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Purpose: This study aimed to investigate the correlation between preoperative pain catastrophizing and social support, and acute post-surgical pain in patients who underwent knee arthroplasty. The study also aimed to determine whether social support moderates the role of pain catastrophizing psychologically in acute post-surgical pain after knee arthroplasty. Patients and Methods: This study recruited participants to survey a tertiary hospital in Dalian, China, between November 2022 and October 2023. Participants completed pain catastrophizing scales and social support reevaluated scales one day (T1) before they were confirmed to undergo knee arthroplasty, and finished the Numeric Rating Scale at 24h (T2), 48h (T3), and 72h (T4) postoperatively. Pearson correlation analyses were used to explore the relationship between social support, pain catastrophizing, and acute post-surgical pain, hierarchical regression analysis was used to test the moderating role of social support between pain catastrophizing and acute post-surgical pain. Results: This study recruited 178 knee arthroplasty patients. The results of the t-test or one-way ANOVA indicated that there were statistically significant differences in gender, age, education, occupation, disease duration, whether the knee replacement was performed for the first time, preoperative pain scores, and operation time in patients with knee arthroplasty (P < 0.05). The correlation analysis of social support, pain catastrophization, and acute post-surgical pain in knee arthroplasty patients showed that social support was negatively correlated with acute post-surgical pain (r=− 0.584, P< 0.01), and pain catastrophizing was positively correlated with postoperative acute pain (r=0.601, P< 0.01); The hierarchical regression analysis revealed that social support had a significant moderating effect on the relationship between pain catastrophizing and acute post-surgical pain (ΔR2=0.606, P< 0.05). Conclusion: The acute post-surgical pain of knee arthroplasty patients was affected by gender, age, education, occupation, disease duration, whether the knee arthroplasty was performed for the first time, preoperative pain scores, and operation time. Acute Post-surgical pain in patients with knee arthroplasty was affected by social support and pain catastrophizing, and social support had a moderating effect on the relationship between pain catastrophizing and acute post-surgical pain. [ABSTRACT FROM AUTHOR]

Purpose: New-onset chronic musculoskeletal (MSK) pain is one of the common persistent symptoms in Long COVID (LC). This study investigated its clinical characteristics, underlying mechanisms, and impact on function, psychological health, and quality of life. Patients and Methods: Thirty adults (19 female, 11 male) with LC and new-onset chronic MSK pain underwent clinical examination, Quantitative Sensory Testing (QST), and blood tests for inflammatory markers and completed the following outcome measures: Timed Up and Go test (TUG), handgrip strength test, COVID-19 Yorkshire Rehabilitation Scale (C19-YRS), Brief Pain Inventory (BPI), Pain Self-Efficacy Questionnaire (PSEQ), Pain Catastrophizing Scale (PCS), International Physical Activity Questionnaire-short form (IPAQ-sf), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), and EuroQol Five Dimensions health-related quality of life (EQ-5D-5L). Results: New-onset chronic MSK pain was widespread and continuous in nature, and worse in the joints. When compared to normative values reported in the literature: a) QST revealed mechanical hyperalgesia, heightened temporal summation of pain, and hypoesthesia to vibration stimuli, which is strongly suggestive of central sensitization; b) Plasma cytokine assays indicated distinct pro-inflammatory profiles; c) TUG time indicated reduced balance and mobility; d) handgrip strength revealed general weakness; e) physical activity was lower; and f) there were moderate levels of depression and anxiety with lower self-efficacy scores and lower levels of pain catastrophizing. LC symptoms were of moderate severity (44.8/100), moderate functional disability (22.8/50) and severely compromised overall health (2.6/10) when compared to pre-COVID scores. Conclusion: New-onset chronic MSK pain in LC tends to be widespread, constant, and associated with weakness, reduced function, depression, anxiety, and reduced quality of life. There is associated central sensitization and proinflammatory state in the condition. Further research is essential to explore the longitudinal progression and natural evolution of the new-onset chronic MSK pain in LC. [ABSTRACT FROM AUTHOR]

Acute postsurgical pain (APSP) has received growing attention as a surgical outcome. When poorly controlled, APSP can affect short- and long-term outcomes in patients. Despite the steady increase in awareness about postoperative pain and standardization of pain prevention and treatment strategies, moderate-to-severe APSP is frequently reported in clinical practice. This is possibly because pain varies widely among individuals and is influenced by distinct factors, such as demographic, perioperative, psychological, and genetic factors. This review investigates the risk factors for APSP, including gender, age, obesity, smoking history, preoperative pain history, pain sensitivity, preoperative anxiety, depression, pain catastrophizing, expected postoperative pain, surgical fear, and genetic polymorphisms. By identifying patients having an increased risk of moderate-to-severe APSP at an early stage, clinicians can more effectively manage individualized analgesic treatment protocols with a combination of pharmacological and non-pharmacological interventions. This would alleviate the transition from APSP to chronic pain and reduce the severity of APSP-induced chronic physical disability and social psychological distress. [ABSTRACT FROM AUTHOR]

Brittany N Rosenbloom,1– 3 P Maxwell Slepian,1,2,4 Muhammed Abid Azam,1,2 Andrea Aternali,1 Kathryn A Birnie,5,6 Kathryn Curtis,2 Sonal Thaker,2 Salima Ladak,2 Anna Waisman,1 Hance Clarke,2,4 Joel Katz,1,2,4 Aliza Z Weinrib1,2 1Department of Psychology, York University, Toronto, ON, Canada; 2Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada; 3Toronto Academic Pain Medicine Institute, Women’s College Hospital, Toronto, ON, Canada; 4Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; 5Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, AB, Canada; 6Department of Community Health Sciences, University of Calgary, Calgary, AB, CanadaCorrespondence: Joel Katz; Aliza Z Weinrib, Department of Psychology, York University, BSB 232, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, Email jkatz@yorku.ca; Aliza.Weinrib@gmail.comAbstract: Clinical hypnosis is an effective strategy for managing acute pain in the surgical setting. However, the opioid sparing effects of clinical hypnosis are not as well understood. This pre-registered (NCT03730350) randomized, controlled trial (RCT) examined the impact of clinical hypnosis, pre- and post-surgery, on opioid consumption during hospitalization as well as on measures of pain intensity, pain interference, depressed mood, anxiety, sleep, and pain catastrophizing. Participants (M = 57.6 years; SD = 10.9) awaiting oncologic surgery were randomized to treatment-as-usual (n = 47) or hypnosis (n = 45). Intent-to-treat analyses were conducted using linear mixed effects modeling. A significant Group × Time interaction, F(6, 323.34) = 3.32, p = 0.003, indicated an opioid sparing effect of clinical hypnosis during the acute postoperative period. Hypnosis also protected against increases in pain catastrophizing at one-week after surgery, F (1, 75.26) = 4.04, p = 0.048. A perioperative clinical hypnosis intervention had a sparing effect on opioid consumption in-hospital after major oncologic surgery. These findings extend the efficacy of clinical hypnosis as an adjunct tool for perioperative pain management.Keywords: clinical hypnosis, oncologic surgery, postoperative opioid use, postoperative pain, pain catastrophizing

Purpose: This study aimed to investigate the effects of different psychological personalities and pain catastrophizing levels on postoperative analgesia in patients undergoing cesarean section.Patients and Methods: Puerperas who underwent cesarean section at our hospital between January and August 2023 were recruited into the study and assessed using the Eysenck Personality Questionnaire-Revised Short Scale (EPQRSC) and Pain Catastrophizing Scale (PCS). Data on the numerical pain intensity at rest and during activity 24 h after surgery, number and dosage of analgesia pumps, and satisfaction with analgesia were recorded. According to the numerical pain score during activity 24 h post-operation, the patients were divided into the analgesia incomplete group (≥ 4) and control group (< 4). Univariate analysis, Spearman correlation analysis, and binary logistic regression analysis were used to evaluate the influence of personality characteristics and PCS on postoperative analgesia.Results: A total of 778 women were included in the study. The incidence of inadequate analgesia was 89.8%. The satisfaction rate of analgesia was 66.8%. Univariate analysis showed that extraversion; neuroticism; PCS; numbers of previous cesarean delivery; ASA; analgesic satisfaction; and 24-h analgesia pump compressions and dosage were associated with postoperative analgesia after cesarean section (P< 0.05). Using binary logistic regression analysis, the first cesarean section (odds ratio [OR]=0.056, 95% confidence interval [CI]=1.913– 19.174), the number of 24-h analgesic pump compressions (OR=8.464, 95% CI=0.356– 0.604), extraversion (OR=0.667, 95% CI=0.513– 0.866), neuroticism (OR=1.427, 95% CI=1.104– 1.844), and PCS (OR=7.718, 95% CI=0.657– 0.783) were factors affecting postoperative analgesia.Conclusion: The incidence of inadequate analgesia after a cesarean section was high (89.8% on the first day after surgery). Formulating accurate analgesia programs for women undergoing cesarean section with extraversion, neuroticism personality characteristics, and pain catastrophizing behaviors is necessary for improving their postoperative analgesia effects and satisfaction and promoting postpartum comfort. [ABSTRACT FROM AUTHOR]

Space travel has been associated with musculoskeletal pain, yet little is known about the nociceptive changes and pain experience during spaceflight. This preliminary study aims to investigate the pain experience and sensory alterations in astronauts following a 17-day mission to the International Space Station (ISS) on Axiom Space's AX-1 commercial space flight. Two participants were enrolled, and data were collected pre-flight, in-flight, post-flight, and three-month post-flight. Validated pain questionnaires assessed anxiety, catastrophizing, impact on physical and mental health, disability, and overall pain experience. Qualitative interviews were conducted post-landing and conditioned pain modulation (CPM) and quantitative sensory testing (QST) were performed. Both astronauts reported musculoskeletal pain during and after the flight, which was managed with anti-inflammatories and stretching techniques. Pain levels returned to baseline after three months. Pain questionnaires revealed heightened pain experiences in-flight and immediately post-flight, although their adequacy in assessing pain in space is uncertain. Qualitative interviews allowed astronauts to describe their pain experiences during the flight. Sensory changes included increased mechanical touch detection thresholds, temporal pain summation, heat pain thresholds, and differences in conditioned pain modulation post-flight. This preliminary study suggested that spaceflight may affect various aspects of sensory perception and regulation in astronauts, albeit in a variable manner. More data are needed to gain insight of on gain and loss of sensory functions during space missions. Further investigation into the multifactorial stressors affecting the somatosensory system during space travel could contribute to advancements in space and pain medicine. [ABSTRACT FROM AUTHOR]

Yi Zhou,1 Weina Gao,2 Shumin Gao,2 Xutong Guo,2 Meng Liu,2 Congjie Cao1 1School of Nursing, Langfang Health Vocational College, Langfang, Hebei, People’s Republic of China; 2Department of Orthopedics, Baoding No.1 Central Hospital, Baoding, Hebei, People’s Republic of ChinaCorrespondence: Weina Gao, Department of Orthopedics, Baoding No.1 Central Hospital, No. 320, Changcheng North Street, Lianchi District, Baoding, Hebei, 071000, People’s Republic of China, Tel/Fax +86 312-5975023, Email gaoweina984926@163.comPurpose: To examine whether exercise self-efficacy mediates the contributions of pain catastrophizing and kinesiophobia to exercise adherence in patients after total knee arthroplasty.Patients and Methods: A cross-sectional study design was conducted. A total 211 post-total knee arthroplasty patients were recruited from three orthopedics units of a tertiary hospital in China. Participants were invited to complete questionnaires on pain catastrophizing, kinesiophobia, exercise self-efficacy, and exercise adherence. Mplus 8.3 software was used to construct mediation models.Results: Pain catastrophizing and kinesiophobia were negatively correlated with exercise adherence (r = − 0.509, r = − 0.605, p < 0.001 respectively), while exercise self-efficacy were positively associated with exercise adherence (r = 0.799, p < 0.001). The results found exercise self-efficacy mediated the correlations of pain catastrophizing and kinesiophobia with exercise adherence after adjusting for demographic and clinical covariates. Pain catastrophizing indirectly affected patients’ exercise adherence through its effect on exercise efficacy (indirect effect: − 0.412), while Kinesiophobia is directly associated with exercise adherence and also indirectly through exercise self-efficacy (direct effect: − 0.184, indirect effect: − 0.415).Conclusion: Patients after total knee arthroplasty who have high levels of psychological distress (pain catastrophizing and kinesiophobia) are vulnerable to be non-adherent to exercise behaviors. Exercise self-efficacy explains the effects of pain catastrophizing and kinesiophobia on exercise adherence and may be a key target for measures to improve exercise behaviors in patients after total knee arthroplasty.Keywords: pain catastrophizing, kinesiophobia, self-efficacy, exercise, adherence, total knee arthroplasty

Sherrill Schaaf,1,&ast; Diane M Flynn,2,&ast; Alana D Steffen,3 Jeffrey Ransom,2 Ardith Doorenbos3,4 1School of Health Sciences, A.T. Still University, Mesa, AZ, USA; 2Interdisciplinary Pain Management Center, Madigan Army Medical Center, Tacoma, WA, USA; 3College of Nursing, University of Illinois Chicago, Chicago, IL, USA; 4Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA&ast;These authors contributed equally to this workCorrespondence: Diane M Flynn, Physical Performance Service Line, Madigan Army Medical Center, Tacoma, WA, 98431, USA, Tel +1-253-968-0618, Fax +1-253-968-0469, Email diane.m.flynn4.civ@health.milContext: Pain catastrophizing is characterized by negative emotional and cognitive responses to pain and is a predictor of work-related disability. Its association with military medical disability has not been studied.Objective: To (1) identify the pain catastrophizing scale (PCS) score cut point most strongly associated with military medical disability, (2) measure the difference in rate of disability between service members with baseline PCS scores above versus below the cut point, and (3) determine if improvement in PCS score during pain specialty care is associated with decreased likelihood of disability.Methods: This was a retrospective cohort analysis comparing PCS scores collected from US Army active duty service members at time of initial visit to an interdisciplinary pain management center and periodically during pain treatment. Outcome was determination during the following year of a military service-disqualifying disability.Results: Receiver operating characteristic (ROC) curves determined that a PCS score of 20 was the single cut point most closely associated with subsequent disability. Kaplan–Meier curves showed significantly higher disability rate during the following year among those with baseline PCS scores ≥ 20 (52%) compared to those with lower scores (26%). Scheffe-adjusted contrasts showed that service members with PCS scores ≥ 20 whose scores improved to < 20 at follow-up were significantly less likely to have a medical disability (42.6%; 95% CI, 0.07– 0.58) than those whose PCS score remained ≥ 20 (76.3%; 95% CI, 68.0%– 84.7%).Conclusion: A PCS score cut point of 20 distinguishes between high versus low likelihood of disability among service members. Those with high baseline PCS score had twice the likelihood of disability than those with low scores. Service members who decreased their PCS score from high to low during pain specialty care had lower likelihood of disability. Prospective research is needed to determine if treatments that lower pain catastrophizing yield reduced likelihood of subsequent disability.Plain Language Summary: Pain catastrophizing is a persistent tendency to have distressing thoughts and emotions related to pain and worsens work-related outcomes. This study examined the association between pain catastrophizing and military medical disability in a population of active duty US Army service members. The pain catastrophizing scale (PCS) scale is a 13-item questionnaire with a range of 0 (lowest catastrophizing) to 52 (highest catastrophizing). The aims of the study were to (1) identify the PCS score cut point most strongly associated with later military medical disability, (2) measure the difference in rate of disability between service members with baseline PCS scores above versus below the cut point, and (3) determine if improvement in PCS score during pain specialty care is associated with a decreased likelihood of disability. The study found that service members with high PCS scores were twice as likely to have medical disability than those with low scores. Additionally, those who reduced their PCS score were less likely to be medically disabled later. This study showed that PCS score may help to identify service members at increased risk of disability so that they may be offered therapies that reduce pain catastrophizing. The main limitation of this study is its retrospective design; we cannot be certain if improvement in PCS resulted in lower disability rates or if inherently more disabling conditions resulted in greater catastrophizing.Keywords: pain catastrophizing, chronic pain, interdisciplinary, disability, military

Purpose: Widely used therapeutic approaches, such as cognitive-behavioral and mindfulness-based therapies, can improve pain and functioning in people with chronic back pain, but the magnitude and duration of their effects are limited. Our team developed a novel 12-week program, psychophysiologic symptom relief therapy (PSRT), to substantially reduce or eliminate pain and disability. This study examined whether PSRT helped more patients achieve large-magnitude (≥ 30%, ≥ 50%, ≥ 75%) reductions in back pain-related disability compared to mindfulness-based stress reduction (MBSR) and usual care (UC), and if the beneficial effects of PSRT were explained by reductions in pain-related anxiety following treatment.Patients and Methods: Data from a three-armed randomized controlled trial were used (N=35 adults with chronic back pain). Change scores (baseline to 4-, 8-, 13-, and 26-weeks post-enrollment) were computed for back pain disability (RDQ) and pain-related anxiety (PASS-20). Fisher's exact tests and mediation analyses were conducted.Results: Compared to MBSR and UC, PSRT helped significantly more patients achieve ≥ 75% reductions in back pain disability at all timepoints and in pain anxiety at all timepoints except 13-weeks. Change in pain anxiety significantly mediated the relationship between treatment group and change in back pain disability from baseline to 26-weeks.Conclusion: PSRT helped more patients achieve substantial reductions in disability than an established treatment (MBSR) and usual care. Findings indicate reduced pain anxiety may be a mechanism by which PSRT confers long-term benefits on disability. Importantly, this work aims to move the field toward more precise and effective treatment for chronic back pain. [ABSTRACT FROM AUTHOR]

Purpose: The Patient Self-Report Survey for the Assessment of Fibromyalgia may potentially be a method for subgrouping patients with musculoskeletal pain who have a nociplastic pain presentation. Limited research has explored the convergent validity of this questionnaire against psychophysical measures of pain sensitivity and psychological factors in individuals with musculoskeletal pain. Therefore, the purpose of this study is to examine the strength of the association between total scores on the Patient Self-Report Survey for the Assessment of Fibromyalgia with clinical, pain sensitivity, and psychological factors.Patients and Methods: As a secondary analysis of a cross-sectional study, participants with shoulder (n = 20) or low back pain (n = 20) completed Quantitative Sensory Testing (QST), pain-related psychological questionnaires, and the Patient Self-Report Survey for the Assessment of Fibromyalgia. A Spearman correlation determined the association between total scores on the Patient Self Report Survey for the Assessment of Fibromyalgia with psychological factors and pain sensitivity behaviorally assessed with QST.Results: Negative psychological factors demonstrate moderate to strong positive associations with the Patient Self-Report Survey for the Assessment of Fibromyalgia (rho range = 0.36– 0.80), suggesting greater negative psychological factors were observed in patients with higher severity of fibromyalgia symptoms. Pain sensitivity factors demonstrated weak to moderate negative associations with The Patient Self-Report Survey for the Assessment of Fibromyalgia (PPT rho range=− 0.36- − 0.41), suggesting that elevated pain sensitivity was observed in individuals with higher severity of nociplastic pain symptoms.Conclusion: Collectively, this supports the convergent validity of the Patient Self-Report Survey for the Assessment of Fibromyalgia with psychological and pain sensitivity factors in patients with musculoskeletal pain. [ABSTRACT FROM AUTHOR]

Identifying biopsychosocial factors underlying chronic pain vulnerability is essential for the design of preventative efforts. Multiple chronic pain vulnerability models exist, however, there is a lack of comprehensive evaluation of these models in the literature, potentially due to the lack of guidelines that specify the criteria by which these types of work should be assessed. In this work, we created evaluation criteria (based on the general goals of conceptual models), and we then used them to critically review the chronic pain vulnerability models available in the current peer-reviewed literature (identified through a systematic search). Particularly, we evaluated the models on the basis of conceptual clarity/specificity of measures, depth of description of aetiological and mechanistic factors, use of a whole system approach, and quality of the evidence associated with the models. We found nine conceptual models that have been explored in detail (eg, fear avoidance model, diathesis-stress model). These models excel at clarity and are supported mostly by self-report evidence of a psychological nature (anxiety sensitivity, pain catastrophizing, etc.), but provide little explanation of mechanistic and aetiological factors. In the future, models could be improved by complementing them with proposals from other models and exploring potential causal factors and mechanisms maintaining the condition. This task could be carried out through prospective cohort studies, and computational approaches, amongst others.Plain Language Summary: Several theories explain why some people are more vulnerable to develop chronic pain; however, there is no previous work that compares these theories or evaluates their quality. After evaluating these theories, we concluded that they are very good at identifying what psychological characteristics make someone vulnerable to develop chronic pain. However, they lack an explanation regarding what makes people develop those characteristics or how they lead to pain. We propose ways in which the different theories could be complemented. [ABSTRACT FROM AUTHOR]

Gilad J Regev,1,2 Roi Treister,3 Silviu Brill,2,4 Dror Ofir,1,2 Khalil Salame,1,2 Zvi Lidar,1,2 Morsi Khashan,1,2 Rivka Litvin,5 Uri Hochberg2,4 1Spine Surgery Unit, Neurosurgical Department, Tel Aviv Medical Center, Tel Aviv, Israel; 2Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel; 3The Cheryl Spencer Department of Nursing, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel; 4Institute of Pain Medicine, Division of Anesthesiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 5Department of surgery, Tel Aviv Medical Center, Tel Aviv, IsraelCorrespondence: Uri Hochberg, Institute of Pain Medicine, Division of Anesthesiology, Tel Aviv Medical Center, 6 Weismann St. Tel-Aviv, Israel, Tel +972-3-6974477, Email urih@tlvmc.gov.ilPurpose: While advanced medical technology and unlimited access to medical information might benefit and empower patients, these same advantages may pose some risks, especially in the cases where patients have direct access to advanced imaging studies. The aim of this work was to evaluate three domains related to patients with lower back pain: the patients’ perceptions, misconceptions and the experience of anxiety-related symptoms following direct access to their thoraco-lumbar spine radiology report. An additional aim was the assessment of possible associations with catastrophization.Patients and Methods: Patients who were referred to the spine clinic, following the completion of a CT or MRI of their thoraco-lumbar spine were surveyed. Patient perceptions of the importance of having direct access to their imaging report and of the concern they attribute to the medical terms found in their report were evaluated using a set of questionnaires. The medical terms severity scores were then correlated to a reference clinical score created for the same medical terms by spine surgeons. Lastly, patients’ anxiety-related symptoms and Pain Catastrophizing Scale (PCS) after reading their radiology report were evaluated.Results: Data from 162 participants (44.6% female), with mean age of 53.1 ± 15.6 years, were collected. Sixty-three percent of the patients stated that reading their report helped them gain better understanding of their medical condition and 84% agreed that having early access to the report helped improve communication with the physician. Patients’ degree of concern associated with the medical terms in their imaging report ranged between 2.07 and 3.75, on a scale of 1– 5. The patient’s degree of concerns were significantly higher for six common medical terms and significantly lower in one, when compared to experts’ opinions. A mean (± SD) of 2.86± 2.79 anxiety-related symptoms was reported. The mean Pain Catastrophizing Scale (PSC) score was 29.18 ± 11.86, ranging from 2 to 52. Both the degree of concerns and the number of symptoms reported were significantly associated with the PCS.Conclusion: Direct access to radiology reports might provoke anxiety symptoms, especially in patients with a tendency for catastrophic thinking. Increasing awareness amongst spine clinicians and radiologist about possible risks associated with direct access to radiology reports could contribute to preventing patients’ misconceptions and unnecessary anxiety-related symptoms.Keywords: low back pain, pain catastrophizing, anxiety, radiology reports

Ruipeng Zhao,1 Yupei Ji,2 Jiahui Li,1 Xinhua Li,1 Ting Wu,1 Hongru Wu,3 Cuizhen Liu2 1Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, People’s Republic of China; 2School of Psychology, Shaanxi Normal University, Xi’an, People’s Republic of China; 3Shanxi Institute of Sports Science, Taiyuan, People’s Republic of ChinaCorrespondence: Cuizhen Liu, 199 South Chang’an Road, Xi’an, 710062, People’s Republic of China, Tel +86-15129060061, Email liucuizhen28@gmail.comObjective: Knee osteoarthritis (KOA) is a painful chronic disorder. Evidence has shown that a history of chronic pain plays an important role in shaping empathy. Empathy, a valuable indicator of social functioning that refers to an individual’s ability to share the experiences of others, however, has been overlooked in KOA patients. This study aimed to investigate empathy and its association with clinical pain in KOA patients.Methods: KOA patients (n=47) and healthy controls (HCs, n=44) completed two empathy-for-pain tasks: a pain judgment task in which participants judged whether a person in an image felt pain or not, and a pain rating task in which they estimated pain intensity for themselves and others. The Interpersonal Reactivity Index was used to measure participants’ trait empathy, and clinical severity and psychological factors were assessed using relevant instruments.Results: Compared to HCs, KOA patients showed higher accuracy when judging pain and non-pain images and reported overall higher pain intensity when rating for themselves and others. KOA patients also showed greater personal distress than HCs in terms of their self-reported empathy. Moreover, pain catastrophizing particularly mediated the relationship between pain severity and pain ratings for others, and depression, anxiety, and pain catastrophizing all mediated the association between pain severity and empathy-induced personal distress.Conclusion: These findings suggest that patients with KOA have increased empathy, demonstrated by elevated sensitivity to pain-related scenes and intense emotional responses.Keywords: empathy, pain, knee osteoarthritis, pain catastrophizing, emotion

Jenna M Wilson, Carin A Colebaugh, Samantha M Meints, K Mikayla Flowers, Robert R Edwards, Kristin L Schreiber Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USACorrespondence: Jenna M Wilson, Brigham and Women’s Hospital, Harvard Medical School, 45 Francis St, Boston, MA, 02115, USA, Tel +1 7813673972, Email jwilson47@bwh.harvard.eduPurpose: Loneliness increased during the COVID-19 pandemic and social distancing guidelines, potentially exacerbating negative cognitions about pain. The present study investigated the longitudinal relationship between loneliness, assessed during the early weeks of the pandemic, and pain catastrophizing, assessed after living in the pandemic for approximately 1 year, among chronic pain patients. We also examined whether severity of depressive symptoms mediated this association.Methods: This prospective longitudinal study recruited individuals with chronic pain (N=93) from Massachusetts using an online convenience sampling method via the platform Rally. Participants completed an initial survey early after the onset of social distancing (4/28/20– 6/17/20; Time 1) and a follow-up survey 1 year later (5/21/21– 6/7/21; Time 2). Participants completed validated assessments of loneliness (T1), pain catastrophizing (T2), and depression (T2). Spearman correlations and Mann–Whitney U-tests were used to explore associations among psychosocial, pain, and participant characteristics. A mediation analysis was conducted to test whether the association between loneliness and pain catastrophizing was mediated by depression.Results: Participants had a mean age of 40.6 years and were majority female (80%) and White (82%). Greater loneliness was associated with subsequent higher pain catastrophizing (b=1.23, 95% CI [0.03, 2.44]). Mediation analysis showed a significant indirect effect (b=0.57, 95% CI [0.10, 1.18) of loneliness (T1) on catastrophizing (T2) through depression (T2) while accounting for several important covariates. The direct effect of loneliness on catastrophizing was no longer significant when depression was included in the model (b=0.66, 95% CI [− 0.54, 1.87]).Conclusion: Findings suggest that greater loneliness during the pandemic was associated with higher pain catastrophizing 1 year later, and severity of depression after living in the pandemic mediated this association. As loneliness, depression, and catastrophizing can all be modified with behavioral interventions, understanding the temporal associations among these variables is important for the employment of future empirically supported treatments.Keywords: loneliness, pain catastrophizing, depression, chronic pain, COVID-19

Purpose: We developed the Athlete Fear Avoidance Questionnaire (AFAQ) to measure fear avoidance in athletes. Previous fear avoidance scales were developed for the general population and have demonstrated significant predictive capabilities regarding rehabilitation. No research to date has examined the association between athlete fear avoidance as measured by the AFAQ and the rehabilitation time in athletes. Patients and Methods: Fifty-nine athletes who were injured during sport season participated in the study (40 males and 19 females). At injury onset, all participants completed self-report functional questionnaires. In addition, we measured multiple aspects of fear avoidance including athlete fear avoidance (AFAQ), kinesiophobia (TSK), and pain catastrophizing (PCS). Finally, we assessed pain severity and interference, as well as depression. Once the athletes were able to return to competition all participants answered the questionnaires again. Pearson correlations and a regression analysis were used to identify relationships between function, psychological variables, pain, and return to competition time. Results: The AFAQ yielded the strongest correlation with return to competition time (r=0.544, p< 0.001). In addition, function at initial injury time and pain interference were also significantly correlated with return to competition time (r=0.442, p< 0.001 and r=0.356, p=0.006 respectively). Athlete fear-avoidance combined with function at the time of injury explained 34% of the variance of return to competition time in the multivariate regression model (p< 0.001). Conclusion: Athlete fear-avoidance as measured by the AFAQ is associated with rehabilitation time and returning to competition in injured athletes. Psychosocial factors including athlete fear avoidance may explain why some athletes take longer to rehabilitate than others and should be evaluated in athletes who are taking longer than anticipated to complete their rehabilitation. Reducing athlete fear avoidance may facilitate rehabilitation in future studies. [ABSTRACT FROM AUTHOR]

Purpose: To explore the relationship between pain intensity, pain resilience, pain catastrophizing, and pain-related activity patterns in older adults with chronic musculoskeletal pain (CMP). Patients and Methods: A total of 220 elderly Chinese with chronic musculoskeletal pain were recruited from a tertiary general hospital. Participants completed several measures including a demographic questionnaire, Brief Pain Inventory (BPI), Pain Resilience Scale (PRS), Pain Catastrophizing Scale (PCS), and Patterns of Activity Measure-Pain (POAM-P). Moreover, Process version 3.5 plug-in SPSS26 was used to test the mediation effect between variables. Results: The scores of POAM-P in older adults with CMP from high to low were: avoidance (27.39 ± 8.10), pacing (24.25 ± 9.48), and overdoing (16.65 ± 10.95). Mediation analysis revealed that pain resilience and pain catastrophizing mediated the relationship between pain intensity and pain-related activity patterns (avoidance and pacing) in older adults with CMP. Conclusion: These results provide evidence for the role of pain resilience and pain catastrophizing in the relationship between pain intensity and pain-related activity patterns. Interventions targeting these factors should be included in activity management programs for elderly CMP patients. It may be possible to reduce the negative impact of pain intensity on activity patterns by improving pain resilience and reducing pain catastrophizing. [ABSTRACT FROM AUTHOR]

Rupal M Patel, Bethany L Anderson, John B Bartholomew Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USACorrespondence: Rupal M Patel, Email rupal@utexas.eduBackground: Pain catastrophizing is a maladaptive cognitive strategy that is associated with increased emotional responses and poor pain outcomes. Total knee replacement procedures are on the rise and 20% of those who have the procedure go on to have ongoing pain. Pain catastrophizing complicates this pain and management of this is important for recovery from surgery and prevention of chronic pain. This study examines the effect of interventions on PC for patients undergoing total knee replacement (TKR).Methods: Multiple search engines were searched from inception up to March 2021 for relevant studies measuring PC in adults who have undergone TKR. Studies were screened using the Downs and Black Checklist. We included 10 studies (n = 574) which recruited peri surgical TKR participants. Effect sizes were calculated and compared on effect of intervention on PC.Results: Five studies examined the effect of cognitive behavioral therapy-based intervention on PC with low to moderate effects. Two studies examined the effect of a pain neuroscience education on PC with small effects short term. One study examined the effect of hypnotic therapy on PC with small, short-term effect (1 month) but large effect at 6 months. One study compared the effect of an isometric quadricep exercise with auditory and visual feedback on PC to treatment as usual with small, short-term effects. One study compared the effects of an activity and goal setting diary on PC with a moderate effect at 4 weeks.Conclusion: PC is a modifiable characteristic. Several interventions show modest benefit, however more research is needed to aid in clinical decision-making for this population. Interventions are most likely to produce benefits when they are targeted to people with high levels of PC.Keywords: pain catastrophizing, fear-avoidance, fear of pain, psychological, psychosocial, treatment

Purpose: This cross-sectional study aimed to investigate whether psychosocial factors were predictive for exercise-induced hypoalgesia (EIH) in pain-free adults. Methods: A sample of 38 pain-free nurses with a mean (SD) age of 26 (6) years were included in this study. Participants completed psychosocial questionnaires prior to physical tests. Pressure pain threshold (PPT) was assessed bilaterally at the calves (local), lower back (semi-local) and forearm (remote) before and immediately after a maximal graded cycling exercise test. Separate linear mixed effects models were used to determine change in PPT before and after cycling exercise (EIH). Multiple linear regression for all psychosocial variables and best subset regression was used to identify predictors of EIH at all locations. Results: The relative mean increase in PPT at the forearm, lumbar, calf, and globally (all sites pooled) was 6.0% (p< 0.001), 10.1% (p< 0.001), 13.9% (p< 0.001), and 10.2% (p=0.013), respectively. Separate best subset multiple linear regression models at the forearm (predictors; Multidimensional Scale of Perceived Social Support (MSPSS) total), lumbar (predictors; MSPSS total, Pain Catastrophizing Scale (PCS) total, Depression Anxiety Stress Scale (DASS) depression), calf (predictors; MSPSS friends, PCS total), and global (predictors; MSPSS friends, PCS total) accounted for 7.5% (p=0.053), 13% (p=0.052), 24% (p=0.003), and 17% (p=0.015) of the variance, respectively. Conclusion: These findings confirm that cycling exercise produced EIH in young nurses and provided preliminary evidence to support the interaction between perceived social support, pain catastrophizing and EIH. Further investigation is required to better understand psychological and social factors that mediate EIH on a larger sample of adults at high risk of developing chronic musculoskeletal pain. [ABSTRACT FROM AUTHOR]

Keywords: tDCS; hypnosis; hypnotic analgesia; chronic pain; fibromyalgia; pain threshold; cold pressor test; CPM-test EN tDCS hypnosis hypnotic analgesia chronic pain fibromyalgia pain threshold cold pressor test CPM-test 187 203 17 03/13/23 20230101 NES 230101 Bruno Schein, SP 1, sp SP 2 sp Gerardo Beltran, SP 1- 3 sp Bárbara Regina França, SP 1, sp SP 2 sp Paulo RS Sanches, SP 4 sp Danton P Silva Jr, SP 4 sp Iraci Lucena Torres, SP 5, sp SP 6 sp Felipe Fegni, SP 7 sp Wolnei Caumo SP 1, sp SP 2, sp SP 5, sp SP 8 sp SP 1 sp Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul (RS), Brazil; SP 2 sp Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; SP 3 sp Institute of Neurosciences, Universidad Catolica de Cuenca, Cuenca, Ecuador; SP 4 sp Laboratory of Biomedical Engineer, HCPA, Porto Alegre, RS, Brazil; SP 5 sp Pain and Palliative Care Service, HCPA, Porto Alegre, RS, Brazil; SP 6 sp Laboratory of Pharmacology of Pain and Neuromodulation, Experimental Research Center, HCPA, Porto Alegre, RS, Brazil; SP 7 sp Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, MA, USA; SP 8 sp Department of Surgery, School of Medicine, UFRGS, Porto Alegre, RS, Brazil Correspondence: Wolnei Caumo, Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre at UFRGS, Ramiro Barcelos, 2350 - CEP 90035-003 Bairro Rio Branco, Porto Alegre, RS, Brazil, Tel/Fax +55 51- 33598083, Email [email protected] Plain Language Summary There is a lack of data to comprehend the difference between the effects of hypnotic analgesia suggestion and a-tDCS in fibromyalgia. TDCS, hypnosis, hypnotic analgesia, chronic pain, fibromyalgia, pain threshold, cold pressor test, CPM-test. [Extracted from the article]

Purpose: Chronic pain is a complex phenomenon. Understanding its multiple dimensions requires the use of a combination of several patient-reported outcome measures (PROMs). However, completing multiple PROMs is time-consuming and can be a burden for patients. The objective of our study was to simultaneously reduce the French versions of the Pain Catastrophizing Scale (PCS) and Tampa Scale for Kinesiophobia (TSK) questionnaires to enable their use in an ambulatory and clinical settings. Patients and Methods: We conducted a clinical study between May 2014 and August 2020 in our rehabilitation center. 1428 chronic musculoskeletal pain patients (CMSP) were included. The originality of our approach is that the reduction method included qualitative as well as quantitative analyses. The study was divided into two parts: 1) reduction of the questionnaires (n=1363) based on internal consistency (item-to-total correlation), principal component analysis (item loadings), Rasch analysis (infit/outfit), floor and ceiling effect (quantitative analyses) and expert judgment of items (qualitative analysis), and 2) validation of the reduced questionnaires (n=65), including test–retest reliability (intraclass correlation coefficient [ICC]), homogeneity (Cronbach α), criterion validity (Pearson correlation [r] with the long-version score), determination of the pathological cutoff and Minimal Clinically Important Difference (MCID). The two full-length questionnaires include 30 items in total. Results: The reduction resulted in a 5-item PCS (score 0– 20) and 6-item TSK (score 0– 24). Psychometric properties of the reduced questionnaires were all acceptable as compared with other version (α=0.89 and 0.71, ICC=0.75 and 0.60, r=0.86 and 0.70, MCID=2 and 2 for PCS and TSK, respectively) while keeping the structure and coherence of the long versions. Conclusion: The two reduced versions of the PCS and TSK can be used in CMSP patient. As their administration only requires a few minutes, they can be implemented in outpatient consultation as well as in clinical settings. [ABSTRACT FROM AUTHOR]

Purpose: Individuals with fibromyalgia and obesity experience significant impairment in physical functioning. Pain catastrophizing, kinesiophobia, and pain acceptance have all been identified as important factors associated with the level of disability. The objective of this study was to evaluate the role of pain catastrophizing, kinesiophobia, and pain acceptance as mediators of the association between perceived pain severity and physical functioning in individuals with fibromyalgia and obesity. Patients and Methods: In this cross-sectional study, 165 women with fibromyalgia and obesity completed self-report questionnaires of perceived pain severity (ie, Numeric Pain Rating Scale), pain catastrophizing (ie, Pain Catastrophizing Scale), kinesiophobia (ie Tampa Scale of Kinesiophobia), pain acceptance (ie, Chronic Pain Acceptance Questionnaire), and perceived physical functioning (ie, Physical Functioning subscale of the Fibromyalgia Impact Questionnaire). In addition, a performance-based test (ie, 6-minute walking test) was conducted to assess objective physical functioning. Two multiple mediation analyses were performed. Results: Pain acceptance and kinesiophobia mediated the relationship between pain severity and self-reported physical functioning. Pain catastrophizing and kinesiophobia mediated the relationship between pain severity and performance-based functioning. Conclusion: Pain acceptance, kinesiophobia, and pain catastrophizing should be addressed in rehabilitative intervention to improve physical functioning. Interestingly, the subjective and objective aspects of physical functioning are influenced by different factors. Therefore, interventions for women with fibromyalgia and obesity should focus on factors related to both subjective and performance-based physical functioning. [ABSTRACT FROM AUTHOR]

Xiu Ling Jacqueline Sim,1 Chin Wen Tan,2,3 Cheng Teng Yeam,4 Hon Sen Tan,2,3 Rehena Sultana,5 Ban Leong Sng2,3 1Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore; 2Department of Women’s Anesthesia, KK Women’s and Children’s Hospital, Singapore, Singapore; 3Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore; 4MOH Holdings, Singapore, Singapore; 5Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, SingaporeCorrespondence: Ban Leong Sng Tel +65 6394 1081Fax +65 6291 2661Email sng.ban.leong@singhealth.com.sgBackground: Labor pain is a variable and complex experience with both sensory and affective components. Pain catastrophizing tendencies are predictive of increased distress during labor. Likewise, pain severity has important associations with increased depressive symptoms in mothers, with consequences on perinatal and infant outcomes. Hence, we investigated the association between increased early labor pain with both pre-delivery pain catastrophizing and depressive states.Methods: We recruited nulliparous women who had requested labor epidural analgesia. Pre-delivery questionnaires including short-form McGill pain questionnaire– 2 (SF-MPQ-2), pain catastrophizing scale (PCS), and Edinburgh postnatal depression score (EPDS) were administered.Results: A total of 712 women completed the pre-delivery questionnaires. There was a significant association between SF-MPQ-2 neuropathic subscale and EPDS ≥ 10 (unadjusted OR 1.74, 95% CI 1.11– 2.73, p = 0.0161), as well as PCS ≥ 25 (unadjusted OR 1.55, 95% CI 1.06– 2.26, p = 0.0244). SF-MPQ-2 sensory intermittent subscale and EPDS ≥ 10 (unadjusted OR 2.02, 95% CI 1.34– 3.03, p = 0.0007), and PCS ≥ 25 (unadjusted OR 1.59, 95% CI 1.14– 2.23, p = 0.0069) also showed significant association.Conclusion: Increased sensory intermittent and neuropathic subsets of early labor pain are significantly correlated with increased pre-delivery pain catastrophizing and depressive states in nulliparous women. This positive association may be useful for pre-delivery risk stratification for early interventions towards a more holistic care management.Keywords: labor pain, pain catastrophizing, pre-delivery depression, survey

Purpose: To investigate the outcome of patients with long-term refractory temporomandibular disorders (TMD) three years after a Norwegian interdisciplinary evaluation program with attention to patient satisfaction, function, pain, and psychosocial variables. Patients and Methods: The study population consisted of 60 long-term refractory TMD patients who were investigated by a Norwegian interdisciplinary team. A questionnaire that covered medical history, function, pain, lifestyle factors, TMD-status and follow-up from their general medical practitioner (GMP) was sent to the patients three years after the evaluation. Questionnaires that assessed function (Mandibular Functional Index Questionnaire [MFIQ] and Roland Morrison Scale [RMS]), pain intensity (General Pain Intensity questionnaire [GPI]) and psychosocial factors (Hospital Anxiety and Depression scale [HADS]); a 2-item version of the Coping Strategies Questionnaire [CSQ]) were included in the package. Results: Thirty-nine out of 60 TMD patients completed the questionnaires. Improvements in TMD symptoms were reported in 10 patients (26%), were unchanged in 16 patients (41%) and worsened in 13 patients (33%). Only 8 patients (21%) were satisfied with the follow-up of the suggested treatments from their GMP. Significant improvements of symptoms were noted in MFIQ (jaw function), GPI (including pain intensity at maximum and suffering from pain), and CSQ (pain related catastrophizing), in all 39 TMD patients as one group. However, a subgroup analysis showed that the significant improvements were mostly within patients who reported improvement of TMD symptoms. A high pain intensity at baseline was a significant risk factor (OR = 5.79, 95% CI: 1.34, 24.96) for patients who reported worsening of TMD symptoms at follow-up. Conclusion: High pain intensity at baseline was a significant risk factor for poorer recovery three years after an interdisciplinary evaluation. Our data support the notion that improved coping with TMD pain includes both decreased pain intensity, CSQ and MFIQ scores. [ABSTRACT FROM AUTHOR]

Background: Chronic orofacial pain is associated with substantial pain-related disability and emotional distress. Understanding the relationship between individuals' coping strategies and pain-related outcomes is important yet understudied in this population. Purpose: To test the cross-sectional association of three coping strategies (pain catastrophizing, kinesiophobia and mindfulness) to four pain-related outcomes (depression, anxiety, pain intensity, and pain-related disability) among individuals with chronic orofacial pain, after accounting for relevant demographic and clinical variables. Methods: Individuals (N=303) with heterogeneous chronic orofacial pain (eg, trigeminal neuralgia, other trigeminal neuropathic pain, persistent idiopathic facial pain and other types) completed self-report measures of coping (Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia, and the 15-item Five Facet Mindfulness Questionnaire), pain intensity and pain-related disability (Graded Chronic Pain Scale), and PROMIS measure of anxiety and depression. We conducted 4 two-step hierarchical regressions for each of the four pain-related and emotional outcomes, with the first step including demographic and clinical covariates, and the second step including the three coping variables together. Results: Pain catastrophizing was the only coping variable significantly associated with pain intensity (B=0.362, SE=0.115, p=0.002, 3% variance explained) and pain-related disability (B =0.813, SE=0.162, p< 0.001, 7% variance explained). Pain catastrophizing (B=0.231-0.267, SE=0.046-0.051-0.050, p< 0.001), kinesiophobia (B=0.201-0.316, SE=0.081-0.084, p< 0.001-0.018), and mindfulness (B=0.231– 0.306, SE=0.046-0.067, p< 0.001) were each independently associated with symptoms of anxiety and depression, with the largest incremental variance added by catastrophizing (5– 8%) and mindfulness (5%). Conclusion: Pain catastrophizing appears to be an important intervention target to improve pain intensity, pain-related disability, anxiety and depression among individuals with chronic orofacial pain. Kinesiophobia and mindfulness may be additional treatment targets for interventions to improve anxiety and depression. [ABSTRACT FROM AUTHOR]

Jamie L Rhudy,1 Randolph C Arnau,2 Felicitas A Huber,1 Edward W Lannon,1 Bethany L Kuhn,1 Shreela Palit,1 Michael F Payne,1,3 Cassandra A Sturycz,1 Natalie Hellman,1 Yvette M Guereca,1 Tyler A Toledo,1 Joanna O Shadlow1 1The University of Tulsa, Department of Psychology, Tulsa, OK, USA; 2University of Southern Mississippi, Department of Psychology, Hattiesburg, MS, USA; 3Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USACorrespondence: Jamie L RhudyThe University of Tulsa, Department of Psychology, Tulsa, OK, USATel +1918 631-2839Fax +1918 631-2833Email jamie-rhudy@utulsa.eduIntroduction: Native Americans (NAs) have a higher prevalence of chronic pain than other US racial/ethnic groups, but the mechanisms contributing to this pain disparity are under-researched. Pain catastrophizing is one of the most important psychosocial predictors of negative pain outcomes, and the Pain Catastrophizing Scale (PCS) has been established as a reliable and valid measure of the pain catastrophizing construct. However, before the PCS can be used to study pain risk in NAs, it is prudent to first determine whether the established 3-factor structure of the PCS also holds true for NAs.Methods: The current study examined the measurement (configural, metric, and scalar) invariance of the PCS in a healthy, pain-free sample of 138 NA and 144 non-Hispanic white (NHW) participants.Results: Results suggest that the previously established 3-factor solution fits for both groups (configural invariance) and that the factor loadings were equivalent across groups (metric invariance). Scalar invariance was also established, except for 1 minor scalar difference in a single threshold for item 3 (suggesting NHWs were more likely to respond with a 4 on that item than NAs).Discussion: Results provide additional evidence for the psychometric properties of the PCS and suggest it can be used to study pain catastrophizing in healthy, pain-free NA samples.Keywords: confirmatory factor analysis, pain catastrophizing, Native Americans, pain, ethnic differences, pain coping

Ellen L Terry,1 M Dottington Fullwood,2 Staja Q Booker,1 Josue S Cardoso,3 Kimberly T Sibille,2 Toni L Glover,4 Kathryn A Thompson,5 Adriana S Addison,6 Burel R Goodin,5 Roland Staud,7 Laura B Hughes,6 Laurence A Bradley,6 David T Redden,8 Emily J Bartley,9 Roger B Fillingim3,9 1Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, United States; 2Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, United States; 3Pain Research and Intervention Center of Excellence (PRICE), Gainesville, Florida, United States; 4Oakland University, School of Nursing, Rochester, MI, United States; 5Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, United States; 6University of Alabama at Birmingham, Division of Clinical Immunology & Rheumatology, Birmingham, Alabama, United States; 7Department of Medicine, University of Florida, Gainesville, Florida, United States; 8Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, United States; 9University of Florida, Community Dentistry and Behavioral Science, Gainesville, Florida, United StatesCorrespondence: Ellen L TerryDepartment of Biobehavioral Nursing Science, University of Florida, PO Box 100197, Gainesville FL 32610-0197 Tel ( +352) 273-6441Email elterry@ufl.eduPurpose: Research indicates pain-related disparities in the impact of knee osteoarthritis (OA) across both sex and ethnicity/race. While several factors likely contribute to these disparities, experiences of discrimination are associated with poor OA-related pain, disability, and functional performance. However, the mechanisms that mediate experiences of discrimination and OA-related outcomes are unclear. The current cross-sectional study examined the associations between everyday experiences of discrimination and clinical pain, disability and functional performance among non-Hispanic Black (NHB) and non-Hispanic White (NHW) persons with or at risk of knee OA and assessed the serial mediated model of perceived stress and pain catastrophizing on these relationships in women only.Patients and Methods: Participants were 188 community-dwelling adults who presented with unilateral or bilateral knee pain and screened positive for clinical knee pain. Participants completed several measures including experiences of discrimination, Perceived Stress Scale, Coping Strategies Questionnaire-Revised (CSQ-R): Pain Catastrophizing subscale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Graded Chronic Pain Scale (GCPS), and Short Physical Performance Battery (SPPB).Results: As compared to NHW participants, NHB individuals reported experiencing significantly higher levels of discrimination (F(1, 175)=26.660, p< 0.001), greater levels of pain catastrophizing (F(1, 180)=12.919, p< 0.001), higher levels of clinical pain and disability, and lower levels of physical function (ps< 0.05). However, perceived stress was positively correlated with discrimination in the NHW group only (NHW females: r=0.40, p< 0.01; NHW males: r=0.37, p< 0.05). Further, perceived stress and pain catastrophizing mediated the relationship between discrimination and outcome variables (WOMAC pain, GCPS interference [pain disability], and SPPB function) in female participants after controlling for relevant sociodemographic variables (study site, age, race, income, and body mass index).Conclusion: These results may have implications for the treatment of perceived stress and catastrophizing as a means to reduce the negative impact of experiences of discrimination on the experience of chronic pain, particularly for women.Keywords: experiences of discrimination, Perceived Stress Scale, pain catastrophizing, knee osteoarthritis, pain, disability, physical function

Purpose: On 10 March 2020, Greece entered an increasingly restrictive 42-day lockdown, in order to contain the first wave of the COVID-19 pandemic. All scheduled appointments and activities of the pain clinics around the country were postponed indefinitely. The aim of this prospective study was to assess the perceived impact of the first wave of the pandemic on pain, quality of life, and access to treatment, during the first austere lockdown in Greece. Patients and Methods: In this cross-sectional study, 101 patients suffering from chronic pain completed a structured questionnaire. Levels of depression, anxiety, stress, personal wellbeing, optimism and personality traits were also evaluated, using the Depression, Anxiety and Stress Scale (DASS42), the Ten Item Personality Index (TIPI), the Life Orientation Test-Revised (GrLOT-R) and the Personal Wellbeing Index (PWI). Results: Despite the dramatic decrease in health care visitations before, during and after the imposed lockdown, most patients did not feel that access to pain physicians and medication was significantly affected. Higher levels of stress, anxiety, depression, neuroticism, openness to experience and general satisfaction with life seemed to be important determinant factors in how patients experienced their level, intensity and duration of pain, quality of life and response to medication. Conclusion: The effects of the lockdown had a more severe impact on patients than the pandemic itself. For most, the level of their pain was not affected by the pandemic and was affected only slightly by the lockdown. Quality of life, however, was affected formost participants. Both the necessity and the complications of introducing the use of telemedicine to Greek chronic pain patients became evident during the study. [ABSTRACT FROM AUTHOR]

Purpose: The present study aimed to assess the influence of personality traits on the variability of sensitivity to pain in two distinct groups of healthy subjects with low versus high sensitivity to pain (LSP vs HSP, respectively). Methods: Healthy subjects (n=156) were allocated to two groups according to their tolerability to cold stimulation (cold pressor test, CPT, 1°C). Group LSP (n=76) reached the cut-off time of 180± 0 sec, and a size matched group of HSP (n=80) tolerated the CPT for an average of 10.5± 3.4 sec only. Subjects from both groups completed the self-reported pain sensitivity questionnaire (PSQ), the Pain Catastrophizing Scale (PCS), and the Neuroticism Extraversion Openness - Five Factor Inventory (NEO-FFI). Results: In comparison to the LSP group, HSP individuals had higher scores of PSQ (p< 0.001), catastrophizing (p=0.001), and extraversion (p=0.01). By adjusting for age and gender, mediation analyses revealed that catastrophizing mediated the relationship between neuroticism and pain sensitivity, both in the allocation of subjects to a certain group of sensitivity to pain (LSP or HSP, B=0.02 95% CI: 0.006– 0.040) and in the PSQ score (B=0.01 95% CI: 0.001– 0.023). Conclusion: These results, which were demonstrated by two different prisms (CPT and PSQ), point to the potential of the five-factor inventory and pain catastrophizing scale as tools for identifying specific personality traits associated with a high sensitivity to pain. [ABSTRACT FROM AUTHOR]

Attila Galambos,1–3 Edina Szabó,1–3 Zita Nagy,2 Andrea Edit Édes,4,5 Natália Kocsel,1,2,4 Gabriella Juhász,4–6 Gyöngyi Kökönyei2,4,51Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; 2Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; 3MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary; 4SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary; 5Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary; 6Neuroscience and Psychiatry Unit, The University of Manchester, Manchester, United Kingdom and Manchester Academic Health Sciences Centre, Manchester, United KingdomObjectives: Pain catastrophizing is reliably associated with pain reports during experimental pain in healthy, pain-free subjects and in people with chronic pain. It also correlates with self-reports of clinical pain intensity/severity in a variety of disorders characterized by chronic pain in adults, adolescents and children. However, processes, through which it exerts its effects are yet unclear. In this paper, our primary aim was to synthesize neuroimaging research to open a window to possible mechanisms underlying pain catastrophizing in both chronic pain patients and healthy controls. We also aimed to compare whether the neural correlates of pain catastrophizing are similar in these two groups.Methods: PubMed and the Web of Science were searched for magnetic resonance imaging (MRI) studies that explored neural correlates of pain catastrophizing.Results: Twenty articles met the inclusion criteria. The results of our review show a connection between pain catastrophizing and brain areas tightly connected to pain perception (including the somatosensory cortices, anterior insula, anterior cingulate cortex and thalamus) and/or modulation (eg, the dorsolateral prefrontal cortex). Our results also highlight that these processes - in relation to pain catastrophizing - are more pronounced in chronic pain patients, suggesting that structural and functional brain alterations (and perhaps mechanisms) related to pain catastrophizing may depend on prior and/or relatively stable/constant pain experience. However, we also found methodological issues and differences that could lead to divergent results.Discussion: Based on our results, pain catastrophizing might be related to salience detection, pain processing, and top-down attentional processes. More research is recommended to explore neural changes to specific types of catastrophizing thoughts (eg, experimentally induced and/or state). Furthermore, we provide ideas regarding pain catastrophizing studies in the future for a more standardized approach.Keywords: pain catastrophizing, DLPFC, anterior insula, chronic pain, neuroimaging

Trang TH Tu,1 Anna Miura,1 Yukiko Shinohara,1 Lou Mikuzuki,1 Kaoru Kawasaki,1 Shiori Sugawara,1 Takayuki Suga,1 Takeshi Watanabe,1 Yuma Aota,1 Yojiro Umezaki,2 Miho Takenoshita,1 Akira Toyofuku1 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; 2Department of Geriatric Dentistry, Fukuoka Dental College, Fukuoka, Japan Objectives: There has been considerable research which has focused on clarifying the origin of pain in patients with atypical odontalgia (AO), also known as “idiopathic toothache”, and on identifying effective treatment, but there has been limited success so far. In this study, we assessed the outcomes of treatment and attempted to identify factors that could account for pain remission in patients with AO.Patients and methods: Data for 165 patients diagnosed with AO from June 2015 to August 2017 were retrospectively reviewed. The patients’ sex, age, duration of pain, and psychiatric history were collected, along with information on pain intensity, depressive status, and catastrophizing scores. Responses at 4 and 16 weeks from the start of treatment were observed. The associations between potentially associated factors and outcome were investigated using Bayesian model averaging.Results: A 30% reduction in pain was reported by 38 patients (46.3%) at 4 weeks and by 54 patients (65.9%) at 16 weeks. The pain intensity decreased as the depression and catastrophizing score improved; all of the changes were statistically significant (P

Background and Aims: PainData is an electronic internet-based clinical pain registry established to improve the understanding and treatment of high-impact chronic pain. The primary aim of this paper is to describe socio-demographics, pain characteristics, quality of life, and treatment values at baseline and follow-up in individuals referred to public and private interdisciplinary pain centers in Denmark between 2018 and 2020. Methods: Self-reported patient-reported outcomes collected through PainData before (n=12,257) and after (n=4,111) treatment across 13 public and private interdisciplinary specialized pain centers in Denmark (87% of all pain centers in Denmark) are described. Results: Mean duration of pain was 10 years, and one in three patients reported chronic widespread pain. More than 40% reported opioid use, and 50% had tried four or more different treatment modalities prior to referral. More than 60% reported poor sleep, severe fatigue, and memory and/or concentration deficits. Mean scores on pain catastrophizing, fear of movement, and pain-related disability were high, whereas scores on pain acceptance and self-efficacy were low. Physical and mental health were rated as poor and fair, respectively. One in four patients reported being very much improved or much improved after treatment. Items commonly reported after treatment were increased knowledge about pain, emotions and mood (66.5%), being better at accepting life with chronic pain (63.1%), and improved activity pacing (60.6%). Conclusion: The PainData registry, containing data from a large cohort of individuals, can help to improve the understanding and treatment of high-impact chronic pain, and collaborations with other researchers are welcome. [ABSTRACT FROM AUTHOR]

Purpose: Central sensitization (CS) is defined as the increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold afferent input. CS has been proposed as an underlying mechanism of chronic pain in musculoskeletal disorders including low back pain (LBP). A Central Sensitization Inventory (CSI) has recently been developed for screening participants with CS. However, the association of CS with chronic LBP (cLBP) in the general population remains unknown. The purpose of this study was to investigate the association of CS with cLBP using the CSI in a population-based cohort of a Japanese mountain village. Participants and Methods: Participants aged more than 50 years were recruited from the inhabitants of a mountain village in Japan. Participants completed the following patient-reported outcome measures. Severity of CS was assessed by the CSI. LBP intensity was measured on a numerical rating scale (NRS). Health-related quality of life (QOL) was measured using the EuroQol 5-dimension (EQ-5D), EuroQol-visual analogue scales (EQ-VAS), and the Oswestry Disability Index (ODI). The association of CS and each parameter was statistically evaluated. Results: A total of 272 participants (average age: 72.1 years-old) were analyzed in this study, and 28.3% had cLBP. Average NRS, ODI and CSI scores were significantly higher in the cLBP group than in the without LBP (LBP−) group. There was a significant correlation between CSI and NRS scores (r=0.34, P< 0.0001), ODI (r=0.60, P< 0.0001), EQ5D (r=− 0.55, P< 0.0001) and EQ-VAS (r=− 0.52, P< 0.0001). A multiple regression analysis identified that ODI, EQ-VAS and age were factors significantly associated with CSI. Conclusion: The results of this study suggest that CS is involved in the pathological condition of cLBP in the local residents of a Japanese mountain village. [ABSTRACT FROM AUTHOR]

Introduction: Racial minorities are disproportionally affected by pain. Compared to non-Hispanic Whites (NHWs), non-Hispanic Blacks (NHBs) report higher pain intensity, greater pain-related disability, and higher levels of mood disturbance. While risk factors contribute to these disparities, little is known regarding how sources of resilience influence these differences, despite the growing body of research supporting the protective role of resilience in pain and disability among older adults with chronic pain. The current study examined the association between psychological resilience and pain, and the moderating role of race across these relationships in older adults with chronic low back pain (cLBP). Methods: This is a secondary analysis of the Adaptability and Resilience in Aging Adults (ARIAA). Participants completed measures of resilience (ie, gratitude, trait resilience, emotional support), as well as a performance-based measure assessing lower-extremity function and movement-evoked pain. Results: There were 45 participants that identified as non-Hispanic White (NHW) and 15 participants that identified as non-Hispanic Black (NHB). Race was a significant correlate of pain outcomes with NHBs reporting greater movement-evoked pain (r = 0.27) than NHWs. After controlling for relevant sociodemographic characteristics, measures of movement-evoked pain were similar across both racial groups, F (1, 48) = 0.31, p = 0.57. Moderation analyses revealed that higher levels of gratitude (b = − 1.23, p = 0.02) and trait resilience (b = − 10.99, p = 0.02) were protective against movement-evoked pain in NHWs. In contrast, higher levels of gratitude were associated with lower functional performance in NHBs (b = − 0.13, p =0.02). Discussion: These findings highlight racial differences in the relationship between resilience and pain-related outcomes among older adults with cLBP. Future studies should examine the potential benefits of targeted interventions that improve resilience and ameliorate pain disparities among racial minorities. [ABSTRACT FROM AUTHOR]

Purpose: The association between depression and chronic pain is well established. However, few studies have examined the pathways from depression to chronic pain. The present cross-cultural study aimed to test the mediating effects of pain catastrophizing on associations between depression and chronic pain (eg, pain severity, pain intensity) among Korean American elderly. Patients and Methods: A total of 132 elderly Korean Americans with chronic pain were recruited from elderly daycare centers and Korean ethnic churches in the community. For mediation analyses, structural equation modeling with full information maximum likelihood estimation method was used. The bias-corrected bootstrap confidence interval (CI) method for inferential tests of the indirect effects was also conducted in mediation analysis. Results: The results indicated that the proportion of comorbid depression and chronic pain was 45.7%. Elderly Korean Americans with depression scored higher in pain severity, pain interference, and pain catastrophizing than those without depression. Pain catastrophizing was found to have a significant mediating effect on the relationship between depression and pain severity (indirect effect = 0.147, Bootstrap 95% CI = [0.079, 0.226]), controlling for demographic covariates, comorbidities and pain area. Pain catastrophizing also mediated the relationship between depression and pain interference (indirect effect =0.164, Bootstrap 95% CI = [0.097, 0.244]), controlling for the covariates. Conclusion: These findings add to the literature by providing evidence that pain catastrophizing plays a role in high levels of pain severity and pain interference comorbid chronic pain and depression in Asian elderly immigrants. Appropriate culturally tailored programs to redirect pain catastrophizing cognitive process should be developed and provided for elderly Asian Americans to reduce chronic pain disparity. [ABSTRACT FROM AUTHOR]

Paul A Borsa,1 Jeffrey J Parr,2 Margaret R Wallace,3 Samuel S Wu,4 Yunfeng Dai,4 Roger B Fillingim,5 Steven Z George6 1Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA; 2School of Health Professions, University of Southern Mississippi, Hattiesburg, MS, USA; 3Department of Molecular Genetics and Microbiology, Center for Epigenetics, UF Genetics Institute, University of Florida, Gainesville, FL, USA; 4Department of Biostatistics, University of Florida, Gainesville, FL, USA; 5Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA; 6Duke Clinical Research Institute and Department of Orthopaedic Surgery, Duke University, Durham, NC, USABackground: We investigated interactions between genetic and psychological factors in predicting shoulder impairment phenotypes. We hypothesized that pro-inflammatory genes would display stronger relationships compared with pain-related genes when combined with psychological factors for predicting phenotypic changes.Subjects and methods: Altogether, 190 participants completed a 5-day experimental protocol. An experimental shoulder injury model was used to induce physical impairment, and a priori selected genetic (pain-related, pro-inflammatory) and psychological (anxiety, depressive symptoms, pain catastrophizing, fear of pain, kinesiophobia) factors were included as predictors of interest. Impairment phenotypes were injury-induced deficits in range of motion (ROM) and strength. After controlling for age, sex, and race, genetic and psychological predictors were entered separately as main effects and interaction terms in regression models for each phenotype.Results: Strong statistical evidence was provided for interactions between: 1) IL-1β (rs1143634) and fear of pain for predicting loss of shoulder flexion and abduction, 2) IL-1β (rs1143634) and anxiety for predicting loss of flexion, and 3) IL-1β (rs1143634) and depressive symptoms for predicting loss of internal rotation. In addition, the interaction between OPRM1 (rs1799971) and fear of pain as well as COMT (rs4818) and pain catastrophizing provided strong statistical evidence for predicting strength loss.Conclusion: Pro-inflammatory gene variants contributed more to physical impairment with two single nucleotide polymorphisms (SNPs; IL-1β [rs1143634] and TNF/LTA [rs2229094]) interacting with psychological factors to predict six shoulder impairment phenotypes. In comparison, two pain-related gene SNPs (OPRM1 [rs1799971] and COMT [rs4818]) interacted with psychological factors to predict four shoulder impairment phenotypes (abduction: 5-day average loss; strength loss: 5-day average, peak, and relative loss). Keywords: single nucleotide polymorphisms, inflammation, IL-1β, fear of pain, pain catastrophizing

Purpose: We describe two case studies that use embodiment in virtual reality as a treatment for chronic low back pain. The purpose of this case series was to determine the feasibility of a novel virtual reality-based digital therapeutic for the treatment of chronic pain. Patients and Methods: Two patients with chronic low back pain received seven sessions, two sessions per week, of a novel digital therapeutic that combines virtual embodiment with graded motor imagery to deliver functional rehabilitation exercises using an off-the-shelf virtual reality system. Pain intensity was measured using a visual analog scale before and after each session to get an indication whether individual sessions of virtual embodiment training decrease pain intensity. Pain catastrophizing scale was assessed before the first session and after the seventh session to determine the extent to which virtual embodiment training can improve psychological symptoms of chronic low back pain. Results: In both patients, pain intensity was improved after individual sessions of virtual embodiment training as measured by a paired t-test: (Patient A: t = 2.890, P < 0.05) and (Patient B: t = 5.346, P < 0.005). This indicates that individual sessions of virtual embodiment training decrease pain intensity. In both patients, improvements were observed in three subscales of the pain catastrophizing scale (rumination, magnification, and helplessness). This indicates that virtual embodiment training may have benefits for chronic pain symptoms such as pain intensity, pain-related mobility impairment, and disability. Conclusion: This case series provides evidence that embodiment in virtual reality improves symptoms of persistent chronic low back pain. We propose a mechanism by which virtual embodiment may improve chronic pain symptoms by recontextualizing sensory feedback from the body as patients engage in functional rehabilitation exercises while in virtual reality. [ABSTRACT FROM AUTHOR]

Background: Improving all aspects of physical function is an important goal of chronic pain management. Few studies follow recent guidelines to comprehensively assess physical function via patient-reported, performance-based, and objective/ambulatory measures. Purpose: To test 1) the interrelation between the 3 types of physical function measurement and 2) the association between psychosocial factors and each type of physical function measurement. Methods: Patients with chronic pain (N=79) completed measures of: 1) physical function (patient-reported disability; performance-based  6-minute walk-test; objective accelerometer step count); 2) pain and non-adaptive coping (pain during rest and activity, pain-catastrophizing, kinesiophobia); 3) adaptive coping (mindfulness, general coping, pain-resilience); and 4) social-emotional dysfunction (anxiety, depression, social isolation and emotional support). First, we tested the interrelation among the 3 aspects of physical function. Second, we used structural equation modeling to test associations between psychosocial factors (pain and non-adaptive coping, adaptive coping, and social-emotional dysfunction) and each measurement of physical function. Results: Performance-based and objective physical function were significantly interrelated (r=0.48, p< 0.001) but did not correlate with patient-reported disability. Pain and non-adaptive coping (β=0.68, p< 0.001), adaptive coping (β=− 0.65, p< 0.001) and social-emotional dysfunction (β=0.65, p< 0.001) were associated with patient-reported disability but not to performance-based or objective physical function (ps> 0.1). Conclusion: Results suggest that patient-reported physical function may provide limited information about patients' physical capacity or ambulatory activity. While pain and non-adaptive reactions to it, adaptive coping, and social-emotional dysfunction may potentially improve patient-reported physical function, additional targets may be needed to improve functional capacity and ambulatory activity. Trial Registration: ClinicalTrials.gov NCT03412916. [ABSTRACT FROM AUTHOR]

Purpose: Hysterectomy is associated with a high incidence of chronic post-hysterectomy pain (CPHP). Pain catastrophizing, a negative cognitive-affective response to pain, is associated with various pain disorders but its role in CPHP is unclear. We aimed to determine the association of high preoperative pain catastrophizing with CPHP development and functional impairment 4 months after surgery. Patients and Methods: Secondary analysis of a prospective cohort study of women undergoing abdominal/laparoscopic hysterectomy to investigate the association between high pain catastrophizing (pain catastrophizing scale, PCS≥ 20) with CPHP and associated functional impairment (defined as impairment with standing for ≥ 30 minutes, sitting for ≥ 30 minutes, or walking up or down stairs). CPHP and functional impairment were assessed via 4- and 6-month phone surveys. Results: Of 216 patients, 72 (33.3%) had high PCS, with mean (SD) of 30.0 (7.9). In contrast, 144 (66.7%) patients had low PCS, with mean (SD) of 9.0 (4.7). At 4 months, 26/63 (41.3%) patients in the high PCS group developed CPHP, compared to 24/109 (22.0%) in the low PCS group. At 6 months, 14/53 (26.4%) high PCS patients developed CPHP, compared to 10/97 (10.3%) patients with low PCS. High PCS was independently associated with CPHP at 4 months (OR 2.49 [95% CI 1.27 to 4.89], p=0.0082) and 6 months (OR 3.12 [95% CI 1.28 to 7.64], p=0.0126) but was not associated with functional impairment. High PCS≥ 20, presence of evoked mechanical temporal summation (MTS), and history of abdominal/pelvic surgery predict CPHP at 4 months with area under the curve (AUC) of 0.69. Similarly, PCS≥ 20 and increasing MTS magnitude predicted CPHP at 6 months with AUC of 0.76. Conclusion: High PCS was independently associated with CPHP. Future studies should identify other CPHP associated factors to formulate a risk-prediction model and investigate the effectiveness of early intervention for pain catastrophizers in improving pain-related outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Non-specific low back pain (NLBP) causes an enormous burden to patients and tremendous costs for health care systems worldwide. Frequently, treatments are not oriented to existing guidelines. In the future, digital elements may be promising tools to support guideline-oriented treatment in a broader range of patients. The cluster-randomized controlled "Rise-uP" trial aims to support a General Practitioner (GP)-centered back pain treatment (Registration No: DRKS00015048) and includes the following digital elements: 1) electronic case report form (eCRF), 2) a treatment algorithm for guideline-based clinical decision making of GPs, 3) teleconsultation between GPs and pain specialists for patients at risk for development of chronic back pain, and 4) a multidisciplinary mobile back pain app for all patients (Kaia App). Methods: In the Rise-uP trial, 111 GPs throughout Bavaria (southern Germany) were randomized either to the Rise-uP intervention group (IG) or the control group (CG). Rise-uP patients were treated according to the guideline-oriented Rise-uP treatment algorithm. Standard of care was applied to the CG patients with consideration given to the "National guideline for the treatment of non-specific back pain". Pain rating on the numeric rating scale was the primary outcome measure. Psychological measures (anxiety, depression, stress), functional ability, as well as physical and mental wellbeing, served as secondary outcomes. All values were assessed at the beginning of the treatment and at 3-month follow-ups. Results: In total, 1245 patients (IG: 933; CG: 312) with NLBP were included in the study. The Rise-uP group showed a significantly stronger pain reduction compared to the control group after 3 months (IG: M=− 33.3% vs CG: M=− 14.3%). The Rise-uP group was also superior in secondary outcomes. Furthermore, high-risk patients who received a teleconsultation showed a larger decrease in pain intensity (− 43.5%) than CG patients (− 14.3%). ANCOVA analysis showed that the impact of teleconsultation was mediated by an increased training activity in the Kaia App. Conclusion: Our results show the superiority of the innovative digital treatment algorithm realized in Rise-uP, even though the CG also received relevant active treatment by their GPs. This provides clear evidence that digital treatment may be a promising tool to improve the quality of treatment of non-specific back pain. In 2021, analyses of routine data from statutory health insurances will enable us to investigate the cost-effectiveness of digital treatment. [ABSTRACT FROM AUTHOR]

Purpose: The INTERMED instrument, which was developed to measure patient's biopsychosocial (BPS) complexity, represents a powerful diagnostic and therapeutic tool. Epigenetic changes are the interface between signals from the environment and genetic modifications, affecting gene expression, in particular, by DNA methylation of CpG dinucleotides in promotor regions of the corresponding genes. The brain-derived neurotrophic factor (BDNF) gene plays a crucial role in the central sensitization (CS) of pain. In this study, we hypothesized that chronic pain modifies the methylation levels of the BDNF gene in a manner that is interconnected with the BPS status. Patients and Methods: Fifty-eight chronic musculoskeletal pain patients (CMSP) were enrolled in the study. DNA was extracted from blood samples, the methylation levels of 13 CpG sites in the BDNF promoter were measured by pyrosequencing, and association studies with various patient parameters and the INTERMED scores were performed. Results: Interestingly, a negative correlation (− 0.40) was found between the total INTERMED scores and the average CpG methylation values of the BDNF gene, but no correlation was observed with the severity of pain, degree of anxiety, depression, or kinesiophobia and catastrophism. Moreover, the association was independent of age, sex and level of comorbidities. Conclusion: This result shows that CMSP, in association with its biopsychosocial context, epigenetically decreases the degree of methylation of the BDNF promoter and should therefore increase the level of BDNF transcription. It also suggests a role of the INTERMED tool to detect a relationship between the BPS complexity and the epigenetic control of a target gene. The possible upregulation of BDNF expression might be, at least in part, the signal for chronic pain-induced central sensitization (CS). This could partly explain why patients with a higher level of complexity feel more pain than those with lower complexity. [ABSTRACT FROM AUTHOR]

Purpose: Youth with sickle cell disease (SCD), a genetic disorder of red blood cells, may experience acute pain episodes lasting 2 to 3 days on average. While existing research has demonstrated associations between SCD pain and poor social functioning in youth with SCD, there are no data on whether symptoms of depression and anxiety modify the relationship between pain and functional outcomes in pediatric pain populations. It was hypothesized that more symptoms of depression and anxiety would exacerbate the relationship between high pain and poor social functioning in youth with SCD. Patients and Methods: We conducted a cross-sectional study of 114 youth with SCD and their guardians assessing the youth's pain, social functioning, and symptoms of depression and anxiety. Results: Analyses indicated that elevated levels of depressive symptoms were related to poorer self-reported interpersonal skills. More anxiety symptoms were related to better guardian-reported social skills and weakened the relationship between high pain frequency and poor self-reported interpersonal skills. Conclusion: Findings build on previous work supporting the need for multidisciplinary approaches to care for youth with SCD who experience pain, and provide rationale for future studies to investigate the direct and possible moderating effects of depression and anxiety symptoms on other functional outcomes in youth with SCD and other pediatric pain populations. [ABSTRACT FROM AUTHOR]

Purpose: To examine the relationship between baseline kinesiophobia and baseline pain catastrophizing with the 4-day average activity intensity at different times of the day while accounting for different wake and sleep-onset times in chronic pain patients. Methods: Twenty-one participants suffering from idiopathic chronic pain completed baseline questionnaires about kinesiophobia, catastrophizing, disability, depression, and pain. We measured the participants' activity using accelerometers and calculated activity intensity in the morning, afternoon, and evening. We performed a 2-way repeated measures ANOVA to compare activity levels at different times of the day, and multiple linear regressions. Results: Baseline kinesiophobia was significantly associated with 4-day average evening light activity and sedentary activity at all time periods while baseline catastrophizing was significantly associated with increased 4-day average light activity in the evening and more moderate to vigorous activity in the morning. Our participants engaged in more light activity on average than sedentary activity, and very little moderate-vigorous activity. Participants were most active in the afternoon. Conclusion: Baseline kinesiophobia and baseline catastrophizing were not associated with the 4-day average total daily activity; however, they were associated with 4-day average activity intensities at different times throughout the day. Segmenting daily activity into morning, afternoon, evening may influence the relationship between daily activity, and kinesiophobia and pain catastrophizing. Individuals with chronic pain are less sedentary than previously thought which may affect future interventions. [ABSTRACT FROM AUTHOR]

Purpose: Everyday variations in night sleep in healthy pain-free subjects are at most weakly associated with pain, whereas strong alterations (eg, sleep deprivation, insomnia) lead to hyperalgesic pain changes. Since it remains unclear how substantial sleep alterations need to be in order to affect the pain system and lead to a coupling of both functions, the present study aimed at providing sufficient variance for co-variance analyses by examining a sample consisting of both healthy subjects and chronic pain patients. Methods: A sample of 20 chronic musculoskeletal pain patients and 20 healthy controls was examined. This sample was assumed to show high inter-individual variability in sleep and pain, as pain patients frequently report sleep disturbances, whereas healthy subjects were required to be pain-free and normal sleepers. Sleep of two non-consecutive nights was measured using portable polysomnography and questionnaires. Experimental pain parameters (pressure pain thresholds (PPT), temporal summation of pain (TSP), conditioned pain modulation (CPM)) and situational pain catastrophizing (SCQ) were assessed in laboratory sessions before and after sleep. Pain patients' clinical pain was assessed via questionnaire. Results: As expected, both groups differed in several sleep parameters (reduced total sleep time and sleep efficiency, more time awake after sleep onset, lower subjective sleep quality in the patients) and in a few pain parameters (lower PPTs in the patients). In contrast, no differences were found in TSP, CPM, and SCQ. Contrary to our expectations, regression analyses indicated no prediction of overnight pain changes by sleep parameters. Conclusion: Since sleep parameters were hardly apt to predict overnight pain changes, this leaves the association of both systems mainly unproven when using between-subject variance for verification. [ABSTRACT FROM AUTHOR]

C Horn-Hofmann,1 D Wolf,1 S Wolff,1 M Heesen,2 K Knippenberg-Bigge,3 P M Lang,3 S Lautenbacher1 1Department of Physiological Psychology, University of Bamberg, Germany; 2Department of Anesthesiology and Pain Therapy, Kantonsspital Baden, Switzerland; 3Department of Anesthesiology and Pain Therapy, Sozialstiftung Bamberg, Bamberg, Germany Background: Empirical evidence suggests that affective responses to pain are changed in chronic pain. The investigation of startle responses to pain might contribute to clarifying whether such alterations also expand to motivational defensive reactions. We aimed at comparing startle responses to tonic heat pain with high threat (HT) or low threat (LT) in patients with chronic musculoskeletal pain and controls. As pain-related anxiety and catastrophizing are typically elevated in chronic pain, we expected to find stronger startle responses in patients specifically under experimental HT. Methods: Patients with chronic musculoskeletal, preferentially, back pain (N = 19) and matched pain-free controls (N = 19) underwent two pain-related threat conditions (high and low) in balanced order. Only, in the HT condition, 50% of the trials were announced to include a short further noxious temperature increase at the end. Startle responses to loud tones were always assessed prior to a potential temperature increase in the phase of anticipation and were recorded by surface electromyogram. Results: Surprisingly, we observed no differences in startle responses and ratings of emotional and pain responses between patients and controls despite significantly higher pain-related anxiety and catastrophizing in the patients. Overall, startle was potentiated in the HT condition, but only in participants who started with this condition. Conclusion: Our results suggest that, in general, patients with pain are not more responsive emotionally to experimental threat manipulations despite elevated pain anxiety and catastrophizing. Instead, exaggerated responses in patients might be triggered only by individual concerns relating to pain, which are not sufficiently mirrored by our threat paradigm. Keywords: musculoskeletal pain, catastrophizing, anxiety, defensive motivation, experimental pain, startle reflex, threat induction

Jennifer M Hah,1 John A Sturgeon,1 Jennifer Zocca,2 Yasamin Sharifzadeh,3 Sean C Mackey1 1Division of Pain Medicine, 2Department of Anesthesiology, Perioperative, and Pain Medicine, 3Stanford Systems Neuroscience and Pain Lab, Stanford University, Palo Alto, CA, USA Objective: To examine demographic features, psychosocial characteristics, pain-specific behavioral factors, substance abuse history, sleep, and indicators of overall physical function as predictors of opioid misuse in patients presenting for new patient evaluation at a tertiary pain clinic.Methods: Overall, 625 patients with chronic non-cancer pain prospectively completed the Collaborative Health Outcomes Information Registry, assessing pain catastrophizing, National Institutes of Health Patient-Reported Outcomes Measurement Information System standardized measures (pain intensity, pain behavior, pain interference, physical function, sleep disturbance, sleep-related impairment, anger, depression, anxiety, and fatigue), and substance use history. Additional information regarding current opioid prescriptions and opioid misuse was examined through retrospective chart review.Results: In all, 41 (6.6%) patients presented with some indication of prescription opioid misuse. In the final multivariable logistic regression model, those with a history of illicit drug use (odds ratio [OR] 5.45, 95% confidence interval [CI] 2.48–11.98, p

Cassie Dance,1 M. Scott DeBerard,1 Jessica Gundy Cuneo2 1Department of Psychology, Utah State University, Logan, UT, 2Department of Psychiatry, University of California, San Diego, CA, USA Purpose: Chronic low back pain is highly prevalent and often treatment recalcitrant condition, particularly among workers’ compensation patients. There is a need to identify psychological factors that may predispose such patients to pain chronicity. The primary aim of this study was to examine whether pain acceptance potentially mediated the relationship between pain catastrophizing and post-surgical outcomes in a sample of compensated lumbar fusion patients.Patients and methods: Patients insured with the Workers Compensation Fund of Utah and who were at least 2 years post-lumbar fusion surgery completed an outcome survey. These data were obtained from a prior retrospective-cohort study that administered measures of pain catastrophizing, pain acceptance, mental and physical health, and disability.Results: Of the 101 patients who completed the outcome survey, 75.2% were male with a mean age of 42.42 years and predominantly identified as White (97.0%). The majority of the participants had a posterior lumbar interbody fusion surgery. Pain acceptance, including activity engagement and pain willingness, was significantly correlated with better physical health and mental health, and lower disability rates. Pain catastrophizing was inversely correlated with measures of pain acceptance (activity engagement r=–0.67, p

Purpose: We aimed to quantitatively investigate how the neuroscience field developed over time in terms of its concept on how pain is represented in the brain and compare the research trends of pain with those of mental disorders through literature mining of accumulated published articles. Methods: The abstracts and publication years of 137,525 pain-related articles were retrieved from the PubMed database. We defined 22 pain-related brain regions that appeared more than 100 times in the retrieved abstracts. Time-evolving networks of pain-related brain regions were constructed using the co-occurrence frequency. The state-space model was implemented to capture the trend patterns of the pain-related brain regions and the patterns were compared with those of mental disorders. Results: The number of pain-related abstracts including brain areas steadily increased; however, the relative frequency of each brain region showed different patterns. According to the chronological patterns of relative frequencies, pain-related brain regions were clustered into three groups: rising, falling, and consistent. The network of pain-related brain regions extended over time from localized regions (mainly including brain stem and diencephalon) to wider cortical/subcortical regions. In the state-space model, the relative frequency trajectory of pain-related brain regions gradually became closer to that of mental disorder-related brain regions. Conclusion: Temporal changes of pain-related brain regions in the abstracts indicate that emotional/cognitive aspects of pain have been gradually emphasized. The networks of pain-related brain regions imply perspective changes on pain from the simple percept to the multidimensional experience. Based on the notable occurrence patterns of the cerebellum and motor cortex, we suggest that motor-related areas will be actively explored in pain studies. [ABSTRACT FROM AUTHOR]

aime K Devine,2 Monika Haack,2 Robert N Jamison,1 Robert R Edwards,1 Kristin L Schreiber11Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA 02467, USA; 2Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USACorrespondence: Kristin L SchreiberDepartment of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USATel +1 617 732 8218Email klschreiber@bwh.harvard.edu Background: Fibromyalgia (FM) is a chronic widespread pain disorder characterized by negative affect, sleep disturbance, and fatigue. This uncontrolled pilot study investigated the efficacy of daily yoga-based exercise to improve FM symptoms and explored baseline phenotypic characteristics associated with the greatest benefit. Methods: FM patients (n=46, with 36 completers) reported psychosocial functioning and a range of FM symptoms using validated instruments before and after participation in Satyananda yoga, which included weekly in-person pain-tailored group classes for 6 weeks and daily home yoga video practice. Results: Changes in FM symptoms from pre- to post-yoga were variable amongst participants. Group means for pain decreased, as reported by average daily diary and Brief Pain Inventory, with greater home practice minutes associated with a greater decrease in pain. Average daily ratings of sleep and fatigue improved. Pain catastrophizing was decreased overall, with greater change correlated to a decrease in FM symptoms. We did not observe any group mean changes in actigraphy sleep efficiency, Patient-Reported Outcomes Measurement Information System-anxiety and the Revised Fibromyalgia Impact Questionnaire. Multilevel Modeling analysis revealed a significant interaction between anxiety and catastrophizing for end-study sleep efficiency, fatigue, and pain, such that patients with higher baseline catastrophizing and lower baseline anxiety reported less pain and fatigue, and higher sleep efficiency after the sixth week of yoga practice. Conclusion: This pilot study suggests that yoga may reduce pain and catastrophizing, as well as improve sleep, but these changes were modest across study participants. Greater uptake of home yoga practice as well as a phenotype of higher baseline catastrophizing combined with lower baseline anxiety were associated with greater impact. Future randomized, controlled trials comparing different types of yoga or exercise will allow determination of the most effective treatments for FM and allow closer targeting to the patients who will benefit most from them. [ABSTRACT FROM AUTHOR]

Introduction: Multidisciplinary pain management is a useful method for treating chronic musculoskeletal pain. Currently, few facilities in Japan offer multidisciplinary pain treatment, especially in the inpatient setting. We implemented a multidisciplinary pain management program based on International Association for the Study of Pain recommendations. This study described our initial efforts in implementing the program, and reported 3- and 6-month follow-up results. Materials and methods: Our pain management team included orthopedic surgeons, psychiatrists, nurses, physical therapists, clinical psychologists, pharmacists, and nutritionists. The 3-week inpatient pain management program comprised exercise therapy, psychotherapy, and patient education. We evaluated patients using the Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), Pain Disability-Assessment Scale (PDAS), Hospital Anxiety and Depression Scale (HADS), Pain Self-Efficacy Questionnaire (PSEQ), EuroQol Five Dimensions (EQ-5D), and physical examinations (flexibility, muscle endurance, walking ability, and physical fitness). Statistical analyses were performed using paired t-tests and Wilcoxon matched-pairs signed-rank sum tests with Bonferroni correction after the Friedman test. Results: Data for 23 patients were analyzed before and immediately after the program. Statistically significant improvements were seen in BPI, PCS, PDAS, HADS, PSEQ, EQ-5D, flexibility, muscle endurance, walking ability, and physical fitness. Eight patients were also assessed 3 and 6 months after the program. PCS (rumination and helplessness) scores and flexibility showed significant improvement at 3 and 6 months. Significant improvement was seen in PDAS and HADS (anxiety) scores and muscle endurance at 6 months, and in PSEQ scores immediately and at 3 and 6 months. Conclusion: Our inpatient pain management program can improve patients' physical function and ability to cope with chronic musculoskeletal pain, which supports improved quality of life. Our program is currently being expanded to better assist patients with chronic musculoskeletal pain. [ABSTRACT FROM AUTHOR]

aimed to investigate the prevalence of and risk factors associated with pain and to compare the correlation between depression and sleep quality and pain among adults in Northwest China, where health care resources are limited. Methods: In total, 7,602 subjects (age ≥40 years) participated in this survey. Using the Brief Pain Inventory-Chinese version, we evaluated the overall pain among respondents, including pain sites, pain intensity, and its interference in daily life. In addition, depression symptoms were measured using the Center for Epidemiologic Studies Depression Scale Chinese edition. Furthermore, the subjective sleep quality among participants was assessed using the Pittsburgh Sleep Quality Index. Results: Approximately 25.2% of the participants experienced pain, and 41.7% of those perceived the worst pain they had experienced as severe pain. Chronic disease exhibited the most robust correlation with severe pain, followed by poor sleep quality. Furthermore, the correlation between depression and pain was found only in the population with severe pain. Conclusion: The study reveals that pain affects a large proportion of Chinese adults, especially females, living in rural areas, having lower incomes, unemployed, and suffering from poor health status or mental illness. Furthermore, this study suggests we should have a screen and intervention for depression and poor sleep quality among pain suffers, which will be helpful for pain management in Northwest China. [ABSTRACT FROM AUTHOR]