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Chronic pain is a leading cause of disability in the United States. Limited efficacy associated with pharmacologic management and surgical interventions in refractory patients has led to further exploration of cognitive and behavioral interventions as both an adjunctive and primary therapeutic modality. Mindfulness-based meditation has shown to be effective in reducing pain in randomized studies of chronic pain patients as well as models of experimentally induced pain in healthy participants. These studies have revealed specific neural mechanisms which may explain both short-term and sustained pain relief associated with mindfulness-based interventions.

Meditation has been shown to improve outcomes for chronic pain by increasing patients' awareness of their own bodies. Some patients have an innate ability to leverage their mind–body connection, and this interoceptive awareness may aid them in garnering pain relief. We explored whether spinal cord stimulation (SCS) patients with greater innate awareness had better outcomes. We contacted 30 thoracic SCS patients with baseline and postoperative pain, psychological, and disability outcomes to complete the Multidimensional Assessment of Interoceptive Awareness (MAIA) survey. MAIA distinguishes between beneficial and maladaptive aspects of the perception of body sensations via six positive subscales (noticing, attention regulation, emotional awareness, self‐regulation, body listening, and trusting) and two negative subscales (not distracting, not worrying). MAIA subscales and positive/negative groups were correlated with percentage change in Numerical Rating Scale (NRS), Oswestry Disability Index (ODI), Beck's Depression Inventory (BDI), Pain Catastrophizing Scale (PCS), and McGill Pain Questionnaire (MPQ). Patients included 14 males/16 females with a mean age of 58. At a mean follow‐up of 14.13 months (range 6–26), NRS, ODI, BDI, PCS, and MPQ showed improvements. Positive traits correlated with improvements in pain (MAIA‐self regulation with NRS‐worst [p= 0.018], NRS‐least [p= 0.042], NRS‐average [p= 0.006], NRS‐current [p= 0.001]; MAIA‐body listening with MPQ‐total [p= 0.016] and MPQ‐sensory [p= 0.026]). Improvement in PCS‐total was associated with higher scores in noticing (p= 0.002), attention regulation (p= 0.017), emotional awareness (p= 0.039), and trusting (p= 0.047). PCS‐rumination correlated with MAIA‐positive total (p= 0.012). In contrast, better attention regulation signified less improvement in ODI (p= 0.043) and MPQ affective (p= 0.026). Higher interoceptive awareness in SCS patients correlated with greater improvement following the procedure, particularly with regards to pain relief and pain catastrophizing. These findings suggest that patients with better mind–body connections may achieve greater pain relief following SCS in this patient population, thereby aiding providers in determining who may benefit from this intervention.

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Secondary to the complex care, involved specialty providers, and various etiologies, chronic pelvic pain patients do not receive holistic care.

Loneliness as a whole has been characterized as a health‐related risk factor and is associated with worse outcomes after cardiac procedures. Evidence suggests that chronic pain patients are particularly vulnerable to feeling lonely. We examined the relationship between different aspects of loneliness and one‐year postoperative outcomes after spinal cord stimulation (SCS) for chronic pain. We contacted 69 patients with thoracic SCS who had participated in our prospective outcomes database with one‐year follow‐up to complete the validated, abbreviated UCLA Loneliness Scale (UCLA‐3). We examined responses on question 9 of the Oswestry Disability Index (ODI), question 12 of the Beck Depression Inventory (BDI), and UCLA‐3 due to their relevance to different aspects of loneliness. We conducted regression analyses to determine the relationship between aspects of loneliness and pain outcomes. We identified that loss of interest in people, companionship, and feeling excluded were associated with pain outcomes. Loss of interest in people was associated with improvement in pain (NRS worst p= 0.021, r= 0.32, NRS least p= 0.004, r= 0.4; NRS right now p= 0.016, r= 0.33). Companionship and feeling excluded were also associated with pain. We examined the interface between depression and total loneliness and found that while both were related to each other, depression was not associated with pain outcomes. This study demonstrates an association between loss of interest in people, companionship, and feeling excluded and worse postoperative pain outcomes after receiving SCS. It identifies aspects of loneliness as important factors to consider when predicting the outcomes of SCS therapy for chronic pain control.

Objective real‐world experience with peripheral nerve stimulation (PNS) is limited. Furthermore, the lack of robust outcome metrics, long‐term follow‐up and data comparing responders and nonresponders limit the refinement of selection criteria to better identify patients likely to benefit from PNS. We retrospectively analyzed 22 patients with craniofacial pain treated with PNS, and responders were classified as having ≥50% postoperative improvement in the numeric rating scale (NRS). In a subset of patients (n= 11), detailed prospective outcomes metrics were obtained preoperatively and postoperatively, including NRS, Beck Depression Index (BDI), Pain Catastrophizing Scale (PCS), and McGill Pain Questionnaire (MPQ). About 59.1% (13 of 22) of subjects were classified as responders at a mean follow‐up of 37.5 ±5.27 months. Diagnoses included migraine (n= 6), occipital neuralgia (n= 9), trigeminal neuropathic pain (TNP; n= 6), and central poststroke pain (n= 1). Within the TNP subgroup, responders were more likely to have undergone two or more trigeminal neuralgia procedures prior to PNS (p< 0.05). In the 11 patients with comprehensive preoperative and postoperative outcome data, we noted significant improvement in NRS (p =0.0005), BDI (p= 0.04), PCS (p= 0.01), as well as components of PCS (helplessness and magnification, p= 0.02) and MPQ (affective, p= 0.02). The present study adds to the PNS literature by providing long‐term data and multiple outcome metrics in a subset of patients. We suggest that BDI, PCS, and MPQ may provide more insight into meaningful response over time. Evaluating functional and quality of life outcomes in patients with craniofacial pain may be more informative than assessing benefit solely based on pain intensity and responder rates.

Spinal cord stimulation (SCS) is a well‐established procedure for chronic neuropathic pain. Research has established patients with personal psychiatric history do not fare as well as their correspondents following SCS surgery. We explored whether a documented psychiatric family history (PFH) correlated with worse outcomes following SCS surgery. We retrospectively reviewed our single‐center, prospectively collected database of patients who received permanent SCS implants over the past eight years. Subjects were separated into those with documented PFH and those without. Subjects completed validated scales at preoperative, 6 ± 2 postoperative, and 12 ± 3 months postoperative visits. The percent change in scores from preoperative to postoperative timepoints was compared between subjects with PFH vs. controls. SCS subjects reporting a PFH demonstrated significantly worse 6‐month outcomes on Pain Catastrophizing Scale‐rumination subscale (p= 0.02), numeric rating scale (NRS) scores on “pain at its least” (p= 0.04) and NRS “pain right now” (p= 0.02). This group also endorsed greater disability as measured by the Oswestry Disability Index (ODI) throughout the follow‐up period (p= 0.04 at 6 ± 2 months, p =0.001 at 12 ± 3 months). Subjects with PFH may experience less improvement in disability following SCS as compared to subjects without PFH. They may take longer to achieve the same outcomes, including pain relief and decrease in pain rumination. Our findings show that improvements in the PFH cohort are equivalent to that of the no PFH cohort on all measures except ODI at 12‐month follow‐up. Thus obtaining a detailed PFH prior to performing SCS is important in order to implement pre‐operative coping training for PFH patients, rather than exclusion from SCS.

Background Faster time to treatment for stroke is associated with improved outcomes. In cases of large vessel occlusion (LVO), standard of care treatment with thrombectomy can only be provided at a comprehensive stroke center (CSC). We examine the outcomes of patients who are directly brought to our center, a CSC, compared to those seen at a primary stroke center (PSC) and then transferred.Methods Patients with LVO presenting to our center from 1/1/2019 to 12/31/2019 were included. Cohorts of patients presenting first to a PSC and presenting first to a CSC were compared. Demographics and outcome metrics (Discharge Modified Rankin Scale (mRS) and National Institute of Health Stroke Severity Scale (NIHSS) scores) were obtained for all LVO patients. Imaging was also assessed.Results Of 864 stroke admissions, 346 had LVO (40%) with 183 (53%) transferring from a PSC and 163 (47%) presenting directly. Similar percentages of each cohort were taken for thrombectomy (25.1% transfer and 31.3% direct). However, as distance between PSC and CSC increased, likelihood of thrombectomy decreased. Transfer patients were more likely to be excluded from thrombectomy secondary to a large volume of complete stroke (p  =  0.0001). Direct presenters had lower discharge mRS scores than transfer patients (p < 0.01), however, severity of stroke upon admission was similar in the two groups.Conclusion Patients transferred from a PSC were more likely to have a worse outcome at time of discharge than those presenting directly to our center. Large volume of completed stroke was a frequent reason for exclusion from thrombectomy. Optimizing stroke protocols to CSC in cases of LVOs may result in better outcomes.

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