Faculty Opinions recommendation of A neural circuit for comorbid depressive symptoms in chronic pain.

Abstract Background Chronic pain in Veterans is a major problem compounded by comorbid posttraumatic stress disorder (PTSD) and depression. Adopting a transdiagnostic framework to understanding “shared territory” among these diagnoses has the potential to inform our understanding of the underlying cognitive processes and mechanisms that transverse diagnostic boundaries. Purpose To examine the associations between pain-related cognitive processes (diversion, distancing, absorption, and openness), pain intensity, PTSD and depressive symptoms, and the extent to which Veterans with chronic pain with and without comorbid PTSD and depression engage in different/similar pain-related cognitive processes. Methods Secondary analysis of pretreatment data with a subsample (n = 147) of Veterans with chronic pain from a larger clinical trial. Pretreatment PCL-5 and PROMIS Depression scales were used to categorize participants into three groups: (a) Pain-only; (b) Pain-PTSD; and (c) Pain-PTSD-DEP. Results Compared to the Pain-only group, the Pain-PTSD and Pain-PTSD-DEP groups reported significantly greater pain intensity, PTSD and depressive symptoms, and ruminative pain absorption. The Pain-PTSD-DEP group had significantly lower pain diversion and pain openness scores. When diversion and openness were used within the Pain-PTSD-DEP group, however, they were both associated with lower pain intensity and openness was additionally associated with lower PTSD scores. However, in the Pain-PTSD group, pain openness was associated with higher depression scores. Conclusions Across increasing complexity of comorbidity profiles (i.e., one vs. two comorbid conditions), ruminative absorption with pain emerged as a cognitive process that transverses diagnoses and contributes to worse outcomes. Nonjudgmental acceptance may not be universally beneficial, potentially depending upon the nature of comorbidity profiles.

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School Functioning in Adolescents With Chronic Pain: The Role of Depressive Symptoms in School Impairment

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsn143 ◽

2009 ◽

Vol 34 (8) ◽

pp. 882-892 ◽

Cited By ~ 48

Author(s):

D. E. Logan ◽

L. E. Simons ◽

K. J. Kaczynski

Keyword(s):

Chronic Pain ◽

Depressive Symptoms ◽

School Functioning

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Effect of Psychological Inflexibility on Depressive Symptoms and Sleep Disturbance among Japanese Young Women with Chronic Pain

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17207426 ◽

2020 ◽

Vol 17 (20) ◽

pp. 7426

Author(s):

Tsukasa Kato

Keyword(s):

Chronic Pain ◽

Depressive Symptoms ◽

Sleep Disturbance ◽

Sleep Disturbances ◽

Female College Students ◽

Psychological Inflexibility ◽

Management Interventions ◽

Pain Status ◽

Acceptance And Commitment ◽

Acceptance And Action Questionnaire

Background: Psychological inflexibility based on an acceptance and commitment therapy model is theoretically well-established as a process to exacerbate psychological distress, such as depressive symptoms and sleep disturbance. This study aimed to examine the associations of psychological inflexibility with depressive symptoms and sleep distribution. We hypothesized that psychological inflexibility would be associated with higher levels of depressive symptoms and sleep disturbance in women with chronic pain. Methods: Female college students in Japan answered a questionnaire on pain status, treatment, and psychological inflexibility as measured by the Acceptance and Action Questionnaire-Ⅱ before answering questionnaires on depressive symptoms and sleep disturbance eight months after. Results: Women with chronic pain (n = 320) reported more severe depressive symptoms and sleep disturbances compared to women without chronic pain (n = 90). Hierarchical multiple regressions revealed that psychological inflexibility predicted higher levels of depressive symptoms and sleep disturbance, independent of the pain intensity, whether they consulted a doctor or used pain medication. Conclusion: Based on our findings self-management interventions aimed at reducing psychological inflexibility should be developed for individuals who are experiencing chronic pain.

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Transition to chronic pain in men with low back pain: Predictive relationships among pain intensity, disability, and depressive symptoms.

Health Psychology ◽

10.1037/0278-6133.17.5.421 ◽

1998 ◽

Vol 17 (5) ◽

pp. 421-427 ◽

Cited By ~ 52

Author(s):

JoAnne E. Epping-Jordan ◽

Dennis R. Wahlgren ◽

Rebecca A. Williams ◽

Sheri D. Pruitt ◽

Mark A. Slater ◽

...

Keyword(s):

Chronic Pain ◽

Low Back Pain ◽

Back Pain ◽

Depressive Symptoms ◽

Pain Intensity ◽

Low Back ◽

Predictive Relationships

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Depressive symptoms and pain evaluations among persons with chronic pain: Catastrophizing, but not pain acceptance, shows significant effects

Pain ◽

10.1016/j.pain.2009.08.030 ◽

2009 ◽

Vol 147 (1) ◽

pp. 147-152 ◽

Cited By ~ 36

Author(s):

Elizabeth J. Richardson ◽

Timothy J. Ness ◽

Daniel M. Doleys ◽

James H. Baños ◽

Leanne Cianfrini ◽

...

Keyword(s):

Chronic Pain ◽

Depressive Symptoms ◽

Pain Catastrophizing ◽

Pain Acceptance

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Association between Chronic Pain and Alterations in the Mesolimbic Dopaminergic System

Brain Sciences ◽

10.3390/brainsci10100701 ◽

2020 ◽

Vol 10 (10) ◽

pp. 701

Author(s):

Seoyon Yang ◽

Mathieu Boudier-Revéret ◽

Yoo Jin Choo ◽

Min Cheol Chang

Keyword(s):

Chronic Pain ◽

Dopaminergic System ◽

Neural Circuit ◽

Chronic Back Pain ◽

Radicular Pain ◽

Anterior Cingulate ◽

Mesolimbic System ◽

Dopaminergic Drugs ◽

Underlying Mechanisms ◽

Control Pain

Chronic pain (pain lasting for >3 months) decreases patient quality of life and even occupational abilities. It can be controlled by treatment, but often persists even after management. To properly control pain, its underlying mechanisms must be determined. This review outlines the role of the mesolimbic dopaminergic system in chronic pain. The mesolimbic system, a neural circuit, delivers dopamine from the ventral tegmental area to neural structures such as the nucleus accumbens, prefrontal cortex, anterior cingulate cortex, and amygdala. It controls executive, affective, and motivational functions. Chronic pain patients suffer from low dopamine production and delivery in this system. The volumes of structures constituting the mesolimbic system are known to be decreased in such patients. Studies on administration of dopaminergic drugs to control chronic pain, with a focus on increasing low dopamine levels in the mesolimbic system, show that it is effective in patients with Parkinson’s disease, restless legs syndrome, fibromyalgia, dry mouth syndrome, lumbar radicular pain, and chronic back pain. However, very few studies have confirmed these effects, and dopaminergic drugs are not commonly used to treat the various diseases causing chronic pain. Thus, further studies are required to determine the effectiveness of such treatment for chronic pain.

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The Role of Anxiety Sensitivity in the Relation Between Pain Intensity with Substance Use and Anxiety and Depressive Symptoms Among Smokers with Chronic Pain

International Journal of Behavioral Medicine ◽

10.1007/s12529-020-09914-4 ◽

2020 ◽

Vol 27 (6) ◽

pp. 668-676

Author(s):

Michael J. Zvolensky ◽

Andrew H. Rogers ◽

Lorra Garey ◽

Joseph W. Ditre ◽

Justin M. Shepherd ◽

...

Keyword(s):

Chronic Pain ◽

Substance Use ◽

Depressive Symptoms ◽

Pain Intensity ◽

Anxiety Sensitivity

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Dialectical Pain Management: Feasibility of a Hybrid Third-Wave Cognitive Behavioral Therapy Approach for Adults Receiving Opioids for Chronic Pain

Pain Medicine ◽

10.1093/pm/pnaa361 ◽

2020 ◽

Author(s):

Deborah Barrett ◽

Carrie E Brintz ◽

Amanda M Zaski ◽

Mark J Edlund

Keyword(s):

Chronic Pain ◽

Depressive Symptoms ◽

Pain Management ◽

Dialectical Behavior Therapy ◽

Emotion Dysregulation ◽

Qualitative Interviews ◽

Self Report ◽

Control Group ◽

Global Rating ◽

Pain Acceptance

Abstract Objectives This study evaluated the feasibility, acceptability, and potential effectiveness of a hybrid skills-based group intervention, dialectical pain management (DPM), for adults with chronic pain who are receiving long-term opioid therapy. DPM adapts dialectical behavior therapy, a rigorous psychotherapeutic approach to emotion dysregulation, to treat disorders of physiological dysregulation. Methods Individuals with chronic pain (N = 17) participated in one of two 8-week DPM intervention cohorts. At pre-test and post-test, participants completed quantitative self-report assessments measuring pain intensity and interference, depressive symptoms, pain acceptance, beliefs about pain medications, and global rating of change. Within 2 weeks after the intervention, participants completed qualitative interviews to assess participant satisfaction and obtain feedback about specific intervention components. Results Of the 17 enrolled, 15 participants completed the group with 12 (70%) attending six or more sessions. Participants reported high satisfaction with the intervention. Preliminary findings suggested a significant increase in pain acceptance and a significant reduction in depressive symptoms. Participants also reported an improved relationship with their pain conditions and increased flexibility in responding to pain and applying coping skills. Several participants showed a reduction in opioid dosage over the course of the intervention. Discussion Findings support that DPM is a feasible and well-received intervention for individuals with chronic pain. Additional research with a control group is needed to further determine the intervention’s efficacy and impact.

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