A Comparison of Pain Beliefs and Coping Strategies and Their Association with Chronic Pain Adjustment Between Singapore and United States.

OBJECTIVES: Research examining the importance of pain beliefs and coping strategies to chronic pain adjustment has been performed almost exclusively using Western populations. The purpose of this study was to examine empirically the generalizability of this research to Singapore. METHODS: Employing a cross-sectional design, measures assessing pain beliefs, coping strategies, pain intensity, pain interference, and depressive symptoms were administered to 101 patients with chronic pain from Singapore. Analyses examined the means of belief and coping strategies measures and their associations with measures of pain intensity, pain interference, and depressive symptoms and compared the results with the data of a sample of 100 patients with chronic pain from a previously published study from the United States. RESULTS: Mean differences between the Singapore and US samples were found for four of the seven belief scales, and four of the eight coping scales. When significant, associations between belief and coping strategies with measures of pain and dysfunction were in the hypothesized directions in both samples. We also found that the strength of four out of 30 of the associations between beliefs/coping strategies and measures of pain and dysfunction were different between the Singapore and US samples. CONCLUSION: The findings provide further support for the potential influence of culture on how individuals view and cope with pain. However, the many similarities found in direction and strength of the associations between beliefs/coping strategies and measures of pain/dysfunction provide preliminary support for the appropriateness of the use of cognitive behavioral therapy developed in the United States with the Singapore population.

Unmarried patients with early cognitive impairment are more likely than their married counterparts to complete advance care plans.

BACKGROUND: Patients with early cognitive impairment (ECI) face the prospect of progressive cognitive decline that impairs their ability to make decisions on financial and personal matters. Advance care planning (ACP) is a process that facilitates decision making on future care and often includes identifying a proxy decision maker. This prospective study explores factors related to completion or non-completion of ACP in patients with ECI. METHODS: Patients with ECI (n = 158, M age = 76.2 ± 7.25 years) at a memory clinic received psycho-education and counseling on the importance of ACP and followed-up longitudinally for up to 12 months to ascertain if ACP had been completed. Univariate and logistic regression were used to analyze factors related to completion and non-completion of ACP. RESULTS: Seventy-seven patients (48.7%) were initially willing to consider ACP after the counseling and psycho-educational session but only 17 (11.0%) eventually completed ACP. On logistic regression, patients who were single were 8.9 times more likely to complete ACP than those who were married (p = 0.007). Among those initially willing to consider ACP, factors impeding completion of ACP included patient (48.0%), process (31.0%), and family factors (21.0%). CONCLUSIONS: As unmarried patients may not have immediate family members to depend on to make decisions, they may perceive ACP to be more important and relevant. Understanding the barriers to ACP completion can facilitate targeted interventions to improve the uptake of ACP.

Profile differences between overdose and non-overdose suicide attempts in a multi-ethnic Asian society.

BACKGROUND: This study explores differences in characteristics of overdose (OD) and non-overdose (NOD) suicide attempts in Singapore. METHODS: Four hundred eighty-five medical records of people who attempted suicide were extracted from a local general hospital patient database and classified into OD and NOD groups. Differences in socio-demographic factors, suicide characteristics and hospital admission types between both groups were examined. RESULTS: Indians were more likely than the Chinese and Malays to employ OD method in their attempts. More suicide attempts in the OD group than NOD group were self-reported. The most likely place for suicide attempts for both groups was at home, though more NOD suicide attempts were in public areas as compared to the OD group. Analgesics were the most used substance in the OD group. Those who attempted suicide using OD had a higher number of psychiatric ward admissions than the NOD group. Risk and protective factors varied between both groups. CONCLUSION: Differences in socio-demographics, suicide characteristics and admission characteristics between OD and NOD groups were observed. Recommendations for suicide prevention in the community are discussed. Further studies on the mediators and moderators of these trends and characteristics of suicide attempts are necessary to ensure maximal efficacy of prevention and management.

Impact of Facilitation on Cognitive Flow in a Novel Diabetes Management Rehearsal Game for Health Professions Education: Mixed Methods, Open-Label, Superiority Randomized Controlled Trial.

BACKGROUND: Though the prevalence of diabetes is set to increase, most serious game solutions typically target patient self-management and education. Few games target health care professions education, and even fewer consider the factors that may increase their efficacies. The impact of facilitation, a prominent feature of health professions education, is examined in the context of a rehearsal-based diabetes management serious game. OBJECTIVE: In this mixed methods, open-label, superiority randomized controlled trial, we compare student performance, attitudes, and perceptions of a rehearsal-based diabetes management game for health care professionals. METHODS: Student participants were randomized into 2 groups to play a diabetes management game. The control group played the game alone, and the intervention group played the same game alongside a facilitator tasked to moderate overall challenge levels and address queries. Both groups were administered the Flow Short Scale, a 13-item measure rated on a 7-point Likert scale ranging from 1 ("not at all") to 7 ("very much") immediately after the game. Students were then invited to voluntary focus group discussions to elicit their attitudes and perceptions of the game. Findings were subject to between-group comparisons and inductive thematic analysis respectively. RESULTS: A total of 48 (26 control, 22 intervention) clinical-year undergraduates from the Lee Kong Chian School of Medicine in Singapore participated in this study, with 18 continuing to the focus group discussions. Flow Short Scale results indicated the superiority of the intervention group for overall flow (t46=-2.17, P=.04) and the absorption subdomain (t46=-2.6, P=.01). Qualitative results indicated students viewed facilitation as helpful and appropriate, and were able to identify improvable elements of the game's theoretical foundations and overall design. CONCLUSIONS: While serious games are efficacious means of rehearsing previously learned knowledge, facilitation allows for their efficiency to be greatly increased. Such increases are likely crucial in the coming years with the increased digitization of health care professions education and the prevalence of diabetes. TRIAL REGISTRATION: ClinicalTrials.gov NCT05637749; https://www.clinicaltrials.gov/study/NCT05637749.

Improving access to care for women veterans suffering from chronic pain and depression associated with trauma.

OBJECTIVE: Access to care has become a priority for the Veterans Administration (VA) health care system as a significant number of veterans enrolled in the VA health care system reside in rural areas. The feasibility and effects of a novel clinical intervention that combined group therapy and biofeedback training was evaluated on women veterans living in rural areas. METHODS: The study was conducted at selected community-based outpatient clinics (CBOCs) in Texas. Thirty four women veterans with chronic pain and comorbid depression and/or posttraumatic stress disorder (PTSD) were recruited. Five sessions of education/therapy were delivered via telemedicine in combination with daily home practice of a portable biofeedback device (Stress Eraser®, Helicor, New York, NY, USA). Participants responded to self-report questionnaires at baseline, at posttreatment, and at 6-week follow-up. Daily practice logs were also maintained by participants. RESULTS: The clinical protocol was acceptable, easy to administer, and associated with statistically significant decreases in self-reported pain unpleasantness, pain interference, depressive symptoms, PTSD symptoms, and sleep disturbance at posttreatment. Improvements were maintained at 6-week follow-up. Qualitative analyses indicated that many participants 1) wished to continue to meet as a support group in their respective CBOCs and 2) felt less isolated and more empowered to cope with their problems of daily living as a result of the treatment. CONCLUSIONS: It is feasible to provide treatment to women veterans living in rural areas by utilizing video-teleconferencing technology between larger VA medical centers and facilities at CBOCs in more rural settings. A controlled trial of the intervention is warranted.

Executive Function Deficits and Borderline Personality Disorder Symptomatology in a Nonclinical Adult Sample: A Latent Variable Analysis.

While borderline personality disorder (BPD) symptomatology has been studied extensively in clinical populations, the mechanisms underlying its manifestation in nonclinical populations remain largely understudied. One aspect of BPD symptomatology in nonclinical populations that has not been well studied is cognitive mechanisms, especially in relation to executive functions. To explore the cognitive mechanisms underlying BPD symptomatology in nonclinical populations, we analysed a large-scale dataset of 233 young adults that were administered with nine executive function tasks and BPD symptomatology assessments. Our structural equation modelling did not find any significant relations between latent factors of executive functions and the severity of BPD symptomatology. Contrary to our hypothesis, our result suggests that deficits in executive functions were not a risk factor for BPD symptomatology in the nonclinical young adult sample.

Steroids Significantly Decrease Postoperative Postural Hypotension in Total Knee Replacement.

Total knee replacement (TKR) is one of the most common orthopaedic procedures performed, and enhanced recovery after surgery (ERAS) has been developed and incorporated into inpatient surgical pathways to improve patient outcomes. Under ERAS recommendations, multimodal prophylaxis has been used to help manage postoperative nausea and vomiting (PONV) following TKR. Dexamethasone is one of the commonly used for this and the anti-inflammatory properties could depress vagal activity, reducing postural hypotension (PH). The hypothesis of this study is that postoperative dexamethasone use is associated with lower rates of early postoperative PH following TKR surgery. In our institution, patients who undergo elective primary TKR are admitted on the day of surgery and follow a standardized ERAS protocol. Data on patients who underwent elective primary TKR under a single adult reconstruction team from September 2017 to March 2020 were reviewed and analyzed. A review of demographic characteristics, surgical data, postoperative medications, and postoperative notes was performed. Binary logistic regression was used to assess the effect of the use of dexamethasone on PH, with an adjusted odds ratio (OR) calculated after accounting for potential confounders. Of the 149 patients were included in the study, 78 had dexamethasone postoperatively, and 71 did not. Patients who had received dexamethasone were statistically less likely to suffer from PH (OR = 0.31, p = 0.03) and less likely to develop PONV (OR = 0.21, p = 0.006). Patients who had received dexamethasone were more likely able to participate in early physiotherapy (OR = 2.42, p = 0.14), and this result was statistically insignificant. The use of postoperative intravenous dexamethasone is significantly associated with lower rates of postoperative PH after TKR. However, more studies are required to assess the optimal dosing amount and frequency, as well as to assess other factors which can enhance early postoperative patient mobilization as part of our goals for ERAS. This therapeutic study reflects level of evidence III.

Incidence of Radiolucent Lines after Cemented Total Knee Arthroplasty.

Background: Cemented Total Knee Arthroplasty (TKA) provides excellent long-term survival rates and functional results, however, radiolucent lines (RLLs) often appear during early post-operative follow-up and their incidence and clinical significance are unknown. The primary aim was to establish the incidence, location, frequency, and time taken for RLLs to appear within the first year after a primary cemented TKA with an anatomic tibial baseplate (Smith and Nephew, LEGION Total Knee System). Methods: This was a retrospective analysis of 135 primary cemented TKA in 131 patients over three years. We compared demographics, serial radiographs, and early clinical and functional outcomes. Results: There were 65 TKAs (48%) in 62 patients who had RLLs within the first year post-operatively. Most were females (58.8%). Mean age was 68.3 ± 7.9 years. There were 88 RLLs, with the most and second commonest location at the medial tibial baseplate (38%) and anterior femoral flange (23%). 89% were in the bone-cement interface. The largest average length of RLLs were at the anterior flange of the femoral component (1.98 ± 1.33 mm). The average time to development was 6.5 ± 4.1 months. None of these patients had infections nor required revision. Patients with RLLs did not do worse in functional and clinical scoring at 1-year. Conclusion: There was a 48% incidence of physiological RLLs after cemented TKA, with the highest occurrence at the medial tibial baseplate at 38%. These radiolucent lines did not affect early post-operative clinical and functional outcomes of patients.

Innovative dual-function protective scope mask and filtration system for aerosol generating ENT scope procedures.

Background: Aerosol-generating procedures (AGPs), such as nasoendoscopy, are considered high-risk during the COVID-19 pandemic due to risk of virus aerosol transmission. We aim to evaluate the efficacy of an innovative system in reduction of aerosol contamination. Methods: Pilot study involving 15 healthy volunteers performing aerosol-generating activities with the prototype, compared with and without a standard surgical mask. Results: We found an increased frequency of smaller-sized particle emissions for all four expiratory activities. The particle emission rate with the prototype mask was significantly slower over time for the smallest sized particle (0.3 µm) during breathing, speaking and singing compared with similar activities without the mask (p < .05). We found similar trends for coughing for larger particles but that did not reach statistical significance. Conclusion: The innovation offers good protection against aerosol transmission through the physical barrier of the mask, the negative pressure environment within the mask, and the unit's dual filtration function. Level of evidence: Level 2b.

Efficacy of cranial electrotherapy stimulation for neuropathic pain following spinal cord injury: a multi-site randomized controlled trial with a secondary 6-month open-label phase.

BACKGROUND: Chronic pain is a significant problem for many individuals following spinal cord injury (SCI). Unfortunately, SCI-related neuropathic pain has proven to be largely refractory to analgesic medications and other available treatments. Cranial electrotherapy stimulation (CES) has been effective in managing some types of pain. It involves the application of a small amount of current through the head via ear clip electrodes. OBJECTIVE: Explore the effectiveness of CES for neuropathic pain in persons with SCI and chronic pain. STUDY DESIGN: Multi-site, double-blind, sham-controlled study. PARTICIPANTS: Adults with SCI and chronic neuropathic pain at or below the level of injury were randomized to receive active or sham CES. INTERVENTION: Application of active CES or sham CES 1 hour daily for 21 days. Six-month open-label phase to assess 'as-needed' CES use. OUTCOME MEASURES: Change in pre- to post-session pain ratings as well as change in pain intensity, pain interference, pain quality, pain beliefs and coping strategies, general physical and mental health status, depressive symptomatology, perceived stress, and anxiety pre- to post-treatment. RESULTS: The active group reported a significantly greater average decrease in pain during daily treatments than the sham group (Kruskal-Wallis chi-square = 4.70, P < 0.05). During the 21-day trial, there was a significant group × time interaction for only one outcome variable; the active group showed larger pre- to post-treatment decreases in pain interference than the sham group did (F = 8.50, P < 0.01, d = 0.59). CONCLUSIONS: On average, CES appears to have provided a small but statistically significant improvement in pain intensity and pain interference with few troublesome side effects. Individual results varied from no pain relief to a great deal of relief.

Heart rate variability (HRV) and posttraumatic stress disorder (PTSD): a pilot study.

Exposure to combat experiences is associated with increased risk of developing Post Traumatic Stress Disorder. Prolonged exposure therapy and cognitive processing therapy have garnered a significant amount of empirical support for PTSD treatment; however, they are not universally effective with some patients continuing to struggle with residual PTSD symptoms. Heart rate variability (HRV) is a measure of the autonomic nervous system functioning and reflects an individual's ability to adaptively cope with stress. A pilot study was undertaken to determine if veterans with PTSD (as measured by the Clinician-Administered PTSD Scale and the PTSD Checklist) would show significantly different HRV prior to an intervention at baseline compared to controls; specifically, to determine whether the HRV among veterans with PTSD is more depressed than that among veterans without PTSD. The study also aimed at assessing the feasibility, acceptability, and potential efficacy of providing HRV biofeedback as a treatment for PTSD. The findings suggest that implementing an HRV biofeedback as a treatment for PTSD is effective, feasible, and acceptable for veterans. Veterans with combat-related PTSD displayed significantly depressed HRV as compared to subjects without PTSD. When the veterans with PTSD were randomly assigned to receive either HRV biofeedback plus treatment as usual (TAU) or just TAU, the results indicated that HRV biofeedback significantly increased the HRV while reducing symptoms of PTSD. However, the TAU had no significant effect on either HRV or symptom reduction. A larger randomized control trial to validate these findings appears warranted.

Clinical outcomes following long versus short cephalomedullary devices for fixation of extracapsular hip fractures: a systematic review and meta-analysis.

Although both long and short cephalomedullary devices (CMDs) are used in the treatment of extracapsular hip fractures, the advantages of either option are subject to debate. This study aims to evaluate the differences in clinical outcomes with long versus short CMDs for extracapsular hip fractures. Studies included must have included subjects with at least 1 year of follow-up and reported on at least one of the following outcomes: rate of reoperation; rate of peri-implant fracture; operating time; blood loss; complication rate; length of hospital stay; 1-year mortality. Only articles written in the English language were included in this study. A search was conducted across the databases of Medline, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL and Scopus for articles published from the inception of the database to 1 November 2020. Included studies were assessed for their risk of bias using the Risk of Bias Tool (RoB2) and the risk-of-bias in non-randomized studies - of interventions (ROBINS-I) tool. A total of 8460 fractures from 16 studies were included in the analysis, with 3690 fixed with short, and 4770 fixed with long CMDs. A meta-analysis of the results revealed that short CMDs offer peri-operative advantages, while long CMDs could offer longer-term advantages. Limitations of this study include a lack of randomized control trials included in the analysis. In conclusion, when planning for the treatment of extracapsular hip fractures, a patient specific approach may be necessary to make a decision according to the individual risk profile of the patient.

Quantitative Image-Based Cell Viability (QuantICV) Assay for Microfluidic 3D Tissue Culture Applications.

Microfluidic 3D tissue culture systems are attractive for in vitro drug testing applications due to the ability of these platforms to generate 3D tissue models and perform drug testing at a very small scale. However, the minute cell number and liquid volume impose significant technical challenges to perform quantitative cell viability measurements using conventional colorimetric or fluorometric assays, such as MTS or Alamar Blue. Similarly, live-dead staining approaches often utilize metabolic dyes that typically label the cytoplasm of live cells, which makes it difficult to segment and count individual cells in compact 3D tissue cultures. In this paper, we present a quantitative image-based cell viability (QuantICV) assay technique that circumvents current challenges of performing the quantitative cell viability assay in microfluidic 3D tissue cultures. A pair of cell-impermeant nuclear dyes (EthD-1 and DAPI) were used to sequentially label the nuclei of necrotic and total cell populations, respectively. Confocal microscopy and image processing algorithms were employed to visualize and quantify the cell nuclei in the 3D tissue volume. The QuantICV assay was validated and showed good concordance with the conventional bulk MTS assay in static 2D and 3D tumor cell cultures. Finally, the QuantICV assay was employed as an on-chip readout to determine the differential dose responses of parental and metastatic 3D oral squamous cell carcinoma (OSCC) to Gefitinib in a microfluidic 3D culture device. This proposed technique can be useful in microfluidic cell cultures as well as in a situation where conventional cell viability assays are not available.

Associations among pain, PTSD, mTBI, and heart rate variability in veterans of Operation Enduring and Iraqi Freedom: a pilot study.

OBJECTIVE: The objective of the study was to determine if there is dysregulated autonomic nervous system activity as manifested by depressed heart rate variability (HRV) among veterans of Operations Enduring and Iraqi Freedom (OEF/OIF). PARTICIPANTS AND SETTING: The study used a convenience sample of OEF/OIF veterans (n = 28) seen at a Level II Polytrauma Network Site at the Michael E. DeBakey VA Medical Center. Participants were similar to other OEF/OIF veterans who received care at this site. DESIGN: Cross sectional study. MEASURES: Time domain analysis (standard deviation of beat-to-beat intervals [SDNN]) of HRV, diagnoses of mild traumatic brain injury and post-traumatic stress disorder (PTSD), and pain ratings from medical records. RESULTS: As a group, the sample evidenced markedly depressed HRV (as reflected by SDNN) as compared with available age and gender corrected normative data. Pain (71%), PTSD (57%), and mild traumatic brain injury (mTBI) (64%) were prevalent. Thirty-six percent had all three measures (P3). Pain and P3 were significantly and negatively associated with SDNN (r = -0.460, P = 0.014; r = -0.373, P = 0.05, respectively). CONCLUSIONS: These preliminary findings support the high prevalence of depressed HRV and P3 among veterans seen in a level II Polytrauma Center. The findings also suggest a possible synergistic effect of pain, PTSD, and mTBI on depressed HRV. The nature and implications of these relationships require additional research to elucidate.

Symptom severity and quality of life in patients with atrial fibrillation: Psychological function outweighs clinical predictors.

BACKGROUND: The key drivers of symptom severity and health-related quality of life (hr-QOL) in patients with atrial fibrillation (AF) remain unclear. We aimed to determine the relative contribution to symptom severity and hr-QOL of clinical factors including left ventricular (LV) diastolic function and ventricular rate control during AF and of psychological functioning. METHODS: Seventy-eight consecutive patients with symptomatic AF and preserved LV systolic function underwent detailed evaluation of i) AF symptom severity and hr-QOL; ii) clinical factors including left ventricular (LV) diastolic function, AF burden, and ventricular rate during AF and iii) state and trait aspects of psychological functioning. RESULTS: Moderate-to-severe AF-related symptoms were reported by 64% of the study population whilst 36% reported no more than mild symptoms. Worse symptom severity was associated with a higher score on the Perceived Stress Scale (16.7 ±â€¯4.4 vs. 5.4 ±â€¯4.4, p < 0.0001) and higher prevalence of the Type D Personality (20/50 vs. 4/28, p = 0.012). In multivariable models, only a predisposition to subjectively appraise life situations as stressful (higher PSS score) and a personality with a higher degree of negative affectivity and social inhibition (higher TDPS score) were independent predictors of higher AF symptom severity and poorer hr-QOL. No clinical factors including AF burden, ventricular rates during AF or LV diastolic function were significant predictors of AF-specific symptoms or hr-QOL. CONCLUSION: In a tertiary AF population with preserved LV systolic function, only psychological functioning consistently predicts both AF-related symptoms and hr-QOL. LV diastolic function, AF burden, and ventricular rate during AF are not independent predictors.

Study descriptions of healing touch with veterans experiencing chronic neuropathic pain from spinal cord injury.

CONTEXT: Spinal cord injury often results in chronic pain syndromes that conventional pain management is unable to resolve. Healing Touch (HT) is a biofield therapy that involves using the hands to promote healing and mediate the perception of pain by affecting the energy field of the person. The practice of HT is based on the premise that the energy field has the ability to provide valuable information about the person's physical, emotional, mental, and spiritual condition and can influence the dense matter of physical form. OBJECTIVE: This secondary analysis using case study reviews describes two different experiences of receiving a HT session for management of chronic neuropathic pain and its sequelae, utilizing energy field data and reports of participants and their HT practitioners. DESIGN: Qualitative case study approach was used. SETTING: Data were obtained from 42 HT sessions that took place within the homes of seven veterans with spinal cord injury. METHOD: Two cases involving the most common patterns of response were selected from seven cases to represent the participants' and practitioners' experiences. A descriptive qualitative approach informed the results. RESULTS: The findings indicate that a variety of experiences can exist in individuals with chronic pain due to spinal cord injury; experiences will also vary with their healing touch practitioners. There are commonalities in the perception of the practitioners in the damage to the energy field and energy centers, with individualized and consistent resolution of the field over time.

The validity of pain intensity measures: what do the NRS, VAS, VRS, and FPS-R measure?

BACKGROUND AND AIMS: The Numerical Rating Scale (NRS), Visual Analogue Scale (VAS), Verbal Rating Scale (VRS), and Faces Pain Scale-Revised (FPS-R) are valid measures of pain intensity. However, ratings on these measures may be influenced by factors other than pain intensity. The purpose of this study was to evaluate the influence of non-pain intensity factors on the pain intensity scales. METHODS: We administered measures of pain intensity (NRS, VAS, VRS, FPS-R), pain unpleasantness, catastrophizing, depressive symptoms, and pain interference to 101 individuals with chronic lower back or knee pain. Correlation analyses examined the associations among the pain intensity scales, and regression analyses evaluated the contributions of the non-pain intensity factors (depressive symptoms, and pain unpleasantness, catastrophizing, and interference) to the VAS, VRS, and FPS-R ratings, while controlling for NRS, age, and gender. RESULTS: Although the NRS, VAS, VRS, FPR-S, scales were strongly associated with one another, supporting their validity as measures of pain intensity, regression analyses showed that the VRS also reflected pain interference, the FPS-R also reflected pain unpleasantness, and the VAS was not associated with any of the additional non-pain intensity factors when controlling for NRS, age, and gender. CONCLUSIONS: The VAS appears to be most similar to the NRS and less influenced by non-pain intensity factors than the VRS or FPS-R. Although the VRS and FPS-R ratings both reflect pain intensity, they also contain additional information about pain interference and pain unpleasantness, respectively. These findings should be kept in mind when selecting pain measures and interpreting the results of research studies using these scales. IMPLICATIONS: The influence of pain interference and pain unpleasantness on VRS and FPS-R, respectively should be kept in mind when selecting pain measures and interpreting the results of research studies using these scales.

Psychological Distress and Suicidal Ideation in Patients With Atrial Fibrillation: Prevalence and Response to Management Strategy.

Background An association between atrial fibrillation ( AF ), anxiety, and depression is recognized, but the spectrum of psychological distress remains unclear. We aimed to characterize the severity and predictors of distress associated with AF in a tertiary population and its response to AF management. Methods and Results Seventy-eight patients with symptomatic AF underwent evaluation, including of AF symptom severity, health-related quality of life, psychological distress, suicidal ideation, and specific personality traits. Twenty participants underwent AF ablation and 58 were managed medically, with repeat assessments at 4, 8, and 12 months. Severe distress (Hospital Anxiety and Depression Scale score, ≥15/42) was identified in 27 of 78 (35%). Independent predictors were a personality marked by vulnerability to stress (Perceived Stress Scale: R2, 0.54; ß=0.7±0.1; t=7.8; P<0.001) and 1 marked by negativity/social inhibition (Type D Personality Scale: R2, 0.47; ß=0.7±0.1; t=6.7; P<0.001). Suicidal ideation was reported by 16 of 78 (20%) and was predicted by personality traits (Perceived Stress Scale score: R2, 0.35; odds ratio, 1.22±0.06; P<0.001; Type D Personality Scale score: R2, 0.48; odds ratio, 1.43±0.14; P<0.001). Effective AF ablation (median AF burden 1% [0-1%] over 12 months) was associated with significant reductions in distress (Hospital Anxiety and Depression Scale score, 13.9±1.8 to 4.3±1.8; P<0.05) and prevalence of suicidal ideation (30-5%; P=0.02). Conclusions There was a high prevalence of severe psychological distress (35%) and of suicidal ideation (20%) in a tertiary AF population, with personality traits predicting both. Effective AF ablation was associated with significant improvements, suggesting AF itself may be a treatable causative factor of distress.

The buffering role of positive affect on the association between pain intensity and pain related outcomes.

OBJECTIVES: Chronic pain is a significant problem worldwide and is associated with significant elevations in negative affect, depressive symptoms, sleep problems, and physical dysfunction. Positive affect could potentially buffer the impact of pain on patient functioning. If it does, then positive affect could be directly targeted in treatment to benefit individuals with chronic pain. The purpose of this study was to test for such moderating effects. METHODS: This was a cross-sectional study, we administered measures of pain intensity, depressive symptoms, sleep problems, pain interference, and positive and negative affect to 100 individuals with chronic back or knee pain in a single face-to-face assessment session. RESULTS: The associations between pain intensity and negative affect, and between pain intensity and depressive symptoms were moderated by positive affect. This moderation effect was explained by the fact that participants with low positive affect evidenced strong associations between pain intensity and both depression and negative affect; participants with high positive affect, on the other hand, evidenced weak and non-significant associations between pain intensity and both depression and negative affect. Positive affect did not moderate the associations between pain intensity and either sleep problems or pain interference. CONCLUSION: The findings are consistent with the possibility that positive affect may buffer the impact of pain intensity on negative affect and depressive symptoms. Longitudinal and experimental research is needed to determine the potential benefits of treatments that increase positive affect on negative affect and depressive symptoms in chronic pain populations. IMPLICATIONS: The study findings suggest the possibility that "positive psychology" interventions which increase positive affect could benefit individuals with chronic pain by reducing the impact of pain on negative outcomes. Research to test this possibility is warranted.