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Jonathan Greenberg,1– 3 Jafar Bakhshaie,1– 3 Brenda C Lovette,3,4 Ana-Maria Vranceanu1– 3 1Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; 2Harvard Medical School, Boston, MA, USA; 3Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; 4MGH Institute of Health Professions, Boston, MA, USACorrespondence: Jonathan Greenberg, Integrated Brain Health Clinical and Research Program & Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, One Bowdoin Square, 1st Floor, Suite 106, Boston, MA, 02114, USA, Email jgreenberg5@mgh.harvard.eduBackground: Chronic orofacial pain is associated with substantial pain-related disability and emotional distress. Understanding the relationship between individuals’ coping strategies and pain-related outcomes is important yet understudied in this population.Purpose: To test the cross-sectional association of three coping strategies (pain catastrophizing, kinesiophobia and mindfulness) to four pain-related outcomes (depression, anxiety, pain intensity, and pain-related disability) among individuals with chronic orofacial pain, after accounting for relevant demographic and clinical variables.Methods: Individuals (N=303) with heterogeneous chronic orofacial pain (eg, trigeminal neuralgia, other trigeminal neuropathic pain, persistent idiopathic facial pain and other types) completed self-report measures of coping (Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia, and the 15-item Five Facet Mindfulness Questionnaire), pain intensity and pain-related disability (Graded Chronic Pain Scale), and PROMIS measure of anxiety and depression. We conducted 4 two-step hierarchical regressions for each of the four pain-related and emotional outcomes, with the first step including demographic and clinical covariates, and the second step including the three coping variables together.Results: Pain catastrophizing was the only coping variable significantly associated with pain intensity (B=0.362, SE=0.115, p=0.002, 3% variance explained) and pain-related disability (B =0.813, SE=0.162, p< 0.001, 7% variance explained). Pain catastrophizing (B=0.231-0.267, SE=0.046-0.051-0.050, p< 0.001), kinesiophobia (B=0.201-0.316, SE=0.081-0.084, p< 0.001-0.018), and mindfulness (B=0.231– 0.306, SE=0.046-0.067, p< 0.001) were each independently associated with symptoms of anxiety and depression, with the largest incremental variance added by catastrophizing (5– 8%) and mindfulness (5%).Conclusion: Pain catastrophizing appears to be an important intervention target to improve pain intensity, pain-related disability, anxiety and depression among individuals with chronic orofacial pain. Kinesiophobia and mindfulness may be additional treatment targets for interventions to improve anxiety and depression.Keywords: chronic orofacial pain, coping, pain-related disability, anxiety, depression

Jonathan Greenberg,1,2 Ryan A Mace,1,2 Sarah M Bannon,1,2 Ronald J Kulich,2,3 Ana-Maria Vranceanu2 1Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; 2Harvard Medical School, Boston, MA, USA; 3Center for Pain Medicine, Massachusetts General Hospital, Boston, MA, USACorrespondence: Ana-Maria VranceanuIntegrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, 02114, USATel +1 617 724 4977Email avranceanu@mgh.harvard.eduBackground: Improving physical function among patients with chronic pain is critical for reducing disability and healthcare costs. However, mechanisms underlying improvement in patient-reported, performance-based, and ambulatory physical function in chronic pain remain poorly understood.Purpose: To explore psychosocial mediators of improvement in patient-reported, performance-based, and objective/accelerometer-measured physical function among participants in a mind-body activity program.Methods: Individuals with chronic pain were randomized to one of two identical 10-week mind-body activity interventions aimed at improving physical function with (GetActive-Fitbit; N=41) or without (GetActive; N=41) a Fitbit device. They completed self-reported (WHODAS 2.0), performance-based (6-minute walk test), and objective (accelerometer-measured step-count) measures of physical function, as well as measures of kinesiophobia (Tampa Kinesiophobia Scale), mindfulness (CAMS-R), and pain resilience (Pain Resilience Scale) before and after the intervention. We conducted secondary data analyses to test mediation via mixed-effects modeline.Results: Improvements in patient-reported physical function were fully and uniquely mediated by kinesiophobia (Completely Standardized Indirect Effect (CSIE)=.18; CI=0.08, 0.30; medium-large effect size), mindfulness (CSIE=− .14; CI=− 25, − .05; medium effect size) and pain resilience (CSIE=− .07; CI=− .16, − .005; small-medium effect size). Improvements in performance-based physical function were mediated only by kinesiophobia (CSIE=− .11; CI=− 23, − .008; medium effect size). No measures mediated improvements in objective (accelerometer measured) physical function.Conclusion: Interventions aiming to improve patient-reported physical function in patients with chronic pain may benefit from skills that target kinesiophobia, mindfulness, and pain resilience, while those focused on improving performance-based physical function should target primarily kinesiophobia. More research is needed to understand mechanisms of improvement in objective, accelerometer-measured physical function.Trial Registration: ClinicalTrials.gov NCT03412916.Keywords: chronic pain, disability, mind-body, physical function, mediation, psychosocial variables

Jonathan Greenberg,1,2 Ann Lin,1 Emily L Zale,1 Ronald J Kulich,2,3 Peter James,2,4 Rachel A Millstein,1,2 Hannah Shapiro,5 Michael E Schatman,6,7 Robert R Edwards,2,8 Ana-Maria Vranceanu1,2 1Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; 2Harvard Medical School, Boston, MA, USA; 3Center For Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; 4Department of Population Medicine, Harvard T. H. Chan School of Public Health, Boston, MA, USA; 5Department of Biology, Tufts University, Medford, MA, USA; 6Research and Network Development, Boston Pain Care, Waltham, MA, USA; 7Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA; 8Pain Management Center, Brigham and Women’s Hospital, Boston, MA, USACorrespondence: Ana-Maria VranceanuIntegrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 1 st Floor, Suite 100, Boston, MA, USATel +1 6177244977Fax +1 617-643-8777Email avranceanu@mgh.harvard.eduBackground: Increasing physical function is a challenging, yet imperative goal of pain management programs. Physical activity can improve physical function, but uptake is low due to chronic pain misconceptions, poor pain management skills, and doing too much too soon.Purpose: To increase physical function by 1) adapting an evidence-based, group, mind-body program to address the needs of patients with heterogeneous chronic pain and to facilitate individually tailored quota-based pacing with a Fitbit (GetActive with Fitbit) or without it (GetActive) (phase 1), and 2) assessing preliminary feasibility benchmarks (phase 2).Methods: We followed evidence based frameworks for developing interventions and for early feasibility testing. In phase 1 we conducted 4 focus groups with 22 patients with heterogeneous chronic pain and adapted the mind-body program. In phase 2 we conducted a nonrandomized pilot trial of the 2 programs (N=7 and 6) with qualitative exit interviews.Results: Focus groups showed high interest in increasing activity, a preference for walking linked to pleasurable activities, using a Fitbit to track number of steps, and learning skills to manage pain and aid with increased activity. Both programs had good to excellent feasibility markers. Participation in both programs was associated with signal of improvements in physical and emotional function, as well as intervention targets. Exit interviews confirmed high satisfaction and suggested modification.Conclusion: Results informed subsequent adaptations of the 2 programs and methodology for an ongoing pilot randomized controlled trial (RCT) of the 2 programs, necessary before an efficacy RCT of the 2 programs against an education control.Keywords: mind-body, chronic pain, fitbit, physical activity, focus groups, feasibility, physical function

William Jackson,1 Emily L Zale,2 Stanley J Berman,3 Alberto Malacarne,1 Amy Lapidow,4 Michael E Schatman,5,6 Ronald Kulich,1,7,* Ana-Maria Vranceanu2,* 1Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; 2Department of Psychiatry, Massachusetts General Hospital, Harvard School of Medicine, MA, USA; 3Department of Clinical Health Psychology, William James College, MA, USA; 4Department of Health Sciences Library, Tufts University School of Dental Medicine, Boston, MA, USA; 5Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA; 6Research and Network Development, Boston PainCare, Waltham, MA, USA; 7Department of Anesthesia, Massachusetts General Hospital, Harvard School of Medicine, MA, USA *These authors contributed equally to this work Purpose: The importance of improved physical function as a primary outcome in the treatment of chronic pain is widely accepted. There have been limited attempts to assess the effects mindfulness skills training (MST) has on objective outcomes in chronic pain care. Methods: This systematic review evaluated published reports of original randomized controlled trials that described physical function outcomes after MST in the chronic pain population and met methodological quality according to a list of predefined criteria. PRISMA criteria were used to identify and select studies, and assess their eligibility for inclusion. The established guidelines for best practice of systematic reviews were followed to report the results. Results: Of the 2,818 articles identified from the original search of four electronic databases, inclusionary criteria were met by 15 studies published as of August 10, 2015, totaling 1,199 patients. All included studies used self-report measures of physical function, and only two studies also employed performance-based measures of function. There were wide variations in how physical function was conceptualized and measured. Although the quality of the studies was rated as high, there was inconclusive evidence for improvement in physical function assessed by self-report due to contradiction in individual study findings and the measures used to assess function. Strong evidence for lack of improvement in physical function assessed via performance-based measures was found. Conclusion: This review draws attention to the importance of having a unified approach to how physical function is conceptualized and assessed, as well as the importance of using quality performance-based measures in addition to subjective self-reports that appropriately assess the physical function construct within MSTs for chronic pain. Keywords: mindfulness, chronic pain, physical functioning, systematic review, outcome measures, activity trackers

Objectives/Interrogation: Recent research has outlined the pivotal role of psychological factors in pain and disability associated with first carpometacarpal osteoarthritis (CMC-1 OA). However, the association of pre-treatment expectations and illness perceptions (patients set of beliefs about [for full text, please go to the a.m. URL], 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)