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Introduction Existing data demonstrate reduced delta power during sleep in chronic pain and depressed patients. However, there has been little examination of the relationship between delta power and next-day reports of pain. We tested the extent to which nocturnal (during the concurrent sleep period) and daytime pain reports are associated with delta power during sleep, as well as the extent to which this association is moderated by depressive symptoms. We hypothesised that reduced delta power and SWS would be associated with increased pain, pain catastrophising, and pain sensitivity. Methods 149 female participants with insomnia and temporomandibular joint pain (TMD) were recruited. We examined nocturnal and daytime measures of pain (pain severity, average pain), pain catastrophizing, and objective pain sensitivity (obtained through quantitative sensory testing (QST)), and calculated relative nocturnal delta (0.5-3.4 Hz) power using polysomnography. We fit linear regression models correcting for depressive symptom severity, age, and total sleep time, and further examined the moderating effect of depression severity on these measures. Results reduced delta power was associated with increased average nocturnal pain (Unstandardized β = -17.67, p= 0.02), morning pain (Unstandardized β = -15.67, p=0.02), and average next-day pain (Unstandardized β = -16.74, p= 0.03). Depression severity did not moderate these relationships. Delta power was not significantly associated with objective pain-sensitivity, nocturnal, or daytime pain catastrophising. However the association between nocturnal pain catastrophising and delta power was moderated by depressive symptom severity (p = 0.04). Simple slopes analysis revealed that when participants had low depressive symptoms ( Discussion These findings demonstrate that delta power during sleep is associated with both nocturnal and daytime experience of pain in patients with TMD. In patients with TMD and low depressive symptoms, reduced delta power was associated with increased nocturnal pain catastrophising.

This study sought to identify reliable subgroups of patients with chronic pain based on profiles of subscale scores on the Pain Stages of Change Questionnaire (PSOCQ), a reliable and valid measure of individuals' readiness to adopt a self-management approach to chronic pain. The PSOCQ was administered to 633 people seeking treatment for chronic pain. Participants were predominantly White, averaged 48 years of age, about half were men, and about half reported back pain as the primary complaint. In a first study, cluster analysis was applied to 250 respondents. Five clusters were identified and named Precontemplation (11.0% of the sample), Contemplation (18.0%), Noncontemplative Action (12.4%), Participation (25%), and Ambivalent (33.6%). Results of a discriminant function analysis (DFA) on this sample, using the solution from the cluster analysis yielded a total error rate of 0.036. In a second study, the results of the first DFA were applied to an independent sample of 383 respondents in order to cross validate the solution from the first study. Cluster assignment proportions were very similar to the first sample and the posterior probability error rate for the second DFA was 13%. As predicted, clusters did not differ on measures of pain, disability, or demographics. Moreover, clusters differed significantly in theoretically consistent directions by scores on the Survey of Pain Attitudes, thus demonstrating criterion related validity for the clusters. Future research should examine the utility of PSOCQ profiles, relative to individual PSOCQ scale scores alone, in predicting response to self-management treatment approaches.

To assess disparities in the quality of healthcare provider communication experienced by African-American adults with and without sickle cell disease (SCD) in the U.S.Poor provider communication was assessed by the Provider Communication subscale of the Consumer Assessment of Healthcare Plans and Systems survey. The SCD sample was obtained from participants in a multicenter observational study of healthcare experiences. The national African-American sample data was obtained from published national estimates.The SCD sample was more likely than the national sample to report poor communication in 3 out of 4 communication domains: listening (22.3% vs. 11.5%, p0.0001); showing respect (26.1% vs. 9.5%, p0.0001); and spending enough time (38.3% vs. 16.2%, p0.0001). Differences were consistent in young, but not old, patients and showed some variation by self-reported health status and education.The communication difficulties experienced by persons with SCD do not appear reducible to their predominantly African-American race, but may result from more disease-specific factors.Healthcare providers should take particular care in recognizing and demonstrating recommended communication skills with SCD patients as these patients may be particularly vulnerable to, and cognizant of, poor quality interactions.

Adults with sickle cell disease (SCD) report experiencing discriminatory behavior from some healthcare providers. The impact of discrimination on health outcomes in SCD, including adherence to physician recommendations, is not known.Our aim was to evaluate the association between perceived discrimination from healthcare providers and nonadherence to physician recommendations among persons with SCD, and to test the potentially mediating role of patient trust.Patients with SCD (age 15 years and older) participating in the Improving Patient Outcomes with Respect and Trust (IMPORT) Study.Perceived discrimination from healthcare providers and reported adherence to physician recommendations were assessed by patient self-report using items from the 2001 Commonwealth Fund Health Survey. Interpersonal trust in medical professionals was assessed using the short form of the Wake Forest Trust in Medical Professionals instrument.We used a cross-sectional analysis of IMPORT participant data. Multivariable Poisson regression models were used to test the independent association of discrimination with adherence and to test patient trust as a potential mediator.Among 273 SCD patients with complete data on all variables of interest, patients reporting experiences of discrimination in the healthcare system were 53% more likely to also report being nonadherent to physician recommendations. Trust in medical professionals appeared to mediate the discrimination/nonadherence relationship, accounting for 50% of the excess prevalence of nonadherence among those experiencing discrimination.SCD patient perceptions of discriminatory experiences from healthcare providers are associated with greater nonadherence to physician recommendations, and may be a potential factor contributing to disparities in health and health quality among this patient population. Perceived discrimination appears to affect adherence behaviors through the pathway of patient trust. Improving relationships between healthcare providers and SCD patients may improve the trust that SCD patients have in medical professionals, which in turn may improve other outcomes among this underserved patient population.

The purpose of this study was to examine the relative contributions of sets of descriptive, organic, and psychosocial variables to a prediction of nocturnal penile rigidity among a group of men presenting with significant erectile dysfunction. Seventy veterans referred for evaluation of their erectile dysfunction completed several standardized questionnaires and two nights of nocturnal penile rigidity monitoring (NPRM) using the snap gauge technique. Results suggest that each set of variables uniquely contributes to a prediction of NPRM. Findings support the view that a biopsychosocial approach should be used in the evaluation and treatment of erectile dysfunction.