Risk-Targeted Behavioral Activation for the Management of Work-Disability Associated with Co-Morbid Pain and Depression: A Feasibility Study

Purpose The purpose of the present study was to conduct a preliminary evaluation the feasibility and impact of a risk-targeted behavioral activation intervention for work-disabled individuals with co-morbid pain and depression. Methods The design of the study was a single arm non-randomized trial. The sample consisted of 66 work-disabled individuals with co-morbid pain and depression. The treatment program consisted of a 10-week standardized behavioral activation intervention supplemented by techniques to target two psychosocial risk-factors for delayed recovery, namely, catastrophic thinking and perceptions of injustice. Measures of pain severity, depression, catastrophic thinking, perceived injustice and self-reported disability were completed pre-, mid-, and post-treatment. Satisfaction with treatment was assessed at post-treatment. Return to work was assessed at 6-month follow-up. Results The drop-out rate was 18%. At treatment termination, 91% of participants indicated that they were ‘very’ or ‘completely’ satisfied with their involvement in the treatment program. Significant reductions in pain (d = .71), depression (d = .86), catastrophic thinking (d = 1.1) and perceived injustice (d = 1.0) were observed through the course of treatment. In multivariate analyses, treatment-related reductions in depression, catastrophic thinking, perceived injustice, but not pain, contributed significant unique variance to the prediction of return-to-work outcomes. Conclusions Risk-targeted behavioral activation was found to be an acceptable and effective intervention for work-disabled individuals with co-morbid pain and depression. The findings suggest that interventions targeting psychosocial risk factors for pain and depression might contribute to more positive recovery outcomes in work-disabled individuals with co-morbid pain and depression.

Changing Pain Management Strategy from Opioid-Centric towards Improve Postoperative Cognitive Dysfunction with Dexmedetomidine

Objective: This study was aimed to investigate the effectiveness of dexmedetomidine (DEX) on improving the level of pain and disability to find out the possible correlation between psychological factors with pain management satisfaction and physical function in patients with femoral neck fractures. Methods: One hundred twenty-four adult patients with stable femoral neck fractures (type I and II, Garden classification) who underwent internal fixation, were prospectively enrolled including 62 patients in the DEX group and 62 patients in the control group. The magnitude of disability using Harris Hip Score, Postoperative Cognitive Dysfunction (POCD) using Mini-Mental State Examination (MMSE score), Quality of Recovery (QoR-40), pain-related anxiety (PASS-20), pain management and pain catastrophizing scale (PCS) were recorded on the first and second day after surgery. Results: The DEX group on the first and second days after surgery exhibited higher quality of recovery scores, greater satisfaction with pain management, low disability scores, less catastrophic thinking, lower pain anxiety, greater mini mental state examination scores and less opioid intake and the differences were statistically significant compared with the control group (P<0.001). Emergence agitation and incidence of POCD were significantly less in the DEX group (P<0.001). Decreased disability was associated with less catastrophic thinking and lower pain anxiety, but not associated with more opioid intake (P<0.001). Higher QoR-40 scores had a negative correlation with more catastrophic thinking and more opioid intake (P<0.001). Greater satisfaction with pain management was correlated with less catastrophic thinking and less opioid intake (P<0.001). Conclusion: Using DEX as an adjunct to anesthesia could significantly improve postoperative cognitive dysfunction and the quality of recovery and these improvements were accompanied by decrease in pain, emergence agitation, and opioid consumption by DEX administration. Since pain relief and decreased disability were not associated with prescribing greater amounts of opioid intake in the patients, improving psychological factors, including reducing catastrophic thinking or self-efficacy about pain, could be a more effective strategy to reduce pain and disability, meanwhile reducing opioid prescription in the patients. Our findings showed that DEX administration is safe sedation with anti-inflammatory, analgesic and antiemetic effects and it could help change pain management strategy from opioid-centric towards improved postoperative cognitive dysfunction.

Weather-Related Pain or Meteoropathy has been Attracting Attention

Recent topic concerning weather-related pain or meteoropathy is described. Such symptoms are observed in patients with rheumatoid arthritis (RA), fibromyalgia, osteoarthritis, or headache, neck pain, stiff shoulder, back pain. Patients often feel pain when atmospheric pressure showed lower pressure of 1003-1007 hPa or decrease of 6-10 hPa. From psychosomatic point of view, decreased self-efficacy or higher catastrophic thinking are involved. Several questionnaires are useful for the evaluation, such as Pain Disability Assessment Scale (PDAS), Hospital Anxiety and Depression Scale (HADS), Pain Self–Efficacy Questionnaire (PSEQ), and Pain Catastrophizing Scale (PCS). For treatment, exercise–induced hypoalgesia (EIH) would be effective.

A Scoping Review of the Evidence regarding Assessment and Management of Psychological Features of Shoulder Pain

Background and Aim. Shoulder pain is second only to low back pain among costs associated with the care of musculoskeletal disorders. Psychological factors, social factors, and mental health can contribute to shoulder pain and resulting functional disability. The purpose of this scoping review was to identify the nature of the research that has integrated psychological assessment and treatment in the management of shoulder pain. Methods. A scoping review of research studies identified through PubMed, EMBASE, and CINAHL and graduate theses identified using Google Scholar was conducted to determine studies and systematic reviews that addressed the management of psychological aspects of shoulder pain with or without neck pain. The search terms included psychological factors, anxiety, depression, catastrophic thinking, fear of movement, and psychological treatments. Two investigators screened study titles and abstracts. Data extraction, content analysis, and thematic coding focused on the dimensions of pain addressed (emotional, behavioural, and cognitive) and treatment approaches used (dimensions targeted, specific treatment parameters) and the linkage between treatment targets/rationale with interventions/outcomes measured. Results. Ten studies (seven randomized trials and three cohorts) were identified that addressed the psychological aspects of shoulder pain. Out of seven RCTs, four compared psychological interventions with usual care. Eight studies used cognitive approaches, including emotional freedom techniques (EFT), pain coping strategies (PCS), physical-cognitive-mindfulness training (PCMT), psychological flexibility, face-to-face cognitive-behavioural treatment (CBT), and cognitive therapy using virtual reality (V.R.). Three studies used the behavioural approaches as their intervention, including behavioural therapy and Graded Exercise Therapy (GET). Pain intensity was addressed as the primary outcome in two studies and as a secondary outcome in five studies. Cognitive factors were evaluated in 50% of the articles using nine different measures. Emotional factors were evaluated in 80% of articles using ten different measures. Reduction of pain intensity and catastrophic thinking concerning pain was achieved in most studies using a biopsychosocial approach (70%). Applying a behavioural approach was associated with reductions in kinesiophobia and pain catastrophizing. Cognitive approaches had a positive association with reductions in the emotional aspect of pain. Only one study specifically linked rationale or specific physical and psychosocial treatment targets with the treatments provided and outcomes measured. Conclusions. Small pools of studies indicate that the rationale and treatment targeting are poorly defined in biopsychosocial interventions for shoulder pain. However, these benefits have been demonstrated when cognitive or behavioural components are added to the standard physical treatment of shoulder pain. A better definition of treatment targets, description of intervention components, and linkage of outcomes to targets are needed to advance our understanding of optimizing bio-psychosocial approaches.

Altered Hippocampal Functional Connectivity Is Closely Related to Pain and Catastrophic Thinking Habits in Patients With Postherpetic Neuralgia

Postherpetic neuralgia (PHN) is a chronic pain condition after a cure of herpes zoster. Patients with PHN often suffer from physical pain and psychological distress. We investigated the relationship between functional alternations in the brains of patients with PHN and their clinical manifestations using resting-state fMRI. We acquired resting-state fMRI data from 17 patients with PHN and matched healthy controls. We performed seed-based functional connectivity (FC) analysis and statistical comparisons in FC. We also performed correlation analysis between FC strengths and clinical scores about pain intensity, anxiety, depression and pain catastrophizing. In FC analysis, brain regions in the salience, default mode, sensorimotor and reward network were set as seeds. FC between the medial prefrontal cortex (mPFC) and hippocampus increased in PHN group. In contrast, FC between the hippocampus and primary somatosensory cortex (SI) decreased in PHN group. Furthermore, the SI-hippocampus FC was negatively correlated with pain intensity and the mPFC-hippocampus FC was positively correlated with pain catastrophizing tendency. Our findings indicate that the hippocampus is related to pain perception and catastrophic thinking habits in patients with PHN. Functional alteration of the hippocampus may have a major role in the development and maintenance of chronic pain condition in patients with PHN.

Psychological Features in the Inflammatory Bowel Disease–Irritable Bowel Syndrome Overlap: Developing a Preliminary Understanding of Cognitive and Behavioral Factors

Background Inflammatory bowel disease (IBD) patients in clinical remission may experience ongoing symptoms, such as diarrhea and abdominal pain, attributed to IBD–irritable bowel syndrome (IBS) overlap. This study aims to characterize the psychosocial needs of patients with IBD–IBS overlap, particularly in regard to cognitive and behavioral functioning. Methods Adults with an established IBD diagnosis were recruited from a gastroenterology clinic. Participants completed self-report questionnaires about psychological functioning and quality of life. The Rome IV Diagnostic Questionnaire for Adults-IBS Module assessed IBS criteria. The treating gastroenterologist completed a clinician rating of IBD activity to determine clinical disease activity. Biomarkers of inflammation collected in routine care within 90 days of the research encounter were obtained via medical record review to further contextualize IBD activity status. Participants were separated into the following groups: “inactive IBD” (IBD activity rating indicating inactive disease and no IBS criteria met), “active IBD” (IBD activity rating indicating mild, moderate, or severe regardless of IBS criteria), or “IBD–IBS overlap” (IBD activity rating indicating inactive disease and IBS criteria met). Results One hundred and seventeen participants were recruited. Those with IBD–IBS overlap reported no significant differences in ratings of anxiety, depression, somatization, catastrophic thinking patterns, and behavioral avoidance, to patients with active IBD whereas participants with inactive IBD reported significantly lower ratings on these factors. However, a significant portion of participants with IBD–IBS overlap who were rated as inactive on IBD activity measures had laboratory or endoscopic findings indicating mild inflammation within 90 days of the research encounter. Conclusions The study findings provide preliminary evidence that suggests patients with IBD–IBS overlap display similar rates of psychological distress, catastrophic thinking, and avoidance behaviors as those with active IBD. Those with mild ongoing inflammation despite meeting a definition for clinical remission may have similar psychological needs compared to those with moderate-to-severely active IBD. Incorporating a mental health provider with training in psychogastroenterology can help a patient with IBD learn how to effectively with these cognitive and behavioral patterns.

Parental Catastrophizing and Goal Pursuit in the Context of Child Chronic Pain: A Daily Diary Study

Background: Despite daily variability in children's chronic pain experiences, little is known about how parents' emotions and goals toward their child's pain are influenced by these daily changes. This diary study examined how daily child pain intensity (as perceived by parents) moderates the associations between parental catastrophic thoughts about child pain on the one hand, and daily parental distress and parents' goals with regard to their child's pain (pain control vs. activity engagement) on the other hand.Method: Participants were 25 parents of 20 different children (N = 18; 90% girls). Children, aged 8–14 years (M = 9.5, SD = 2.09), experienced either chronic headache or functional abdominal pain with an average pain duration of 22.5 months (SD = 24.5 months). Daily parental responses (i.e., perceived child pain intensity, distress and goal endorsement) were collected through a 3-week daily diary (resulting in 413 valid diary reports). Parents completed the Pain Catastrophizing Scale for Parents prior to starting the diary (PCS-P general) and a daily measure (PCS-P daily) included in the diary. To account for the interdependence of the data, the data were analyzed using multilevel modeling.Results: Perceived daily child pain intensity moderated the impact of parental general and daily catastrophic thoughts on parents' daily distress. Only for parents experiencing low general catastrophic thoughts an increase in distress was observed on days when they perceived their child's pain intensity as high. For all parents, high levels of perceived child pain intensity were related to more distress on days where parents reported high levels of catastrophic thinking (i.e., PCS-P daily). Perceived daily child pain intensity also moderated the impact of parental general catastrophic thinking on parents' daily endorsement of goals. Parents with high levels of general catastrophic thinking reported a lower focus on child pain control on days when child pain intensity was perceived to be low. Parents with low general catastrophic thinking reported lower endorsement of the activity engagement goal on days where the child's pain intensity was perceived to be low.Conclusion: These findings highlight the complexity of daily fluctuations in parental distress and goals regarding their child's pain. Clinical implications and future directions are critically assessed.