Central Sensitization: The Missing Link Between Psychological Distress and Poor Outcome Following Primary Total Knee Arthroplasty

BACKGROUND

While preoperative psychological distress is known to predict risk for worse total knee arthroplasty (TKA) outcomes, distress may be too broad and nonspecific a predictor in isolation. We tested whether there are distinct preoperative TKA patient types based jointly on psychological status and measures of altered pain processing that predict adverse clinical outcomes.

METHODS

In 112 TKA patients, we preoperatively assessed psychological status (depression, anxiety, and catastrophizing) and altered pain processing via a simple quantitative sensory testing protocol capturing peripheral and central pain sensitization. Outcomes (pain, function, opioid use) were prospectively evaluated at 6 weeks and 6 months after TKA. Cluster analyses were used to empirically identify TKA patient subgroups.

RESULTS

There were 3 distinct preoperative TKA patient subgroups identified from the cluster analysis. A low-risk (LR) group was characterized by low psychological distress and low peripheral and central sensitization. In addition, 2 subgroups with similarly elevated preoperative psychological distress were identified, differing by pain processing alterations observed: high-risk centralized pain and high-risk peripheral pain. Relative to LR patients, high-risk centralized pain patients displayed significantly worse function and greater opioid use at 6 months after TKA (P values <.05). The LR and high-risk peripheral pain patient subgroups had similar 6-month outcomes (P values >.05).

CONCLUSIONS

Among patients who have psychological comorbidity, only patients who have central sensitization were at elevated risk for poor functional outcomes and increased opioid use. Central sensitization may be the missing link between psychological comorbidity and poor TKA clinical outcomes. Preoperative testing for central sensitization may have clinical utility for improving risk stratification in TKA patients who have psychosocial risk factors.

The moderating role of catastrophizing in day-to-day dynamic stress and depressive symptoms

The way individuals handle daily stressors can significantly influence their mental health. Those who struggle with emotion regulation are especially vulnerable to the negative effects of stress. This study explored the role of catastrophizing, a maladaptive emotion regulation strategy, in shaping the relationships between daily stress responses and depressive symptoms. A total of 75 healthy college students participated in the study. We adopted an Ecological Momentary Assessment protocol over 14 consecutive days to capture the day-to-day dynamics of stress reactivity and recovery. Our findings indicate that individuals with higher levels of catastrophizing exhibited increased daily stress reactivity and delayed daily stress recovery, consequently raising their likelihood of experiencing amplified depressive symptoms. In contrast, those with lower levels of catastrophizing did not experience the same negative effects of increased daily stress reactivity on their mental health. These results enhance understanding of how real-life stressors contribute to the development of mental health issues and underscore the importance of adaptive emotion regulation for improved overall health and well-being.

Variables associated with nonresponders to high-frequency (10 kHz) spinal cord stimulation

INTRODUCTION

The use of spinal cord stimulation (SCS) therapy to treat chronic pain continues to rise. Optimal patient selection remains one of the most important factors for SCS success. However, despite increased utilization and the existence of general indications, predicting which patients will benefit from neuromodulation remains one of the main challenges for this therapy. Therefore, this study aims to identify the variables that may correlate with nonresponders to high-frequency (10 kHz) SCS to distinguish the subset of patients less likely to benefit from this intervention.

MATERIALS AND METHODS

This was a retrospective single-center observational study of patients who underwent 10 kHz SCS implant. Patients were divided into nonresponders and responders groups. Demographic data and clinical outcomes were collected at baseline and statistical analysis was performed for all continuous and categorical variables between the two groups to calculate statistically significant differences.

RESULTS

The study population comprised of 237 patients, of which 67.51% were responders and 32.49% were nonresponders. There was a statistically significant difference of high levels of kinesiophobia, high self-perceived disability, greater pain intensity, and clinically relevant pain catastrophizing at baseline in the nonresponders compared to the responders. A few variables deemed potentially relevant, such as age, gender, history of spinal surgery, diabetes, alcohol use, tobacco use, psychiatric illness, and opioid utilization at baseline were not statistically significant.

CONCLUSION

Our study is the first in the neuromodulation literature to raise awareness to the association of high levels of kinesiophobia preoperatively in nonresponders to 10 kHz SCS therapy. We also found statistically significant differences with greater pain intensity, higher self-perceived disability, and clinically relevant pain catastrophizing at baseline in the nonresponders relative to responders. It may be appropriate to screen for these factors preoperatively to identify patients who are less likely to respond to SCS. If these modifiable risk factors are present, it might be prudent to consider a pre-rehabilitation program with pain neuroscience education to address these factors prior to SCS therapy, to enhance successful outcomes in neuromodulation.

Parental attachment security and problematic internet use in children: The mediating role of maladaptive cognitive emotion regulation strategies

Problematic Internet Use (PIU) is a growing problem among children. Insecure attachment has been associated with PIU and emotion dysregulation. Furthermore, there is evidence suggesting that maladaptive Cognitive Emotion Regulation Strategies (CERS), such as Self-blame, Rumination, Catastrophizing and Other-blame, lead to PIU, nevertheless, the mediating role of CERS between attachment and PIU has not been explored. A sample of 641 children (M = 10.15; SD = .89) participated in the study. The findings showed that there were significant differences between problematic and non-problematic users in terms of secure attachment and emotion dysregulation. Results show a negative association between attachment security and PIU and a negative association between attachment and maladaptive CERS, whilst maladaptive CERS were positively related with PIU. Finally, maladaptive CERS, particularly Rumination, were found to mediate the relationship between attachment security and PIU. However, Catastrophizing and Other Blame partially mediated the relationship between maternal attachment, but not the relationship between Father attachment and PIU. Limitations and implications are discussed, motivating the promotion of prevention and intervention programs.

Withdrawal catastrophizing scale: initial psychometric properties and implications for the study of opioid use disorder and hyperkatifeia

Background: Discovery of modifiable factors influencing subjective withdrawal experience might advance opioid use disorder (OUD) research and precision treatment. This study explores one factor - withdrawal catastrophizing - a negative cognitive and emotional orientation toward withdrawal characterized by excessive fear, worry or inability to divert attention from withdrawal symptoms.Objectives: We define a novel concept - withdrawal catastrophizing - and present an initial evaluation of the Withdrawal Catastrophizing Scale (WCS).Methods: Prospective observational study (n = 122, 48.7% women). Factor structure (exploratory factor analysis) and internal consistency (Cronbach's α) were assessed. Predictive validity was tested via correlation between WCS and next-day subjective opiate withdrawal scale (SOWS) severity. The clinical salience of WCS was evaluated by correlation between WCS and withdrawal-motivated behaviors including risk taking, OUD maintenance, OUD treatment delay, history of leaving the hospital against medical advice and buprenorphine-precipitated withdrawal.Results: WCS was found to have a two-factor structure (distortion and despair), strong internal consistency (α = .901), and predictive validity - Greater withdrawal catastrophizing was associated with next-day SOWS (rs (99) = 0.237, p = .017). Withdrawal catastrophizing was also correlated with risk-taking behavior to relieve withdrawal (rs (119) = 0.357, p < .001); withdrawal-motivated OUD treatment avoidance (rs (119) = 0.421, p < .001), history of leaving the hospital against medical advice (rs (119) = 0.373, p < .001) and buprenorphine-precipitated withdrawal (rs (119) = 0.369, p < .001).Conclusion: This study provides first evidence of withdrawal catastrophizing as a clinically important phenomenon with implications for the future study and treatment of OUD.

Pain Catastrophizing: Controversies, Misconceptions and Future Directions

Recent reports have pointed to problems with the term "pain catastrophizing." Critiques of the term pain catastrophizing have come from several sources including individuals with chronic pain, advocates for individuals with chronic pain, and pain scholars. Reports indicate that the term has been used to dismiss the medical basis of pain complaints, to question the authenticity of pain complaints, and to blame individuals with pain for their pain condition. In this paper, we advance the position that the problems prompting calls to rename the construct of pain catastrophizing have little to do with the term, and as such, changing the term will do little to solve these problems. We argue that continued calls for changing or deleting the term pain catastrophizing will only divert attention away from some fundamental flaws in how individuals with pain conditions are assessed and treated. Some of these fundamental flaws have their roots in the inadequate training of health and allied health professionals in evidence-based models of pain, in the use of psychological assessment and intervention tools for the clinical management of pain, and in gender equity and antiracism. Critiques that pain scholars have leveled against the defining, operational, and conceptual bases of pain catastrophizing are also addressed. Arguments for reconceptualizing pain catastrophizing as a worry-related construct are discussed. Recommendations are made for remediation of the problems that have contributed to calls to rename the term pain catastrophizing. PERSPECTIVE: The issues prompting calls to rename the construct of pain catastrophizing have their roots in fundamental flaws in how individuals with pain are assessed and treated. Efforts to address these problems will require more than a simple change in terminology.

The Moderating Effects of Cognitive Processes on Pain-related Outcomes

Although evidence supports the importance of pain-related thoughts (ie, cognitive content, or what people think) as predictors of pain and pain-related function, evidence regarding the role of cognitive processes (ie, how people think about pain, eg, by accepting pain, not making judgments about pain, or being absorbed by the pain experience) in adjustment to chronic pain is in its early stages. Using baseline data from a clinical trial of individuals with chronic low back pain (N = 327), the study aimed to increase knowledge regarding the associations between cognitive processes, pain intensity, pain interference, and depression. The results indicate that a number of cognitive processes are significantly related to pain intensity when controlling for catastrophizing, although the pattern of associations found was opposite to those anticipated. One cognitive process (pain absorption) was found to be significantly associated with pain interference, and 9 of 10 cognitive processes were significantly associated with depression when controlling for catastrophizing. In each case, the processes thought to be adaptive were negatively associated with pain interference and depression, and processes thought to be maladaptive evidenced the opposite pattern. The findings are consistent with-but do not prove, given the cross-sectional nature of the data-the possibility that cognitive processes play an important role in adjustment to chronic pain. The potential role these variables play in depression was particularly noteworthy. Longitudinal and experimental studies to evaluate the causal nature of the associations identified are warranted. PERSPECTIVE: The study findings highlight the potential importance of cognitive process variables (ie, how people think) in adjustment to chronic pain. Research to evaluate cognitive processes as potential mechanism variables in pain treatment is warranted.

Oxidative stress mediates associations between preoperative psychosocial phenotype and pain-related outcomes at 6 months following total knee arthroplasty: a longitudinal cohort study

OBJECTIVE

Greater preoperative depression, anxiety, and pain catastrophizing are associated with more severe long-term pain following total knee arthroplasty (TKA). In a secondary analysis of previously reported data, we tested the hypothesis that these associations are mediated by oxidative stress (OS).

DESIGN

A mixed between/within-subjects longitudinal cohort design.

SETTING

A single academic medical center.

SUBJECTS

Osteoarthritis patients (n = 91; 62.6% female) undergoing unilateral TKA.

METHODS

We assessed depression, anxiety, and catastrophizing, as well as markers of central sensitization (widespread pain, temporal summation of pain) preoperatively. Blood samples were then obtained immediately prior to intraoperative tourniquet placement for quantification of in vivo biomarkers of systemic OS, F2-isoprostanes and isofurans. Post-TKA pain intensity (numeric rating scale worst pain [NRS], McGill Pain Questionnaire-2 [MPQ-2]) and function (PROMIS Pain Interference) were assessed at 6 months following TKA.

RESULTS

Greater preoperative depression, catastrophizing, and widespread pain were associated with higher intraoperative combined OS (F2-isoprostanes+isofurans/2), which was in turn associated with higher post-TKA pain intensity and worse function (P < .05). All preoperative phenotype predictors except anxiety were correlated positively with post-TKA pain and/or function (P < .05). Bootstrapped mediation analyses revealed significant (P < .05) indirect (mediated) effects of depression (NRS Worst Pain, MPQ-2, PROMIS Pain Interference), anxiety (MPQ-2, PROMIS Pain Interference), and catastrophizing (PROMIS Pain Interference) on adverse long-term post-TKA outcomes via elevated OS. Central sensitization-related predictors demonstrated only direct effects (P < .05) on post-TKA outcomes that were independent of OS mechanisms.

CONCLUSIONS

Results suggest that the adverse impact of depression, anxiety, and pain catastrophizing on post-TKA pain and functional outcomes are mediated in part by elevated OS.

Pain coping and catastrophizing in youth with and without cerebral palsy

OBJECTIVES

The aim of this study is to compare the use of pain coping strategies and pain catastrophizing in youth with and without cerebral palsy (CP), and to examine how these two groups differ with respect to the associations between pain coping, catastrophizing, and measures of psychological function and sleep disturbance.

METHODS

Twenty-seven individuals with CP and 49 healthy controls aged 15-22 were included in this cross-sectional observational study. Pain was assessed using a semi-structured interviews and participants completed measures of pain coping, pain catastrophizing, psychological function, and sleep.

RESULTS

Youth with CP used information seeking and problem solving (p = 0.003, Cohen's d (d) = -0.80) and sought social support (p = 0.044, d = -0.51) less often, and used internalizing as a coping strategy more often (p = 0.045, d = 0.59) than healthy controls. The use of information seeking and problem solving correlated more strongly with measures of depression (p = 0.023, Cohen's f (f) = 0.08) and sleep disturbance (p = 0.022, f = 0.08), while behavioral distraction correlated more strongly with measures of anxiety (p = 0.006, f = 0.11) and sleep disturbance (p = 0.017, f = 0.09) in youth with CP, compared to healthy controls.

CONCLUSIONS

The study findings raise the possibility that youth with CP may benefit more in terms of psychological function and sleep quality from coping training interventions that focus on behavioral distraction, information seeking, and problem solving. Research to test these ideas in additional samples of youth with CP is warranted.

Pediatric Neural Changes to Physical and Emotional Pain After Intensive Interdisciplinary Pain Treatment: A Pilot Study

Brain areas activated during pain can contribute to enhancing or reducing the pain experience, showing a potential connection between chronic pain and the neural response to pain in adolescents and youth. This study examined changes in brain activation associated with experiencing physical pain, and the observation of physical and emotional pain in others, by using functional magnetic resonance imaging (fMRI) before and after intensive interdisciplinary pain treatment (IIPT). Eighteen youth (age 14 to 18) with widespread chronic pain completed fMRI testing before and after IIPT to assess changes in brain activation in response to physical and emotional pain. Broadly, brain activation changes were observed in frontal, somatosensory, and limbic regions. These changes suggest improvements in descending pain modulation via thalamus and caudate, and the different pattern of brain activation after treatment suggests better discrimination between physical and emotional pain. Brain activation changes were also correlated with improvements in clinical outcomes of catastrophizing (reduced activation in right caudate, right mid-cingulate, and postcentral gyrus) and pain-related disability (increased activation in precentral gyrus, left hippocampus, right middle occipital cortex, and left superior frontal gyrus). These changes support interpretation that reduced brain protective responses to pain were associated with treatment-related improvements. This pilot study highlights the need for larger trials designed to better understand the brain mechanisms involved in pediatric widespread pain treatment.

Association of Sleep Disturbance With Catastrophizing and Knee Pain: Data From the Osteoarthritis Initiative

OBJECTIVE

To investigate the relationship between sleep disturbance, catastrophizing, and knee pain in middle-aged and older individuals.

METHODS

Data from the Osteoarthritis Initiative cohort from months 48 to 96 were used, where month 48 was treated as baseline. Knee pain (Western Ontario and McMaster Universities Osteoarthritis Index pain scale score ≥5 [range 0-20]), catastrophizing (extracted from Coping Strategies Questionnaire score ≥3 [range 0-6]), and sleep quality (extracted from Center for Epidemiologic Studies Depression Scale [range 1-4]) were assessed annually. We described the association of sleep disturbance with the presence and risk of knee pain and catastrophizing. The mediation effect of knee pain and catastrophizing on the sleep-catastrophizing and sleep-pain association was evaluated, respectively.

RESULTS

Catastrophizing and knee pain were reported in 346 (10%) and 917 (24%) of the 3,813 participants (mean 64.9 years, 58% female) at baseline. Participants with worse sleep disturbance were more likely to have knee pain (prevalence ratio [PR] 1.4-2.0, P for trend <0.001) and catastrophizing (PR 1.4-3.1, P for trend <0.001). Sleep disturbance at baseline predicted the risk of knee pain (risk ratio [RR] 1.1, P for trend <0.001) and catastrophizing (RR 1.2-1.7, P for trend <0.001) during follow-up. No statistically significant interactions between sleep disturbance and knee pain or catastrophizing were observed. Knee pain and catastrophizing mediated the sleep-catastrophizing and sleep-pain association, respectively, at baseline, and knee pain negatively mediated the sleep-catastrophizing association longitudinally.

CONCLUSION

Sleep disturbance was associated with the presence and risk of catastrophizing and knee pain. Sleep interventions may have a universal and independent effect in preventing incident knee pain.

Catastrophizing and acceptance are mediators between insomnia and pain intensity-an SQRP study of more than 6,400 patients with non-malignant chronic pain conditions

Background

Sleep problems (insomnia) and chronic pain are associated. Chronic pain and insomnia/insufficient sleep quality share similar symptoms and features. Although they have a bidirectional relationship, more research is needed to understand how they interact via mediators and how moderators influence this relationship.

Aims

In this large clinical registry-based cohort study (N = 6,497), we investigate important mediators between insomnia and pain intensity in a cross-sectional sample of chronic pain patients using advanced path analysis. In addition, we investigate whether some background variables were moderators of the identified important paths or not and the correlation patterns between insomnia and pain intensity in relation to the mediators.

Methods

This study includes a cohort of adult patients with chronic non-cancer pain from the Swedish Quality Registry for Pain Rehabilitation (SQRP) with data on patient-reported outcome measures (PROMs) (2008-2016). The PROMs cover the background, pain aspects, psychological distress, pain-related cognitions, activity/participation, and health-related quality of life variables of the patients. Partial least squares structural equation modeling was used to explore the direct and indirect (via mediators) relationships between insomnia and pain intensity at baseline.

Results

In this cohort study, insomnia was prevalent at 62.3%, and both direct and indirect mediating paths were present for the insomnia-pain intensity relationship. All of the mediating effects combined were weaker than the direct effect between insomnia and pain intensity. The mediating effects via catastrophizing and acceptance showed the strongest and equal mediating paths, and mediating effects via fear avoidance were the second strongest. Insomnia showed stronger direct significant correlations with psychological distress, catastrophizing, and acceptance compared with those of pain intensity. Sex, age, education level, spatial extent of pain, or body mass index did not moderate the mediating paths.

Discussion and conclusion

This study confirms the existence of significant direct and mediating paths between reported insomnia and pain intensity. Future studies should focus on illuminating how sleep interventions influence pain intensity and other important key factors that contribute to the distress of chronic pain patients.

Towards a better Comprehension and Management of Pain and Psychological Distress in Parkinson's: The Role of Catastrophizing

OBJECTIVES

Pain is very prevalent in Parkinson's and challenging to manage. As many people with Parkinson's (PwP) with pain suffer from anxious and depressive symptoms, we examined the role of catastrophizing in mediating the relationship between pain and psychological distress for this population.

METHODS

169 international PwP completed an online survey with socio-demographic and medical data. Participants completed psychometric tests to assess their pain (King's Parkinson's Disease Pain Questionnaire, McGill Pain Questionnaire and Brief Pain Inventory), psychological distress (Beck Depression Inventory and Parkinson Anxiety Scale), pain coping strategies (Coping Strategies Questionnaire) and pain catastrophizing (Pain Catastrophizing Scale).

RESULTS

Depending on the tool used, 82.8% to 95.2% of participants reported pain. 23.5 % and 67.5% of participants showed respectively significant levels of depressive and anxiety symptoms. Psychological distress was significantly correlated with the quality of pain (both sensory and affective dimensions). Statistical models highlighted the mediating role of catastrophizing in the relationship between psychological distress and pain in Parkinson's.

CONCLUSION

These findings offer new perspectives toward understanding the underlying mechanisms of pain in Parkinson's and for effective therapeutic intervention goals to facilitate adaptation to pain symptoms in Parkinson's.

Baseline Factors Associated with Pain Intensity, Pain Catastrophizing, and Pain Interference in Intensive Interdisciplinary Pain Treatment for Youth

Background: More could be known about baseline factors related to desirable Intensive Interdisciplinary Pain Treatment (IIPT) outcomes. This study examined how baseline characteristics (age, gender, child pain catastrophizing (PCS-C), pain interference, pain intensity, anxiety, depression, paediatric health-related quality of life (PedsQLTM), and parent catastrophizing (PCS-P)) were associated with discharge and 3-month follow-up scores of PCS-C, pain intensity, and pain interference. Methods: PCS-C, pain intensity, and pain interference T-scores were acquired in 45 IIPT patients aged 12-18 at intake (baseline), discharge, and 3-month follow-up. Using available and imputed data, linear mixed models were developed to explore associations between PCS-C, pain intensity, and pain interference aggregated scores at discharge and follow-up with baseline demographics and a priori selected baseline measures of pain, depression, anxiety, and PCS-C/P. Results: PCS-C and pain interference scores decreased over time compared to baseline. Pain intensity did not change significantly. Baseline PCS-C, pain interference, anxiety, depression, and PedsQLTM were associated with discharge/follow-up PCS-C (available and imputed data) and pain interference scores (available data). Only baseline pain intensity was significantly associated with itself at discharge/follow-up. Conclusions: Participants who completed the IIPT program presented with reduced PCS-C and pain interference over time. Interventions that target pre-treatment anxiety and depression may optimize IIPT outcomes.

Catastrophizing moderates the relationship between pain severity and depressive symptomatology among women with endometriosis

The link between pain severity, depressive symptomatology and catastrophizing among women with endometriosis is still under-investigated. The aim of this study was to (i) evaluate differences in depressive symptomatology between women with and without endometriosis; (ii) investigate if pain severity is associated with depressive symptoms; and (iii) test if catastrophizing moderates the link between these two variables. A total of 172 women with a diagnosis of endometriosis and 62 healthy controls volunteered for this cross-sectional study. Depressive symptomatology, pain severity, and catastrophizing were assessed.Compared to healthy controls, women with endometriosis were more likely to score above the cutoff for depressive symptomatology, with 60.5% of the latter being classified as having a subthreshold depression or minor depression and 15.7% as having moderate or severe major depression. Pain severity was significantly associated with depressive symptoms even after controlling for several covariates. Finally, the moderation model suggested that among patients with endometriosis, the relationship between pain severity and depressive symptomatology depended on the level of catastrophizing, with this association being stronger for high levels of the moderator.Mental health practitioners working with women with endometriosis may consider those who report high levels of pain severity and of catastrophizing at high risk of depression and are advised to promote adaptive coping strategies among patients to foster a better adaptation to this chronic disease.

The association between pain-related factors and psychological distress in patients with temporomandibular disorder

Chronic pain is associated with high levels of psychological distress, which can have implications for general functioning, acceptance, quality of life, and compliance with health-promoting behaviour. This study explored the association between pain-related factors and psychological distress in a sample of patients with long lasting temporomandibular disorder (TMD). In this cross-sectional study design, psychological distress was measured in 133 Norwegian patients with long lasting and severe TMD. Participants completed a survey including the hospital anxiety and depression scale (HADS), and questions about pain intensity, pain duration, catastrophizing, and causal attributions of their TMD symptoms along with a clinical interdisciplinary investigation. Higher levels of catastrophizing were associated with psychological distress. Pain intensity was associated with psychological distress in the unadjusted model, but not when controlling for the other variables. The majority attributed their TMD symptoms to physical factors. The findings support psychological interventions aimed at reducing catastrophizing in treatment of TMD. However, the patients emphasized physical causes for their TMD symptoms, suggesting that psychological interventions alone are not sufficient. The findings support a multidisciplinary approach to the treatment of TMD.

Preoperative Pain Catastrophizing and Neuropathic Pain Do Not Predict Length of Stay and Early Post-Operative Complications following Total Joint Arthroplasty

BACKGROUND

Both pain catastrophizing and neuropathic pain have been suggested as prospective risk factors for poor postoperative pain outcomes in total joint arthroplasty (TJA).

OBJECTIVE

We hypothesized that pain catastrophizers, as well as patients with pain characterized as neuropathic, would exhibit higher pain scores, higher early complication rates and longer lengths of stay following primary TJA.

METHODS

A prospective, observational study in a single academic institution included 100 patients with end-stage hip or knee osteoarthritis scheduled for TJA. In pre-surgery, measures of health status, socio-demographics, opioid use, neuropathic pain (PainDETECT), pain catastrophizing (PCS), pain at rest and pain during activity (WOMAC pain items) were collected. The primary outcome measure was the length of stay (LOS) and secondary measures were the discharge destinations, early postoperative complications, readmissions, visual analog scale (VAS) levels and distances walked during the hospital stay.

RESULTS

The prevalence of pain catastrophizing (PCS ≥ 30) and neuropathic pain (PainDETECT ≥ 19) was 45% and 20.4%, respectively. Preoperative PCS correlated positively with PainDETECT (rs = 0.501, p = 0.001). The WOMAC positively correlated more strongly with PCS (rs = 0.512 p = 0.01) than with PainDETECT (rs = 0.329 p = 0.038). Neither PCS nor PainDETECT correlated with the LOS. Using multivariate regression analysis, a history of chronic pain medication use was found to predict early postoperative complications (OR 38.1, p = 0.47, CI 1.047-1386.1). There were no differences in the remaining secondary outcomes.

CONCLUSIONS

Both PCS and PainDETECT were found to be poor predictors of postoperative pain, LOS and other immediate postoperative outcomes following TJA.

A psychometric evaluation of the Italian short version of the Fear of Pain Questionnaire-III: Psychometric properties, measurement invariance across gender, convergent, and discriminant validity

Introduction

The Fear of Pain Questionnaire-III (FPQ-III) is a self-assessment instrument developed specifically to measure fear based on various pain stimuli converging on three factors: severe pain, medical pain, and minor pain. It actually remains the most studied and internationally used tool even in its short versions. The aim of this work was to propose a new validation study oriented to confirm the good psychometric properties of a short model of the FPQ-III for the Italian context.

Methods

A large sample of participants was recruited (n  = 1,064) and Exploratory Factor Analysis (EFA) as well as Confirmatory Factor Analysis (CFA) were performed. Measurement invariance of the FPQ-III across gender was also evaluated. In order to examine convergent validity, a further convenient sample (n  = 292) was used and variables related to the individual's pain experience, locus of control and coping orientations were assessed. A final discriminant assessment using experimental manipulation through fear eliciting videos was performed.

Results

The three factors structure of the 13-item version of the questionnaire was confirmed (χ² = 148.092, CFI = 0.971, TLI = 0.962, RMSEA = 0.046, RMSEA 90% CI = 0.037-0.056) as well as the measurement invariance across gender. Item internal reliability was satisfactory. The results provided evidence of the good predictive validity of the FPQ-III and the discriminant assessment demonstrated that the instrument is suitable in detecting changes in fear of pain induced by specific situational conditions.

Discussion

The scale in this short version is suitable for quickly and efficiently gathering information about the perceived intensity of such anticipatory fears that might affect even the healthy person dysfunctionally.

Dysmenorrhea catastrophizing and functional impairment in female pelvic pain

Background

Dysmenorrhea is suggested to increase the risk of chronic pain by enhancing central sensitization. However, little is known about whether emotional and cognitive responses induced by dysmenorrhea contribute to chronic pain interference. This study examined the association between catastrophizing specific to dysmenorrhea and both dysmenorrhea and chronic pelvic pain (CPP)-associated pain interference.

Methods

Women (N = 104) receiving care for CPP through a tertiary gynecological pain clinic between 2017 and 2020 were recruited. They completed the Pain Catastrophizing Scale, the Brief Pain Inventory-pain interference, and a separate questionnaire regarding dysmenorrhea symptoms and treatment preceding the development of CPP. Dysmenorrhea catastrophizing and interference measures were developed and tested for internal consistency and construct validity. Multiple linear regression models examined dysmenorrhea catastrophizing in association with dysmenorrhea interference and CPP-associated pain interference.

Results

Dysmenorrhea catastrophizing and interference measures demonstrated excellent internal consistency (Cronbach's Alpha = 0.93 and 0.92 respectively) and evidence of construct validity (correlated with dysmenorrhea severity and treatment, Ps < 0.01). Dysmenorrhea catastrophizing was moderately correlated with pain catastrophizing (ρ = 0.30, P = 0.003), and was associated with greater dysmenorrhea interference (P < 0.001) and CPP-associated pain interference (P = 0.032) accounting for general pain catastrophizing and other outcome-specific confounders. Dysmenorrhea intensity was most predictive of dysmenorrhea catastrophizing.

Conclusion

Among our clinical sample of women with CPP, dysmenorrhea catastrophizing was associated with greater dysmenorrhea interference and subsequent CPP-associated pain interference. More research is needed to determine whether reduction in dysmenorrhea catastrophizing leads to reduced pain interference associated with female pelvic pain.

The role of catastrophizing in chronic cyclical pelvic pain: A systematic review and meta-analysis

BACKGROUND

Dysmenorrhea (painful menstrual cramps) is one of the most common gynecological complaints in women and girls. Dysmenorrhea may be a condition itself or a result of another medical condition, including endometriosis and chronic pelvic pain. Research examining the relationship between menstrual pain ratings and catastrophizing has produced mixed results.

OBJECTIVE

To review and meta-analyze the relationship between catastrophizing and pain ratings of chronic cyclical pelvic pain.

DESIGN

Cross-sectional, longitudinal, and intervention studies that reported the relationship between menstrual/pelvic pain and catastrophizing were included. Study populations had to include healthy menstruating persons or persons with a condition associated with cyclical pelvic pain including primary dysmenorrhea, endometriosis, and/or chronic pelvic pain.

DATA SOURCES AND METHODS

A systematic search of articles published since 2012 on PubMed, PsychInfo, CINHAL, and Medline was conducted in January and rerun in November of 2022. Search terms included cyclical pelvic pain, dysmenorrhea, endometriosis, pelvic pain, and catastrophizing. Data extraction was completed independently by two extractors and cross-checked for errors. A random-effects meta-regression was used to synthesize the data using restricted maximum likelihood.

RESULTS

Twenty-five studies examining 4,540 participants were included. A random effects model found a meta-correlation between catastrophizing and pain of r = .31 (95% confidence interval: .23-.40) p < .001. Heterogeneity was large and significant (I2 = 84.5%, Q(24) = 155.16, p < .001). Studies that measured general pelvic pain rather than cyclical pelvic pain specifically and those that used multi-item rather than single-item measures of pain had significantly higher correlations. Age and depression did not moderate the relationship between catastrophizing and pain.

CONCLUSION

A systematic review and meta-analysis found that catastrophizing had a small but significant positive association with pain ratings. Patients experiencing cyclical pelvic pain may benefit from interventions targeting the psychological management of pain.

REGISTRATION

This meta-analysis was registered in PROSPERO on 14 January 2022. Registration number: CRD42022295328.

Examining the roles of depression, pain catastrophizing, and self-efficacy in quality of life changes following chronic pain treatment

Background

Adults with chronic pain have a lower quality of life (QOL) compared to the general population. Chronic pain requires specialized treatment to address the multitude of factors that contribute to an individual's pain experience, and effectively managing pain requires a biopsychosocial approach to improve patients' QOL.

Aim

This study examined adults with chronic pain after a year of specialized treatment to determine the role of cognitive markers (i.e., pain catastrophizing, depression, pain self-efficacy) in predicting changes in QOL.

Methods

Patients in an interdisciplinary chronic pain clinic (N = 197) completed measures of pain catastrophizing, depression, pain self-efficacy, and QOL at baseline and 1 year later. Correlations and a moderated mediation were completed to understand the relationships between the variables.

Results

Higher baseline pain catastrophizing was significantly associated with increased mental QOL (b = 0.39, 95% confidence interval [CI] 0.141; 0.648) and decreased depression (b = -0.18, 95% CI -0.306; -0.052) over a year. Furthermore, the relationship between baseline pain catastrophizing and the change in depression was moderated by the change in pain self-efficacy (b = -0.10, 95% CI -0.145; -0.043) over a year. Patients with high baseline pain catastrophizing reported decreased depression after a year of treatment, which was associated with greater QOL improvements but only in patients with unchanged or improved pain self-efficacy.

Conclusions

Our findings highlight the roles of cognitive and affective factors and their impact on QOL in adults with chronic pain. Understanding the psychological factors that predict increased mental QOL is clinically useful, because medical teams can optimize these positive changes in QOL through psychosocial interventions aimed at improving patients' pain self-efficacy.

Predictors of disability in patients with chronic low back pain

INTRODUCTION

Chronic low back pain (CLBP) is a common and disabling health problem. In this study, we aimed to assess the relationship between pain intensity, the components of catastrophizing, depression and disability in patients with chronic low back pain.

MATERIAL AND METHODS

Seventy-six patients diagnosed with CLBP (age range 25-77 years; 73.7% female) participated in the study. Participants' socio-demographic data were collected: age, gender, height, weight, and work status (employed or retired). All participants were asked to complete the Pain Catastrophizing Scale (PCS), the visual analogue scale (VAS), the Oswestry Disability Questionnaire (ODQ), and the Beck Depression Inventory (BDI).

RESULTS

The mean group scores revealed moderate CLBP complaints (VAS - 4 [3-6]), mild depression (BDI - 10 [5-16]), a moderate level of catastrophizing (PCS total score 20.5 [10-34]) and moderate disability (Oswestry Disability Index [ODI] - 31 [14-38]). Positive significant correlations were found between ODI and age, residence, work status, VAS, PCS-rumination, PCS-magnification, PCS-helplessness and BDI, and also between PCS subscales and VAS. Our multivariate linear regression analysis showed that age, pain intensity, PCS-helplessness and depression can predict disability in patients with CLBP, explaining 84% of the variance of disability (R² = 0.851, adjusted R² = 0.843).

CONCLUSIONS

A multidisciplinary approach is needed for patients with CLBP and should include physical, mental and social evaluation in order to offer an optimal treatment.

Effects of Walking as Physical Exercise on Functional Limitation through Pain in Patients with Fibromyalgia-How Does Catastrophic Thinking Contribute?

Background: Aerobic exercise has a beneficial impact on physical and mental health. However, patients with fibromyalgia do not always report perceiving these improvements. Objective: The aim of this study was to examine whether catastrophic thinking moderated the effects of perceived pain severity once an active and regular lifestyle had been established on functional limitation in chronic pain patients, in particular in fibromyalgia patients. Methods: The sample consisted of a total of 491 women with fibromyalgia diagnosed according to the criteria of the American College of Rheumatology. Participants completed an ad-hoc item about lifestyle related to walking pattern, the Brief Pain Inventory, the Pain Catastrophization Scale, and the Fibromyalgia Impact Questionnaire-Revised. To examine the relationship between the variables, a moderate mediation analysis was performed through the macro PROCESS (model 14). Results: The relationship between the performance of the recommended walking pattern and functional limitation was mediated by the severity of pain (B = −5.19, SE = 1.59, t = −3.25, 95% CI = [−4.06, −0.28], p < 0.001). Furthermore, it was found that the mediating effect of pain severity was moderated by catastrophic thinking (Index = −0.014, SE = 0.007, 95% CI [0.002, 0.030]). Conclusions: The positive effect of walking on functionality through the reduction of pain levels is favored when patients present low catastrophizing, which affects the relevance of including interventions focused on the reduction of catastrophizing in the prescription of physical exercise in patients with fibromyalgia as the treatment of choice.

Effects of Depression, Anxiety, and Pain Catastrophizing on Total Hip Arthroplasty Patient Activity Level

BACKGROUND

Improvements in psychological factors are strongly associated with increased physical activity in the general population. The effects of depression, anxiety, and pain catastrophizing on activity level have not been thoroughly explored in patients undergoing total hip arthroplasty (THA). Mental health markedly influences patient perspectives on treatment success and quality of life. We hypothesized that improvements in screenings for depression, anxiety, and catastrophizing correlate with improvements in activity levels after THA.

METHODS

Two hundred ninety two patients (313 hips) who underwent THA with a minimum 1-year (mean 615 ± 270 days) follow-up completed preoperative and postoperative surveys containing the University of California Los Angeles (UCLA) Activity Score, Hospital Anxiety Depression Scale (HADS), Pain Catastrophizing Scale (PCS), and Depression Anxiety Stress Scale-21 (DASS). Wilcoxon signed-rank tests were performed between preoperative and postoperative times for outcome measures. Partial Spearman's rank-order correlations were performed between the change in UCLA Score and the change in HADS, PCS, and DASS.

RESULTS

There were significant improvements in UCLA Score (P value < .0001) and every subscale of PCS, HADS, and DASS (P values < .0001). Significant negative correlations existed between change in UCLA Score and change in HADS-anxiety (r_s = -0.21, P value < .001), change in HADS-depression (r_s = -0.23, P value < .001), and change in DASS-anxiety (r_s = -0.22, P value = .004) following THA. Weaker significant negative correlations existed between change in UCLA Score and change in the remaining PCS (P values = .006) and DASS-depression(P value = .037) subscales.

CONCLUSION

Improvements in patient-reported depression, anxiety, and pain catastrophizing screenings following THA were associated with increased activity levels. Patients who were screened for catastrophizing, depression, and anxiety achieved statistically and clinically meaningful improvements in symptoms following THA. Addressing patient mental health provides another avenue for holistic care of THA patients.

Is Mindfulness Associated With Lower Pain Reactivity and Connectivity of the Default Mode Network? A Replication and Extension Study in Healthy and Episodic Migraine Participants

Formal training in mindfulness-based practices promotes reduced experimental and clinical pain, which may be driven by reduced emotional pain reactivity and undergirded by alterations in the default mode network, implicated in mind-wandering and self-referential processing. Recent results published in this journal suggest that mindfulness, defined here as the day-to-day tendency to maintain a non-reactive mental state in the absence of training, associates with lower pain reactivity, greater heat-pain thresholds, and resting-state default mode network functional connectivity in healthy adults in a similar manner to trained mindfulness. The extent to which these findings extend to chronic pain samples and replicate in healthy samples is unknown. Using data from healthy adults (n = 36) and episodic migraine patients (n = 98) and replicating previously published methods, we observed no significant association between mindfulness and heat-pain threshold, pain intensity or unpleasantness, or pain catastrophizing in healthy controls, or between mindfulness and headache frequency, severity, impactor pain catastrophizing in patients. There was no association between default mode network connectivity and mindfulness in either sample when probed via seed-based functional connectivity analyses. In post-hoc whole brain exploratory analyses, a meta-analytically derived default mode network node (ie, posterior cingulate cortex) showed connectivity with regions unassociated with pain processing as a function of mindfulness, such that healthy adults higher in mindfulness showed greater functional connectivity between the posterior cingulate cortex-and cerebellum. Collectively, these findings suggest that the relationship between mindfulness and default mode network functional connectivity may be nuanced or non-robust, and encourage further investigation of how mindfulness relates to pain. PERSPECTIVE: This study found few significant associations between dispositional mindfulness and pain, pain reactivity and default mode connectivity in healthy adults and migraine patients. The relationship between mindfulness and default mode network connectivity may be nuanced or non-robust.

Prognosis of shoulder pain in those with and without a psychological disorder: A prospective cohort study with a six-month follow-up

BACKGROUND

Because shoulder pain can have an unfavorable prognosis, it is important to have a better understanding of factors that may influence recovery.

OBJECTIVE

To determine the association between recovery from shoulder pain and the presence of depression, anxiety, and pain catastrophizing.

METHODS

In a prospective cohort study with a six months follow-up, we included patients visiting an orthopaedic department with shoulder pain. Primary outcome was recovery from shoulder pain measured with the Shoulder Pain and Disability Index at three and six months. Information about depression and anxiety (Hospital Anxiety and Depression Scale), pain catastrophizing (Pain Catastrophizing Scale), and demographic and clinical factors were collected at baseline. A linear mixed model was used to estimate the effects of depression, anxiety, pain catastrophizing, and underlying shoulder disorders on recovery.

RESULTS

We included 190 patients. There were no statistically significant associations between the presence of depression, anxiety, and pain catastrophizing, and three- and six-month recovery. Also between the underlying shoulder disorders and recovery at three and six months, there were no statistically significant associations.

CONCLUSIONS

We could not prove that depression, anxiety, and pain catastrophizing, as well as underlying shoulder disorders, were associated with recovery of shoulder pain at six months.

Validation of pain catastrophizing scale on breast cancer survivor

INTRODUCTION

Pain catastrophizing scale (PCS) is the most used scale to measure pain catastrophizing. In breast cancer survivors (BCS), pain catastrophizing is related to upper-limbs dysfunction and disability. This study aimed to assess the internal consistency, internal structure, and convergent validity of the Spanish version of the PCS in Spanish BCS.

MATERIAL AND METHODS

Breast cancer survivors were recruited from the service of Medical Oncology of the University Clinical Hospital Virgen de la Victoria, in Málaga (Spain). The psychometric properties were evaluated with analysis factor structure by maximum likelihood extraction (MLE), internal consistency, and construct validity by confirmatory factor analysis (CFA).

RESULTS

Factor structure was three-dimensional, and one item was removed due to cross-loading. The new 12-item PCS showed a high internal consistency for the total score (α = 0.91) and a good homogeneity, and CFA revealed a satisfactory fit. PCS showed an acceptable correlation with FACS (r = 0.53, p < 0.01).

CONCLUSION

Pain catastrophizing scale is a valid and reliable instrument to evaluate pain catastrophizing in Spanish BCS. This tool may help clinicians in the management of pain by assessing pain and by measuring the effect of interventions.

Psychological Profile in Women with Chronic Pelvic Pain

(1) Background: Chronic Pelvic Pain (CPP) is a prevalent medical condition with a complex treatment due to different variables that influence its clinical course. (2) Methods: Psychological variables such as depression, anxiety, catastrophizing or neuroticism have been described as influencing CPP. This is a cross-sectional study of 63 patients with CPP sent for a psychological evaluation due to participation in group therapy for CPP. The main purpose of this study was to characterize the baseline psychological characteristics of women with CPP. The NEO Five Factor Inventory (NEO-FFI), State and Trait Anxiety Inventory (STAI), Beck Depression Inventory-Fast Screen (BDI-FS), Pain Catastrophizing Scale (PCS) and Chronic Pain Acceptance Questionnaire (CPAQ) were performed. (3) Results: The personality profile of patients (NEO FFI) shows high neuroticism, low extraversion and low conscientiousness. The 25.4% of patients had moderate or severe depression according to BDI-FS results, almost half of the patients had high levels of anxiety trait (>P75, 49.2%) and more than half the patients had high levels of anxiety state (>P75, 59.5%). Punctuations of PCS and CPAQ are similar to patients with fibromyalgia. (4) Conclusions: CPP is associated with high levels of depression, anxiety, neuroticism, catastrophizing and low pain acceptance. It is important to develop interventions that can modify these psychological factors in order to improve the clinical course of CPP.

The relationship between fear of recurrence and depression in patients with cancer: The role of invasive rumination and catastrophizing

Objective

To examine the relationship between fear of recurrence and depression in patients with cancer.

Materials and methods

Two hundred and fifty-nine participants completed self-report questionnaires, including the Fear of Progression Questionnaire-Short Form, Rumination Inventory, Cognitive Emotion Regulation Questionnaire (Chinese version), and Center for Epidemiological Studies Depression Scale.

Results

Fear of recurrence in patients with cancer was moderate, and the level of depression was significantly higher than that in the normal population. Fear of recurrence, invasive rumination, catastrophizing, and depression in patients with cancer were significantly positively correlated. The level of fear of recurrence was a significant positive predictor of the level of depression. Invasive rumination played a partial mediating role between fear of recurrence and depression; that is, fear of recurrence directly affected depression, and fear of recurrence indirectly affected depression through invasive rumination. Catastrophizing played a moderating role in the mediation model, in which fear of recurrence affected depression through invasive rumination.

Conclusion

Invasive rumination plays a mediating role between fear of recurrence and depression in patients with cancer. Catastrophizing moderates the relationship between fear of recurrence and depression as well as the relationship between invasive rumination and depression.

In the Shoulder or in the Brain? Behavioral, Psychosocial and Cognitive Characteristics of Unilateral Chronic Shoulder Pain with Symptoms of Central Sensitization

The recognition of central sensitization (CS) is crucial, as it determines the results of rehabilitation. The aim of this study was to examine associations between CS and catastrophizing, functionality, disability, illness perceptions, kinesiophobia, anxiety, and depression in people with chronic shoulder pain (SP). In this cross-sectional study, 64 patients with unilateral chronic SP completed a few questionnaires including the Central Sensitization Inventory, the Oxford Shoulder Score, the Tampa Scale for Kinesiophobia, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale, the Brief Illness Perception Questionnaire and the “arm endurance” test. On the basis of three constructed linear regression models, it was found that pain catastrophizing and depression (model 1: p < 0.001, R = 0.57, R2 = 0.33), functionality (model 2: p < 0.001, R = 0.50, R2 = 0.25), and helplessness (model 3: p < 0.001, R = 0.53, R2 = 0.28) were significant predictors for CS symptoms in chronic SP. Two additional logistic regression models also showed that depression (model 4: p < 0.001, Nagelkerke R2 = 0.43, overall correct prediction 87.5%) and functionality (model 5: p < 0.001, Nagelkerke R2 = 0.26, overall correct prediction 84.4%) can significantly predict the classification of chronic SP as centrally sensitized. Patients who were classified as centrally sensitized (n = 10) were found to have significantly worse functionality, psychological factors (anxiety, depression, kinesiophobia, catastrophizing), and pain intensity (p < 0.05). Catastrophizing, depression, and functionality are predictive factors of CS symptoms in patients with chronic shoulder pain. Health care providers should adopt a precision medicine approach during assessment and a holistic rehabilitation of patients with unilateral chronic SP.

Exploration of the trait-activation model of pain catastrophizing in Native Americans: results from the Oklahoma Study of Native American pain risk (OK-SNAP)

OBJECTIVES

Native Americans (NAs) have the highest prevalence of chronic pain of any racial/ethnic group. This issue has received little attention from the scientific community. One factor that may contribute to racial pain disparities is pain catastrophizing. Pain catastrophizing is a construct related to negative pain outcomes in persons with/without chronic pain. It has been suggested that the relationship between trait catastrophizing and pain is mediated by situation-specific (state) catastrophizing. The present study has 2 aims: (1) to investigate whether state pain catastrophizing mediates the relationship between trait catastrophizing and experimental pain (e.g., cold, ischemic, heat and electric tolerance), and (2) to investigate whether this relationship is stronger for NAs.

METHODS

145 non-Hispanic Whites (NHWs) and 137 NAs completed the study. Bootstrapped indirect effects were calculated for 4 unmoderated and 8 moderated mediation models (4 models with path a moderated and 4 with path b).

RESULTS

Consistent with trait-activation theory, significant indirect effects indicated a tendency for trait catastrophizing to be associated with greater state catastrophizing which in turn is associated with reduced pain tolerance during tonic cold (a × b=-0.158) and ischemia stimuli (a × b=-0.126), but not during phasic electric and heat stimuli. Moderation was only noted for the prediction of cold tolerance (path a). Contrary to expectations, the indirect path was stronger for NHWs (a × b for NHW=-.142).

CONCLUSIONS

Together, these findings suggest that state catastrophizing mediates the relationship between trait catastrophizing and some measures of pain tolerance but this indirect effect was non-significant for NAs.

Testing a Combined Cognitive Bias Hypothesis of Pain and Pain-related Worry in Young People

Cognitive factors are thought to contribute and maintain pain experiences in young people. However, most of these factors have been assessed in isolation. Considering more than 1 cognitive factor could increase explanatory power and identify multiple targets for intervention. Here, we tested a Combined Cognitive Bias Hypothesis (CCBH) that suggests information-processing factors associate with each other and exert either additive and/or interactive influences on pain outcomes. We conducted secondary analysis of data from 243 adolescents aged 16 to 19 years, who had completed a task measuring pain-related attention control impairments (emotion-priming visual search task) and a task measuring biased interpretations towards threatening cues (Adolescent Interpretation of Bodily Threat task). These young people also completed measures of recent pain experiences and pain catastrophizing, which served as primary and secondary outcomes, respectively. Regression analyses revealed that difficulties with attention control (following presentation of pain-related stimuli) and tendencies to endorse threatening interpretations of ambiguous situations had significant additive effects on both pain outcomes. However, correlations between these factors were non-significant. They also did not interact to influence pain outcomes. These findings require replication in broader age ranges and clinical samples but potentially suggest that, measuring multiple cognitive factors increases explanatory power of youth pain outcomes. PERSPECTIVE: Weak attention control following exposure to pain cues and tendencies to endorse threat interpretations, uniquely and additively associate with self-reported pain experiences and pain catastrophizing in community youth. Measuring several cognitive factors simultaneously could improve our ability to explain pain outcomes in adolescent populations.

Multimodal Chronic Pain Therapy for Adults via Smartphone: Randomized Controlled Clinical Trial

BACKGROUND

Combination therapies delivered remotely via the internet or mobile devices are increasingly being used to improve and promote the self-management of chronic conditions. However, little is known regarding the long-term effects of these interventions.

OBJECTIVE

The aim of this study is to evaluate the effectiveness of a multimodal intervention program that measures associated variables such as catastrophizing, pain acceptance, and quality of life using a mobile device in people with chronic pain in an outpatient setting.

METHODS

A randomized controlled clinical trial was performed using parallel treatment groups. A total of 209 patients with chronic musculoskeletal pain were randomly assigned to one of the two study arms. The intervention group received a standard web-based psychosocial therapy-type program of activities through a smartphone for 6 weeks. The control group only had access to the Find out more section of the app, which contained audiovisual material for pain management based on a self-help approach. The primary outcome was catastrophizing measured using the Pain Catastrophizing Scale (PCS). Secondary outcomes were pain acceptance measured using the Chronic Pain Acceptance Questionnaire and health-related quality of life measured using the EuroQol Visual Analogue Scale. Assessments were conducted at baseline (T1), after treatment (T2), and at the 3-month follow-up (T3). The variations between the different phases were assessed using the percentage change rescaled with log base 2. The Cohen d was calculated based on the results of the linear mixed model. The investigators of the study who evaluated the results were not involved in patient recruitment and were blinded to the group assignment.

RESULTS

Positive effects were found in the intervention group (T2-T1) in catastrophizing between the baseline and posttreatment phases (P<.001) and in helplessness (-0.72 vs 0.1; P=.002), rumination (-1.59 vs -0.53; P<.001), acceptance (0.38 vs 0.05; P=.001), and quality of life (0.43 vs -0.01; P=.002), although no significant changes were found for magnification (0.2 vs 0.77; P=.14) and satisfaction with health (0.25 vs -0.27; P=.13). Three months after treatment, significant differences were observed in the intervention group for the outcome variable of catastrophizing (PCS; -0.59 vs 0.2; P=.006) and the PCS subscales of helplessness (-0.65 vs 0.01; P=.07), rumination (1.23 vs -0.59; P=.04), and magnification (0.1 vs 0.86; P=.02).

CONCLUSIONS

The results of our study suggest that app-based mobile multidimensional treatments for adults with chronic pain improve catastrophizing, quality of life, and psychological flexibility immediately after treatment and that the effects are maintained for the primary outcome of catastrophizing for at least 3 months following treatment. Moreover, they promote self-management and can be used to complement face-to-face pain treatments.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04509154; https://clinicaltrials.gov/ct2/show/NCT04509154.

Understanding Pain and Trauma Symptoms in Veterans From Resting-State Connectivity: Unsupervised Modeling

Trauma and posttraumatic stress are highly comorbid with chronic pain and are often antecedents to developing chronic pain conditions. Pain and trauma are associated with greater utilization of medical services, greater use of psychiatric medication, and increased total cost of treatment. Despite the high overlap in the clinic, the neural mechanisms of pain and trauma are often studied separately. In this study, resting-state functional magnetic resonance imaging (rs-fMRI) scans were completed among a diagnostically heterogeneous sample of veterans with a range of back pain and trauma symptoms. Using Group Iterative Multiple Model Estimation (GIMME), an effective functional connectivity analysis, we explored an unsupervised model deriving subgroups based on path similarity in a priori defined regions of interest (ROIs) from brain regions implicated in the experience of pain and trauma. Three subgroups were identified by patterns in functional connection and differed significantly on several psychological measures despite similar demographic and diagnostic characteristics. The first subgroup was highly connected overall, was characterized by functional connectivity from the nucleus accumbens (NAc), the anterior cingulate cortex (ACC), and the posterior cingulate cortex (PCC) to the insula and scored low on pain and trauma symptoms. The second subgroup did not significantly differ from the first subgroup on pain and trauma measures but was characterized by functional connectivity from the ACC and NAc to the thalamus and from ACC to PCC. The third subgroup was characterized by functional connectivity from the thalamus and PCC to NAc and scored high on pain and trauma symptoms. Our results suggest that, despite demographic and diagnostic similarities, there may be neurobiologically dissociable biotypes with different mechanisms for managing pain and trauma. These findings may have implications for the determination of appropriate biotype-specific interventions that target these neurological systems.

Passive Recharge Burst Spinal Cord Stimulation Provides Sustainable Improvements in Pain and Psychosocial Function: 2-year Results From the TRIUMPH Study

STUDY DESIGN

Prospective, international, multicenter, single-arm, post-market study.

OBJECTIVE

The aim of this study was to assess long-term safety and effectiveness of spinal cord stimulation using a passive recharge burst stimulation design for chronic intractable pain in the trunk and/or limbs. Herein we present 24-month outcomes from the TRIUMPH study (NCT03082261).

SUMMARY OF BACKGROUND DATA

Passive recharge burst spinal cord stimulation (B-SCS) uniquely mimics neuronal burst firing patterns in the nervous system and has been shown to modulate the affective and attentional components of pain processing.

METHODS

After a successful trial period, subjects received a permanent SCS implant and returned for follow-up at 6, 12, 18, and 24 months.

RESULTS

Significant improvements in physical, mental, and emotional functioning observed after 6 months of treatment were maintained at 2 years. Pain catastrophizing scale (PCS) scores dropped below the population norm. Health-related quality of life on EQ-5D improved across all domains and the mean index score was within one standard deviation of norm. Pain reduction (on NRS) was statistically significant (P < 0.001) at all timepoints. Patient reported pain relief, a stated percentage of improvement in pain, was consistent at all timepoints at 60%. Patients reported significant improvements across all measures including activity levels and impact of pain on daily life. At 24 months, 84% of subjects were satisfied and 90% would recommend the procedure. Subjects decreased their chronic pain medication intake for all categories; 38% reduced psychotropic and muscle relaxants, 46% reduced analgesic, anti-convulsant and NSAIDs, and 48% reduced opioid medication. Adverse events occurred at low rates without unanticipated events.

CONCLUSION

Early positive results with B-SCS were maintained long term. Evidence across multiple assessment tools show that B-SCS can alleviate pain intensity, psychological distress, and improve physical function and health-related quality of life.Level of Evidence: 3.

Kinesiophobia Severity Categories and Clinically Meaningful Symptom Change in Persons With Achilles Tendinopathy in a Cross-Sectional Study: Implications for Assessment and Willingness to Exercise

Objectives: (1) Validate thresholds for minimal, low, moderate, and high fear of movement on the 11-item Tampa Scale of Kinesiophobia (TSK-11), and (2) Establish a patient-driven minimal clinically important difference (MCID) for Achilles tendinopathy (AT) symptoms of pain with heel raises and tendon stiffness.

Methods: Four hundred and forty-two adults with chronic AT responded to an online survey, including psychosocial questionnaires and symptom-related questions (severity and willingness to complete heel raises and hops). Kinesiophobia subgroups (Minimal ≤ 22, Low 23–28, Moderate 29–35, High ≥ 36 scores on the TSK-11), pain MCID subgroups (10-, 20-, 30-, >30-points on a 0- to 100-point scale), and stiffness MCID subgroups (5, 10, 20, >20 min) were described as median [interquartile range] and compared using non-parametric statistics.

Results: Subgroups with higher kinesiophobia reported were less likely to complete three heel raises (Minimal = 93%, Low = 74%, Moderate = 58%, High = 24%). Higher kinesiophobia was associated with higher expected pain (Minimal = 20.0 [9.3–40.0], Low = 43.0 [20.0–60.0], Moderate = 50.0 [24.0–64.0], High = 60.5 [41.3–71.0]) yet not with movement-evoked pain (Minimal = 25.0 [5.0–43.0], Low = 31.0 [18.0–59.0], Moderate = 35.0 [20.0–60.0], High = 43.0 [24.0–65.3]). The most common pain MCID was 10 points (39% of respondents). Half of respondents considered a 5-min (35% of sample) or 10-min (16%) decrease in morning stiffness as clinically meaningful.

Conclusions: Convergent validity of TSK-11 thresholds was supported by association with pain catastrophizing, severity of expected pain with movement, and willingness to complete tendon loading exercises. Most participants indicated that reducing their pain severity to the mild range would be clinically meaningful.

Effectiveness of Interventions Based on Pain Neuroscience Education on Pain and Psychosocial Variables for Osteoarthritis: A Systematic Review

Osteoarthritis (OA) is the most common joint condition. It affects more than 300 million people worldwide, who suffer from pain and physical disability. Objective: To determine the results of cognitive educational interventions for pain management and psychosocial variables in adults with OA. Method: A systematic review was conducted based on searches in MEDLINE, OVID, LILACS, Scopus, PEDro, OTseeker, The Cochrane Library, EBSCO, and Google Scholar. The search strategy included the main terms neuroscience education and osteoarthritis, without any re-strictions with regard to dates or study type (PROSPERO register CRD42021222763). Results: We included four articles that implemented the intervention in 1–6 sessions, addressing concepts related to goal orientation and providing strategies for understanding pain. The results suggest that there is an improvement between the groups (PNE) when compared, but this cannot necessarily be attributed to pain neuroscience education (PNE), as small effect sizes for variables such as pain catastrophizing and kinesiophobia were observed. The response in the modulation of acute pain following the surgical procedure may produce a variation in the responses and this may be mediated by medications. Conclusion: The study revealed an improvement in favor of the groups managed with PNE, although more studies documenting the topic are warranted.

Measuring Fear of Cancer Recurrence in Survivors of Childhood Cancer: Development and Preliminary Validation of the FCRI-Child and FCRI-Parent Versions

OBJECTIVE

Fear of cancer recurrence (FCR) is a common and distressing psychosocial concern for adult cancer survivors. Data on this construct in child survivors is limited and there are no validated measures for this population. This study aimed to adapt the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF) for survivors of childhood cancer aged 8-18 years (FCRI-C) and their parents (FCRI-P) to self-report on their own FCR and to examine the initial psychometric properties.

METHODS

The FCRI-SF was adapted through expert panel input and cognitive interviews with child survivors <18 years. The factor structure, internal consistency and construct and criterion validity of the FCRI-C and FCRI-P were examined in 124 survivors of childhood cancer (43% female; M_age =14.58 years, SD=2.90) and 106 parents (90% mothers).

RESULTS

All FCRI-SF items were retained for the FCRI-C with simplified language. The internal consistencies of the FCRI-C (α= .88) and FCRI-P (α= .83) were good. Exploratory factor analyses yielded one-factor structures for both measures. Higher scores on the FCRI-C and FCRI-P were associated with greater intolerance of uncertainty and pain catastrophizing. Higher child FCR was also related to more hypervigilance to bodily symptoms. Parents with higher FCR reported contacting their child's doctors and nurses and scheduling medical appointments for their child more frequently. Children reported significantly lower FCR compared to parents.

CONCLUSIONS

The FCRI-C and FCRI-P demonstrated strong reliability and preliminary validity. This study offers preliminary data to support the use of the FCRI-C and FCRI-P to measure FCR in survivors of childhood cancer aged 8-18 years and their parents. This article is protected by copyright. All rights reserved.

Event centrality and post-traumatic stress symptoms among college students during the COVID-19 pandemic: the roles of attention to negative information, catastrophizing, and rumination

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has affected college students' mental health and caused post-traumatic stress symptoms (PTSS). Event centrality is thought to play a key role in the development of PTSS, but it is not yet clear by what mechanism. Theoretically, event centrality may affect the retrieval of traumatic memories and further prompt post-traumatic cognitions to understand events, and so may in turn be associated with PTSS in college students. However, few empirical studies have examined the mediating role of post-traumatic cognitions in the relationship between event centrality and PTSS, especially among college students during the COVID-19 pandemic.

OBJECTIVES

The objective of this study was to examine the mediating roles of post-traumatic cognitive factors (e.g. attention to negative information, catastrophizing, and rumination) in the relationship between event centrality and PTSS among college students during the COVID-19 pandemic.

METHODS

We recruited 1153 college students who completed the pandemic experiences scale, the centrality of event scale, the attention to positive and negative information scale, the cognitive emotion regulation questionnaire, and the PTSD Checklist for DSM-5 during the COVID-19 pandemic in May 2020.

RESULTS

In this sample of college students, event centrality directly predicted PTSS, and PTSS was also indirectly predicted by event centrality through attention to negative information, catastrophizing, and rumination.

CONCLUSIONS

These findings support the existing literature on the relationship between event centrality, proposed cognitive variables, and PTSS, and shed light on the mechanisms underlying PTSS. Our findings also highlight the importance and applicability of targeted cognitive interventions for PTSS in college students during the COVID-19 pandemic.

HIGHLIGHTS

The COVID-19 pandemic has caused post-traumatic stress symptoms among college students.Event centrality is a risk factor of post-traumatic stress symptoms among college students during the COVID-19 pandemic.Attention to negative information, catastrophizing and rumination mediate the relationship between event centrality and post-traumatic stress symptoms.

The relationship between symptom severity, bother and psychological factors in women with pelvic organ prolapse: A cross-sectional observational study

AIM

The primary aim is to explore the relationship between symptom severity and prolapse bother in women with pelvic organ prolapse (POP). The secondary aim is to determine the association between psychological variables and prolapse bother.

METHODS

A cross-sectional observational study was conducted via online surveys assessing POP bother (visual analog scale for bother), POP symptom severity (International Consultation on Incontinence Questionnaire-Vaginal Symptoms), and psychological measures of depression and anxiety (Kessler psychological distress scale [K-10]), catastrophizing (modified pain catastrophizing scale [mPCS]), and self-efficacy (modified pain self-efficacy questionnaire [mPSEQ]) in women with self-reported POP. Symptom severity, bother and psychological variables were analyzed using linear regression.

RESULTS

Seventy-six women with a mean (SD) age of 42.8 (14.57) years were included in analysis. A moderate to strong positive linear relationship (R²  = 0.449, p < 0.001) was found between symptom severity and POP bother. Prolapse bother and psychological variables were moderately correlated, where increased K-10 scores (R²  = 0.230, p = 0.001), higher mPCS scores (R²  = 0.460, p < 0.001), and lower mPSEQ scores (R²  = 0.460, p < 0.001) were associated with increased POP bother. Moderate and severe catastrophizing was associated with significantly higher POP bother, with mean POP bother scores of 7.861 ± 0.45 (p < 0.001) and 8.652 ± 0.45 (p < 0.001), respectively.

CONCLUSION

A moderate positive relationship between POP bother and symptom severity was found, with greater psychological distress and lower self-efficacy associated with increasing POP bother. Women presenting with POP should be screened for psychological factors to guide management.

The relationship between chronic pain and psychosocial aspects in patients with haemophilic arthropathy. A cross-sectional study

BACKGROUND

Pain is a major characteristic in haemophilic arthropathy. Identifying the psychosocial variables affected by pain can help when addressing these patients.

AIM

To assess the relationship between perceived intensity of chronic pain and joint damage, kinesiophobia, catastrophism, anxiety and perceived quality of life in adult patients with haemophilic arthropathy.

METHODS

Multicentre cross-sectional descriptive study. Seventy-seven adult patients with haemophilic arthropathy were recruited. The usual and maximum pain intensity (Visual Analog Scale), joint status (Haemophilia Joint Health Score), Kinesiophobia (Tampa Scale of Kinesiophobia), catastrophism (Pain catastrophizing scale), anxiety (State-Trait Anxiety inventory) and perceived quality of life (36-Item Short Form Health Survey) were evaluated. The correlation between usual and maximum pain intensity with quantitative variables was obtained with Spearman`s correlation test. Kruskal-Wallis one-way ANOVA analysed differences in perceived pain according to the severity and type of treatment, and development of inhibitors.

RESULTS

The usual intensity of perceived pain correlated positively with catastrophism, kinesiophobia, and state and trait anxiety. The same results were obtained when analysing the maximum perception of pain. We found an inverse correlation between the physical component of perceived quality of life and usual and maximum pain intensity perceived by patients.

CONCLUSION

Psychosocial factors affect the painful experience of patients with haemophilic arthropathy. Pain intensity affects the quality of life of these patients.

A Comparative Study of a Novel Postural Garment Versus Exercise for Women with Nonspecific Cervical Pain: A Randomized Cross-over Trial

STUDY DESIGN

Randomized cross-over study.

OBJECTIVE

The aim of this study was to compare exercise, the criterion standard, to the postural garment PosturePlusForce in the management of nonspecific cervical pain in women. We also analyzed both interventions with regards to baseline posture, use of pharmacological pain relievers, compliance, and comfort.

SUMMARY OF BACKGROUND DATA

The prevalence of neck pain has increased during the last decade, preferentially affecting women. Those suffering from this condition may manifest a decrease in quality of life and inability to work. Consistent recommendations highlight the importance of exercise and posture for neck pain improvement.

METHODS

A total of 32 female health care professionals with cervical pain (≥3 on the visual analogue scale) entered the trial. Participants were allocated to either performing exercises or wearing the postural garment. The cross-over between interventions was separated by a 3-month washout period. Primary outcomes included pain intensity and posture. Secondary outcomes comprised cervical pain-related disability, psychological factors, physical activity, global perceived effect of treatment, and garment comfort. Treatment compliance, medication use, and adverse events were also recorded.

RESULTS

Both interventions showed a significant improvement in pain in subjects with an adherence >60%. However, in participants with dorsal hyperkyphosis (>45°), the garment demonstrated a greater reduction in pain than exercise (P = 0.019). Additionally, those wearing the garment needed fewer pain relievers than those performing exercises (P = 0.007). Compliance was >50% for both interventions and comfort was contingent on season.

CONCLUSION

In our study, PosturePlusForce showed, at least, a similar effect on pain to exercise, although those with dorsal hyperkyphosis exhibited a greater reduction in pain and related variables with the garment. Pain relievers were less required by those wearing PosturePlusForce than by those performing the exercises.Level of Evidence: 1.

Impact of bifrontal home-based transcranial direct current stimulation in pain catastrophizing and disability due to pain in fibromyalgia: a randomized, double-blind sham-controlled study

This randomized, double-blind trial tested the hypothesis that twenty sessions of home-based anodal(a)-transcranial direct current stimulation (tDCS) (2mA for 20 min) bifrontal, with anodal on the left dorsolateral prefrontal cortex (l-DLPFC) would be better than sham-(s)-tDCS to reduce scores on Pain Catastrophizing Scale (PCS) and disability-related to pain (DRP) assessed by the Profile of Chronic Pain: Screen (PCP:S) (primary outcomes). Secondary outcomes were depressive symptoms, sleep quality, heat pain threshold (HPT), heat pain tolerance (HPTo), and serum brain-derived-neurotrophic-factor (BDNF). Forty-eight women with fibromyalgia, 30-65 years-old were randomized into 2:1 groups [a-tDCS (n=32) or s-tDCS (n=16)]. Post hoc analysis revealed that a-tDCS reduced the PCS total scores by 51.38% compared to 26.96% in s-tDCS, and a-tDCS reduced PCP:S total scores by 31.43% compared to 19.15% in s-tDCS. The a-tDCS improved depressive symptoms, sleep quality and increased the HPTo. The delta-value in the serum BDNF (mean post treatment end minus pre-treatment) was conversely correlated with the a-tDCS effect in pain catastrophizing. In contrast, the a-tDCS impact on reducing the DRP at the treatment end was positively associated with a reduction in the serum BDNF and improvement of depressive symptoms, sleep quality and pain catastrophizing symptoms. PERSPECTIVE: Home-based bifrontal tDCS with a-tDCS on the l-DLPFC are associated with a moderate effect size (ES) in the following outcomes: (i) Decreased rumination and magnification of pain catastrophizing. (ii) Improved the disability for daily activities due to fibromyalgia symptoms. Overall, these findings support the feasibility of self-applied home-based tDCS on DLPFC to improve fibromyalgia symptoms.

Effect of a Mindfulness-Based Intervention for Chronic Migraine and High Frequency Episodic Migraine in Adolescents: A Pilot Single-Arm Open-Label Study

In this single-arm pilot open-label study we examined the effect of a mindfulness-based intervention on reduction of headache frequency after 12 months in adolescents aged 12-18 with chronic or high-frequency migraine without aura. Adolescents were recruited at the headache center of the C. Besta Neurological Institute and followed-up for 12 months. The mindfulness-based intervention was delivered in small groups and consisted of six weekly group sessions of guided meditation, and one booster session 15 days after. Patients filled in questionnaires assessing headache frequency (primary endpoint), medication intake, disability, anxiety, depression, catastrophizing, and caregivers' burden. Within-person ANOVA was used to address variation of endpoints over time. Thirty-five out of 37 patients completed the study for primary endpoints, and 33 for secondary endpoints. Headache frequency dropped from 21.3 (95% CI 18.5; 24.1) to 9.6 (95% CI 6.1; 13.1) days per month at 12 months (F = 30.5, p < 0.001); 23 patients out of 35 (65.7%) achieved a headache frequency reduction greater than or equal to 50%. Significant improvements were also reported for medication intake (F = 18.7, p < 0.001), disability (F = 3.8, p = 0.027), trait anxiety (F = 5.1, p = 0.009), symptoms of depression (F = 9.5, p < 0.001), and catastrophizing (F = 23.6, p < 0.001). In conclusions, our study shows a reduction of headache attacks in adolescents who follow a mindfulness-based program, suggesting benefit of this nonpharmacological approach.

Information seeking and health anxiety during the COVID-19 pandemic: The mediating role of catastrophic cognitions

Cognitive–behavioural models of health anxiety propose a positive association between information seeking and health anxiety; however, it is unclear the extent to which cognitive mechanisms may mediate this relationship. Catastrophic cognitions are one type of cognition that may mediate this relationship, and the COVID‐19 pandemic has presented an opportunity to examine these relationships within the context of a global health catastrophe. The current study investigated both cross‐sectional (N = 797) and longitudinal (n = 395) relationships between information seeking, health anxiety and catastrophizing during the pandemic. Data were collected using Amazon Mechanical Turk during April and May 2020. Information seeking and health anxiety were positively associated both cross‐sectionally and longitudinally (rs = .25–.29). Catastrophic cognitions significantly mediated the relationship between information seeking and health anxiety both cross‐sectionally and longitudinally. Developing effective methods of reducing information seeking and catastrophizing may serve to reduce health anxiety during global health crises such as the current pandemic.

Interactional Effects of Multidimensional Perfectionism and Cognitive Emotion Regulation Strategies on Eating Disorder Symptoms in Female College Students

Given the inconclusive findings regarding the relation between perfectionism and eating disorder symptoms, it is important that we determine whether this relation is modulated by emotion dysregulation, which is a prominent risk factor for eating disorders. We sought to identify specific cognitive emotion regulatory strategies—rumination, self-blame, and catastrophizing—that interact with multidimensional perfectionism to shape eating disorder symptoms (i.e., shape, weight, eating concerns, and dietary restraint). Using latent moderated structural equation modeling, we analyzed data from 167 healthy young female adults. We found that only rumination significantly moderated the relation between socially prescribed perfectionism and eating disorder symptoms. However, this was not observed for self-oriented perfectionism or other regulatory strategies. These findings held true when a host of covariates were controlled for. Our findings underscore the crucial role of rumination, a modifiable emotion regulatory strategy, in augmenting the relation between socially prescribed perfectionism and eating disorder symptoms in young women.

Psychological factors and trajectories of post-surgical pain: A longitudinal prospective study

A significant proportion of patients do not experience relief from pain during the early postsurgical period after joint arthroplasty and are at risk for developing chronic pain. The objectives of this study were to identify biopsychosocial factors associated with acute postsurgical pain trajectories and with pain intensity and interference after 1, 3, and 12 months. Two hundred ten patients listed for joint arthroplasty filled a presurgical battery of questionnaires assessing presurgical pain intensity, catastrophizing, emotional distress, state anxiety and depression, self-efficacy, central sensitization, and executive functions. From the day after surgery, they were asked to fill a 7-day diary, including questions about postsurgical pain and postsurgical state catastrophizing. Finally, they provided data about pain intensity and interference after 1, 3, and 12 months. Predictors of acute pain trajectories were investigated using multilevel growth curve analysis. Results showed that central sensitization was a predictor of the intercept of pain trajectories and daily postsurgical catastrophizing was a significant covariate of pain intensity in the acute phase. Analyses of follow-up data showed that central sensitization was a predictor of pain intensity and pain interference at 3 and 12 months, that emotional distress was related with pain intensity and interference at 1 month, and with pain interference at 3 months, and that cognitive flexibility was associated with pain interference at 1 month. Assessment of these factors could enable to identify patients at risk for worse outcomes and to plan targeted treatments to be implemented during the patient's inward stay.

Chronic pain severity, impact, and opioid use among patients with cancer: An analysis of biopsychosocial factors using the CHOIR learning health care system

BACKGROUND

Despite the biopsychosocial underpinnings of chronic noncancer pain, relatively little is known about the contribution of psychosocial factors to chronic cancer pain. The authors aimed to characterize associations between biopsychosocial factors and pain and opioid use among individuals with chronic pain and cancer.

METHODS

The authors conducted a retrospective, cross-sectional study of 700 patients with chronic pain and cancer seeking treatment at an academic tertiary pain clinic. Patients completed demographic questionnaires and validated psychosocial and pain measures. Multivariable, hierarchical linear and logistic regressions assessed the relative contributions of biopsychosocial factors to the primary dependent variables of pain severity, pain interference, and opioid use.

RESULTS

Participants were 62% female and 66% White with a mean age of 59 ± 15 years, and 55% held a college degree or higher. Older age, African American or "other" race, sleep disturbance, and pain catastrophizing were significantly associated with higher pain severity (F(5,657) = 22.45; P ≤ .001; R² = 0.22). Depression, sleep disturbance, pain catastrophizing, lower emotional support, and higher pain severity were significantly associated with pain interference (F(5,653) = 9.47; P ≤ .001; R² = 0.44). Lastly, a poor cancer prognosis (Exp(B) = 1.62) and sleep disturbance (Exp(B) = 1.02) were associated with taking opioids, whereas identifying as Asian (Exp(B) = 0.48) or Hispanic (Exp(B) = 0.47) was associated with lower odds of using opioids.

CONCLUSIONS

Modifiable psychological factors-specifically sleep disturbance, depression, and pain catastrophizing-were uniquely associated with pain and opioid use in patients with chronic pain and diverse cancer diagnoses. Future behavioral pain interventions that concurrently target sleep may improve pain among patients with cancer.

LAY SUMMARY

Feeling depressed, worrying about pain, and bad sleep are related to higher pain symptoms in individuals with chronic pain and cancer. Specifically, those who struggle to sleep have worse pain and use more opioids. Also, individuals who have a bad prognosis for their cancer are more likely to be using opioid pain medications. Although race and cancer are related to chronic pain in patients, psychological well-being is also strongly related to this same pain.

Battle of the Appraisals: Pain-Related Injustice Versus Catastrophizing as Mediators in the Relationship Between Pain Intensity and 3-Month Outcomes in Adolescents with Chronic Pain

Pain appraisals are closely tied to pain and functional outcomes. Pain-related injustice and pain catastrophizing appraisals have both been identified as important cognitive-emotional factors in the pain experience of youth. Although pain-related injustice and catastrophizing have been linked to worse pain outcomes - as primary predictors and intermediary variables - little is known about whether they operate as independent or parallel mediators of the relationship between pain and functioning in youth. We tested pain-related injustice and catastrophizing appraisals as candidate mediators of the relationship between baseline pain intensity and 3-month functional outcomes in adolescents. Youth with chronic pain (N = 89, 76% female, 89% White, average age = 15 years) completed measures assessing pain intensity, pain-related injustice, and catastrophizing at baseline, as well as measures assessing functional disability and overall quality of life 3 months later. Multiple mediation analyses indicated that injustice mediated the relationship between pain intensity and 3 month quality of life. Exploratory analyses of specific quality of life domains indicated that injustice mediated the relationship between pain intensity and 3 month emotional functioning, whereas catastrophizing mediated the relationship between pain intensity and 3 month social functioning. The findings suggest these pain-related appraisals play different intermediary roles in the relationships among pain and future psychosocial outcomes. PERSPECTIVE: Pain-related injustice and catastrophizing appraisals play different intermediary roles in the relationships among pain and future psychosocial outcomes in youth with chronic pain. Treatments targeting pain-related injustice appraisals in pediatric populations are needed to complement existing treatments for catastrophizing.

Pain catastrophizing is associated with pain thresholds for heat, cold and pressure in women with chronic pelvic pain

Background and aims Psychological traits such as pain catastrophizing may play a role in the development of chronic pelvic pain (CPP). Pain catastrophizing is the tendency to amplify negative cognitive and emotional pain processes. The Pain Catastrophizing Scale (PCS) assesses elements of pain catastrophizing divided into three subgroups of factors (rumination, helplessness and magnification). Previous studies have shown associations between CPP and increased pain sensitivity, widespread generalized hyperalgesia, and decreased pain thresholds, but the relation between pain catastrophizing and specific pain thresholds has not yet been widely examined in this patient group. The aims of this study were (a) to determine if catastrophizing is increased in women with CPP compared with pain-free women, (b) to assess the importance of pain catastrophizing, psychological distress variables, and subjective pain sensitivity for pain thresholds of heat, cold and pressure in these two groups, and (c) to determine whether psychological variables or pain thresholds best contribute to the differentiation between CPP and controls. Methods Thirty-seven women with chronic pelvic pain who underwent diagnostic laparoscopy on the suspicion of endometriosis participated along with 55 healthy and pain-free controls. All underwent quantitative sensory testing on six locations on the body to determine heat (HPT), cold (CPT) and pressure (PPT) pain thresholds. The PCS, the Pain Sensitivity Questionnaire (PSQ), the Hospital Anxiety Depression Scale, (HADS) demographics and clinical data were collected prospectively. Principal component analysis and orthogonal partial least square regressions were used to assess the associations between PCS scores and pain thresholds. Results The women with CPP scored significantly higher on PCS than the healthy controls. PCS-helplessness, PCS-rumination and HADS-depression were significantly associated with pain thresholds for the whole group. In the CPP group, PCS-rumination, body mass index and PSQ were significant regressors for HPT and CPT. The PCS and the HADS subscales were strongly intercorrelated in women with CPP and were stronger regressors of group membership than the three pain thresholds. In the group of healthy control women, no relationships were found to be significant. The psychological variables were somewhat stronger significant regressors than pain thresholds (also significant) for group membership. Conclusions Women with CPP have significantly higher pain catastrophizing scores than women without CPP. The pain catastrophizing rumination factor is significantly associated with pain thresholds of heat and cold in CPP women. PCS and HADS are strongly intercorrelated and PSQ correlates positively with these variables. It seems that the psychological variables are important for group differentiation. Implications The results clearly indicate the need for a multimodal assessment (bio-psycho-social) of CPP patients including psychological symptoms such as catastrophizing, anxiety and depression. The registration of semi-objective pain thresholds captures both specific pain sensitivity information (mechanical pressure, cold or heat) and the degree of wide spread pain hypersensitivity. There is a need for future larger studies investigating whether certain profiles in the clinical presentations (including pain thresholds and psychological variables) are associated with outcomes after different types of interventions.