A Brief Survey of the COVID-19 Pandemic's Impact on the Chronic Pain Experience.

BACKGROUND: The COVID-19 pandemic has forced sweeping social and behavioral changes that have adversely affected the general population. Many changes, such as business closures, working from home, increased psychological distress, and delayed access to health care, could have unique adverse effects on patients diagnosed with chronic pain (CP). The present study sought to examine perceived changes in the CP experience brought about by the COVID-19 pandemic. DESIGN: Participants included 487 self-reported patients with musculoskeletal, neuropathic, or postsurgical pain recruited using CloudResearch. A 53-item survey was created to assess changes in perceived pain, mood, control over pain, physical activity, employment, and medical access since the onset of the pandemic. RESULTS: Results suggested a worsening of the pain experience, particularly for women, with greater pain, negative affect, sedentary functioning, perceived decline in treatment quality, and increased treatment delays. Of note, pandemic-related declines in control over pain, which represents an important clinical target, are associated with other pandemic-related declines and also mediates relevant associations. CONCLUSIONS: For frontline treatment providers, particularly primary care nurses and physicians, these findings may be relevant in order to reduce the likelihood of a worsening of symptoms, loss of self-efficacy regarding management of pain and/or potential maladaptive increase in the use of pain medications.

The Impact of Emotional Regulation Strategies on Pain Catastrophizing in the Context of Interpersonal Relationships.

OBJECTIVES: The Communal Coping Model suggests that pain catastrophizing may serve to elicit support from others. What is not known is how emotional regulation, namely emotional inhibition, impacts pain catastrophizing within the context of an interpersonal relationship. Individuals who have a greater tendency to emotionally inhibit may have a greater likelihood to use catastrophizing as a means for seeking support, particularly in relationships characterized by satisfaction and emotional validation. METHODS: Data were collected from 50 undergraduate couples at the University of Michigan-Dearborn. Participants were videotaped during the completion of an acute pain cold pressor task and completed measures involving pain catastrophizing, emotional inhibition, and relationship dynamics (ie, Ambivalence Over Emotional Expressiveness Questionnaire, White Bear Suppression Inventory, Dyadic Adjustment Scale). In addition, the videotaped interactions were coded for both invalidation/validation and overt expressions of pain catastrophizing. RESULTS: Emotional inhibition, and both validation and invalidation were associated with pain catastrophizing. Observed validation and invalidation were not, however, directly associated with relationship satisfaction. Hierarchical linear regression showed a significant interaction between thought suppression and relationship satisfaction to predict pain catastrophizing. DISCUSSION: Results show relationship satisfaction moderates the association between pain catastrophizing and thought suppression in a manner in which couples with high levels of relationship satisfaction who also engage in thought suppression are more likely to use pain catastrophizing as a cognitive strategy to elicit support. This study offers direction into treatment and suggests that couples based cognitive-behavioral treatments that aim to utilize adaptive cognitive and behavioral coping strategies, as well as emotional exploration and validation, may be beneficial.

Couples' Relationship Satisfaction and Its Association with Depression and Spouse Responses Within the Context of Chronic Pain Adjustment.

BACKGROUND: Chronic pain is one specific health condition where couple relationships have been directly linked to physical and psychological outcomes. Understanding how relationship satisfaction, couple dynamics, and pain adjustment interrelate is crucial for nurses who provide patient-centered care for patients with pain. AIMS: The current study was aimed at examining the associations of depressive symptoms and spouse response styles with relationship satisfaction in the context of West Haven-Yale Multidimensional Pain Inventory classifications. METHODS: Seventy-eight middle-aged outpatients with chronic pain (average pain duration of 8.98 years (SD = 9.51)) were recruited from a pain clinic in southeastern Michigan. Participants completed the Multidimensional Pain Inventory, from which pain adjustment classifications (adaptive, dysfunctional, interpersonally distressed) and spouse response styles were derived, the Dyadic Adjustment Scale to assess relationship satisfaction, and the Mood and Anxiety Symptom Questionnaire to assess depressive symptoms. RESULTS: Interpersonally distressed patients scored lower on relationship satisfaction than those classified as either adaptive or dysfunctional, F(2,66) = 6.38, p < .01. Significant inverse associations were found between punishing spouse response styles and relationship satisfaction for both interpersonally distressed and dysfunctional adjustment classifications: r = -.53, p < .05; r = -.57, p < .01, respectively. CONCLUSIONS: Overall, findings indicate that relationship satisfaction may be an area of concern among interpersonally distressed pain patients and that spouse response style may be a particularly important area of clinical attention.

Pain catastrophizing differs between and within West Haven-Yale Multidimensonal Pain Inventory (MPI) pain adjustment classifications: theoretical and clinical implications from preliminary data.

OBJECTIVES: Pain catastrophizing is associated with multiple pain outcomes, and is differentially associated with the adaptive coping (AC), dysfunctional (DYS), and interpersonally distressed (ID) coping classifications of the West Haven-Yale Multidimensional Pain Inventory (MPI). We examined how catastrophizing, and the underlying components of magnification, rumination, and helplessness, may relate to MPI classifications and differentially relate to pain outcomes across classification groups to inform clinical treatment planning. MATERIALS AND METHODS: Sixty-nine adults (70% women) diagnosed with musculoskeletal pain were recruited from 2 pain clinics and completed self-report measures of pain severity, the MPI, Pain Catastrophizing Scale, and the Mood and Anxiety Symptom Questionnaire. RESULTS: Patients in the DYS and ID groups reported the greatest levels of rumination, helplessness, and overall catastrophizing, as well as the greatest depression, anxiety, and pain interference compared with the AC group. Catastrophizing related to average pain only in the DYS group (P<0.05), however, catastrophizing was associated with depression, anxiety, and interference (Ps<0.05) among those in the AC group, with a similar pattern observed among the ID group. DISCUSSION: Our findings suggest a continued need for targeting catastrophizing and negative affect among pain patients. However, our data suggest that even among relatively well-adjusted patients, there may be clinical utility in assessing catastrophic thinking given the associations of it with pain-related outcomes. The present findings additionally support the value of enlisting multiple theoretical perspectives such as the stress appraisal and attentional models in future research and clinical applications.

Can we improve cognitive-behavioral therapy for chronic back pain treatment engagement and adherence? A controlled trial of tailored versus standard therapy.

OBJECTIVE: This study evaluated whether tailored cognitive-behavioral therapy (TCBT) that incorporated preferences for learning specific cognitive and/or behavioral skills and used motivational enhancement strategies would improve treatment engagement and participation compared with standard CBT (SCBT). We hypothesized that participants receiving TCBT would show a lower dropout rate, attend more sessions, and report more frequent intersession pain coping skill practice than those receiving SCBT. We also hypothesized that indices of engagement and adherence would correlate with pre- to posttreatment changes in outcome factors. METHOD: One hundred twenty-eight of 161 consenting persons with chronic back pain who completed baseline measures were allocated to either TCBT or SCBT using a modified randomization procedure. Participants completed daily ratings of pain coping skill practice and goal accomplishment during treatment, as well as measures of pain severity, disability, and other key outcomes at the end of treatment. RESULTS: No significant differences between treatment groups were noted on measures of treatment engagement or adherence. However, these factors were significantly related to some pre- to posttreatment improvements in outcomes, regardless of treatment condition. CONCLUSIONS: Participants in this study evidenced a high degree of participation and adherence, but treatment tailored to take into account participant preferences, and that employed motivational enhancement strategies, failed to increase treatment participation over and above SCBT for chronic back pain. Evidence that participation and adherence were associated with positive outcomes supports continued clinical and research efforts focusing on these therapeutic processes.

Association between pain catastrophizing, spouse responses to pain, and blood pressure in chronic pain patients: a pathway to potential comorbidity.

BACKGROUND: Chronic pain has been shown to be highly comorbid with other medical conditions. Theoretical and empirical associations between pain and cardiovascular health can be made based on the current literature. Psychosocial variables associated with the pain experience may, however, have an impact on cardiovascular health. PURPOSE: The purpose of this study was to examine how cognitive and interpersonal aspects of chronic pain, including pain catastrophizing (PC) and negative spouse responses (NSR), relate to systolic and diastolic blood pressure (SBP, DBP) as cardiovascular risk factors. METHODS: Data were collected from 57 treatment-seeking patients with chronic musculoskeletal pain. Participants completed the West Haven-Yale Multidimensional Pain Inventory, Pain Catastrophizing Scale, and pain severity ratings based on an analog pain scale. In addition, participants consented to a medical chart review to collect blood pressure and prescribed medication data. Hierarchical linear regressions were used to test associations between PC and NSR, and blood pressure while controlling cardiac medication status. RESULTS: A positive association between PC and both SBP and DBP was found. A positive association was also found for NSR and SBP. These findings suggest that psychosocial aspects of chronic pain may represent a direct risk for elevated blood pressure and, thus, increased risk for cardiovascular health problems. CONCLUSIONS: Psychosocial aspects of pain may constitute a form of chronic stress as described in the cardiovascular reactivity literature. The findings highlight the need for comprehensive multidimensional treatments of pain.

Novel virus, atypical risk group: understanding young adults in college as an under-protected population during H1N1 2009.

OBJECTIVE: To examine illness/vaccination perceptions of and intentions to vaccinate for seasonal influenza (SI) and 2009 H1N1 in the college setting. PARTICIPANTS: 1190 adults [M=23.5 years (SD=9.5)] from a university in the North-Eastern U.S. METHODS: We deployed a web-based survey via campus email just prior to the 2009 H1N1 vaccine release. RESULTS: Younger adults (18-24 years) had lesser understanding of the difference between influenza types, and they reported less regular and current SI vaccination compared to older adults (25-64 years). Younger respondents perceived lesser likelihood of illness from, but attributed greater severity to H1N1 versus SI. Regularity of SI vaccination and perceived vaccine efficacy were the strongest predictors of intent to vaccinate against H1N1, followed by perceived likelihood of illness and confidence in what experts know about vaccine safety. CONCLUSIONS: Young adults in college may require additional information during novel influenza pandemics. Measuring perceptions and past vaccination behaviors may facilitate targeting of preventive efforts in the college setting.

Nonlinear associations between chronic stress and cardiovascular reactivity and recovery.

A mixed literature on the influence of chronic and acute stress on cardiovascular reactivity (CVR) and recovery suggests a need for improved modeling of these associations. We examined these associations using both linear and nonlinear (quadratic) models. Data were collected on 129 healthy adults [59% female, ages 18-29 years]. Participants completed the Perceived Stress Scale (PSS) after engaging in a mental arithmetic and a stress recall task. Heart rate (HR), systolic and diastolic blood pressure (SBP, DBP) were measured during rest, task, and recovery periods. Hierarchical ordinary least squares regression was used to examine the association of chronic stress to CVR and recovery with initial cardiovascular values and body mass index entered first as covariates. Hierarchical linear modeling (HLM) was also used for recovery. For reactivity, a quadratic relationship between PSS scores and DBP was observed in females such that those scoring at moderate levels of stress displayed lesser reactivity than those scoring either low or high. For recovery, a quadratic model was supported for SBP among females, with moderate levels of stress associated with greater recovery relative to either low or high levels. For females the quadratic model was also supported for SBP and DBP when examined using HLM. Quadratic modeling may better represent current theories of how chronic stress influences CVR and recovery. Our findings further suggest that these associations may be differentially evident by gender, perhaps due to gender differences in reported stress levels or gender-related task relevance.

A preliminary investigation of cognitive appraisal and cardiovascular reactivity and recovery in Arab Americans.

BACKGROUND: Arab Americans exhibit higher rates of hypertension and other cardiovascular risk factors relative to national averages. While research suggests some minorities may exhibit increased cardiovascular reactivity (CVR) to, and slowed recovery from, stress compared to Whites, which may represent a risk factor for hypertension and cardiovascular disease, this has not been studied in Arab Americans. This study examined differences between Arab Americans and Whites in cognitive appraisal, and blood pressure and heart rate (HR) reactivity and recovery to laboratory stressors. METHODS: The undergraduate sample included 27 Arab Americans (16 female) and 27 gender matched Whites. Eligible participants completed two stressful laboratory tasks (mental arithmetic [MA] and stress-recall [SR]). Cognitive appraisals were assessed for each task, and physiological data were collected during baseline, each laboratory task, and recovery. Ethnicity differences in baseline cardiovascular values and cognitive appraisals were examined with t-tests, while differences in CVR and recovery were tested with ANCOVA, controlling for initial values. RESULTS: Arab Americans showed lower baseline systolic blood pressure and mean arterial pressure than Whites. Arab Americans also reported greater threat and stress associated with MA, and greater threat for SR. No CVR differences were observed during MA; however during and after SR, Arab Americans evidenced lesser systolic and diastolic blood pressure reactivity and lesser HR recovery compared to Whites. CONCLUSIONS: Overall, Arab Americans showed lesser reactivity than Whites, but also exhibited slower HR recovery. These results may be attributable to physiological habituation to chronic stress associated with minority status.

Behavioral, environmental, metabolic and intergenerational components of early life undernutrition leading to later obesity in developing nations and in minority groups in the U.S.A.

Nutritional transition, urbanization, and physical inactivity are primary factors responsible for the worldwide epidemic of overweight/obesity (OW/OB). However, these factors fail to explain the epidemic of OW/OB in developing countries and in recent-migrants to developed countries. Among these, OW/OB is associated with short/stunted stature and coexists with undernutrition at much higher rates than is statistically expected. Changes in metabolic pathways toward reduced fat oxidation and increased metabolism of carbohydrate may explain, in part, this phenomenon. Also, intergenerational consequences of malnutrition and poor health of the mothers may lead to impaired phenotypes in their offspring. We propose a novel methodology to assess the history of early life malnutrition by assessing the sitting height ratio of the mothers. The degree of "short leggedness" reflects undernutrition when the mother was an infant/child. Collectively, behavioral, environmental, metabolic and intergenerational components of early life undernutrition may provide a more satisfactory explanation for later life obesity.

Meta-analysis of psychological interventions for chronic low back pain.

The purpose of this meta-analysis of randomized controlled trials was to evaluate the efficacy of psychological interventions for adults with noncancerous chronic low back pain (CLBP). The authors updated and expanded upon prior meta-analyses by using broad definitions of CLBP and psychological intervention, a broad data search strategy, and state-of-the-art data analysis techniques. All relevant controlled clinical trials meeting the inclusion criteria were identified primarily through a computer-aided literature search. Two independent reviewers screened abstracts and articles for inclusion criteria and extracted relevant data. Cohen's d effect sizes were calculated by using a random effects model. Outcomes included pain intensity, emotional functioning, physical functioning (pain interference or pain-specific disability, health-related quality of life), participant ratings of global improvement, health care utilization, health care provider visits, pain medications, and employment/disability compensation status. A total of 205 effect sizes from 22 studies were pooled in 34 analyses. Positive effects of psychological interventions, contrasted with various control groups, were noted for pain intensity, pain-related interference, health-related quality of life, and depression. Cognitive-behavioral and self-regulatory treatments were specifically found to be efficacious. Multidisciplinary approaches that included a psychological component, when compared with active control conditions, were also noted to have positive short-term effects on pain interference and positive long-term effects on return to work. The results demonstrated positive effects of psychological interventions for CLBP. The rigor of the methods used, as well as the results that reflect mild to moderate heterogeneity and minimal publication bias, suggest confidence in the conclusions of this review.