Chronic Pain Program Research Articles

Experience-based design: Empowering individuals while they wait for interprofessional chronic pain care

ObjectivesChronic pain is highly prevalent and a leading cause of disability. Long wait times for interprofessional care provide an opportunity to introduce web-based interventions that improve psychosocial function and patients’ readiness and ability to manage their condition. Here we describe the process of partnering with people with lived experience (PWLE) to develop an online self-management program enhanced by motivational interviewing. We also report the multiphase usability testing of the program. MethodsPWLE were included in all aspects of this project from program inception to content creation, module development, usability testing, and knowledge dissemination. Phase 1 included the development of the interactive, web-based modules. This process involved weekly meetings and asynchronous content creation with a core team of interprofessional pain experts, researchers, and PWLE. Phase 2 included usability testing by our PWLE and clinical expert advisory. Phase 3 included survey-based usability testing with a sample of 10 PWLE. ResultsWe created a chronic pain & motivational empowerment program includes a series of eight interactive educational web-based modules. Topics included: setting expectations, chronic pain explained, biopsychosocial factors, empowered management, self-awareness & compassion & acceptance, values, goal setting, and communication. The program is accompanied by a reflection journal and can be enhanced by one-on-one coaching sessions using a motivational interviewing approach. Phase two usability testing resulted in numerous content changes and the addition of accessibility features. Phase 3 usability testing with PWLE found the program highly accessible and easy to use. ConclusionsThe engagement of our PWLE team member and advisors made the online program more relevant, sensitive and helpful to the needs of people with pain. Practical valueThis PWLE-centric project sets the foundation for future work to examine the feasibility and effectiveness of the program for supporting individuals with chronic pain self-manage.

The Sensitivity to Pain Traumatization Scale–Child Version (SPTS-C): Development and preliminary validation

ABSTRACT Background Sensitivity to pain traumatization is defined as the propensity to develop cognitive, affective, and behavioral responses to pain that resemble a traumatic stress reaction. To date, sensitivity to pain traumatization has been assessed in adults (Sensitivity to Pain Traumatization Scale [SPTS-12]) and parents of youth with chronic pain (Sensitivity to Pain Traumatization Scale–Parent version [SPTS-P]). SPT may be relevant in the context of pediatric chronic pain given the substantial comorbidity between posttraumatic stress symptoms and pain. Aims This prospective study aimed to adapt the SPTS-12 for use in youth and to evaluate the psychometric properties of the new scale. Methods Participants included 175 youth with chronic pain (M age = 14.31 years, 73% girls) referred to outpatient chronic pain programs. At baseline, youth self-reported the levels of their sensitivity to pain traumatization (Sensitivity to Pain Traumatization Scale–Child version [SPTS-C]), as well as their pain symptoms, pain-related anxiety, posttraumatic stress symptoms, and attentional control. Three months later, youth self-reported their pain symptoms and completed the SPTS-C. Results The SPTS-C had a one-factor structure that explained 48% of variance and demonstrated good reliability and construct validity. SPTS-C baseline scores predicted follow-up levels of pain interference but not pain intensity or pain unpleasantness. Conclusions The results provide preliminary evidence for the psychometric properties of the SPTS-C and the potential role of SPT in pediatric chronic pain outcomes.

Impact on productivity impairment of a digital care program for chronic low back pain: A prospective longitudinal cohort study

BackgroundLow back pain (LBP) is the leading cause of disability in the United States and the main reason for absenteeism. Successful management of chronic LBP (CLBP) is dependent on multimodal evidence-based interventions. Digital interventions (DI) may ease accessibility to such treatments, increasing adherence, while reducing healthcare-related costs. ObjectivesAssess the impact of a completely remote multimodal DI on productivity impairment in a real-work context cohort of patients with CLBP. DesignLongitudinal study. MethodsAd-hoc analysis of an interventional, single-arm study of individuals with CLBP undergoing a DI for 12 weeks. Outcomes included the mean change in work productivity and activity impairment (including overall and non-work related activities), pain, depression, anxiety, fear-avoidance beliefs, analgesic usage, and engagement. Minimal clinically important change (MCIC) was calculated for productivity using anchor- and distribution-based methods. ResultsFrom 560 patients at program start, 78.4% completed the DI. A significant improvement in overall productivity (20.21, 95%CI: 16.48–23.94) and in non-work related activities (21.36, 95%CI: 17.49–25.22) was observed, corresponding to a responder rate of 57.1–83.3% and 60.5–79.8%, respectively, and depending on the MCIC method. Significant improvements were reported for pain (2.32 points, 95%CI: 2.02–2.61), anxiety (5.24, 95%CI: 4.18–6.29), depression (6.38, 95%CI: 4.78–7.98) and fear-avoidance beliefs (8.11, 95%CI: 6.20–10.02). Both engagement (sessions per week) and patient satisfaction scores were high, 2.9 (SD 1.0) and 8.8/10 (SD 1.6), respectively. ConclusionsThis study demonstrated the utility of a multimodal DI to address productivity impairment. DIs have great potential to ease the burden of CLBP, providing an accessible and cost-effective modality of care. Trial registrationThe study was approved by the New England IRB (protocol number 120190313) and prospectively registered in ClinicalTrials.gov, NCT04092946, on September 17th, 2019.

Analysis of the Utah Department of Health's Living Well with Chronic Pain program.

Wyatt, Waliah; Duarte, Teresa; Falcon, David; Harkin, Cameron; Coombs, Jennifer PhD, PA-C Author Information

Association Between Intracompartmental Pressures in the Deep Posterior Compartment of the Leg and Conservative Treatment Outcome for Exercise-Related Leg Pain in Military Service Members

To evaluate the relationship between intracompartmental pressure (ICP) values of the deep posterior compartment and the outcomes of a comprehensive conservative outpatient treatment program in service members with chronic exercise-related leg pain. Historic cohort study. Department of sports medicine at a military secondary care facility. During the 5-year study period, 266 military patients completed a treatment program for chronic exercise-related leg pain. Eighty-three service members with 145 affected legs met all inclusion criteria (N=83; 59 men, 24 women; median age, 22 years). The primary outcome measure was return to active duty. The secondary outcome measure was development of acute on chronic compartment syndrome. A generalized linear mixed model was used to identify predictor variables associated with return to active duty, including ICP values of the deep posterior compartment and Single Assessment Numeric Evaluation (SANE) score. Sixty service members (72%) successfully returned to active duty. No association between ICP values of the deep posterior compartment and treatment outcome was found (odds ratio, 1.02; 95% confidence interval, 0.97-1.07; P=.50). A low SANE score (ie, more severe symptoms at baseline) was negatively associated with primary outcome (odds ratio, 0.95; 95% confidence interval, 0.90-0.99; P=.01). None of the patients developed acute on chronic compartment syndrome during the treatment program. There was no association between a single postexercise ICP value of the deep posterior compartment of both legs in military service members and return to active duty after a comprehensive conservative outpatient treatment program. None of the patients developed acute on chronic compartment syndrome. In this population, ICP measurement of the deep posterior compartment can be safely postponed until conservative treatment fails and surgical treatment is considered.

Will This Treatment Help My Child?: How Parent/Caregiver Treatment Expectations Relate to Intensive Pain Rehabilitation Outcomes for Youth With Chronic Pain.

An extensive body of research has highlighted the impact that parent/caregiver factors have on functioning and treatment outcomes among youth with chronic pain. However, parent/caregiver expectations in pain treatment have been largely understudied, despite strong evidence that treatment expectations are associated with treatment engagement and overall outcomes in nonpain populations. Accordingly, the primary aim of this investigation was to preliminarily examine the manifestation and measurement of parent/caregiver treatment expectations in an intensive interdisciplinary pediatric pain treatment (IIPT) setting. Participants in this study (N=328) included children and adolescents who attended an IIPT program for chronic pain between August 2013 and March 2020 and their parent/caregiver(s). Outcomes examined include parent/caregiver self-report of treatment expectations for their child upon admission to the IIPT in addition to pain-related and psychosocial factors at admission and discharge. Findings revealed a high level of expectations (ie, belief that the treatment will be helpful) on average, with higher parent/caregiver expectations associated with poorer functioning at admission to and discharge from the IIPT program. Extremely high treatment expectations among parents of more disabled youth may be indicative of unrealistic hopes or the "need" for IIPT to help their child; tempering parental expectations with psychoeducation about IIPT goals and realistic outcomes may indirectly improve treatment outcomes for their children. Future research should examine the potentially unique and important role that treatment expectations, of both parent/caregivers and their children, may have in overall IIPT outcomes.

Patient Outcomes from Multidisciplinary Chronic Pain Programs in Safety Net Clinics: A Scoping Review.

Patients within the safety net, defined as gap healthcare services for un- or under-insured persons, disproportionately suffer high impact chronic pain. The purpose of this review was to examine pain-related outcomes from multidisciplinary programs for patients with chronic pain within the safety net. A scoping review was conducted based on the Arksey and O'Malley framework coupled with the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Scoping Review checklist. CINAHL, MEDLINE, PubMed, and Google Scholar were searched for eligible articles published between January 1, 2010, and December 31, 2020. Grey literature was searched by typing relevant keywords into Google. Quantitative and qualitative outcomes were included. Data collected were charted and analyzed. Ten articles were included, with five demonstrating primarily quantitative results, three demonstrating primarily qualitative results, and the remaining two demonstrating primarily mixed results. Of the studies that utilized qualitative measures, themes included reduction in pain symptoms and the positive reception of a group-based pain management approach. Of the studies that employed quantitative measures, most demonstrated improvements in pain-related outcomes post-intervention, although not all statistically significant. Multidisciplinary pain programs may be of benefit to safety net patients with chronic pain. Further data collection is needed to determine the efficacy of these programs.

The therapeutic effect of the multidisciplinary inpatient pain management program for chronic musculoskeletal pain classified by ICD–11J

The therapeutic effect of the multidisciplinary inpatient pain management program for chronic musculoskeletal pain classified by ICD–11J

Evaluation of a non-pharmacological interdisciplinary pain rehabilitation and functional restoration program for chronic pain in veterans.

To conduct a quality improvement evaluation of the Empower Veterans Program (EVP), an interdisciplinary pain rehabilitation/functional restoration program option for functional restoration for high-impact chronic pain, offered in a large metro-area Veterans Health Administration (VHA) system. VHA Corporate Data Warehouse electronic medical record data for patients treated by EVP between 2015 and 2019. This retrospective design first compared EVP patients considered engaged or not engaged in completing treatment in terms of demographic characteristics and post-treatment changes in clinical measures related to opioid use and mental health. We then compared mortality risk between matched groups of treated and untreated patients with chronic pain and concurrent opioid prescriptions using propensity score matching and Cox proportional hazards methods. "Treated" in the matched groups was defined as any level of EVP participation (i.e., both engaged and not engaged). We first identified 1053 EVP patients with 1year of pre-and post-treatment follow-time and determined their engagement level. From those with chronic pain and prescription opioids, we matched 237 EVP patients to 375 untreated patients. Engaged patients (57.4% of treated patients), were somewhat older than the non-engaged (mean age 57.1 vs. 53.7, Cohen's D=0.30), and achieved lower mean PHQ9 depression scores in the post-treatment year (9.2 vs. 10.6, Cohen's D=0.20). Participation in EVP was associated with a 65% lower mortality risk among Veterans with chronic pain and opioid use when compared to the untreated patients: (HR: 0.35, 95% CI: 0.17, 0.75). EVP was associated with a large reduction in mortality risk for Veterans with both chronic pain and opioid use. This result could inform the decision process in a VA station or region when considering providing or expanding access to an interdisciplinary rehabilitation/functional restoration program for chronic pain.

Internet-Delivered Cognitive Behavioural Therapy for the Management of Chronic Non-Cancer Pain


 This Health Technology Assessment (HTA) was conducted to inform decision-makers about whether internet-delivered cognitive behavioural therapy (iCBT) should be offered as a treatment option for chronic non-cancer pain as part of a multidisciplinary approach when in-person cognitive behavioural therapy (CBT) would otherwise be offered. This HTA consists of a systematic review of clinical effectiveness and safety, an interview study, and an Environmental Scan.
 In this HTA, iCBT is defined as psychotherapy based on CBT principles delivered through the internet, including self-directed app-based programs (with or without therapist support) and CBT delivered through the internet in real time by a therapist (e.g., videoconference).
 The Clinical Review found there was little to no difference between iCBT and in-person CBT for most outcomes, but the evidence was very uncertain because of risk of bias, inconsistency, indirectness, and imprecision. The uncertain clinical evidence prevents a strong conclusion about the safety and effectiveness of iCBT as a treatment option when in-person CBT would otherwise be offered for chronic non-cancer pain.
 Five women living with chronic non-cancer pain were interviewed regarding their experiences with, or perspectives on, the use of iCBT for chronic pain. All the women interviewed felt iCBT has the potential to be a supportive treatment option if offered as part of comprehensive, multidisciplinary pain care. Based on their experiences, the women interviewed reported that multidisciplinary pain care does not always happen in practice, and they described potential concerns of offering iCBT in the absence of other treatments. They also indicated that determining a patient’s readiness for iCBT is important. If iCBT is determined to be appropriate, the women emphasized that a tailored treatment approach and a strong therapeutic relationship between the patient and iCBT provider might improve the success of iCBT treatment for chronic pain.
 The Environmental Scan identified 16 iCBT programs for chronic pain that are available in Canada. Many potential facilitators (e.g., improving access, improving treatment experience, efficiency, and convenience) and barriers (preference for in-person treatment, privacy concerns, technology issues, and no access to a device or internet connection) for iCBT programs in Canada were identified.
 If decision-makers decide to implement an iCBT program for chronic pain as part of their multidisciplinary pain care approach, they may wish to consider offering programs that:
 
 are guided by therapists specifically trained in chronic pain
 foster strong therapeutic relationships, encourage shared decision-making practices, and can be tailored to the needs of the person living with chronic pain
 consider the readiness and suitability of the person living with chronic pain before offering iCBT
 consider privacy and technological concerns or challenges.
 
 

Attaining expert consensus on diagnostic expectations of primary chronic pain diagnoses for patients referred to interdisciplinary pediatric chronic pain programs: A delphi study with pediatric chronic pain physicians and advanced practice nurses.

Pediatric primary chronic pain disorders come with diagnostic uncertainty, which may obscure diagnostic expectations for referring providers and the decision to accept or re-direct patients into interdisciplinary pediatric chronic pain programs based on diagnostic completeness. We aimed to attain expert consensus on diagnostic expectations for patients who are referred to interdisciplinary pediatric chronic pain programs with six common primary chronic pain diagnoses. We conducted a modified Delphi study with pediatric chronic pain physicians, nurse practitioners and clinical nurse specialists to determine degree of importance on significant clinical indicators and diagnostic items relevant to each of the six primary chronic pain diagnoses. Items were identified through point of care databases and complimentary literature and were rated by participants on a 5-point Likert scale. Our consensus threshold was set at 70%. Amongst 22 experts across 14 interdisciplinary programs in round one and 16 experts across 12 interdisciplinary programs in round two, consensus was reached on 84% of diagnostic items, where the highest degree of agreement was with Complex Regional Pain Syndrome (CRPS), Type 1 (100%) and the lowest with chronic pelvic pain (67%). This study demonstrated a general agreement amongst pediatric chronic pain experts regarding diagnostic expectations of patients referred to interdisciplinary chronic pain programs with primary chronic pain diagnoses. Study findings may help to clarify referral expectations and the decision to accept or re-direct patients into such programs based on diagnostic completeness while reducing the occurrence of unnecessary diagnostic tests and subsequent delays in accessing specialized care.

Factors Associated With the Presence of Co-occurring Pain and Substance Use Disorder Programs in Substance Use Treatment Facilities.

The rise in deaths related to substance use has caused a push toward linking patients to pharmacological maintenance treatment and, when appropriate, to residential substance use treatment facilities. One of the underlying issues in a subset of patients with substance use disorder (SUD) is chronic pain. We evaluated the prevalence and characteristics of those facilities that offer treatment programs tailored for patients with co-occurring pain and SUD. This study was a retrospective review of data collected by the National Survey of Substance Abuse Treatment Services in 2019. The National Survey of Substance Abuse Treatment Services is sent annually to all substance use treatment facilities and collects information on their characteristics and services. We calculated prevalence of chronic pain programs, reported characteristics, and did a binomial logistic regression to determine predictors of a facility offering such a program. Of 15,945 respondents, 2990 (18.8%) of facilities offered a tailored program for patients with co-occurring pain and SUDs. Characteristics that were best predictors included the following: facility has a tailored program for veterans ( P < 0.001), serves only clients with opioid use disorder ( P = 0.03), and provides maintenance services with methadone or buprenorphine for treating opioid use disorder ( P = 0.009). As of 2019, only a small percentage of substance use treatment facilities reported having a program that treats patients with co-occurring pain and SUD. Given the known high prevalence of co-occurring pain and SUD, further understanding of the role of these programs and barriers to implementation may enhance acceptance in treatment programs.

Fitbit Activity, Quota-Based Pacing, and Physical and Emotional Functioning Among Adults With Chronic Pain

Physical activity can improve function in patients with chronic pain, however, adherence is low, in part due to inconsistent activity patterns. Smart wearable activity trackers, such as Fitbits, may help promote activity. In our program for chronic pain, we examined: 1) Fitbit activity patterns (ie, step count, moderate-to-vigorous physical activity (MVPA), sedentary behavior), and 2) whether achievement of weekly, individualized Fitbit step goals was associated with functional outcomes. We conducted a secondary analysis of Fitbit data from our 10-week mind-body activity program for chronic pain (GetActive-Fitbit arm, N = 41). Participants self-reported emotional and physical function and completed performance-based and accelerometer-based assessments. From week 1 to week 10, 30% of participants increased >800 steps; 32.5% increased MVPA; and 30% decreased sedentary behavior. Only step count significantly changed across time with mean steps peaking at week 8 (M = +1897.60, SD = 467.67). Fitbit step goal achievement was associated with improvements in anxiety (ß = -.35, CI [-2.80, -.43]), self-reported physical function (ß = -.34, CI [-5.17, 8.05]), and performance-based physical function (ß = .29, CI [-71.93, 28.38]), but not accelerometer-based physical function or depression. Adhering to individualized Fitbit step goals in the context of a mind-body activity program may improve anxiety and self-reported and performance-based physical function. PerspectiveWe examine Fitbit activity patterns and the association between quota-based pacing and functional outcomes within a mind-body activity program for adults with chronic pain. Complementing quota-based pacing and coping skills with Fitbits may be a useful approach to promote activity engagement and behavior change in chronic pain populations.

Durability of the Treatment Effects of an 8-Week Self-administered Home-Based Virtual Reality Program for Chronic Low Back Pain: 6-Month Follow-up Study of a Randomized Clinical Trial.

BackgroundWe previously reported the efficacy of an 8-week home-based therapeutic immersive virtual reality (VR) program in a double-blind randomized placebo-controlled study. Community-based adults with self-reported chronic low back pain were randomized 1:1 to receive either (1) a 56-day immersive therapeutic pain relief skills VR program (EaseVRx) or (2) a 56-day sham VR program. Immediate posttreatment results revealed the superiority of therapeutic VR over sham VR for reducing pain intensity; pain-related interference with activity, mood, and stress (but not sleep); physical function; and sleep disturbance. At 3 months posttreatment, therapeutic VR maintained superiority for reducing pain intensity and pain-related interference with activity, stress, and sleep (new finding).ObjectiveThis study assessed between-group and within-group treatment effects 6 months posttreatment to determine the extended efficacy, magnitude of efficacy, and clinical importance of home-based therapeutic VR.MethodsE-surveys were deployed at pretreatment, end-of-treatment, and posttreatment months 1, 2, 3, and 6. Self-reported data for 188 participants were analyzed in a mixed-model framework using a marginal model to allow for correlated responses across the repeated measures. Primary outcomes were pain intensity and pain-related interference with activity, mood, stress, and sleep at 6 months posttreatment. Secondary outcomes were Patient-Reported Outcome Measurement Information System (PROMIS) sleep disturbance and physical function.ResultsTherapeutic VR maintained significant and clinically meaningful effects 6 months posttreatment and remained superior to sham VR for reducing pain intensity and pain-related interference with activity, stress, and sleep (ds=0.44-0.54; P<.003). Between-group comparisons for physical function and sleep disturbance showed superiority of EaseVRx over sham VR (ds=0.34; P=.02 and ds=0.46; P<.001, respectively). Participants were encouraged to contact study staff with any problems experienced during treatment; however, no participants contacted study staff to report adverse events of any type, including nausea and motion sickness.ConclusionsOur 8-week home-based VR pain management program caused important reductions in pain intensity and interference up to 6 months after treatment. Additional studies are needed in diverse samples.Trial RegistrationClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177International Registered Report Identifier (IRRID)RR2-10.2196/25291

Online Self-Management for Chronic Burn Pain: Results of a Randomized Controlled Trial

Following burn injury, survivors experience high rates of chronic pain and psychosocial concerns, including post-traumatic stress disorder (PTSD) and depression. Despite long-term pain and distress, survivors have limited access to effective pain psychology treatments after discharge in the United States. The current study compared the efficacy of an online self-management program for chronic pain after burn injuries to a time equivalent education control. The Take Charge of Burn Pain Recovery (TCBR-Pain) program involved seven online chronic pain coping modules based on cognitive-behavioral therapy. Adults at least six months post burn injury hospital discharge and experiencing pain greater than 3/10 severity were recruited and randomized into the TCBR-Pain (N = 47) or Control program (N = 49). Outcomes were assessed at pre-treatment, immediately post-treatment, 2-month, and 5-month follow-up. Full program completion was lower for the TCBR-Pain group (53%) relative to the Control group (90%). Linear models were fit to outcomes, adjusting for pre-treatment scores, adherence, and completion. On average, the TCBR-Pain group reported lower pain intensity relative to the Control group at post-treatment (MTCBR-Pain = 3.2, SDTCBR-Pain = 1.8; MControl = 4.1, SDControl = 1.9; p < .001). Among secondary outcomes, the TCBR-Pain group reported lower pain catastrophizing (MTCBR-Pain = 14.0, SDTCBR-Pain = 10.3; MControl = 17.6, SDControl = 11.8; p = .03) and borderline effects toward lower PTSD symptoms (MTCBR-Pain = 14.0, SDTCBR-Pain = 6.5; MControl = 16.0, SDControl = 6.1; p = .08) at post-treatment relative to the Control group. Although preliminary, these findings suggest online self-management programs can serve a role in delivering effective pain psychology interventions to survivors with chronic burn pain. The TCBR-Pain program attrition rate was higher than the Control program, but lower than typical e-health intervention attrition rates (60–80%). However, future research is needed to improve patient engagement in online pain self-management programs.

Postural Orthostatic Tachycardia Syndrome (POTS): Characteristics of Youth Enrolled in an Outpatient Interdisciplinary Pediatric Chronic Pain Program

Postural Orthostatic Tachycardia Syndrome (POTS) is a common form of orthostatic intolerance that affects about 3,000,000 people in the United States. For youth, significant functional impairment is noted, especially related to school attendance, limited participation in social and physical activities, and lower quality of life. Although previous research highlights the unique challenges for youth with chronic pain, fewer studies have focused on the clinical presentation of pediatric patients with POTS. This study aimed to explore characteristics of youth with POTS presenting to an interdisciplinary pediatric chronic pain program. Twenty-nine adolescents (14.7 +/- 1.7 years; 79% female) diagnosed with POTS presenting with their caregiver to an initial visit at an interdisciplinary pediatric chronic pain management program at a large Northeastern children's hospital in the United States were asked to complete questionnaires assessing demographic and pain characteristics, pain acceptance, and functional impairment and anxiety (PROMIS; t-scores). Number of visits within the program were gathered from medical record. Youth were primarily Caucasian/White (86.2%), Other (6.9%), AAPI (3.4%) and Mixed Race (3.4%). Youth reported overall low pain acceptance (M=34.1, SD=9.3), moderate anxiety (M=57.1, SD=13.1) and high pain interference (M=63, SD =7.4). Caregivers reported observing moderate anxiety (M=59.1, SD =11.5) and high pain interference (M=65.1, SD=4.6) for youth. Adolescents were observed to attend a wide range of visits within the program, including medical (1.7 +/- 2.5), physical therapy (3.4 +/- 4.9), occupational therapy (.5 +/- 1.7), and psychology (4.3 +/- 3.6). Less is known about youth with POTS who present for treatment. Additionally, youth with POTS meet with multiple doctors before receiving a diagnosis leading to disparities in access to treatment and the type of treatment that is received. Data here highlights that youth with POTS are experiencing significant impairment and more research targeting this population is necessary to improve outcomes. Postural Orthostatic Tachycardia Syndrome (POTS) is a common form of orthostatic intolerance that affects about 3,000,000 people in the United States. For youth, significant functional impairment is noted, especially related to school attendance, limited participation in social and physical activities, and lower quality of life. Although previous research highlights the unique challenges for youth with chronic pain, fewer studies have focused on the clinical presentation of pediatric patients with POTS. This study aimed to explore characteristics of youth with POTS presenting to an interdisciplinary pediatric chronic pain program. Twenty-nine adolescents (14.7 +/- 1.7 years; 79% female) diagnosed with POTS presenting with their caregiver to an initial visit at an interdisciplinary pediatric chronic pain management program at a large Northeastern children's hospital in the United States were asked to complete questionnaires assessing demographic and pain characteristics, pain acceptance, and functional impairment and anxiety (PROMIS; t-scores). Number of visits within the program were gathered from medical record. Youth were primarily Caucasian/White (86.2%), Other (6.9%), AAPI (3.4%) and Mixed Race (3.4%). Youth reported overall low pain acceptance (M=34.1, SD=9.3), moderate anxiety (M=57.1, SD=13.1) and high pain interference (M=63, SD =7.4). Caregivers reported observing moderate anxiety (M=59.1, SD =11.5) and high pain interference (M=65.1, SD=4.6) for youth. Adolescents were observed to attend a wide range of visits within the program, including medical (1.7 +/- 2.5), physical therapy (3.4 +/- 4.9), occupational therapy (.5 +/- 1.7), and psychology (4.3 +/- 3.6). Less is known about youth with POTS who present for treatment. Additionally, youth with POTS meet with multiple doctors before receiving a diagnosis leading to disparities in access to treatment and the type of treatment that is received. Data here highlights that youth with POTS are experiencing significant impairment and more research targeting this population is necessary to improve outcomes.

The Uptake and Effectiveness of a Multidisciplinary Online Program for Managing Chronic Pain before and During the COVID-19 Pandemic

ObjectivesSocietal and health system pressures associated with the coronavirus disease 2019 (COVID-19) pandemic exacerbated the burden of chronic pain and limited access to pain management services for many. Online multidisciplinary pain programs offer an effective and scalable treatment option, but have not been evaluated within the context of COVID-19. This study aimed to investigate the uptake and effectiveness of the Reboot Online chronic pain program before and during the first year of the COVID-19 pandemic.MethodsRetrospective cohort analyses were conducted on routine service users of the Reboot Online program, comparing those who commenced the program during the COVID-19 pandemic (March 2020–March 2021), to those prior to the pandemic (April 2017–March 2020). Outcomes included the number of course registrations; commencements; completion rates; and measures of pain severity, interference, self-efficacy, pain-related disability, and distress.ResultsData from 2,585 course users were included (n = 1138 pre-COVID-19 and n = 1,447 during-COVID-19). There was a 287% increase in monthly course registrations during COVID-19, relative to previously. Users were younger, and more likely to reside in a metropolitan area during COVID-19, but initial symptom severity was comparable. Course adherence and effectiveness were similar before and during COVID-19, with moderate effect size improvements in clinical outcomes post-treatment (g = 0.23–0.55).DiscussionUptake of an online chronic pain management program substantially increased during the COVID-19 pandemic. Program adherence and effectiveness were similar pre- and during-COVID. These findings support the effectiveness and scalability of online chronic pain management programs to meet increasing demand.

Trauma and pain sensitization in youth with chronic pain.

Chronic pain (pain lasting ≥3 months) co-occurs with internalizing mental health issues, such as posttraumatic stress symptoms (PTSS), at high rates in youth. The mechanisms underlying these relationships remain unclear. Posttraumatic stress symptoms, including re-experiencing (eg, intrusive memories), alterations in cognition and mood, hyperarousal, and avoidance could lead to altered neuronal processing, pain sensitization, and greater reports of pain. However, the relationships between PTSS and pain sensitization in youth with chronic pain are not known. Youth (n = 165) aged 10 to 18 years were recruited from outpatient multidisciplinary chronic pain programs. Symptoms of PTSS were assessed using psychometrically sound questionnaires. Youth also underwent a cold-pressor task, the most commonly used experimental pain induction technique. During this task, they reported on their expected pain, actual pain intensity, and pre- and post-state pain catastrophizing. Their pain threshold was recorded. A multivariate general linear model was used to examine the relationships between PTSS, ratings of pain intensity, state pain catastrophizing, and pain threshold, controlling for age, gender, ethnicity, anxiety, and depressive symptoms. Higher PTSS were associated with greater pain thresholds (P = 0.03) and higher pre- and post-state pain catastrophizing (P ≤ 0.05). Individuals with higher PTSS may avoid or dissociate from pain-inducing stimuli, thus leading to higher pain thresholds. However, individuals with higher PTSS also tend to catastrophize prior to and following exposure to pain. Avoidant and pain catastrophizing behaviors may serve to perpetuate chronic pain conditions. Future research is needed to determine how PTSS are related to pain sensitization prior to the development of chronic pain in at-risk youth.

Sex Disparity Persists in Pain Medicine: A Cross-Sectional Study of Chairpersons Within ACGME-Accredited Chronic Pain Fellowship Programs in the United States.

To compare the representation of female and male chairpersons and evaluate their respective demographic, academic, and program-related characteristics in academic chronic pain institutions. We identified all chronic pain fellowship programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME) on April 19, 2021. We queried institutional websites or contacted programs directly to identify the respective departmental/divisional program chairperson. We abstracted data on program chairpersons from public databases and performed statistical comparisons of demographic, academic, and program-related characteristics between female and male program chairpersons. Of the 111 ACGME-accredited chronic pain fellowship programs, we identified the current chairperson at 87 programs (78.4%). There were 17 female chairpersons (19.5%) and 70 male chairpersons (80.5%). A higher proportion of female chairpersons reported an academic rank of assistant professor compared with male chairpersons (35.3% vs 11.4%, P = .027). Male chairpersons published more peer-reviewed articles compared with female chairpersons (median 32.0 vs 10.0 publications, P = .001). Concordantly, male chairpersons achieved a higher H-index score compared with female chairpersons (median 10.0 vs 3.0, P = .001). No differences were identified in other academic or program-related characteristics. This cross-sectional study illuminates important details on sex-related differences in the chronic pain program chair role. Women chairpersons are underrepresented, have fewer peer-reviewed publications, and achieved a lower H-index score compared with male chairpersons. Establishing these baseline associations provides a reference for future studies to evaluate changes over time.

Qualitative analysis of long-term chronic pain program management outcomes: Veterans and civilians

LAY SUMMARY This study sought to determine how much patients with chronic pain could be helped to function better long after completing a four-week interdisciplinary pain management program. Comments from 16 Veterans and 23 civilians four months to four years after the end of the program showed 10 common themes: 1) gratefulness for their treatment in the program, 2) improved ability to function, 3) better coping strategies and confidence, 4) empowered to overcome daily challenges, 5) on a path to rehabilitation and recovery, 6) the need for support groups, 7) still had struggles, 8) the need for additional follow-up to maintain gains, 9) wishing they had attended the program sooner, and 10) would recommend the program to others. Veterans’ comments were no different from those of civilians. Results emphasize that Veterans and civilians share a common experience and maintain their benefits from interdisciplinary care in managing chronic pain. On the basis of these findings, clinicians have opportunities to improve quality and apply new services to the program.