Chronic Pain Sample Research Articles

Sudden gains in depression and anxiety during an online pain management programme for chronic pain.

Chronic pain is associated with depression and anxiety symptoms. Pain management programms, delivered face-to-face or via the internet, can effectively help adults manage the impacts of chronic pain. Sudden gains are defined as substantial, rapid, and lasting symptom reductions that occur between consecutive treatment sessions and have been associated with better treatment outcomes in non-pain samples. This study examined whether adults with chronic pain report sudden gains in depression or anxiety symptoms during an 8-week online pain management programme, and whether sudden gains were associated with better treatment outcomes for depression or anxiety. Dominant theories of sudden gains argue that therapists are required for sudden gains to be maintained and improve treatment outcomes. Using data from a published randomized controlled trial (n = 338), sudden gains and treatment outcomes were compared across three levels of therapist guidance provided alongside the programme: weekly, optional, and self-guided. Similar rates of sudden gains were observed in depression (22%) and anxiety (24%) across the treatment period, and most sudden gains occurred between Weeks 1 and 2 of treatment. Therapist guidance was not associated with sudden gains; higher baseline symptom severity emerged as the only consistent predictor of sudden gain status. No significant differences in treatment outcomes for depression or anxiety symptoms between sudden gainers and non-gainers were observed across therapist guidance conditions. These results do not support an association between sudden gains in depression or anxiety symptoms and better post-treatment outcomes, at least for adults with chronic pain. Sudden gains in depression and anxiety symptoms were not associated with improved treatment outcomes for adults with chronic pain who participated in an online pain management programme, regardless of the level of therapist guidance provided. These findings suggest possible differences in symptom change in chronic pain samples compared to general population samples.

Parental narrative style moderates the relation between pain-related attention and memory biases in youth with chronic pain.

Negatively biased pain memories robustly predict maladaptive pain outcomes in children. Both attention bias to pain and parental narrative style have been linked with the development of these negative biases, with previous studies indicating that how parents talk to their child about the pain might buffer the influence of children's attention bias to pain on the development of such negatively biased pain memories. This study investigated the moderating role of parental narrative style in the relation between pain-related attention and memory biases in a pediatric chronic pain sample who underwent a cold pressor task. Participants were 85 youth-parent dyads who reminisced about youth's painful event. Eye-tracking technology was used to assess youth's attention bias to pain information, whereas youth's pain-related memories were elicited 1 month later through telephone interview. Results indicated that a parental narrative style using less repetitive yes-no questions, more emotion words, and less fear words buffered the influence of high levels of youth's attention bias to pain in the development of negatively biased pain memories. Opposite effects were observed for youth with low levels of attention bias to pain. Current findings corroborate earlier results on parental reminiscing in the context of pain (memories) but stress the importance of matching narrative style with child characteristics, such as child attention bias to pain, in the development of negatively biased pain memories. Future avenues for parent-child reminiscing and clinical implications for pediatric chronic pain are discussed.

Validity and Reliability of the Greek Version of Pittsburgh Sleep Quality Index in Chronic Non-Specific Low Back Pain Patients.

The purpose of this study was to investigate psychometric properties of the Greek translation of Pittsburgh Sleep Quality Index (GR-PSQI) in a Greek chronic non-specific low back pain (CNSLBP) sample, thus, providing insight on its clarity and acceptability as a widely used sleep assessment tool in clinical practice. Asymptomatic volunteers (n = 73) and CNSLBP volunteers (n = 47), participated in the study. For the assessment of construct validity, the known-groups method was used. Thus, all the participants (asymptomatic and CNSLBP) completed the GR-PSQI. For the assessment of concurrent validity, the CNSLBP participants additionally completed the following validated questionnaires for depression, insomnia and sleep quality: Beck Depression Inventory Questionnaire (BDI), Insomnia Severity Index (ISI), and Sleep Quality Numeric Rating Scale (SQNRS). For the assessment of test-retest reliability, the CNSLBP participants completed the GR-PSQI a second time, one week after the first time. The results showed excellent test-retest reliability (ICC = 0.969, SEM = 0.90, SDD = 2.49%) and internal consistency (Cronbach α = 0.985), moderate to good concurrent validity (from r = 0.556 to r = 0.860) among PSQI, BDI, SQNRS, and ISI, as well as excellent construct validity (p = 0.000) between the two groups. The Greek translation of PSQI could be a valuable tool for Greek healthcare professionals in both clinical and research environments.

Unraveling the Left-Right Judgment Task in Chronic Low Back Pain: Insights Through Behavioral, Electrophysiological, Motor Imagery, and Bodily Disruption Perspectives

Bodily disruptions have been consistently demonstrated in individuals with chronic low back pain. The performance on the left-right judgment task has been purposed as an indirect measure of the cortical proprioceptive representation of the body. It has been suggested to be dependent on implicit motor imagery, although the available evidence is conflicting. Hence, the aim of this case-control observational study was to examine the performance (accuracy and reaction times) and event-related potentials while performing the left-right judgment task for back and hand images in individuals with chronic low back pain versus healthy controls, along with its relationship with self-reported measurements and quantitative sensory testing. While self-reported data suggested bodily disruptions in the chronic low back pain sample, this was not supported by quantitative sensory testing. Although both groups displayed the same performance, our results suggested an increased attentional load on participants with chronic low back pain to achieve equal performance, measured by a higher N1 peak amplitude in occipital electrodes, especially when the effect of contextual images arises. The absence of differences in the reaction times for the left-right judgment task between both groups, along with inconsistencies in self-reported and quantitative sensory testing data, could question the involvement of implicit motor imagery in solving the task. In conclusion, our results suggest disrupted attentional processing in participants with chronic low back pain to solve the left-right judgment task. PerspectiveAlthough there are no differences in the performance of the left-right judgment task (hits, reaction times) between chronic low back pain patients and controls, the analysis of event-related potentials revealed that patients require a higher cognitive load, measured by N1 peak amplitude.

Avoidance and Endurance Responses to Pain Before and with Advanced Chronification: Preliminary Results from a Questionnaire Survey in Adult Patients with Non-Cancer Pain Conditions.

The Avoidance-Endurance Model postulates fear-avoidance responses and endurance responses as important psychological mechanisms in the development and maintenance of chronic pain. The present study aims to investigate potential differences in avoidance and endurance responses to pain before and with advanced chronification. Two samples of adults with non-cancer pain at two different stages of chronicity were compared: One with pain and risk factors for chronicity (n=26, part of the PAIN2020 project) and one with chronic pain (n=33 from a pain day care clinic). The German Pain Questionnaire, the Graded Chronic Pain Scale (GCPS) and medical reports were used to measure duration and severity of pain. Responses to pain were assessed with the Avoidance-Endurance Questionnaire (AEQ) and psychological strain with the Depression, Anxiety and Stress Scales (DASS). Both groups were primarily affected by musculoskeletal pain. Although not yet chronified, the risk group reported comparable GCPS levels of pain intensity and disability. Depression and stress ratings were also similar, except for anxiety, which was significantly elevated in the chronic pain sample (p<.001). The AEQ scales did not differ between groups, neither on any of the fear-avoidance- nor endurance-related dimensions. A post-hoc regression analysis revealed a significant prediction of fear-avoidance by pain-related disability (p<.001). The regression model for endurance responses was not significant. Patients with risk factors of chronification experience substantial pain-related burden. Responses to pain in the realm of the Avoidance-Endurance model do not appear to vary as a function of chronification. While fear-avoidance and pain-related disability correlate positively, endurance could not be associated to any of our variables.

Development and validation of the Pain-Induced Comfort Eating Scale in a chronic pain sample

ABSTRACT Background Chronic pain and higher body weight frequently co-occur. This common comorbidity is thought to be mediated by the use of comfort eating as a strategy for managing both the physical and psychological pain and discomfort associated with flare-ups of chronic pain. Valid and reliable assessment tools are needed to inform the development of effective treatments. Aims This study aimed to assess the psychometric properties of a new brief measure of pain-induced comfort eating in chronic pain, the Pain-Induced Comfort Eating Scale (PICES). Methods A sample of 166 patients with chronic pain completed an online test battery including the PICES along with measures of chronic pain and pain-related symptoms, disordered eating, and related psychological factors. Results Results of exploratory factor analysis revealed a single-factor model for the four-item PICES. Further, the PICES demonstrated evidence of good internal consistency as well as convergent validity with demonstrated correlations with related measures. The results of this study also revealed that comfort eating in chronic pain appears to be related to psychological distress; the PICES correlated more strongly with measures assessing mood and psychological distress compared to interference/intensity of physical pain itself. Scores on the PICES also correlated strongly with measures of uncontrolled and emotional eating. Conclusions Overall, our results indicate that the PICES provides a valid and useful brief measure of comfort eating in chronic pain that might be useful to inform treatments targeting the comorbid disordered eating practices that can lead to higher body weights in patients with chronic pain.

76 Differential Performance in Visual Learning and Retrieval in a Validity Controlled Chronic Pain Sample

Objective:Individuals with chronic pain frequently report diminished cognitive functioning. Prior cross-sectional studies have demonstrated strong associations between chronic pain and neurocognitive impairment, most notably in memory, attention, processing speed, and executive functioning. However, there is a paucity of research evaluating visual learning and memory abilities in this population. Further, while current practice standards advocate for the use of performance validity tests (PVTs) to assess the credibility of neuropsychological test performance, they have infrequently been incorporated into studies examining chronic pain samples, despite a higher observed rate of noncredible performance in the literature. This study aimed to compare visual learning and memory performance between a mixed neuropsychiatric (MNP) group and a chronic pain group in a validity-controlled sample.Participants and Methods:The study consisted of 371 adults referred for outpatient neuropsychological evaluation. Between groups, various PVTs were administered, which included, at minimum, one freestanding and four embedded PVTs. All patients were administered the Brief Visuospatial Memory Test-Revised (BVMT-R) as part of a comprehensive neuropsychological evaluation. Only patients classified as valid performers (&lt;1 PVT fails; n=295) were included in the analyses (Pain: n=109; MNP: n=186). The overall sample was 69% female and racially diverse (22% non-Hispanic Black, 43% non-Hispanic White, 30% Hispanic, 3% Asian/Pacific Islander, and 2% other race/ethnicities), with a mean age of 46.8 (SD=14.8) and mean education of 13.7 years (SD=2.7). Independent samples t-tests were performed to investigate the differences in visual learning and memory abilities between the chronic pain and MNP groups.Results:Chi-square analyses revealed significant differences between the pain and MNP groups on race, with more non-Hispanic White and Hispanic patients represented in the MNP group. There were also modest group differences in age and education. For the chronic pain group, patients scored lower on both BVMT-R Total T-Score (mean difference = 9.65T, p&lt;.001) and BVMT Delayed Recall T-Score (mean difference = 8.97T, p&lt;.001). The effect size was robust for both for Total T-Score (d = 0.682) and Delayed Recall T-Score (d = 0.632). In contrast, the difference in BVMT Recognition Discriminability was not statistically significant.Conclusions:This study demonstrated significant differences in performance between mixed neuropsychiatric and chronic pain patients. Preliminary evidence indicated that chronic pain patients displayed lower visual mediated encoding and retrieval performance, although their recognition is comparable. Although the nature of this study was targeted toward visual learning and retrieval, it is likely that the known impact of chronic pain on attention, working memory, and processing speed accounts for this relationship. Future studies will benefit from further elucidating these potential mechanisms and better inform clinical decision-making and neuropsychological testing performance in patients with chronic pain.

Factors associated with pain pressure threshold in both local and remote sites in knee osteoarthritis.

Knee osteoarthritis (KOA) is a prevalent condition, and its most frequent symptom is pain that often leads to disability. Pain sensitization is a core feature of KOA, and it can be measured through quantitative sensory testing protocols such as pain pressure threshold (PPT). However, there is a lack of understanding about the factors that may influence changes in PPTs in the KOA population. To explore the clinical and functional factors associated with PPTs in a sample of people with chronic KOA pain and to compare models of local (knees) and remote (thenar regions) sites. Cross-sectional analysis of a prospective cohort. Primary care in public institution. 113 adults with KOA. N/A. Multivariable regression analyses evaluating demographic, clinical, and functional variables that could be associated with local and remote PPTs (main outcomes) were performed. Both thenar region (adjusted-R2 : 0.29) and knee (adjusted-R2 : 0.45) models had the same significant negative association with being a female, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain levels (thenar: β: -0.15, p = .002; knee: β: -0.2, p < .001), and the 10-Meter Walking Test (thenar: β: -0.05, p = .038; knee: β: -0.08, p = .004). A small significant positive association with depressive symptoms was identified in both models, which acted as a confounder for WOMAC pain and was likely affected by unmeasured confounders. PPTs in KOA pain are associated with functional outcomes such as the 10-Meter Walking Test and activity-related pain intensity; thus more disability is associated with smaller pain thresholds. Similarity between models may suggest central sensitization.

Interpretation bias and the transition from acute to chronic pain.

Most theories of pain emphasize cognitive factors in the development of chronicity, but they have rarely been studied in the context of the transition from acute to chronic pain. The aim of the present study was to assess the role of interpretation bias, pain anxiety, and pain avoidance in acute and chronic pain and the transition from acute to chronic pain. Study 1 recruited a sample of N = 85 adults with chronic pain. Study 2 recruited a sample of N = 254 adults with acute pain and followed them up 3 months later. Both studies assessed interpretation bias with the word association task, as well as measuring pain-related anxiety, pain avoidance, pain severity, and pain interference. In study 2, pain outcomes at 3 months were also assessed. Across both acute and chronic pain samples, interpretation bias was associated with pain interference, but not pain severity. Path analysis mediation models for study 2 showed that interpretation bias was associated with increased pain anxiety, which predicted both pain severity and pain interference 3 months later. Pain anxiety was also associated with pain avoidance, but pain avoidance did not predict pain outcomes. This research provides further insight into the transition from acute to chronic pain, suggesting that interpretation bias in acute pain may play a role in pain-related anxiety that drives pain interference, thus maintaining chronic pain. These findings hold promise for further research into potential large-scale preventative interventions targeting interpretation bias and pain anxiety in acute pain.

Trauma in childhood is associated with greater pain catastrophizing but not anxiety sensitivity: a cross-sectional study.

Adverse life experiences have been identified as a possible vulnerability factor for chronic pain. This association could result from the effect of trauma on the psychological state of individuals. Previous studies found childhood trauma to be associated with pain catastrophizing and anxiety sensitivity, both of which have been associated with an increased risk of chronic pain. However, it is unknown whether trauma in adulthood affects these variables and whether the effect on pain catastrophizing is independent of confounds such as depression and anxiety. To test the effect of childhood and adulthood trauma on pain catastrophizing and anxiety sensitivity whilst controlling for depression and anxiety. In the current study, we conducted an online survey in the United Kingdom in a chronic pain sample (N = 138; 123 women; age range 19-78). We analysed whether there is an association between different types of trauma (both in childhood and through the lifespan), pain catastrophizing, and anxiety sensitivity while controlling for anxiety and depression. We found that childhood trauma (particularly emotional abuse) significantly predicts pain catastrophizing, even when controlling for depression and anxiety, whereas it did not have a significant effect on anxiety sensitivity. Trauma through the lifespan (not childhood) did not have a significant effect on anxiety sensitivity nor did it have a significant effect on pain catastrophizing. Our results show that the life stage in which trauma occurs is key in its psychological effects on patients with chronic pain. Furthermore, it shows that trauma affects some psychological variables but not others.

Psychometric examination of the Malay version of the Pain Catastrophising Scale in a Malaysian chronic pain sample

Introduction: The purpose of this study was to examine the psychometric properties of the Malay version of the Pain Catastrophizing Scale (PCS-M). Methods: The original PCS was translated into Malay using the back-translation method and was administered to 132 outpatients with non-malignant chronic pain. Results: Confirmatory factor analysis revealed that a 10-item single-factor model had a better fit profile compared to 8 competing models as documented in previous studies. In terms of internal consistency, Cronbach’s α value for the PCS-M was 0.93. In terms of predictive validity, the PCS-M explained 47%, 24%, and 22% of the variance in anxiety, depression, and kinesiophobia, respectively. Conclusion: Best presented as a unidimensional construct, the 10-item PCS-M demonstrated excellent reliability estimate and initial evidence for predictive validity in a Malaysian chronic pain sample. The 10-item PCS-M is a reliable and valid tool to be used in chronic pain management in the Malaysian context.

Individual Differences in Pain Catastrophizing and Regional Gray Matter Volume Among Community-dwelling Adults With Chronic Pain: A Voxel-based Morphology Study.

Elevations in pain catastrophizing (PC) are associated with more severe pain, emotional distress, and impairment within samples with chronic pain. However, brain structure correlates underlying individual differences in PC are not well understood and predict more severe pain and impairment within samples with chronic pain. This study assessed links between regional gray matter volume (GMV) and individual differences in PC within a large mixed chronic pain sample. Chinese adult community dwellers with chronic pain of at least 3 months duration (101 women and 59 men) completed self-report measures of background characteristics, pain severity, depression, and a widely validated PC questionnaire as well as a structural magnetic resonance imagining scan featuring voxel-based morphology to assess regional GMV correlates of PC. After controlling for demographic correlates of PC, pain severity, and depression, higher PC scores had a significant, unique association with lower GMV levels in the inferior temporal area of the right fusiform gyrus, a region previously implicated in emotion regulation. GMV deficits, particularly in right temporal-occipital emotion regulation regions, correspond to high levels of PC among individuals with chronic pain.

Pain Catastrophizing Dimensions Mediate the Relationship between Chronic Pain Severity and Depression

BackgroundAlthough past studies have found significant positive correlations of both pain severity and overall pain catastrophizing (PC) levels with depression in chronic pain samples, less is known about the extent to which specific PC dimensions (i.e., helplessness, magnification, rumination) explain links between pain severity and depression. AimThis study assessed the relative importance of PC dimensions as mediators of relations between chronic pain severity and depression. DesignA cross sectional study design was employed. MethodMainland Chinese adults with chronic pain (n = 983) completed validated questionnaire measures of PC, depression, and chronic pain severity within a cross-sectional research design. ResultsAnalyses indicated helplessness mediated the association between pain severity and depression while magnification partially mediated the association of helplessness with depression. Conversely, rumination did not make a significant contribution in the mediation model. ConclusionsThe helplessness dimension of PC, in particular, may help to explain why people with more severe chronic pain are prone to co-occurring depression.

Dimensionality and Validation of the Highly Sensitive Person Scale (HSPS) in a Dutch General Population Sample and Two Clinical Samples

Abstract: Previous studies on the Highly Sensitive Person Scale (HSPS) were primarily conducted in highly selective, mostly student populations. The objective of the present study was to examine the factor structure of the Dutch HSPS in the general population ( n = 998), prolonged fatigue ( n = 340), and chronic pain samples ( n = 283), and investigate its psychometric properties. The factorial structure of the HSPS was assessed by an exploratory factor analysis, followed by a confirmatory factor analysis. To this end, the overall sample consisting of 1,621 subjects was randomly split into two subsamples. The factor structure was subsequently confirmed in the general population, fatigue, and chronic pain samples separately. A bi-factor model, consisting of a general factor and three separate factors, provided the best fit to the data in each sample. The three separate factors, capturing different dimensions of sensory processing sensitivity, were labeled “Ease of Excitation” (11 items), “Sensory and Aesthetic Sensitivity” (5 items), and “Low Sensory Threshold” (5 items). Internal consistency was satisfactory. Distinct patterns of associations were found between these factors and (un)related personality constructs.

The German version of the Revised Children's Anxiety and Depression Scale-Psychometric properties and normative data for German 8- to 17-year-olds.

Anxiety and depression are internalizing mental disorders often commencing in childhood and manifesting in adolescence. The Revised Anxiety and Depression Scale (RCADS) is an internationally widely used standardized diagnostic tool, but the German version has only been validated in a pediatric chronic pain sample; normative data are not available. The aim of this study is to test its reliability (internal consistency) and validity (factorial, convergent, known-groups) in a representative German school sample and to provide norm data. Data were collected from N=1562 German schoolchildren (Mage =12.2; SDage =2.33; range 8-17years; 52.4% girls). Cronbach's α ranged from 0.73 to 0.96 for the total and the six subscales (five anxiety and one depression). Confirmatory factor analysis showed the 6-factor model had acceptable to good model fit with CFI=0.93, TLI=0.93, RMSEA=0.05, SRMR=0.05, which was better than 1- and 2-factor models. The (sub)scales correlated moderate to high negatively with health-related quality of life (-0.31≤ τ≤-0.51; p<0.001) and positively with functional impairment (0.31≤τ≤0.48; p<0.001). Mean scores of anxiety and depression scales were significantly higher in girls and partly in adolescents. Findings provide support for the good psychometric properties of the German RCADS in a community sample.

Assessing Opioid Abuse in Chronic Pain Patients: Further Validation of the Prescription Opioid Misuse Index (POMI) Using Item Response Theory

AbstractDue the limitations of the previous validations, the purpose of this study was to further validate the Prescription Opioid Misuse Index (POMI) in a larger sample of chronic non-cancer pain (CNCP) patients and to examine differential item functioning (DIF) across sex. Participants (n=225 CNCP patients under long-term opioid therapy) completed patient characteristics, self-reported POMI and DSM-5 prescription opioid use disorder measurements. Reliability and factor structure were assessed using both item response theory and classical test theory. ROC curve analysis was used to establish the optimum cut-off score for detecting the presence of DSM-5 prescription opioid-use disorder. Concurrent validity was also tested. The POMI showed a unidimensional factor structure and acceptable internal consistency (ωcat =0.62). DIF analysis showed that males and females respond similarly to each item of the POMI, supporting unbiased measurement of the latent trait across both groups. A cut-off point of 2 is suggested in order to maximize the accuracy of the instrument as a first-screening tool for opioid misuse (AUC=0.78; p&lt;0.001; CI 95%: 0.72–0.85). Concurrent validity of the POMI was high with DSM-5 moderate to severe opioid-use disorder criteria (OR=7.824, p&lt;0.001). These results indicate that the POMI is a valid and clinically feasible screening instrument for detecting CNCP patients who misuse opioid medications. The short length of the scale could meet the needs of clinical practice as it allows clinicians to precisely identify and monitor prescription opioid misuse in both male and female patients.

Associations between Chronic Pain and Attention-Deficit Hyperactivity Disorder (ADHD) in Youth: A Scoping Review.

Background: Chronic pain and ADHD are common conditions among youth that negatively impact functioning. This review fills a critical gap by summarizing current research on chronic pain and ADHD comorbidity, and it proposes a conceptual model of shared associations and underlying mechanisms. Objective: The aims of the current study were to: (1) review the extant literature and present estimates of the prevalence of comorbid non-headache chronic pain and ADHD in youth and (2) describe potential shared mechanisms for ADHD and chronic non-headache pain in youth. We also outline future directions to inform future research and interventions directed to youth with comorbid pain and ADHD. Design: A scoping review of the literature was performed in MEDLINE, PsycInfo, and Cochrane Database of Systematic Reviews using a wide range of search terms related to pain, Attention Deficit-Hyperactivity Disorder, childhood, adolescence, and young adulthood. Results: Eleven published studies were included in the review. These studies examined the prevalence of chronic pain among youth with ADHD, the prevalence of ADHD in chronic pain samples, and the association between chronic pain and ADHD among youth. Findings revealed results from studies indicating a higher prevalence of ADHD among youth with chronic pain and a higher prevalence of chronic pain in samples of youth with ADHD. Conclusions: Findings from this scoping review suggest an association between chronic pain and ADHD among youth. Little research was found to examine the etiology of this association. Future studies should examine underlying mechanisms of comorbid chronic pain and ADHD.

Assessing Psychological Flexibility and Inflexibility in Chronic Pain Using the Multidimensional Psychological Flexibility Inventory (MPFI)

Psychological flexibility (PF) is a model of well-being and daily functioning that is applied to chronic pain, and is the model behind Acceptance and Commitment Therapy (ACT). However, studies of PF in chronic pain are limited by the lack of a single measure capturing all facets. The Multidimensional Psychological Flexibility Inventory (MPFI) assesses all facets of PF and psychological inflexibility (PI) and could remedy this problem. The current study employs this measure. Adult participants with chronic pain (N = 404) were recruited online and completed the MPFI, other validated measures of PF/PI, and measures of pain, work and social adjustment, and depression, at two time points. The reliability, factor structure, and validity of the MPFI were assessed. Confirmatory factor analysis results demonstrated a good model fit for the proposed factor-and subscale structure. Correlations between MPFI and theoretically similar measures were moderate to strong, and correlations with pain intensity, pain interference, work-and social adjustment, and depression, were small to large. In this first examination of the potential utility of the MPFI within a chronic pain population, we found it to be valid and reliable. It should be noted that the MPFI was less predictive of outcomes compared with more established measures in most cases. Despite this, results from the wide range of variables available from the MPFI highlights the potential importance of aspects of PF and PI not previously emphasized, including the greater predictive utility of the inflexibility facets. Further use and study of the MPFI is recommended.ClinicalTrials.gov ID: NCT05050565 PerspectiveThis article presents a comprehensive examination of a self-report measure assessing all facets of psychological flexibility and inflexibility, in a chronic pain sample. The results support the role of facets not previously emphasized. Comprehensive assessment of PF and PI appears possible and is recommended depending on research questions being asked.

Is Mindfulness Associated With Lower Pain Reactivity and Connectivity of the Default Mode Network? A Replication and Extension Study in Healthy and Episodic Migraine Participants

Formal training in mindfulness-based practices promotes reduced experimental and clinical pain, which may be driven by reduced emotional pain reactivity and undergirded by alterations in the default mode network, implicated in mind-wandering and self-referential processing. Recent results published in this journal suggest that mindfulness, defined here as the day-to-day tendency to maintain a non-reactive mental state in the absence of training, associates with lower pain reactivity, greater heat-pain thresholds, and resting-state default mode network functional connectivity in healthy adults in a similar manner to trained mindfulness. The extent to which these findings extend to chronic pain samples and replicate in healthy samples is unknown. Using data from healthy adults (n = 36) and episodic migraine patients (n = 98) and replicating previously published methods, we observed no significant association between mindfulness and heat-pain threshold, pain intensity or unpleasantness, or pain catastrophizing in healthy controls, or between mindfulness and headache frequency, severity, impactor pain catastrophizing in patients. There was no association between default mode network connectivity and mindfulness in either sample when probed via seed-based functional connectivity analyses. In post-hoc whole brain exploratory analyses, a meta-analytically derived default mode network node (ie, posterior cingulate cortex) showed connectivity with regions unassociated with pain processing as a function of mindfulness, such that healthy adults higher in mindfulness showed greater functional connectivity between the posterior cingulate cortex-and cerebellum. Collectively, these findings suggest that the relationship between mindfulness and default mode network functional connectivity may be nuanced or non-robust, and encourage further investigation of how mindfulness relates to pain. PerspectiveThis study found few significant associations between dispositional mindfulness and pain, pain reactivity and default mode connectivity in healthy adults and migraine patients. The relationship between mindfulness and default mode network connectivity may be nuanced or non-robust.

0148 Associations Between Subjective and Objective Sleep Outcomes and Nightly Pain Changes in a Chronic Pain Sample

Abstract Introduction Patients with chronic pain often experience poor sleep. Research demonstrating the bidirectional nature of the pain/sleep association has focused on interindividual patterns based on between person averages, leaving acute, intraindividual patterns based on night-to-night fluctuations understudied. Because both pain and sleep fluctuate considerably, better understanding of those fluctuations may provide important insight into the pain/sleep relationship. Here we examine inter- and intraindividual associations between subjective and objective sleep outcomes and nightly pain changes in individuals with chronic pain and sleep complaints. Methods Adults with chronic pain and sleep complaints (n=169, Mage=52, SD= 12, 95% female) completed 14 days of actigraphy and sleep diaries each morning and evening. Evening diaries recorded pain and sleep medication use (yes/no), and evening pain intensity (0-none, 100-most intense). Actigraphy and morning diaries recorded sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and morning pain intensity (0-none, 100-most intense). A nightly pain difference score (morning – evening) was calculated, where positive values indicate worse morning pain relative to previous evening pain. Multi-level models examined the inter- and intraindividual associations between sleep (subjective and objective SOL, WASO, TST) and nightly pain difference scores. Analyses controlled for age, sleep, and pain medication use. Results Greater interindividual subjective WASO was associated (B=0.06, SE=0.03, p=0.02) with greater interindividual pain difference scores. Other interindividual sleep outcomes (subjective and objective) were not significantly associated with interindividual pain difference scores. There were no associations between sleep outcomes (subjective and objective) and pain difference scores at the intraindividual level. Conclusion Findings show sleep and pain were not linked at the daily, intraindividual level. However, on average, greater WASO was linked with worse morning relative to evening pain. Thus, although a single night of poor sleep may not impact pain, the buildup of fragmented sleep over time may interfere with restorative properties of sleep and exacerbate morning pain. Future work should investigate mechanisms underlying sleep fragmentation (e.g., sleep architecture, physiological arousal) and how such factors relate to nightly pain changes. Support (If Any) NIH/NIAMS R01AR055160, ClinicalTrials-NCT02001077, PI McCrae.