Veteran spinal cord injury: An investigation of the mediating role of pain interference on the relationship between pain and emotional distress.

Veteran Spinal Cord Injury: An Investigation of the Mediating Role of Pain Interference on the Relationship between Pain and Emotional Distress Carly Blaine, Dept. of Psychology, Jack Watson, and Richard Henry, Dept. of Psychology Graduate Student, with Dr. Scott McDonald, VCU School of Medicine Background: Pain commonly co-occurs with spinal cord injury (SCI) and has been linked to poorer psychological function. SCI patients who experience chronic pain report great levels of interference with daily life.Pain interference with daily life may lead to emotional distress and depression.Objective: Using the PROCESS macro (model 4; Hayes, 2017), this study examines whether pain interference with daily life mediates a positive relationship between pain severity and mental health. Design: This study used a cross-sectional design. Setting and Participants: 221 veterans with SCI were interviewed by a psychologist during their annual evaluation at a Veteran Affairs medical center outpatient clinic. Outcome Measures: Single-item, self-report, Likert scale measures of pain severity and pain interference (M-HIP) were used along with the Patient Health Questionaire-4 (PHQ-4), a measure of mental health symptom severity. Results: Pain severity had a direct effect on mental health as well as an indirect effect through pain interference, using 5,000 bootstrap samples. The overall model was significant (F[1, 219] = 17.763, R2= .075, p \u3c .001). The direct paths from pain severity to pain interference (b= .857, p\u3c .001) and from pain interference to mental health (b= .929, p\u3c .001) were both statistically significant. Further, the indirect effect of pain on mental health through pain interference was statistically significant (b= .796, 95% CI [.493, 1.140]), indicating a full mediation because the direct path from pain severity to mental health was no longer statistically significant in the model (b= .094, p= .683). Discussion: Findings suggest SCI-related emotional distress can result from the inability to participate in daily activities such as going to work, spending time with others, or engaging in hobbies due to pain. Such interference with regular life was found to significantly mediated the positive relationship between SCI-related pain and emotional distress. Future research may take a more qualitative account of how pain inhibits daily life emotionally and physically and focus on interventions designed to decrease pain’s interference with daily living.https://scholarscompass.vcu.edu/uresposters/1293/thumbnail.jp

Pain and analgesic use associated with skeletal-related events in patients with advanced cancer and bone metastases

PURPOSE: Bone metastases secondary to solid tumors increase the risk of skeletal-related events (SREs), including the occurrence of pathological fracture (PF), radiation to bone (RB), surgery to bone (SB), and spinal cord compression (SCC). The aim of this study was to evaluate the impact of SREs on patients' pain, analgesic use, and pain interference with daily functioning. METHODS: Data were combined from patients with solid tumors and bone metastases who received denosumab or zoledronic acid across three identically designed phase 3 trials (N = 5543). Pain severity (worst pain) and pain interference were assessed using the Brief Pain Inventory at baseline and each monthly visit. Analgesic use was quantified using the Analgesic Quantification Algorithm. RESULTS: The proportion of patients with moderate/severe pain and strong opioid use generally increased in the 6 months preceding an SRE and remained elevated, while they remained relatively consistent over time in patients without an SRE. Regression analysis indicated that all SRE types were significantly associated with an increased risk of progression to moderate/severe pain and strong opioid use. PF, RB, and SCC were associated with significantly greater risk of pain interference overall. Results were similar for pain interference with emotional well-being. All SRE types were associated with significantly greater risk of pain interference with physical function. CONCLUSIONS: SREs are associated with increased pain and analgesic use in patients with bone metastases. Treatments that prevent SREs may decrease pain and the need for opioid analgesics and reduce the impact of pain on daily functioning

Pain and analgesic use associated with skeletal-related events in patients with advanced cancer and bone metastases

PURPOSE: Bone metastases secondary to solid tumors increase the risk of skeletal-related events (SREs), including the occurrence of pathological fracture (PF), radiation to bone (RB), surgery to bone (SB), and spinal cord compression (SCC). The aim of this study was to evaluate the impact of SREs on patients' pain, analgesic use, and pain interference with daily functioning. METHODS: Data were combined from patients with solid tumors and bone metastases who received denosumab or zoledronic acid across three identically designed phase 3 trials (N = 5543). Pain severity (worst pain) and pain interference were assessed using the Brief Pain Inventory at baseline and each monthly visit. Analgesic use was quantified using the Analgesic Quantification Algorithm. RESULTS: The proportion of patients with moderate/severe pain and strong opioid use generally increased in the 6 months preceding an SRE and remained elevated, while they remained relatively consistent over time in patients without an SRE. Regression analysis indicated that all SRE types were significantly associated with an increased risk of progression to moderate/severe pain and strong opioid use. PF, RB, and SCC were associated with significantly greater risk of pain interference overall. Results were similar for pain interference with emotional well-being. All SRE types were associated with significantly greater risk of pain interference with physical function. CONCLUSIONS: SREs are associated with increased pain and analgesic use in patients with bone metastases. Treatments that prevent SREs may decrease pain and the need for opioid analgesics and reduce the impact of pain on daily functioning

One Year Follow-up of a Randomized, Double-Blind, Placebo-Controlled Trial of Percutaneous Peripheral Nerve Stimulation for Chronic Neuropathic Pain Following Amputation

Abstract INTRODUCTION Over 85% of patients experience residual limb (RLP) and/or phantom limb (PLP) pain following amputation. Peripheral nerve stimulation (PNS) is a non-opioid approach to relieve postamputation neuropathic pain. A recent multicenter, randomized, double-blind, placebo-controlled study using a novel percutaneous PNS system demonstrated clinically and statistically significant improvements in pain and pain interference with PNS compared to placebo (Gilmore et al, 2019). This work presents prospective 1-yr follow-up to assess durability of pain relief and functional improvements. METHODS Over 85% of patients experience residual limb (RLP) and/or phantom limb (PLP) pain following amputation. Peripheral nerve stimulation (PNS) is a non-opioid approach to relieve post-amputation neuropathic pain. A recent multicenter, randomized, double-blind, placebo-controlled study using a novel percutaneous PNS system demonstrated clinically and statistically significant improvements in pain and pain interference with PNS compared to placebo (Gilmore et al, 2019). This work presents prospective one-year follow-up to assess durability of pain relief and functional improvements. RESULTS A significantly greater proportion of subjects who completed the 12-mo visit reported = 50% pain relief on the BPI-SF (5/8, 63%; average pain relief = 73% among responders) compared to the placebo group at the time of crossover (0/14, 0%, P = .003; average pain relief = 23%). A majority of subjects also reported = 50% reductions in pain interference at 12 mo (5/8, 63%). Two of 13 (15%) subjects in the placebo group reported sustained improvements in pain interference (P = .06). Average reduction in pain interference among responders in the PNS group was 87%. CONCLUSION This work suggests that PNS delivered over 60 d may provide clinically significant and enduring pain relief, enabling improved function and potentially reducing the need for a permanently implanted system

Changes in pain-related beliefs, coping, and catastrophizing predict changes in pain intensity, pain interference, and psychological functioning in individuals with myotonic muscular dystrophy and facioscapulohumeral dystrophy

The primary aim of this study was to test hypothesized associations between changes in psychological variables (i.e., pain beliefs, catastrophizing and coping strategies) and changes in pain intensity and related adjustment (i.e., pain interference and psychological functioning) in individuals with Myotonic Muscular Dystrophy (MMD) and Facioscapulohumeral Muscular Dystrophy (FSHD). Methods: A sample of 107 adults with a diagnosis of MMD or FSHD, reporting pain in the past three months, completed assessments at two time-points, separated by about 24 months. Results showed that changes in pain-related psychological variables were significantly associated with changes in psychological functioning, pain intensity and pain interference. Specifically, increases in the belief that emotion influences pain, and catastrophizing were associated with decreases in psychological functioning. Increases in the coping strategies of asking for assistance and resting, and the increases of catastrophizing were associated with increases in pain intensity. Finally, increases in pain intensity and asking for assistance were associated with increases in pain interference. Discussion: The results support the utility of the biopsychosocial model of pain for understanding pain and its impact in individuals with MMD or FSHD. These findings may inform the design and implementation of psychosocial pain treatments for people with muscular dystrophy and chronic pain

Grading the intensity of nondental orofacial pain: Identification of cutoff points for mild, moderate, and severe pain

Background: When assessing pain in clinical practice, clinicians often label pain as mild, moderate, and severe. However, these categories are not distinctly defined, and are often used arbitrarily. Instruments for pain assessment use more sophisticated scales, such as a 0–10 numerical rating scale, and apart from pain intensity assess pain-related interference and disability. The aim of the study was to identify cutoff points for mild, moderate, and severe nondental orofacial pain using a numerical rating scale, a pain-related interference scale, and a disability measurement. Materials and methods: A total of 245 patients referred to the Facial Pain Unit in London were included in the study. Intensity and pain-related interference were assessed by the Brief Pain Inventory. Pain-related disability was assessed by the Chronic Graded Pain Scale. Average pain intensity (0–10) was classified into nine schemes with varying cutoff points of mild, moderate, and severe pain. The scheme with the most significant intergroup difference, expressed by multivariate analysis of variance, provided the cutoffs between mild, moderate, and severe pain. Results: The combination that showed the greatest intergroup differences for all patients was scheme 47 (mild 1–4, moderate 5–7, severe 8–10). The same combination provided the greatest intergroup differences in subgroups of patients with temporomandibular disorder and chronic idiopathic facial pain, respectively. Among the trigeminal neuralgia patients alone, the combination with the highest intergroup differences was scheme 48 (mild 1–4, moderate 5–8, severe 9–10). Conclusion: The cutoff points established in this study can discriminate in pain intensity categories reasonably well, and showed a significant difference in most of the outcome measures used

Differential item functioning in the Patient Reported Outcomes Measurement Information System Pediatric Short Forms in a sample of children and adolescents with cerebral palsy.

AIM: The present study examined the Patient Reported Outcomes Measurement Information System (PROMIS) Mobility, Fatigue, and Pain Interference Short Forms (SFs) in children and adolescents with cerebral palsy (CP) for the presence of differential item functioning (DIF) relative to the original calibration sample. METHOD: Using the Graded Response Model we compared item parameter estimates generated from a sample of 303 children and adolescents with CP (175 males, 128 females; mean age 15y 5mo) to parameter estimates from the PROMIS calibration sample, which served as the reference group. DIF was assessed in a two-step process using the item response theory-likelihood ratio-differential item functioning detection procedure. RESULTS: Significant DIF was identified for four of eight items in the PROMIS Mobility SF, for two of eight items in the Pain Interference Scale, and for one item out of 10 on the Fatigue Scale. Impact of DIF on total score estimation was notable for Mobility and Pain Interference, but not for Fatigue. INTERPRETATION: Results suggest differences in the responses of adolescents with CP to some items on the PROMIS Mobility and Pain Interference SFs. Cognitive interviews about the PROMIS items with adolescents with varying degrees of mobility limitations would provide better understanding of how they are interpreting and selecting responses to the PROMIS items and thus help guide selection of the most appropriate way to address this issue

Pain Interference Across Chronic Pain Populations: Variability and Associated Psychosocial Processes

Chronic pain is one of the most common health complaints, yet the limited effectiveness of existing treatment options suggests that chronic pain is still not fully understood. The goals of this study are to identify and organize well-established and emerging psychosocial factors associated with pain interference, clarify the nature of between- and within-diagnostic group differences in psychosocial and demographic factors associated with pain interference, and identify interactions among diagnostic and psychosocial factors associated with pain interference. Community-dwelling participants (N = 284) completed a one-time survey which included demographic information, information about pain and diagnosis, and five existing measures that assess chronic pain severity, interference, and coping. To derive higher order psychosocial factors common to the chronic pain measures, individual scale items were analyzed using confirmatory factor analysis (CFA). A subsequent principal components analysis (PCA) was performed to achieve parsimonious grouping of psychosocial constructs. Hierarchical ordinary least squares regression models tested the effects of demographics, diagnosis, psychosocial factors, and their interactions on the relationship between pain intensity and pain interference. CFA did not support the hypothesized psychosocial factor model. The subsequent PCA suggested that a 5-component structure adequately captured most of the variance, accounting for 61% of the total variance. The five emergent psychosocial factors were positive engagement, disengagement, positive thinking, social support, and physical activity. In the regression models, positive engagement showed a remarkably strong negative association with all types of pain interference and disengagement showed a strong positive association with all types of pain interference. Across all diagnoses, greater physical activity was associated with less total pain interference, less interference in daily activities and less interference in social and recreational activities. Positive thinking and social support were differentially associated with higher interference in specific types of interference. Regarding diagnosis, osteoarthritis was associated with less total and work interference. In total interference and interference in social and recreational activities, individuals with Complex Regional Pain Syndrome and multiple conditions exhibited a tapering-off wherein pain interference was not significantly higher among those reporting higher levels of pain. There were no significant interactions between diagnostic group and psychosocial factors. This study is one of the first to systematically compare multiple types of pain interference across a large variety of clinical pain populations. The results provide discriminant validity for the various types of pain interference and more clearly define the role that diagnosis plays as a covariate in the chronic pain experience. Clinically, the pain coping and response model resulting from this PCA offers an opportunity to reconceptualize how people respond to their pain and sets the foundation for more efficient screening and intervention. Scientifically, variables identified in this study appear to represent a vast majority of nodes in the nomological net of pain interference such that a comprehensive understanding of pain interference may soon be within reach

Cognitive behavioral therapy for the management of multiple sclerosis–related pain: a randomized clinical trial

BACKGROUND: Pain is a common and often debilitating symptom among persons with multiple sclerosis (PwMS). Besides interfering with daily functioning, pain in MS is associated with higher levels of depression and anxiety. While cognitive-behavioral therapy (CBT) for pain has been found to be an effective treatment in other populations, there has been a dearth of research in PwMS. METHODS: PwMS with at least moderate pain severity (N = 20) were randomly assigned to one of two groups: CBT plus standard care (CBT/SC) or MS-related education plus standard care (ED/SC), each of which met for 12 sessions. Changes in pain severity, pain interference, and depressive symptom severity from baseline to the 15 week follow-up were assessed using a 2×2 factorial design. Participants also rated their satisfaction with their treatment and accomplishment of personally meaningful behavioral goals. RESULTS: Both treatment groups rated their treatment satisfaction as very high and their behavioral goals as largely met, although only the CBT/SC group's mean goal accomplishment ratings represented significant improvement. While there were no significant differences between groups post-treatment on the three primary outcomes, there was an overall improvement over time for pain severity, pain interference, and depressive symptom severity. CONCLUSIONS: CBT or education-based programs may be helpful adjunctive treatments for PwMS experiencing pain.Accepted manuscrip

OPTIMISM AND PAIN INTERFERENCE IN AGING WOMEN

Pain interferes with people\u27s daily lives and often limits the extent to which they can pursue goals and engages in activities that promote well-being. The present study test how optimism affects and is affected by pain interference and activity among older women. Every three months for two years, middle- and older-age women (N = 199) complete daily diaries at home for a seven-day period, reporting their daily pain, pain interference, and activity. Optimism was measured at baseline and end-of-study. Multilevel models test the between- and within-person relationships among pain, optimism, pain interference and activity. Pain best predicted pain interference and optimism best predicted activity. Accumulated activity and pain interference across the study predicted longitudinal changes in optimism over two years. Optimism may play a protective role in disruptions caused by pain, leading to decreased pain interference and increased activity. In turn, less interference and more activity feed forward into increased optimism, resulting in a cycle that enhances optimism and well-being among older women