Characterizing the Impact of Disorders of the Gut-Brain Interaction on Mental and Physical Health Functioning Among Spanish-Speaking Latino Adults Living in the United States.

INTRODUCTION: Latino individuals are underrepresented in the disorders of the gut-brain interaction (DGBI) literature, and no work has explored how disorders of the gut-brain interaction affect health and well-being in this group. METHODS: This study sought to explore how disorders of the gut-brain interaction affect health factors in a sample of Latino individuals (N = 292; 80.80% female; M age = 37.65 years, SD = 11.98) with (n = 60) and without (n = 232) a disorder of the gut-brain interaction based on current Rome Foundation diagnostic criteria (Rome IV). RESULTS: DGBI was associated with increased pain intensity, pain disability, cardiovascular risk, depressive symptoms, and anxiety/panic symptoms and lower physical health-related quality of life and mental health-related quality of life controlling for age, sex, and nativity. DISCUSSION: Better understanding mental health and treatment-seeking behaviors among Latino individuals may help clinical gastroenterologists engage their Latino patients to a greater extent and thus provide higher quality of care.

Posttraumatic Stress and Opioid Use and Pain among Individuals with Probable Posttraumatic Stress Disorder and Self-Reported Chronic Pain: The Role of Health Literacy.

BACKGROUND: Chronic pain and opioid misuse are a prevalent comorbidity with deleterious health outcomes. Growing work indicates that posttraumatic stress disorder (PTSD) can increase the risk for chronic pain and opioid misuse and dependence. However, there is little understanding of social determinants of health (SDoH) that may account for interrelations of PTSD with chronic pain and opioid misuse and dependence. Health literacy is one relevant SDoH construct, reflecting the ability to gather, process, and comprehend health-related information required to engage in a healthcare setting. OBJECTIVE: The purpose of the present cross-sectional study was to examine the indirect effect of health literacy in the association between PTSD and opioid misuse, opioid dependence, pain intensity, and pain disability. METHOD: The sample included 142 adults (Mage = 35.2, SD = 9.9; 67.4% female; 70.1% White/Caucasian) with self-reported chronic pain and probable PTSD who were using opioid medication. RESULTS: Results demonstrated that PTSD symptom severity had a small indirect effect on opioid misuse and opioid dependence via health literacy; no indirect effects were evident for pain intensity and disability. CONCLUSION: The present investigation provides evidence that health literacy may serve as an important explanatory factor in associations between PTSD symptom severity and opioid misuse and dependence among adults with co-occurring probable PTSD and chronic pain.

Opioid coping motives and pain intensity among adults with chronic low back pain: associations with mood, pain reactivity, and opioid misuse.

Chronic low back pain (CLBP) is a significant public health problem that is associated with opioid misuse and use disorder. Despite limited evidence for the efficacy of opioids in the management of chronic pain, they continue to be prescribed and people with CLBP are at increased risk for misuse. Identifying individual difference factors involved in opioid misuse, such as pain intensity as well as reasons for using opioids (also known as motives), may provide pertinent clinical information to reduce opioid misuse among this vulnerable population. Therefore, the aims of the current study were to examine the relationships between opioid motives-to cope with pain-related distress and pain intensity, in terms of anxiety, depression, pain catastrophizing, pain-related anxiety, and opioid misuse among 300 (Mage= 45.69, SD = 11.17, 69% female) adults with CLBP currently using opioids. Results from the current study suggest that both pain intensity and motives to cope with pain-related distress with opioids were associated with all criterion variables, but the magnitude of variance explained by coping motives was larger than pain intensity in terms of opioid misuse. The present findings provide initial empirical evidence for the importance of motives to cope with pain-related distress with opioids and pain intensity in efforts to better understand opioid misuse and related clinical correlates among adults with CLBP.

Indirect Effects of Negative Mood on Opioid Misuse and Dependence via Anxiety Sensitivity Subfacets: Evidence from Adults Reporting Chronic Pain.

Background: Opioid misuse in the context of pain management exacts a significant public health burden. Past work has established linkages between negative mood (i.e., symptoms of anxiety and depression) and opioid misuse/dependence, yet the mechanisms underlying these associations have received little scientific investigation. Anxiety sensitivity (AS), the fear of the negative consequences of internal states, may be relevant to better understanding negative mood-opioid relations among adults with chronic pain. Methods: Simultaneous indirect effects of negative mood on opioid misuse and opioid dependence via lower-order factors of AS (physical, cognitive, and social concerns) were examined cross-sectionally in the present study. The study sample consisted of 428 adults (74.1% female, Mage = 38.27 years, SD = 11.06) who self-reported current moderate to severe chronic pain and opioid use for chronic pain. Results: Results indicated that negative mood was (in part) indirectly related to opioid misuse (in part) via AS physical and cognitive concerns and was (in part) indirectly related to opioid dependence via AS cognitive concerns only. No significant indirect effects via social concerns were observed. Discussion and Conclusions: Findings suggest the importance of further exploring the role of anxiety sensitivity cognitive and physical concerns in terms of opioid misuse and dependence among adults with chronic pain.

Intraindividual change in pain tolerance and negative affect over 20 years: findings from the MIDUS study.

Pain tolerance, defined as the ability to withstand physical pain states, is a clinically important psychobiological process associated with several deleterious outcomes, including increased pain experience, mental health problems, physical health problems, and substance use. A significant body of experimental work indicates that negative affect is associated with pain tolerance, such that increased negative affect is associated with decreased pain tolerance. Although research has documented the associations between pain tolerance and negative affect, little work has examined these associations over time, and how change in pain tolerance is related to changes in negative affect. Therefore, the current study examined the relationship between intraindividual change in self-reported pain tolerance and intraindividual change in negative affect over 20 years in a large, longitudinal, observation-based national sample of adults (n = 4,665, Mage = 46.78, SD =12.50, 53.8% female). Results from parallel process latent growth curve models indicated that slope of pain tolerance and negative affect were associated with each other over time (r = .272, 95% CI [.08, .46] p = .006). Cohen's d effect size estimates provide initial, correlational evidence that changes in pain tolerance may precede changes in negative affect. Given the relevance of pain tolerance to deleterious health outcomes, better understanding how individual difference factors, including negative affect, influence pain tolerance over time, are clinically important to reduce disease-related burden.

Pain Intensity Moderates the Association between Obsessive-Compulsive Symptoms and Problematic Alcohol Use among Emerging Adults.

Objective: Emerging adulthood is a vulnerable period for problematic alcohol use, defined by a pattern of use associated with physical and functional impairment. Obsessive-compulsive psychopathology, which demonstrates high rates of onset in emerging adults, seems to be related to problematic alcohol use in this age group, consistent with research among the general population suggesting an association between emotional disorders and alcohol use in the context of coping drinking motives. Pain intensity, another risk factor of problematic alcohol use, may link obsessive-compulsive symptoms to problematic alcohol use among emerging adults. Therefore, the current study examined the moderating role of pain intensity on the association between obsessive-compulsive symptoms and problematic alcohol use among emerging adults. Methods: Participants were 198 college students (81.30% female, Mage = 22.33, SD = 4.38) who reported problematic alcohol use. Results: Results from the current study supported a significant moderation role of pain intensity for the association between obsessive-compulsive symptoms and problematic alcohol use, whereby the association between obsessive-compulsive symptoms and problematic alcohol use was stronger for emerging adults with high compared to low pain intensity. Conclusions: These results highlighted a clinically-relevant interaction between obsessive-compulsive symptoms and pain intensity concerning the risk of problematic alcohol use among emerging adults as a vulnerable population.

Alcohol and marijuana co-use among adults with chronic low back pain: Associations with substance misuse, mental health, and pain experience.

BACKGROUND AND OBJECTIVES: Individuals with chronic lower back pain (CLBP) report using alcohol and marijuana to cope with pain. Little research has tested whether co-use is associated with worse psychological outcomes. METHODS: Participants had CLBP and past-month alcohol/marijuana co-use (n = 192), alcohol use (n = 148), marijuana use (n = 78), or no use (n = 101). RESULTS: Co-use was associated with more drinking-related problems, anxiety, and pain anxiety compared to alcohol-(but not marijuana-) only, whereas marijuana-only use was associated with worse psychological outcomes than alcohol use-only; effect sizes were small to medium. DISCUSSION AND CONCLUSIONS: Co-use and marijuana-only were associated with worse outcomes than alcohol-only. SCIENTIFIC SIGNIFICANCE: The present findings extend current understanding of co-use by finding that marijuana use among people with CLBP (a group with especially high rates of use of these substances) is associated with worse alcohol-related problems and psychological outcomes.

Anxiety sensitivity and modifiable cardiovascular disease risk factors: the role of pain intensity among individuals with chronic pain.

Chronic pain is often comorbid with modifiable cardiovascular disease risk factors, such as obesity and tobacco use. Among individuals with chronic pain, psychological risk factors may increase pain which, in turn, may increase risk for modifiable cardiovascular disease correlates. Thus, the current study examined the explanatory role of pain intensity in the relationship between anxiety sensitivity and two well-documented modifiable cardiovascular disease risk factors. Participants included 396 adults with chronic pain who completed an online survey from a larger study examining chronic pain-mental health relations. Results revealed that higher levels of anxiety sensitivity were related to higher levels of body mass index (BMI) through greater levels of pain intensity. Bi-directional relations were observed between anxiety sensitivity and pain intensity for tobacco risk. The current study highlights a potential transdiagnostic cognitive vulnerability factor, anxiety sensitivity, which may be an important treatment target to reduce modifiable cardiovascular disease risk factors via reductions in pain intensity.

Anxiety sensitivity and Pain Experience: a prospective investigation among World Trade Center Responders.

Chronic pain is a significant public health problem and is exacerbated by stress. The World Trade Center (WTC) Disaster represents a unique stressor, and responders to the WTC disaster are at increased risk for pain and other health complaints. Therefore, there is a significant need to identify vulnerability factors for exacerbated pain experience among this high-risk population. Anxiety sensitivity (AS), defined as fear of anxiety-related sensations, is one such vulnerability factor associated with pain intensity and disability. Yet, no work has tested the predictive effects of AS on pain, limiting conclusions regarding the predictive utility and direction of associations. Therefore, the current study examined the prospective associations of AS, pain intensity, and pain interference among 452 (Mage = 55.22, SD = 8.73, 89.4% male) responders to the WTC disaster completing a 2-week daily diary study. Using multi-level modeling, AS total score was positively associated with both pain intensity and pain interference, and that AS cognitive concerns, but not social or physical concerns, were associated with increased pain. These results highlight the importance of AS as a predictor of pain complaints among WTC responders and provide initial empirical evidence to support AS as a clinical target for treating pain complaints among WTC responders.

Exploring pain experience and anxiety sensitivity among Latinx adults in a federally qualified health center.

The Latinx population is the largest minority group in the United States (U.S.) and is expected to continue to grow through at least 2050. Although there is growing recognition of the importance of pain among Latinx individuals, few studies have examined individualized psychological processes governing pain severity and disability in Latinx populations. One psychological factor that has shown promise in relation to pain experience specifically and clinical conditions more generally is anxiety sensitivity. The present investigation sought to (1) characterize the severity of pain among an unselected sample of adult Latinx individuals attending a Federally Qualified Health Center (FQHC); (2) evaluate the severity of anxiety sensitivity as a function of pain severity; and (3) test the potential explanatory relevance of anxiety sensitivity as an individual difference factor for pain intensity, pain disability, psychological inflexibility for emotional distress, and global life impairment. Participants included 406 adult Spanish-speaking Latinx persons (87.2% female; Mage = 40.26 years, SD = 11.20, and 98.3% used Spanish as their first language) who attended an FQHC in Houston, Texas. Analyses revealed that 62.6% of the sample had at least some pain, and 21.9% of the same had high intensity, moderate interference, or severe interference chronic pain. Further, results provided evidence for anxiety sensitivity as a function of pain grade, such that individuals with grade 2 (high-intensity pain), grade 3 (moderate pain interference), and grade 4 (severe pain interference) chronic pain reported significantly higher levels of anxiety sensitivity than those with grade 0 pain (no chronic pain). Additionally, after controlling for age, gender, marital status, years of education, years living in the U.S., and generalized anxiety, anxiety sensitivity significantly accounted for significant variance in pain intensity, inflexibility in relation to emotional distress, and life impairment. Overall, the current study builds upon what is currently understood about anxiety sensitivity among the Latinx population and uniquely extends past work by linking individual differences in this construct to clinically relevant aspects of pain experience and life impairment among adults attending FQHC's. Additional clinical attention should be focused on anxiety sensitivity to offset pain disparities among this established health disparities group.

Anxiety and depressive symptoms among adults with obesity and chronic pain: the role of anxiety sensitivity.

Obesity and chronic pain frequently co-occur, and this co-occurrence can have potential negative consequences, particularly as it relates to mental health. As such, there is a need to understand potential risk factors for poor mental health among this co-morbid population. Thus, the current study examined the predictive role of anxiety sensitivity (and its sub-facets) on anxiety and depressive symptoms among adults (82.5% female, Mage = 40.2 years, SD = 10.92) with obesity and chronic pain. Results revealed that greater levels of anxiety sensitivity were associated with greater levels of both anxiety and depressive symptoms, with medium to large effect sizes. Post hoc analyses also indicated that specific sub-facets of anxiety sensitivity (cognitive and social concerns) were significant predictors of the criterion variables. The current study highlights the potential clinical utility in targeting anxiety sensitivity among individuals with co-occurring obesity and chronic pain in the treatment of anxiety and depressive symptoms.

Fatigue severity and fatigue sensitivity: relations to anxiety, depression, pain catastrophizing, and pain severity among adults with severe fatigue and chronic low back pain.

Chronic low back pain is the second leading cause of disability in the United States, and it is often associated with severe fatigue. However, little is known about individual differences that may be related to poorer mental health and pain among individuals with severe fatigue and chronic low back pain. The aim of the current investigation was to explore the role of fatigue severity and fatigue sensitivity in terms of anxiety and depressive symptoms, pain catastrophizing, pain interference, and pain severity among 783 adults with severe fatigue and chronic low back pain. Results suggest that fatigue severity and fatigue sensitivity were statistically significant predictors for anxiety, depression, pain interference, and pain catastrophizing. However, only fatigue sensitivity significantly predicted pain severity. Overall, the current study provides initial support for the role of fatigue severity and fatigue sensitivity in the presence of mental and physical health complaints among individuals with severe fatigue and chronic low back pain.

Pain-Related Anxiety among Adults with Obesity and Chronic Pain: Relations with Pain, Opioid Misuse, and Mental Health.

Obesity affect a significant proportion of the population in the United States, and is associated with numerous health consequences including anxiety, depression, and chronic pain. Additionally, pain among adults with obesity has been associated with greater mental health problems and substance use problems. Yet little work has examined psychological vulnerability factors associated with these relations, and pain-related anxiety may be one candidate psychological correlate of these relations. Therefore, the current study examined the association of pain-related anxiety with pain intensity, disability, opioid misuse, anxiety, and depression among 164 adults (81.7% female, Mage = 40.13 years, SD = 10.85) with obesity (MBMI= 37.21, SD = 6.70) and chronic pain. Results suggested that pain-related anxiety was significantly associated with all outcomes, and these results suggest that pain-related anxiety may play an important role in physical health, mental health, and substance use outcomes among adults with obesity and chronic pain.

The relationship between sex-related alcohol expectancies and hazardous drinking among persons with HIV disease.

Hazardous drinking is a clinically significant problem among persons with HIV (PWH) disease, and is associated with a number of poor outcomes. Hazardous drinking among PWH is associated with risky substance use and sexual behavior, but little work has examined factors that may be associated with greater hazardous drinking and subsequent risky sexual behaviors among PWH. Research among the general population suggests that sex-related alcohol expectancies, defined as drinking to enhance sexual experience, increase sexual risk-taking, and disinhibition of sexual behavior, are associated with greater hazardous alcohol use and risky sexual behavior, but these relations have not been explored among PWH. Therefore, the current study examined the associations of sex-related alcohol expectancies with hazardous alcohol consumption, dependence, and problems among 146 PWH (Mage = 50.99, SD = 9.41) \ enrolled in a clinical trial examining a personalized feedback intervention to reduce hazardous drinking in primary HIV care. Results showed that only sexual disinhibition-related alcohol expectancies were significantly associated with the criterion variables, such that greater drinking alcohol for sexual disinhibition was associated with greater hazardous drinking behaviors. These results sit on the backdrop of a larger literature documenting the links between disinhibition and hazardous alcohol use and provide explanatory specificity to PWH who are hazardous drinkers.

Anxiety, depression, and opioid misuse among adults with chronic pain: the role of emotion dysregulation.

The opioid epidemic is a significant public health concern in the United States, particularly among adults with chronic pain. Considerable research suggests that people with mental health problems, including anxiety and depression, may experience more opioid-related problems in the context of chronic pain. Yet, little work has examined potential mechanisms underyling these relations. Emotion dysregulation is one mechanistic factor that may link anxiety and depression and opioid-related problems among persons with chronic pain. Therefore, the current study examined the explanatory role of emotion dysregulation in the cross-sectional relationship between anxiety and depression problems and current opioid misuse and severity of opioid dependence among 431 adults with chronic pain who reported currently using opioid medications (74% female, Mage=38.32 years, SD = 11.11). Results indicated that emotion dysregulation explained, in part, the relationship between anxiety and depression symptoms and opioid-related problems. These findings highlight the need to further consider the role of emotion dysregulation among adults with chronic pain who use prescription opioids and experience symptoms of anxiety or depression. Future prospective research will be needed to further establish emotion dysregulation as a mechanism in anxiety/depression-opioid misuse/dependence processes.

Transdiagnostic vulnerability factors for behavioral health problems during COVID-19.

The novel 2019 SARS-2-CoV causing COVID-19 has had a devastating impact on the entire world. COVID-19 is a broad-based stressor, and research to date has documented increases in mental health problems, including anxiety, depression, and substance use, since the onset of COVID-19. By taking a transdiagnostic approach, scholars can help elucidate mechanisms and vulnerability as well as resiliency related to behavioral health problems in the context of COVID-19. The aim of the current special issue of Cognitive Behaviour Therapy was to showcase ongoing research focused on transdiagnostic factors in the context of COVID-19. The purpose of this issue is to highlight the significance of this work in the pandemic for research and practice; illustrate some of the many domains currently being explored via innovative approaches; and explicate fruitful areas for programmatic study. We hope that readers will recognize the important role of transdiagnostic models and their potential to offset the mental, addictive, and physical health disease burden of COVID-19.

COVID-19 psychological factors associated with pain status, pain intensity, and pain-related interference.

The 2019 novel SARS-CoV2 disease causing COVID-19 has had a devastating impact on the world, and those with pain conditions may be at heightened risk for these negative consequences. Given COVID-19 limitations, including social distancing and stay-at-home orders, pain is likely largely going untreated, leading to greater pain and associated consequences. Mental health symptoms, which have been found to be elevated due to COVID-19, may contribute to elevated pain experience, but little work has examined how COVID-19-specific mental health factors may be associated with pain. Therefore, the current study examined (1) how COVID-19-specific psychological factors and general mental health symptoms differ between those with pain and without, and (2) among those with pain, which psychological factors were most strongly associated with pain experience. Results from a national (U.S. based) online sample of 174 adults (42.5% female, Mage = 37.80 years, SD = 11.30, 88 with pain) collected between April and May 2020 indicated that, compared to those individuals reporting no pain, those with pain reported significantly higher values on all variables. Additionally, COVID-19 fear and sleep problems were associated with pain intensity, and for pain-related interference, fear, sleep problems, and depression were significantly associated. These results highlight the potential importance of COVID-19-specific psychological factors in pain experience.

Evaluating the psychometric properties of the e-cigarette barriers to cessation scale.

Evidence suggests that electronic cigarette (e-cigarette) users have difficulty quitting e-cigarettes. The Electronic Cigarette Barriers to Cessation Scale (E-BCS) was developed to assess barriers to cessation among e-cigarette users. Yet, no work has evaluated the psychometric properties of the E-BCS. The current study utilized data from two independent samples of adult e-cigarette users to evaluate the psychometric properties and structure of the E-BCS. In Study 1, competing models of the E-BCS were evaluated, and initial construct validity and reliability were explored using data from 599 adult e-cigarettes users (52.3% female, Mage = 35.16 years, SD = 10.30). Results supported a unidimensional structure for the E-BCS comprised of 18 items. In Study 2, the unidimensional structure of the 18-item E-BCS and construct validity were evaluated among a sample of 516 current e-cigarette using adults (52.3% female; Mage = 34.74, SD = 11.37). Results confirmed the unidimensional structure, measurement invariance across sex, and construct validity across related e-cigarette behavior constructs and psychopathology for the E-BCS. These findings suggest that the E-BCS is a potentially useful clinical instrument for measuring barriers that may interfere with e-cigarette cessation.

Opioid Misuse among Smokers with Chronic Pain: Relations with Substance Use and Mental Health.

Opioid misuse is a significant public health concern with substantial medical, social, and economic costs. Cross cutting the personal and societal effects of this current crisis, opioid misuse is associated with poorer physical and mental health outcomes that impair function across numerous life domains. Importantly, opioid misuse disproportionately affects persons with chronic pain and individuals who smoke tobacco. Despite the higher risk for smokers with chronic pain to engage in opioid misuse, little work has examined how opioid misuse may be related to mental health problems, including other substance use, among this vulnerable group. The current study examined opioid misuse as a predictor of substance use and mental health problems among 187 (Mage = 39.02, SD = 9.94, 74.9% female) daily cigarette smokers with chronic pain who currently use opioids. Results indicated that opioid misuse is associated with greater tobacco (13% of variance), alcohol (27% of variance), and cannabis (22% of variance) problems, as well as anxiety (26% of variance) and depressive symptoms (26% of variance). These results highlight the potential importance of opioid misuse in terms of concurrent substance and mental health problems among smokers with chronic pain. Future work is needed to explicate directionality and temporal ordering in the observed relations.

Emotion dysregulation in the experience of pain among persons living with HIV/AIDS.

Persons living with HIV and AIDS (PLWHA) report disproportionally high rates of pain. Pain among PLWHA has been associated with poor medication adherence and anxiety and depressive symptoms. This relationship may be primarily driven by elevated negative affect, and one factor that may be important to understanding elevated negative affect is emotion dysregulation. Therefore, the current study sought to examine emotion dysregulation (Difficulties in Emotion Regulation Scale) in terms of multi-dimensional pain experience (pain severity, pain interference, pain affective distress, pain life control; Multidimensional Pain Inventory; Turk and Rudy (1988) among a sample of 162 HIV+ individuals (Mage = 47.65, SD = 8.59, 35.2% female). Two-step hierarchical regression analyses revealed that emotion dysregulation total score was significantly associated with each of the pain variables. These results may suggest PLWHA who demonstrate greater emotion dysregulation struggle to effectively manage negative affect associated with their pain experience, exacerbating the severity of pain symptoms across numerous clinically-relevant domains. The novel findings may provide important assessment and intervention targets for PLWHA living with pain.