Bio

Bio

Dr. Ziadni is a licensed clinical psychologist with a specialization in pain psychology. She is an Instructor at Stanford University School of Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine. She is also a Principal Investigator on a Career Development Award at Stanford's Neurosciences and Pain laboratory, examining the impact of a behavioral intervention on opioid use among patients with chronic pain. Her research is focused on developing and testing novel interventions for chronic pain. Prior to Stanford, she received her doctoral degree in clinical psychology from Wayne State University with a focus on health psychology, and completed an APA-accredited internship at Rush University Medical Center. Dr. Ziadni completed a combined 3-year clinical and research fellowship in pain psychology at Stanford University before joining the faculty group in 2019.

Dr. Ziadni's clinical focus is broadly focused on pain management, adjustment-related issues, and emotional, awareness, processing and expression related to traumatic events. She uses a number of treatment approaches including cognitive-behavioral therapy, emotion-focused therapy, biofeedback and values-based treatments. She offers individual, as well as group therapy groups at the Pain Management Center.

Clinical Focus

  • Psychology
  • Pain Management
  • Emotion-focused treatments
  • Cognitive Behavioral Therapy for pain

Academic Appointments

  • Instructor, Anesthesiology, Perioperative and Pain Medicine

Professional Education

  • Fellowship: Stanford University Division of Pain Medicine (2019) CA
  • Fellowship: Stanford University Psychology Postdoctoral Fellowship (2018) CA
  • Internship: Rush University Medical Center GME Office (2016) IL
  • PhD Training: Wayne State University School of Medicine (2016) MI

Contact

  • Stanford Pain Management Center 450 Broadway St Pavilion A 1st Fl MC 5340 Redwood City, CA 94063
    • Tel: (650) 723-6238
    Fax: (650) 721-3417

Research & Scholarship

Current Research and Scholarly Interests

Development and testing of novel interventions for chronic pain.
Understanding mechanisms of treatment among patients with chronic with pain.
Understanding predictors of opioid use among patients with chronic pain.

Clinical Trials

  • Single Session Class to Reduce Opioid Use in Chronic Pain Recruiting

    Prescription opioids are one of the most commonly used treatments for chronic pain, despite limited evidence of their efficacy and high morbidity and mortality risks. The study aims to determine the efficacy of a targeted single-session psychology class in reducing opioid use among patients with chronic pain. The information gained from this study has the potential to identify patients who achieve a meaningful reduction in opioid use and inform opioid reduction strategies.

    View full details

Publications

All Publications

  • Validation of CARE Scale-7 in treatment-seeking patients with chronic pain: measurement of sex invariance. Pain reports Ziadni, M., You, D. S., Chen, A., Wilson, A. C., Darnall, B. D. 2020; 5 (6): e862

    Abstract

    Objectives: Social and interpersonal factors impact the trajectory of chronic pain. We previously developed and validated a 2-factor, 7-item measure to assess interpersonal factors, including relationship guilt and worry and difficulty prioritizing self-care in chronic pain. Here, we confirm the factor structure and examine the sex invariance of the two-factor structure of the CARE Scale-7.Methods: Data were collected as part of routine clinical care at a tertiary pain clinic using the Collaborative Health Outcomes Information Registry. Patient participants (67% women) were predominantly middle-aged (M = 50.9 years, SD = 17.8), married (55.2%), and White/non-Hispanic (55.7%). Data included demographics, pain characteristics, CARE Scale-7, pain catastrophizing, and Patient-Reported Outcomes Measurement Information System psychological and physical function measures. Confirmatory factor analysis was conducted to validate the factor structure of the CARE Scale, and a stepwise approach to measurement invariances by sex examined configural, metric, and scalar invariance.Results: Internal consistency of the scale items ensured suitability for factor analyses. Confirmatory factor analysis findings revealed an overall good fit of the 2-factor model among males and females and that CARE Scale-7 is in fact sex invariant. Finally, CARE Scale-7 showed convergent validity with pain-related outcomes.Discussion: The CARE Scale is the first validated instrument to assess self-care in both sexes among patients with chronic pain. The subscale of difficulty prioritizing self-care emerged as a potentially unique factor that should be integrated in clinical assessment. CARE Scale may facilitate standardized measurement in research and clinical contexts, which may inform a comprehensive treatment focus that integrates individualized self-care planning.

    View details for DOI 10.1097/PR9.0000000000000862

    View details for PubMedID 33204930

  • Association of State Policies Allowing Medical Cannabis for Opioid Use Disorder With Dispensary Marketing for This Indication. JAMA network open Shover, C. L., Vest, N. A., Chen, D., Stueber, A., Falasinnu, T. O., Hah, J. M., Kim, J., Mackey, I., Weber, K. A., Ziadni, M., Humphreys, K. 2020; 3 (7): e2010001

    Abstract

    Importance: Misinformation about cannabis and opioid use disorder (OUD) may increase morbidity and mortality if it leads individuals with OUD to forego evidence-based treatment. It has not been systematically evaluated whether officially designating OUD as a qualifying condition for medical cannabis is associated with cannabis dispensaries suggesting cannabis as a treatment for OUD.Objective: To examine whether state-level policies designating OUD a qualifying condition for medical cannabis are associated with more dispensaries claiming cannabis can treat OUD.Design, Setting, and Participants: This cross-sectional, mixed-methods study of 208 medical dispensary brands was conducted in 2019 using the brands' online content. The study included dispensaries operating in New Jersey, New York, and Pennsylvania, where OUD is a qualifying condition for medical cannabis, and in Connecticut, Delaware, Maryland, Ohio, and West Virginia, where this policy does not exist.Exposures: Presence of OUD on the list of qualifying conditions for a state's medical cannabis program.Main Outcomes and Measures: Binary indicators of whether online content from the brand said cannabis can treat OUD, can replace US Food and Drug Administration-approved medications for OUD, can be an adjunctive therapy to Food and Drug Administration-approved medications for OUD, or can be used as a substitute for opioids to treat other conditions (eg, chronic pain).Results: After excluding duplicates, listings for nonexistent dispensaries, and those without online content, 167 brands across 7 states were included in the analysis (44 [26.3%] in states where OUD was a qualifying condition and 123 [73.7%] in adjacent states). A dispensary listed in a directory for West Virginia was not operational; therefore, comparison states were Connecticut, Delaware, Maryland, and Ohio. In policy-exposed states, 39% (95% CI, 23%-55%) more dispensaries claimed cannabis could treat OUD compared with unexposed states (P<.001). For replacing medications for OUD and being an adjunctive therapy, the differences were 14% (95% CI, 2%-26%; P=.002) and 28% (95% CI, 14%-42%; P<.001), respectively. The suggestion that cannabis could substitute for opioids (eg, to treat chronic pain) was made by 25% (95% CI, 9%-41%) more brands in policy-exposed states than adjacent states (P=.002).Conclusions and Relevance: In this study, state-level policies designating OUD as a qualifying condition for medical cannabis were associated with more dispensaries claiming cannabis can treat OUD. In the current policy environment, in which medical claims by cannabis dispensaries are largely unregulated, these advertisements could harm patients. Future research linking these policies to patient outcomes is warranted.

    View details for DOI 10.1001/jamanetworkopen.2020.10001

    View details for PubMedID 32662844

  • ASSOCIATION BETWEEN PAIN CATASTROPHIZING AND FREQUENT CRAVING FOR PRESCRIPTION OPIOIDS IN PATIENTS WITH CHRONIC PAIN You, D. S., Ziadni, M., Hah, J., Darnall, B. D., Mackey, S. OXFORD UNIV PRESS INC. 2020: S89

    View details for Web of Science ID 000546262400184

  • Perceived Injustice Mediates the Relationship Between Perceived Childhood Neglect and Current Function in Patients with Chronic Pain: A Preliminary Pilot Study. Journal of clinical psychology in medical settings Ziadni, M. S., You, D. S., Sturgeon, J. A., Mackey, S. C., Darnall, B. D. 2020

    Abstract

    Cumulative evidence supports the association between perceived childhood neglect and adulthood psychological and physical health. To date, pathways mediating this association remain largely unknown, though other evidence suggests that negative patterns of appraisal, including injustice perception related to pain, may be shaped by prior adverse social experiences. Consequently, the current study examined perceived injustice about chronic pain as a possible factor connecting childhood neglect and pain-related outcomes, given its relevance for both adaptation to chronic pain and to prior adverse life experiences. Patients (n?=?742) visiting a tertiary pain clinic completed a survey administered via the Collaborative Health Outcomes Information Registry. Path modeling analyses were used to examine perceived injustice as a mediator of the relationships between childhood neglect and affective distress and physical function, after controlling for pain intensity and pain catastrophizing. Patients endorsing childhood neglect reported higher levels of perceived injustice and worse affective distress and physical function. Further, inclusion of perceived injustice as a mediator fully accounted for the relationship between neglect and current levels of physical function, and accounted for a significant proportion of the relationship between neglect and current levels of affective distress. These preliminary findings suggest that perceived injustice appears to be a more proximal factor by which prior experiences of neglect may adversely affect adaptation to chronic pain. Given the single-item assessment of childhood neglect and cross-sectional nature of the current findings, further research may focus on replicating these findings in longitudinal studies with validated measures and examining other adverse social experiences (e.g., abuse, social disparities) that may contribute to injustice perception and poor pain-related outcomes.

    View details for DOI 10.1007/s10880-020-09722-8

    View details for PubMedID 32382872

  • Efficacy and mechanisms of a single-session behavioral medicine class among patients with chronic pain taking prescription opioids: study protocol for a randomized controlled trial. Trials Ziadni, M. S., Chen, A. L., Winslow, T., Mackey, S. C., Darnall, B. D. 2020; 21 (1): 521

    Abstract

    Independent of pain intensity, pain-specific distress is highly predictive of pain treatment needs, including the need for prescription opioids. Given the inherently distressing nature of chronic pain, there is a need to equip individuals with pain education and self-regulatory skills that are shown to improve adaptation and improve their response to medical treatments. Brief, targeted behavioral medicine interventions may efficiently address the key individual factors, improve self-regulation in the context of pain, and reduce the need for opioid therapy. This highlights the critical need for targeted, cost-effective interventions that efficiently address the key psychological factors that can amplify the need for opioids and increased risk for misuse. In this trial, the primary goal is to test the comparative efficacy of a single-session skills-based pain management class to a health education active control group among patients with chronic pain who are taking opioids.Our study is a randomized, double-blind clinical trial testing the superiority of our 2-h, single-session skills-based pain management class against a 2-h health education class. We will enroll 136 adult patients with mixed-etiology chronic pain who are taking opioid prescription medication and randomize 1:1 to one of the two treatment arms. We hypothesize superiority for the skills-based pain class for pain control, self-regulation of pain-specific distress, and reduced opioid use measured by daily morphine equivalent. Team researchers masked to treatment assignment will assess outcomes up to 12 months post treatment.This study aims to test the utility of a single-session, 2-h skills-based pain management class to improve self-regulation of pain and reduce opioid use. Findings from our project have the potential to shift current research and clinical paradigms by testing a brief and scalable intervention that could reduce the need for opioids and prevent misuse effectively, efficiently, and economically. Further, elucidation of the mechanisms of opioid use can facilitate refinement of more targeted future treatments.ClinicalTrials.gov, ID: NCT03950791. Registered on 10 May 2019.

    View details for DOI 10.1186/s13063-020-04415-x

    View details for PubMedID 32532346

  • Emotions Matter: The Role of Emotional Approach Coping in Chronic Pain. European journal of pain (London, England) Ziadni, M. S., You, D. S., Johnson, L., Lumley, M. A., Darnall, B. D. 2020

    Abstract

    Emotional approach coping (EAC) is a potentially adaptive emotion-focused coping style that involves understanding or processing one's emotions and expressing them appropriately. Although EAC has been studied in various populations, little is known about this construct among people with chronic pain, including potential mediators such as negative affect, which might link EAC to pain-related variables, and moderators of these relationships.Participants (N = 670; 76% women; 30% older adults-age 60 or over) with chronic pain completed online the Emotional Approach Coping Scale and measures of pain severity, pain interference, and negative affect. Analyses correlated EAC to pain severity and interference and tested whether gender and age group (older adults vs. young/middle-age adults) moderated the mediated relationships of EAC with pain-related variables through negative affect.Findings reveal that higher EAC was associated with lower pain intensity through lower negative affect in the young/middle-age portion of the sample, but not older adults. Also, higher EAC was associated with lower pain interference through lower negative affect among women in the sample, but not men. The associations of EAC to pain intensity and interference are small in magnitude, however, and should be considered preliminary.EAC is associated with lower pain intensity in young/middle-age adults and lower pain interference in women, and lower negative affect mediates these relationships. These results suggest the potential value of assessing and bolstering emotional approach coping processes in some people with chronic pain.

    View details for DOI 10.1002/ejp.1625

    View details for PubMedID 32603553

  • "My Surgical Success": Effect of a Digital Behavioral Pain Medicine Intervention on Time to Opioid Cessation After Breast Cancer Surgery-A Pilot Randomized Controlled Clinical Trial PAIN MEDICINE Darnall, B. D., Ziadni, M. S., Krishnamurthy, P., Flood, P., Heathcote, L. C., Mackey, I. G., Taub, C., Wheeler, A. 2019; 20 (11): 2228?37

    View details for DOI 10.1093/pm/pnz094

    View details for Web of Science ID 000504316200017

  • Evaluation of the Preliminary Validity of Misuse of Prescription Pain Medication Items from the Patient-Reported Outcomes Measurement Information System (PROMIS)(R) PAIN MEDICINE You, D., Hah, J. M., Collins, S., Ziadni, M. S., Domingue, B. W., Cook, K. F., Mackey, S. C. 2019; 20 (10): 1925?33

    View details for DOI 10.1093/pm/pnz001

    View details for Web of Science ID 000498052000007

  • "My Surgical Success": Effect of a Digital Behavioral Pain Medicine Intervention on Time to Opioid Cessation After Breast Cancer Surgery-A Pilot Randomized Controlled Clinical Trial. Pain medicine (Malden, Mass.) Darnall, B. D., Ziadni, M. S., Krishnamurthy, P., Flood, P., Heathcote, L., Mackey, I. G., Taub, C. J., Wheeler, A. 2019

    Abstract

    OBJECTIVE: This study aims to assess the feasibility of digital perioperative behavioral pain medicine intervention in breast cancer surgery and evaluate its impact on pain catastrophizing, pain, and opioid cessation after surgery.DESIGN AND SETTING: A randomized controlled clinical trial was conducted at Stanford University (Palo Alto, CA, USA) comparing a digital behavioral pain medicine intervention ("My Surgical Success" [MSS]) with digital general health education (HE).PARTICIPANTS: A convenience sample of 127 participants were randomized to treatment group. The analytic sample was 68 patients (N=36 MSS, N=32 HE).MAIN OUTCOMES: The primary outcome was feasibility and acceptability of a digital behavioral pain medicine intervention (80% threshold for acceptability items). Secondary outcomes were pain catastrophizing, past seven-day average pain intensity, and time to opioid cessation after surgery for patients who initiated opioid use.RESULTS: The attrition rate for MSS intervention (44%) was notably higher than for HE controls (18%), but it was lower than typical attrition rates for e-health interventions (60-80%). Despite greater attrition for MSS, feasibility was demonstrated for the 56% of MSS engagers, and the 80% threshold for acceptability was met. We observed a floor effect for baseline pain catastrophizing, and no significant group differences were found for postsurgical pain catastrophizing or pain intensity. MSS was associated with 86% increased odds of opioid cessation within the 12-week study period relative to HE controls (hazard ratio = 1.86, 95% confidence interval = 1.12-3.10, P=0.016).CONCLUSIONS: Fifty-six percent of patients assigned to MSS engaged with the online platform and reported high satisfaction. MSS was associated with significantly accelerated opioid cessation after surgery (five-day difference) with no difference in pain report relative to controls. Perioperative digital behavioral pain medicine may be a low-cost, accessible adjunct that could promote opioid cessation after breast cancer surgery.

    View details for PubMedID 31087093

  • Emotional Awareness and Expression Therapy for Chronic Pain: Outcomes and Emotion-focused Moderators Lumley, M. A., Schubiner, H., Williams, D., Thakur, E., Ziadni, M., Holmes, H. A., Carty, J. LIPPINCOTT WILLIAMS & WILKINS. 2019: A191

    View details for Web of Science ID 000467560700534

  • Evaluation of the Preliminary Validity of Misuse of Prescription Pain Medication Items from the Patient-Reported Outcomes Measurement Information System (PROMIS). Pain medicine (Malden, Mass.) You, D. S., Hah, J. M., Collins, S., Ziadni, M. S., Domingue, B. W., Cook, K. F., Mackey, S. C. 2019

    Abstract

    OBJECTIVE: The National Institutes of Health's Patient-Reported Outcomes Measurement Information System (PROMIS) includes an item bank for measuring misuse of prescription pain medication (PROMIS-Rx Misuse). The bank was developed and its validity evaluated in samples of community-dwelling adults and patients in addiction treatment programs. The goal of the current study was to investigate the validity of the item bank among patients with mixed-etiology chronic pain conditions.METHOD: A consecutive sample of 288 patients who presented for initial medical evaluations at a tertiary pain clinic completed questionnaires using the open-source Collaborative Health Outcomes Information Registry. Participants were predominantly middle-aged (M [SD]=51.6 [15.5] years), female (62.2%), and white/non-Hispanic (51.7%). Validity was evaluated by estimating the association between PROMIS-Rx Misuse scores and scores on other measures and testing the ability of scores to distinguish among risk factor subgroups expected to have different levels of prescription pain medicine misuse (known groups analyses).RESULTS: Overall, score associations with other measures were as expected and scores effectively distinguished among patients with and without relevant risk factors.CONCLUSION: The study results supported the preliminary validity of PROMIS-Rx Misuse item bank scores for the assessment of prescription opioid misuse in patients visiting an outpatient pain clinic.

    View details for PubMedID 30856659

  • Use of Immersive Learning and Simulation Techniques to Teach and Research Opioid Prescribing Practices PAIN MEDICINE Heirich, M. S., Sinjary, L. S., Ziadni, M. S., Sacks, S., Buchanan, A. S., Mackey, S. C., Newmark, J. L. 2019; 20 (3): 456?63

    View details for DOI 10.1093/pm/pny171

    View details for Web of Science ID 000467966600006

  • Evaluation of Candidate Items for Severe PTSD Screening for Patients with Chronic Pain: Pilot Data Analysis with IRT Approach. Pain practice : the official journal of World Institute of Pain You, D. S., Ziadni, M. S., Gilam, G., Darnall, B. D., Mackey, S. C. 2019

    Abstract

    Post-traumatic Stress Disorder (PTSD) commonly co-occurs with chronic pain. Although PTSD symptoms are associated with negative health outcomes in patients with chronic pain, PTSD is typically under-detected and under-treated in outpatient pain settings. There is a need for rapid, brief screening tools to identify those at greatest risk for severe PTSD symptoms. To achieve that goal, our aim was to use item response theory (IRT) to identify the most informative PTSD symptoms characterizing severe PTSD in patients with chronic pain.Fifty-six patients (71% female, 61% White) with mixed etiology chronic pain completed the PTSD Checklist Civilian Version (PCL-C) as part of their appointment with a pain psychologist at a tertiary outpatient pain clinic. We used an IRT approach to evaluate each item's discriminant (a) and severity (b) parameters.Findings revealed that 'feeling upset at reminders' (a = 3.67, b = 2.44) and 'avoid thinking or talking about it' (a = 3.61, b = 2.17) as being highly discriminant for severe PTSD.We identified two candidate items for a brief PTSD screener as they were associated with severe PTSD symptoms. These two items may provide clinical utility in outpatient pain treatment settings to identify those suffering from severe PTSD enabling physicians to refer them to trauma-specific evaluation or therapy. Future research is needed to further validate and confirm these candidate PTSD items in a larger clinic sample.

    View details for DOI 10.1111/papr.12848

    View details for PubMedID 31646748

  • Injustice Appraisal but not Pain Catastrophizing Mediates the Relationship Between Perceived Ethnic Discrimination and Depression and Disability in Low Back Pain. The journal of pain : official journal of the American Pain Society Ziadni, M. S., Sturgeon, J. A., Bissell, D., Guck, A., Martin, K. J., Scott, W., Trost, Z. 2019

    Abstract

    Despite growing evidence of significant racial disparities in the experience and treatment of chronic pain, the mechanisms by which these disparities manifest have remained relatively understudied. The current study examined the relationship between past experiences of racial discrimination and pain-related outcomes (self-rated disability and depressive symptomatology), and tested the potential mediating roles of pain catastrophizing and perceived injustice related to pain. Analyses consisted of cross-sectional path modeling in a multiracial sample of 137 individuals with chronic low back pain (Hispanics N=43; Blacks N=43; Whites N=51). Results indicated a positive relationship between prior discriminatory experiences and severity of disability and depressive symptoms. In mediation analyses, pain-related appraisals of injustice, but not pain catastrophizing, were found to mediate these relationships. Notably, the association between discrimination history and perceived injustice was significantly stronger in Black and Hispanic participants and was not statistically significant in White participants. The findings suggest that race-based discriminatory experiences may contribute to racial disparities in pain outcomes and highlight the specificity of pain-related, injustice-related appraisals as a mechanism by which these experiences may impair physical and psychosocial function. Future research is needed to investigate temporal and causal mechanisms suggested by the model through longitudinal and clinical intervention studies. PERSPECTIVE: More frequent prior experiences of racial discrimination are associated with greater depressive symptomatology and pain-related disability in individuals with chronic low back pain. These associations are explained by the degree of injustice perception related to pain, but not pain catastrophizing, and were stronger among Black and Hispanic participants.

    View details for DOI 10.1016/j.jpain.2019.09.007

    View details for PubMedID 31562992

  • Examining Injustice Appraisals in a Racially Diverse Sample of Individuals With Chronic Low Back Pain JOURNAL OF PAIN Trost, Z., Sturgeon, J., Guck, A., Ziadni, M., Nowlin, L., Goodin, B., Scott, W. 2019; 20 (1): 83?96

    View details for DOI 10.1016/j.jpain.2018.08.005

    View details for Web of Science ID 000455169700008

  • Perceived lack of training moderates relationship between healthcare providers' personality and sense of efficacy in trauma-informed care. Anxiety, stress, and coping Stevens, N. R., Ziadni, M. S., Lillis, T. A., Gerhart, J., Baker, C., Hobfoll, S. E. 2019: 1?15

    Abstract

    Medical patients often have trauma histories that are not routinely assessed, which can adversely affect health outcomes. Despite growing awareness of this issue, there is limited understanding of factors that influence provider competency in trauma-informed care (TIC). The study examined healthcare providers' personality traits in relation to their sense of TIC efficacy, taking into account perceived barriers to TIC and professional quality of life.The study used cross-sectional survey methods to examine our central hypothesis that provider personality traits and perceived barriers to TIC would be associated with TIC-efficacy, and to explore interactions among study variables.Survey data were collected from 172 healthcare providers examining TIC knowledge, TIC-efficacy, perceived barriers to TIC, personality traits, and professional quality of life.TIC-efficacy was positively correlated with "intellectence/openness" and inversely correlated with "neuroticism" and perceived lack of training as a barrier. "Intellectence/openness" interacted with perceived lack of training to predict TIC-efficacy, suggesting that providers with lower "intellectence/openness" report greater TIC-efficacy when lack of training is not perceived as a barrier.Provider personality traits and perceived barriers to TIC appear related to providers' TIC-efficacy. Implications for overcoming barriers to TIC through training and implementation are discussed.

    View details for DOI 10.1080/10615806.2019.1645835

    View details for PubMedID 31345075

  • Characterizing chronic pain in late adolescence and early adulthood: prescription opioids, marijuana use, obesity, and predictors for greater pain interference. Pain reports Anastas, T., Colpitts, K., Ziadni, M., Darnall, B. D., Wilson, A. C. 2018; 3 (6): e700

    Abstract

    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 PubMedID 30706040

  • 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 Lillis, T. A., Hamilton, N. A., Pressman, S. D., Ziadni, M. S., Khou, C. S., Boddy, L. E., Wagner, L. M. 2018; 41 (5): 733?46

    Abstract

    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 PubMedID 30191435

  • 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 Lillis, T. A., Hamilton, N. A., Pressman, S. D., Ziadni, M. S., Khou, C. S., Boddy, L. E., Wagner, L. M. 2018; 41 (5): 733?46

    View details for DOI 10.1007/s10865-018-9967-y

    View details for Web of Science ID 000449306900015

  • Use of Immersive Learning and Simulation Techniques to Teach and Research Opioid Prescribing Practices. Pain medicine (Malden, Mass.) Heirich, M. S., Sinjary, L. S., Ziadni, M. S., Sacks, S., Buchanan, A. S., Mackey, S. C., Newmark, J. L. 2018

    Abstract

    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 PubMedID 30215778

  • 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 Trost, Z., Sturgeon, J., Guck, A., Ziadni, M., Nowlin, L., Goodin, B., Scott, W. 2018

    Abstract

    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 PubMedID 30179671

  • Voluntary Opioid Tapering-Reply. JAMA internal medicine Darnall, B. D., Ziadni, M. S., Stieg, R. L. 2018; 178 (6): 875

    View details for PubMedID 29868754

  • Voluntary Opioid Tapering-Barriers to Delivering Care Reply JAMA INTERNAL MEDICINE Darnall, B. D., Ziadni, M. S., Stieg, R. L. 2018; 178 (6): 875

    View details for DOI 10.1001/jamainternmed.2018.2112

    View details for Web of Science ID 000434133500056

  • A Life-Stress, Emotional Awareness, and Expression Interview for Primary Care Patients With Medically Unexplained Symptoms: A Randomized Controlled Trial HEALTH PSYCHOLOGY Ziadni, M. S., Carty, J. N., Doherty, H. K., Porcerelli, J. H., Rapport, L. J., Schubiner, H., Lumley, M. A. 2018; 37 (3): 282?90

    Abstract

    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

  • Perceived injustice in chronic pain: an examination through the lens of predictive processing PAIN MANAGEMENT Bissell, D. A., Ziadni, M. S., Sturgeon, J. A. 2018; 8 (2): 129?38

    View details for DOI 10.2217/pmt-2017-0051

    View details for Web of Science ID 000434189500008

  • Perceived injustice in chronic pain: an examination through the lens of predictive processing. Pain management Bissell, D. A., Ziadni, M. S., Sturgeon, J. A. 2018; 8 (2): 129?38

    Abstract

    Chronic pain conditions have been shown to be exacerbated by psychological factors, and a better understanding of these factors can inform clinical practice and improve the efficacy of interventions. The current paper investigates perceived injustice, a novel psychosocial construct, within a framework influenced by the tenets of predictive processing. The proposed conceptual model derived from tenets of predictive processing yields a single hierarchical self-reconfiguring system driven by prediction, which accounts for a wide range of human experiences such as perception, behavior, learning and emotion. This conceptualization can inform the development and implementation of more targeted therapeutic interventions for chronic pain.

    View details for PubMedID 29451429

  • Patient-Centered Prescription Opioid Tapering in Community Outpatients with Chronic Pain JAMA Internal Medicine Darnall, B., Ziadni, M., Stieg, R., Mackey, I., Kao, M., Flood, P. 2018; Feb 19

    View details for DOI 10.1001/jamainternmed.2017.8709

  • Comparative Efficacy and Mechanisms of a Single-Session Pain Psychology Class in Chronic Low Back Pain: Study Protocol for a Randomized Controlled Trial. Trials Darnall, B. D., Ziadni, M. S., Roy, A., Kao, M. C., Sturgeon, J. A., Cook, K. F., Lorig, K., Burns, J. W., Mackey, S. C. 2018; 19 (1): 165

    Abstract

    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 PubMedID 29510735

  • Patient-Centered Prescription Opioid Tapering in Community Outpatients With Chronic Pain. JAMA internal medicine Darnall, B. D., Ziadni, M. S., Stieg, R. L., Mackey, I. G., Kao, M. C., Flood, P. 2018; 178 (5): 707?8

    View details for PubMedID 29459978

  • CARE Scale - 7: Development and Preliminary Validation of a Measure to Assess Factors Impacting Self-care in Chronic Pain. The Clinical journal of pain Ziadni, M., You, D. S., Wilson, A. C., Darnall, B. D. 2018

    Abstract

    Social and interpersonal factors may impact chronic pain self-care and self-management; however, no integrated measure exists to assess the interplay of these factors. We developed and tested a measure designed to assess salient interpersonal factors, including relationship guilt and worry, and difficulty prioritizing self-care in chronic pain.We tested self-report items broadly relevant to locus of care, limit-setting capacity, and worry/guilt about relationships in 3 discrete chronic pain samples (total N=1,452): (1) online sample of chronic pain clinic patients (N=729; 21 candidate CARE items, sociodemographics, and measures of psychological and physical functioning). Analytic results supported a final 7-item CARE Scale which was next tested in (2) an anonymous online sample of 578 adults with chronic pain. (3) Finally, preliminary validation of the CARE Scale was performed in a tertiary pain clinic sample (N=145).Exploratory factor analysis revealed a 7-item, 2-factor solution (difficulty prioritizing self-care and guilt/worry) that accounted for a combined total of 58% of the variance. CARE Scale-7 had modest convergent validity with pain intensity, pain-related interference, and emotional distress. Extreme difficulty with both factors was reported by about one-third of the total sample, suggesting that relationship factors significantly impact pain management and self-care.Social factors are gaining attention for their influence on the trajectory of chronic pain. The CARE Scale is a brief, integrated measure that may be used to reveal specific interpersonal and personal impediments to self-care, and identify important therapeutic targets to optimize self-management behaviors.

    View details for PubMedID 29554031

  • Comparative Efficacy and Mechanisms of a Single-Session Pain Psychology Class in Chronic Low Back Pain: Study Protocol for a Randomized Controlled Trial Trials Darnall, B., Siadni, M., Roy, A., Kao, M., Sturgeon, J., Cook, K., Lorig, K., Burns, J., Mackey, S. 2018: 165

    Abstract

    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

  • CARE Scale - 7: Development and preliminary validation of a measure assessing factors that impact self-care in chronic pain Clin J Pain Ziadni, M., You, S., Wilson, A., Darnall, B. 2018; March

    View details for DOI 10.1097/AJP.0000000000000606

  • THE EFFECTS OF A STRESS AND EMOTION INTERVIEW FOR WOMEN WITH UROGENITAL PAIN: A RANDOMIZED TRIAL Carty, J., Ziadni, M., Lumley, M., Holmes, H., Tomakowsky, J., Schubiner, H., Dove-Medows, E., Peters, K. M. WILEY-BLACKWELL. 2017: S52

    View details for Web of Science ID 000394664900090

  • Pain catastrophizing, perceived injustice, and pain intensity impair life satisfaction through differential patterns of physical and psychological disruption Scand J Pain Sturgeon, J., Ziadni, M., Zina, T., Darnall, B., Mackey, S. 2017: 390?96

    Abstract

    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

  • Pain catastrophizing, perceived injustice, and pain intensity impair life satisfaction through differential patterns of physical and psychological disruption. Scandinavian journal of pain Sturgeon, J. A., Ziadni, M. S., Trost, Z., Darnall, B. D., Mackey, S. C. 2017; 17: 390?96

    Abstract

    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 PubMedID 29074199

Footer Links:

Stanford Medicine Resources: