Self-report Measures Of Pain Research Articles

Abstract D044: Age and sex effects on quantitative sensory testing values in healthy African American adults

Abstract Introduction: Only a few studies have reported quantitative sensory testing (QST) reference values for healthy African Americans, and those studies are limited in sample size and range of age of participants. The intent of our study was to fill a gap in the understanding of pain and somatosensory function in African Americans by generating QST values for healthy African American adults. In a large cohort of pain-free, healthy African American adults whose past pain experiences and current psychological status were known, our study aim was to determine thermal and mechanical QST values and compare those values at the anterior forearm by age and sex. We also determined the values for 5 other body sites and compared the values for differences by testing site location (upper body versus lower body). Methodology: In this cross-sectional study, 124 pain-free African American adults (age 18 to 69 years, 49% female) completed demographic and self-reported pain, fatigue and psychosocial measures. QST included obtaining thermal and mechanical responses and associated pain intensity levels. We applied the Benjamini-Hochberg procedure to adjust the p values to account for the multiple t tests. Results: We found thermal detection values at the anterior forearm were (29.2°C±1.6) for cool detection (CD) and (34.5°C±1.2) for warm detection (WD). At that site, pain thresholds were: cold pain threshold (CPTh) (26.3°C±5.0), heat pain threshold (HPTh) (37.8°C±3.6), and mechanical pain thresholds (MPTH) (16.7±22.2 grams of force, gF). There was a significant between sex difference for WD, with women being more sensitive (q=0.027). Lower body sites were less sensitive than upper body sites across all thermal modalities (q<0.003), but not for the mechanical modality. Mean pain intensity scores rated immediately after the CPTh and HPTh were 1.9 ± 1.3 to 2.2 ± 1.2 on the 0-10 pain intensity scale. Similarly, after the MPTh tests the mean pain intensity scores were 0.5 ± 0.5 to 0.8 ± 0.6. These scores did not differ significantly by sex or age group and clearly indicate that the participants reported pain threshold at an appropriately low perceptual intensity. Pain intensity values for past pain experiences and low ratings for fatigue, depression and anxiety indicated that these factors were unlikely contributors to their pain threshold reports. Conclusion: The QST values from this protocol at the anterior forearm indicate that healthy African American adults had average thermal pain thresholds within 6°C of the temperature of adaptation and average MPTh under 20 gF. Differences in responses to thermal and mechanical stimuli for upper verses lower body were consistent with prior research. These findings add to the body of literature confirming that African American adults indeed have lower pain thresholds than those reported for White adults. These QST values can be used as controls for African Americans with cancer to understand the neuropathic pain syndromes associated with tumor progression and cancer treatments. Citation Format: Keesha L. Powell-Roach, Starja Q. Booker, Yingwei Yao, Marie L. Suarez, Miriam O. Ezenwa, Roger B. Fillingim, Zaijie J. Wang, Robert E. Molokie, Diana J. Wilkie. Age and sex effects on quantitative sensory testing values in healthy African American adults [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D044.

Patients with Symptomatic Hip Osteoarthritis Have Altered Kinematics during Stair Ambulation

Osteoarthritis (OA) is a degenerative joint disease. Understanding contributing factors to slowing or stopping disease progression is crucial. There has been no research describing lower extremity kinematics of the hip, knee, and ankle during stair ambulation in individuals with hip OA. To explore the differences in lower extremity kinematics between participants with clinical and morphological findings of hip OA and controls. A cross-sectional study. Clinical research laboratory. Participants with radiographic and symptomatic signs of hip OA (n = 42) and healthy controls (n = 30) were enrolled. Participants underwent hip magnetic resonance imaging (MRI). The Scoring Hip Osteoarthritis with MRI (SHOMRI) method was used to assess cartilage abnormalities. Self-reported measures of hip pain and function were obtained using the Hip Disability and Osteoarthritis Outcome Score (HOOS). Participants were assigned into a symptomatic hip osteoarthritis group (HOA) with SHOMRI>0 and HOOS≤80, and a control group (CG) with SHOMRI = 0 and HOOS>90. Patients underwent 3D motion analysis during stair ascent/descent at self-selected speed. The primary outcome measurements were peak hip, knee, and ankle kinematics. General Estimation Equations were used to compare kinematics between groups (P ≤ .05). The HOA group ascended stairs with a more internally rotated hip (CG = 1.77 ± 6.3; HOA = 4.97 ± 4.2; P = .02), more abducted hip (CG = -5 ± 2.7, HOA = -3.5 ± 3; P = .02), and a more externally rotated knee (CG = -8.02 ± 3; HOA = -10.63 ± 6.3; P = .02) and ankle (CG = -11.8 ± 6.1; HOA = -16.3 ± 5.6; P = .01). Similarly, HOA participants descended stairs with a more extended knee (CG = -15.5 ± 4.9; HOA = -12 ± 4.9; P = .01), and more externally rotated knee (CG = -10.1 ± 4.4; HOA = -13.1 ± 6.6; P = .04) and ankle (CG = -13.5 ± 5.3; HOA = -17.9 ± 5.5; P = .002). Participants with hip OA-related morphology and symptoms ambulate stairs utilizing abnormal lower extremity mechanics.

Family History Influences the Effectiveness of Home Exercise in Older People With Chronic Low Back Pain: A Secondary Analysis of a Randomized Controlled Trial

ObjectiveTo investigate whether a family history of low back pain (LBP) influences patient outcomes and treatment effects following home exercises in older people with chronic LBP. DesignSecondary analysis of a randomized controlled trial. SettingLocal community. ParticipantsPeople older than 55 years with chronic LBP (N=60). InterventionsParticipants in the intervention group completed video game exercises for 60 minutes 3 times per week for 8 weeks. Participants in the control group were instructed to maintain their usual levels of activity and care seeking behaviors. Main Outcomes MeasuresParticipants indicated whether any of their immediate family members had a history of “any” LBP or “activity-limiting” LBP at baseline. We collected self-reported measures of pain, function, pain self-efficacy, care seeking, physical activity, disability, fear of movement and/or reinjury, and falls efficacy at baseline, 8 weeks, 3 months, and 6 months. We performed regression analyses to determine whether a family history of LBP predicted patient outcomes and moderated the effects of home exercise. ResultsParticipants with a family history of any LBP were less likely to be highly active than those without a family history (odds ratio, 0.08; 95% CI, 0.01-0.42; P=.003). Home-based video game exercises led to improvements in function in those without a family history of activity-limiting LBP (β=1.78; 95% CI, 0.56-3.00; P=.006) but not in those with a family history (β=−0.17; 95% CI, −2.56 to 2.21; P=.880) (interaction P=.049). A family history of LBP did not influence the remaining patient outcomes or treatment effects. ConclusionsA family history of LBP appears to negatively influence physical activity levels in older people with chronic LBP. Further, home-based video game exercises appear to be beneficial for older people with chronic LBP that do not have a family history of LBP.

A Step Towards a Better Understanding of Pain Phenotypes: Latent Class Analysis in Chronic Pain Patients Receiving Multimodal Inpatient Treatment.

PurposeThe number of non-responders to treatment among patients with chronic pain (CP) is high, although intensive multimodal treatment is broadly accessible. One reason is the large variability in manifestations of CP. To facilitate the development of tailored treatment approaches, phenotypes of CP must be identified. In this study, we aim to identify subgroups in patients with CP based on several aspects of self-reported health.Patients and MethodsA latent class analysis (LCA) was carried out in retrospective data from 411 patients with CP of different origins. All patients experienced severe physical and psychosocial consequences and were therefore undergoing multimodal inpatient pain treatment. Self-reported measures of pain (visual analogue scales for pain intensity, frequency, and impairment; Pain Perception Scale), emotional distress (Patient Health Questionnaire, PHQ-9; Generalized Anxiety Disorder Scale, GAD-7) and physical health (Short Form Health Survey; SF-8) were collected immediately after admission and before discharge. Instruments assessed at admission were used as input to the LCA. Resulting classes were compared in terms of patient characteristics and treatment outcome.ResultsA model with four latent classes demonstrated the best model fit and interpretability. Classes 1 to 4 included patients with high (54.7%), extreme (17.0%), moderate (15.6%), and low (12.7%) pain burden, respectively. Patients in class 4 showed high levels of emotional distress, whereas emotional distress in the other classes corresponded to the levels of pain burden. While pain as well as physical and mental health improved in class 1, only the levels of depression and anxiety improved in patients in the other groups during multimodal treatment.ConclusionThe specific needs of these subgroups should be taken into account when developing individualized treatment programs. However, the retrospective design limits the significance of the results and replication in prospective studies is desirable.

Yoga improves balance, mobility, and perceived occupational performance in adults with chronic brain injury: A preliminary investigation

Background and purposeThis was a preliminary investigation to investigate potential benefits of group yoga, as past work has indicated that one-on-one yoga can improve functional deficits in adults with brain injury. Materials and methodsParticipants served as their own controls. Nine participants with chronic brain injury were recruited, and seven (four female) completed the study. Performance measures of balance and mobility and self-reported measures of balance confidence, pain, and occupational performance and satisfaction were used. Data were collected 3 times: baseline (study onset), pre-yoga (after an 8-week no-contact period), and post-yoga (after 8 weeks of yoga). Group yoga was led by a yoga instructor/occupational therapist, and sessions lasted 1 h and occurred twice a week. ResultsNo participants withdrew due to adverse effects from yoga. There were no significant changes between baseline and pre-yoga. Significant improvement was observed post-yoga in balance (p = 0.05), mobility (p = 0.03), and self-reported occupational performance (p = 0.04). ConclusionWe observed significant improvements in balance, mobility, and self-reported occupational performance in adults with chronic brain injury.

Objective performance tests assess aspects of function not captured by self-report in knee osteoarthritis

Purpose: Knee osteoarthritis (OA) may lead to substantial functional limitation, which can be assessed objectively with validated performance tests or using self-report data. The relationships between the findings of objective performance tests and self-report measures of functional status have received little investigation. We sought to determine whether the performance tests are independent of one another, whether they capture different information from self-report measures of function, and whether they are influenced by features of chronic pain including anxiety and depression, neuropathic pain, widespread pain, and pain catastrophizing. Methods: We used baseline data from participants enrolled in the ORBIT Registry (Osteoarthritis Registry of Biomarker and Imaging Trajectories). At study entry, participants were 40+ years old and had evidence of both symptomatic and radiographic knee OA (Kellgren-Lawrence grade 2-3) in at least one knee. Self-reported pain of the most bothersome knee (index knee) was ascertained using the Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain scale and functional status with the KOOS ADL scale (0-100, 100 best). Subjects completed the five-item Mental Health Index (MHI-5, a measure of anxiety and depressive symptoms), the Neuropathic Pain Scale (NPS), a widespread pain index (WPI; sum of 23 possible musculoskeletal pain locations), and the Pain Catastrophizing Scale (PCS). Performance testing included the 40-meter fast paced walk (40m Walk), Timed-Up-and-Go (TUG), timed single leg balance test (SLB), and 30-second sit-to-stand (30s STS) tests. We used Pearson correlation coefficients to examine linear associations among the four performance tests and the associations between each performance test and the self-report measures of pain, functional status and chronic pain features. We further investigated the associations between performance tests and self-reported knee pain and function with adjustment for MHI-5, WPI, PCS and NPS using partial correlations. Results: We assessed 78 subjects with mean age 63.1 (SD 10.0), mean body mass index (BMI) 30.2 (SD 5.4), 69% female. The mean (SD) values for the performance tests included: 40m Walk 27.9 (5.6) seconds, TUG 9.1 (2.2) seconds, SLB 21.8 (19.7) seconds, and 30s STS 11.7 (4.5) stands. The individual performance measures had modest correlations with one another (Pearson r ranging from 0.33 to 0.74). The highest correlation (r = 0.74) was between TUG and 40m Walk, indicating that just 50% of the variability in TUG was explained by variability in 40m Walk. ORBIT participants had an average KOOS ADL score of 66.1 (18.2) and KOOS Pain of 74.6 (19.8). The correlations between performance tests and KOOS Pain, KOOS ADL, PCS, NPS, WPI and MHI-5 are shown in the Table. None of the correlations exceeded 0.40. Correlations were weakest for the associations between widespread pain and MHI-5 scores and the performance tests (all ≤ 0.23). Partial correlations between KOOS ADL scores and the performance tests were 28-64% lower than the crude correlations, adjusting for PCS, NPS, widespread pain and MHI-5 (Table).Table 1Pearson correlation coefficients for associations between performance tests and self-report measures of pain, function and chronic pain features40 Meter WalkTimed Up and GoTimed Single Leg Balance30-Second Sit to StandKOOS Pain-0.25-0.260.290.40KOOS ADL-0.33-0.290.400.40Pain Catastrophizing0.340.26-0.19-0.24Neuropathic Pain Scale0.320.20-0.24-0.23Widespread Pain0.15-0.08-0.23-0.18Mental Health Index-0.10-0.050.170.03Partial correlations adjusting for pain catastrophizing, NPS, widespread pain, MHI-5KOOS Pain-0.15-0.240.280.30KOOS ADL-0.12-0.200.290.25 Open table in a new tab Conclusions: 40m Walk, TUG, SLB and 30s STS each assess different aspects of functional capacity in knee OA patients. Self-reported functional status in persons with knee OA has weak to modest correlations with objective measures of functional status, which are further attenuated with adjustment for pain catastrophizing, neuropathic symptoms, widespread pain and anxiety and depression. These data suggest that objective performance tests capture elements of physical functional status in persons with knee OA that are not assessed well by frequently used self-report measures of functional status. Objective performance tests are not influenced strongly by other features of chronic pain such as catastrophizing, neuropathic pain symptoms, widespread pain or depression and anxiety. These data point to the importance of adding objective measures to the assessment of functional status in OA trials.

Efficacy of Transcranial Direct Current Stimulation-Enhanced Mindfulness-Based Program for Chronic Pain: a Single-Blind Randomized Sham Controlled Pilot Study

Chronic pain impacts approximately 100 million adults in the USA. Mindfulness-based programs (MBPs) are effective behavioral treatments for chronic pain, yet the effects tend to be small. The current study was designed to assess whether transcranial direct current stimulation (tDCS) could enhance learning of mindfulness skills (primary outcome) in an MBP among adults with chronic pain. We also examined whether MBP + tDCS resulted in improvements in pain acceptance, pain coping, and physical health (secondary outcomes). A single blind randomized controlled trial was used to examine the effectiveness of active tDCS (2.0 mA)-enhanced MBP compared to sham tDCS (0.1 mA)-enhanced MBP for adults with chronic pain. Participants (N = 47) were diagnosed with chronic pain and were recruited from the community. Self-report measures of mindfulness, pain, and physical health were completed at baseline and end of treatment. Participants were randomized to active or sham tDCS of the right dorsolateral prefrontal cortex (dlPFC). Participants were blind to tDCS condition and all participants received a group MBP for eight bi-weekly, 2-hour sessions over 4 weeks. There were no main effects of active tDCS on primary or secondary outcomes. Those who received active tDCS as compared with sham tDCS and who attended more treatment sessions, reported significantly higher rates of mindfulness and greater overall physical health after participating in a group MBP. This study advances our knowledge of behavioral interventions for chronic pain by testing a novel combination intervention that may help those struggling with pain.

Outcomes of prescription opioid dose escalation for chronic pain: results from a prospective cohort study.

The use of long-term opioid therapy for chronic pain remains common, yet data on long-term outcomes, especially after dose escalation, are sparse. This study examined potential benefits and harms associated with prescription opioid dose escalation. Participants from 2 institutions were enrolled in a 2-year prospective cohort study. All participants (n = 517) had a musculoskeletal pain diagnosis and were receiving a stable dose of long-term opioid therapy at baseline. Participants completed self-report measures of pain, disability, depression, and potential adverse effects at baseline and every 6 months for 2 years. We reviewed electronic health record data weekly to identify episodes of prescription opioid dose escalation; participants who had increases in their dose were seen for additional research visits within 1 month of dose escalation. Over 2 years, 19.5% of participants had prescription opioid dose increases. After controlling for covariates, there were no significant changes on any variable after dose escalation. Of those with a dose increase, 3% experienced a clinically meaningful improvement in pain after dose escalation. Participants in the entire sample had small improvements in pain intensity, depressive symptoms, medication-related side effects, and lower risk for prescription opioid misuse during the study period. Sexual functioning worsened over time. There were no significant changes in the full sample on pain disability, sleep functioning, or experiencing a fall. In summary, patients prescribed stable doses of long-term opioid therapy may demonstrate small changes in key pain-related outcomes over time, but prescription opioid dose escalation status is unrelated to clinical outcomes.

Influence of parent-provided distraction and interactive distraction with a handheld video game on the child's responses during local anesthesia administration.

To evaluate the influence of parent-provided distraction (PPD) and interactive distraction (ID) with a handheld video game (HVG) on the child's responses to local anesthesia (LA) administration during dental treatment. Children attending the department of pediatric dentistry were randomly selected and distributed to the two groups (PPD and an ID with HVG). Parents in the operatory and the principles of tell-show-do remained common in both the groups. Behavioral, physiological, and self-report measures of pain were estimated using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale, pulse rate, as well as Iowa pain thermometer-revised (IPT-R) scale and compared for both groups correspondingly. The SPSS (standard statistical package) version 17.0 (SPSS Inc., Chicago, USA) was used for statistical analysis at the significance of P < 0.05. A total of 30 children (15 in each group) aged 7-11 years participated in the study. There were no significant differences observed among boys and girls (P > 0.05). The independent t-test for the pulse rate showed no significant difference between the two groups (P > 0.05). Paired t-test for pulse rate in the PPD group showed a significant difference compared to ID with the HVG group (P < 0.05). The scores for FLACC and ID with HVG, showed a statistically significant decrease in scores recorded for ID with HVG, whereas the scores recorded for FLACC did not show any statistically significant difference. Based on the study results, PPD would be the least distressful option, compared to the ID with HVG in children while administering LA.

Effects of Home Exercises on Shoulder Pain and Pathology in Chronic Spinal Cord Injury: A Randomized Controlled Trial.

The aims of this study were to replicate findings that a home exercise program intervention improved shoulder pain and function and to assess changes in supraspinatus tendon pathology associated with the home exercise program in persons with chronic spinal cord injury. The study is a single-blind randomized controlled trial. Individuals with spinal cord injury of at least 1 yr and chronic shoulder pain of moderate or greater average intensity were enrolled. Participants were randomized to a 12-wk home exercise program consisting of strengthening and stretching exercises or to an education-only control group, with immediate postintervention and 4-wk postintervention (16 wks) follow-ups. The main outcome measures were self-report measures of shoulder pain and impairment, the Physical Examination of the Shoulder Scale, quantitative ultrasound metrics of the supraspinatus tendon, and the Ultrasound Shoulder Pathology Rating Scale. Thirty-two participants were randomized to home exercise program or education-only control condition. The mean ± SD age was 44.8 ± 12.5; 81.3% were male; 65.6% had motor complete paraplegia. Using a per-protocol, within-group analysis method, significant differences were observed between baseline and postintervention for the home exercise program group for the least pain intensity (P = 0.02), number of days with shoulder pain (P = 0.042), Physical Examination of the Shoulder Scale scores (dominant side, P = 0.036; nondominant side, P = 0.008), the Disabilities of the Arm, Shoulder, and Hand (P = 0.028), and the Patient Global Impression of Change (P = 0.015). The education-only control condition group demonstrated significant changes in average unpleasantness of shoulder pain after the intervention period (P = 0.049). Comparisons in changes from baseline between groups showed that the home exercise program group had greater improvements in nondominant-side Physical Examination of the Shoulder Scale scores and global impression of change, whereas the education-only control condition group had greater improvements in depressive symptoms.For quantitative ultrasound measures, no significant changes were found with within-group analyses for the home exercise program group, although the education-only control condition group demonstrated a decrease in tendon width in the nondominant-side supraspinatus tendon (P = 0.036). Comparison of changes between groups suggests that the education-only control condition group had a greater increase in dominant shoulder supraspinatus tendon ultrasound contrast at the end of the study. Changes in several measures of shoulder pain and function occurred after the home exercise program intervention, although the magnitude of changes was only significantly greater than those of the education-only control condition group for two measures. Significant changes in supraspinatus pathology were not detected with quantitative ultrasound metrics.

Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain: A longitudinal analysis.

BackgroundEcological research suggests that increased access to cannabis may facilitate reductions in opioid use and harms, and medical cannabis patients describe the substitution of opioids with cannabis for pain management. However, there is a lack of research using individual-level data to explore this question. We aimed to investigate the longitudinal association between frequency of cannabis use and illicit opioid use among people who use drugs (PWUD) experiencing chronic pain.Methods and findingsThis study included data from people in 2 prospective cohorts of PWUD in Vancouver, Canada, who reported major or persistent pain from June 1, 2014, to December 1, 2017 (n = 1,152). We used descriptive statistics to examine reasons for cannabis use and a multivariable generalized linear mixed-effects model to estimate the relationship between daily (once or more per day) cannabis use and daily illicit opioid use. There were 424 (36.8%) women in the study, and the median age at baseline was 49.3 years (IQR 42.3–54.9). In total, 455 (40%) reported daily illicit opioid use, and 410 (36%) reported daily cannabis use during at least one 6-month follow-up period. The most commonly reported therapeutic reasons for cannabis use were pain (36%), sleep (35%), stress (31%), and nausea (30%). After adjusting for demographic characteristics, substance use, and health-related factors, daily cannabis use was associated with significantly lower odds of daily illicit opioid use (adjusted odds ratio 0.50, 95% CI 0.34–0.74, p < 0.001). Limitations of the study included self-reported measures of substance use and chronic pain, and a lack of data for cannabis preparations, dosages, and modes of administration.ConclusionsWe observed an independent negative association between frequent cannabis use and frequent illicit opioid use among PWUD with chronic pain. These findings provide longitudinal observational evidence that cannabis may serve as an adjunct to or substitute for illicit opioid use among PWUD with chronic pain.

Characterizing and Understanding the Low Back Pain Experience Among Persons with Lower Limb Loss.

This study preliminarily characterizes and compares the impact of lower limb loss and development of chronic low back pain (cLBP) on psychosocial factors, as well as the relationship between these factors and low back pain-related functional disability. Cross-sectional study. Participants were adults, active duty or retired military, with traumatic lower limb loss with and without chronic low back pain. Psychosocial factors and low back pain-related functional disability were measured using common clinical self-report questionnaires. The presence of psychosocial factors was compared between those with and without cLBP using multivariate analysis of covariance (P < 0.05), and correlations determined relationships between psychosocial factors and cLBP-related functional disability. There were no statistically significant differences among psychosocial factors between those with vs without cLBP (F(4, 13) = 0.81, P = 0.54, η2= 0.19). Employment status (ρ = 0.43, P = 0.02), anxiety (ρ = 0.45, P = 0.04), and kinesiophobia (ρ = 0.47, P = 0.04) were moderately associated with low back pain-related disability. Psychological (i.e., anxiety) and social (i.e., employment status) factors may influence how persons with traumatic lower limb loss respond to self-reported measures of low back pain-related disability. The findings suggest that the Modified Oswestry Disability Index identifies cLBP-related functional disability in the context of lower limb loss. These results support the interdependence among biological, psychological, and social factors, which should be collectively considered during the development of rehabilitative strategies to treat secondary musculoskeletal conditions within this population.

THE MEDIATING ROLES OF HEALTH LOCUS OF CONTROL AND COPING ON THE PAIN-DEPRESSION PATHWAY

The literature on health locus of control (HLC) suggests that individuals who believe that their health is internally determined are more likely to use active coping strategies than those who believe their health is determined by chance or powerful others (Brosschot, Gebhardt, & Godaert, 1994; Gibson & Helme, 2000). Coping strategies (Klapow et al., 1995) and HLC (Campbell, Hope, & Dunn, 2017) have been found to influence the relation between chronic pain and depression. We hypothesized that the relation between osteoarthritis pain and depression would be serially mediated by HLC and coping. Self-report measures of osteoarthritis pain (Meenan, Mason, Anderson, Guccione, & Kazis, 1992; Parmelee, Katz, & Lawton), HLC (Wallston, Wallston, & DeVellis, 1978), coping strategies (Felton & Revenson, 1984; Rosenstiel & Keefe, 1983), and depression (Radloff, 1977) were examined in 367 older adults with osteoarthritis of the knee. Hayes’ (2013) PROCESS macro was used to test the hypothesized serial multiple mediation for three subscales of HLC: internality (IHLC), chance (CHLC), and powerful others (PHLC). After controlling for age, the hypothesized serial mediation was statistically significant for IHLC and CHLC but not PHLC. More specifically, osteoarthritis pain significantly increased CHLC, which increased negative coping and depression in turn. Osteoarthritis pain significantly decreased IHLC, which was associated with both positive and negative coping strategies in a complex serial mediation. These findings suggest that interventions targeting HLC and/or coping strategies may be able to alter the pain-depression pathway for older adults with chronic osteoarthritis pain. (Supported by R01-MH51800, P. Parmelee, PI).

Let it be: mindful acceptance down-regulates pain and negative emotion.

Mindfulness training ameliorates clinical and self-report measures of depression and chronic pain, but its use as an emotion regulation strategy—in individuals who do not meditate—remains understudied. As such, whether it (i) down-regulates early affective brain processes or (ii) depends on cognitive control systems remains unclear. We exposed meditation-naïve participants to two kinds of stimuli: negative vs. neutral images and painful vs. warm temperatures. On alternating blocks, we asked participants to either react naturally or exercise mindful acceptance. Emotion regulation using mindful acceptance was associated with reductions in reported pain and negative affect, reduced amygdala responses to negative images and reduced heat-evoked responses in medial and lateral pain systems. Critically, mindful acceptance significantly reduced activity in a distributed, a priori neurologic signature that is sensitive and specific to experimentally induced pain. In addition, these changes occurred in the absence of detectable increases in prefrontal control systems. The findings support the idea that momentary mindful acceptance regulates emotional intensity by changing initial appraisals of the affective significance of stimuli, which has consequences for clinical treatment of pain and emotion.

Effect of a short message service (SMS) intervention on adherence to a physiotherapist-prescribed home exercise program for people with knee osteoarthritis and obesity: protocol for the ADHERE randomised controlled trial

BackgroundKnee osteoarthritis (OA) is a highly prevalent condition. People with knee OA often have other co-morbidities such as obesity. Exercise is advocated in all clinical guidelines for the management of knee OA. It is often undertaken as a home-based program, initially prescribed by a physiotherapist or other qualified health care provider. However, adherence to home-based exercise is often poor, limiting its ability to meaningfully change clinical symptoms of pain and/or physical function. While the efficacy of short message services (SMS) to promote adherence to a range of health behaviours has been demonstrated, its ability to promote home exercise adherence in people with knee OA has not been specifically evaluated. Hence, this trial is investigating whether the addition of an SMS intervention to support adherence to prescribed home-based exercise is more effective than no SMS on self-reported measures of exercise adherence.MethodsWe are conducting a two-arm parallel-design, assessor-and participant-blinded randomised controlled trial (ADHERE) in people with knee OA and obesity. The trial is enrolling participants exiting from another randomised controlled trial, the TARGET trial, where participants are prescribed a 12-week home-based exercise program (either weight bearing functional exercise or non-weight bearing quadriceps strengthening exercise) for their knee by a physiotherapist and seen five times over the 12 weeks for monitoring and supervision. Following completion of outcome measures for the TARGET trial, participants are immediately enrolled into the ADHERE trial. Participants are asked to continue their prescribed home exercise program unsupervised three times a week for 24-weeks and are randomly allocated to receive a behaviour change theory-informed SMS intervention to support home exercise adherence or to have no SMS intervention. Outcomes are measured at baseline and 24-weeks. Primary outcomes are self-reported adherence measures. Secondary outcomes include self-reported measures of knee pain, physical function, quality-of-life, physical activity, self-efficacy, kinesiophobia, pain catastrophising, participant-perceived global change and an additional adherence measure.DiscussionFindings will provide new information into the potential of SMS to improve longer-term exercise adherence and ultimately enhance exercise outcomes in knee OA.Trial registrationProspectively registered with the Australian New Zealand Clinical Trials Registry. Reference: ACTRN12617001243303Date/version: August 2019/two

Novel Interventions for Recalcitrant Achilles Tendinopathy: Benefits Seen Following High-Volume Image-Guided Injection or Extracorporeal Shockwave Therapy-A Prospective Cohort Study.

To compare the outcomes for patients with chronic noninsertional Achilles tendinopathy following extracorporeal shockwave therapy (ESWT) and high-volume image-guided injection (HVIGI). Prospective cohort study. Hospital-based Sports Medicine Outpatient Clinic. Sixty-three consecutive patients with chronic noninsertional Achilles tendinopathy, treated with ESWT (n = 22) or HVIGI (n = 41), with minimum 3-month follow-up. Mean age was 51.2 years, and mean duration of symptoms was 27.8 months. Patients received either 3 sessions of ESWT (1 session per week) or a single ultrasound-guided HVIGI (10 mL of 1% lidocaine and 40 mLs of sterile saline). All patients received standardized aftercare, including continuation of a structured home exercise program of flexibility and eccentric strengthening exercises. Zero to 10 visual analog scale (VAS) for self-reported "average pain" and "average stiffness" values. In addition, Victoria Institute of Sport-Achilles questionnaire, (VISA-A), and Manchester-Oxford Foot Questionnaire (MOXFQ). This study demonstrated statistically significant improvements in self-reported measures of pain and stiffness following either procedure. At 3 months, VAS (pain) was improved from 6.74 ± 1.31 to 3.57 ± 2.37 (P < 0.001) following HVIGI and from 6.57 ± 1.61 to 4.35 ± 2.55 (P = 0.002) following ESWT. At 3 months, VISA-A improved from 35% ± 17% to 51% ± 22% (P < 0.001) following HVIGI and from 34% ± 15% to 49% ± 15% (P < 0.001) following ESWT. Statistically significant improvements were only recorded at 6 weeks for ESWT and at 3 months for HVIGI using MOXFQ. No statistically significant differences were seen between the groups at any period studied. Patients improved to statistically significant extent following either a HVIGI or ESWT procedure, with no significant differences seen between the groups. The small sample sizes in this pragmatic study are noted, which limit interpretation, and larger more robust studies are required to investigate this further. This pragmatic prospective cohort study demonstrates improvements following either ESWT or HVIGI procedures, with no significant differences seen between the groups.

Thermal and mechanical quantitative sensory testing values among healthy African American adults.

PurposeOnly a few studies have reported quantitative sensory testing (QST) reference values for healthy African Americans, and those studies are limited in sample size and age of participants. The study purpose was to characterize QST values in healthy, pain-free African American adults and older adults whose prior pain experiences and psychological status were also measured. We examined the QST values for differences by sex, age, and body test site.Patients and methodsA cross-sectional sample of 124 pain-free African American adults (age 18–69 years, 49% female) completed demographic and self-reported pain, fatigue and psychosocial measures. QST was performed to obtain thermal and mechanical responses and associated pain intensity levels.ResultsWe found thermal detection values at the anterior forearm were (29.2 °C±1.6) for cool detection (CD) and (34.5 °C±1.2) for warm detection (WD). At that site the sample had cold pain threshold (CPTh) (26.3 °C±5.0), heat pain threshold (HPTh) (37.8 °C±3.6), and mechanical pain thresholds (MPTH) (16.7±22.2 grams of force, gF). There was a significant between sex difference for WD, with women being more sensitive (q=0.027). Lower body sites were less sensitive than upper body sites across all thermal modalities (q<0.003), but not for the mechanical modality.ConclusionThe QST values from this protocol at the anterior forearm indicate that the healthy African American adults had average thermal pain thresholds close to the temperature of adaptation and average MPTh under 20 gF. Differences in responses to thermal and mechanical stimuli for upper verses lower body were consistent with prior research.

Prevalence and Correlates of Pain in Adolescent and Young Adult Survivors of Pediatric Brain Tumors.

Purpose: Survivors of pediatric brain tumors (PBTs) are at high risk for medical late effects, including pain. Although pain is common at PBT diagnosis and during treatment, less is known about survivors' pain after completing therapy. This study examined the prevalence and correlates of pain in long-term PBT survivors enrolled on Project REACH (Research Evaluating After Cancer Health), a cohort study of locally treated cancer survivors. Methods: Participants were 116 PBT survivors (ages 13-32; 51% male; mean 10.6 years from diagnosis) who completed self-report measures of pain and quality of life (QOL). Survivors reporting "moderate pain" ≥2 days/week or "severe pain" ≥1 day/week were classified as pain cases. Correlates of pain were examined using logistic regression. Results: In total 42 participants (36.2%) met pain case criteria with headache and muscular/skeletal pain most common sources of their worst pain (16 and 11 survivors, respectively). In adjusted analysis, pain cases were more likely to be female (odds ratio [OR] = 1.96, p = 0.034), and less likely to be in the older age group (18-22 years) than younger (13-17 years) age group (OR = 0.232, p = 0.006). No other demographic, disease, or treatment variables were associated with pain case status. Survivors categorized as pain cases reported inferior QOL across all domains of the PedsQL. Conclusions: A subset of PBT survivors experience significant pain that negatively impacts QOL years after completing therapy. Clinics caring for PBT survivors must incorporate appropriate pain assessment and treatment into standard care. Research is needed to better understand both risk factors and effective treatment strategies for pain in this vulnerable population.

Medial branch radiofrequency ablation outcomes in patients with centralized pain

Background and objectivesWe hypothesized that patients with characteristics of centralized pain (fibromyalgia (FM)-like phenotype) would be less likely to respond to radiofrequency ablation (RFA), which may explain some of the...

Dietary Oxidative Balance Score and Disease Characteristics in Patients with Rheumatoid Arthritis (P01-036-19)

ObjectivesRheumatoid arthritis (RA) is an autoimmune disease accompanied by pain, joint stiffness, and swelling, impacting quality of life. RA is also an articular disorder affecting multiple organ systems. Oxidative stress and antioxidants may play a role in the disease process. The oxidative balance score (OBS) is a composite estimate of exogenous dietary, lifestyle, and medication factors associated with antioxidant and pro-oxidant properties. This study examined the relationship between OBS and disease activity in RA. Methods84 adults with RA (mean age: 52.9 ± 14.4 years; RA disease duration: 13.5 ± 9.2 years) were recruited from the NYU Langone Orthopedic Center. Disease activity was assessed via C-reactive protein, erythrocyte sedimentation rate, and the Multi-Dimensional Health Assessment Questionnaire, which includes self-reported measures of physical function, pain, & global status (summed into the RAPID3 score), fatigue, painful joint count, and duration of morning stiffness. Higher scores indicate greater disease activity. Participants completed 7-day food records, which were analyzed using Nutrition Data System for Research. OBS was calculated by analyzing 13 a priori-defined pro-oxidant (polyunsaturated fatty acid and iron) and antioxidant (selenium, vitamin C, vitamin E, α-carotene, β-carotene, lutein + zeaxanthin, lycopene, cryptoxanthine; use of aspirin and non-steroidal anti-inflammatory drugs, and alcohol) exposure factors. A higher OBS scored indicated more antioxidant and less pro-oxidant exposure. Partial correlations examined the relationship between OBS and disease activity, while controlling for age, using IBM SPSS Statistics. ResultsThere was a negative association between OBS and duration of morning stiffness (r = –0.290, P = 0.010); as OBS increased, duration of morning stiffness decreased. Although not statistically significant, there was a negative trend between OBS and physical function (r = –0.180, P = 0.113), pain (r = –0.194, P = 0.086), and RAPID3 (r = –0.195, P = 0.103); as OBS increased, physical function, pain, and disease activity improved. No statistically significant relationships were seen between OBS and the other measures of disease activity. ConclusionsIn this study, a higher OBS score was associated with lower disease activity. More research is needed to understand the relationship of these lifestyle exposures to RA. Funding SourcesNYU Steinhardt Research Challenge Grant.