Flipping the Pain Care Model: A Sociopsychobiological Approach to High-Value Chronic Pain Care.

OBJECTIVE: Much of the pain care in the United States is costly and associated with limited benefits and significant harms, representing a crisis of value. We explore the current factors that lead to low-value pain care within the United States and provide an alternate model for pain care, as well as an implementation example for this model that is expected to produce high-value pain care. METHODS: From the perspective of aiming for high-value care (defined as care that maximizes clinical benefit while minimizing harm and cost), we describe the current evidence practice gap (EPG) for pain care in the United States, which has developed as current clinical care diverges from existing evidence. A discussion of the biomedical, biopsychosocial, and sociopsychobiological (SPB) models of pain care is used to elucidate the origins of the current EPG and the unconscious factors that perpetuate pain care systems despite poor results. RESULTS: An interprofessional pain team within the Veterans Health Administration is described as an example of a pain care system that has been designed to deliver high-value pain care and close the EPG by implementing the SPB model. CONCLUSIONS: Adopting and implementing a sociopsychobiological model may be an effective approach to address the current evidence practice gap and deliver high-value pain care in the United States. The Phoenix VA Health Care System's Chronic Pain Wellness Center may serve as a template for providing high-value, evidence-based pain care for patients with high-impact chronic pain who also have medical, mental health, and opioid use disorder comorbidities.

Mindfulness-based training for women veterans with chronic pain: A retrospective study.

The majority of women veterans experience chronic pain and many have comorbid posttraumatic stress disorder (PTSD). To enhance resilience in these veterans in terms of both physical functioning and psychosocial well-being, a mindfulness-based, trauma-informed, eight-session group pilot program was designed to target emotion regulation and social belonging. Women who engaged in treatment were asked to complete questionnaires assessing pain, functioning, and affective and social well-being before and after the program. The present retrospective research study evaluated (a) whether women who engaged in treatment showed pre-to-post treatment improvement in psychosocial and physical functioning and (b) whether women referred to the program who engaged versus did not engage in treatment differed in demographic and clinical data (i.e., pain diagnoses, mental health diagnoses, documented trauma history) obtained from medical record review. The sample consisted of 36 women who began the program and filled out a pregroup questionnaire (intent-to-treat sample; ITT) and 105 women who were referred but did not engage in treatment. The majority had a documented history of trauma, a mood disorder, and a PTSD diagnosis. ITT analyses indicated that veterans showed moderate-to-large pre-post improvements in pain severity, pain catastrophizing, physical functioning, depression, self-compassion, and positive affect. Veterans who engaged in treatment were similar to those who did not in demographics, number of pain diagnoses, and mental health diagnoses, but were more likely to have a documented history of trauma. Despite the limitations of this study, the findings are encouraging and point to the value of a future randomized controlled trial. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Community gardening: a parsimonious path to individual, community, and environmental resilience.

The goal of this paper is to introduce community gardening as a promising method of furthering well-being and resilience on multiple levels: individual, social group, and natural environment. We examine empirical evidence for the benefits of gardening, and we advocate the development and testing of social ecological models of community resilience through examination of the impact of community gardens, especially in urban areas. The definition of community is extended beyond human social ties to include connections with other species and the earth itself, what Berry (1988) has called an Earth community. We discuss the potential contribution of an extensive network of community gardens to easing the global climate change crisis and address the role of community psychologists in community gardening research and policy-oriented action.

Massage therapy for patients undergoing cardiac catheterization.

CONTEXT: Anxiety and its pharmacological treatment can interfere with cardiac catheterization. Massage therapy has been used primarily in nonmedical settings for relaxation and stress reduction, and some research demonstrates its efficacy in medical environments. OBJECTIVE: First, to determine whether massage could be administered under "normal" conditions in an interventional cardiology center. Second, to evaluate the efficacy of massage in reducing anxiety before, during, and after a cardiac catheterization procedure. DESIGN: A prospective, randomized, controlled, single-masked, pilot study. SETTING: An interventional cardiology center at an urban hospital in New York, NY PATIENTS: Seventy-eight patients (59 men, 19 women), with a mean age of 60.1 years who were scheduled for an elective, diagnostic catheterization based on routine clinical practices. INTERVENTION: Treatment subjects received a standardized, 10-minute massage. Control subjects spent 10 minutes of quiet time with a massage therapist. MAIN OUTCOME MEASURES: We evaluated the feasibility of incorporating massage into the time period between the patient's arrival at the hospital and catheterization, patient interest in receiving massage, and staff support of this complementary therapy. We further evaluated self-ratings of anxiety and pain or discomfort on visual analog scales, vital signs, cortisol levels, and analgesic or anxiolytic intake. RESULTS: A 10-minute massage was feasibly incorporated before catheterization. Seventy percent of the patients consented to participate, and staff supported the intervention. Mean anxiety scores on a 166 mm visual analog scale dropped by 16.2 mm (SD, 24.6) in the massaged group and by 6.8 mm (SD, 17.3) in the control group (P = .081). No statistically significant results were found in pain or discomfort visual analog scale scores (P =.491), blood pressure (P = .827), heart rate (P = .935), respiration rate (P=.916), or analgesic and anxiolytic usage (P > or = .252). Cortisol levels are discussed as exploratory, data. CONCLUSIONS: The results of the study suggest that a 10-minute massage before an invasive cardiac procedure is insufficient to decrease stress measurably.