Characterizing chronic pain in late adolescence and early adulthood: prescription opioids, marijuana use, obesity, and predictors for greater pain interference.
2018; 3 (6): e700
Sleep quality buffers the effects of negative social interactions on maternal mood in the 3-6month postpartum period: a daily diary study.
Journal of behavioral medicine
2018; 41 (5): 733–46
Introduction: Chronic pain in late adolescence and young adults is understudied and poorly characterized.Objectives: We sought to characterize key variables that may impact pain interference in late adolescents and young adults with chronic pain, including prescription opioid use, marijuana use, psychological symptoms, and obesity.Methods: Retrospective, cross-sectional medical chart review for patients aged 17 to 23 years (N = 283; 61% Females) seeking care at a tertiary care pain clinic. Data on pain characteristics, health behaviors, and mental health distress were examined, in addition to self-reported pain intensity and interference.Results: Overlapping pain conditions were common in this young adult sample (mean ≥ 2 pain conditions). Back pain was the most commonly cited pain condition, and the majority of pain was of unknown etiology. Results revealed high rates for current opioid prescription, overweight or obese status, and mental health problems. Those using prescription opioids were more likely to endorse tobacco use and had greater pain interference. Importantly, the presence of mental health distress and opioid use were predictive of higher levels of pain-related interference.Conclusion: Treatment-seeking adolescents and young adults with chronic pain evidence complex care needs that include pain and mental comorbidities, as well as risky health behaviors. Pain and mental health distress were associated with poorer physical health, opioid prescription and marijuana use, and pain-related interference. Findings underscore the need for additional research on pain, treatment patterns, and health behaviors and their impact on developmental trajectories, as well as the need to develop and apply effective early interventions in this at-risk population.
View details for DOI 10.1097/PR9.0000000000000700
View details for PubMedID 30706040
Use of Immersive Learning and Simulation Techniques to Teach and Research Opioid Prescribing Practices.
Pain medicine (Malden, Mass.)
Sleep and social relationships are two key determinants of psychosocial health that undergo considerable change across the transition to motherhood. The current study investigated the bidirectional relationship between daytime Positive and Negative Social Interactions (PSIs & NSIs) and nighttime sleep quality on maternal mood across 1week in the 3-6month postpartum period. Sixty healthy, non-depressed first-time mothers completed 7-consecutive days of daily social interaction and sleep diaries. Results indicated that higher than average sleep quality buffered the effect of higher than average NSIs on maternal mood (i.e., buffered mood reactivity) and appeared to promote mood recovery following a particularly "bad day" (i.e., higher than average NSIs). In addition, although PSIs were more common than NSIs overall, the most frequent and positively rated PSIs were with baby as were the most frequent and negatively rated NSIs. To our knowledge, our results are the first to characterize the impact of PSIs on postpartum maternal mood, assess maternal-infant social interactions in daily diary study of postpartum social relationships, and demonstrate the role that maternal sleep quality plays in social discord-related mood reactivity and mood recovery processes in the 3-6month postpartum period.
View details for DOI 10.1007/s10865-018-9967-y
View details for PubMedID 30191435
Examining injustice appraisals in a racially diverse sample of individuals with chronic low back pain.
The journal of pain : official journal of the American Pain Society
Introduction: Unsafe opioid prescribing practices to treat acute and chronic pain continue to contribute to the opioid overdose crisis in the United States, a growing public health emergency that harms patients and their communities. Poor opioid prescribing practices stem in part from a lack of education and skills training surrounding pain and opioid management.Methods: As part of the Clinical Pain Medicine Fellowship at Stanford University, physicians were given the opportunity to participate in a pilot program to practice opioid management in a live, simulated interaction. Twenty-seven physician trainees participated in the simulation with a live, standardized patient actor. Before beginning the simulation, participants were given a detailed patient history that included the patient's risk for opioid abuse. They were also provided with relevant risk evaluation and mitigation (REM) tools. All simulation interactions were video-recorded and coded by two independent reviewers. A detailed coding scheme was developed before video analysis, and an inter-rater reliability score showed substantial agreement between reviewers.Results: Contrary to expectations, many of the observed performances by trainees contained aspects of unsafe opioid prescribing, given the patient history. Many trainees did not discuss their patient's aberrant behaviors related to opioids or the patient's risk for opioid abuse. Marked disparities were also observed between the trainees' active patient interactions and their written progress notes.Discussion: This simulation addresses a pressing need to further educate, train, and provide point-of-care tools for providers prescribing opioids. We present our experience and preliminary findings.
View details for DOI 10.1093/pm/pny171
View details for PubMedID 30215778
Voluntary Opioid Tapering-Reply.
JAMA internal medicine
2018; 178 (6): 875
A Life-Stress, Emotional Awareness, and Expression Interview for Primary Care Patients With Medically Unexplained Symptoms: A Randomized Controlled Trial
2018; 37 (3): 282–90
Injustice perception has emerged as a risk factor for problematic musculoskeletal pain outcomes. Despite the prevalence and impact of chronic low back pain (CLBP) no study has addressed injustice appraisals specifically among individuals with CLBP. In addition, despite racial/ethnic disparities in pain, existing injustice research has relied almost exclusively on White/Caucasian participant samples. The current study examined associations between perceived injustice and pain, disability, and depression in a diverse community sample of individuals with CLBP (N=137) - 51(37.2%) White, 43(31.4%) Hispanic, 43(31.4%) Black or African American). Anger variables were tested as potential mediators of these relationships. Controlling for demographic and pain-related covariates, perceived injustice accounted for unique variance in self-reported depression and disability outcomes, but not pain intensity. State and trait anger, and anger inhibition mediated association between perceived injustice and depression; no additional mediation by anger was observed. Significant racial differences were also noted. Compared to White and Hispanic participants, Black participants reported higher levels of perceived injustice related to CLBP, as well as higher depression, and pain-related disability. Black participants also reported higher pain intensity than White participants. Current findings provide initial evidence regarding the role of injustice perception specifically in the context of CLBP and within a racially diverse participant sample. Results highlight the need for greater diversity within injustice and CLBP research as well as research regarding socially-informed antecedents of injustice appraisals.PERSPECTIVE: Perceived injustice predicted worse outcomes in chronic low back pain, with effects partially mediated by anger. Black participants reported worse pain outcomes and higher injustice perception than White or Hispanic counterparts. Given racial inequities within broader health and pain-specific outcomes, this topic is critical for CLBP and perceived injustice research.
View details for DOI 10.1016/j.jpain.2018.08.005
View details for PubMedID 30179671
Patient-Centered Prescription Opioid Tapering in Community Outpatients with Chronic Pain
JAMA Internal Medicine
2018; Feb 19
Comparative Efficacy and Mechanisms of a Single-Session Pain Psychology Class in Chronic Low Back Pain: Study Protocol for a Randomized Controlled Trial
Lifetime trauma, relationship adversities, and emotional conflicts are elevated in primary care patients with medically unexplained symptoms (MUS), and these risk factors likely trigger or exacerbate symptoms. Helping patients disclose stressors, increase awareness and expression of inhibited emotions, and link emotions to physical symptoms may improve health. We developed an emotional awareness and expression interview that targets stressful life experiences and conflicts and then tested its effects on primary care patients with MUS.Patients (N = 75) with MUS were recruited at a family medicine clinic and randomized to an interview condition or treatment-as-usual (TAU) control condition. In a single 90-min interview in the clinic, the interviewer elicited disclosure of the patient's stressors, linked them to the patient's symptom history, and encouraged emotional awareness and expression about unresolved relationship trauma or conflict. At baseline and 6-week follow-up, patients completed self-report measures of their physical and psychological health.Analyses of covariance, controlling for baseline symptoms, compared patients in the interview condition with TAU at 6-week follow-up. Compared with TAU, the interview led to significantly lower pain severity, pain interference, sleep problems, and global psychological symptoms.This study provides preliminary evidence for the value of integrating a disclosure and emotional awareness and expression interview into the primary care setting for patients with MUS. (PsycINFO Database Record
View details for DOI 10.1037/hea0000566
View details for Web of Science ID 000427006100009
View details for PubMedID 29154608
View details for PubMedCentralID PMC5848463
Pain catastrophizing, perceived injustice, and pain intensity impair life satisfaction through differential patterns of physical and psychological disruption
Scand J Pain
The Institute of Medicine (IOM) reported that chronic pain affects about 100 million U.S. adults, with chronic low back pain (CLBP) cited as the most prevalent type. Pain catastrophizing is a psychological construct shown to predict the development and trajectory of chronic pain and patient response to pain treatments. While effective treatment for pain catastrophizing typically includes eight-session groups of cognitive behavioral therapy (CBT), a single-session targeted treatment class yielded promising results which, if replicated and extended, could prove to efficiently and cost-effectively reduce pain catastrophizing. In this trial, we seek to determine the comparative efficacy of this novel single-session pain catastrophizing class to an eight-session course of pain CBT and a single-session back pain health education class. We will also explore the psychosocial mechanisms and outcomes of pain catastrophizing treatment.In this trial we will randomize 231 individuals with CLBP to one of three treatment arms: (1) pain-CBT (eight weekly 2-h group sessions with home exercises and readings); (2) a single 2-h pain catastrophizing class; or (3) a single 2-h back pain health education class (active control). For the primary outcome of pain catastrophizing, the trial is designed as a non-inferiority test between pain-CBT and the single-session pain catastrophizing class, and as a superiority test between the single-session pain catastrophizing class and the health education class. Team researchers masked to treatment assignment will assess outcomes up to six months post treatment.If the single-session targeted pain catastrophizing class is found to be an effective treatment for patients with CLBP, this low cost and low burden treatment could dismantle many of the current barriers and burdens of effective pain care. Further, elucidation of the mechanisms of pain catastrophizing treatments will facilitate future research on the topic as well as further development and refinement of treatments.ClinicalTrials.gov, NCT03167086 . Registered on 22 May 2017.
View details for DOI 10.1186/s13063-018-2537-3
View details for PubMedCentralID PMC5838852
Previous research has highlighted the importance of cognitive appraisal processes in determining the nature and effectiveness of coping with chronic pain. Two of the key variables implicated in appraisal of pain are catastrophizing and perceived injustice, which exacerbate the severity of pain-related distress and increase the risk of long-term disability through maladaptive behavioural responses. However, to date, the influences of these phenomena have not been examined concurrently, nor have they been related specifically to quality of life measures, such as life satisfaction.Using data from an online survey of 330 individuals with chronic pain, structural path modelling techniques were used to examine the independent effects of pain catastrophizing, perceived injustice, and average pain intensity on life satisfaction. Two potential mediators of these relationships were examined: depressive symptoms and pain-related interference.Results indicated that depressive symptoms fully mediated the relationship between pain catastrophizing and life satisfaction, and pain interference fully mediated the relationship between pain intensity and life satisfaction. Both depressive symptoms and pain interference were found to significantly mediate the relationship between perceived injustice and life satisfaction, but perceived injustice continued to demonstrate a significant and negative relationship with life satisfaction, above and beyond the other study variables.The current findings highlight the distinct affective and behavioural mediators of pain and maladaptive cognitive appraisal processes in chronic pain, and highlight their importance in both perceptions of pain-related interference and longer-term quality of life.
View details for DOI 10.1016/j.sjpain.2017.09.020
View details for PubMedCentralID PMC5726907