Anxiety, pain catastrophizing, and pain outcomes among older adults with chronic orofacial pain.

Although chronic orofacial pain (COFP) is common among older adults, the role of psychological factors in pain outcomes among this population has received limited attention. This study examined the role of anxiety and pain catastrophizing, two corelates of pain in other populations, in pain intensity and interference among 166 older adults with COFP (79% female, Mage = 68.84, SD = 5.56). Participants completed an online survey including measures of anxiety, pain catastrophizing, and pain intensity/interference. We applied mediation analyses to test indirect associations between anxiety and pain outcomes via pain catastrophizing. Results indicated that anxiety was positively associated with pain intensity and pain interference (bs = .70-1.12, ps < .05). There was also an indirect association between anxiety and pain interference through pain catastrophizing (b = .35, 95% CI [.0383, .7954]), indicating pain catastrophizing partially accounts for this relationship. Assessing and addressing anxiety and pain catastrophizing has the potential to improve treatment outcomes in this population.

Chronic Pain and Pain Management in Older Adults: Protocol and Pilot Results.

BACKGROUND: Chronic pain occurs in 30% of older adults. This prevalence rate is expected to increase, given the growth in the older adult population and the associated growth of chronic conditions contributing to pain. No population-based studies have provided detailed, longitudinal information on the experience of chronic pain in older adults; the pharmacological and nonpharmacological strategies that older adults use to manage their chronic pain; and the effect of chronic pain on patient-reported outcomes. OBJECTIVES: This article aims to describe the protocol for a population-based, longitudinal study focused on understanding the experience of chronic pain in older adults. The objectives are to determine the prevalence and characteristics of chronic pain; identify the pharmacological and nonpharmacological pain treatments used; evaluate for longitudinal differences in biopsychosocial factors; and examine how pain types and pain trajectories affect important patient-reported outcomes. Also included are the results of a pilot study. METHODS: A population-based sample of approximately 1,888 older adults will be recruited from the National Opinion Research Center at the University of Chicago's AmeriSpeak Panel to complete surveys at three waves: enrollment (Wave 1), 6 months (Wave 2), and 12 months (Wave 3). To determine the feasibility, a pilot test of the enrollment survey was conducted among 123 older adults. RESULTS: In the pilot study, older adults with chronic pain reported a range of pain conditions, with osteoarthritis being the most common. Participants reported an array of pharmacological and nonpharmacological pain strategies. Compared to participants without chronic pain, those with chronic pain reported lower physical and cognitive function and poorer quality of life. Data collection for the primary, longitudinal study is ongoing. DISCUSSION: This project will be the first longitudinal population-based study to examine the experience and overall effect of chronic pain in older adults. Pilot study results provide evidence of the feasibility of study methods. Ultimately, this work will inform the development of tailored interventions for older patients targeted to decrease pain and improve function and quality of life.

Brief Report: Expectancies for alcohol analgesia are associated with greater alcohol use among moderate-to-heavy drinkers without chronic pain.

BACKGROUND AND OBJECTIVES: Expectancies for alcohol analgesia (i.e., expectations that drinking alcohol will reduce pain) have been associated with greater alcohol consumption among individuals with chronic pain, and there is reason to believe that such expectancies may also contribute to drinking behavior among alcohol users without a current chronic pain condition. Therefore, the objective of these analyses was to test associations between a measure of expectancies for alcohol analgesia (EAA) and alcohol use among drinkers without current pain. METHOD: These are secondary analyses of baseline data collected from 200 moderate-to-heavy adult drinkers (39% women). RESULTS: EAA scores were positively associated with quantity/frequency of drinking, urge to drink, and other alcohol outcome expectancies (ps < .01). DISCUSSION AND CONCLUSIONS: Expectancies that alcohol will reduce pain are associated with heavier drinking among drinkers without pain. Over time, such expectancies may contribute to the development of alcohol use disorder and chronically painful conditions. SCIENTIFIC SIGNIFICANCE: This study provides the first evidence that even moderate-to-heavy drinkers without chronic pain may still hold expectancies for alcohol analgesia, and that this may be related to greater quantity/frequency of drinking.

Activity-induced pain as a predictor of physical activity behavior among individuals with chronic pain: the role of physical activity enjoyment.

Nearly 70% of adults with chronic pain experience increased pain during activity, and this may reduce enjoyment of physical activity (PA), and subsequent PA intention/behavior. The goal of this study was to examine increased pain during activity as a predictor of PA, via its effects on PA enjoyment. Participants included 178 overweight/obese midlife adults with chronic pain who completed an online prospective survey. Results indicated that greater increases in pain during activity were associated with less PA enjoyment, and, in turn, lower intention to exercise over the next week (p < 0.05). Activity-induced pain also predicted lower total volume of PA at 1-week follow-up, and this relationship was mediated by PA enjoyment (p < 0.05). These findings have the potential to inform the refinement of PA promotion interventions for individuals with chronic pain.

Prevalence and impact of comorbid chronic pain and cigarette smoking among people living with HIV.

Rates of chronic pain and cigarette smoking are each substantially higher among people living with HIV (PLWH) than in the general population. The goal of these analyses was to examine the prevalence and impact of comorbid chronic pain and cigarette smoking among PLWH. Participants included 3289 PLWH (83% male) who were recruited from five HIV clinics. As expected, the prevalence of smoking was higher among PLWH with chronic pain (41.9%), than PLWH without chronic pain (26.6%, p < .0001), and the prevalence of chronic pain was higher among current smokers (32.9%), than among former (23.6%) or never (17%) smokers (ps < .0001). PLWH who endorsed comorbid chronic pain and smoking (vs. nonsmokers without chronic pain) were more likely to report cocaine/crack and cannabis use, be prescribed long-term opioid therapy, and have virologic failure, even after controlling for relevant sociodemographic and substance-related variables (ps < .05). These results contribute to a growing empirical literature indicating that chronic pain and cigarette smoking frequently co-occur, and extend this work to a large sample of PLWH. Indeed, PLWH may benefit from interventions that are tailored to address bidirectional pain-smoking effects in the context of HIV.

Pain Status as a Predictor of Smoking Cessation Initiation, Lapse, and Relapse.

INTRODUCTION: Pain and cigarette smoking are highly prevalent and frequently co-occurring conditions that interact in the manner of a positive feedback loop. Despite initial evidence that smokers with co-occurring pain may experience greater difficulty quitting, we are unaware of previous research that has tested prospective associations between pain status and the attainment of smoking cessation milestones. AIMS AND METHODS: This study examined past 2-week pain status as a predictor of cessation milestones among current smokers who were motivated to quit (Sample 1; N = 301) and smokers who recently initiated a cessation attempt (Sample 2; N = 242). Cessation milestones included initiation of a quit attempt and 7-day point prevalence abstinence (PPA; Sample 1), lapse/relapse (Sample 2), and 7-day PPA at 2-month follow-up (both samples). Indirect associations between pain status and cessation milestones via confidence in quitting and nicotine withdrawal were also examined. RESULTS: Smokers with pain (vs. no pain) were as follows: less likely to initiate a quit attempt and achieve 7-day PPA; more likely to lapse and/or relapse; and less likely to report 7-day PPA at follow-up. Pain status was indirectly associated with latency cessation milestones via confidence in quitting and with latency to lapse via withdrawal severity. CONCLUSIONS: This study demonstrated that pain status can predict smoking cessation outcomes. Clinical implications include the need to assess pain in the context of quitting and that smokers with co-occurring pain may benefit from tailored/integrated cessation interventions. IMPLICATIONS: A growing empirical literature indicates that the presence of co-occurring pain probably contributes to the maintenance of cigarette dependence. The current results provide novel evidence that smokers with co-occurring past 2-week pain are less likely to initiate a quit attempt and maintain smoking abstinence than smokers without co-occurring pain. These findings suggest that smokers with pain face unique barriers to quitting and underscore the utility of assessing and addressing pain among all smokers who are planning a smoking cessation attempt.

Anxiety sensitivity, pain severity and co-use of cigarettes and e-cigarettes among adults with chronic pain.

Anxiety sensitivity (fear of potential negative consequences of anxiety-related symptoms/sensations) has been identified as a transdiagnostic factor in comorbid pain and nicotine dependence and evidence suggests that anxiety sensitivity may be indirectly associated with nicotine use via greater pain severity. Therefore, this study tested the hypothesis that anxiety sensitivity is associated with cigarette and e-cigarette use/co-use directly and indirectly via greater pain severity. Participants included 273 online survey respondents with chronic musculoskeletal pain (34% female; Mage = 32.9). Anxiety sensitivity was positively associated with cigarette smoking, e-cigarette use and cigarette/e-cigarette co-use (ps < .05). Furthermore, anxiety sensitivity was indirectly and positively associated with cigarette smoking, e-cigarette use and co-use via greater chronic pain severity. Pain severity may play an important role in associations between anxiety sensitivity and nicotine dependence and prospective research should examine temporal/causal effects of anxiety sensitivity in relation to pain severity and nicotine/tobacco use.

Pain Severity and Alcohol Use Among Daily Tobacco Cigarette Smokers.

BACKGROUND AND OBJECTIVES: Pain is associated with hazardous alcohol use. Drinkers have reported using alcohol for pain-coping, and negative affect may be a key mechanism in pain-induced motivation to drink. However, no previous study has examined pain severity in relation to alcohol consumption, dependence, and alcohol-related consequences. Moreover, no studies have examined pain-alcohol interrelations among tobacco cigarette smokers. These secondary analyses tested the hypotheses that greater past 4-week pain severity would be positively associated with indices of hazardous drinking (ie, quantity/frequency, harmful use, and dependence), and that the current pain intensity would be positively/indirectly associated with the urge to drink via negative affect. METHODS: Participants included 225 daily smokers (43% female; MCPD = 22) who completed the baseline session for a larger experimental study. RESULTS: Every one-point increase in pain severity was associated with a 47% increased likelihood of hazardous drinking, and pain severity was positively associated with quantity/frequency of alcohol consumption, harmful patterns of drinking, and alcohol dependence level (Ps < .05). Pain intensity was indirectly associated with urge to drink via negative affect (P < .05). CONCLUSIONS: These findings provide initial evidence that smokers with greater pain severity may also report hazardous patterns of alcohol use. SCIENTIFIC SIGNIFICANCE: This is the first study to demonstrate that past 4-week pain severity may be one factor that maintains three conceptually distinct patterns of hazardous drinking among smokers. The current results also provide the first evidence that greater pain intensity may be associated with an increased urge to drink alcohol, via negative affect. (Am J Addict 2020;29:134-140).

A Reciprocal Model of Pain and Substance Use: Transdiagnostic Considerations, Clinical Implications, and Future Directions.

Pain and substance use are highly prevalent and co-occurring conditions that continue to garner increasing clinical and empirical interest. Although nicotine and tobacco, alcohol, and cannabis each confer acute analgesic effects, frequent or heavy use may contribute to the development and progression of chronic pain, and pain may be heightened during abstinence. Additionally, pain can be a potent motivator of substance self-administration, and it may contribute to escalating use and poorer substance-related treatment outcomes. We integrated converging lines of evidence to propose a reciprocal model in which pain and substance use are hypothesized to interact in the manner of a positive feedback loop, resulting in the exacerbation and maintenance of both conditions over time. Theoretical mechanisms in bidirectional pain-substance use relations are reviewed, including negative reinforcement, social cognitive processes, and allostatic load in overlapping neural circuitry. Finally, candidate transdiagnostic factors are identified, and we conclude with a discussion of clinical implications and future research directions.

Gender differences in associations between pain-related anxiety and alcohol use among adults with chronic pain.

Background: Over 100 million Americans live with chronic pain, and adults with chronic pain may be more likely to experience alcohol-related problems or Alcohol Use Disorder. An evolving conceptual model posits that bidirectional effects between pain and alcohol exacerbate both pain and drinking. Pain has been shown to motivate alcohol urge and consumption, and drinking for pain-coping predicts escalations in alcohol use over time. Pain-related anxiety is a transdiagnostic vulnerability factor that has been implicated in both pain and substance-related (i.e., tobacco, opioids, cannabis) outcomes, but has not yet been studied in relation to alcohol use. Objective: We sought to conduct the first test of cross-sectional associations between pain-related anxiety, gender, and alcohol use. Methods: Adults with chronic pain (N = 234; Mage = 29.54, 67% Female) self-reported pain-related anxiety, gender, and alcohol use (i.e., consumption frequency/quantity, alcohol-related consequences, and dependence symptoms measured with the Alcohol Use Disorders Identification Test; AUDIT). Hierarchical regression and conditional effects models were used to test associations between pain-related anxiety, gender, and alcohol use. Results: Pain-related anxiety was positively associated with alcohol-related consequences and alcohol dependence symptoms measured by the AUDIT among males, but not females. Pain-related anxiety was not associated with the frequency/quantity of alcohol consumption in our sample. Conclusions: These findings are consistent with prior research, which has demonstrated associations between pain-related anxiety and deleterious substance use outcomes. Results provide initial evidence that pain-related anxiety may be a relevant factor to consider in the context of alcohol research and treatment among male drinkers.

Associations between Pain-Related Anxiety, Gender, and Prescription Opioid Misuse among Tobacco Smokers Living with HIV/AIDS.

BACKGROUND: People living with HIV/AIDS (PLWHA) who smoke cigarettes are vulnerable to greater pain and aberrant use of prescription pain medications. Prescription opioid misuse is highly prevalent among PLWHA and can lead to a variety of adverse outcomes. Pain-related anxiety, which has been implicated in the maintenance of both pain and tobacco dependence, may also play a role in prescription pain medication misuse. OBJECTIVES: This study aimed to test associations between pain-related anxiety and prescription opioid misuse. We hypothesized that, among those prescribed opioid medication, pain-related anxiety would be positively associated with current opioid misuse, and stated intentions to misuse prescription opioids in the future. We further hypothesized that these relations would be more pronounced among males (vs. females). METHODS: Participants included 61 PLWHA daily tobacco smokers with pain. Hierarchical regressions were used to test interactions between gender and pain-related anxiety on current and intended opioid misuse among those prescribed opioid medications. RESULTS: There was a significant interactive effect of pain-related anxiety and gender on opioid misuse, such that pain-related anxiety was positively associated with current opioid misuse among male (but not female) participants who were prescribed opioid medications. Among both males and females, pain-related anxiety was positively associated with intention to misuse prescription pain medications in the future. Conclusions/Importance: Additional research into the role of pain-related anxiety in prescription opioid misuse is warranted. This type of work may inform the development of tailored interventions for PLWHA smokers who are prescribed opioid pain medications.

There is no happiness in positive affect: the pervasive misunderstanding of the rotated circumplex model.

Research on positive affect (PA) and negative affect (NA) is often guided by the rotational variant of the circumplex model of affect (RCMA). According to the RCMA, PA and NA are posited to be orthogonal, with PA ranging from the union of positive valence and high activation (e.g., excited) to the union of negative valence and low activation (e.g., sluggish), and NA ranging from the union of negative valence and high activation (e.g., distressed) to the union of positive valence and low activation (e.g., relaxed). However, many authors incorrectly interpret the RCMA as positing that positively valenced affect (i.e., pleasure) and negatively valenced affect (i.e., displeasure)-rather than PA and NA, as defined in the RCMA-are orthogonal. This "received view" of the RCMA has led to significant confusion in the literature. The present paper articulates the "received view" of the RCMA and characterizes its prevalence in psychological research. A random sample of 140 empirical research articles on affect published in 14 high-impact journals covering a range of psychological subdisciplines were reviewed. Over half of the articles subscribing to the RCMA showed evidence of the "received view," demonstrating that misuse of the terms PA and NA in the context of the RCMA is rampant in the psychological literature. To reduce continued confusion in the literature, we recommend abandoning use of the terms positive affect and negative affect. We further recommend referring to the two dimensions of the RCMA as positive activation and negative activation, and the two poles of the valence dimension as positive valence and negative valence (or pleasure and displeasure).

Hazardous Alcohol Use Among Community-Dwelling Older Adults With Persistent or Recurrent Pain: Findings From the Health and Retirement Study.

BACKGROUND: Although pain and alcohol use are highly prevalent and associated with deleterious health outcomes among older adults, a paucity of literature has examined hazardous drinking among older adults with pain. We aimed to examine the prevalence of hazardous drinking among a nationally representative sample of older adults with persistent or recurrent pain. METHODS: We conducted cross-sectional analyses of data collected from the 2018 wave of the Health and Retirement Study. Participants included 1  549 community-dwelling adults aged ≥65 with persistent or recurrent pain (ie, clinically significant pain present at 2 consecutive survey waves). RESULTS: More than one-quarter of older adults with persistent or recurrent pain reported regular alcohol use (≥weekly), nearly half of whom reported hazardous patterns of drinking. Specifically, 32% reported excessive drinking (ie, >2 drinks per day for older men; >1 drink per day for older women), and 22% reported binge drinking (ie, ≥4 drinks on one occasion). Exploratory analyses revealed a high prevalence of hazardous drinking among the subsample of older adults who used opioids (47%). CONCLUSIONS: Hazardous alcohol use-including both excessive and binge drinking-is common among older adults with persistent or recurrent pain, including those who take opioids. Given that hazardous drinking can complicate pain management and increase the risk for adverse opioid effects (eg, overdose), the current findings underscore the importance of assessing and addressing hazardous patterns of alcohol use among older adults with persistent or recurrent pain.

POSITION STATEMENT: Pass the RESTORE (Re-entry Support Through Opportunities for Resources and Essentials) Act.

Under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), current federal policy mandates a lifetime ban for individuals with a past felony drug conviction from receiving Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) benefits. Denying nutritional and financial assistance to individuals with a past felony conviction will widen existing structural health inequities, set back individuals' successful re-entry into society, and contribute to recidivism and poorer health outcomes. Therefore, the Society of Behavioral Medicine supports the RESTORE ACT (Re-Entry Support Through Opportunities for Resources and Essentials Act), which would repeal the lifetime ban on receiving SNAP and TANF benefits for individuals convicted of a drug felony.

Current US law bans people who have been convicted of felony drug crime from participating in nutritional and financial assistance programs (i.e. Supplemental Nutrition Assistance Program [SNAP] and Temporary Assistance for Needy Families [TANF]). By not allowing people who have been convicted of a drug felony to access these programs, this law risks worsening health outcomes and perpetuating existing health disparities. The Society of Behavioral Medicine supports the RESTORE Act (Re-Entry Support Through Opportunities for Resources and Essentials Act), which would end the federal ban and allow all income-eligible people to access SNAP and TANF benefits.

Sleep-Related Cannabis Expectancy Questionnaire (SR-CEQ): Factor Analysis Replication, Internal Reliability, and Construct Validity.

Expectancies regarding the sleep-promoting effects of cannabis may exacerbate the propensity to self-medicate sleep problems with cannabis. Given the potential clinical importance of expectancies for the sedative effects of cannabis, Goodhines et al (2020) developed the Sleep-Related Cannabis Expectancies Questionnaire (SR-CEQ). However, concurrent validity of this instrument has not been evaluated. This study aimed to replicate the two-factor structure and internal reliability and explore incremental construct validity of the SR-CEQ. Cross-sectional online survey data were collected from 287 college students (Mage = 19.07 ± 1.44 years, range 18-25; 47% male; 84% non-Hispanic White; 61% lifetime cannabis use). Confirmatory factor analysis replicated an adequate fit of the two-factor model (SRMR = 0.08) with excellent internal consistency within positive (α = .94) and negative (α = .91) subscales. Novel correlates were observed for positive (greater mood, sleep, cannabis risk; rs = .16-.48, ps = .001-.03) and negative (lesser cannabis risk; rs = -.18-.61, ps = .001-.03) subscales. Positive expectancies were greater among students with insomnia (t[285] = 2.70, p < .01; d = .33) and hazardous cannabis use (t[284] = 6.63, p < .001; d = 0.91). No group differences were observed by sex or for negative sleep-related cannabis expectances. This study extends psychometric validation of the SR-CEQ and highlights positive expectancies as a potential risk factor for insomnia and hazardous cannabis use.

Prevalence and Sociodemographic Correlates of Chronic Pain Among A Nationally Representative Sample of Older Adults in the United States.

Subgroup analyses conducted among U.S. national survey data have estimated that 27-34% of adults aged ≥65 years have chronic pain. However, none of these studies focused specifically on older adults or examined disparities in chronic pain in those aged ≥65 years. To obtain current information on the prevalence and sociodemographic correlates of chronic pain in U.S. older adults, a cross-sectional analysis was conducted of data collected from 3,505 older adults recruited from the AmeriSpeak® Panel. Chronic pain was defined as pain on most or every day in the last three months. Nationally representative chronic pain prevalence estimates were computed by incorporating study-specific survey design weights. Logistic regression analyses evaluated differences in chronic pain status as a function of sociodemographic characteristics (e.g., gender, race/ethnicity, socioeconomic status). Results indicated that 37.8% of older adults reported chronic pain. Compared to White older adults, Black (OR = 0.6, 95% CI: 0.4-0.8) and Asian (OR = 0.2, 95% CI: 0.1-0.8) older adults were less likely to report chronic pain. The prevalence of chronic pain was also lower among those who reported the highest (vs. lowest) household income (OR = 0.6, 95% CI: 0.4-0.8). Those who were not working due to disability (vs. working as a paid employee) were more likely to report chronic pain (OR = 3.2, 95% CI: 2.1-5.0). This study was the first to recruit a large, representative sample of older adults to estimate the prevalence of chronic pain and extends prior work by identifying sub-groups of older adults that are disproportionately affected. PERSPECTIVE: This study was the first to estimate the prevalence and sociodemographic correlates of chronic pain among a large, representative sample of U.S. older adults. Findings underscore the high prevalence of chronic pain and highlight disparities in chronic pain prevalence rates among this historically understudied population.

Activity-Induced Pain as a Predictor of Sedentary Behavior Among Midlife Adults.

Purpose: Midlife adults have been estimated to spend over half of their waking time engaging in sedentary behavior, and greater sedentary behavior has been associated with a reduced likelihood of successful aging. Moreover, more than one-quarter of midlife adults report chronic pain, and there is reason to believe that pain may contribute to sedentary behavior among this population. The goal of these analyses was to test associations between self-reported increases in pain during activity and subsequent sedentary behavior among a sample of midlife adults with chronic pain. Methods: Participants included 200 midlife adults (age 50-64) who reported chronic pain and completed an online prospective survey. Activity-induced pain was assessed at baseline and total time spent engaging in sedentary behavior was assessed at baseline, 1-week, and 4-week follow-up assessments. Results: Activity-induced pain predicted greater sedentary behavior at 1-week (p < .05) and 4-week (p < .01) follow-up assessments, even after controlling for chronic pain intensity and baseline sedentary behavior. Conclusions: Activity-induced pain may represent an important mechanism underlying sedentary behavior among midlife adults with chronic pain, and programs designed to reduce sedentary behavior among this population may benefit from tailoring to account for the antithetical influence of activity-induced pain. Indeed, the current findings suggest that mitigating the extent to which pain increases during activity may be more important than reducing overall pain intensity when attempting to decrease sedentary behavior among this population. This and future work have the potential to inform the refinement of tailored interventions.

Acute exercise-induced changes in motivation and behavioral expectation for quitting smoking as predictors of smoking behavior in women.

OBJECTIVE: Temporally static self-reports of motivation and behavioral expectation are established predictors of addictive behavior. However, previous research has not tested intervention effects on within-day changes in motivation/behavioral expectation for smoking cessation as mediators of smoking abstinence. The goals of this study were to test whether aerobic exercise exerts acute pre-postexercise effects on motivation and behavioral expectation and to test the main and interactive effects of change in motivation/behavioral expectation for cessation on subsequent smoking abstinence. METHOD: We conducted secondary analyses of ecological momentary assessment data collected among N = 105 women who participated in a 12-week randomized controlled trial (RCT) examining thrice weekly aerobic exercise (vs. contact control) as an adjunct to cessation treatment. A multilevel, longitudinal mixed-effects model was used to test all pathways simultaneously. RESULTS: Exercise (vs. control) was associated with greater increases in motivation (p = .04), but not behavioral expectation (p > .05), pre-to-postexercise session. Increases in motivation and behavioral expectation were associated with higher odds of abstinence at next session (ps < .05), and for those with larger changes in behavioral expectation, larger changes in motivation were associated with greater odds of abstinence (p = .02). There was also an indirect effect of exercise on abstinence via acute changes in motivation (p < .05). CONCLUSIONS: A single bout of exercise can increase motivation for quitting smoking, which may improve quit success. Moreover, increasing behavioral expectation may enhance the effect of increased motivation on cessation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Initial validation of the expectancies for Benzodiazepine Analgesia Scale.

Chronic pain populations exhibit greater prevalence of benzodiazepine (BZD) prescription (vs. the general population) and greater likelihood of BZD use not as prescribed and dependence symptoms. Individuals report taking BZDs for pain relief, potentially contributing to maintenance/escalation of BZD use and hazardous couse with prescription opioids. Identifying cognitive factors underlying pain-BZD use relations represents a critical step toward understanding the role of pain in BZD use trajectories. Outcome expectancies for substance-related analgesia have been implicated in pain-substance use comorbidity (e.g., alcohol), and there is reason to believe these processes may extend to BZD use. The present study aimed to examine psychometric properties of a newly adapted Expectancies for Benzodiazepine Analgesia (EBA) scale and probe associations between EBA scores and prescription opioid use behaviors. Participants were 306 adults (38.9% females) endorsing chronic pain and current BZD prescription who completed an online survey. Results provided initial support for psychometric validity of the EBA: evidence of single-factor structure with good model fit (Bollen-Stine bootstrap p = .101), excellent internal consistency (α = .93), and evidence of concurrent validity via correlations with pain variables, likelihood of BZD use not as prescribed, BZD dependence symptoms, and self-reported BZD use for pain relief. Exploratory findings among participants prescribed opioids indicated positive covariation between EBA scores and behaviors associated with higher risk opioid use. This is, to our knowledge, the first study to assess analgesia expectancies for BZD use. BZD analgesic expectancies warrant further study as a treatment target in comorbid pain and BZD use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effects of a Mind-Body Program for Chronic Pain in Older versus Younger Adults.

Purpose: Improving physical function is key to decreasing the burden of chronic pain across the lifespan. Although mind-body interventions show promise in increasing physical function in chronic pain, very little is known about whether older and younger adults derive similar benefit. Indeed, older adults experience higher rates of chronic pain and greater impacts of pain on physical function compared to younger adults. Therefore, additional work is needed to determine the extent of benefit older versus younger adults receive from a mind-body intervention. Here, we examined age differences in the effects of two mind-body and walking programs on pain and multimodal physical function. Participants and Methods: Participants were 82 individuals with heterogenous chronic musculoskeletal pain (66% female, 57% aged ≥50 years) who participated in a feasibility randomized controlled trial of two mind-body interventions. They completed self-reported (WHODAS 2.0), performance-based (6-minute walk test), and objective (accelerometer-measured step count) measures of physical function, as well as self-report measures of pain intensity, before and after the intervention. Results: Results indicated that adults aged ≥50 (vs adults aged <50) demonstrated greater improvements in performance-based physical function (6-minute walk test) and reductions in pain during activity. No age differences in the effects of the intervention on self-reported or objectively measured physical function were observed. Conclusion: Collectively, these findings suggest that older adults can achieve equivalent or greater benefits from mind-body programs for chronic pain, despite facing unique challenges to chronic pain management (eg, multimorbidity, greater sedentary behavior).