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Background: Back pain is the number one condition contributing to years lived with disability worldwide, and one of the most common reasons for seeking primary care. Research on this condition in the ageing population is sparse. Further, the heterogeneity of patients with back pain complicates the management in clinical care. It is possible that subgrouping people with similar characteristics would improve management. This paper aimed to identify latent classes based on demographics, pain characteristics, psychosocial behavior, and beliefs and attitudes about back pain, among older patients seeking primary care with a new episode of back pain, and to examine if there were differences regarding the classes' first point-of-contact. Methods: The study was part of the international BACE (Back complaints in elders) consortium and included 435 patients aged ≥ 55 years seeking primary care (general practitioners, physiotherapists, and chiropractors) in Norway from April 2015 to March 2020. A latent class analysis was performed to identify latent classes. The classes were described in terms of baseline characteristics and first point-of-contact in primary care. Results: Four latent classes were identified. The mean age was similar across groups, as were high expectations towards improvement. Class 1 (n = 169, 39%), the "positive" class, had more positive attitudes and beliefs, less pain catastrophizing and shorter duration of current pain episode. Class 2 (n = 31, 7%), the "fearful" class, exhibited the most fear avoidance behavior, and had higher mean pain intensity. Class 3 (n = 33, 8%), the "distressed" class, had the highest scores on depression, disability, and catastrophizing. Finally, class 4 (n = 202, 46%), the "hopeful" class, showed the highest expectations for recovery, although having high pain intensity. The identified four classes showed high internal homogeneity, sufficient between-group heterogeneity and were considered clinically meaningful. The distribution of first point-of-contact was similar across classes, except for the positive class where significantly more patients visited chiropractors compared to general practitioners and physiotherapists. Conclusions: The identified classes may contribute to targeting clinical management of these patients. Longitudinal research on these latent classes is needed to explore whether the latent classes have prognostic value. Validation studies are needed to evaluate external validity. Trial registration: Clinicaltrials.gov NCT04261309. [ABSTRACT FROM AUTHOR]

Background: Many studies have explored the relationship between self-esteem and quality of life. However, few studies have elucidated the mechanisms underlying the relationship between self-esteem and quality of life in middle-aged and older patients with chronic diseases. The present study aimed to explore the mediating role of death anxiety in this relationship. Methods: Middle-old-aged patients with chronic diseases were selected as the respondents by using a multi-stage sampling method, random number table method from October 2021 to February 2022 in the Second Affiliated Hospital of Zhejiang University School of Medicine. The Cumulative Disease Rating Scale, the Self-Esteem Scale (SES), the Chinese version of the Death Anxiety Scale (CT-DAS), and the Simplified version of the Quality of Life Scale (SF-12) were used as the researching tools to conduct the survey. SPSS26.0 was used to analysis data. AMOS 23.0 software was used to construct structural equation modeling. Results: 294 valid questionnaires were collected. There were significant differences in quality of life among middle-aged and elderly patients with chronic diseases who have different physical activities, socialization, and chronic pain (P < 0.01); Self-esteem was positively associated with quality of life (r = 0.330, P < 0.01), self-esteem was negatively associated with death anxiety (r = -0.222, P < 0.01), and death anxiety was negatively associated with quality of life (r = -0.263, P < 0.01); Death anxiety partially mediated the relationship between self-esteem and quality of life, with the mediating effect accounting for 18.40% of the total effect. Conclusion: Death anxiety partially mediates the relationship between self-esteem and quality of life. Interventions to improve self-esteem and reduce death anxiety should be used to improve the quality of life of middle-aged and senior patients with chronic diseases. [ABSTRACT FROM AUTHOR]

Emotion regulation as a proximal factor has been linked with depressive symptoms. However, studies have mainly focused on a limited number of strategies and have mostly been cross-sectional in design. This is particularly evident when examining the protective effects of adaptive strategies. This study aimed to investigate the prospective relationship between putatively adaptive and maladaptive emotion regulation strategies and depressive symptoms among adolescents. Additionally, a person-oriented approach was applied to identify latent classes of adolescents based on their depressive symptoms and compared these classes in terms of their adaptive and maladaptive strategies. Two waves of data from a prospective study, which included 1371 youth (mean age: 15.66 years; SD = 0.49 years; 55.1% girls), were analysed. The two points of data collection were spaced approximately half a year apart. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale, and putatively adaptive and maladaptive emotion regulation strategies were assessed with the Cognitive Emotion Regulation Questionnaire. Seven strategies (acceptance, positive refocusing, positive reappraisal, putting into perspective, self-blame, rumination, and catastrophizing) were categorised into adaptive and maladaptive factors using exploratory structural equation modeling. After controlling for gender, age, and depressive symptoms at Time 1, both maladaptive and adaptive emotion regulation strategies at Time 1 predicted depressive symptoms at Time 2. Three subgroups emerged based on the intensity of depressive symptoms across the waves: the stable low, stable moderate, and stable high depressive symptom groups. The use of maladaptive emotion regulation strategies (such as rumination, self-blame, and catastrophizing) at Time 1 was more pronounced in the stable moderate and high symptom groups compared to the stable low depressive symptom group. The comparable prospective associations between putatively adaptive and maladaptive strategies with symptoms suggest the need to identify factors that may mitigate the negative impact of maladaptive emotion regulation and/or promote adaptive emotion regulation to buffer the effects of everyday stressors. [ABSTRACT FROM AUTHOR]

Background and Purpose: Frozen shoulder (FS) is defined as a condition characterised by functional restriction and daily and nightly pain. As in other shoulder pathologies, the manifestation of psychological factors is recognised in FS; however, from a psychological point of view, only few studies have reported its prognostic value. The aim of this systematic review is to investigate, in patients with FS, the prognostic value of psychological factors on pain, function, disability, health‐related quality of life, return to work and time to recovery. Materials and Methods: This systematic review was reported following the Preferred Reporting Items for Systematic reviews and Meta‐Analysis—PRISMA 2020 guideline. The authors followed the Cochrane Handbook for Systematic review of Intervention as methodological guidance. The Quality in Prognostic Studies—QUIPS tool was used to assess the risk of bias. Results: Pain‐related fear and depression could be prognostic regarding patient‐reported outcome measures assessing shoulder function, disability, and pain; instead, pain catastrophizing could have a prognostic value assessed by the disability of the arm shoulder and hand ‐DASH scale. Anxiety would appear to impact on disability and pain. Discussion and Conclusions: As widely reported in numerous musculoskeletal conditions, also in FS psychological factors influence the physical dimension such as pain, disability and function. Therefore, clinicians should be encouraged to identify these factors through a comprehensive assessment of the bio‐psychological profile of each individual with FS. Perhaps, patients with FS that show such psychological prognostic factors could benefit from a comprehensive and shared approach with other dedicated professionals. [ABSTRACT FROM AUTHOR]

Objective: Fibromyalgia (FM) is characterized by pervasive pain‐related symptomatology and high levels of negative affect. Mind–body treatments such as cognitive behavioral therapy (CBT) appear to foster improvement in FM via reductions in pain‐related catastrophizing, a set of negative, pain‐amplifying cognitive and emotional processes. However, the neural underpinnings of CBT's catastrophizing‐reducing effects remain uncertain. This randomized controlled mechanistic trial was designed to assess CBT's effects on pain catastrophizing and its underlying brain circuitry. Methods: Of 114 enrolled participants, 98 underwent a baseline neuroimaging assessment and were randomized to 8 weeks of individual CBT or a matched FM education control (EDU) condition. Results: Compared with EDU, CBT produced larger decreases in pain catastrophizing post treatment (P < 0.05) and larger reductions in pain interference and symptom impact. Decreases in pain catastrophizing played a significant role in mediating those functional improvements in the CBT group. At baseline, brain functional connectivity between the ventral posterior cingulate cortex (vPCC), a key node of the default mode network (DMN), and somatomotor and salience network regions was increased during catastrophizing thoughts. Following CBT, vPCC connectivity to somatomotor and salience network areas was reduced. Conclusion: Our results suggest clinically important and CBT‐specific associations between somatosensory/motor‐ and salience‐processing brain regions and the DMN in chronic pain. These patterns of connectivity may contribute to individual differences (and treatment‐related changes) in somatic self‐awareness. CBT appears to provide clinical benefits at least partially by reducing pain‐related catastrophizing and producing adaptive alterations in DMN functional connectivity. [ABSTRACT FROM AUTHOR]

Alterations in postural control have been found in individuals with low back pain (LBP), particularly during challenging postural tasks. Moreover, higher levels of negative pain-related psychological variables are associated with increased trunk muscle activity, reduced spinal movement, and worse maximal physical performance in individuals with LBP. Are pain-related psychological variables associated with postural control during static bipedal standing tasks in individuals with LBP? A systematic review and meta-analysis were conducted. Pubmed, Web of Science, and PsycINFO were searched until March 2023. Studies were included if they evaluated postural control during static bipedal standing in individuals with LBP by measuring center of pressure (CoP) variables, and reported at least one pain-related psychological variable. Correlation coefficients between pain-related psychological variables and CoP variables were extracted. Study quality was assessed with the "Quality In Prognosis Studies" tool (QUIPS). Random-effect models were used to calculate pooled correlation coefficients for different postural tasks. Sub-analyses were performed for positional or dynamic CoP variables. Certainty of evidence was assessed with an adjusted "Grading of Recommendations, Assessment, Development, and Evaluations" tool (GRADE). The protocol was registered on PROSPERO (CRD42021241739). Sixteen studies (n = 723 participants) were included. Pain-related fear (16 studies) and pain catastrophizing (three studies) were the only reported pain-related psychological variables. Both pain-related fear (−0.04 < pooled r < 0.14) and pain catastrophizing (0.28 < pooled r < 0.29) were weakly associated with CoP variables during different postural tasks. For all associations, the certainty of evidence was very low. Pain-related fear and pain catastrophizing are only weakly associated with postural control during static bipedal standing in individuals with LBP, regardless of postural task difficulty. Certainty of evidence is very low thus it is conceivable that future studies accounting for current study limitations might reveal different findings. • We reviewed studies on postural control and psychological variables in low back pain. • Correlations between postural control and psychological variables were extracted. • Meta-analyses were conducted for each postural task and psychological variable. • We found weak associations regardless of task difficulty. [ABSTRACT FROM AUTHOR]

Objective Greater preoperative depression, anxiety, and pain catastrophizing are associated with more severe long-term pain following total knee arthroplasty (TKA). In a secondary analysis of previously reported data, we tested the hypothesis that these associations are mediated by oxidative stress (OS). Design A mixed between/within-subjects longitudinal cohort design. Setting A single academic medical center. Subjects Osteoarthritis patients (n  = 91; 62.6% female) undergoing unilateral TKA. Methods We assessed depression, anxiety, and catastrophizing, as well as markers of central sensitization (widespread pain, temporal summation of pain) preoperatively. Blood samples were then obtained immediately prior to intraoperative tourniquet placement for quantification of in vivo biomarkers of systemic OS, F2-isoprostanes and isofurans. Post-TKA pain intensity (numeric rating scale worst pain [NRS], McGill Pain Questionnaire-2 [MPQ-2]) and function (PROMIS Pain Interference) were assessed at 6 months following TKA. Results Greater preoperative depression, catastrophizing, and widespread pain were associated with higher intraoperative combined OS (F2-isoprostanes+isofurans/2), which was in turn associated with higher post-TKA pain intensity and worse function (P  < .05). All preoperative phenotype predictors except anxiety were correlated positively with post-TKA pain and/or function (P  < .05). Bootstrapped mediation analyses revealed significant (P  < .05) indirect (mediated) effects of depression (NRS Worst Pain, MPQ-2, PROMIS Pain Interference), anxiety (MPQ-2, PROMIS Pain Interference), and catastrophizing (PROMIS Pain Interference) on adverse long-term post-TKA outcomes via elevated OS. Central sensitization-related predictors demonstrated only direct effects (P  < .05) on post-TKA outcomes that were independent of OS mechanisms. Conclusions Results suggest that the adverse impact of depression, anxiety, and pain catastrophizing on post-TKA pain and functional outcomes are mediated in part by elevated OS. [ABSTRACT FROM AUTHOR]

Background The human immunodeficiency virus (HIV) infection is important because it can cause stigma and psychological, family, and social problems in affected people. Objective This study aims to investigate the effect of schema therapy on adaptive and maladaptive strategies of cognitive-emotion regulation in people with HIV. Methods This is an interventional study with a pretest-posttest design. Thirty people with HIV were selected by a convenience sampling method and randomly divided into two groups of intervention and control. Garnefski et al.’s cognitive-emotion regulation questionnaire - short form (CERQ-SF) was used to collect data. The intervention group received 10 two-hour sessions of group treatment based on Young’s schema therapy model. The data analysis was performed in SPSS software, version 26 using descriptive statistics (frequency, percentage, mean, standard deviation) and analysis of covariance (ANCOVA). The significance level was set at 0.05. Results The results ANCOVA showed that group schema therapy affected the use of adaptive strategies (acceptance, positive refocusing, refocusing on planning, positive reappraisal, and putting into perspective) and maladaptive strategies (self-blame and catastrophizing), (P<0.001). However, it had no significant effect on other-blame (P=0.033) and rumination (P=0.102). Conclusion Schema therapy can increase the use of adaptive strategies and reduce the use of maladaptive strategies (self-blame and catastrophizing) of cognitive-emotion regulation in people with HIV. [ABSTRACT FROM AUTHOR]

Aim and background: The purpose of this study was to compare the effectiveness of logotherapy (LT) with Acceptance and Commitment Therapy (ACT) on pain catastrophizing and sense of mental coherence in women who have undergone breast surgery. Material and Methods: This was a semi-experimental study with a pretest-posttest controlled design, including a follow-up. The study population consisted of all women with breast cancer who underwent postmastectomy radiotherapy in Tabriz in 2023. A purposive sampling method was used to select 45 women, who were divided into three groups, with 10 participants in each group. The intervention groups received their respective treatments over 8 sessions, each lasting 1.5 hours. The control group did not receive any intervention. All participants in the three groups completed the 13-item Pain Catastrophizing Scale by Sullivan et al and the 35-item Sense of Coherence Questionnaire by Flensberg, both before and 4 months after the intervention. Data were analyzed using repeated-measures analysis of variance. Results: The results showed that LT (30.1±5.3) and ACT (29.9±5.4), compared to the control group (37.6±5.2), significantly reduced pain catastrophizing in women who underwent breast surgery in the post-test (P<0.001). These results also showed a lasting effect in the follow-up stage (P<0.001). Additionally, the results indicated that LT (55.2±3.5) and ACT (55.0±2.9), compared to the control group (48.8±3.5), significantly increased the sense of mental coherence in women who underwent breast surgery in the post-test (P<0.001). These results also showed a lasting effect in the follow-up stage (P<0.001). The results further revealed no significant difference between the two treatments in terms of their effect on pain catastrophizing and sense of mental coherence in the post-test and follow-up stages (P>0.05). Conclusion: Both logotherapy and Acceptance and Commitment Therapy are effective in reducing pain catastrophizing and increasing the sense of mental coherence in women who have undergone breast surgery. [ABSTRACT FROM AUTHOR]

Objectives: ‒ Pain catastrophizing in the aging population has not been studied in great detail. Existing investigations have reported conflicting results on the effects of age on pain catastrophizing in relation to pain responses. This study investigated the relationship between pain catastrophizing, and its individual components (rumination, magnification, and helplessness), and the responses to standardized experimental pain stimuli in old and young, healthy adults. Methods: ‒ Sixty-six volunteers (32 old: 65–87, 18 females; 34 young: 20–35, 17 females) participated in the study. Pain catastrophizing including the components of rumination, magnification, and helplessness was assessed with the pain catastrophizing scale (PCS). Experimental pain was induced by applying predefined pressure stimulations to the trapezius muscle. Pain intensity and unpleasantness were assessed using numerical rating scales. Pain catastrophizing levels and pain responses were statistically compared between the two age groups. Results: ‒ Elderly individuals reported significantly (p = 0.028) lower scores of pain catastrophizing (Med = 5; interquartile range [IQR] = 14) than younger individuals; this difference was driven by the significantly lower component of rumination (Med = 2; IQR = 4; p = 0.017) and helplessness (Med = 2; IQR = 7; p = 0.049). A larger proportion of young (57.8%) rated pain catastrophizing at high levels, with scores above the 75th percentile (Med = 20). Additionally, elderly reported the lowest pain intensity (Med = 5; p = 0.034) and pain unpleasantness (Med = 4.5; p = 0.011) responses to the experimental pressure stimuli. In the elderly group, pain unpleasantness was positively and significantly associated with pain catastrophizing (rs = 0.416, p = 0.021), rumination (rs = 0.42, p = 0.019), and helplessness (rs = 0.434, p = 0.015), respectively. No associations were found in the young group. Conclusions: ‒ Elderly reported lower PCSs than young adults. Rumination and helplessness were reduced in the elderly group. The elderly population showed positive correlations between catastrophizing levels and pain unpleasantness to standardized pressure pain stimuli. Results supported the view that elderly possess resilience over specific domains of pain catastrophizing that could counteract pain perception due to physiological decline. [ABSTRACT FROM AUTHOR]

Introduction: The present study was conducted with the aim of investigating the effectiveness of cognitive analytic therapy on anxiety sensitivity and pain catastrophizing in patients with chronic pain and alexithymia. Methods: This was a semi-experimental research with pre-test, post-test,a two months' follow-up, and a control group. The statistical population included all the patients with chronic pain in Isfahan city in 2022. Sampling was done through convenience sampling method among the volunteer patients referred to private clinics in two stages. 24 patients with chronic pain who scored above 60 in Toronto alexithymia questionnaire (1994) were selected and were randomly assigned to experimental and control groups (n = 12). The instruments included Sullivan's pain catastrophizing scale questionnaire (1995) and Taylor and Cox's anxiety sensitivity questionnaire (1998. The experimental group received cognitive analytical therapy for 16 90-minute sessions once a week, and the control group did not receive any intervention. Data were analyzed using repeated measure and ANOVA analysis. Results: The results of data analysis showed that there was a significant difference between the adjusted mean of anxiety sensitivity and pain catastrophizing in the two groups. The mean scores of anxiety sensitivity and pain catastrophizing variables increased in post-test and follow-up phase (P<0/05). Therefore, it can be concluded that cognitive analytic therapy was effective for anxiety sensitivity and catastrophizing pain in patients with chronic pain and alexithymia (P<0/05). Conclusion: Considering the effect of cognitive analytic therapy on anxiety sensitivity and pain catastrophizing, this treatment method can be used to improve patients with chronic pain and alexithymia. [ABSTRACT FROM AUTHOR]

Background & Objectives: Terror catastrophizing, defined as an ongoing fear of future terrorist attacks, is associated with a higher incidence of anxiety disorders, among other psychological impacts. However, previous studies examining terror catastrophizing’s relationship to other mental health disorders are limited. The current study sought to determine if patients diagnosed with anxiety and depression would experience increased terror catastrophizing. Additionally, this study aimed to investigate whether parental terror catastrophizing increases children’s internalizing symptoms. Design & Methods: Individuals were randomly drawn from the Danish Civil Registration System and invited to complete a series of questionnaires to measure terror catastrophizing tendency, lifetime parental trauma, and children’s internalizing symptoms. In total, n = 4,175 invitees completed the survey of which 933 reported on a child between 6 and 18 years. Responses were analyzed using a generalized linear regression model. Results: Participants diagnosed with anxiety alone or comorbid with depression were more likely to experience symptoms of terror catastrophizing than undiagnosed participants (β = 0.10, p < .001; β = 0.07, p = .012). Furthermore, the parental tendency to catastrophize terror was associated with higher internalizing symptoms in children (β = 0.09, p = .006), even after taking parental diagnoses, as well as lifetime and childhood trauma into account. Conclusion: The results can inform clinical practices to account for a patient’s potential to exhibit increased terror catastrophizing tendencies or be more affected by traumatic events. Additionally, they can offer insights for designing novel preventative interventions for the whole family, due to the relation between parental tendencies for terror catastrophizing and the internalizing symptoms observed in children. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the physical and psychosocial problems and the clinical and sociodemographic factors affecting sexual life in patients with nonspecific chronic low back pain (CLBP), thus drawing attention to sexual disability and patients’ concerns in the conservative management of the disease. A total of 140 patients were included in the study. The assessment of disease characteristics, information about sexual life and related factors were evaluated by a self-constructed questionnaire. The Oswestry Disability Index (ODI), Pain Catastrophizing Scale (PCS), International Physical Activity Questionnaire (IPAQ), Tampa Scale of Kinesiophobia (TSK) and Beck Depression Inventory (BDI) were used to assess functional disability, pain-related anxiety, physical activity level, fear of movement and depression severity, respectively. Hierarchical cluster analysis was used to discover relationships among variables. Based on the dendrogram, the intensity of CLBP, the impact of CLBP on sexual life, decrease in libido, sexual satisfaction, frequency of intercourse, painful sexual behavior and questionnaire results (BDI, TSK, ODI, PCS) were in the same cluster. Consistent with this, positive correlations were found between BDI and PCS (p < 0.001, r = 0.481), BDI and TSK (p < 0.001, r = 0.319), and BDI and ODI (p < 0.001, r = 0.408). The other main clusters included demographic and clinical characteristics, ODI and IPAQ scores. The sexual lives of patients with CLBP are affected physically and psychosocially. In clinical practice, it is important to counsel sexual disability patients because of their concerns and hesitations. [ABSTRACT FROM AUTHOR]

Objective Chronic postsurgical pain (CPSP) is a significant adverse effect shown in around 20% of people who had undergone a knee arthroplasty (KA). Psychological risk factors have emerged as significant and potentially modifiable risk factors for its development. However, there is still little evidence when assessing these factors during the acute postoperative period. This study aimed to assess the predictive value of postoperative pain catastrophizing, pain-related fear of movement, anxiety, depression, and pain attitudes in developing CPSP after KA. Methods A 6-month follow-up prospective observational study design was used. The study sample comprised 115 people who underwent a KA due to painful primary osteoarthritis. Measures of pain catastrophizing, pain-related fear of movement, anxiety, depression, and pain attitudes were obtained 1 week after surgery. CPSP was set at an intensity of ≥30 using a 100-mm visual analog scale at 3 and 6 months after surgery. Results Analysis revealed that baseline pain intensity, pain catastrophizing, pain-related fear of movement, anxiety, depression, and maladaptive pain attitudes were significant predictors of chronic pain at 3 and 6 months after surgery in a univariate analysis. However, at 3 months after surgery, only pain intensity and pain catastrophizing were predictors in the final multivariate model forecasting disturbing pain. Moreover, 6 months after surgery, pain intensity and distrust in medical procedures remained independent predictors. Most of the psychological factors can be grouped into a single dimension defined as pain-related psychological distress. Conclusion The results suggest that postoperative pain intensity, pain catastrophizing, and pain attitudes are independent predictors for CPSP after KA. Impact Postoperative cognitive and emotional factors should be considered alongside pain intensity during postoperative rehabilitation after KA because they could influence the development of CPSP. [ABSTRACT FROM AUTHOR]

Introduction: Spondyloarthritis (SpA) is a common rheumatic inflammatory disease and can impact patients' work productivity. We aimed to evaluate the impact of pain catastrophizing and central sensitization on work outcomes in young SpA patients and determine the predictive factors of work productivity loss. Material and methods: We performed a cross-sectional study over 6 months. We included patients aged between 18 and 50 years old, diagnosed with axial or peripheral SpA. Pain catastrophizing and central sensitization were assessed using the Pain Catastrophizing Scale (PCS) and Central Sensitization Inventory (CSI) questionnaire, respectively. Impact of SpA on work productivity and activity impairment during and outside of work was measured with the Work Productivity and Activity Impairment Questionnaire (WPAI: Spondyloarthritis). Results: A total of 72 patients were enrolled, with a median age of 39 years (28.3-46), 65.3% men, and 54.4% working patients. Median scores of activity impairment outside of work, and work productivity loss were 50% (40-70), and 50% (40-60), respectively. Median absenteeism and presenteeism scores were 0% (IQR 0-7), and 100% (IQR 86.5-100), respectively. Regarding work-related outcomes: activity impairment was positively correlated with CSI and PCS; presenteeism was significantly associated with male sex (p = 0.009); and work productivity loss was positively associated with anxiety, depression, and poor quality of life. Multivariate regression analysis identified predictive factors of work productivity loss: male sex, poor quality of life, and prolonged morning stiffness. Conclusions: Assessment of the impact of pain catastrophizing and central sensitization on work-related outcomes in patients with SpA is important to understand the burden of illness and to identify early those in need of interventions in clinical practice. [ABSTRACT FROM AUTHOR]

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This paper examines the conceptualizations of endometriosis-related pain by combining Conceptual Metaphor Theory (CMT) with a corpus-based approach. Endometriosis is a complex and multi-faceted condition, affecting one in ten people assigned female at birth and bearing serious consequences on one's physical, social and psychological wellbeing. Especially in cases when the pain is invisible, communication resorts to violent metaphors implying harm, physical damage, or fight. These metaphors are thought to increase the likelihood of eliciting an empathetic response in the interlocutor. However, such narratives may be detrimental at the individual level (e.g., increasing pain catastrophizing) and at the community level (e.g., overshadowing the capacity of communities to construct and use metaphors in alternative ways). Therefore, this study presents an initial exploratory analysis of metaphorical source domains in descriptions of endometriosis-related pain written in online, freely accessible blogs. Metaphorical expressions were manually annotated in a sample of KWICs basing on the MIPVU procedure and thematically categorized. The adoption of a bottom-up and top-down approach within a qualitative framework allowed an empirically grounded analysis of candidate source domains, which calls for further quantitative testing. [ABSTRACT FROM AUTHOR]

Background and Objective: Fibromyalgia-related pain is influenced by numerous factors, including severity, as well as cognitive profiles based on pain catastrophizing or activity patterns. In this context, self-efficacy is identified as a potential predictor for explaining certain health outcomes. This study aimed to contribute to exploring the role of pain avoidance (as activity pattern) between pain severity and self-efficacy along pain catastrophizing. Methods: Through a cross-sectional study, a total of 264 women with fibromyalgia completed self-report measures of pain severity, pain avoidance, pain catastrophizing, and self-efficacy. The severity of the symptoms, the time elapsed since diagnosis, and the time elapsed since the onsets of symptoms were included as covariates to control. Regression-based moderated-mediation analysis was used to test the conditional effect of pain severity on self-efficacy via pain avoidance at varying levels of pain catastrophizing. Results: Pain avoidance mediated the effect of pain severity on self-efficacy. The indirect effects showed a moderated effect when patients scored high on the pain catastrophizing scale. The model evaluated, where catastrophic pain moderates the indirect effect of pain intensity on self-efficacy through pain avoidance, explained 49% of the variance. Conclusions: Catastrophic beliefs associated with pain as being uncontrollable increase the relationship between pain severity and pain avoidance. In turn, pain avoidance is associated with a low perception of capacity. [ABSTRACT FROM AUTHOR]

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]

There is limited understanding of attrition (premature treatment withdrawal and non-completion) from pediatric chronic pain services. This narrative review aimed to summarize attrition prevalence from face-to-face pediatric outpatient chronic pain interventions, identify associated factors and develop a theoretical model to account for attrition in this setting. A comprehensive search of the published literature revealed massive variability (0–100%) in the reported attrition rates from pediatric chronic pain interventions that varied in type and format (individual vs. group, single discipline vs. interdisciplinary, psychological only vs. multiple combined interventions, of different durations). The factors associated with attrition from pediatric chronic pain programs varied between the studies: some have assessed patient sex, psychological and other comorbidities, avoidance strategies, missed schooling, family composition/tensions, caregiver catastrophizing, scheduling, caregiver leave and clinic access. A theoretical model is presented depicting youth, caregiver and service factors that may impact attrition from pediatric chronic pain interventions. Where available, literature is drawn from the pediatric chronic pain context, but also from adult chronic pain and pediatric weight management fields. The implications for research and clinical practice are discussed, including improved reporting, patient screening and targeted supports to promote intervention completion. This review contributes to a better understanding of attrition, which is crucial for optimizing pediatric chronic pain service outcomes. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to determine the effects of core stabilization exercises with Huber® Motion Lab on pain, depression, and activity levels in patients with non-specific low back pain (LBP). Materials and methods: In this study, 30 patients with non-specific LBP were allocated either to an experimental or to a control group. Both groups received a conventional physiotherapy program for 15 sessions. In addition, the control group performed 30 minutes of core stabilization exercises on the floor, whereas the experimental group used the Huber® Motion Lab device. The main outcome measures were pain severity (Visual Analogue Scale VAS), depression (Beck Depression Inventory BDI), and disability level (Oswestry Disability Index ODI) that were performed on the first and the last day of the program. Results: At the end of the program, all outcome measures improved significantly in both groups (p < 0.001). Between-group comparison of mean change score revealed significantly greater improvements regarding VAS (7.40vs4.23), BDI (29.52vs13.81), and ODI score (51.78vs25.29) for the experimental group compared to the control group (p < 0.001). Conclusions: For patients in this study with non-specific LBP, both with and without Huber® Motion Lab, core stabilization exercises in addition to a physiotherapy program were beneficial in terms of pain severity, depression, and disability level in favor of Huber® Motion Lab. [ABSTRACT FROM AUTHOR]

Purpose: To translate and cross-culturally adapt the English version of the Central Sensitisation Inventory (CSI) into Thai (CSI-Thai) and to evaluate its psychometric properties in individuals with chronic non-specific neck pain. Materials and methods: Cross-cultural translation and adaptation of the CSI were performed according to standard guidelines. A total of 340 participants were invited to complete the CSI-Thai, Visual Analogue Scale (pain intensity), Neck Disability Index, Fear-Avoidance Beliefs Questionnaire, Pain Catastrophising Scale (PCS), and Short Form-36. Psychometric evaluation included confirmatory factor analysis, internal consistency, test-retest reliability, agreement, and construct validity. Results: Dimensionality analyses indicated that a bifactor model, comprising one general factor plus four orthogonal factors, fit the CSI structure better than unidimensional and the four-factor models. The general factor showed substantial reliability (Cronbach α=0.91, Omega ω=0.94, and omega hierarchical x-h=0.91). The intraclass correlation coefficient was 0.90, representing excellent stability over a 48 h interval. Moderate-to-strong correlations and acceptable-to-excellent discriminations were found between the CSI-Thai and all questionnaires. The exception was the PCS (no correlation and discrimination). The standard error of measurement and minimal detectable change of the CSI-Thai were 2.33 and 6.47, respectively. Conclusions: The translation and cross-cultural adaptation of the CSI-Thai were successful, with satisfactory reliability and construct validity. [ABSTRACT FROM AUTHOR]

The aim of the present paper was to assess neuropathic pain and its predictors among patients with sciatica. In addition, we sought to investigate the predictors of functional disability in sciatica patients with neuropathic pain. A cross-sectional study was carried out on a sample of 100 sciatica patients aged 18 years and older with a radiating pain from the lower back down to the leg below the knee. Information about socio-demographic characteristics, duration of symptoms, being treated or not, type of treatment, side of sciatica, presence of back pain, leg pain occurrence, leg pain intensity, functional disability and pain catastrophizing were collected. Of the total patients, 57% had neuropathic pain. Multivariable analysis showed that leg pain intensity was higher in the neuropathic pain group as compared to the non-neuropathic pain group. Also, patients with left sciatica were less likely to have neuropathic pain than patients with right sciatica. Patients with neuropathic pain having high levels of pain catastrophizing and being on bed rest for at least one week were at a higher risk of developing functional disability as compared to their counterparts. Low levels of pain catastrophizing and less bed rest should be considered in interventions aimed at improving the functional ability for sciatica patients with neuropathic pain. [ABSTRACT FROM AUTHOR]

Up to 20% of total knee arthroplasty (TKA) patients continue to experience chronic postsurgical pain. Various factors have been identified as potential contributors, including so-called "yellow flags", encompassing symptoms of depression, anxiety, and catastrophizing, which were examined in this study to assess their predictive value concerning functional outcomes after TKA. Methods: Fifty TKA patients were categorized into high-risk and low-risk groups based on clinical assessment, demographic data, medication, and patient-reported outcome measures (DN4, SF-36, WOMAC, NRS, Fibromyalgia Survey Questionnaire, Pain Catastrophizing Scale, and Hospital Anxiety and Depression Scale). Postoperative outcomes within six months after TKA were then compared. Results: Both groups exhibited significant (p < 0.001) improvements in all WOMAC and NRS subscales, as well as in the physical function, role physical, pain, and energy/fatigue subdomains of the SF-36 after six months, while the high-risk group showed lower WOMAC scores regarding stiffness (19.0 ± 18.3 vs. 27.2 ± 20.7, p < 0.001) and pain (13.5 ± 13.3 vs. 15.1 ± 16.3, p = 0.029). The high-risk group showed significantly worse preoperative DN4 scores (1.8 ± 1.3 vs. 3.0 ± 1.1, p = 0.002) than the low-risk group, which persisted for one day (2.3 ± 1.2 vs. 3.5 ± 1.5, p = 0.005) and six weeks (2.2 ± 1.9 vs. 3.6 ± 2.3, p = 0.041) postoperatively. Conclusions: Our results indicate that pre-existing yellow flags contribute to a more challenging early postoperative phase, underscoring the importance of considering individual patient characteristics and psychological factors to optimize TKA outcomes. [ABSTRACT FROM AUTHOR]

Colorectal neoplasms are one of the deadliest diseases among all cancers worldwide. Thymoquinone (TQ) is a natural compound of Nigella sativa that has been used in traditional medicine against a variety of acute/chronic diseases such as asthma, bronchitis, rheumatism, headache, back pain, anorexia, amenorrhea, paralysis, inflammation, mental disability, eczema, obesity, infections, depression, dysentery, hypertension, gastrointestinal, cardiovascular, hepatic, and renal disorders. This review aims to present a detailed report on the studies conducted on the anti-cancer properties of TQ against colorectal cancer, both in vitro and in vivo. TQ stands as a promising natural therapeutic agent that can enhance the efficacy of existing cancer treatments while minimizing the associated adverse effects. The combination of TQ with other anti-neoplastic agents promoted the efficacy of existing cancer treatments. Further research is needed to acquire a more comprehensive understanding of its exact molecular targets and pathways and maximize its clinical usefulness. These investigations may potentially aid in the development of novel techniques to combat drug resistance and surmount the obstacles presented by chemotherapy and radiotherapy. [ABSTRACT FROM AUTHOR]

Background: There is a need to evaluate different options for estimating individual change in health-related quality of life for patients with low back pain. Methods: Secondary analysis of data collected at baseline and 6 weeks later in a randomized trial of 749 adults with low back pain receiving usual medical care (UMC) or UMC plus chiropractic care at a small hospital at a military training site or two large military medical centers. The mean age was 31; 76% were male and 67% were White. The study participants completed the Patient-Reported Outcomes Measurement Information System (PROMIS®)-29 v 1.0 physical function, pain interference, pain intensity, fatigue, sleep disturbance, depression, anxiety, satisfaction with participation in social roles, physical summary, and mental health summary scores (T-scored with mean = 50 and standard deviation (SD) = 10 in the U.S. general population). Results: Reliability estimates at the baseline ranged from 0.700 to 0.969. Six-week test–retest intraclass correlation estimates were substantially lower than these estimates: the median test–retest intraclass correlation for the two-way mixed-effects model was 0. 532. Restricting the test–retest reliability estimates to the subset who reported they were about the same as at baseline on a retrospective rating of change item increased the median test–retest reliability to 0.686. The amount of individual change that was statistically significant varied by how reliability was estimated, and which SD was used. The smallest change needed was found when internal consistency reliability and the SD at baseline were used. When these values were used, the amount of change needed to be statistically significant (p <.05) at the individual level ranged from 3.33 (mental health summary scale) to 12.30 (pain intensity item) T-score points. Conclusions: We recommend that in research studies estimates of the magnitude of individual change needed for statistical significance be provided for multiple reliability and standard deviation estimates. Whenever possible, patients should be classified based on whether they 1) improved significantly and perceived they got better, 2) improved significantly but did not perceive they were better, 3) did not improve significantly but felt they got better, or 4) did not improve significantly or report getting better. [ABSTRACT FROM AUTHOR]

Background: Individuals with spinal cord injury (SCI) report high levels of neuropathic pain. Current treatment options are primarily pharmaceutical, despite their limited effectiveness. Exercise may reduce neuropathic pain among persons with SCI; however, the optimal dose of exercise required to elicit analgesic effects remains unknown. The purpose of this study was to compare neuropathic pain intensity, pain catastrophizing, use of coping strategies, and positive affect and well-being among Paralympic versus recreational athletes with SCI who experience chronic neuropathic pain. Forty-seven athletes with SCI (25 Paralympic, 27 recreational) completed the International SCI Pain Basic Data Set, Douleur Neuropathique-4, coping strategies questionnaire, pain catastrophizing scale, and SCI-quality of life assessment. Results: Paralympic athletes reported significantly greater neuropathic pain (p = 0.032) and positive affect and well-being (p = 0.047) than recreational athletes. No other comparisons were significant (ps > 0.09). Significant, medium-sized positive correlations were observed between neuropathic pain and total minutes of moderate-intensity exercise (r = 0.335, p = 0.023) and average minutes per day of moderate-intensity exercise (r = 0.375, p = 0.010) over the past week. Conclusions: The results suggest that frequent moderate- to high-intensity exercise may exacerbate neuropathic pain sensations for persons with SCI. Research should investigate psychosocial and physiological mechanisms by which exercise may influence neuropathic pain to explain how Paralympic athletes with SCI are able to continue exercising while maintaining positive affect despite neuropathic pain. Key Points: Paralympic athletes with SCI report significantly greater neuropathic pain intensity than recreational athletes with SCI, but also higher levels of positive affect and well-being. Neither pain catastrophizing, pain coping, nor positive affect and well-being significantly moderated the relationship between athlete status (i.e., Paralympic or recreational athlete) and neuropathic pain intensity. Significant, positive correlations were observed between total weekly moderate-intensity exercise and neuropathic pain. No significant correlations were observed between frequency of heavy-intensity exercise and neuropathic pain. [ABSTRACT FROM AUTHOR]

To reduce the patient burden associated with completing the 13-item Pain Catastrophizing Scale (PCS), the 4-item "BriefPCS" was developed. To date, no crosswalk has been developed that associates scores on the BriefPCS with PCS scores. Further, no study has compared the use of BriefPCS and PCS scores in a randomized clinical trial (RCT). We aimed to: (1) establish the interpretability of BriefPCS scores in reference to PCS scores, (2) compare the concurrent validity between the BriefPCS and PCS, and (3) asssess the use of BriefPCS in an RCT. First, we conducted equipercentile linking, created a crosswalk that associated scores of BriefPCS with PCS, and calculated differences between PCS and crosswalked PCS scores. Secondly, we compared Bootstrap correlation coefficients between PCS and self-reported measures of other domains. Lastly, we compared results from an RCT using BriefPCS scores versus PCS scores. Findings indicated that the correlation coefficient estimates with the BriefPCS and PCS scores were not significantly different. BriefPCS and PCS scores had similar ability to detect treatment-related changes. The BriefPCS scores validly, reliably, and accurately distinguish levels of pain catastrophizing. Additionally, the BriefPCS scores are sensitive to changes after behavioral interventions, with less respondent burden compared to the PCS scores. [ABSTRACT FROM AUTHOR]

An improved understanding of the biopsychosocial influences that contribute to and maintain pain has promoted the development of new efficacious treatments for chronic low back pain (CLBP). This study aimed to investigate the mechanisms of a new treatment—education and graded sensorimotor retraining—on pain and disability. We conducted a preplanned causal mediation analysis of a randomized clinical trial which allocated 276 participants with CLBP to 12 weekly clinical sessions of education and graded sensorimotor retraining (n = 138) or a sham and attention control (n = 138). Outcomes were pain intensity and disability, both assessed at 18 weeks. Hypothesized mediators included tactile acuity, motor coordination, back self-perception, beliefs about the consequences of back pain, kinesiophobia, pain self-efficacy, and pain catastrophizing, all assessed at the end of treatment (12 weeks). Four of 7 mechanisms (57%) mediated the intervention effect on pain; the largest mediated effects were for beliefs about back pain consequences (−0.96 [−1.47 to −0.64]), pain catastrophizing (−0.49 [−0.61 to −0.24]), and pain self-efficacy (−0.37 [−0.66 to −0.22]). Five of 7 mechanisms (71%) mediated the intervention effect on disability; the largest mediated effects were for beliefs about back pain consequences (−1.66 [−2.62 to −0.87]), pain catastrophizing (−1.06 [−1.79 to −0.53]), and pain self-efficacy (−0.84 [−1.89 to −0.45]). When all 7 mechanisms were considered simultaneously, the joint mediation effect explained most of the intervention effect for both pain and disability. Optimizing interventions to target beliefs about the consequences of back pain, pain catastrophizing, and pain self-efficacy is likely to lead to improved outcomes for people with CLBP. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate Predictors of Death Anxiety among cancer patients. The study was conducted among cancer patients, especially among stomach, throat and uterus cancer sites. Cancer is the leading cause of death worldwide; in which body cells grow uncontrollably. The study consisted of a total of 80 patients (37.5% males and 62.5% females) aged above 50 to 84 years old (Middle-Aged Adults 63.75%. And Old-Aged Adults 36.25%). Samples were taken only from the radiology department from Pathanamthitta district. The data shows that stomach (31.25%), vocal (37.5%) and uterus (31.25%) were suffering. The required data were collected by using Chronic Pain Intrusion and Accommodation Scale (CPIAS), Pain Catastrophizing Scale (PCS), Fear of Progression Questionnaire Short Form (FoP-Q-SF) and Templer Anxiety Scale (TDAS). The data were analyzed with Independent t-test, Pearson Correlation and Linear Regression. Results concluded that: Death Anxiety was found to be low among the old-aged adult category (above 60 years old). It shows a significant positive correlation was also found among the variables, and has significant variables that can predict the dependent variable. [ABSTRACT FROM AUTHOR]

Background: Psychosocial factors such as pain catastrophising (PC), kinesiophobia, and pain self-efficacy (PSE) complicate disease burden among people with chronic pain and disability. Purpose: To investigate the psychosocial correlates of neck pain intensity and disability among Nigerians with non-specific neck pain (NSNP). Methods: We conducted a cross-sectional study of Nigerians with NSNP through hospitals-based consecutive sampling. Numeric Pain Rating Scale and the Neck Disability Index questionnaire were used to assess participants' pain intensity (PI) and neck disability (ND), respectively. Kinesiophobia, PC, and PSE were assessed using Tampa Scale for Kinesiophobia (TSK), Pain Catastrophising Scale, and Pain Self-efficacy Questionnaire, respectively. Data analyses were completed using descriptive statistics, independent samples t-test, Pearson's correlation coefficient, and multiple linear regression at p0.05. Results: Participants were (24 males, 48 females) aged 51.56 ± 14.31 years. The average PI (5.28 ± 1.80) and ND (35.03 ± 17.85) were moderate. There were significant correlations between PC and PI (r=0.350, p=0.003), and ND (r=0.339, p=0.004); kinesiophobia and ND (r=0.314, p=0.007); and PSE and ND (r 0.561, p<0.001). Multiple linear regression analysis showed that PC (b=0.270, p=0.026) and ND (b=0.494, p=0.001) significantly predicts PI, while age (b=0.197, p=0.038), PI (b=0.344, p=0.001), and PSE (b=0.474, p<0.001) predicts ND. There were no statistically significant gender differences in PC, kinesiophobia and PSE. Conclusion: Non-specific neck pain and ND correlates with psychosocial factors such as PC and PSE, respectively. There were no gendered differences in psychosocial responses to NSNP, however, older individuals tend to have more severe ND. Assessment of age and psychosocial factors should be included in management of NSNP. [ABSTRACT FROM AUTHOR]

Chronic low back pain (CLBP) substantially impacts quality of life through a multifarious interplay of physical and psychological elements. A comprehensive understanding of this relationship is imperative for developing effective treatment strategies. This study recruited 64 participants (35 males and 29 females) experiencing chronic low back pain to explore the associations between psychological factors, muscle endurance, and functional impairments. The study was conducted over six months in an outpatient department and a rehabilitation unit. The study utilized established outcome measures, such as the Biering-Sorensen Test and the Roland Morris Disability Questionnaire, and psychological variants as the core dependent variables, including the Beck Depression Inventory (BDI), STAI questionnaire, the FABQ-PA, and the Pain Catastrophizing Scale (PCS). The findings uncovered pronounced gender disparities, with females exhibiting elevated levels of depression (BDI: 27.68 ± 9.43, p < 0.001) and anxiety (STAI: 42.34 ± 8.94, p < 0.001) and diminished muscle endurance (130.47 ± 30.56 sec, p = 0.001). These revelations are congruent with the prevailing literature, emphasizing the need for gender-sensitive and personalized interventions. Bivariate correlations presented robust associations between psychological distress and decreased muscle endurance (r values ranging from −0.82 to −0.88, p < 0.001) alongside elevated functional impairments (r values from 0.89 to 0.94, p < 0.001) for both genders. Additionally, linear regression analyses illuminated the consequential impact of specific psychological variables such as the BDI, FABQ-PA, and PCS on muscle endurance and functional impairments (all p < 0.001). This study reveals gender-specific variations in chronic back pain, highlighting the influence of psychological factors on pain perception. It underscores the necessity for gender-sensitive treatment strategies. Future research is needed to explore these differences further and assess treatment efficacy to improve care and quality of life for chronic low back pain sufferers through personalized treatment plans. [ABSTRACT FROM AUTHOR]

Purpose: To define the prevalence of Central Sensitization (CS) in patients with Anterior Knee Pain (AKP) and determine whether there is an association between CS and the magnitude of pain, disability, quality-of-life and psychological impairment. Methods: The data of a total of 44 AKP female patients with a mean age of 27.7 years (15–50) recruited consecutively from hospital outpatient knee clinics were prospectively included in this study. The patients had no antecedents of knee trauma or surgery and no history of injury or disease of the nervous system. There were also 50 healthy female controls with a mean age of 26.1 years (16–46). CS was evaluated using the Central Sensitization Inventory (CSI). Quality-of-life was evaluated using the EuroQoL-5D questionnaire. Self-reporting of clinical pain intensity was obtained using the Visual Analogue Scale. The Kujala Knee Scale and IKDC form were used to evaluate disability. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Subscale (HAD). Kinesiophobia was measured with the Tampa Scale for Kinesiophobia (TSK-11) and catastrophizing by means of the Pain Catastrophizing Scale (PCS). Results: Sixteen AKP patients (36%), and 2 (4%) of the healthy controls presented with central sensitization (p < 0.01). AKP patients with CS have a greater degree of disability based on the Kujala Scale and higher levels of anxiety and depression than AKP patients without CS. The score of AKP patients in the CSI correlated weakly with disability and quality of life and moderately with anxiety and depression. However, no association was seen between CSI score and pain intensity, nor with catastrophizing and kinesiophobia. A multivariate logistic regression analysis showed that only depression was statistically significant in the prediction of the presence of CS (odds ratio 1.45; 95% CI 1.07 to 1.96). Conclusions: AKP patients have a significantly higher prevalence of CS in comparison with what has been reported for the general population. This finding suggests the presence of altered pain modulation in a subgroup of AKP patients. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study is to explore the neural correlates of pain sensitization in patients with chronic low back pain (cLBP). While the association between cLBP and pain sensitization has been widely reported, the underlying brain mechanism responsible for this relationship requires further investigation. Methods: Our study included 56 cLBP patients and 56 healthy controls (HC). Functional magnetic resonance imaging data were obtained, and the voxel-wise amplitude of low-frequency fluctuation (ALFF) was calculated to identify brain alterations in cLBP patients compared to HC groups. Pearson correlation coefficients were computed to explore the association between clinical data and brain alterations. Furthermore, mediation analyses were performed to investigate the path association between brain alterations and pain-related behaviors. Results: Our findings revealed that patients with cLBP exhibited higher sensitivity, attention, and catastrophizing tendencies towards pain compared to HC. Furthermore, cLBP patients displayed significantly higher ALFF in various brain regions within the "pain matrix" and the default mode network when compared to HC. The altered precuneus ALFF was positively correlated with pain intensity (R = 0.51, P<0.001) and was negatively correlated with pain sensitivity (R = −0.43, P<0.001) in cLBP patients. Importantly, the effect of altered precuneus ALFF on pain intensity was mediated by pain threshold in these patients. Conclusion: Our study suggests that altered neural activity in the precuneus may contribute to pain hypersensitivity, which further exacerbating pain in cLBP patients. [ABSTRACT FROM AUTHOR]

Rationale: Although interest in the neurobiology of facial communication of pain has increased over the last decades, little is known about which neurotransmitter systems might be involved in regulating facial expressions of pain. Objectives: We aim to investigate whether the serotonergic system (5-HT), which has been implicated in various aspects of pain processing as well as in behavioral response inhibition, might play a role in facial expressions of pain. Using acute tryptophan depletion (ATD) to manipulate 5-HT function, we examined its effects on facial and subjective pain responses. Methods: In a double-blind, placebo-controlled within-subject design, 27 participants received either an ATD or a control drink in two separate sessions. Approximately 5-h post-oral consumption, we assessed pain thresholds (heat, pressure) as well as facial and subjective responses to phasic heat pain. Moreover, situational pain catastrophizing and mood were assessed as affective state indicators. Results: ATD neither influenced pain thresholds nor self-report ratings, nor catastrophizing or mood. Only facial responses were significantly affected by ATD. ATD led to a decrease in pain-indicative as well as in pain-non-indicative facial responses to painful heat, compared to the control condition. Conclusions: Decrease in brain 5-HT synthesis via ATD significantly reduced facial responses to phasic heat pain; possibly due to (i) diminished disposition to display social behavior or due to (ii) decreased facilitation of excitatory inputs to the facial motor neuron. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to establish the psychometric properties of the 9-Item Vestibular Activities Avoidance Instrument (VAAI-9), a patient-reported outcome measure developed to identify fear avoidance beliefs in persons with vestibular disorders. Methods This prospective cohort study included 100 participants 18 years and older seeking care at a balance disorders clinic for dizziness. Participants completed the VAAI-9, the Dizziness Handicap Inventory (DHI), and other patient-reported outcomes at the initial visit and the 3-month follow-up. To measure test–retest reliability, the VAAI-9 was completed again 5 days after the initial visit and was analyzed using a 2-way mixed ICC for absolute agreement. Internal consistency was determined using the Cronbach alpha. The Spearman correlation coefficient was used to assess convergent validity of the VAAI-9 with other outcomes. Receiver operating characteristic curves were used to identify baseline VAAI-9 cutoff scores for those who reported mild (DHI ≤ 30) or moderate or severe (DHI > 30) perceived disability at the 3-month follow-up. Results The mean age of the study cohort was 49 (SD = 16) years; 73 (73%) were women. Seventy-one participants completed the 5-day follow-up, and 68 completed the 3-month follow-up. The VAAI-9 demonstrated excellent internal consistency (α = 0.91) and test–retest reliability (ICC = 0.90). Baseline VAAI-9 scores had moderate to strong associations with other outcome measures at baseline and 3 months. A baseline VAAI-9 score of 26 or higher had a sensitivity of 80.6% and a specificity of 78.4% for identifying a DHI score of >30 at 3 months (area under the curve = 0.86). Conclusions The results provide evidence of excellent reliability and validity for the 9-item VAAI in persons with vestibular disorders. A baseline VAAI-9 score of ≥26 identified individuals at risk of persistent moderate to severe disability due to dizziness. Impact Initial levels of fear avoidance beliefs measured using the VAAI-9 provided important prognostic information about outcomes for persons with vestibular symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Mindfulness-based stress reduction (MBSR) has demonstrated its effectiveness in reducing pain-related stress in adults with chronic pain. However, the implementation of MBSR needs modifications across cultures. This pilot study reports the findings of a randomized controlled trial that investigated the effects of a culturally adaptive MBSR program on self-report and neuroimaging outcomes for chronic pain adults in China. Methods: Sixty-seven participants were randomly assigned to the treatment group (n = 40) or the treatment-as-usual group (n = 27) group at a ratio of 1.5:1. Participants completed self-report measures of pain severity, pain interference, depression, perceived stress, pain catastrophizing, mindfulness, and resilience at baseline assessment (T1), post-treatment (T2), and 3-month follow-up (T3) assessments. Functional magnetic resonance imaging (fMRI) scanning was also performed at T1 and T3 assessments. Results: For the intention-to-treat sample, the results of the mixed-effect model indicated that Group × Time interaction was significant for pain catastrophizing only (F (2, 130) = 3.51, p = 0.033). Compared with the control group, those in the MBSR group reported greater reductions in pain catastrophizing at T2 (d = − 0.60), though this effect was not maintained at T3 (d = − 0.05). Additionally, the results of completer analyses found significant Group × Time interactions for pain interference (F (2, 88) = 4.40, p = 0.015) and perceived stress (F (2, 88) = 3.13, p = 0.048), but not for other measures. Finally, both groups exhibited decreased regional homogeneity (ReHo) in the frontal lobe, while increased ReHo in the cerebellum anterior lobe was unique to the MBSR group. Conclusions: The present findings suggest that the minor modified MBSR program improves certain pain-related outcomes for Chinese adults with chronic pain. Future studies with larger samples of Chinese chronic pain patients are needed to detect the small-to-moderate benefit of MBSR on fMRI and/or other objective methods. [ABSTRACT FROM AUTHOR]

Background: Patients recovering from lower extremity injuries often interpret discomfort associated with increased use of the uninjured leg as a potential indication of harm. If expressed concerns regarding contralateral leg pain are associated with unhelpful thinking regarding symptoms, they can signal orthopaedic surgeons to gently reorient these thoughts to help improve comfort and capability during recovery. Questions/purposes: We asked: (1) Among people recovering from isolated traumatic lower extremity injury, is pain intensity in the uninjured leg associated with unhelpful thoughts and feelings of distress regarding symptoms, accounting for other factors? (2) Are pain intensity in the injured leg, magnitude of capability, and accommodation of pain associated with unhelpful thoughts and feelings of distress regarding symptoms. Methods: Between February 2020 and February 2022, we enrolled 139 patients presenting for an initial evaluation or return visit for any traumatic lower extremity injury at the offices of one of three musculoskeletal specialists. Patients had the option to decline filling out our surveys, but because of the cross-sectional design, required fields on the electronic survey tools, and monitored completion, there were few declines and few incomplete surveys. The median age of participants was 41 years (IQR 32 to 58), and 48% (67 of 139) were women. Fifty percent (70 of 139) injured their right leg. Sixty-five percent (91 of 139) had operative treatment of their fracture. Patients completed measures of pain intensity in the uninjured leg, pain intensity in the injured leg, lower extremity-specific magnitude of capability, symptoms of depression, symptoms of health anxiety, catastrophic thinking, and accommodation of pain. Multivariable analysis sought factors independently associated with pain intensity in the uninjured leg, pain intensity in the injured leg, magnitude of capability, and pain accommodation, controlling for other demographic and injury-related factors. Results: Greater pain intensity in the uninjured leg (regression coefficient [RC] 0.09 [95% CI 0.02 to 0.16]; p < 0.01) was moderately associated with more unhelpful thinking regarding symptoms. This indicates that for every one-unit increase in unhelpful thinking regarding symptoms on the 17-point scale we used to measure pain catastrophizing, pain intensity in the uninjured leg increases by 0.94 points on the 11-point scale that we used to measure pain intensity, holding all other independent variables constant. Greater pain intensity in the injured leg (RC 0.18 [95% CI 0.08 to 0.27]; p < 0.01) was modestly associated with more unhelpful thinking regarding symptoms. Greater pain accommodation (RC -0.25 [95% CI -0.38 to -0.12]; p < 0.01) was modestly associated with less unhelpful thinking regarding symptoms. Greater magnitude of capability was not independently associated with less unhelpful thinking regarding symptoms. Conclusion: A patient's report of concerns regarding pain in the uninjured limb (such as, "I'm overcompensating for the pain in my other leg") can be considered an indicator of unhelpful thinking regarding symptoms. Orthopaedic surgeons can use such reports to recognize unhelpful thinking and begin guiding patients toward healthier thoughts and behaviors. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to investigate the effects of lumbar stabilization exercise (LSE) and graded activity exercise (GAE) on concentrations of interleukin (IL) 1A (IL1A), IL18 receptor 1 (IL18R1), IL18 receptor accessory protein (IL18RAP), IL-6, cyclooxygenase-2 (COX2), and clinical outcomes of pain intensity, disability, catastrophizing, diverting-attention, cognitivecoping and pain-reinterpretation in patients with non-specific chronic low back pain (NSCLBP). Methods: This study was a single-blind parallel trial with an adaptive trial design. Fiftyfour patients with NSCLBP were randomly assigned to LSE and GAE treatment groups. Demographic and anthropometric characteristics were measured. Treatments were administered twice a week for 10 weeks. The concentrations of IL1A, IL18R1, IL18RAP, IL-6, and COX2 of patients were assessed at four time points with enzyme-linked immunosorbent assay. Pain, disability, catastrophizing, diverting attention, cognitive coping, and pain reinterpretation were assessed at three time points with valid instruments. The responsiveness of the biochemical mediators to LSE and GAE was determined with a Bayesian one-way analysis of variance (ANOVA). Data were analyzed with descriptive and inferential statistics at P<0.05. Results: The concentrations of IL1A, IL18R1, IL18RAP, and COX2 were unresponsive (Bayes factor [BF]<1) to LSE and GAE, while IL-6 concentrations were responsive (Bayes factor [BF]>1). The concentrations of IL-6 increased significantly (P<0.05) after LSE with a significant reduction (P<0.05) in pain, disability, and catastrophizing, while the concentration of IL-6 increased significantly (P<0.05) after GAE with a significant reduction (P<0.05) in pain, and disability. Effects of LSE and GAE on IL-6 concentrations, pain, and disability were comparable (P>0.05). Catastrophizing of patients with LSE was significantly less (P<0.05) compared to GAE. Discussion: LSE increases IL-6 concentrations in NSCLBP patients while reducing pain, disability, and catastrophizing, while GAE increases IL-6 concentrations and reduces pain and disability. IL-6 concentrations, pain, and disability of patients were similar after LSE and GAE. Patients catastrophize less with LSE compared to GAE, hence LSE shows more beneficial effects for patients with NSCLBP than GAE. [ABSTRACT FROM AUTHOR]

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Objective: This study aimed to explore the factors related to pain catastrophizing (PC) in hospitalized patients with trauma within 72 hours of injury. Materials and Methods: The study was a cross-sectional correlation study. The sample was 109 patients who were admitted to ICU Trauma or General Trauma Unit within 72 hours after injury and were aged 18 years and over. They were diagnosed with at least one or multiple organs of injury with a Glasgow Coma Scale (GCS) between 13 and 15. Pearson's product-moment correlation coefficient, spearman rank correlation, point-biserial correlation, and linear multiple regression were used to analyze the data. Results: The results showed that more than half of the sample was male (67.0%) with the age range from 18 to 91 years. During admission, the subjects complained about pain at moderate to severe levels (68.5%). The prevalence of PC was 11.9%. A few participants (2.8%) experienced anxiety. Also, more than half of them (63.3%) had ADLs in independent to absolutely independent levels. Almost 50.5% of the participants experienced poor sleep quality. Lastly, 49.5% of them were in frailty and pre-frailty conditions. There was a positive relationship between PC and anxiety (r = .439, p < .01). Finally, anxiety could explain the variance of PC by 19.3% (F1,107 = 25.571, P < .001). Conclusion: Based on the study findings, the predictor of PC was anxiety. Thus, healthcare providers should assess this factor, in order to provide interventions to reduce high levels of anxiety leading to the prevention of PC occurrences in hospitalized trauma within 72 hours after injury. [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]

The aim of the present study is to describe and measure the cognitive emotion regulation strategies of inpatient adolescents with clinical depression, aged 13–18, and to analyse these coping strategies in relation to different comorbidities of Major Depressive Disorder (MDD). Methods: There were 112 adolescents with MDD who were admitted to hospital and 78 healthy adolescents included in the study. The Cognitive Emotion Regulation Questionnaire (CERQ) was used to assess nine specific cognitive coping strategies. A cognitive coping style model for depression in adolescents was described by analysing the differences between the two groups. The CERQ scores in MDD participants, grouped by comorbidity, were also assessed. Results: Adolescents with MDD had significantly higher scores for Self-Blame and Catastrophising strategies, and significantly lower scores for Positive Refocusing, Refocusing on Planning, and Positive Reappraisal. Adolescents with MDD and Borderline Personality Disorder (BPD) traits had significantly higher scores for Rumination, Catastrophising, and Blaming Others than adolescents with MDD and anxiety or with no comorbidity. Conclusions: Clinical depression in adolescents is associated with a cognitive profile that consists of an increased use of maladaptive coping styles and low employment of adaptive strategies. Early identification can contribute to the development of specific, individualised prevention and intervention programmes, while further longitudinal studies are necessary to adequately measure the outcome of these interventions. [ABSTRACT FROM AUTHOR]

Background and Objectives: To identify the most frequently reported predictive factors for the persistency of pregnancy-related pelvic girdle pain (PPGP) at 3–6 months after childbirth in women with PPGP alone or PPGP in association with pregnancy-related lower back pain (PLBP). Methods: Eligibility criteria: Two authors independently selected studies excluding PPGP determined by a specific, traumatic, gynecological/urological cause or isolated PLBP and studies that did not include the presence/absence of PPGP as the the primary outcome. We, instead, included studies with an initial assessment in pregnancy (within 1 month of delivery) and with a follow-up of at least 3 months after delivery. Data sources: The research was performed using the databases of Medline, Cochrane, Pedro, Scopus, Web of Science and Cinahl from December 2018 to January 2022, following the indications of the PRISMA statement 2021 and the MOOSE checklist. It includes observational cohort studies in which data were often collected through prospective questionnaires (all in English). Study appraisal and risk of bias: Two independent authors performed evaluations of the risk of bias (ROB) using the quality in prognostic studies (QUIPS) tool. Synthesis of results: An in-depth qualitative analysis was conducted because, due to a high degree of heterogeneity in the data collection of the included studies and a lack of raw data suitable for quantitative analysis, it was not possible to carry out the originally planned meta-analyses for the subgroups. Results: The research process led to the inclusion of 10 articles which were evaluated using the QUIPS tool: 5 studies were evaluated as low ROB and 5 were evaluated as moderate ROB. High levels of pain in pregnancy, a large number of positive provocation tests, a history of lower back pain and lumbo-pelvic pain, high levels of disability in pregnancy, neurotic behavior and high levels of fear-avoidance belief were identified as strong predictors of long-term PPGP, while there was weak or contradictory evidence regarding predictions of emotional distress, catastrophizing and sleep disturbances. Discussion: The impossibility of carrying out the meta-analysis by subgroups suggests the need for further research with greater methodological rigor in the acquisition of measures based on an already existing PPGP core predictors/outcome sets. [ABSTRACT FROM AUTHOR]

Purpose: In Germany, there are several microcurrent medical devices that are certified for the treatment of patients suffering from one of the indications chronic back pain, skeletal system pain, fibromyalgia, migraine or depression. While certification is based on controlled, randomized clinical trials, evidence of efficacy and safety under real-world conditions is limited to very few observational studies. To fill this gap, this study was conducted.Patients and Methods: Fifty patients per indication already using the investigational device before study entry were included and followed for a total 6 months. Each participant used the Healy in an individualized schedule to optimize the treatment of his/her special indication. This means that each participant performed on average 1– 2 microcurrent applications per day for 20 to 30 minutes each. In all indications, the improvement of health-related quality of life was assessed by the SF-36 questionnaire and other validated indication specific surveys.Results: In all indications, the improvement of health-related quality of life as assessed by the SF-36 questionnaire was statistically highly significant and clinically relevant. These findings were supported by more specific outcome measures applied in each indication. Only four adverse events related to the application of microcurrent occurred during the trial.Conclusion: Microcurrent therapy has been demonstrated to be efficient and safe under real-world conditions for the treatment of each of the conditions for which the device is certified. [ABSTRACT FROM AUTHOR]

Abstract Background and Aims Research suggests that various psychosocial factors influence chronic pain, with psychotherapies like cognitive behavioral therapy proving effective. However, the limited availability and accessibility have prolonged suffering among patients with chronic pain. This challenge has led to a growing demand for accessible online interventions. We developed an online cognitive behavioral group therapy (CBGT) program, building upon our existing face‐to‐face CBGT program. We compared the scores obtained by patients during the treatment‐as‐usual (TAU) period with those collected at the beginning and at the end of the intervention. Methods Patients with chronic pain (N = 22) agreed to participate in the online CBGT program, which was conducted once a week for 12 sessions. The sample size was decided based on the effect sizes of our past face‐to‐face CBGT. We assessed pain intensity [Visual Analogue Scale (VAS)], pain catastrophizing [pain catastrophizing scale (PCS)] and psychiatric assessment [Beck Depression Inventory‐Second Edition (BDI)‐II], State‐Trait‐Anxiety Inventory (STAI), and Short Form Health Survey (SF‐36) at three points: entry, pretreatment, and posttreatment. We also evaluated the participants' therapeutic alliance with the treatment staff [short‐form version of the Working Alliance Inventory (WAI‐S)]. We utilized analyses of variance, Friedman test, paired t‐tests, Wilcoxon signed‐rank test, and Pearson correlation analysis for data evaluation. Results Results indicated a significant posttreatment improvement in VAS, PCS, and BDI‐II scores compared to the TAU period. Furthermore, posttreatment WAI‐S scores increased significantly compared to pretreatment scores. Also, positive correlations were observed among pre‐ and posttreatment changes in WAI‐S, pain intensity, and pain catastrophizing scores. Conclusion There is a possibility that a therapeutic alliance can be established, and therapeutic effects achieved through an online CBGT intervention; however, additional research is required to substantiate this potential. We have registered this clinical trial in UMIN‐CTR on 04/21/2021 with the number UMIN000043982.

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