Higher Pain Catastrophizing Research Articles

Cortical function and sensorimotor plasticity are prognostic factors associated with future low back pain after an acute episode: the Understanding persistent Pain Where it ResiDes prospective cohort study.

Predicting the development of chronic low back pain (LBP) at the time of an acute episode remains challenging. The Understanding persistent Pain Where it ResiDes study aimed to identify neurobiological and psychological risk factors for chronic LBP. Individuals with acute LBP (N = 120) participated in a prospective cohort study with 6-month follow-up. Candidate predictors were selected from the neurobiological (eg, sensorimotor cortical excitability assessed by sensory and motor-evoked potentials and brain-derived neurotrophic factor genotype), psychological (eg, depression and anxiety), symptom-related (eg, LBP history), and demographic domains. Analyses involved multivariable linear regression models with pain intensity or disability degree as continuous variables. Secondary analyses involved a multivariable logistic model with the presence of LBP at 6 months (thresholding pain intensity and disability degree) as a dichotomous variable. Lower sensory cortex and corticomotor excitability, higher baseline pain intensity, higher depression, stress, and pain catastrophizing were the strongest predictors ( R2 = 0.47) of pain intensity at 6 months. Older age and higher pain catastrophizing were the strongest predictors ( R2 = 0.30) of disability at 6 months. When the LBP outcome was dichotomised, sensory cortex and corticomotor excitability, brain-derived neurotrophic factor genotype, depression and anxiety, LBP history and baseline pain intensity, discriminated between those who did and did not report LBP at 6 months (C-statistic 0.91). This study identifies novel risk factors for the development of future LBP. Neurobiological risk factors, when added to a multivariable linear regression model, explained a further 15% of the variance in the 6-month pain intensity.

Association of Preoperative Pain Severity and Pain Catastrophizing with Increased Risk for Prolonged Postoperative Opioid Use

Prolonged postoperative opioid use (PPOU) is considered an unfavorable post-surgical outcome. Demographic, clinical, and psychosocial factors have been associated with PPOU, but methods to prospectively identify patients at increased risk are lacking. We sought to determine whether individual or a combination of several psychological factors could identify a subset of patients at increased risk for PPOU. We conducted a prospective cohort study of patients undergoing elective surgery at a single VA Medical Center. Participants were recruited from a preoperative anesthesia clinic where they were undergoing evaluation prior to elective surgery, and they completed a survey before surgery. The primary outcome was PPOU, defined as outpatient receipt of a prescribed opioid 31 to 90 days after surgery as determined from pharmacy records. Primary covariates of interest were pain catastrophizing, self-efficacy, and optimism. Additional covariates included social and demographic factors, pain severity, medication use, depression, anxiety, and surgical fear. Of 123 participants included in the final analyses, 30 (24.4%) had PPOU. In bivariate analyses, preoperative opioid use, preoperative NSAID use, and preoperative pain were significantly associated with PPOU. The combination of high pain catastrophizing and high preoperative pain (OR 3.32, 95% CI 1.41 - 7.79) was associated with higher odds of PPOU than either alone, and the association remained significant after adjusting for preoperative opioid use (OR 2.56, 95% CI 1.04 - 6.29). A combination of high pain catastrophizing and high preoperative pain has the potential to be a clinically useful means of identifying patients at elevated risk of PPOU. Grant support from AHRQ K12 HS023009.

Increased functional connectivity between limbic brain areas in healthy individuals with high versus low sensitivity to cold pain: A resting state fMRI study.

BackgroundThe representation of variability in sensitivity to pain by differences in neural connectivity patterns and its association with psychological factors needs further investigation. This study assessed differences in resting-state functional connectivity (rsFC) and its association to cognitive-affective aspects of pain in two groups of healthy subjects with low versus high sensitivity to pain (LSP vs. HSP). We hypothesized that HSP will show stronger connectivity in brain regions involved in the affective-motivational processing of pain and that this higher connectivity would be related to negative affective and cognitive evaluations of pain.MethodsForty-eight healthy subjects were allocated to two groups according to their tolerability to cold stimulation (cold pressor test, CPT, 1°C). Group LSP (N = 24) reached the cut-off time of 180±0 sec and group HSP tolerated the CPT for an average of 13±4.8 sec. Heat, cold and mechanical evoked pain were measured, as well as pain-catastrophizing (PCS), depression, anxiety and stress (DASS-21). All subjects underwent resting state fMRI. ROI-to-ROI analysis was performed.ResultsIn comparison to the LSP, the HSP had stronger interhemispheric connectivity of the amygdala (p = 0.01) and between the amygdala and nucleus accumbens (NAc) (p = 0.01). Amygdala connectivity was associated with higher pain catastrophizing in the HSP only (p<0.01).ConclusionsThese findings suggest that high sensitivity to pain may be reflected by neural circuits involved in affective and motivational aspects of pain. To what extent this connectivity within limbic brain structures relates to higher alertness and more profound withdrawal behavior to aversive events needs to be further investigated.

Psychological Predictors of Response to Open-Label Versus Double-Blind Placebo in a Randomized Controlled Trial in Irritable Bowel Syndrome.

There is growing evidence that open-label placebo (OLP) may be an efficacious treatment of chronic and functional conditions. However, patient-level predictors of response to OLP have not been clearly identified. The aim of this study is to evaluate the psychological predictors of response to OLP and to compare this to double-blind placebo (DBP) and no-pill control (NPC). This study is a secondary analysis of data collected in a 6-week randomized controlled trial evaluating placebo effects in irritable bowel syndrome (IBS). The primary outcome was change in IBS severity. Hierarchical linear regression identified predictors of placebo response in general and compared them between those randomized to OLP, DBP, and NPC. Predictor variables included personality traits, generalized anxiety, depression, visceral sensitivity (a measure of symptom-specific anxiety), and pain catastrophizing. A total of 210 participants (mean age = 42.3 years, 73.3% female) were included. Regression models revealed that visceral sensitivity was a predictor of response to OLP and NPC but not DBP. Interestingly, the effects were opposite, with high visceral sensitivity predicting less improvement in NPC and more improvement in OLP. Pain catastrophizing was a negative predictor of response to OLP (i.e., high pain catastrophizing was associated with less improvement in OLP). Neither visceral sensitivity nor pain catastrophizing played a significant role for response to DBP. IBS participants who score low on the Pain Catastrophizing Scale but high on the Visceral Sensitivity Index seem to benefit particularly from OLP. Our study suggests that different psychological mechanisms may be involved in DBP and OLP interventions.

Real world data collection and cluster analysis in patients with sciatica due to lumbar disc herniation

ObjectiveThe aim of this study was to identify and describe clusters of patients with similar characteristics presenting with sciatica caused by a lumbar disc herniation in secondary care. MethodsForty-six percent (n = 163) of the eligible patients (n = 352) completed all questionnaires and were included in a hierarchical cluster analysis. The analysis was based on baseline characteristics for pain, pain awareness and catastrophizing, disability and quality of life (QOL). Clusters were compared for the use of pain medication, employment status and allocated treatment. ResultsThree significant clusters were identified.Cluster 2 (n = 49), coined the painfulness cluster, reported the lowest baseline characteristics for pain (>5) and disability together with a higher health-related QOL. Patients in cluster 3, labeled the painfulness and suffering cluster, had relatively high pain scores for back and leg pain (>6), high pain awareness and catastrophizing, i.e. suffering, but relatively limited disability and maintained QOL. Cluster 1 (n = 71), the painfulness-suffering and disability cluster, was characterized by the most severe back and leg pain (>7), high pain awareness and catastrophizing with the lowest QOL and highest disability. Patients in cluster 1 underwent significantly more surgery and used the most extensive pain medication (WHO III). ConclusionThis research gives insight in the complex population with sciatica and is of added value to the recent, sparsely existing literature on relevant patient subgroups in the low back and leg pain population. The data suggest that VAS scores < 6 do not lead to suffering and VAS scores < 7 not to disability.

452 An Intrinsic Pathway in the Brain Underlying the Relationship Between Pain Catastrophizing and Chronic Pain in Temporomandibular Disorders

OBJECTIVES/GOALS: Pain Catastrophizing is a negative coping mechanism involving rumination, magnification, and helplessness and is associated with worse chronic pain. The neurobiological mechanisms underlying this relationship are poorly understood. We aim to examine the intrinsic activity of a functional pathway in patients with chronic orofacial pain. METHODS/STUDY POPULATION: This is the second phase of a parent study examining genetics, placebos, and the brain in temporomandibular disorders (TMD). We intend to recruit 120 of the original 398 TMD patients for this phase. Participants completed the Graded Chronic Pain Scale to assess TMD pain intensity and disability and the Pain Catastrophizing Scale. Behaviorally, pain catastrophizing scores and pain intensity and disability will be analyzed using structural equation modeling. Resting-state functional magnetic resonance imaging will be used to record intrinsic brain activity. The functional connectivity between the posterior cingulate, anterior insula, and periaqueductal grey will be assessed as a causal pathway relating pain catastrophizing to pain intensity and disability. Mediation analyses will be used to test causality. RESULTS/ANTICIPATED RESULTS: We anticipate that greater engagement in catastrophic thinking about pain increases the functional connectivity strength between the posterior cingulate, anterior insula, and periaqueductal grey, which ultimately leads to heightened perception of pain intensity and disability. Therefore, we expect to see increased functional connectivity in those with high pain catastrophizing levels as compared to those with low pain catastrophizing levels, and that this pathway will mediate the relationship between pain catastrophizing and pain intensity and disability. Further, we predict that helplessness will most strongly correlate with the change in functional connectivity as compared to rumination and magnification. Results will be presented in full at the conference. DISCUSSION/SIGNIFICANCE: Understanding how pain catastrophizing can influence chronic pain pathways will not only promote a more integrative approach to chronic pain management but will also help identify the mechanisms by which pain itself develops and persists in the particularly vulnerable pain population of TMD.

Balance control in unstable sitting in individuals with an acute episode of low back pain

BackgroundLow back pain (LBP) is associated with altered postural control, mostly observed at later stages in the LBP trajectory. It is unclear whether postural control differs in the acute phase of LBP. Research questionIs postural control different in the acute phase of LBP (<2 weeks) and do differences depend on pain intensity, psychological features and/or availability of vision to control posture? MethodsCross-sectional study design. An unstable sitting paradigm (to reduce the contribution of the legs) assessed postural control of participants with acute LBP (n = 133) and pain-free controls (n = 74). Centre of pressure (CoP) reflected seat movements. Participants balanced with eyes closed, open, or with visual feedback of the anteroposterior CoP position. Balance performance was expressed by CoP displacement and velocity, and stabilogram diffusion analysis. Generalised estimating equations (GEEs) including body mass index, sex, and safety bar touch, tested differences between groups and between balance conditions. Separate GEEs were used to model performance measures and bar touch (yes/no) including pain intensity, disability and psychological features. ResultsCoP displacement and critical point coordinates (time and distance where CoP diffusion rate or spread slows) were larger in LBP than pain-free controls independent of balance condition. Long-term diffusion rate was greater in LBP than controls with eyes closed. CoP velocity measures (RMS, short term diffusion rate) were not different between groups. Pain intensity and psychological features were not linearly related to balance performance in participants with acute LBP. Higher pain catastrophizing was associated with touching the safety bar. SignificancePostural control differs in acute LBP than pain-free controls. Findings might be explained by altered sensory processing, lesser ability to reweight proprioceptive information and/or less accurate trunk muscle control. Although not linearly related to pain-intensity or psychological features in the acute stage, reduced balance performance could potentially have impact on LBP recovery.

Role of self-efficacy for pain management and pain catastrophizing in the relationship between pain severity and depressive symptoms in women with breast cancer and pain

Purpose This study evaluated the relationship between pain and depressive symptoms through pain self-efficacy and pain catastrophizing in breast cancer patients with pain. Design Secondary analysis of a randomized trial investigating a cognitive-behavioral pain management protocol. Sample Females (N = 327) with stage I–III breast cancer and report of at least moderate pain. Methods Pain severity, pain self-efficacy, pain catastrophizing, and depressive symptoms were measured. The proposed model was assessed using structural equation modeling. Results Higher pain severity was significantly related to lower pain self-efficacy and higher pain catastrophizing. Lower pain self-efficacy and higher pain catastrophizing were significantly related to more depressive symptoms. Higher pain severity was significantly associated with more depressive symptoms through lower pain self-efficacy and higher pain catastrophizing. The association between pain severity and depressive symptoms was not significant when specified as a direct effect. Conclusion Pain severity related to depressive symptoms in breast cancer patients via pain self-efficacy and pain catastrophizing. Implications for psychosocial providers Measurement of pain self-efficacy and pain catastrophizing should be incorporated into comprehensive pain assessments for women with breast cancer, as these variables may be relevant therapeutic targets. Psychosocial symptom management interventions should include strategies that increase pain self-efficacy and decrease pain catastrophizing because these pain-related cognitive variables appear to drive the relationship between pain severity and depressive symptoms.

The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity.

Impaired physical functioning is one of the most critical consequences associated with fibromyalgia, especially when there is comorbid obesity. Psychological factors are known to contribute to perceived (i.e., subjective) physical functioning. However, physical function is a multidimensional concept encompassing both subjective and objective functioning. The contribution of psychological factors to performance-based (i.e., objective) functioning is unclear. This study aims to investigate the contribution of pain catastrophizing and pain acceptance to both self-reported and performance-based physical functioning. In this cross-sectional study, 160 participants completed self-report measures of pain catastrophizing, pain acceptance, and pain severity. A self-report measure and a performance-based test were used to assess physical functioning. Higher pain catastrophizing and lower pain acceptance were associated with poorer physical functioning at both self-reported and performance-based levels. Our results are consistent with previous evidence on the association between pain catastrophizing and pain acceptance with self-reported physical functioning. This study contributes to the current literature by providing novel insights into the role of psychological factors in performance-based physical functioning. Multidisciplinary interventions that address pain catastrophizing and pain acceptance are recommended and might be effective to improve both perceived and performance-based functioning in women with FM and obesity.

Sociodemographic and Clinical Predictors of Prescription Opioid Use in a Longitudinal Community-Based Cohort Study of Middle-Aged and Older Adults.

ObjectivesIdentifying factors associated with opioid use in middle-aged and older adults is a fundamental step in the mitigation of potentially unnecessary opioid consumption and opioid-related harms.MethodsUsing longitudinal data on a community-based cohort of adults aged 50–90 years residing in Johnston County, North Carolina, we examined sociodemographic and clinical factors in non-opioid users (n = 786) at baseline (2006–2010) as predictors of opioid use at follow-up (2013–2015). Variables included age, sex, race, obesity, educational attainment, employment status, household poverty rate, marital status, depressive symptoms, social support, pain catastrophizing, pain sensitivity, insurance status, polypharmacy, and smoking status.ResultsAt follow-up, 13% of participants were using prescription opioids. In the multivariable model, high pain catastrophizing (adjusted odds ratio; 95% confidence interval = 2.14; 1.33–3.46), polypharmacy (2.08; 1.23–3.53), and history of depressive symptoms (2.00; 1.19–3.38) were independent markers of opioid use.DiscussionFindings support the assessment of these modifiable factors during clinical encounters in patients ≥ 50 years old with chronic pain.

Characterizing pain in long-term survivors of childhood cancer.

Many long-term survivors of childhood cancer (LTSCC), individuals at least 5 years post-diagnosis or 2 years post-treatment, experience late- and long-term effects from their treatments, including pain. Yet, pain is poorly understood among LTSCC. The current study aimed to (1a) describe rates and multiple dimensions of pain; (1b) identify patterns of chronic pain; and (2) test correlates of chronic pain in LTSCC. Survivors (n = 140; 48.6% male, Mage = 17.3 years (range = 8-25)) were recruited from across Canada. Between 2017 and 2019, participants completed the Pain Questionnaire, Pain Catastrophizing Scale, Pediatric Quality of Life Inventory, Patient-Reported Outcome Measurement Information System (PROMIS)-Pain Interference, Anxiety, and Depression scales, Child Posttraumatic Stress Scale, the Posttraumatic Stress Disorder Checklist for the DSM-V, and the Cancer Worry Scale. RESULTS: Twenty-six percent of LTSCC reported experiencing chronic pain. Exploratory cluster analysis showed 20% of survivors had moderate to severe chronic pain based on measures of pain intensity and interference. The combination of higher posttraumatic stress symptoms, older current age, more pain catastrophizing, and sex (being female) significantly predicted the presence of chronic pain in logistic regression, χ2 (4, N = 107) = 28.10, p < .001. Higher pain catastrophizing (OR = 1.09; 95% CI = 1.02-1.16), older current age (OR = 1.20; 95% CI = 1.07-1.34), and higher posttraumatic stress (OR = 1.92; 95% CI = 1.01-3.63) were significant predictors of chronic pain. LTSCC should be screened for the presence and magnitude of chronic pain during long-term follow-up visits so appropriate interventions can be offered and implemented. Future research should investigate pain interventions tailored for this population. RELEVANCE: Findings support regular screening for the presence and magnitude of chronic pain in survivors of childhood cancer in long-term follow-up care.

Pain Catastrophizing Throughout the Perioperative Period in Adolescents With Idiopathic Scoliosis.

Objectives:Pain catastrophizing in children and adolescents has been associated to unfavorable postsurgical outcomes. However, pain catastrophizing is rarely measured throughout the perioperative period. Using a prospective longitudinal approach, the present study aimed to identify how pain catastrophizing changes over the perioperative period in pediatric surgical patients with adolescent idiopathic scoliosis.Materials and Methods:Adolescent patients undergoing spinal fusion surgery completed the Pain Catastrophizing Scale for Children and additional questionnaires to assess pain intensity, state and trait anxiety, and kinesiophobia before surgery, and 1, 2, 5 days, 6 weeks, and 6 months after surgery.Results:Patients who had higher levels of pain catastrophizing before surgery were more likely to be anxious, avoid activity that may cause pain, report higher pain intensity before surgery and anticipate more pain after surgery. Low pain catastrophizers increased into a moderate level of pain catastrophizing before decreasing after discharge from the hospital. Meanwhile, moderate and high pain catastrophizers both decreased into lower and moderate levels of catastrophizing, respectively, after discharge from the hospital.Discussion:These findings demonstrate that pain catastrophizing in adolescents changes over the perioperative period. Observing changes in pain catastrophizing throughout the perioperative period may help in recognizing when patients are most vulnerable during this time. Decreasing pain catastrophizing before surgery or in the acute postoperative period through therapies that target pain catastrophizing may help reduce the patient’s likelihood of experiencing unfavorable postoperative outcomes.

Intersectional identity approach to chronic pain disparities using latent class analysis.

Research on intersectionality and chronic pain disparities is very limited. Intersectionality explores the interconnections between multiple aspects of identity and provides a more accurate image of disparities. This study applied a relatively novel statistical approach (ie, Latent Class Analysis) to examine chronic pain disparities with an intersectional identity approach. Cross-sectional data were analyzed using pretreatment data from the Learning About My Pain trial, a randomized comparative effectiveness study of group-based psychosocial interventions (Patient-Centered Outcomes Research Institute Contract #941, Beverly Thorn, PI; clinicaltrials.gov identifier NCT01967342) for patients receiving care for chronic pain at low-income clinics in rural and suburban Alabama. Latent Class Analysis results suggested a 5-class model. To easily identify each class, the following labels were created: older adults, younger adults, severe disparity, older Black or African American, and Working Women. The latent disparity classes varied by pretreatment chronic pain functioning. Overall, the severe disparity group had the lowest levels of functioning, and the Working Women group had the highest levels of functioning. Although younger and with higher literacy levels, the younger adults group had similar levels of pain interference and depressive symptoms to the severe disparity group (P's < 0.05). The younger adults group also had higher pain catastrophizing than the older adults group (P < 0.005). Results highlighted the importance of the interactions between the multiple factors of socioeconomic status, age, and race in the experience of chronic pain. The intersectional identity theory approach through Latent Class Analysis provided an integrated image of chronic pain disparities in a highly understudied and underserved population.

Transient Reductions in Postoperative Pain and Anxiety with the Use of Virtual Reality in Children.

Virtual reality is a promising method to manage pain. Distraction-based virtual reality (VR-D) is thought to reduce pain by redirecting attention. Although VR-D can reduce pain associated with acutely painful procedures, it is unclear whether VR-D can reduce pain after surgery. We assessed the ability of a single VR-D session to decrease postoperative pain and anxiety and explored whether pain catastrophizing and anxiety sensitivity influenced these outcomes in children after surgery. Single-center, prospective, pilot study. Cincinnati Children's Hospital Medical Center (CCHMC). Fifty children (7-21 years of age) with postoperative pain followed by the Acute Pain Service. Patients received one VR-D session after surgery. Before the session, patients completed pain catastrophizing (Pain Catastrophizing Scale for Children) and anxiety sensitivity (Child Anxiety Sensitivity Index) questionnaires. The primary outcome consisted of changes in pain intensity after VR-D (immediately, 15 minutes, and 30 minutes). Secondary outcomes included changes in pain unpleasantness and anxiety. VR-D use was associated with a decrease in pain intensity immediately and 15 minutes after VR-D. Reductions in pain unpleasantness were observed up to 30 minutes after VR-D. VR-D was also associated with a reduction in anxiety immediately and at 15 minutes. Although patients with higher pain catastrophizing had higher baseline pain intensity and unpleasantness, they did not show larger pain reductions after VR-D than those with lower pain catastrophizing. VR-D may be beneficial in transiently reducing pain intensity, unpleasantness, and anxiety in children with postoperative pain. This study informs the design of a larger, randomized, controlled study assessing VR-D for acute postoperative pain and anxiety management.

Perceived Injustice Is Associated With Pain-related Function and Mood in Youth With Acute Musculoskeletal Pain.

Perceived injustice (PI), which is one's appraisal of justice or fairness regarding the pain experience, is an emerging area of interest in pediatric pain research. No previous studies have investigated PI in youth with acute pain. To fill this gap, this study examined (1) associations among PI, pain-related function, and psychological function in treatment-seeking youth with acute musculoskeletal (MSK) pain, and (2) the impact of parent-child PI discordance on children's pain and psychosocial function. Participants were youth (aged 11 to 17, 55% male) with acute pain (onset <1 mo) recruited from emergency departments or outpatient clinics and participating parents (102 parent-child dyads). Dyads completed study questionnaires within 1 month of the child's pain onset. Youth-reported PI was significantly correlated with poorer physical and psychosocial quality of life, higher pain catastrophizing, higher fear of pain, increased pain-related disability, and greater depression and anxiety. Furthermore, PI was significantly associated with the physical quality of life, psychosocial quality of life, and pain-related disability. Moreover, discordance in youth and parent ratings of PI was associated with children's psychological and pain-related function. Specifically, compared with Concordant dyads, youth in the Discordant dyads (youth high PI/parent low PI) reported significantly poorer physical quality of life, psychosocial quality of life, higher pain-related disability, depression, anxiety, and pain catastrophizing. These findings reveal that PI in youth with acute MSK pain is associated with quality of life and pain-related disability. Furthermore, results highlight the importance of discordance between youth and parent reports of PI on pain-related functioning.

OP0089 DO PAIN CATASTROPHIZING REDUCE THE LIKELIHOOD OF REMISSION IN PATIENTS WITH CHRONIC INFLAMMATORY JOINT DISORDERS?

Background:Rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (ax-SpA) may have a devastating impact on patients’ lives, including chronic and relapsing pain. One factor contributing to bio-psycho-social model of pain in these diseases, is pain catastrophizing (PC) defined as tendency to report pain experience in exaggerated terms, to ruminate more or to feel helpless about it. In one RA study PC has been shown to be associated with patient reported outcomes e.g. reduced likelihood of remission using composite measures.[1]Objectives:Main objective of this study was to explore if pain catastrophizing score is associated with remission rates in the chronic inflammatory joint disorders RA, PsA and ax-SpA.Methods:Patients were recruited during routine assessment at an outpatient clinic in Norway. Variables collected included demographics, treatment, disease duration, global pain VAS, pain catastrophizing score (PCS), and disease activity scores: DAS28-CRP for RA, BASDAI for ax-SpA and DAPSA for PsA. Cut off definitions of remission was for DAS28 &lt;2.6, for BASDAI &lt;4.0 and for DAPSA ≤4.0. Two questions from Coping Strategies Questionnaire as recommended by Jensen et al [2] were used to describe PC, range PC total score (PCS) 0–6. Patients with PCS ≥ 4 were defined as high pain catastrophizers. Statistics included Chi-Square test and adjusted logistic regression (enter procedure).Results:For RA (N=580), PsA (N=394) and ax-SpA (N=225) mean age (SD) was 61.5 (13.1), 54.4 (12.9) and 47.5 (12.9) years, mean disease duration 12.6 (10.9), 10.2 (8.4) and 12.2 (10.7) years and percentage of women 66.7%, 47.0% and 38.4%. Mean (SD) DAS28-CRP in RA was 2.3 (1.0), BASDAI for ax-SpA 3.7 (2.3) and DAPSA for PsA 10.8 (8.5). Mean (SD) global pain (VAS 0-100mm) was for RA 32.0 (25.6), for PsA 35.5 (25.4) and for ax-SpA 39.4 (25.4) mm. Conventional synthetic DMARDs were used by 65.0% of RA patients, 54.8% by PsA and 9.8% in ax-SpA and for biologic DMARDs the corresponding numbers were 36.7%, 43.9%, 65.9%, respectively.Percentage of patients in remission was significantly lower in high pain catastrophizers compared with low pain catastrophizers in RA (34.1% vs 70.3%, p&lt;0.01) and ax-SpA patients (17.9% vs 64.5%, p&lt;0.01) but not in PsA (10.3% vs 26.7%, p=0.06).In analysis adjusting for age, gender, disease duration and global pain (Tab. 1), PC was independently associated with lower remission rate in RA (OR 0.79 (95% CI 0.63, 0.99), p=0.04) and in ax-SpA (OR 0.65 (95% CI 0.46, 0.93), p=0.02) but not in PsA (OR 0.83 (95% CI 0.55, 1.25), p=0.37)Conclusion:Our data indicates that high level of patient’s PC may reduce likelihood of achieving remission in RA and ax-SpA. Interestingly, this was not shown in PsA patients. Further studies are needed to reveal the importance of PC and its influence on composite disease activity measures used to define disease status e.g. remission.Table 1.Variables and their associations with remission rates in RA, PsA, ax-SpA in logistic regression analysis.RA remissionPsA remissionax-SpA remissionOR (95%CI)pOR (95%CI)pOR (95%CI)pPCS0.79 (0.63, 0.99)0.040.83 (0.55, 1.25)0.370.65 (0.46, 0.93)0.02Age0.99 (0.97, 1.01)0.171.00 (0.96, 1.04)0.850.98 (0.94, 1.02)0.27Gender0.87 (0.52, 1.45)0.590.37 (0.15, 0.93)0.030.92 (0.40, 2.14)0.85Disease duration1.03 (1.00, 1.05)0.030.95 (0.90, 1.00)0.061.04 (0.99, 1.09)0.09Global pain (VAS)0.96 (0.95, 0.97)&lt;0.010.85 (0.81, 0.89)&lt;0.010.90 (0.88, 0.92)&lt;0.01

The Moderating Role of Attention Control in the Relationship Between Pain Catastrophizing and Negatively-Biased Pain Memories in Youth With Chronic Pain

The present study examined the role of attention control in understanding the development of negatively-biased pain memories as well as its moderating role in the relationship between pain catastrophizing and negatively-biased pain memories. Youth with chronic pain (N = 105) performed a cold pressor task (CPT) and completed self-report measures of state/trait pain catastrophizing and attention control, with the latter comprising both attention focusing and attention shifting. Two weeks after the CPT, youth's pain-related memories were elicited via telephone allowing to compute pain and anxiety memory bias indices (ie, recalling pain intensity or pain-related anxiety, respectively, as higher than initially reported). Results indicated no main effects of attention control and pain catastrophizing on pain memories. However, both components of attention control (ie, attention focusing and attention shifting) moderated the impact of pain catastrophizing on youth's memory bias, with opposite interaction effects. Specifically, whereas high levels of attention shifting buffered the influence of high pain catastrophizing on the development of pain memory bias, high levels of attention focusing strengthened the influence of high pain catastrophizing on the development of anxiety memory bias. Interaction effects were confined to trait catastrophizing (ie, not state catastrophizing). Theoretical and clinical implications are discussed. PerspectiveThis article investigates the role of attention control in the development of negatively-biased pain memories in children with chronic pain. Findings underscore the importance of targeting differential components of attention control and can inform intervention efforts to minimize the development of negatively biased pain memories in youth with chronic pain.

Memory bias for learned threat and safety cues in youth with chronic pain

Negatively-biased memories for painful events (recalled pain greater than initial reported pain) are consistently associated with worse pain outcomes in adults and youth; thus, the tendency to develop negative memory biases is suggested to be a risk factor for chronic pain. From a transdiagnostic perspective, this may reflect a more general bias in recalling threatening vs. safe stimuli; this has not yet been tested. Sixty-seven youth (N=43 chronic pain patients, mixed diagnoses; N=24 controls) completed a developmentally-appropriate fear conditioning task (the Screaming Lady) in which they rated their fear towards learned threat and safety cues. Patients completed self-report measures of pain catastrophizing (PCS-C), pain-related fear-avoidance (FOPQ-C, fear and avoidance subscales), and physical functioning (FDI). Two months later (M=59 days), youth rated their recalled fear towards the threat and safety stimuli. For a subsample (N=32, 23 patients), their open-ended recall of the stimuli were coded. T-tests examined patient-control differences in memory biases. Partial correlations controlled for initial fear ratings to examine how memory biases covary with pain catastrophizing, fear-avoidance, and functioning. Patients and controls did not significantly differ in their memory biases (p's > .05). Patients with higher pain catastrophizing (r = .415, p = .007) and greater pain-related fear (r = .363, p = .02) had greater negatively-biased recall of fear towards safety stimuli at follow-up; there was no association with functional disability. Youth with greater negatively-biased recall of fear towards threat stimuli described the stimulus’ appearance (r = .430, p = .018) and emotional expression (r = .506, p = .006) in greater detail. Negatively-biased recall of safety cues is related to higher pain catastrophizing and pain-related fear in youth with chronic pain. Mixed quantitative-qualitative probing of threat-related memories will be helpful to reveal how memory biases are a risk factor for pediatric chronic pain. NIH R01HD083270 to LE Simons.

Assessing disparities on caregiver factors known to affect children's pain and outcomes

Parental health, beliefs and behaviors influence pediatric pain experiences and treatment outcomes. There is increasing acknowledgment of pain disparities in underrepresented ethnic groups and growing understanding of social and economic factors (SEFs) that affect pain. Less is known about SEFs’ impact on caregivers and whether the presence of multiple SEFs increases risk of disparities. The present study assesses 1) disparities by ethnicity and insurance status in mental health (MH), physical health (PH), pain catastrophizing (PC) and protective behaviors (PB) of caregivers of children with pain, and 2) whether insurance status moderates ethnic disparities. 792 caregivers identifying as Hispanic (26%) and Non-Hispanic White (NHW; 74%) provided data before initial visit to an outpatient pediatric pain clinic. Measures included demographic information, insurance, PROMIS Global Health, the parent version of the Pain Catastrophizing Scale, and the Protect subscale of the Adult Responses to Children's Symptoms scale. Health-insurance was coded as private (73.4%) or public (25.5%). Hispanic caregivers were younger, had lower educational levels, and were more likely to have public insurance. Hispanic caregivers reported poorer PH and higher levels of PC and PB. Public insurance was associated with poorer PH and MH and with higher PC and PB. Two-way ANOVAs revealed main effects for ethnicity on PH, MH, and PB were no longer significant with insurance entered into model but remained significant for PC. Insurance main effects were significant for PH, PM, PC, and PB. None of the interaction terms were significant. Findings highlight disparities by ethnicity and insurance status in caregiver factors known to affect children's pain and treatment outcomes and underscore the role of insurance as a contributor to disparities. Results highlight the importance of assessing SEFs that may affect caregivers of children with pain to provide optimal support to families and maximize child treatment outcomes.

A Live Video Program to Prevent Chronic Pain and Disability in At-Risk Adults With Acute Orthopedic Injuries (Toolkit for Optimal Recovery): Protocol for a Multisite Feasibility Study.

BackgroundDespite the pivotal role of psychosocial factors in pain and disability after orthopedic injury, there are no evidence-based preventive interventions targeting psychosocial factors in patients with acute orthopedic injuries. We developed the first mind-body intervention focused on optimizing recovery and improving pain and disability in patients with acute orthopedic injuries who exhibit high levels of catastrophic thinking about pain and/or pain anxiety (Toolkit for Optimal Recovery [TOR] after orthopedic injury). In a pilot single-site randomized controlled trial (RCT), the TOR met a priori set benchmarks for feasibility, acceptability, and satisfaction. The next step in developing TOR is to conduct a multisite feasibility RCT to set the stage for a scientifically rigorous hybrid efficacy-effectiveness trial.ObjectiveThe objective of this study is to conduct a rigorous multisite feasibility RCT of TOR to determine whether the intervention and study methodology meet a priori set benchmarks necessary for the successful implementation of a future multisite hybrid efficacy-effectiveness trial. In this paper, we describe the study design, manualized treatments, and specific strategies used to conduct this multisite feasibility RCT investigation.MethodsThis study will be conducted at 3 geographically diverse level 1 trauma centers, anonymized as sites A, B, and C. We will conduct a multisite feasibility RCT of TOR versus the minimally enhanced usual care (MEUC) control (60 patients per site; 30 per arm) targeting a priori set feasibility benchmarks. Adult patients with acute orthopedic injuries who endorse high pain catastrophizing or pain anxiety will be recruited approximately 1-2 months after injury or surgery (baseline). Participants randomized to the TOR will receive a 4-session mind-body treatment delivered via a secure live video by trained clinical psychologists. Participants randomized to the MEUC will receive an educational booklet. Primary outcomes include feasibility of recruitment, appropriateness, feasibility of data collection, acceptability of TOR (adherence to sessions), and treatment satisfaction across all sites. We will also collect data on secondary implementation outcomes, as well as pain severity, physical and emotional function, coping skills, and adverse events. Outcomes will be assessed at baseline, posttreatment, and at the 3-month follow-up.ResultsEnrollment for the RCT is estimated to begin in June 2021. The target date of completion of the feasibility RCT is April 2024. The institutional review board approval has been obtained (January 2020).ConclusionsThis investigation examines the multisite feasibility of TOR administered via live videoconferencing in adult patients with acute orthopedic injuries. If feasible, the next step is a multisite, hybrid efficacy-effectiveness trial of TOR versus MEUC. Preventive psychosocial interventions can provide a new way to improve patient and provider satisfaction and decrease suffering and health care costs among patients with orthopedic injuries who are at risk for chronic pain and disability.International Registered Report Identifier (IRRID)PRR1-10.2196/28155