developed to address limitations of previous pain-rating metrics and is available in a short form (BPI-SF). However, the BPI-SF is a self-report scale dependent on patient comprehension and interpretation of items.

Objective

To examine patterns in how patients completed the BPI-SF and determine whether incorrectly completing the BPI-SF was related to cognitive functioning or education.

Methods

A secondary analysis was completed using data from a study examining brain aging and cognitive impairment in SCD. T-tests were performed to examine whether neurocognitive function (immediate and delayed memory, visuospatial skills, attention, and language), word reading, and years of education differed based on correct BPI-SF completion.

Results

The sample (n = 71) was 43.7% male, 98.6% African American or mixed race. Of that, 53.5% had sickle cell anemia, and the mean years of education was 13.6. Overall, 21.1% of participants (n = 15) incorrectly completed the BPI-SF pain severity items, and 57.7% completed the body map item incorrectly. Those who completed the severity items incorrectly had statistically significant differences in education. Group differences in neurocognitive function were no longer significant after familywise error rates were controlled for. Literacy was not associated with error rates.

Conclusion

Education level may influence patients' ability to correctly complete the BPI-SF. Findings suggest that careful consideration is warranted for use of the BPI in patients with SCD. Recommended revisions to the BPI include simplifying the language, shortening sentence length, and clearly specifying the timeframes.

Early CRPS Is a Heterogeneous Condition: Results From a Latent Class Analysis

BACKGROUND

Complex regional pain syndrome (CRPS) is a debilitating condition characterised by significant heterogeneity. Early diagnosis is critical, but limited data exists on the condition's early stages. This study aimed to characterise (very) early CRPS patients and explore potential subgroups to enhance understanding of its mechanisms.

METHODS

A total of 113 early CRPS patients were recruited, with 89 undergoing physical assessments. Data included demographic information, work-related factors, CRPS history and clinical features, body perception disturbances, quantitative sensory testing (QST), and a visuospatial attention task.

RESULTS

QST identified deficits in detecting thermal and mechanical stimuli, alongside increased sensitivity to thermal and blunt pressure painful stimuli. Participants reported body perception disturbances similar to those of persistent CRPS. Visuospatial biases were observed in two subgroups of patients. Latent class analysis (LCA) of 85 participants, based on five clinical parameters, identified four profiles: Mild, Moderate, Body Representation Disturbance (BRD), and Pressure Allodynia CRPS. The Mild and Moderate profiles were associated with higher-intensity trauma, with the latter showing worse outcomes. BRD and Pressure Allodynia CRPS followed mild trauma but exhibited the poorest outcomes. BRD CRPS displayed significant body perception disturbances, while Pressure Allodynia CRPS presented the highest sensitivity to pressure and psychosocial risk of chronification. Neither condition duration nor skin temperature effectively distinguished subgroups.

CONCLUSIONS

These findings emphasise the heterogeneity within (very) early CRPS patients and support the absence of a minimum required duration prior to the CRPS diagnosis. Central/systemic mechanisms may play critical roles in severe cases.

SIGNIFICANCE

This study identifies distinct (very) early CRPS profiles, suggesting different pathophysiological mechanisms and challenging traditional classifications. It paves the way for improved diagnosis and tailored treatments.

Validating the SONG-PKD Pain Instrument, a Core Outcome Measure for Pain in ADPKD

Introduction

Pain is a critically important outcome in autosomal dominant polycystic kidney disease (ADPKD); however, it is infrequently and inconsistently reported in clinical trials. This study aimed to validate the Standardized Outcomes in Nephrology-Polycystic Kidney Disease (SONG-PKD) Pain measure, which includes 3 items related to pain (frequency, severity, and impact on life participation) measured on a 5-point Likert scale, in adults with ADPKD.

Methods

A total of 316 adults with ADPKD from 21 countries participated online. The median (interquartile range) age of participants was 56 (44-66) years, 219 (69%) were female, and 222 (70%) had a university degree or higher. Participants completed a demographic questionnaire, brief medical history, and 4 pain measures at baseline. The pain measures were readministered 2 days later. Internal consistency was evaluated with Cronbach's alpha. Test-retest reliability was assessed using intraclass correlation coefficient (ICC), and convergent validity was assessed using Spearman's rho. Known groups comparisons for patients with or without a history of kidney complications were performed using a Mann-Whitney rank sum test.

Results

The SONG-PKD Pain measure demonstrated high internal consistency (0.94, 95% confidence interval [CI]: 0.93-0.95) and test-retest reliability (0.92, 95% CI: 0.90-0.94). There was a high convergence of SONG-PKD Pain with the Brief Pain Inventory-Short Form (BPI-SF; 0.84, 95% CI: 0.80-0.87) and a visual analog scale (VAS; 0.84, 95% CI: 0.81-0.87). There was a significant difference in the median scores of patients with and without a history of complications (4.0 vs. 0.0, P < 0.001).

Conclusion

SONG-PKD Pain instrument is a brief and simple measure that has demonstrated strong psychometric properties.

Clinical Efficacy of Virtual Reality Cave Automatic Virtual Environments (CAVE) for Chronic Musculoskeletal Pain in Older Adults: A Randomized Controlled Trial

OBJECTIVES

To assess whether tai chi assisted by the Cave Automatic Virtual Environment (CAVE), a novel virtual reality (VR) technology, was superior to tai chi alone in managing chronic pain in older adults. CAVE may offer a promising alternative to head-mounted displays in chronic pain treatment.

DESIGN

The study was a 12-week, 2-arm, parallel, randomized controlled trial implemented in VR and non-VR groups (N = 80, each arm = 40). The VR group underwent an 8-week tai chi program in a 3-wall VR-CAVE with projections of nature scenes and music, whereas the control group received tai chi only.

SETTING AND PARTICIPANTS

Community-dwelling older adults with chronic musculoskeletal pain were randomized (1:1) to VR and non-VR groups.

MEASURES

Participants were assessed at baseline, posttreatment at 8 weeks, and 12 weeks. The primary outcome was the Brief Pain Inventory severity score at 8 weeks, modeled within an intention-to-treat framework using generalized estimating equations.

RESULTS

Participants had a mean age of 65.1 ± 5.6 years, with 78.8% female and mean BPI-pain severity score of 4.4 ± 1.5. At 8 weeks, the VR group demonstrated a statistically significant improvement in BPI severity score compared with the non-VR group (β = -0.75, 95% CI -1.48 to -0.03, P = .043), with the effect sustained to 12 weeks (β = -1.18, 95% CI -1.90 to -0.46, P = .001). No major adverse events were reported.

CONCLUSIONS AND IMPLICATIONS

VR-CAVE tai chi was superior to non-VR tai chi for chronic musculoskeletal pain. Future trials that are longer-term, larger in scale, and include other forms of exercise will further inform VR-CAVE's role in post-acute and long-term rehabilitation.

Promoting Adherence to a Yoga Intervention for Veterans With Chronic Low Back Pain

Background

Research demonstrates that yoga can be effective for improving chronic low back pain (cLBP) among military veterans and non-veterans. Attendance of yoga interventions is necessary to obtain benefits, yet yoga class attendance can be a challenge both within and outside of research, especially for persons who lack resources.

Objective

Our objective was to describe efforts to boost attendance within a randomized trial of yoga for cLBP, and to examine factors related to attendance.

Methods

A previous trial of yoga for cLBP among military veterans randomly assigned participants to 2x weekly yoga for 12 weeks, or delayed treatment. After the second of 6 intervention cohorts, efforts were made to improve participant attendance. Attendance and reasons for missing yoga sessions were tracked using sign-in logs and phone calls. Regression analysis was used to examine factors related to attendance.

Results

After efforts to boost attendance, mean attendance increased from 10.2/24 sessions, (42% attending at least half of sessions), to 13.3/24 sessions, (df (1,74), t = -1.44; P = 0.15) (59% attending half of the sessions). The most common reasons for non-attendance were transportation, financial problems, other health issues, and work or school conflicts. Living status and back pain-related disability at baseline were significantly associated with attendance (P= < .001 and P = .038 respectively). When including all participants, yoga session attendance was significantly associated with reduced pain severity (P = 0.01).

Conclusions

Efforts to boost attendance appeared meaningful but the changes were not statistically significant. Attendance rate in later cohorts were comparable to those in other studies. Reasons provided for non-attendance by participants, and the regression results suggest that resources such as transportation, a stable living situation, and disability levels at baseline were related to attendance rates for this in-person intervention. Remotely delivered yoga may address some of these barriers but hybrid interventions that bring in-person yoga closer to participants may be the best option.

High-frequency spinal cord stimulation in treatment of phantom lower limb pain following spinal cord injury: A case report

INTRODUCTION

Pain management in patients with complete spinal cord injury is complex.

CASE REPORT

We report a successful case of managing neuropathic, phantom limb, and back pain below the level of spinal cord injury (T5 American Spinal Injury Association [ASIA] A) using a 10 kHz high-frequency spinal cord stimulator (SCS) over a 6-month follow-up period.

CONCLUSION

The effectiveness of this approach may be attributed to its ability to modulate supraspinal pain processing, allowing for targeted relief of various pain mechanisms below the level of injury.

Psychologically Informed Physical Therapy Management of Chronic Musculoskeletal Pain in Culturally Diverse Populations: An Intervention Logic Model

Culturally and linguistically diverse (CALD) individuals are underrepresented in pain research, including studies of psychologically informed physical therapy (PIPT) for musculoskeletal pain. This perspective describes a conceptual framework for PIPT management of chronic musculoskeletal pain that identifies essential elements that can be culturally tailored to meet the needs of different CALD populations. Essential interventions, determinants of behavior change, and clinical outcomes were identified from studies of existing PIPT interventions for chronic pain. PIPT approaches shared the following essential interventions: 1) cognitive skill training, 2) general aerobic activity, 3) impairment-based therapeutic exercises, and 4) graded functional movement training. An intervention logic model was developed to conceptualize how these interventions might promote active coping behaviors and greater engagement in physical activity, therapeutic exercise, and functional mobility. The model included physical and cognitive-emotional processes that may contribute to behavioral changes that ultimately reduce pain-related disability. To illustrate the cultural tailoring of model constructs, we describe how intervention delivery and assessments were customized for Latino persons with chronic spine pain at a health center located near the United States-Mexico border. A literature review of sociocultural influences on the pain experience of Latino persons was conducted, and essential elements of the model were operationalized to ensure that therapeutic goals, language, content, and processes were compatible with Latino cultural beliefs, values, and behaviors. Future research using the proposed model to adapt and test PIPT interventions for other CALD populations may help identify shared and divergent mechanisms of treatment response for culturally tailored pain management programs. PERSPECTIVE: A novel conceptual framework may help inform the cultural tailoring of PIPT management approaches for chronic musculoskeletal pain by maintaining fidelity to essential treatment elements while also leveraging the unique sociocultural context of different CALD communities to improve health outcomes.

"When you're in pain you do go into your shell" A community-based pain management programme co-designed with Māori whānau to address inequities to pain management - A qualitative case study

Chronic or persistent non-cancer pain disproportionately affects Māori - the Indigenous population of Aotearoa New Zealand (NZ) and their whānau (family and significant others). In a previous study with a Māori community service provider - Tū Kotahi Māori Asthma and Research Trust - Tū Kotahi, identified a need for a Kaupapa Māori (by Māori, for Māori) pain management programme (PMP) with embedded principles of Whānau Ora (care focusing on the wellbeing of the individual and their significant others as a collective). Using a qualitative case-study design, the main aims were to describe (1) the implementation of a community-based, whānau-focused PMP; (2) the participant experiences of the programme. This is community-based participatory action research guided by a Māori-centred research approach. Based on our previous co-design study with Tū Kotahi, a 6-week PMP (July - August 2021) was implemented at Kokiri Marae (community meeting place). Eight whānau living with persistent pain participated in the 6 sessions led by our Māori community partner and a pain management physiotherapist including a dedicated session on Rongoā Māori (Māori traditional treatment). Supporting resources were co-developed with our community partner, pain service clinicians, a Māori Health literacy expert, and a Māori illustrator. On completion, whānau reported enhanced confidence towards managing pain with "more tools to manage". The role of meaningful relationships, co-design, use of metaphors, and inclusion of traditional treatments - Rongoā were key aspects for the successful implementation. This initiative provides an exemplar for community and mainstream pain service partnership to address inequities in accessing pain management services for Māori. PERSPECTIVE: This study explains the key cultural processes of implementing a community-based pain management programme for Māori with persistent pain in Aotearoa New Zealand. The principles from our engagement could be applicable globally to engage with Indigenous and culturally and linguistically diverse communities with persistent pain to address longstanding health inequities.

Correlates of neurocognitive performance in older adults with chronic pain and negative emotions: baseline data from the problem adaptation therapy for pain (PATH-pain) randomized controlled trial

Chronic pain is highly prevalent among older adults, is associated with cognitive deficits, and is commonly treated in primary care. We sought to document the extent of impairment across specific neurocognitive domains and its correlates among older adults with chronic pain in primary care. We analyzed baseline data from the Problem Adaptation Therapy for Pain trial, which examined a psychosocial intervention to improve emotion regulation in 100 adults ≥ 60 years with comorbid chronic pain and negative emotions, who did not have evidence of moderate-to-severe cognitive impairment. Questionnaires on comorbidities, depressive symptoms, pain intensity, and pain-related disability were administered along with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Montreal Cognitive Assessment (MoCA). Multiple regression assessed the relationship between demographic and clinical characteristics with specific neurocognitive domains. Over half of participants (56%) had mild-to-moderate cognitive impairment (<26 on the MoCA). Across domains, participants scored the lowest in visuospatial/constructional (M = 86.2; SD = 15.7), and 15%-23% scored at least one standard deviation below the mean for immediate and delayed memory, visuospatial/constructional, and attention. In adjusted models, greater medical comorbidities were associated with poorer performance on the total RBANS, immediate memory, and attention. Cognitive deficits in older adults with chronic pain in primary care are substantial, with varying levels of deficits by neurocognitive domain. Future research should examine synergistic effects of chronic pain and comorbidities on cognition, and the impact of cognitive deficits on older adults' ability to engage in pain interventions and self-management behaviors.

Adapting a pain coping skills training intervention for people with chronic pain receiving maintenance hemodialysis for end stage Kidney disease

Pain Coping Skills Training (PCST) is a first-line cognitive-behavioral, non-pharmacological treatment for chronic pain and comorbid symptoms. PCST has been shown to be effective in racially and ethnically diverse cohorts across several chronic medical conditions. However, PCST has not been evaluated in those with end stage kidney disease (ESKD) receiving in-center maintenance hemodialysis. Due to the high rates of morbidity associated with ESKD, and time-intensive treatment, an adaptation of PCST was warranted to address the unique challenges experienced by people living with ESKD. Using current guidelines developed by Card and colleagues for intervention adaptation, PCST was adapted so that it could be implemented among people living with ESKD in a national multisite trial. The objective of this paper was to describe the adaption process outlined by Card and colleagues including how the team selected an effective intervention to adapt, developed a program model, identified mismatches in the original intervention and study population, and then adapted the intervention for those with ESKD treated with in-center maintenance hemodialysis. Finally, we briefly describe future directions for clinical practice and research with the adapted PCST intervention for those with ESKD.Trial registration: ClinicalTrials.gov #NCT04571619.

A 5-day course of repetitive transcranial magnetic stimulation before pain onset ameliorates future pain and increases sensorimotor peak alpha frequency

ABSTRACT

Repetitive transcranial magnetic stimulation (rTMS) has shown promise as an intervention for pain. An unexplored research question is whether the delivery of rTMS prior to pain onset might protect against a future episode of prolonged pain. The present study aimed to determine whether (1) 5 consecutive days of rTMS delivered prior to experimentally induced prolonged jaw pain has a prophylactic effect on future pain intensity and (2) whether these effects were accompanied by increases in corticomotor excitability (CME) and/or sensorimotor peak alpha frequency (PAF). On each day from day 0 to 4, 40 healthy individuals received a single session of active (n = 21) or sham (n = 19) rTMS over the left primary motor cortex. Peak alpha frequency and CME were assessed on day 0 (before rTMS) and day 4 (after rTMS). Prolonged pain was induced via intramuscular injection of nerve growth factor in the right masseter muscle after the final rTMS session. From days 5 to 25, participants completed twice-daily electronic diaries including pain on chewing and yawning (primary outcomes), as well as pain during other activities (eg, talking), functional limitation in jaw function and muscle soreness (secondary outcomes). Compared to sham, individuals who received active rTMS subsequently experienced lower pain on chewing and yawning. Furthermore, active rTMS led to an increase in PAF. This is the first study to show that rTMS delivered prior to prolonged pain onset can protect against future pain. Our findings suggest that rTMS may hold promise as a prophylactic intervention for pain.

The Relationship of Pain Intensity, Perceived Injustice, and Pain Catastrophizing to Heart Rate Variability In Naturally Occurring Acute Pain

OBJECTIVES

Behavioral factors of pain catastrophizing and perceived injustice are associated with pain intensity in chronic pain. Diminished heart rate variability (HRV) is also strongly associated with chronic pain. These factors have been less explored earlier in the pain experience and it is unclear whether they play a role in the transition from acute to chronic pain. The aim of this study was to determine the relationship between pain catastrophizing, perceived injustice, pain intensity, and HRV in naturally occurring acute pain.

MATERIALS AND METHODS

Ninety-seven patients were recruited from local outpatient physical therapy clinics. Seated HRV was captured on 94 patients via Polar chest strap while patients were taking a survey via iPad. In addition to sociodemographic data, the survey included the Pain Catastrophizing Scale (PCS), Injustice Experience Questionnaire (IEQ), and Numeric Pain Rating Scale (NPRS). The natural log of high-frequency power (lnHFP) HRV was used in the statistical analysis.

RESULTS

Multiple linear regression modeling revealed that lower pain catastrophizing, higher perceived injustice, and lower pain intensity were associated with lower HRV, and accounted for 11.4% of the variance in HRV.

DISCUSSION

While greater chronic pain intensity is associated with lower HRV, the relationship is reversed in the setting of acute pain. These findings highlight the need to better understand the unique factors that contribute to lower HRV in the acute phase.

Influence of Qigong Wuqinxi on Pain, Sleep, and Tongue Features in Older Adults

BACKGROUND

Chronic pain and sleep disorders are commonly seen symptoms in community-dwelling older adults at traditional Chinese medicine (TCM) clinics. TCM modalities such as herbal medication and acupuncture have side effects and usage limitations. Therefore, nonpharmacological and noninvasive interventions may be applied to relieve the symptoms of these conditions.

PURPOSE

This study was designed to test the effect of Qigong Wuqinxi exercise on chronic pain, sleep quality, TCM constitutions, and tongue features in community-dwelling older adults.

METHODS

This was a cluster randomized controlled trial. Older adults in two community care centers who met the inclusion criteria were assigned by drawing lots to either the experimental group (n = 32) or the control group (n = 31). Experimental group members practiced the Qigong Wuqinxi exercise for 50 minutes three times each week for 12 weeks, whereas those in the control group maintained their normal daily routine. Before and after the 12-week study, data on chronic pain, sleep quality, TCM constitutions, and tongue features were collected from all participants to assess the effectiveness of the intervention. Between-group pretest and posttest comparisons were analyzed using independent samples t tests, and within-group differences were analyzed using paired t tests.

RESULTS

The experimental group reported significantly greater average posttest improvements in chronic pain, yang deficiency, phlegm-stasis, thick fur, and red dots than the control group (all ps < .05). The maximum change in pretest to posttest pain scores favored the experimental group (-0.56 ± 0.76 vs. 0.39 ± 1.91, p = .011). Also, the experimental group had a significantly better change in the pain interference index (-3.31 ± 3.30 vs. -0.58 ± 1.91, p < .001). In addition, the experimental group exhibited greater improvements in yang-deficiency tendency (-2.38 ± 4.89 vs. 0.35 ± 4.67, p = .027), phlegm and stasis tendency (-2.19 ± 4.52 vs. 1.77 ± 2.47, p < .001), thick fur (1.44 ± 11.28 vs. 6.03 ± 6.04, p = .049), and red dots (-5.09 ± 21.45 vs. 2.81 ± 4.03, p = .048). However, no significant between-group difference in posttest sleep quality (p = .357) was observed.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The Qigong Wuqinxi exercise was found to positively improve chronic pain and TCM constitutions in community-dwelling older adults and may be promoted in community care centers to improve the health status of older adults.

Clinical Efficacy of Two Different Low-Level Laser Therapies for the Treatment of Trigeminal Neuralgia: A Randomized, Placebo-Controlled Trial

Background: Trigeminal neuralgia (TN) is a disease that causes severe pain that can seriously affect the quality of life. This study aimed to compare the effectiveness of two different low-level laser therapies (LLLT) as alternatives to medical treatment to reduce pain and improve the quality of life in patients with TN. Methods: A total of 45 patients were randomly divided into 3 groups. In the first group, a new-generation diode laser (GRR laser) was applied at predetermined points in the trigeminal nerve line. In the second group, a low-level neodymium-doped yttrium aluminum garnet (Nd:YAG) laser was applied along the affected nerve line. The placebo group received the same protocol with a Nd:YAG laser without the device switched on. The scores were recorded pre- and post-treatment using the Brief Pain Inventory-Facial (BPI-facial) scale. Results: A statistically significant difference was found between the pre- and post-treatment values of all four variables in the GRR laser, Nd:YAG laser, and placebo groups. When the post-treatment values were compared, statistically significant differences were found between the groups in pain frequency, pain intensity, and interference in facial-specific activities, but no differences were found in general activities. Conclusions: Both LLLTs can be considered alternative treatment modalities for TN, but the GRR laser treatment was more effective than the Nd:YAG laser treatment in reducing pain and improving the quality of life in patients with TN.

Assessing the fidelity of the "photo-with-movement program" (PMP) for community-dwelling older adults with pain: A randomized controlled trial

PURPOSE

To measure intervention fidelity of the Photo-with-Movement Program (PMP) and to report the findings of the program.

METHODS

This study was a two-arm, pilot randomized controlled trial of the PMP. An intervention fidelity checklist and semi-structured interviews were utilize to evaluate the fidelity of the PMP. Twenty-four older adults and informal caregiver dyads enrolled in the study, with 12 dyads in the experimental group and another 12 in the control group. The PMP integrated visual stimulation, physical exercise, and digital-based activity to deliver a comprehensive, non-pharmacological pain relief syllabus to the participants in the experimental group. The control group received pain management pamphlets. The data collected were analyzed using SPSS to compare the outcomes between the experimental and control groups.

RESULTS

The PMP led to significant findings on reducing pain intensity and high scores on intervention fidelity. Participants showed great acceptance of this delivery format.

CONCLUSIONS

This study revealed the fidelity and effectiveness of a multimodal non-pharmacological intervention, suggesting that it could be used for pain management and caregiving.

The brief pain inventory-Interference Subscale has acceptable reliability but questionable validity in acute back and neck pain populations

BACKGROUND

The Brief Pain Inventory-Interference Subscale (BPI-IS) is a subscale of the BPI assessment tool developed to rapidly assess the impact of a person's pain on their function. It is uncertain whether it has one or two factors, and whether it has acceptable clinimetric properties in a mixed spinal pain (back and/or neck) population.

OBJECTIVES

To determine the clinimetric properties of the BPI-IS in a population with mixed spinal pain.

METHODS

We completed a clinimetric evaluation with a test-retest design, factor analysis, and hypothesis testing. We used data collected for a randomised clinical trial including a population presenting to primary care or emergency departments with acute spinal pain (back and/or neck).

RESULTS

Confirmatory factor analysis better supported the two-factor model of the BPI-IS (physical interference factor and affective interference factor) as compared to the one-factor model. Both one and two-factor models had acceptable reliability (high internal consistency and no evidence of floor or ceiling effects). Both models failed to reach our a-priori thresholds for acceptable construct (cross sectional) validity, and responsiveness (longitudinal validity) in either back or neck pain populations.

CONCLUSION

The BPI-IS has two factors and both have acceptable reliability, but tests for validity did not reach our a priori thresholds for acceptability (construct validity and responsiveness). The BPI-IS may not be suitable to measure the impact of pain on function in back and neck pain populations.

Conceptualizing problematic use of medicinal Cannabis: Development and preliminary validation of a brief screening questionnaire

The use of Medicinal Cannabis (MC) for treating chronic pain is increasing, globally, yet the definition of problematic MC use remains unclear. Defining problematic use of cannabis in medical and non-medical contexts may be fundamentally different since individuals prescribed MC often experience physical dependence, which do not necessarily imply pathology. We aimed to conceptualize problematic use of MC and develop a brief questionnaire for identifying and quantifying problematic MC use. Content validation used a broad definition of problematic substance use, adapting and compiling an initial list of 36 items from various sources: (a) screening tools for assessing problematic prescription opioid medication use; (b) screening tools for problematic recreational cannabis use and (c) qualitative interviews with MC patients. 390 American self-identified chronic pain patients holding a MC card rated each item from the initial list on a 5-point frequency scale and filled out questionnaires assessing various clinical outcomes. Following initial item titration, a multi-group measurement invariance comparison strategy, using two external indicators: alcohol-related problems and depression, resulted a final eight-item list that met fit quality in a baseline model, presented excellent internal consistency reliability (α = 0.929), and significantly correlated with anxiety and low quality of life. Items in the final list related predominantly to negative consequences of MC use. Problematic use of MC is characterized by negative physiological, social, emotional and functional consequences. The final eight-item list was named the Medicinal Cannabis Negative Consequences Scale (MCNCS), emerging as a brief measure for problematic MC use and demonstrating preliminary reliability and validity, which could aid clinicians and researchers.

The efficacy of an eight-week exercise program for the management of chronic low back pain in the equestrian population

BACKGROUND

Equestrians (horse riders) are more susceptible to low back pain than the general population due to loads placed on their bodies during the activity. A specific eight-week exercise intervention program targeting the muscles used during horse riding was implemented for a group of equestrians with low back pain.

METHODS

Volunteers were invited to participate in the study through social media posts in Melbourne, Australia. The participants were required to complete an exercise screening test prior to enrolment in the study to ensure they were suitable to participate in the iteration program. Participants then completed the Brief Pain Inventory (BPI) (Short Form) and Patient Specific Functional Scale (PSFS) before commencing the exercise program. These outcome measures were completed again by participants after completing the 8-week exercise program.

RESULTS

Nine equestrians (23-65 years of age; mean=43±14: average worst back pain on riding=7/10 with a range of 3-10/10) completed all outcome measures and the 8-week exercise intervention. Data indicate that all achieved improved pain severity, pain interference and riding functionality (P<0.01).

CONCLUSIONS

An eight-week exercise program may be beneficial in improving a sample of equestrians' chronic LBP symptoms. From a practitioner's perspective, the findings provide an indication as to suitable exercises to prescribe to an equestrian to help reduce their LBP.

Associations Between Cognitive Performance and Self-Efficacy for Pain Management in Older Adults With Chronic Pain

BACKGROUND

Self-efficacy for pain management is the key to successful pain management, yet little is known about the effect of cognitive performance on self-efficacy for pain management. This study aimed to examine to what extent cognitive performance is related to self-efficacy for pain management in older adults with chronic pain.

METHODS

The analyses utilized data from the baseline assessment of the MOBILIZE Boston Study. Five neuropsychological tests-the Clock in the Box Test, Letter Fluency Test, Trail-making Test, Hopkins Verbal Learning Test, and WORLD Test-were performed to measure the cognitive performance domains of 458 participants, aged 70 years and reporting chronic pain and self-efficacy for pain management. We measured self-efficacy for pain management using the Chronic Pain Self-Efficacy Scale. Statistical analyses were done using multiple linear regression analysis.

RESULTS

After adjusting for sociodemographic factors, general cognitive performance, executive function, as measured by the Clock in the Box Test, and attention, as measured by the Trail-Making Test Part A, were significantly associated with self-efficacy for pain management in older adults with chronic pain. However, after controlling for sociodemographic factors, chronic conditions, pain interference, and physical performance, the associations between cognitive performance measures and self-efficacy for pain management weakened.

CONCLUSION

Greater cognitive performance in attention and executive function might be associated with better self-efficacy for pain management. Future longitudinal research is required to investigate the long-term implications of cognitive performance changes on the progress of self-efficacy for pain management in community-dwelling older adults.

Is One Enough? The Effectiveness of a Single Session of Education and Exercise Compared to Multiple Sessions of a Multimodal Physiotherapy Intervention for Adults With Spinal Disorders in an Advanced Practice Physiotherapy Model of Care: A Randomized Controlled Trial

OBJECTIVE: To assess the effectiveness of a single session of education and exercise compared with multiple sessions of a multimodal physiotherapy intervention for adults with spinal disorders in an advanced practice physiotherapy specialized spine model of care. DESIGN: Pragmatic randomized controlled trial. METHODS: We randomized patients with spinal disorders, who were referred for a spinal surgery consultation and triaged as nonsurgical cases by an advanced practice physiotherapist, to a single session of education and prescription of an exercise program (n = 52) or multiple sessions (6 in total) of a multimodal physiotherapy intervention (n = 54). The primary outcomes were the short form Brief Pain Inventory pain severity scale (BPI-S) and the Brief Pain Inventory pain interference scale (BPI-I), and secondary outcomes included disability, quality of life, catastrophization, and satisfaction. Linear mixed models were used to assess differences between groups across time points at 6, 12, and 26 weeks. RESULTS: There were no significant between-group differences on the BPI-S and only a significant improvement at 6 weeks on the BPI-I in the multiple-session group (mean difference: -0.96/10; 95% CI, -1.87 to -0.05). There were no other statistically significant differences between groups, except for satisfaction where participants in the multiple-session group reported statistically significantly greater satisfaction on the 9-item Visit-Specific Satisfaction Questionnaire and the MedRisk questionnaire. Both groups saw significant improvements over time on all outcomes except for the BPI-S. CONCLUSION: Adding supervised multimodal physiotherapy sessions did not result in better clinical outcomes when compared to a single session of education and exercise. Patients were more satisfied with the multiple-session approach. J Orthop Sports Phys Ther 2024;54(10):1-13. Epub 9 September 2024. doi:10.2519/jospt.2024.12618.

Social support and the association between post-traumatic stress disorder and risk for long-term prescription opioid use

ABSTRACT

Post-traumatic stress disorder (PTSD) is common in patients with chronic pain, adversely affects chronic pain outcomes, and is associated with opioid use and adverse opioid outcomes. Social support is a robust predictor of PTSD incidence and course as well as chronic pain outcome. We determined whether the association between PTSD and persistent opioid use was modified by emotional support in a cohort of patients receiving opioids for noncancer pain. Eligible participants were ≥18 years and had completed a new period of prescription opioid use lasting 30 to 90 days. Bivariate associations between cohort characteristics and each key variable was assessed using χ 2 tests for categorical variables and t -tests for continuous variables. Interaction between PTSD and emotional support was assessed by a priori stratification on low vs high emotional support. Participants (n = 808) were 53.6 (SD ± 11.6) years of age, 69.8% female, 69.6% White, and 26.4% African American. Overall, 17.2% had probable PTSD. High emotional support was significantly ( P < 0.0001) more common among those without probable PTSD. Prescription opioid use at 6-month follow-up was significantly ( P = 0.0368) more common among patients with vs without probable PTSD. In fully adjusted models, PTSD was no longer associated with opioid use at 6-month follow-up among participants with high emotional support. Among those with lower emotional support, PTSD was significantly associated with opioid use at 6-month follow-up in unadjusted (odds ratio = 2.40; 95% confidence interval: 1.24-4.64) and adjusted models (odds ratio = 2.39; 95% confidence interval: 1.14-4.99). Results point to the hypothesis that improvement of emotional support in vulnerable patients with chronic pain and PTSD may help reduce sustained opioid use.

Pelvic myofascial pain is associated with restriction of sexual activity in women with pelvic pain: a cross-sectional study

Background Dyspareunia and restriction of sexual activity are often reported by patients with chronic pelvic pain, but less is known about which conditions or factors contribute most to these symptoms. Methods This is a cross-sectional study of consecutive new patients who presented to a chronic pelvic pain and endometriosis referral clinic between January 2013 and December 2015. Patients completed a detailed questionnaire prior to their first visit and underwent a comprehensive standardised pelvic examination at their first visit. Patients were grouped according to description of sexual activity as 'normal activity without pain', 'normal activity but painful', 'severely restricted by pain', or 'absent due to pain.' Primary outcome was restriction of sexual activity due to pain. Multinomial logistic regression was performed with 'normal activity without pain' group as reference category and adjusted for age, depression, history of endometriosis, and pelvic myofascial pain. Results Over half of the 187 patients with chronic pelvic pain described severely restricted (n =75, 40.1%) or absent (n =21, 11.2%) sexual activity due to pain. Pelvic myofascial pain was highly prevalent in this population and pelvic myofascial tenderness score was associated with higher odds of sexual activity that was severely restricted by pain (OR 1.05, 95% CI 1.01-1.09, P =0.006) or absent due to pain (OR 1.09, 95% CI 1.04-1.13, P Conclusion Dyspareunia and sexual dysfunction are highly prevalent among patients with chronic pelvic pain, and pelvic myofascial pain is strongly associated with restriction of sexual activity due to pain.

Pain-related threat and coordination in adults with chronic low back pain during a lifting task: A cross-sectional study

OBJECTIVES

People with low back pain (LBP) exhibit altered coordination, possibly indicating guarded movement. The connection between these changes and pain-related threat remains unclear. We aimed to determine if pain-related threat was related to spinal coordination and variability, during a lifting task, in people with chronic LBP.

METHODS

Participants were adults with chronic LBP (n = 47). Upper lumbar, lower lumbar, and hipkinematics were measured during 10crate lifting/lowering repetitions. Coordination and variability of the Hip-Lower Lumbar, and Lower Lumbar-Upper Lumbar joint pairs were calculated. Pain-related threat was measured using the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, and task-specific fear. Linear regression analyses tested the relationship between pain-related threat and coordination.

RESULTS

Adding catastrophizing to our base model (sex) explained variance in Hip-Lower lumbar coordination (r2 change = 0.125, p = 0.013). General and task specific measures of fear were unrelated to coordination and variability at both joint pairs (r2 change < 0.064, p > 0.05). Exploratory t-tests revealed subgroups aligned with phenotypes of "tight" and "loose" control, where "tight" control was characterized by greater catastrophizing and disability.

CONCLUSION

Pain catastrophizing, but not measures of fear, was related to more in-phase ("tight") Hip-Lower Lumbar coordination during lifting/lowering. Considering this relationship based on subgroups may add clarity.

Psychological predictors of performance-based physical functioning among pediatric pain program participants

PURPOSE

The purpose of the present study was to evaluate changes in performance-based physical functioning and investigate psychological predictors of physical functioning over time in pediatric patients with chronic pain who completed an interdisciplinary rehabilitation intensive outpatient program (IOP).

METHODS

Participants (N = 55; mean age = 14.92 years; 12.7% male, 87.3% female; 83.6% White, 5.6% African-American/Black; 9.1% Latinx) completed baseline measures assessing pain intensity and modifiable psychological factors (i.e., pain catastrophizing, kinesiophobia, anxiety and depressive symptoms). Participants were administered performance-based assessments of physical functioning (i.e., physical endurance, high-level motor abilities) before and after IOP completion.

RESULTS

Pain intensity was not significantly associated with physical functioning at either timepoint. There was significant improvement on measures of physical functioning after completion of the IOP when controlling for the effects of sex, race, and ethnicity. Depressive symptoms were associated with baseline physical endurance, β = - .28, p = .047, while pain catastrophizing was associated with baseline gross motor abilities, β = - .28, p = .032.

CONCLUSION

Participation in an IOP led to significant improvement in physical endurance and high-level motor ability. Depressive symptoms and pain catastrophizing were associated with physical functioning at baseline but not post-program completion. Integration of pain psychology and physical therapy in an IOP can help address the interrelated psychological and physical factors impacting physical functioning to improve outcomes for children with chronic pain.

Intravenous Lidocaine for Refractory Pain in Patients With Pancreatic Ductal Adenocarcinoma and Chronic Pancreatitis: A Multicenter Prospective Nonrandomized Pilot Study

INTRODUCTION

Refractory pain is a major clinical problem in patients with pancreatic ductal adenocarcinoma (PDAC) and chronic pancreatitis (CP). New, effective therapies to reduce pain are urgently needed. Intravenous lidocaine is used in clinical practice in patients with PDAC and CP, but its efficacy has not been studied prospectively.

METHODS

Multicenter prospective nonrandomized pilot study included patients with moderate or severe pain (Numeric Rating Scale ≥ 4) associated with PDAC or CP in 5 Dutch centers. An intravenous lidocaine bolus of 1.5 mg/kg was followed by continuous infusion at 1.5 mg/kg/hr. The dose was raised every 15 minutes until treatment response (up to a maximum 2 mg/kg/hr) and consecutively administered for 2 hours. Primary outcome was the mean difference in pain severity, preinfusion, and the first day after (Brief Pain Inventory [BPI] scale 1-10). A BPI decrease ≥1.3 points was considered clinically relevant.

RESULTS

Overall, 30 patients were included, 19 with PDAC (63%) and 11 with CP (37%). The mean difference in BPI at day 1 was 1.1 (SD ± 1.3) points for patients with PDAC and 0.5 (SD ± 1.7) for patients with CP. A clinically relevant decrease in BPI on day 1 was reported in 9 of 29 patients (31%), and this response lasted up to 1 month. No serious complications were reported, and only 3 minor complications (vertigo, nausea, and tingling of mouth). Treatment with lidocaine did not impact quality of life.

DISCUSSION

Intravenous lidocaine in patients with painful PDAC and CP did not show an overall clinically relevant reduction of pain. However, this pilot study shows that the treatment is feasible in this patient group and had a positive effect in a third of patients which lasted up to a month with only minor side effects. To prove or exclude the efficacy of intravenous lidocaine, the study should be performed in a study with a greater sample size and less heterogeneous patient group.

Avoidance and Rumination as Predictors of Substance Use, Mental Health, and Pain Outcomes Among People Living With HIV

Pain, substance use, and mental health conditions are common among people living with HIV (PLWH), and avoidance and rumination may influence the co-occurrence of these conditions. The present study examined longitudinal associations between avoidance/rumination and pain outcomes, anxiety, anger, and substance use among PLWH. Participants (N = 187) with chronic pain and depressive symptoms completed self-report assessments over a 1-year period. Greater avoidance/rumination was positively associated with mental health outcomes (anxiety, anger), pain interference, and alcohol use across participants after controlling for depression severity. At time points with greater avoidance/rumination than average, participants also reported increased pain severity and interference, anxiety and anger symptoms, and alcohol use. No associations were found between avoidance/rumination and cannabis use. Results suggest a mechanistic effect of avoidance/rumination, such that increases in avoidance/rumination correspond with poorer health outcomes among PLWH over time. Targeting avoidance/rumination through intervention approaches may be beneficial for addressing comorbid health conditions among PLWH. Additional research is necessary to investigate this possibility and further characterize the effects of avoidance/rumination on health outcomes for PLWH.

Feasibility and acceptability of remote administration of the cold pressor test

Objective

Quantitative sensory testing is often used to investigate pain in the context of experimental and clinical research studies. However, many of the devices used for QST protocols are only available in resource rich environments, thereby inadvertently limiting the possible pool of participants. Development of remote protocols for appropriate QST measures has the potential to reduce barriers to participation in research.

Methods

Participants with insomnia and Crohn's disease were recruited as part of a clinical trial. We adapted a remote version of the cold pressor test for use during telehealth-based study assessments. Herein, we present data from the baseline assessments including an assessment of feasibility and acceptability of the task.

Results

100% of participants (N = 28) were able to complete the remote cold pressor test using a combination of materials from their homes and mailed by the study team. Temperature changes during the test were minimal and fairly evenly balanced between increases and decreases. Correlations between submersion time and both general and disease specific pain trended toward significance.

Conclusions

We demonstrated that a remote version of the cold pressor test is feasible and acceptable in a clinical population and provided a step-by-step protocol for administration to facilitate use in other studies.

Improving Access to Yoga for Chronic Pain in a Spanish-Speaking Community: A Quality Improvement Initiative

BACKGROUND

The recent increase in opioid misuse and overdose among the Hispanic population signifies the need for an initiative to increase efforts in pain management in the Hispanic population. Yoga is an evidence-based therapeutic intervention that is effective for several pain-associated disorders. However, in the United States, it is primarily taught in English and not always accessible. This quality improvement (QI) project aimed to assess the outcome of implementing a yoga program on pain and quality of life in the Hispanic population.

METHODS

Twenty Spanish-speaking community center members participated in a linguistically-tailored yoga program over the course of 10 weeks that included educational, demonstration, and practice videos. Outcome measures of the QI program included changes in pain interference, physical function, opioid medication use, the overall impression of change in pain, satisfaction with the program, and the likelihood of continuation of yoga practice.

RESULTS

Data collected from participants (n = 16) after the 10-week period indicated that nearly 60% experienced an improvement in their overall impression of change in pain; their reported likelihood of continuation of yoga practice at home or another location were 6.8 and 7.4, respectively, on a 10-point scale. While pain interference was unaffected, there was an improvement in markers of physical function, including a two-fold improvement in general activity without limitations. The mean average intensity of pain decreased by 33%.

CONCLUSION

The use of a linguistically-tailored yoga program improved self-reported overall pain, physical function, average intensity of pain, and initiated an interest in participants in utilizing yoga practice for self-management of pain. This QI project provides results that can be used for further implementation initiatives at other sites and consideration of use in diverse populations.

Living well with chronic pain: a 12-month randomized controlled trial revealing impact from the digital pain self-management program EPIO

Introduction

Chronic pain affects a wide range of physical and psychological aspects of life for those impacted. Psychosocial treatment approaches may be of support, but outreach is still limited.

Objectives

To evaluate the efficacy of EPIO, an evidence-informed, user-centered digital self-management intervention for people with chronic pain, in a 12-month randomized controlled trial.

Methods

People living with chronic pain (N = 266) were randomized to the EPIO intervention (n = 132) or a usual-care control group (n = 134). The intervention was delivered in a simple blended care model, and outcome measures collected at baseline, 6 months, and 12 months. Generalized linear models for repeated measures were fitted to compare groups over time.

Results

Participants were primarily female (81%), median age 49 years (range 22-78), with heterogeneous pain conditions, and had lived with pain >5 years (77.6%). A mixed linear model with all timepoints included revealed no statistically significant group differences for the primary outcome of pain interference. Significant psychological benefits in favor of the intervention group were however detected for depression (P = 0.022), self-regulatory fatigue (P = 0.024), vitality (P = 0.016), and mental health (P = 0.047). Baseline to 12-month changes showed additional favorable effects for anxiety (between-group mean differences [MDs] = 0.79, P = 0.047), depression (MD = 1.08, P = 0.004), self-regulatory fatigue (MD = 2.42, P = 0.021), pain catastrophizing (MD = 2.62, P = 0.009), and health-related quality of life.

Conclusions

The EPIO program aims to improve outreach of evidence-based pain self-management interventions. Findings demonstrate how using EPIO can lead to sustainable psychological change, enhancing mental health and health-related quality of life for people suffering from pain, providing a chance to live well with the pain.

Effects of mindfulness-based stress reduction on quality of life of breast cancer patient: A systematic review and meta-analysis

BACKGROUND

Breast cancer is the most common malignancy that occurs in women. Due to the pain caused by the disease itself and the adverse reactions in the treatment process, breast cancer patients are prone to anxiety, depression, fear of recurrence, and other negative emotions, which seriously affect the quality of life. As a systematic stress reduction therapy, mindfulness-based stress reduction is widely applied to the treatment of breast cancer patients and has been found by a growing number of studies to relieve stress, regulate mood, and improve the state. However, due to the absence of recent research and uniform outcome measures, previous studies have failed to fully explain the role of mindfulness-based stress reduction in improving the quality of life in breast cancer patients.

OBJECTIVE

We conducted a systematic review and meta-analysis to evaluate and compare the effects of mindfulness-based stress reduction therapy and standard care on the quality of life and psychological status of breast cancer patients.

METHODS

We searched PubMed, Web of Science, Embase, China's National Knowledge Infrastructure and the Cochrane Central Registry of Controlled Trials up to July 2023 to identify candidate randomized clinical trials addressing the values of mindfulness-based stress reduction in breast cancer patients.

RESULTS

A total of 1644 patients participated in 11 randomized controlled trials. The results of the meta-analysis showed that mindfulness-based stress reduction therapy can significantly reduce negative emotions such as perceived stress (MD = -1.46, 95%CI = -2.53 to -0.38, p = 0.03), depression (MD = -1.84, 95%CI = -3.99 to -0.30, p = 0.0004), anxiety (MD = -2.81, 95%CI = -5.31 to -0.32, p = 0.002), and fear of recurrence (MD = -1.27, 95%CI = -3.44 to 0.90, p = 0.0004). Mindfulness-based stress reduction therapy also has certain advantages in improving the coping ability (MD = 1.26, 95%CI = -3.23 to5.76, p = 0.03) and the emotional state (MD = -7.73, 95%CI = -27.34 to 11.88, p = 0.0007) of patients with breast cancer.

CONCLUSION

Our analyses support that, compared with standard care, mindfulness-based stress reduction therapy can significantly improve patients' coping ability, reduce adverse emotions and improve patients' emotional states.

Chronic pain and complex regional pain syndrome are associated with alterations to the intestinal microbiota in both humans and mice. An observational cross-sectional study

Objective

This study aimed to evaluate pain metrics and gut microbiota differences from human subjects with complex regional pain syndrome (CRPS) compared to cohabitants (HHC) and non-cohabitating (biobank) controls. In addition, we aimed evaluate longitudinal changes of gut microbiota using a mouse model of acute and chronic CRPS.

Methods

In an observational, cross-sectional study, 25 patients with CRPS and 24 household controls (HHC) were recruited, completed pain questionnaires, and submitted stool samples. 23 biobank stool samples were matched to the CRPS group. Additionally, longitudinal stool samples were collected from a mouse model of acute and chronic CRPS. 16S rRNA gene sequencing analysis was performed on all samples.

Results

A diagnosis of CRPS is associated with higher pain, increased pain interference, and decreased physical and social function when compared to HHC. Interestingly, 46% of HHC reported significant daily pain. In the households where HHC were also suffering from pain, there was decreased bacterial richness and diversity when compared to households wherein only the participant with CRPS suffered from pain. Furthermore, when comparing households where the HHC had significant pain, CRPS was clinically more severe. In the mouse model of CRPS, we observed decreased bacterial richness and diversity when compared to non-cohabitating littermate controls.

Conclusions

Both humans living in chronic pain households and mice shared distinct taxa over the time course of disease and pain chronicity. These findings suggest that microbiota changes seen in CRPS as well as in a mouse model of CRPS may reflect pain chronicity and may indicate that pain alone can contribute to microbiota dysbiosis. The trial was registered at ClinicalTrials.gov (NCT03612193).

Prevalence and factors associated with the correlation between malnutrition and pain in hemodialysis patients

Malnutrition and pain are common in patients with chronic kidney disease who undergo hemodialysis. Although both pain and malnutrition are associated with increased morbidity and mortality, few studies have explored the correlation between pain and nutritional status. This study aimed to investigate the factors associated with pain intensity in patients undergoing hemodialysis, focusing on the risk of malnutrition. This was a cross-sectional study conducted at a regional dialysis center in a large tertiary hospital. Convenience sampling was used to recruit adult patients who had undergone hemodialysis for more than three months. An interviewer-administered questionnaire was used to gather sociodemographic and clinical data related to dialysis status, comorbidities, and body mass index (BMI). Pain severity and pain interference with functioning domains of the Brief Pain Index (BPI) were used to assess pain, and the malnutrition inflammation score (MIS) was used to assess nutritional status. Descriptive and inferential statistics were used to report the findings. The data were analyzed using the 25th version of the Statistical Package for the Social Sciences (IBM-SPSS) software. Of the final sample of 230 patients, 63.0% were males and 37.0% were females, with an average age of 58.3 years. Almost one-third of the participants had a BMI within the normal range (33.9%), and nearly one-third had a BMI within the underweight range (33.9%). Slightly more than half had a normal nutritional status or mild malnutrition (54.8%), while just under half had moderate or severe malnutrition (45.2%). The prevalence of pain was 47.0%. At the multivariate level, the severity of pain was associated with malnutrition (p < 0.001). Pain interference with function was associated with marital status (p = 0.045), number of comorbidities (p = 0.012), and malnutrition (p < 0.001). The MIS was positively correlated with both the severity of pain and the interference score. Pain and malnutrition were found to be prevalent in patients undergoing hemodialysis. Pain severity was associated with malnutrition, and pain interference was associated with malnutrition, marital status, and the number of comorbidities. Hemodialysis treatment should follow a patient-tailored approach that addresses pain, nutritional status, and associated chronic conditions. In addition, pain assessment and management should be included in the curriculum of nephrology training programs.

A 5-day course of rTMS before pain onset ameliorates future pain and increases sensorimotor peak alpha frequency

Repetitive transcranial magnetic stimulation (rTMS) has shown promise as an intervention for pain. An unexplored research question is whether the delivery of rTMS prior to pain onset might protect against a future episode of prolonged pain. The present study aimed to determine i) whether 5 consecutive days of rTMS delivered prior to experimentally-induced prolonged jaw pain could reduce future pain intensity and ii) whether any effects of rTMS on pain were mediated by changes in corticomotor excitability (CME) and/or sensorimotor peak alpha frequency (PAF). On each day from Day 0-4, forty healthy individuals received a single session of active (n = 21) or sham (n = 19) rTMS over the left primary motor cortex. PAF and CME were assessed on Day 0 (before rTMS) and Day 4 (after rTMS). Prolonged pain was induced via intramuscular injection of nerve growth factor (NGF) in the right masseter muscle after the final rTMS session. From Days 5-25, participants completed twice-daily electronic dairies including pain on chewing and yawning (primary outcomes), as well as pain during other activities (e.g. talking), functional limitation in jaw function and muscle soreness (secondary outcomes). Compared to sham, individuals who received active rTMS subsequently experienced lower pain on chewing and yawning. Although active rTMS increased PAF, the effects of rTMS on pain were not mediated by changes in PAF or CME. This study is the first to show that rTMS delivered prior to pain onset can protect against future pain and associated functional impairment. Thus, rTMS may hold promise as a prophylactic intervention for persistent pain.

Associations between pain intensity, psychosocial factors, and pain-related disability in 4285 patients with chronic pain

Pain, a widespread challenge affecting daily life, is closely linked with psychological and social factors. While pain clearly influences daily function in those affected, the complete extent of its impact is not fully understood. Given the close connection between pain and psychosocial factors, a deeper exploration of these aspects is needed. In this study, we aim to examine the associations between psychosocial factors, pain intensity, and pain-related disability among patients with chronic pain. We used data on 4285 patients from the Oslo University Hospital Pain Registry, and investigated pain-related disability, pain intensity, pain catastrophizing, psychological distress, perceived injustice, insomnia, fatigue, and self-efficacy. We found significant associations between all psychosocial variables and pain-related disability, even after adjusting for demographic factors. In the multiple regression model, sleep problems and pain intensity were identified as primary contributors, alongside psychological distress, and fatigue. Combined, these factors accounted for 26.5% of the variability in pain-related disability, with insomnia and pain intensity exhibiting the strongest associations. While the direction of causation remains unclear, our findings emphasize the potential of interventions aimed at targeting psychosocial factors. Considering the strong link between psychosocial factors and pain-related disability, interventions targeting these factors-particularly insomnia-could reduce disability and enhance quality of life in those who suffer.

Fatigue and Depressive Mood in Chronic Low Back Pain

PURPOSE

Fatigue is prevalent, problematic, and co-occurs in chronic low back pain. When left untreated, fatigue can increase depressive mood, and intensify pain burden and disability in patients with chronic low back pain. The purpose of this study was to examine the relationship of fatigue to depressive mood, pain severity, and pain interference in patients with chronic low back pain.

DESIGN AND METHODS

A cross-sectional design was used to enroll and evaluate adults (n = 67) with chronic low back pain (>6 months) during their visit to an outpatient pain clinic. Participants completed psychometric instruments for fatigue, depressive mood, pain severity, and pain interference.

RESULTS

Participants were primarily women (73%), White (59%), with a median age of 59 years (range 22-70 years). Multiple regression models showed significant positive associations between fatigue and depressive mood (SD: 0.025 p = 0.017) with a coefficient of 0.069; fatigue and pain interference (SD: 0.123 p = 0.010) with a coefficient of 0.652; fatigue and pain severity (SD: 0.125 p-value <0.05) with a coefficient of 0.359. After adjusting for demographic factors (age, sex, and race/ethnicity) the associations remained significant.

CONCLUSIONS

The findings suggest that fatigue is associated with greater depressive mood, pain severity, and pain interference in adults with chronic low back pain.

CLINICAL IMPLICATIONS

Assessing the extent of fatigue and depressive mood as part of pain management may benefit patients with chronic low back, thereby reducing symptom burden.

Depressive Symptoms, Sleep Quality, and Pain Are Associated With Frailty in Nursing Home Residents During the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic has caused severe effects on older adults. Depressive symptoms, poor sleep quality, and pain are common in older adults with frailty. However, it is unknown the relationship between these symptoms and frailty in nursing home residents and the difference of importance between pain intensity and pain impact on frailty during the COVID-19 Pandemic. Therefore, this study aims to explore the associations between depressive symptoms, poor sleep quality, pain intensity, and pain impact with frailty in older adults living in nursing homes.

METHODS

In this cross-sectional population-based study, 172 older adults living in nursing homes from Changsha in China were included. We collected data on depressive symptoms, sleep quality, pain, and frailty using the Patient Health Questionnaire, the Pittsburgh Sleep Quality, the Brief Pain Inventory-short form, and the FRAIL-NH Scale. Generalized linear regression models were used to explore the interaction association between these symptoms with frailty.

RESULTS

Most older adults were between 80 and 90 years old. Approximately 11.6% of older adults experienced one of the following symptoms: depressive symptoms, poor sleep quality, pain intensity, or pain impact. Moreover, 76.7% of older adults experienced at least two of these symptoms. The most common overlapping symptoms were depressive symptoms and poor sleep quality (14.5%). Among nursing home residents, the most common sites of pain were the lower limbs, followed by the back. There was a strong correlation between depressive symptoms, sleep quality, pain intensity, pain impact, and frailty. After adjusting for covariates, the interaction term between any two or three symptoms of depressive symptoms, poor sleep quality, pain intensity, and pain impact was found to be associated with a higher likelihood of frailty in older adults residing in nursing homes (p< .05).

CONCLUSIONS

Depressive symptoms, poor sleep quality, pain intensity, and pain impact are common among nursing home residents. Furthermore, these symptoms interacted with each other. In future studies, multidisciplinary interventions aimed at releasing these symptoms and reducing the adverse outcome of frailty are needed.

Gender differences in PTSD severity and pain outcomes: Baseline results from the LAMP trial

BACKGROUND

Post-traumatic stress disorder (PTSD) and chronic pain are highly prevalent comorbid conditions. Veterans dually burdened by PTSD and chronic pain experience more severe outcomes compared to either disorder alone. Few studies have enrolled enough women Veterans to test gender differences in pain outcomes [catastrophizing, intensity, interference] by the severity of PTSD symptoms.

AIM

Examine gender differences in the association between PTSD symptoms and pain outcomes among Veterans enrolled in a chronic pain clinical trial.

METHODS

Participants were 421 men and 386 women Veterans with chronic pain who provided complete data on PTSD symptoms and pain outcomes. We used hierarchical linear regression models to examine gender differences in pain outcomes by PTSD symptoms.

RESULTS

Adjusted multivariable models indicated that PTSD symptoms were associated with higher levels of pain catastrophizing (0.57, 95% CI [0.51, 0.63]), pain intensity (0.30, 95% CI [0.24, 0.37]), and pain interference (0.46, 95% CI [0.39, 0.52]). No evidence suggesting gender differences in this association were found in either the crude or adjusted models (all interaction p-values<0.05).

CONCLUSION

These findings may reflect the underlying mutual maintenance of these conditions whereby the sensation of pain could trigger PTSD symptoms, particularly if the trauma and pain are associated with the same event. Clinical implications and opportunities testing relevant treatments that may benefit both chronic pain and PTSD are discussed.

Implementation of an integrated primary care prevention and management program for chronic low back pain (LBP): patient-reported outcomes and predictors of pain interference after six months

BACKGROUND

Integrated primary care programs for patients living with chronic pain which are accessible, interdisciplinary, and patient-centered are needed for preventing chronicity and improving outcomes. Evaluation of the implementation and impact of such programs supports further development of primary care chronic pain management. This study examined patient-reported outcomes among individuals with low back pain (LBP) receiving care in a novel interdisciplinary primary care program.

METHODS

Patients were referred by primary care physicians in four regions of Quebec, Canada, and eligible patients received an evidence-based interdisciplinary pain management program over a six-month period. Patients were screened for risk of chronicity. Patient-reported outcome measures of pain interference and intensity, physical function, depression, and anxiety were evaluated at regular intervals over the six-month follow-up. A multilevel regression analysis was performed to evaluate the association between patient characteristics at baseline, including risk of chronicity, and change in pain outcomes.

RESULTS

Four hundred and sixty-four individuals (mean age 55.4y, 63% female) completed the program. The majority (≥ 60%) experienced a clinically meaningful improvement in pain intensity and interference at six months. Patients with moderate (71%) or high risk (81%) of chronicity showed greater improvement in pain interference than those with low risk (51%). Significant predictors of improvement in pain interference included a higher risk of chronicity, younger age, female sex, and lower baseline disability.

CONCLUSION

The outcomes of this novel LBP program will inform wider implementation considerations by identifying key components for further effectiveness, sustainability, and scale-up of the program.

EEG-Based Cortical Alterations in Individuals With Chronic Knee Pain Secondary to Osteoarthritis: A Cross-sectional Investigation

Chronic painful knee osteoarthritis (OA) is a disabling physical health condition. Alterations in brain responses to arthritic changes in the knee may explain persistent pain. This study investigated source localized, resting-state electroencephalography activity and functional connectivity in people with knee OA, compared to healthy controls. Adults aged 44 to 85 years with knee OA (n = 37) and healthy control (n = 39) were recruited. Resting-state electroencephalography was collected for 10 minutes and decomposed into infraslow frequency (ISF) to gamma frequency bands. Standard low-resolution electromagnetic brain tomography statistical nonparametric maps were conducted, current densities of regions of interest were compared between groups and correlation analyses were performed between electroencephalography (EEG) measures and clinical pain and functional outcomes in the knee OA group. Standard low-resolution electromagnetic brain tomography nonparametric maps revealed higher (P = .006) gamma band activity over the right insula (RIns) in the knee OA group. A significant (P < .0001) reduction in ISF band activity at the pregenual anterior cingulate cortex, whereas higher theta, alpha, beta, and gamma band activity at the dorsal anterior cingulate cortex, pregenual anterior cingulate cortex, the somatosensory cortex, and RIns in the knee OA group were identified. ISF activity of the dorsal anterior cingulate cortex was positively correlated with pain measures and psychological distress scores. Theta and alpha activity of RIns were negatively correlated with pain interference. In conclusion, aberrations in infraslow and faster frequency EEG oscillations at sensory discriminative, motivational-affective, and descending inhibitory cortical regions were demonstrated in people with chronic painful knee OA. Moreover, EEG oscillations were correlated with pain and functional outcome measures. PERSPECTIVE: This study confirms alterations in the rsEEG oscillations and its relationship with pain experience in people with knee OA. The study provides potential cortical targets and the EEG frequency bands for neuromodulatory interventions for managing chronic pain experience in knee OA.

The Impact of Acute Postoperative Pain in Developing Chronic Pain after Total Knee Arthroplasty

While total knee arthroplasties (TKAs) are performed with the intent to reduce pain, chronic postsurgical pain (CPSP) is one of the most well-documented complications that can occur following surgery. This study aimed to assess whether perioperative factors, focusing on acute postsurgical pain and perioperative opioid consumption, were associated with the development of chronic postsurgical pain. Under general anesthesia, 108 patients underwent TKA and were treated postoperatively with a multimodal analgesia approach. Numeric Rating Scale (NRS) pain scores at rest and with movement were recorded on postoperative days 0-3, 7, 14, and 30. Patients were sent a survey to assess chronic pain at months 22-66, which was examined as a single-group post hoc analysis. Based on the responses, patients were either classified into the CPSP or non-CPSP patient group. Chronic postsurgical pain was defined as an NRS score ≥ 4 with movement and the presence of resting pain. The primary outcome was a change in NRS. There were no differences in NRS pain scores with movement in the first 30 days postoperatively between patients with CPSP and without CPSP. Each unit increase in resting pain on postoperative days 3 and 14 was associated with significantly greater odds of CPSP presence (OR = 1.52; OR = 1.61, respectively), with a trend towards greater odds of CPSP at days 7 and 30 (OR = 1.33; OR = 1.43, respectively). We found that very intense pain in the initial phase seems to be related to the development of CPSP after TKA.