Catastrophizing Scores Research Articles

Chronic Pain Patients' Gaze Patterns toward Pain-Related Information: Comparison between Pictorial and Linguistic Stimuli.

Background and Objectives: The attentional bias and information processing model explained that individuals who interpret pain stimuli as threatening may increase their attention toward pain-related information. Previous eye tracking studies found pain attentional bias among individuals with chronic pain; however, those studies investigated this phenomenon by using only one stimulus modality. Therefore, the present study investigated attentional engagement to pain-related information and the role of pain catastrophizing on pain attentional engagement to pain-related stimuli among chronic pain patients by utilizing both linguistic and visual stimulus. Materials and Methods: Forty chronic pain patients were recruited from the rehabilitation center, the back pain clinic, and the rheumatology department of Chung-Ang University Hospital in Seoul, Korea. Patients observed pictures of faces and words displaying pain, presented simultaneously with neutral expressions, while their eye movements were measured using the eye tracking system. A t-test and ANOVA were conducted to compare stimulus pairs for the total gaze duration. Results: Results revealed that chronic pain patients demonstrated attentional preference toward pain words but not for pain faces. An ANOVA with bias scores was conducted to investigate the role of pain catastrophizing on attentional patterns. Results indicated that chronic pain patients with high pain catastrophizing scores gazed significantly longer at pain- and anger-related words than neutral words compared to those with low pain catastrophizing scores. The same patterns were not observed for the facial expression stimulus pairs. Conclusions: The results of the present study revealed attentional preference toward pain-related words and the significant role of pain catastrophizing on pain attentional engagement to pain-related words. However, different patterns were observed between linguistic and visual stimuli. Clinical implications related to use in pain treatment and future research suggestions are discussed.

Spinal Cord Stimulation With Nonlinear Burst Stimulation Design Improves Psychosocial Function Through the Medial Spinothalamic Tract

Abstract INTRODUCTION Tonic spinal cord stimulation (SCS) mainly modulates the lateral spinothalamic tract relaying information for quality and intensity of pain. In contrast, nonlinear burst stimulation affects the lateral, medial, and descending pain pathways. The medial spinothalamic tract has been associated with emotional and motivational aspects of pain, such as pain catastrophizing and suffering. The objective of this prospective, multi-center, single arm trial was to assess functional and psychosocial outcomes after SCS using a burst stimulation design. METHODS Eligible patients with chronic, intractable pain of the trunk and/or lower limbs were enrolled. After a successful trial period, patients received a permanent SCS implant and returned for follow-up at 6 mo. Quality of life (EQ-5D), mental health (PCS, PHQ-9), and physical function (TSK, PROMIS-8) were recorded. RESULTS 173 patients at 21 centers received a permanent implant. We observed an improvement in all functional and psychosocial outcomes compared to baseline (P < .0001). About 74% of patients achieved a result that was equal to (within 10%) or better than the population norm for at least one outcome measure. Specifically, overall quality of life (EQ-5D) improved from 0.4 to 0.7. Mean pain catastrophizing (PCS) score dropped below the population norm (14); 70% of patients who were clinically catastrophizing (score of ≥30) at baseline, were not at 6 mo. Patients who were moderately or severely depressed at baseline (n = 82) showed a clinically significant improvement to mild depression. Patients displayed an improved physical function and reduced kinesiophobia (TSK). Furthermore, 75% of patients were satisfied or very satisfied with their therapy. Finally, 68% (84/123) reduced their opioid usage at 6 mo. CONCLUSION Our study provides additional support for nonlinear burst SCS by showing this therapy improves patients' mental and physical health and quality of life. These results provide evidence that this stimulation design acts upon motivational-affective responses of pain through the medial spinothalamic tract.

Financial Distress Is Associated With Delay in Seeking Care for Hand Conditions.

Background: As medical costs continue to rise, financial distress due to these costs has led to poorer health outcomes and patient cost-coping behavior. Here, we test the null hypothesis that financial distress is not associated with delay of seeking care for hand conditions. Methods: Eighty-seven new patients presenting to the hand clinic for nontraumatic conditions completed our study. Patients completed validated instruments for measuring financial distress, pain catastrophizing, and pain. Questions regarding delay of care were included. The primary outcome was self-reported delay of the current hand clinic visit. Results: Patients who experience high financial distress differed significantly from those who experience low financial distress with respect to age, race, annual household income, and employment status. Those experiencing high financial distress were more likely to report having delayed their visit to the hand clinic (57% vs 30%), higher pain catastrophizing scores (17.7 vs 7.6), and higher average pain in the preceding week (4.5 vs 2.3). After adjusting for age, sex, and pain, high financial distress (adjusted odds ratio [OR] = 4.90) and pain catastrophizing score (adjusted OR = 0.96) were found to be independent predictors of delay. Financial distress was highly associated with annual household income in a multivariable linear regression model. Conclusions: Patients with nontraumatic hand conditions who experience higher financial distress are more likely to delay their visit to the hand clinic. Within health care systems, identification of patients with high financial distress and targeted interventions (eg, social or financial services) may help prevent unnecessary delays in care.

Pain Catastrophizing in College Athletes.

Pain is the most common patient-reported symptom but the perception of pain is complex, differs between individuals and is not directly proportional to the extent of injury. The relationship between aberrant pain coping strategies such as pain catastrophizing and the presence of pain in competitive athletes should be further established to employ the most optimal treatment. The hypotheses were that numeric pain rating and pain catastrophizing (Pain Catastrophizing Scale, PCS) scores would have a moderate to strong relationship in college athletes, and athletes with either a current injury or previous injury, or playing with pain, would have significantly higher pain catastrophizing scores compared with noninjured/nonpainful athletes. Cross-sectional study. III. College athletes completed a demographic form, injury questionnaire, numeric pain rating, and the PCS. All athletes were medically cleared for sports participation at the time of survey completion. A total PCS score was calculated in addition to a rumination, magnification, and helplessness score. Spearman rank was utilized to measure the strength of relationship between the PCS score and pain rating. A total of 291 athletes from 15 different sports completed the questionnaires (males: 156, females: 135; age: 19 [2]y). Negligible correlations existed between the PCS score and pain (r = .27). Athletes who were currently injured or previously injured had significantly higher PCS scores compared with uninjured athletes (P < .01). Approximately one-third of college athletes reported playing injured and/or with pain, but the relationship between pain rating and PCS score was negligible. The individualistic nature of pain perception and coping strategies would suggest that clinicians may want to consider screening for pain catastrophizing either prior to athletic participation or for athletes not following an expected recovery after injury in an effort to enhance individualized patient care.

Transcultural adaptation and French validation of the Pain Sensitivity Questionnaire.

To validate a French translation of the Pain Sensitivity Questionnaire (PSQ), which is a valuable tool to predict an individual's natural disposition to feel pain that could be used after surgery. We studied content validity, internal consistency, convergent validity (anxiety, depression and catastrophism) and test-retest reliability of the French version of the PSQ (PSQ-F) in 146 patients either before scheduled surgery or during pregnancy; then, convergent and concurrent validity in 85 healthy volunteers submitted to nociceptive tests. Internal consistency of the PSQ-F was foundto be excellent, with Cronbach's α at 0.866, 0.886, and 0.927, respectively for its "minor", "moderate" and "total"scores. Test-retest reliability was significant, with intraclass correlation coefficients at 0.629, 0.629, and 0.635, respectively for the above- mentioned scores. These three scores correlated with anxiety, depression and catastrophizing scores in patients, but not in healthy volunteers, possibly because of low and few variant psychometric scores in this group. They were inversely correlated to the temperature needed to evoke heat pain rated 6 out of 10, but not to the mechanical pain threshold (electronic von Frey), nor to the heat pain threshold. Finally, they directly correlated to the pain induced by the cold pressor test (minor and total scores only). This validated version can now be used by French-speaking researchers and physicians. www.ClinicalTrials.gov (NCT03113903); 14 April, 2017.

Pharmacotherapeutic outcomes in atypical odontalgia: determinants of pain relief.

ObjectivesThere has been considerable research which has focused on clarifying the origin of pain in patients with atypical odontalgia (AO), also known as “idiopathic toothache”, and on identifying effective treatment, but there has been limited success so far. In this study, we assessed the outcomes of treatment and attempted to identify factors that could account for pain remission in patients with AO.Patients and methodsData for 165 patients diagnosed with AO from June 2015 to August 2017 were retrospectively reviewed. The patients’ sex, age, duration of pain, and psychiatric history were collected, along with information on pain intensity, depressive status, and catastrophizing scores. Responses at 4 and 16 weeks from the start of treatment were observed. The associations between potentially associated factors and outcome were investigated using Bayesian model averaging.ResultsA 30% reduction in pain was reported by 38 patients (46.3%) at 4 weeks and by 54 patients (65.9%) at 16 weeks. The pain intensity decreased as the depression and catastrophizing score improved; all of the changes were statistically significant (P<0.001). Four elements, that is, patient sex, depression score at baseline, pain score at 4 weeks, and change in the catastrophizing score, explained 52.5% of the variation in final outcome between individual patients.ConclusionOur findings confirm the efficacy of tricyclic antidepressants (TCAs) as a treatment for AO and indicate that other medications, especially aripiprazole used in combination with a TCA, may be useful. A considerable number of patients, especially women, those with lower levels of depression at baseline, and those who responded to 4 weeks of treatment, achieved pain relief.

Risk factors for severe acute pain and persistent pain after surgery for breast cancer: a prospective observational study

Background and objectivesThere are few prospective studies providing comprehensive assessment of risk factors for acute and persistent pain after breast surgery. This prospective observational study assessed patient-related, perioperative, and genetic...

Toward a phenomic analysis of chronic postsurgical pain following cardiac surgery

ABSTRACT Background Despite the same surgical approach, up to 40% of patients develop chronic postsurgical pain (CPSP) following cardiac surgery, whereas the rest are chronic pain free. This variability suggests that CPSP is controlled partially through genetics, but the genes for CPSP are largely unknown. Aims The aim of this study was to identify potential CPSP phenotypes by comparing patients who developed CPSP following cardiac surgery vs. those who did not. Methods A research ethics board–approved, cross-sectional study of post–cardiac surgery pain was conducted at Toronto General Hospital from 2011 to 2015. Patients were recruited to complete a short survey of chronic pain scores and the Short-Form McGill Pain Questionnaire–2. A subset of patients completed a longer survey of eight validated pain phenotyping questionnaires and/or four psychophysical assessments. All surveys and psychophysical testing were conducted after surgery. Patients were stratified by presence of chronic pain and groups were compared using descriptive statistics. Results Six hundred forty-three patients completed the short form survey. The mean postsurgery assessment time was 41.5 (SD = ±25.1) months. Over a quarter (27.8%) reported CPSP at the chest as a consequence of their surgery. Of patients reporting CPSP, 46.6% reported mild pain (0–3), 35.8% reported moderate pain (4–7), and 17.6% reported severe pain (7–10) in accordance with the numerical rating scale. Patients with moderate and/or severe CPSP were younger, had a greater body mass index, and had higher anxiety sensitivity, pain catastrophizing, and somatization scores. Conclusions Chronic pain levels after cardiac surgery are associated with anxiety, catastrophizing, and sensory abnormalities in body parts outside the field innervated by injured nerves, indicating the presence of widespread central sensitization to incoming sensory inputs from intact nerves.

The relationship between childhood trauma and health risk behavior in rural orphans: mediating effect of cognitive emotion regulation

Objective To explore the status of health risk behaviors and its relationships with childhood trauma and cognitive emotion regulation in rural orphans. Methods Totally 56 orphans and 56 non-orphans in rural middle school were surveyed with the adolescent health related risky behavior inventory (AHRBI), the childhood trauma questionnaire (CTQ) and the cognitive emotion regulation questionnaire-Chinese version (CERQ-C). Results (1) Orphans performed significant higher scores in aggression & violence, rule & law breaking, suicide & self-injury, smoking & drinking, health-compromising behaviors and uprotected sex of AHRBI (1.67±0.64, 1.63±0.58, 1.53±0.67, 1.75±0.98, 2.33±0.59, 1.28±0.40, respectively) than non-orphans (1.44±0.36, 1.40±0.29, 1.31±0.36, 1.38±0.48, 2.12±0.43, 1.13±0.19, respectively)(P<0.05). (2) Orphans performed significant higher scores in emotional abuse, physical abuse, emotional neglect and physical neglect (1.88±0.69, 1.62±0.72, 2.89±0.94, 2.33±0.45, respectively) than non-orphans (1.58±0.67, 1.31±0.57, 2.41±1.07, 2.06±0.68, respectively) (P<0.05). (3) Orphans performed significant higher scores in self-blame and catastrophizing (12.34±4.41, 10.25±4.14) than non-orphans (10.86±2.42, 8.36±3.43) (P<0.05), while lower scores in positive refocusing and positive reappraisal (11.27±3.50, 12.55±4.75) than non-orphans (12.63±3.54, 14.45±3.40) (P<0.05). (4) The structural equation models which the cognitive emotion regulation mediated the relationship between health risk behavior and childhood trauma fitted well, and the mediating effects of positive regulation and negative regulation respectively accounted for 15.41% and 68.92% of the total effects. Conclusion The current study suggests that rural orphans tend to adopt negative cognitive emotion regulations to copy with their childhood traumas, thus increasing their risk of health risk behaviors. Key words: Rural orphan; Health risk behavior; Childhood trauma; Cognitive emotion regulation

Pain coping skills training for African Americans with osteoarthritis study: baseline participant characteristics and comparison to prior studies

BackgroundThe Pain Coping Skills Training for African Americans with OsteoaRTthritis (STAART) trial is examining the effectiveness of a culturally enhanced pain coping skills training (CST) program for African Americans with osteoarthritis (OA). This disparities-focused trial aimed to reach a population with greater symptom severity and risk factors for poor pain-related outcomes than previous studies. This paper compares characteristics of STAART participants with prior studies of CST or cognitive behavioral therapy (CBT)-informed training in pain coping strategies for OA.MethodsA literature search identified 10 prior trials of pain CST or CBT-informed pain coping training among individuals with OA. We descriptively compared characteristics of STAART participants with other studies, in 3 domains of the National Institutes of Minority Health and Health Disparities’ Research Framework: Sociocultural Environment (e.g., age, education, marital status), Biological Vulnerability and Mechanisms (e.g, pain and function, body mass index), and Health Behaviors and Coping (e.g., pain catastrophizing). Means and standard deviations (SDs) or proportions were calculated for STAART participants and extracted from published manuscripts for comparator studies.ResultsThe mean age of STAART participants, 59 years (SD = 10.3), was lower than 9 of 10 comparator studies; the proportion of individuals with some education beyond high school, 75%, was comparable to comparator studies (61–86%); and the proportion of individuals who are married or living with a partner, 42%, was lower than comparator studies (62–66%). Comparator studies had less than about 1/3 African American participants. Mean scores on the Western Ontario and McMaster Universities Osteoarthritis Index pain and function scales were higher (worse) for STAART participants than for other studies, and mean body mass index of STAART participants, 35.2 kg/m2 (SD = 8.2), was higher than all other studies (30–34 kg/m2). STAART participants’ mean score on the Pain Catastrophizing scale, 19.8 (SD = 12.3), was higher (worse) than other studies reporting this measure (7–17).ConclusionsCompared with prior studies with predominantly white samples, STAART participants have worse pain and function and more risk factors for negative pain-related outcomes across several domains. Given STAART participants’ high mean pain catastrophizing scores, this sample may particularly benefit from the CST intervention approach.Trial registrationNCT02560922

28 Comorbid Psychological Factors in Emergency Department Patients With Low Risk Chest Pain Associated With Anxiety

Anxiety is thought to be a significant contributor to chest pain symptoms in approximately 40% of patients with low risk chest pain seen in the emergency department (ED). The validated Hospital Anxiety Depression Scale - Anxiety subscale (HADS-A) has been used as an anxiety screening tool in this population. These patients have been shown to have persistent anxiety symptoms at follow-up and significantly higher ED utilization. The objective of this study was to determine the prevalence of abnormal anxiety levels in a cohort of low-risk chest pain patients and characterize their comorbid psychological contributors. We hypothesized that those with abnormal anxiety scores would have worse concomitant depression, optimism and pain catastrophizing scores in addition to experiencing more life trauma. This was a pre-planned secondary analysis of a single-center, prospective observational cohort study of ED subjects with low risk chest pain. Eligible subjects between 18 and 70 years old with no history of acute coronary syndrome (ACS) and a physician-reported HEART score < 4, were enrolled. The HADS-A was used to stratify participants into 2 groups: Low Anxiety (score<8) and High Anxiety (score≥8). Outcomes assessed included concomitant depression via the Hospital Anxiety Depression Scale - Depression subscale (HADS-D), previous trauma (Traumatic Life Events Questionnaire), optimism (Life Optimism Test-Revised), and pain catastrophizing (Pain Catastrophizing Scale). These groups were analyzed and compared using t-tests for continuous data and chi-square for proportional/categorical data. Of 442 screened subjects, 304 met enrollment criteria and 163 (36.8%) gave informed consent. Seventy-six (47%) were stratified into the High Anxiety group with a score≥8. There were no differences in baseline demographics between groups. Overall, there was a moderate positive correlation between HADS-A and HADS-D scores with a Pearson’s R of 0.519. Thirty percent of all subjects had abnormal depression scores ≥8 on the HADS-D and 35 subjects (45%) had both abnormal anxiety as well as depression. Mean depression scores were significantly different between the low anxiety and high anxiety groups (3.64, 95% CI 2.17 to 5.10). Traumatic experiences of assault with a weapon (p=0.000), physical assault (p=0.012), sexual assault (p=0.046), witnessing fire (p=0.034), natural disaster (p=0.035) were all associated with abnormal levels of anxiety. However, only sexual assault (p=0.030) and other unwanted sexual encounters (p=0.040) were associated with abnormal levels of depression. Optimism was negatively correlated with both anxiety (R=-0.489) and depression (R=-0.504). Additionally, optimism was significantly lower for subjects with either abnormal anxiety (mean difference of 3.86, 95% CI 2.46 to 5.26) or abnormal depression (mean difference 4.32, 95% CI 2.80 to 5.83). Pain catastrophizing was also significantly higher in subjects with either abnormal anxiety or depression (p=0.000). The prevalence of abnormal levels of anxiety in our low risk chest pain cohort was 47%. These patients were more likely to have concurrent symptoms of depression, multiple traumatic exposures, a less optimistic outlook, and a pain catastrophizing phenotype. These data indicate there may be an opportunity to address these problems in many low risk chest pain patients as a best practice.

Pain Self-Management: Easier Said than Done? Factors Associated with Early Dropout from Pain Self-Management in a Rural Primary Care Population.

To explore whether psychosocial or demographic factors are associated with early dropout from pain self-management in a rural, low-socioeconomic status population. Secondary analysis of retrospective data. Multidisciplinary pain clinic located in an outer regional area of Australia. One hundred eighty-six people attending a public community health center with chronic noncancer pain (mean age 54.9 years; 58.1% women; 81.7% in receipt of government benefit as their primary source of income). Bivariate analysis and logistic regression, with early dropout as the dependent variable and a range of demographic and psychological independent variables. Following bivariate analysis, early dropout was significantly associated (P < 0.05) with male gender, younger age, history of substance use, being a past victim of assault/abuse, receiving unemployment or disability benefit, having literacy difficulties, higher pain catastrophizing score, higher daily opioid dose, and not holding a multifactorial belief about the cause of pain. Logistic regression analysis resulted in three significant predictors of dropout: substance use history (P = 0.002), past victim of assault or abuse (P = 0.029), high pain catastrophising score (P = 0.048); and one of engagement: holding a multifactorial belief about pain cause (P = 0.005). In a rural, low-socioeconomic status population, addressing social stressors related to lifetime adversity may be important to increasing engagement in pain self-management. Lack of attention to these factors may increase health inequity among those most disabled by chronic pain. Further research into dropout and engagement, especially among disadvantaged populations, is recommended.

Pain Related Psychological Factors Influence Postoperative Opioid Use After Ambulatory Hand Surgery

Grant support received from: 2016 AFSH Residents and Fellows Fast Track Grant Consulting Fee: Medartis (Fufa) Contracted Research: Medatis (Fufa) Pain related psychological factors, including pain catastrophization and dispositional mindfulness, have been shown to influence patient pain levels and outcomes after orthopedic surgery. Less is known about the relationship between these factors and postoperative opioid use after hand surgery. The purpose of this study is to examine the association between preoperative pain catastrophization and mindfulness and postoperative opioid use in patients undergoing ambulatory hand surgery. Patients undergoing ambulatory hand surgery at our institution between May 2017 and January 2018 were prospectively enrolled in an ongoing clinical trial. Procedures (Figure 4-1) were separated into 2 tiers based on anticipated postoperative pain. Patients completed the Pain Catastrophizing Scale (PCS) and Mindfulness Attention Awareness Scale (MAAS) preoperatively (Figure 4-2A). Patients completed a pain medication diary for 2 weeks postoperatively and were contacted on postoperative days 3, 8, and 15 to review their medication usage and pain levels. Spearman’s correlations and Mann Whitney U tests were performed to evaluate the association between PCS/MAAS scores and postoperative opioid use, average patient-reported pain levels, and refill rates (Figure 2B). A total of 71 patients (57% male), mean age 60.2, were included in the analysis (46.4% tier 1 procedures, 53.5% tier 2 procedures). The average total number of opioids used at 2 weeks postoperatively across all procedures was 6.78 pills (range 0-49). Age and sex were not associated with postoperative opioid use. Tier 2 procedures were associated with increased postoperative opioid use, higher average postoperative week 1 pain, and higher refill rates (P = .05) (Figure 4-2B). •Patients demonstrating higher pain catastrophizing scores preoperatively used more opioids postoperatively after a range of ambulatory hand surgeries.•In the setting of the opioid epidemic, hand surgeons should be aware of pain-related psychological factors that can influence postoperative opioid use.•Further studies evaluating predictors of postoperative opioid use may help identify patients for preoperative pain education and pain coping/reduction techniques.Figure 4-2APain Catastrophizing and Mindfulness Attention Awareness Scale Scores (†: PCS= Pain Catastrophizing Scale. Range of scale is 0-52; MAAS= Mindfulness Attention Awareness Scale. Range of scale is 1-6.)View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 4-2BAssociation between PCS/MAAS Score and Postoperative Pain and Opioid use (€= Median [range] for continuous variables, Number of patients [% of cohort] for categorical variables, ρ= Spearman’s correlation coefficient; *= significant P values are defined as <.05Show full caption; ♮= Median [Range])View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT) ; ♮= Median [Range]) This research was supported by a Residents & Fellows Fast Track Grant from the American Foundation for Surgery of the Hand.

Chronic Pain After Breast Surgery: A Prospective, Observational Study.

Chronic pain is an important complication of breast surgery, estimated to affect 20-30% of patients. We prospectively examined surgical, demographic, and psychosocial factors associated with chronic pain 6months after breast surgery. Patients undergoing breast surgery for benign and malignant disease preoperatively completed validated questionnaires to assess baseline pain and psychosocial characteristics. Pain at 6months was quantified as the Pain Burden Index (PBI), which encompasses pain locations, severity, and frequency. Surgical type was categorized as breast-conserving surgery (BCS), mastectomy, and mastectomy with reconstruction; axillary procedure was categorized as no axillary surgery, sentinel lymph node biopsy (SLNB), and axillary dissection. PBI was compared between groups using one-way analysis of variance (ANOVA) or Kruskal-Wallis ANOVA, and the relationship between baseline demographic and psychosocial factors and PBI was assessed using Spearman's Rank Correlation. p < 0.05 was considered significant. PBI was variable amongst patients reporting this endpoint (n = 216) at 6months, but no difference was found between primary breast surgical types (BCS, mastectomy, and mastectomy with reconstruction) or with surgical duration. However, axillary dissection was associated with higher PBI than SLNB and no axillary procedure (p < 0.001). Younger age (< 0.001) and higher BMI (p = 0.010), as well as higher preoperative anxiety (p = 0.017), depression (p < 0.001), and catastrophizing scores (p = 0.005) correlated with higher 6-month PBI. Amongst surgical variables, only axillary dissection was associated with greater pain at 6months after surgery. Patient characteristics that were associated with higher PBI included lower age and higher BMI, as well as higher baseline anxiety, depression, and catastrophizing.

Pain catastrophizing behaviors and their relation to poor patient-reported outcomes after scapular muscle reattachment

We hypothesized that the patient-reported status following treatment of traumatic scapular muscle detachment would improve from the preoperative status and that higher pain catastrophizing scores would be more common in patients with poor postsurgical outcomes. We studied 50 patients who met the diagnostic criteria for scapular muscle detachment and in whom rehabilitation failed. American Shoulder and Elbow Surgeons (ASES) scores were collected preoperatively and postoperatively. Patients completed a 7-point global rating of change scale, the Pain Catastrophizing Scale (PCS), and a 10-point satisfaction scale (0-3, not satisfied [NS]; 4-6, moderately satisfied [MS]; or 7-10, highly satisfied [HS]) focused on current shoulder use. Statistical analyses compared preoperative and postoperative ASES scores, compared the 3 levels of satisfaction and ASES scores, and compared ASES scores in patients with low PCS scores (LPCS) (<20) versus high PCS scores (HPCS) (≥20). Significance was set at P < .05. ASES scores significantly improved following surgery (42 ± 20 preoperatively and 73 ± 21 postoperatively) (P < .001), and the global rating of change score was 2 ± 2. There were 39 LPCS patients (mean PCS, 7 ± 6) and 11 HPCS patients (mean PCS, 34 ± 8). HPCS patients had significantly lower postoperative ASES scores (53 ± 18) than LPCS patients (79 ± 18) (P < .001). The MS patients (n = 11) had significantly higher ASES scores than the NS patients (n = 10) (P = .003), while the HS patients (n = 29) had significantly greater ASES scores than the other groups (P ≤ .001). Of the HPCS patients, 90% were in the NS and MS groups compared with 10% in the HS group. Surgical restoration for scapular muscle detachment can result in meaningful improvement in outcomes. Pain catastrophizing negatively affected the self-reported outcome scores.

Chronic pelvic pain - pain catastrophizing, pelvic pain and quality of life.

Background and aims Chronic pelvic pain (CPP) impacts significantly on the lives of women. Negative coping responses such as pain catastrophizing are thought to be significant in predicting both pain severity and outcome. The combined effect of the individual's response to pain and its severity on their quality of life (QoL) has not been well studied in women with CPP. Aims were to determine the prevalence of pain catastrophizing in women with CPP and to examine the associations between pain catastrophizing and levels of dysmenorrhea, non-cyclical pelvic pain, dyspareunia, dysuria, dyschezia and QoL. Methods A cross-sectional study including women aged 18-50 years, referred to a tertiary gynecology outpatients department at an Australian women's hospital in 2015. Participants completed questionnaires including: pain catastrophizing scale (PCS); pelvic pain levels in the prior 3 months; and the World Health Organisation Quality of life - Bref Questionnaire (WHOQoL-Bref). Statistical analysis was performed using STATA (StataCorp, USA Version13). Results Participants (n = 115) had a median age of 29.0 [interquartile range (IQR): 23.0-38.0] years. The Pain catastrophizing score revealed that 60/113 [95% confidence interval (CI): 48.6, 71.2] of participants had a clinically relevant total score ≥30. There were statistically significant positive correlations between pain catastrophizing scores and pelvic pain levels in all five pain categories studied, dysmenorrhea (ρ = 0.37, p = 0.0001), non-cyclical pelvic pain (ρ = 0.46, p<0.0001), dyspareunia (ρ = 0.32, p = 0.0008), dysuria (ρ = 0.32, p = 0.0005) and dyschezia (ρ = 0.38, p = 0.0012). Participants who reported maximal pain levels (5/5) had significantly higher median pain catastrophizing scores when compared to those who reported no pain (0/5) in all categories. Overall QoL was considered as "good" in 71/113 (95% CI: 60.1, 81.0) participants and "poor" in 42/113 (95% CI: 32.0, 53.0) participants. Comparison to Australian female norms revealed significantly lower QoL scores in the physical domain, across all ages, and in psychological domain for those aged <30 and 30-40 years. There was a significant association between increased catastrophizing scores and reduced odds of good QoL. An increase in PCS by one point is associated with a 6.3% decrease in the odds of good QoL [odds ratio (OR) per one-point increase: 0.94 (95% CI: 0.89, 0.98), p = 0.008]. Conclusions Pain catastrophizing is prevalent at clinically relevant levels in women with CPP across all domains. It is associated with higher pain levels and decreased QoL. Implications There is potential for further studies to investigate the predictive nature of pain catastrophizing and management targeting catastrophizing to improve outcomes in women with CPP.

Do mHealth interventions at the bedside work?—a pilot intervention for pediatric patients admitted with pain complaints

Background: Pediatric admissions for pain have been increasing, and pediatric consultation-liaison (CL) psychologists are frequently consulted to address pain coping for hospitalized youth. Many apps have been developed to target pain coping strategies, but no specific intervention has been developed to target pain coping using mobile health (mHealth) at the bedside. We describe an innovative, pilot, proof of concept mHealth intervention program using clinical apps to target pain coping strategies in youth referred for a pediatric psychology consult during their hospitalization. Methods: Parent-child dyads (n=18, youth ages 7–19) completed measures assessing the child’s pain history, pain catastrophizing, and pain interference during their child’s inpatient admission. Participants were loaned a tablet and prescribed specific clinical apps as part of their psychology consult to target pain coping. Youth tracked the frequency and duration of clinical app use. At about 2 weeks post-discharge families (n=10) completed a satisfaction survey about their experience with the intervention and again completed the pain outcome measures administered at baseline. Results: The clinical apps were used frequently during the hospitalization, primarily for relaxation. Youth who tracked their app use in the hospital were more likely to participate at Time 2. There was significant attrition from enrollment to Time 2. There were no changes in pain level from Time 1 to Time 2. Pain catastrophizing scores for youth decreased significantly at the follow-up interval. Most participants felt that the clinical apps helped with inpatient pain management and 70% continued to use the clinical apps after discharge. Parents universally would recommend the mHealth intervention to other families. Conclusions: The feasibility of this proof of concept intervention is mixed. The intervention was acceptable to our CL team, we had no implementation issues, and there were high levels of acceptability and accessibility for patients. However, attrition from across time points presents a challenge to interpretation of results and highlights the difficulty in implementing such an intervention with a high acuity population. Further research is needed to better describe the impact of clinical apps use on post-discharge outcomes, but this mHealth pilot showed promise as an adjunct to standard inpatient CL interventions for pediatric pain.

(173) - The relationship between catastrophizing, anxiety, and sleep quality in fibromyalgia

Fibromyalgia (FM) is a chronic musculoskeletal pain condition that affects 2–4% of the population and is characterized by anatomically widespread pain symptoms accompanied by fatigue, disturbed sleep and mood. In patients with fibromyalgia (FM), catastrophizing is related to greater pain severity, amplified pain sensitivity as well as higher anxiety that can disturb sleep. Understanding catastrophizing's mechanisms of action, therefore, would potentially provide valuable scientific information as well as pragmatic, treatment-related benefits in relation to sleep. In the present study we explored the relationship between daily catastrophizing, anxiety and sleep quality. We used a diary-based micro-longitudinal design to examine this question in fibromyalgia patients. Patients completed daily surveys of fibromyalgia pain, symptoms, sleep and catastrophizing for a period of 7 days. Multilevel modeling (MLM) analyses indicated that, as expected, high scores on catastrophizing were associated with lower levels of daily quality of sleep (B = -.12, p < .01) as well as higher daily anxiety symptoms. Interestingly, however, anxiety was not found to be associated directly with sleep quality (p > .05). Results of a multilevel moderation analysis revealed that the association between anxiety and sleep quality was moderated by catastrophizing (B = -.004, p < .05) such that patients with both relatively higher catastrophizing scores and high levels of anxiety reported by far the lowest quality of sleep.

Temporomandibular Disorders Related to Stress and HPA-Axis Regulation.

Temporomandibular disorders (TMDs) are characterized by pain and dysfunction in the masticatory apparatus and the temporomandibular joint (TMJ). Previous trauma, stress symptoms, psychosocial impairment, and catastrophizing have been related to TMD. To assess if the hypothalamic-pituitary-adrenal (HPA) axis is upregulated in TMD patients, we performed a cross-sectional study with saliva from 44 TMD patients and 44 healthy sex- and age-matched controls for cortisol (F) and cortisone (E) with liquid chromatography-tandem mass spectrometry. Furthermore, we calculated the F/E ratio for the evaluation of 11β-hydroxysteroid dehydrogenase activity. We also assessed anxiety/depression and pain catastrophizing scores from a questionnaire that participants completed prior to the examination. We found that F (P=0.01), E (P=0.04), the F/E ratio (P=0.002), and the sum of glucocorticoids (E + E) in saliva (P=0.02) were significantly higher in the TMD group. Anxiety/depression and catastrophizing scores were also significantly higher in the TMD group (P < 0.0001). Our findings indicate that patients with TMDs may have an upregulated HPA axis with higher F secretion from the adrenal cortex. Anxiety/depression and pain catastrophizing scores were significantly higher in the TMD group, and psychological factors may contribute to chronic upregulation of the HPA axis.

Association of Pain Quality with Pain Catastrophizing and Self-efficacy in People with Knee Osteoarthritis.

Patients with chronic pain often have symptoms similar to neuropathic pain (NeP). Such symptoms are also frequently observed in people with knee osteoarthritis (OA). However, pain quality may be related to psychological problems such as high pain catastrophizing and/or low self-efficacy. The objective of the current study was to investigate whether pain quality is associated with pain catastrophizing and self-efficacy in individuals with symptomatic knee OA. This was a cross-sectional study in which 50 subjects with symptomatic knee OA were enrolled. NeP scores were evaluated using the painDETECT questionnaire (PDQ), the pain catastrophizing scores were evaluated using the coping strategy questionnaire, and the self-efficacy scores were evaluated using the self-efficacy scale for rheumatoid arthritis (SERA). Participants were classified as members of the unlikely NeP group (PDQ score ≤12) or the uncertain/likely NeP group (PDQ score >12). The pain catastrophizing scores and the self-efficacy scores were compared between the two groups. Of the 50 participants, 17 (34%) were classified in the uncertain/likely NeP group. The pain catastrophizing score was higher for the uncertain/likely NeP group (6.2 ± 3.3) than for the unlikely NeP group (4.5 ± 2.8; P=0.03). On the SERA scale, the self-efficacy for pain score was lower for the uncertain/likely NeP group (21.9 ± 3.1) than for the unlikely NeP group (24.2 ± 3.1; P=0.03). High pain catastrophizing and low self-efficacy for pain control are significantly associated with the existence of an NeP component on PDQ in people with symptomatic knee OA.