Do Cognitive Abilities Influence Physical and Mental Fatigue in Patients with Chronic Pain after Walking According to a Clinical Guideline for Physical Exercise?

A Nursing Home Clinician Survey to Explain Gabapentinoid Increases

OBJECTIVES

Survey nursing home (NH) clinicians about the indications for NH gabapentinoid use, the factors driving increased prescribing, and their experiences with gabapentinoid deprescribing.

DESIGN

Online clinician survey.

SETTING AND PARTICIPANTS

NH clinicians prescribing gabapentinoids in US NHs.

METHODS

An anonymous survey of NH prescribers was conducted using SurveyMonkey from March 15 to July 1, 2024. Recruitment employed crowdsourcing, targeting the membership of NH clinician organizations. A multidisciplinary team developed the instrument. Content focused on the magnitude of gabapentinoid prescribing for different, previously identified, indications, as well as clinician deprescribing experiences and perspectives.

RESULTS

Sixty-two self-identified NH prescribers participated: 76% white, 55% female, 77% physicians. One-third had geriatric training certifications. Most NH gabapentinoids were started in other care settings by non-NH clinicians. Gabapentinoid prescribing initiated in NHs was principally off-label for pain syndromes. Although prescribing solely for psycho-behavioral symptoms was rare, most clinicians reported that gabapentinoids have some utility in treating these symptoms and consequently may be preferred over alternative analgesics when psycho-behavioral symptoms coexist with pain. Gabapentinoid deprescribing occurs infrequently and is deprioritized relative to opioid reduction efforts. Most clinicians acknowledged potential gabapentinoid side effects; however, severe harms were rarely observed, and half agreed that gabapentinoids are generally safe and well-tolerated. Seventy-nine percent perceive gabapentinoids as safer and better tolerated than opioids, 57% than benzodiazepines, and 40% than antipsychotics.

CONCLUSIONS AND IMPLICATIONS

An opportunity exists to increase NH safety by prioritizing gabapentinoid gradual dose reduction requirements. Because so many prescriptions originate outside NHs, any reduction effort should emphasize deprescribing across all care settings. Clinicians' perceptions of gabapentinoids as reasonable but unmonitored alternatives to opioids and psychotropics contribute to their increased use. Safety and efficacy data supporting such prescribing for nonapproved indications in NHs is lacking. Existing NH psychotropic reporting and reduction mandates should include gabapentinoids regardless of indication.

Effects of Astaxanthin Supplementation on Fatigue, Motor Function and Cognition: A Meta-Analysis of Randomized Controlled Trials

Dietary astaxanthin supplementation has been demonstrated to have many beneficial and health-promoting effects. The purpose of this systematic review and meta-analysis was to assess the effect of astaxanthin supplementation on fatigue, cognition, and exercise efficiency. A total of 11 randomized controlled trials (RCTs) with 346 healthy participants were included. The random effects model and pooled standardized mean difference (SMDs) were used according to Hedge's g for the meta-analysis, and a meta-regression was also conducted. The results of the two existing studies showed a positive trend for astaxanthin in subjective fatigue relief. The effects of astaxanthin supplementation for 8-12 weeks on cognitive accuracy were marginally significant (SMD: .12; 95% CI: -.02-.26) and on reaction time was not significant (SMD: -.08; 95% CI: -.26 to .10). Remarkably, astaxanthin supplementation combined with regular training could enhance the fat oxidation (SMD: 2.56; 95% CI: 1.24-3.89), and significantly improve the physical performance (SMD: .62; 95% CI: .17-1.06). The subgroup analysis further showed significantly greater benefits when performing the aerobic exercises performance (SMD: .45; 95% CI: .13-.76), when the dose was ≥ 20 mg (SMD: .37; 95% CI: .11-.63), and when the supplementation duration was > 12 weeks (SMD: .66; 95% CI: .13-.63). We conclude that astaxanthin supplementation could significantly enhance aerobic exercise efficiency, especially at higher doses and for longer durations. Further studies based on large sample sizes are imperatively warranted.

Personality and Pain Outcomes in Rheumatic Disease: The Mediating Role of Psychological Flexibility

BACKGROUND

Chronic pain is associated with increased disability and vulnerability to emotional disorders. Personality and psychological flexibility (PF) describe interindividual differences that shape the adjustment to chronic pain. Specifically, PF was found to be associated with pain, fatigue, anxiety, and depression intensity. Although previous studies established strong correlations between personality and pain outcomes, evidence on the nature of this relationship is scarce. Therefore, the objective of this study is to explore the mediating effect of PF on the relationship between personality and distress.

METHODS

This transversal study included 108 participants (age M = 56.7, SD = 11.3) diagnosed with musculoskeletal chronic pain. Self-reported measures were administered by the medical care team. Multiple mediation models were performed for estimating the indirect effects on each outcome variable.

RESULTS

After controlling for age and gender covariates, we found that PF completely mediated the relationship between personality traits and all pain outcomes and partially mediated the impact of extraversion on anxiety. In addition, emotional stability also had an indirect effect on anxiety through PF.

CONCLUSIONS

Personality traits and PF are significant predictors of pain outcomes. PF represents a core process mediating the impact of personality traits on the perceived intensity of pain, fatigue, anxiety, and depression in patients with rheumatic disease. These results could facilitate the application of individualized psychological interventions in clinical contexts targeting the reduction of emotional avoidance and in chronic pain patients.

The effects of mental fatigue on fine motor performance in humans and its neural network connectivity mechanism: a dart throwing study

While it is well known that mental fatigue impairs fine motor performance, the investigation into its neural basis remains scant. Here, we investigate the impact of mental fatigue on fine motor performance and explore its underlying neural network connectivity mechanisms. A total of 24 healthy male university students were recruited and randomly divided into two groups: a mental fatigue group (MF) and a control group (Control). Both groups completed 50 dart throws, while electroencephalography (EEG) data were collected. Following the Stroop intervention, participants in the MF group exhibited a decrease in Stroop task accuracy and throwing performance, and an increase in reaction time along with VAS and NASA scores. The EEG data during dart-throwing revealed that the network connectivity strength of theta oscillations in the frontal and left central regions was significantly higher in the MF group compared with the Control group, while the network connectivity strength of alpha oscillations in the left parietal region was significantly enhanced. The interregional connectivity within the theta and alpha rhythm bands, particularly in the frontal-central-parietal network connections, also showed a significant increase in the MF group. Mental fatigue impairs dart throwing performance and is accompanied by increased connectivity in alpha and theta.

Does Pain Acceptance Contribute to Improved Functionality through Walking in Women with Fibromyalgia? Looking at Depressive Comorbidity

In the last decade, research has pointed to physical exercise as an effective treatment in fibromyalgia patients. Some studies have highlighted the role of acceptance and commitment therapy in optimizing the benefits of exercise in patients. However, given the high comorbidity in fibromyalgia, it is necessary to value its possible influence on the effect of certain variables, such as acceptance, on the benefits of treatments, such as physical exercise. Our aim is to test the role of acceptance in the benefits of walking over functional limitation, further assessing whether this model is equally valid, considering depressive symptomatology as an additional differential diagnosis. A cross-sectional study with a convenience sample through contacting Spanish fibromyalgia associations was carried out. A total of 231 women with fibromyalgia (mean age 56.91 years) participated in the study. Data were analyzed with the Process program (Model 4, Model 58, Model 7). The results highlight the role of acceptance as a mediator between walking and functional limitation (B = -1.86, SE = 0.93, 95% CI = [-3.83, -0.15]). This model, when depression is incorporated as a moderator, is significant only in patients without depression, revealing the need for personalized treatments in fibromyalgia, considering their most prevalent comorbidity.