The Moderating Role of Depression on Momentary Pain-Affect Associations in Osteoarthritis

Previous research has found a reciprocal relationship between pain and depression, in which each influences the severity of the other (Chou, 2007; Hawker et al., 2011, Kroenke et al., 2011; Schieir et al., 2009). Studies have found that depressed individuals exhibit stronger pain-mood associations than never-depressed individuals (Conner et al., 2006; Tennen et al., 2006). The current study investigated main and interactive effects of depressive symptoms on the momentary associations between pain and mood. Experience sampling (ESM) data was used from a multi-site study examining individuals with knee osteoarthritis (OA). Participants completed self-report measures of global depression and momentary pain, negative affect (NA), and positive affect (PA). Cross-sectional associations among momentary pain and affect were examined in a series of hierarchical multilevel models that nested the 28 ESM calls (Level 1) within participants (Level 2). A parallel set of multilevel models tested lagged associations among momentary variables. Depression significantly moderated the contemporaneous (p < .001) and lagged (p < .003) associations between pain and NA, suggesting that depression intensifies the momentary pain-NA linkage. There were no significant interaction effects for PA. These findings extend existing knowledge by illustrating how depressive symptoms influence the everyday experience of OA pain and its impact on affective well-being. (Supported by AG041655, P. Parmelee and D. Smith, Co-PIs)

Medical Cannabis Use and Pain: An Experience Sampling Study

Background: Little research has tested associations of pain and MC use after long-term treatment and through methods that have external validity outside experimental settings. The study examined associations of pain, associated painful experiences, and long-term medical cannabis (MC) use in chronic pain (CP) patients using a naturalistic daily diary study that provided novel and externally valid data.Methods: Data were obtained from 78 MC users with CP three times daily over a 10-day period (nobservations = 1,688). Mixed-effects models were used to test the associations between MC use and momentary experiences of pain, affect, and fatigue.Results: Within persons, elevated experiences of pain intensity were associated with greater intention to use MC within the next hour. No evidence was found that the time lapse since last MC use was associated with pain levels, negative affect, or fatigue.Conclusions: The results imply that after long-term use, CP patients intend to use MC in response to pain experiences. Yet, they may not actually achieve the pain relief. More research is needed to examine whether continued MC use despite lack of pain relief is related to relief of other symptoms (e.g., dependence, withdrawal) or positive benefits (e.g., general sense of well-being) or tolerance.

Pain, cognition and disability in advanced multiple sclerosis

Objectives In patients with multiple sclerosis (MS), a relationship between physical disability and pain has been observed. In addition a relationship between physical disability and cognition in MS has been suggested. However, cognitive functions and pain appear not to be correlated in MS patients. Therefore, we examined whether a possible relationship between pain and cognitive functioning may exist, and if so, if such a relationship is mediated by physical disability. Methods Forty-five MS patients with chronic pain, and in an advanced stage of the disease were included. Physical disabilities were assessed by the Expanded Disability Status Scale (EDSS). Episodic memory was assessed by means of the Eight Words test, and Face and Picture Recognition. Executive functions (EF) were examined by Digit Span Backward for working memory, and the Rule Shift Cards and Category Fluency test for cognitive flexibility. Pain Intensity and Pain Affect were assessed by means of visual analogue scales and one verbal pain scale and mood (depression, anxiety) by the Beck Depression Inventory and the Symptom Check List (SCL-90). The research questions were analyzed by means of regression analyses and the Sobel test for mediation. Results A significant relationship was found between Pain Affect and EF, but that relationship was not mediated by physical disabilities (EDSS). In addition, Pain Intensity and EF showed a significant relationship but only in combination with physical disabilities (EDSS). Finally, mood was related to pain affect. Discussion The findings suggest that the lower the EF, exclusively or in combination with more physical disabilities, the more the patient may suffer from pain. Implications The more one is cognitively and physically impaired, the more one might suffer from pain, and, the less one is able to communicate pain. The latter could put MS patients at risk for underdiagnosing and undertreatment of pain.

Musculoskeletal Pain and its Associated risk factors in school teachers of Lahore

Aim: To find out the occurrence of musculoskeletal pain and its associated risk factors in schoolteachers of Lahore. Study Design: Cross-sectional study. Place and duration of Study: The study was done in different public and private schools of Lahore from December 2020 to May 2021. Methodology: In this observational study, 921 schoolteachers, fulfilling the eligibility criteria, from different school participated. The data was collected by using a self-administered Performa. Results: In the survey 921 participants participated among which 686(74.8%) were males and 232(25.2%) were females. Out of 921 participants, a high percentage 652(70.8%) had Musculoskeletal pain while 269(29.2%) reported no pain in any region. The frequency of pain in neck, upper extremity, low back and lower extremity in l was 157(17%), 258(28%), 153(16.6%) and 84(9.1%) in multiple sites of body. The frequency of participants with mild, moderate, severe and worst pain was 198(21.5%), 324(35.3%), 110(11.9%) and 20(2.2%) respectively. Conclusion: This study concluded that the Musculoskeletal pain affect schoolteachers and it is highly associated with history of trauma, the hours of standing and the back support while sitting while less association of overhead activities such as writing on board. Keywords: Musculoskeletal pain, schoolteachers, electronic devices, risk factors, MSK pain

Fatigue, depression, and pain in multiple sclerosis: How neuroinflammation translates into dysfunctional reward processing and anhedonic symptoms

Fatigue, depression, and pain affect the majority of multiple sclerosis (MS) patients, which causes a substantial burden to patients and society. The pathophysiology of these symptoms is not entirely clear, and current treatments are only partially effective. Clinically, these symptoms share signs of anhedonia, such as reduced motivation and a lack of positive affect. In the brain, they are associated with overlapping structural and functional alterations in areas involved in reward processing. Moreover, neuroinflammation has been shown to directly impede monoaminergic neurotransmission that plays a key role in reward processing. Here, we review recent neuroimaging and neuroimmunological findings, which indicate that dysfunctional reward processing might represent a shared functional mechanism fostering the symptom cluster of fatigue, depression, and pain in MS. We propose a framework that integrates these findings with a focus on monoaminergic neurotransmission and discuss its therapeutic implications, limitations, and perspectives.