Exercise as Medicine for People with a Substance Use Disorder: An ACSM Call to Action Statement.

ABSTRACT: Over 20 million Americans are living with a substance use disorder (SUD) and nearly 100,000 die annually from drug overdoses, with a majority involving an opioid. Many people with SUD have co-occurring chronic pain and/or a mental health disorder. Exercise is a frontline treatment for chronic pain and is an effective strategy for reducing depression and anxiety and improving overall mental health. Several studies have shown that exercise improves SUD-related outcomes including abstinence; however, there is limited large-scale randomized clinical trial evidence to inform integration of exercise into practice. In this Call to Action, we aim to raise awareness of the specific issues that should be addressed to advance exercise as medicine in people with SUD including the challenges of co-occurring chronic pain, mental illness, and cardiopulmonary health conditions. In addition, specialized training for exercise professionals and other support staff should be provided on these issues, as well as on the multiple dimensions of stigma that can impair engagement in treatment and overall recovery in people with SUD.

The Relationship Between Body Mass Index and Pain Intensity Among Veterans with Musculoskeletal Disorders: Findings from the MSD Cohort Study.

OBJECTIVE: To examine the relationship between body mass index (BMI) and pain intensity among veterans with musculoskeletal disorder diagnoses (MSDs; nontraumatic joint disorder; osteoarthritis; low back, back, and neck pain). SETTING: Administrative and electronic health record data from the Veterans Health Administration (VHA). SUBJECTS: A national cohort of US military veterans with MSDs in VHA care during 2001-2012 (N = 1,759,338). METHODS: These cross-sectional data were analyzed using hurdle negative binomial models of pain intensity as a function of BMI, adjusted for comorbidities and demographics. RESULTS: The sample had a mean age of 59.4, 95% were male, 77% were white/Non-Hispanic, 79% were overweight or obese, and 42% reported no pain at index MSD diagnosis. Overall, there was a J-shaped relationship between BMI and pain (nadir = 27 kg/m2), with the severely obese (BMI ≥ 40 kg/m2) being most likely to report any pain (OR vs normal weight = 1.23, 95% confidence interval = 1.21-1.26). The association between BMI and pain varied by MSD, with a stronger relationship in the osteoarthritis group and a less pronounced relationship in the back and low back pain groups. CONCLUSIONS: There was a high prevalence of overweight/obesity among veterans with MSD. High levels of BMI (>27 kg/m2) were associated with increased odds of pain, most markedly among veterans with osteoarthritis.

The Society of Behavioral Medicine supports an increase in funding for Medication-Assisted-Treatment (MAT) to address the opioid crisis.

Opioid use has become an epidemic in the USA. Although there are safe uses for opioids to help manage acute pain, the effects of long-term use and any misuse of opioids can have grave outcomes, including death. To provide an empirically based "ask" for increased funding from the federal government to increase the reimbursement for and the integration of the behavioral component of Medication-Assisted-Treatment (MAT) for opioid use disorders, current policy was reviewed and important gaps in funding and treatment fidelity were identified. Current barriers to treatment include a dearth of treatment programs and a greater emphasis on and reimbursement for the pharmacological component of MAT only, leaving the behavioral component largely underfunded. We recommend additional funding to (a) increase the availability of and coverage for MAT that combines both pharmacological and behavioral components and (b) support the scientific inquiry into the factors that contribute to, maintain, and exacerbate opioid-related issues. We also recommend declaring the opioid epidemic a national emergency and not just a public health emergency, which would provide immediate access to billions of dollars in federal dollars to fund treatment programs.

Cancer Survivorship at the Intersections of Care and Personhood.

Surviving colorectal cancer following ostomy surgery with an intestinal stoma presents numerous challenges to the cultural category of full adult personhood. The foremost is managing unpredictable bowel activity. The technical management of the ostomy facilitated by biomedical specialists, is essential for personhood realignment. This article focuses on how some female long-term cancer survivors manage and adapt to this new fecal habitus by mobilizing various assemblages of care - receiving care, continuing to provide particular gendered forms of care, and returning to caregiving roles. These interdependent practices of care realign personhood, or at the very least, minimize the assaults that having an ostomy presents to the cultural category of full adult personhood.

Society of Behavioral Medicine (SBM) position statement: improving access to psychosocial care for individuals with persistent pain: supporting the National Pain Strategy's call for interdisciplinary pain care.

Policy makers have articulated a need for clear, evidence-based guidance to help inform pain policy. Persistent pain is common, expensive, and debilitating, and requires comprehensive assessment and treatment planning. Recently released opioid prescribing guidelines by the CDC (2016) emphasize the importance of using nonopioid therapies before considering opioid treatment for those without a malignant illness. The National Pain Strategy (2016) underscores the importance of comprehensive, interdisciplinary pain care. Unfortunately, despite persuasive evidence supporting the efficacy of psychosocial approaches, these interventions are inaccessible to the majority of Americans. Psychosocial approaches to pain management should be available for all individuals with persistent pain and in all health care settings and contexts as part of the comprehensive, interdisciplinary approach to pain care as outlined in the National Pain Strategy. To achieve this, we must prioritize reimbursement of evidence-based psychosocial approaches for pain assessment and management and improve provider training and competencies to implement these approaches.

Increasing the public health impact of evidence-based interventions in behavioral medicine: new approaches and future directions.

The dissemination and implementation of evidence-based behavioral medicine interventions into real world practice has been limited. The purpose of this paper is to discuss specific limitations of current behavioral medicine research within the context of the RE-AIM framework, and potential opportunities to increase public health impact by applying novel intervention designs and data collection approaches. The MOST framework has recently emerged as an alternative approach to development and evaluation that aims to optimize multicomponent behavioral and bio-behavioral interventions. SMART designs, imbedded within the MOST framework, are an approach to optimize adaptive interventions. In addition to innovative design strategies, novel data collection approaches that have the potential to improve the public-health dissemination include mHealth approaches and considering environment as a potential data source. Finally, becoming involved in advocacy via policy related work may help to improve the impact of evidence-based behavioral interventions. Innovative methods, if increasingly implemented, may have the ability to increase the public health impact of evidence-based behavioral interventions to prevent disease.

Catastrophizing and anxiety sensitivity mediate the relationship between persistent pain and emotional eating.

Stress-induced or "emotional eating" contributes to increased caloric intake and weight gain, yet models examining psychosocial factors that promote and sustain this behavior are incomplete. There is a need to identify explicit, clinically-relevant mechanisms of emotional eating behavior. Pain is a common stressor associated with increased weight and, potentially, altered eating behaviors. The present study applies the Fear Avoidance Model (FAM) of pain to examine processes that may explain the relationship between pain and increased weight while also providing the opportunity to examine specific mechanisms that may encourage eating during a variety of stressors. Our aim is to better understand the impact of pain on eating behavior and the potential for the FAM to improve our understanding of the psychological mechanisms that promote eating during times of duress. A survey of 312 adults explored the link between pain experience and stress-induced eating, further examining the mediating effects of the psychological aspects of the FAM (e.g., anxiety sensitivity, catastrophizing, and pain-related fear). 24% of respondents reported persistent pain, and had significantly higher BMIs than their pain-free peers. All three FAM components were positively correlated with measures of emotional, external, and restrained eating. Anxiety sensitivity and catastrophizing significantly mediated the relationship between persistent pain and emotional eating behavior, while anxiety sensitivity alone mediated the relationship between persistent pain and external eating. Findings suggest pain may be associated with increased likelihood for emotional eating and that characteristics from FAM, in particular anxiety sensitivity and catastrophizing, may mediate the relationship between the presence of persistent pain and emotional eating behavior. Evidence-based treatments targeting anxiety sensitivity and catastrophizing could be useful to address emotional eating in individuals struggling with both weight and chronic pain.

Patient's experience with comorbidity management in primary care: a qualitative study of comorbid pain and obesity.

AIM: The aim of this research is to examine perceptions of those with comorbid chronic pain and obesity regarding their experience of comorbidity management in primary care settings. BACKGROUND: Chronic pain and obesity are common comorbidities frequently managed in primary care settings. Evidence suggests individuals with this comorbidity may be at risk for suboptimal clinical interactions; however, treatment experiences and preferences of those with comorbid chronic pain and obesity have received little attention. METHODS: Semi-structured interviews conducted with 30 primary care patients with mean body mass index=36.8 and comorbid persistent pain. The constant comparative method was used to analyze data. FINDINGS: Participants discussed frustration with a perceived lack of information tailored to their needs and a desire for a personalized treatment experience. Participants found available medical approaches unsatisfying and sought a more holistic approach to management. Discussions also focused around the need for providers to initiate efforts at education and motivation enhancement and to show concern for and understanding of the unique difficulties associated with comorbidity. Findings suggest providers should engage in integrated communication regarding weight and pain, targeting this multimorbidity using methods aligned with priorities discussed by patients.