Self-report Measures Of Pain Research Articles

Severe Cognitive Impairment in Trauma-Affected Refugees-Exploring the Impact of Traumatic Brain Injury.

Background/Objectives: This study explores the relationship between cognitive performance measured by the Symbol Digit Modality Test (SDMT) and the severity of self-reported head injury, traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), depression, pain, and psychosocial dysfunction in a population of trauma-affected refugees. Refugees, especially those who have been subjected to torture, often face various difficulties, such as PTSD, depression and somatic disturbances (e.g., pain), which can significantly impact their day-to-day functioning. Methods: Participants included 141 adult refugees (38% women) with a mean age of 45.4 years (SD = 9.4) and 9.7 years (SD = 4.9) of education who were referred for treatment of post-traumatic distress to DIGNITY, Danish Institute Against Torture. Participants completed standardized self-report measures of PTSD, anxiety, depression, pain, and health-related disability and measures of trauma history, physical injuries including head injury and loss of consciousness, and the SDMT, a quick standardized performance-based measure of cognitive impairment. Results: Eighty-eight percent of participants evidenced signs of substantial cognitive impairment as indexed by lower SDMT scores. Those with a self-reported history of TBI, marked by loss of consciousness, exhibited lower SDMT scores and higher health-related disabilities. Severity of PTSD, depression, anxiety, and pain were highly correlated with lower SDMT scores. TBI history was not significantly associated with the severity of PTSD, depression, anxiety, or pain, suggesting a complex interplay among these factors. Conclusions: Cognitive impairments are prevalent in trauma-affected refugees, interacting with symptoms of post-traumatic stress and pain, likely explaining the high disability levels in this population. Further research should employ a broader range of cognitive measures and detailed investigations of head injury/TBI experiences to investigate their impact on overall functioning, treatment response, and longer-term outcomes. This study adds to a small but growing body of studies documenting cognitive impairments in trauma-affected refugees, highlighting the importance of addressing cognitive impairments in treatment for trauma-affected refugees, particularly those with histories of torture and TBI. Clinicians working with trauma-affected refugees should consider the assessment of cognitive difficulties as part of comprehensive care planning.

Clinical and biobehavioral phenotypic assessments and data harmonization for the RE-JOIN research consortium: Recommendations for common data element selection

BackgroundThe Restoring Joint Health and Function to Reduce Pain (RE-JOIN) Consortium is part of the Helping to End Addiction Long-term® (HEAL) Initiative. HEAL is an ambitious, NIH-wide initiative to speed scientific solutions to stem the national opioid public health crisis. The RE-JOIN consortium’s over-arching goal is to define how chronic joint pain-mediating neurons innervate different articular and peri-articular tissues, with a focus on the knee and temporomandibular joints (TMJ) across species employing the latest neuroscience approaches. The aim of this manuscript is to elucidate the human data gathered by the RE-JOIN consortium, as well as to expound upon its underlying rationale and the methodologies and protocols for harmonization and standardization that have been instituted by the RE-JOIN Consortium. MethodsThe consortium-wide human models working subgroup established the RE-JOIN minimal harmonized data elements that will be collected across all human studies and set the stage to develop parallel pre-clinical data collection standards. Data harmonization considerations included requirements from the HEAL program and recommendations from the consortium’s researchers and experts on informatics, knowledge management, and data curation. ResultsMultidisciplinary experts − including preclinical and clinical researchers, with both clinician-scientists- developed the RE-JOIN’s Minimal Human Data Standard with required domains and outcome measures to be collected across projects and institutions. The RE-JOIN minimal data standard will include HEAL Common Data Elements (CDEs) (e.g., standardized demographics, general pain, psychosocial and functional measures), and RE-JOIN common data elements (R-CDE) (i.e., both general and joint-specific standardized and clinically important self-reported pain and function measures, as well as pressure pain thresholds part of quantitative sensory testing). In addition, discretionary, site-specific measures will be collected by individual institutions (e.g., expanded quantitative sensory testing and gait biomechanical assessments), specific to the knee or TMJ. Research teams will submit datasets of standardized metadata to the RE-JOIN Data Coordinating Center (DCG) via a secure cloud-based central data repository and computing infrastructure for researchers to share and conduct analyses on data collected by or acquired for RE-JOIN. RE-JOIN datasets will have protected health information (PHI) removed and be publicly available on the SPARC portal and accessible through the HEAL Data Ecosystem. ConclusionData Harmonization efforts provide the multidisciplinary consortium with an opportunity to effectively collaborate across decentralized research teams, and data standardization sets the framework for efficient future analyses of RE-JOIN data collected by the consortium. The harmonized phenotypic information obtained will significantly enhance our understanding of the neurobiology of the pain-pathology relationships in humans, providing valuable insights for comparison with pre-clinical models.

Alternative models to support weight loss in chronic musculoskeletal conditions: effectiveness of a physiotherapist-delivered intensive diet programme for knee osteoarthritis, the POWER randomised controlled trial

ObjectivesTo determine if physiotherapists can deliver a clinically effective very low energy diet (VLED) supplementary to exercise in people with knee osteoarthritis (OA) and overweight or obesity.Methods88 participants with knee...

490. Functional Connectivity Patterns Associated With Self-Reported Pain Measures in Individuals With Opioid Use Disorder

490. Functional Connectivity Patterns Associated With Self-Reported Pain Measures in Individuals With Opioid Use Disorder

Comparison of time-matched aerobic, resistance or combined exercise training in women living with obesity: The EXOFFIT study.

Improvements in cardiorespiratory fitness (CRF) have been shown to largely attenuate the negative health risks associated with obesity. To date, literature on women with obesity has focused upon the evaluation of aerobic-based exercise interventions. Hence, there is a need to evaluate resistance and combined interventions with this cohort. This study aimed to evaluate the feasibility and efficacy of three exercise modalities in women with obesity for improving CRF, strength, body composition and other health outcomes. Sixty-seven women with obesity were randomly assigned to the control (CON) or one of three exercise groups (aerobic [AE], resistance [RE], COM). Exercise groups were trained x3 times/week for 12weeks (up to 150-min/week). Feasibility outcomes included adherence, attendance, recruitment and retention rates and adverse events. Secondary outcomes were CRF (predicted VO2 max), body composition (body weight [BW], waist circumference [WC], body fat percentage [%BF], fat mass [FM] and lean mass) and strength (5RM bench press, leg dynamometry, grip strength) and self-reported measures of physical activity, mood, sleep, pain and quality of life. Findings support the feasibility of all three exercise modalities in terms of adherence, attendance, and retention. Interventions with a resistance component (COM and RE) were associated with the greatest improvements across the broad range of health outcomes measured. Combined was the most promising for body composition outcomes including body mass index (Effect size [ES]=0.79, p=0.04), BW (ES=0.75, p=0.05), %BF (ES=0.77, p=0.04), FM (ES=0.83, p=0.03) and WC (ES=0.90, p=0.02), physical activity (i.e., moderate physical activity [ES=0.69, p=0.07), mood (ES=0.83, p=0.03) and sleep (ES=0.78, p=0.04). Resistance was most promising for CRF (ES=1.47, p=0.002), strength (i.e., bench press [ES=2.88, p=<0.001]) and pain (i.e., pain severity [ES=0.40, p=0.31]). For health outcomes, these results indicate the importance of including a resistance component when prescribing exercise for women with obesity to achieve meaningful improvements. ISRCTN13517067.

Telehealth delivery of adapted CBT-I for insomnia in chronic pain patients: a single arm feasibility study.

A large proportion of individuals with chronic pain experience insomnia-related symptoms which can be persistent in nature, and negatively impact one's quality of life. This single arm trial aimed to investigate the feasibility and preliminary efficacy of CBT-I, adapted for people with chronic musculoskeletal pain, delivered via telehealth. We conducted a single arm feasibility trial in which 10 adult women (M age = 50.76 years, SD = 8.03 years) with self-reported insomnia and a diagnosed chronic musculoskeletal chronic pain received six CBT-I individual treatment sessions over 6-10 weeks. Treatment was delivered via telehealth. Participants completed weekly sleep diaries, and self-reported measures of insomnia, pain, anxiety and depression pre-treatment, post-treatment, and one-month follow-up. The trial yielded, high levels of compliance with intervention protocols, and affirmative feedback on satisfaction which demonstrated feasibility. The enrolment rate into the study was 37% (27 participants screened, 10 participants enrolled). The intervention was associated with statistically and clinically meaningful improvements in self-reported insomnia severity. There were statistically significant improvements in sleep efficiency, wake after sleep onset, sleep onset latency, anxiety and depression. Adapted CBT-I delivered via telehealth may be a feasible, acceptable, and efficacious therapeutic approach for individuals with co-existent sleep and chronic pain. Future trials should adopt a randomized design against usual care.

A preliminary examination of the effects of childhood abuse and resilience on pain and physical functioning in patients with knee osteoarthritis.

We examined associations of a self-reported history of childhood abuse with pain and physical functioning in patients with knee osteoarthritis (KOA) awaiting total knee arthroplasty (TKA). We also explored the potential moderating effects of positive childhood experiences (PCEs), an index of resilience, on these associations. Prior to TKA, participants with KOA awaiting surgery (N = 239) completed self-report measures of adverse childhood experiences (ACEs), PCEs, pain, and physical functioning. We evaluated associations of pain and physical functioning (Brief Pain Inventory [BPI] and Western Ontario and McMaster University of Osteoarthritis Index [WOMAC]) based on the experience of ACEs (childhood abuse), with PCEs (childhood happiness and supportive parental care) as potential moderators. Greater exposure to childhood abuse was positively correlated with BPI pain interference as well as WOMAC pain and functioning scores. Additionally, childhood happiness and supportive parental care moderated the positive associations of childhood abuse with pain and physical functioning; though, surprisingly, the adverse effects of childhood abuse on these outcomes were more pronounced among participants with high levels of childhood happiness and supportive parental care. Overall, results show an association between a self-reported history of childhood abuse and pain and functioning in patients with KOA awaiting TKA. However, PCEs did not protect against the negative consequences of childhood abuse in our cohort. Further research is needed to validate these associations and gain a more comprehensive understanding of the complex interplay between childhood abuse and PCEs and their potential influences on pain experiences in adults with chronic pain conditions, including KOA.

Are Formal and Informal Home Mindfulness Practice Quantities Associated With Outcomes? Results From a Pilot Study of a Four-Week Mindfulness Intervention for Chronic Pain Management.

The association between home mindfulness practice quantity in standard length mindfulness-based interventions (MBIs) and chronic pain outcomes is variable. Few studies focus on abbreviated MBIs (< 8weeks) and distinguish between formal guided practices and informal practices in daily life. To characterize home mindfulness practice and explore associations between home practice quantity and pre-to-post-outcome changes after an MBI for chronic pain. In this single-arm study, 21 adults with chronic pain (mean age = 54years, 81% White, mean pain duration = 7years) completed an MBI with four weekly group sessions. Pre and post self-report measures of pain intensity/interference, physical function, depression, anxiety, positive affect, sleep disturbance (all PROMIS measures), and pain acceptance, catastrophizing, perceived stress and mindfulness were completed, along with daily surveys of formal (mindfulness of breath, body scan) and informal (breathing space, mindfulness of daily activities) practice. Bivariate correlations and multivariable regression models were used to assess the association between days and minutes of practice and change in outcomes. On average, formal practice was completed on 4.3days per week and 13.5minutes per day. Informal practice was completed on 3.5days per week and 8.6minutes per day. Formal practice was not significantly correlated with outcomes (Spearman's ρ = |.01|-|.32|), whereas informal practice was correlated with multiple outcomes (ρ = |.04|-|.66|). Number of days practiced informally was associated with improved pain interference, physical function, sleep disturbance, and catastrophizing (p's ≤ .05). Number of minutes practiced informally was associated with improved pain interference, anxiety, positive affect, and catastrophizing (p's ≤ .05). Informal home practice quantity, but not formal practice quantity, is associated with improved outcomes during an abbreviated MBI for chronic pain. For these MBIs, it is important to evaluate the distinct roles of formal and informal practice. NCT03495856.

Effect Sizes for Changes in Health and Well-Being Following Treatment With the One-To-Zero Technique in Individuals With Occipito-Atlantal Joint Dysfunction: A Repeated Measures Study

ObjectivesThe purpose of this study was to determine effect sizes (ES) for changes in self-reported measures of musculoskeletal pain and dysfunction resulting from the one-to-zero method using a repeated measures study design. MethodsTwenty participants presenting with articular dysfunction of the occipito-atlantal (C0-C1) complex were treated using the one-to-zero method, a high-velocity low-amplitude thrust administered between the C0-C1 complex before treating other restrictive segments in a cephalocaudal direction. The participants completed online questionnaires using Google Forms that assessed aspects of the biopsychosocial model of pain at baseline and within a week after treatment. The questionnaires included the following: (1) Demographic and Health Behavior Survey; (2) Neck Bournemouth Questionnaire (NBQ) or Neck Disability Index (NDI); (3) Beck Anxiety Index (BAI); (4) Insomnia Severity Index (ISI); and (5) 36-Item Short Form Health Survey (SF-36). Paired t test or Wilcoxon signed ranks test was performed, dependent on normality. Cohen's d values were calculated for each questionnaire score (0.20 indicative of small; ≥0.50 medium; and ≥0.80 large ES). ResultsThe NDI, NBQ, BAI, and ISI had a large ES (all d ≥ 0.80). In the SF-36, 4 subscales had a small to near-medium ES, 1 subscale had a medium to near-large ES, and the remaining 2 had a large ES (d ≥ 0.80). The physical and mental component summary had a large (d = 0.88) and small ES (d = 0.35), respectively. ConclusionThe effect sizes suggest the one-to-zero treatment induces change in various aspects of the biopsychosocial model.

Validity and Responsiveness of the Portable Warrior Test of Tactical Agility After Rehabilitation in Service Members With Mild Traumatic Brain Injury.

The Portable Warrior Test of Tactical Agility (POWAR-TOTAL) is a performance-based test designed to assess active-duty service members diagnosed with mild traumatic brain injuries (mTBIs) and could potentially inform return to duty decisions. To examine the validity and responsiveness of the POWAR-TOTAL measure, this study collected self-reported and performance measures by active-duty service members before and after an episode of physical therapist care. Seventy-four individuals, enrolled in care for mTBI symptoms at 1 of 2 concussion specialty Intrepid Spirit Centers, were examined the week that they initiated physical therapy with the intention to return to active duty. Self-reported measures of concussion symptoms, pain, posttraumatic stress, headache, dizziness, and sleep quality were used, as were concurrent measures of mobility and balance. The POWAR-TOTAL task (motor and cognitive skills in single and dual-task conditions) was administered. Forty-nine active-duty service members returned for posttherapy testing using the same test battery. Effect sizes for change in measures were calculated. Construct validity was assessed by correlating change scores on POWAR with concurrent self-report and mobility measures. Responsiveness was evaluated using an anchor-based approach. Significant improvements in self-reported and performance-based measures, including POWAR, were observed after therapy with moderate to large effect sizes. Improvement in POWAR performance correlated with improvement in both performance and self-reported measures. After therapy, individuals who registered improvement on the Patient Global Impression of Change scale demonstrated significantly faster POWAR motor performance than those who rated little or no improvement in their condition. The POWAR-TOTAL captured improvement on a military-specific task after completing physical therapy for mTBI and could serve as an indicator of physical recovery and readiness for return to duty. Challenging cognitive and motor measures for service members may aid in the assessment of recovery and the ability to successfully return to duty after concussion as part of a comprehensive examination approach.

Epidemiology and 12-Month Outcomes of Patients Managed in a Thoracolumbosacral Orthosis After Trauma

Abstract Introduction Traumatic fractures of the thoracolumbar junction (T10–L3) are the most common fractures of the spinal column. The management of these injuries can be operative or nonoperative, and braces are often used, including the Boston Overlap Brace (BOB), a type of thoracolumbosacral orthosis (TSLO). Methods All patients admitted to the Alfred Hospital in 2015 and managed in a BOB for 2- or 3-column thoracolumbar burst fractures (without neurology) were included in the study. In-hospital and 6- and 12-month patient-reported outcome measures were collected. A random-effects regression model analysis for each outcome (self-reported) pain and functional outcome measures by the Glasgow Outcomes Scale–Extended (GOS-E) was undertaken. Results A total of 115 patients (62 male) were included with a median age of 53 years. Using a random-effects model, having a lower-limb fracture or a regional kyphosis angle &gt;8° was associated with not having a good recovery after taking into account all other factors with a univariate relationship with this outcome. In terms of the outcome of self-reported pain, only female sex was associated with reporting pain. Conclusions This study included a large cohort of patients with management of a traumatic fracture with a BOB-type TLSO and provided information that should guide a larger study to review whether the factors associated with poorer outcome, including female sex and local kyphotic angle, need to be considered before deciding on the management of these fractures. Clinical Relevance The association between degree of deformity of fracture (&gt;8°) and associated lower-limb injury with poorer patient outcomes may need to be taken into account before deciding to manage thoracolumbar fractures with a BOB-type TLSO although further longitudinal studies are required.

Incremental Contribution of the Minnesota Multiphasic Personality Inventory - 3 to Predicting One-Year Postoperative Spinal Cord Surgery/Spinal Cord Stimulation Outcomes.

Pre-surgical psychological assessments are becoming common in the United States and are recommended or required prior to surgical/spinal cord stimulator intervention for chronic back pain. Psychological testing is often recommended for these evaluations and the various versions of the Minnesota Multiphasic Personality Inventory (MMPI) have demonstrated utility for predicting outcomes in this setting. This investigation sought to extend that literature with the newest version of the MMPI, the MMPI-3. The sample comprised of 909 patients (50.5% men, 49.5% women) who consented to participating in an outcome study and took the MMPI-3 along with other self-report measures of pain, functional disability, and emotional functioning prior to surgery as part of their pre-surgical psychological assessment. Self-report measures of pain, functional disability, and emotional functioning were administered again one-year following the intervention. MMPI-3 scale scores accounted for up to 9% of additional variance in the outcomes after controlling for pre-surgical measures. Measures of emotional/internalizing dysfunction, somatic dysfunction, and, to a lesser extent, behavioral/externalizing dysfunction contributed the most to the prediction of poorer outcomes.

Remodeling of the Temporomandibular Joint After Mandibular Setback Surgery: A 3D Cephalometric Analysis

Condylar adaptations following orthognathic surgery remain an area of interest. Prior studies do not use 3-dimensional imaging modalities and lack standardization in the choice of osteotomy and movement when assessing condylar changes. The purpose of this study was to use 3-dimensional cephalometry to measure the association between osteotomy type (sagittal split osteotomy [SSO] vs vertical ramus osteotomy [VRO]) and changes in condylar volume and position. This is a retrospective cohort study from January 2021 through December 2022 of patients at Bellevue Hospital in New York City, New York who were treated with either SSO or VRO for the correction of Class III skeletal malocclusion. The primary predictor was the type of mandibular osteotomy, sagittal split osteotomy, and vertical ramus osteotomy. The primary outcomes were changes in condylar volume (change measured in mm3) and relative position (anterior-posterior change utilizing the Pullinger and Hollinder method). Covariates included patient age, sex, setback magnitude, temporomandibular joint symptoms, and fixation method for SSO patients. Univariate comparisons were performed between independent variables and study outcomes. Volume changes were compared within each predictor using paired t-tests. Position changes were compared within each predictor using χ2 tests. If there were multiple significant univariate predictors, multiple regression models were created to predict volume and position changes. A P<.05 value was considered statistically significant. The final sample comprised 30 condyles derived from 30 subjects. Mean age was 22.7years (SD=5.7) and mean setback was 3.9mm (SD=0.9). Twenty two condyles (73.3%) were subject to SSO with fixation, while the remaining 8 (26.7%) condyles were subject to intraoral VRO without fixation. When compared to VRO, condyles manipulated with SSO had greater volume loss (-177.2 vs -60.9mm3; P=.03) and positional change (68.2 vs 12.5%; P<.01). Self-reported measures of postoperative pain, internal derangement, and myofascial symptoms were not significantly associated with either volume or positional changes. The SSO resulted in greater postoperative condylar volume loss and positional changes. These volume and positional changes were not correlated with self-reported temporomandibular disorder symptoms.

The social context of burning mouth syndrome: an exploratory pilot study of stigma, discrimination, and pain.

The social context of burning mouth syndrome (BMS) has received little attention in the scientific literature. However, social psychological theory and insights from those with lived experiences suggest that people living with BMS experience compounding effects of stigma related to their pain, diagnosis (or lack thereof), and intersectional identities. Our aim is to provide initial evidence and to motivate new directions for research on BMS. Here, we present the results of an exploratory pilot study (n = 16) of women living with BMS in the United States. Participants completed self-report measures of stigma, discrimination, and pain, as well as laboratory assessments of pain through quantitative sensory testing. Results indicate a high prevalence of internalized BMS stigma, experience of BMS-related discrimination from clinicians, and gender stigma consciousness in this population. Moreover, results provide initial evidence that these experiences are related to pain outcomes. The most robust pattern of findings is that internalized BMS stigma was related to greater clinical pain severity, interference, intensity, and unpleasantness. Given the prevalence and pain-relevance of intersectional stigma and discrimination identified in this pilot study, lived experience and social context should be incorporated into future research on BMS.

Self-reported Measures of Function Compared to Lower Limb Motor Performance in People With and Without Imaging Evidence of Unilateral Lumbar Nerve Root Compression: A Cross-sectional Study

ObjectiveThe primary objective of the present study was to determine if imaging findings of unilateral lumbar nerve root compression (ULNRC) impact performance on a coordinated motor performance task and to determine if there were correlations between motor performance and self-reported clinical measures. MethodsPeople with back pain (N = 45) were stratified into 3 groups based on combinations of: lumbar imaging; and clinical presentation for ULNRC. Group 1 included people with imaging of lumbar nerve root compression, who presented with neurological deficit. Group 2 people demonstrated imaging evidence of nerve compression, without motor, sensory or reflex change. Group 3 participants possessed only degenerative changes on lumbar imaging films, and were neurologically intact. Performance measures included behavioral and kinematic variables from an established lower limb Fitts’ Task requiring movements to targets of different difficulties. Self-reported measures of disability, function and pain were collected. Analysis of variance for between and within group variables were conducted, and Pearson correlation compared performance with self-reported measures. ResultsAll groups yielded main effects for movement time with increasing task difficulty as predicted by Fitts’ Law. A main effect revealed Group 1 participants performed less accurately than Group 3 participants. Positive correlations were predominantly found between self-report measures and motor performance for Group 2 and Group 3. ConclusionImaging, and self-reported measures alone did not predict function, however, Fitts’ task performance accuracy effectively differentiated groups.

Cross-cultural adaptation, reliability, and validity of the pain self-efficacy questionnaire - Hebrew version

PurposeThis study aims to translate, culturally adapt, and evaluate the psychometric properties of the Hebrew Pain Self-Efficacy Questionnaire (PSEQ). MethodsThe study was designed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) recommendations for patient-reported outcome measurement instruments. The PSEQ was initially translated into Hebrew and cross-culturally adapted. The Hebrew version of the PSEQ (PSEQ-H) was administered to participants suffering from chronic musculoskeletal pain, along with other self-report measures of pain (NPRS, FABQ, HADS, PCS, and SF-12). Eight hypotheses on expected correlations of the PSEQ-H with other instruments were formulated a priori to assess construct validity. Structural validity was assessed using confirmatory factor analysis. Floor and ceiling effects, test-retest, and internal consistency reliability were also assessed. ResultsThe translation process retained the unidimensional model of the PSEQ. The PSEQ-H demonstrates excellent internal consistency (Cronbach's α = 0.97) and test-retest reliability (ICC = 0.88), and no significant floor and ceiling effects were observed. Construct validity was found satisfactory as 75% (six) of the analyses between the PSEQ-H and the other self-reported measures met the hypotheses. Factor analysis confirmed the single-factor structure of the questionnaire. ConclusionsThe PSEQ-H version was found to have excellent reliability, good construct, and structural validity, and can be used with heterogeneous chronic musculoskeletal pain populations. Future studies should test the PSEQ-H's responsiveness and psychometric properties with specific pain populations.

Psychological and physical function in allogeneic hematopoietic cell transplant survivors with chronic graft-versus-host disease.

Chronic graft-versus-host disease (cGVHD) is a common late complication of allogeneic hematopoietic cell transplantation (HCT). This study comprehensively evaluated physical and psychological function among individuals with cGVHD. Additional aims were to investigate relationships between disease severity and psychological and physical function, and to investigate patterns of psychological and physical function by disease site. Adults at least 6months post allogeneic HCT were enrolled and either had cGVHD (n =59) or served as a reference sample of HCT survivors with no cGVHD history (n = 19). Participants completed self-report measures of depression, anxiety, fatigue, insomnia, pain, cognition, and sexual function and had a comprehensive clinical evaluation of cGVHD using NIH consensus scoring criteria. Participants with cGVHD were stratified by disease severity and site and compared to the reference group with no cGVHD. Participants with mild cGVHD had comparable psychological and physical symptoms to the reference sample, while participants with moderate cGVHD experienced more severe anxiety and problems with sexual function, and participants with severe cGVHD experienced more severe depressive symptoms and pain compared to the reference sample. Participants with cGVHD manifesting in the skin and GI tract had the most severe symptoms, including mood disturbance, fatigue, and pain. Results suggest that patients with more severe cGVHD and those with cGVHD manifesting in the skin, GI tract, and lungs are at risk for poorer psychological and physical outcomes and may benefit from proactive interventions to optimize function.

What are small, medium and large effect sizes for exercise treatments of tendinopathy? A systematic review and meta-analysis

ObjectiveTo quantify and describe effect size distributions from exercise therapies across a range of tendinopathies and outcome domains to inform future research and clinical practice through conducting a systematic review...

Brain-predicted age difference mediates the association between PROMIS sleep impairment, and self-reported pain measure in persons with knee pain

Knee pain, the most common cause of musculoskeletal pain (MSK), constitutes a severe public health burden. Its neurobiological causes, however, remain poorly understood. Among many possible causes, it has been proposed that sleep problems could lead to an increase in chronic pain symptomatology, which may be driven by central nervous system changes. In fact, we previously found that brain cortical thickness mediated the relationship between sleep qualities and pain severity in older adults with MSK. We also demonstrated a significant difference in a machine-learning-derived brain-aging biomarker between participants with low-and high-impact knee pain. Considering this, we examined whether brain aging was associated with self-reported sleep and pain measures, and whether brain aging mediated the relationship between sleep problems and knee pain. Exploratory Spearman and Pearson partial correlations, controlling for age, sex, race and study site, showed a significant association of brain aging with sleep related impairment and self-reported pain measures. Moreover, mediation analysis showed that brain aging significantly mediated the effect of sleep related impairment on clinical pain and physical symptoms. Our findings extend our prior work demonstrating advanced brain aging among individuals with chronic pain and the mediating role of brain-aging on the association between sleep and pain severity. Future longitudinal studies are needed to further understand whether the brain can be a therapeutic target to reverse the possible effect of sleep problems on chronic pain.

Telehealth for Pediatric Disorders of Gut-Brain Interaction During the COVID-19 Pandemic.

A retrospective chart review was completed to examine psychological treatment duration and response among pediatric patients with a disorder of gut-brain interaction including functional abdominal pain and irritable bowel syndrome. Cognitive behavioral therapy (CBT) was delivered via telehealth with a licensed psychologist or supervised psychology trainee embedded in a pediatric gastroenterology clinic. Participants were 22 youth (mean age = 14.36 years) who received CBT via telehealth between February and September of 2021, after completing an initial evaluation between February and July of 2021. Patients completed reliable and valid self-report measures of functional disability and pain during treatment. A unique CBT model was employed with an initial focus on psychoeducation and function regardless of level of severity of functional impairment. Consistent with study hypotheses, nonparametric statistical analyses demonstrated statistically significant reductions in functional disability and pain following implementation of the CBT model via telehealth. Contrary to predictions, there was no relation found between severity of functional impairment and duration of treatment.