Treatment Goals and Preferences of Black Veterans with Chronic Musculoskeletal Pain.

Understanding patient goals and preferences is critical in the context of complex conditions such as chronic pain. This need may be especially pronounced for Black patients, who experience significant health and healthcare disparities. The primary aim of this study was to describe the treatment goals and preferences of Black veterans with chronic musculoskeletal pain who were enrolled in the intervention arm of a randomized controlled trial testing a coaching intervention. In the coaching sessions, participants (n = 106) identified their most important pain-related treatment goals and preferences. Participants' top treatment goals were to improve physical functioning (61%), increase engagement in valued activities (45%), and reduce pain intensity (37%). Most participants (73%) preferred non-pharmacological treatments (eg, physical therapy, exercise, acupuncture, yoga). The 17% of participants who identified medications as a preferred treatment demonstrated higher levels of depression and anxiety compared to those who did not. Approximately 42% and 21% of participants stated a preference to avoid pharmacological and surgical pain treatments, respectively. Black patients with chronic pain prioritize improving physical functioning and pain intensity in service of increasing their engagement in exercise, work, relationships, and leisure activities. Also, in the current study, patients expressed a clear preference for non-pharmacological pain treatments. Future research should investigate ways to improve communication of goals and preferences with providers and facilitate access to non-pharmacological treatments for Black patients with chronic pain. PERSPECTIVE: This article describes the treatment goals and preferences of Black veterans with chronic pain. Most patients prioritized goals to improve physical functioning, pain severity, and participation in valued activities. Patients primarily preferred non-pharmacological treatments. This emphasizes the need for clear communication with Black patients regarding pain-related goals and non-pharmacological treatment options.

Efficacy of psychological interventions for dysmenorrhea: a meta-analysis.

Dysmenorrhea is pelvic pain associated with menstruation and is one of the most common pain conditions among reproductive-age women. It is commonly treated with medications, complementary and alternative medicine, and self-management techniques. However, there is increased focus on psychological interventions which modify thoughts, beliefs, emotions, and behavioral responses to dysmenorrhea. This review examined the efficacy of psychological interventions on dysmenorrhea pain severity and interference. We conducted a systematic search of the literature using PsycINFO, PubMed, CINHAL, and Embase. A total of 22 studies were included; 21 examined within-group improvement (ie, within-group analysis) and 14 examined between-group improvement (ie, between-group analysis). Random-effects meta-analyses were conducted on pain severity and interference, with average effect sizes calculated using Hedges's g. Within-group analyses showed decreased pain severity and interference at post-treatment (g = 0.986 and 0.949, respectively) and first follow-up (g = 1.239 and 0.842, respectively). Between-group analyses showed decreased pain severity at post-treatment (g = 0.909) and decreased pain severity and interference at first follow-up (g = 0.964 and 0.884, respectively) compared to control groups. This review supports the efficacy of psychological interventions for dysmenorrhea, but conclusions are tempered by suboptimal methodological quality of the included studies and high heterogeneity across studies. Additional, rigorous research is needed to determine the clinical utility of psychological interventions for dysmenorrhea.

Engineered resistance to camptothecin and antifolates by retroviral coexpression of tyrosyl DNA phosphodiesterase-I and thymidylate synthase.

PURPOSE: Gene transfer of cDNA sequences that confer drug resistance can be used (1) to protect hematopoietic cells against the toxic effects of chemotherapy, (2) for in vivo enrichment of genetically engineered cells and (3) to protect cytotoxic T lymphocytes in drug-resistant immunotherapy approaches for the treatment of cancer. We have previously developed strategies to confer resistance to agents targeting thymidylate synthase (TS) and have now expanded our drug resistance strategies to include retroviral expression of tyrosyl-DNA phosphodiesterase (TDP-I), an enzyme recently implicated in the repair of topoisomerase-I (Top-I)/DNA lesions induced by camptothecin (CPT). The combination of TS and Top-I inhibition has been shown to be an effective treatment for several types of cancer. MATERIALS AND METHODS: Retroviral vectors were generated that individually encoded TS and TDP-I or that coexpressed both enzymes. Murine fibroblast and Chinese hamster lung transfectants were generated with the vectors and resistance to TS- and Top-I-directed inhibitors was tested. Murine bone marrow progenitor cells were also transduced using recombinant retroviruses encoding TS and TDP-I and the degree of drug resistance conferred to gene-modified cells was tested. RESULTS: Enforced expression of TDP-I increased TDP-I activity in gene-modified cells and conferred up to threefold resistance to CPT. The degree of resistance was dependent on the duration of drug treatment. Simultaneous expression of the TS gene encoding E. coli TS optimized for expression in mammalian cells (optecTS) and TDP-I conferred extremely high-level resistance to concurrent treatment with the TS-inhibitor BW1843U89 and CPT. Furthermore, by direct analysis of DNA fragmentation using the comet assay, substantial protection was conferred (fourfold) against DNA fragmentation associated with combination drug treatments by dual enzyme expression compared to non-modified cells. Hematopoietic progenitor assays of murine bone marrow cells transduced with retroviral vectors encoding TS and TDP-I showed that bone marrow cells could be protected from the cytotoxic effects of TS and Top-I inhibition. CONCLUSIONS: Enforced expression of optecTS and TDP-I conferred antifolate and CPT resistance to genetically modified cells. Additionally, this work further illustrated a role for TDP-I in the repair of dead-end Top-I complexes and implied that TDP-I expression analysis may aid in predicting the therapeutic effectiveness of the CPT class of compounds.