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Background Chronic hip pain is one of the most common and difficult-to-treat causes of disability. Our study's primary aim was to investigate the effects of ultrasound and fluoroscopy-guided radiofrequency thermocoagulation of the femoral and obturator nerve articular branches on chronic hip pain, and the secondary aim was to determine its effects on hip function and quality of life. Methods Fifty-three patients with hip pain lasting more than three months were enrolled in the study. VPS scale and WOMAC, SF-12 questionnaires were applied to the patients before and in the first, third, and sixth months following the procedure. Results Of the patients, 60.4% were female, and 39.6% were male. Hip pain was caused by osteoarthritis in 77.1%, postoperative hip pain in 12.5%, malignancy in 8.3%, and avascular necrosis in 2.1%. The VPS scores were 8.9 ± 1.1 (mean±SD) in the baseline period, 2.4 ± 2.5 in the first postoperative week, 3.8 ± 2.5 in the first month, 5.1 ± 2.8 in the third month, and 5.8 ± 2.7 in the sixth month, with a significant decrease in VPS score (P  < .001). One patient developed a motor deficit that improved spontaneously. Conclusions We concluded that radiofrequency thermocoagulation application to the articular branches of the femoral and obturator nerves provides pain relief, hip function improvement, and better quality of life (better physical component scores but no improvement in mental component scores in SF-12) for up to 6 months in chronic hip pain. [ABSTRACT FROM AUTHOR]

Background Virtual psychotherapy for chronic pain (CP) has been shown to be feasible, efficacious, and acceptable; however, little is known about how virtual delivery of group psychotherapy affects participants' experiences. This study aimed to explore the impact of a virtual medium during the coronavirus disease 2019 (COVID-19) pandemic on social interactions and therapeutic processes in the context of group psychotherapy for CP management. Methods This qualitative, interview-based study collected data on 18 individuals who participated in virtual group psychotherapy in a tertiary care pain management unit. Results Results of the thematic analysis showed 4 themes. First, the ability to participate and connect was modified by not meeting in person. Connections also occurred differently as the usual patterns of interactions changed. Participants described important shifts in how emotions are communicated and subsequent experience of empathy. Finally, the commonality of chronic pain experience was identified as a central driver of connection between participants. Conclusions Mixed impacts of the virtual medium on group psychotherapy dynamics and processes were found. Future research could explore ways to mitigate the negative impacts. [ABSTRACT FROM AUTHOR]

Objective To identify and synthesize patient-related barriers to and enablers of the implementation of high-value physiotherapy (HVP) for chronic pain. Furthermore, to review what patient-related interventions have been used to facilitate the implementation of HVP for chronic pain, as well as their efficacy. Methods We systematically searched the APA PsycInfo, Embase, CINAHL, Medline, Scopus, and PEDro databases for peer-reviewed studies (published in English) of adults with chronic pain. We used the Theoretical Domains Framework of behavior change to synthesize identified themes relating to barriers and enablers. Outcomes from studies reporting on interventions were also qualitatively synthesized. Results Fourteen studies reported on barriers and enablers, 8 of which related to exercise adherence. Themes common to barriers and enablers included perceived efficacy of treatment, interrelationship with the physiotherapist, exercise burden, and the patient's understanding of exercise benefits. Other barriers included fear of movement, fragmented care, and cost. Ten studies explored interventions, 9 of which aimed to improve exercise adherence. Of these, evidence from 4 randomized controlled trials of technology-based interventions demonstrated improved exercise adherence among intervention groups compared with controls. Conclusion Patients with chronic pain experience barriers to HVP, including their beliefs, the nature of their interaction with their physiotherapist, perceived treatment efficacy, and cost. Enablers include rapport with their physiotherapist, achievable exercises, and seamless cost-effective care. Technology-based interventions have demonstrated effectiveness at increasing exercise adherence. Our findings suggest that interventions seeking to enhance implementation of HVP need to consider the multifactorial barriers experienced by patients with chronic pain. Study registration Open Science Framework (https://doi.org/10.17605/OSF.IO/AYGZV). [ABSTRACT FROM AUTHOR]

Objective This case series retrospectively reviewed the outcomes in patients implanted with combined, synchronous dorsal root ganglion stimulation (DRGS) and spinal cord stimulation (SCS) connected to a single implantable pulse generator (IPG) in a tertiary referral neuromodulation centre in the United Kingdom. Methods Twenty-six patients underwent a trial of DRGS+SCS for treating focal neuropathic pain between January 2016 and December 2019, with a follow-up in February 2022. A Transgrade approach was employed for DRGS. Patients were provided with 3 possible stimulation programs: DRGS-only, SCS-only, or DRGS+SCS. Patients were assessed for pain intensity, patients' global impression of change (PGIC), preferred lead(s) and complications. Results Twenty patients were successful and went on for full implantation. The most common diagnosis was Complex Regional Pain Syndrome. After an average of 3.1 years follow-up, 1 patient was lost to follow-up, and 2 were non-responders. Of the remaining 17 patients, 16 (94%) continued to report a PGIC of 7. The average pain intensity at Baseline was 8.5 on an NRS scale of 0–10. At the last follow-up, the average NRS reduction overall was 78.9% with no statistical difference between those preferring DRGS+SCS (n  = 9), SCS-only (n  = 3) and DRGS-only (n  = 5). The combination of DRGS+SCS was preferred by 53% at the last follow-up. There were no serious neurological complications. Conclusions This retrospective case series demonstrates the potential effectiveness of combined DRGS+SCS with sustained analgesia observed at an average follow-up of over 3 years. Implanting combined DRGS+SCS may provide programming flexibility and therapeutic alternatives. [ABSTRACT FROM AUTHOR]

The article offers information on the use of virtual reality (VR) for pain therapy and the challenges associated with VR-induced cybersickness. Topics include the growing interest in VR for pain management, highlighting its potential to immerse patients in a computer-generated world to distract them from pain.

Objective Identifying the factors that determine the quality of life of patients with chronic pain is an integral part of developing interventions to reduce the negative impact of persistent pain. Locus of control (LoC) could play an important role in adaptation to prolonged pain, but the results of studies are inconsistent. We examined the link between pain LoC and quality of life. Moreover, we investigated whether the relationship between LoC and quality of life is mediated by passive and active coping, and whether age moderates the LoC–coping relationship. Methods The study was cross-sectional, and variables (internal, chance and powerful-others LoC, pain coping strategies, average pain intensity, and quality of life) were assessed via questionnaires in a sample of 594 individuals (67% females) with chronic pain who were 18–72 (mean: 36) years of age. Results Mediation and moderated mediation analyses were conducted. Internal and external LoC were associated, respectively, with better and with worse quality of life. Passive coping mediated the association between the powerful-others dimension of LoC and poor quality of life. Additionally, indirect effects of internal LoC on quality of life via passive and active coping were found. The relationship between the powerful-others dimension of LoC and coping was stronger for middle-aged and older individuals than for younger individuals. Conclusions This study contributes to a better understanding of the mechanisms linking LoC with quality of life of patients with chronic pain. Depending on the age, control beliefs might translate differently into strategies used to cope with pain, and thus into quality of life. [ABSTRACT FROM AUTHOR]

Objective To investigate how a behavioral health, artificial intelligence (AI)-powered, digital self-management tool affects the daily functions in adults with chronic back and neck pain. Design Eligible subjects were enrolled in a 12-week prospective, multicenter, single-arm, open-label study and instructed to use the digital coach daily. Primary outcome was a change in Patient-Reported Outcomes Measurement Information Systems (PROMIS) scores for pain interference. Secondary outcomes were changes in PROMIS physical function, anxiety, depression, pain intensity scores and pain catastrophizing scale (PCS) scores. Methods Subjects logged daily activities, using PainDrainerTM, and data analyzed by the AI engine. Questionnaire and web-based data were collected at 6 and 12 weeks and compared to subjects' baseline. Results Subjects completed the 6- (n = 41) and 12-week (n = 34) questionnaires. A statistically significant Minimal Important Difference (MID) for pain interference was demonstrated in 57.5% of the subjects. Similarly, MID for physical function was demonstrated in 72.5% of the subjects. A pre- to post-intervention improvement in depression score was also statistically significant, observed in 100% of subjects, as was the improvement in anxiety scores, evident in 81.3% of the subjects. PCS mean scores was also significantly decreased at 12 weeks. Conclusion Chronic pain self-management, using an AI-powered, digital coach anchored in behavioral health principles significantly improved subjects' pain interference, physical function, depression, anxiety, and pain catastrophizing over the 12-week study period. [ABSTRACT FROM AUTHOR]

The Biospecimen Collection and Processing Working Group of the National Institutes of Health (NIH) HEAL Initiative BACPAC Research Program was charged with identifying molecular biomarkers of interest to chronic low back pain (cLBP). Having identified biomarkers of interest, the Working Group worked with the New York University Grossman School of Medicine, Center for Biospecimen Research and Development—funded by the Early Phase Pain Investigation Clinical Network Data Coordinating Center—to harmonize consortium-wide and site-specific efforts for biospecimen collection and analysis. Biospecimen collected are saliva, blood (whole, plasma, serum), urine, stool, and spine tissue (paraspinal muscle, ligamentum flavum, vertebral bone, facet cartilage, disc endplate, annulus fibrosus, or nucleus pulposus). The omics data acquisition and analyses derived from the biospecimen include genomics and epigenetics from DNA, proteomics from protein, transcriptomics from RNA, and microbiomics from 16S rRNA. These analyses contribute to the overarching goal of BACPAC to phenotype cLBP and will guide future efforts for precision medicine treatment. [ABSTRACT FROM AUTHOR]

Study Design In vivo retrospective study of fully automatic quantitative imaging feature extraction from clinically acquired lumbar spine magnetic resonance imaging (MRI). Objective To demonstrate the feasibility of substituting automatic for human-demarcated segmentation of major anatomic structures in clinical lumbar spine MRI to generate quantitative image-based features and biomechanical models. Setting Previous studies have demonstrated the viability of automatic segmentation applied to medical images; however, the feasibility of these networks to segment clinically acquired images has not yet been demonstrated, as they largely rely on specialized sequences or strict quality of imaging data to achieve good performance. Methods Convolutional neural networks were trained to demarcate vertebral bodies, intervertebral disc, and paraspinous muscles from sagittal and axial T1-weighted MRIs. Intervertebral disc height, muscle cross-sectional area, and subject-specific musculoskeletal models of tissue loading in the lumbar spine were then computed from these segmentations and compared against those computed from human-demarcated masks. Results Segmentation masks, as well as the morphological metrics and biomechanical models computed from those masks, were highly similar between human- and computer-generated methods. Segmentations were similar, with Dice similarity coefficients of 0.77 or greater across networks, and morphological metrics and biomechanical models were similar, with Pearson R correlation coefficients of 0.69 or greater when significant. Conclusions This study demonstrates the feasibility of substituting computer-generated for human-generated segmentations of major anatomic structures in lumbar spine MRI to compute quantitative image-based morphological metrics and subject-specific musculoskeletal models of tissue loading quickly, efficiently, and at scale without interrupting routine clinical care. [ABSTRACT FROM AUTHOR]

The article focuses on alumni engagement and the role of journal clubs in continuing medical education for chronic pain medicine fellowship programs. Topics include the benefits of alumni involvement in virtual journal clubs, the importance of journal clubs in medical education, and the use of virtual platforms for alumni interaction and mentorship.

Patients within the safety net, defined as gap healthcare services for un- or under-insured persons, disproportionately suffer high impact chronic pain. The purpose of this review was to examine pain-related outcomes from multidisciplinary programs for patients with chronic pain within the safety net. A scoping review was conducted based on the Arksey and O'Malley framework coupled with the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Scoping Review checklist. CINAHL, MEDLINE, PubMed, and Google Scholar were searched for eligible articles published between January 1, 2010, and December 31, 2020. Grey literature was searched by typing relevant keywords into Google. Quantitative and qualitative outcomes were included. Data collected were charted and analyzed. Ten articles were included, with five demonstrating primarily quantitative results, three demonstrating primarily qualitative results, and the remaining two demonstrating primarily mixed results. Of the studies that utilized qualitative measures, themes included reduction in pain symptoms and the positive reception of a group-based pain management approach. Of the studies that employed quantitative measures, most demonstrated improvements in pain-related outcomes post-intervention, although not all statistically significant. Multidisciplinary pain programs may be of benefit to safety net patients with chronic pain. Further data collection is needed to determine the efficacy of these programs. [ABSTRACT FROM AUTHOR]

Objective To determine, among patients with chronic pain who had received pain physician referral to pain psychology, the rate of establishing care and factors related to establishing care with pain psychology. Design Retrospective study. Setting Academic tertiary care center. Subjects Patients from the University of California, San Diego (UCSD) Center for Pain Medicine. Methods This was an institutional review board–approved, retrospective study of 150 consecutive referrals of unique patients from UCSD Pain Medicine to UCSD Pain Psychology. Results Of 150 patients referred to pain psychology, 74 (49.3%) established care with pain psychology. Of 98 patients who had previously seen mental health services, 58 established care with pain psychology (59.2%; 95% confidence interval [CI]: 49% to 69%), whereas of 52 patients who had not previously seen mental health services, 16 established care with pain psychology (30.8%; 95% CI: 18% to 43%) (odds ratio [OR] 3.26; 95% CI: 1.60 to 6.66). In the patient subset with depression and/or anxiety, of 82 patients who had previously seen mental health services, 47 established care with pain psychology (57.3%; 95% CI: 47% to 68%), whereas of 20 patients who had not previously seen mental health services, three established care with pain psychology (15%; 95% CI: –1% to 31%) (OR 7.61; 95% CI: 2.07 to 28.01). Of 96 patients referred for general pain psychology evaluations, 43 established care (45%; 95% CI: 35% to 55%), whereas of 38 patients referred for preprocedural evaluation for an implantable device, 24 established care (63%; 95% CI: 48% to 78%). Conclusion Patients are significantly more likely to establish care with pain psychology if they have previously seen a mental health professional. This was even more marked among the patient subset with a history of depression and/or anxiety who had engaged in mental health services than among those with a history of depression and/or anxiety who had not engaged in mental health services. Whether referral was for general psychological evaluation or preprocedural evaluation for an implantable device did not significantly influence whether patients established care. Targeted interventions are needed to improve the likelihood of patients engaging with pain psychology services. [ABSTRACT FROM AUTHOR]

Objective The present study aimed (1) to analyze the relative paraspinal autochthonous intramuscular fat volume before and after radiofrequency neurotomy (RFN) and (2) to compare it to the contralateral non-treated side. Design Retrospective cohort study. Setting Inselspital, University Hospital Bern, University of Bern. Subjects Twenty patients (59.60 ± 8.49 years; 55% female) with chronic low back pain, treated with RFN (L2/3—L5/S1) due to symptomatic facet joint syndrome (FCS) between 2008 and 2017 were included. Methods All patients received a magnetic resonance imaging (MRI) of the lumbar spine before and at a minimum of 6 months after RFN. The absolute (cm3) and relative (%) paraspinal muscle and fat volume was analyzed three-dimensionally on standard T2–MRI sequences using a newly developed software (iSix, Osiris plugin). Both sides were examined and allocated as treated or non-treated side. Results A total of 31 treated and 9 non-treated sides (Level L2/3–L5/S1) were examined. There were no differences in the relative paraspinal intramuscular fat volume before and at a median of 1.4 [0.9 – 2.6] years after RFN (P  = .726). We found no differences in the relative fat volume between the treated and non-treated side before (P  = .481) and after (P  = .578) RFN. Conclusions Our study shows that there are no differences in the paraspinal muscle/fat distribution after RFN. RFN of the medial branches for FCS does not seem to cause fatty degeneration of the lumbar paraspinal muscles as a sign of iatrogenic muscle denervation. [ABSTRACT FROM AUTHOR]

Objectives Globally, 20–25% of people will experience chronic pain in their lifetimes. Dance is a physical activity with psychosocial benefits that might positively impact pain. This review aimed to investigate the effect of dance interventions on the experience of pain by quantitative measures and qualitative themes. Methods Seven major databases were searched from inception to January 2021. Two independent reviewers screened articles at each stage. Qualitative and quantitative studies were included if the dance interventions lasted more than 6 weeks, participants reported pain of duration longer than 3 months, and pain was an outcome of the study. All articles were critically appraised with appropriate Joanna Briggs Institute tools, and data were collated through the use of results-based convergent synthesis. Results From 23,628 articles, 34 full papers were included, with a total of 1,254 participants (75.2% female). Studies predominantly investigated individuals with fibromyalgia (26%) and generalized chronic pain (14%), with aerobic dance (20.7%) and Biodanza (20.7%) being the most common dance genres investigated. Overall, 74% of studies noted either reduced pain through quantitative pain measures or qualitative themes of improved pain experience (88% for chronic primary pain and 80% for chronic secondary musculoskeletal pain). Discussion There were positive effects of dance on chronic primary and secondary musculoskeletal pain across diverse populations. A variety of study designs and interventions noted improved pain measures and themes around pain coping and acceptance, with all dance therapies showing improvements, particularly when performed for 60–150 minutes' duration weekly. Dance should be considered as an effective adjunct in the management of chronic pain. [ABSTRACT FROM AUTHOR]

In the article, the authors discuss the psychologically guided core competencies for health care providers in their self-management of chronic pain. Other topics include the suggested options for pain management like mindfulness, yoga and physical therapy, and the skills needed for effective self-care like the use of cognitive, behavioral, and emotional strategies to manage family, social, and professional roles and responsibilities.

Objective To compare the effects of dry needling or manual pressure release on an active trigger point in the upper trapezius on craniocervical flexion test performance, pressure pain thresholds, and cervical range of motion in chronic neck pain. Design A parallel randomized clinical trial. Setting Physical therapy service. Subjects Individuals with chronic neck pain. Methods Subjects were randomized to receive dry needling (n = 25) or manual trigger point pressure release (n = 25) on upper trapezius active trigger points. Surface electromyography from the upper trapezius, splenius capitis, sternocleidomastoid, and scalene muscles during performance of the craniocervical flexion test was assessed before and immediately after the intervention as the primary outcome. Neck pain intensity, range of motion, and pressure pain thresholds were the secondary outcomes. Results A decrease in sternocleidomastoid activity at all stages of the craniocervical flexion test (time effect, P  < 0.001) was found in both groups after the interventions, with no significant between-group difference. Pressure pain thresholds measured over the cervical spine and second metacarpal increased after dry needling when compared with manual trigger point pressure release (P  < 0.05). Pain intensity decreased immediately after both treatments with moderate to large effect sizes, whereas cervical range of motion increased for both groups but with small effect sizes. Conclusion A single session of dry needling or manual pressure release over upper trapezius active trigger points promotes limited effects on muscle performance during the craniocervical flexion test, pressure pain thresholds, and cervical range of motion in patients with chronic neck pain. [ABSTRACT FROM AUTHOR]

The article discusses that chronic pain interventionalists' duty is to do no harm to the environment. Pain physicians should implement sustainability practices by using a systematic "Triple R: Reduce, Replace, Rethink" approach to greening the healthcare sector. The aim of reducing carbon footprint can be achieved while providing exceptional care for vulnerable patients with pain. The curricula for interventional pain fellowships should incorporate sustainability education.

Objectives Societal and health system pressures associated with the coronavirus disease 2019 (COVID-19) pandemic exacerbated the burden of chronic pain and limited access to pain management services for many. Online multidisciplinary pain programs offer an effective and scalable treatment option, but have not been evaluated within the context of COVID-19. This study aimed to investigate the uptake and effectiveness of the Reboot Online chronic pain program before and during the first year of the COVID-19 pandemic. Methods Retrospective cohort analyses were conducted on routine service users of the Reboot Online program, comparing those who commenced the program during the COVID-19 pandemic (March 2020–March 2021), to those prior to the pandemic (April 2017–March 2020). Outcomes included the number of course registrations; commencements; completion rates; and measures of pain severity, interference, self-efficacy, pain-related disability, and distress. Results Data from 2,585 course users were included (n = 1138 pre-COVID-19 and n = 1,447 during-COVID-19). There was a 287% increase in monthly course registrations during COVID-19, relative to previously. Users were younger, and more likely to reside in a metropolitan area during COVID-19, but initial symptom severity was comparable. Course adherence and effectiveness were similar before and during COVID-19, with moderate effect size improvements in clinical outcomes post-treatment (g =  0.23–0.55). Discussion Uptake of an online chronic pain management program substantially increased during the COVID-19 pandemic. Program adherence and effectiveness were similar pre- and during-COVID. These findings support the effectiveness and scalability of online chronic pain management programs to meet increasing demand. [ABSTRACT FROM AUTHOR]

Objective Respiratory-gated Auricular Vagal Afferent Nerve stimulation (RAVANS) is a safe nonpharmacological approach to managing chronic pain. The purpose of the current study was to examine (1) the feasibility and acceptability of RAVANS, combined with mindful meditation (MM) for chronic low back pain (CLBP), (2) the potential synergy of MM+RAVANS on improving pain, and (3) possible moderators of the influence of MM+RAVANS on pain. Design Pilot feasibility and acceptability study. Setting Pain management center at large academic medical center. Subjects Nineteen adults with CLBP and previous MM training. Methods Participants attended two sessions during which they completed quantitative sensory testing (QST), rated pain severity, and completed a MM+stimulation session. Participants received RAVANS during one visit and sham stimulation during the other, randomized in order. Following intervention, participants repeated QST. Results MM+RAVANS was well tolerated, acceptable, and feasible to provide relief for CLBP. Both MM+stimulation sessions resulted in improved back pain severity, punctate pain ratings, and pressure pain threshold. Individuals with greater negative affect showed greater back pain improvement from MM+RAVANS while those with greater mindfulness showed greater back pain improvement from MM+sham. Conclusions Results suggest that for CLBP patients with prior MM training, the analgesic effects of MM may have overshadowed effects of RAVANS given the brief single session MM+RAVANS intervention. However, those with greater negative affect may benefit from combined MM+RAVANS. [ABSTRACT FROM AUTHOR]

The article presents a case of a 45 year old woman with C5-C7 fusion who was rushed to a clinic due to chronic left sided shoulder pain reflective of surgeries and interventional pain procedures like cervical spinal cord stimulation to discuss the unexpected motor response of peripheral nerve stimulation (PNS) in a patient with chronic shoulder pain. Other topics include the abnormal motor response to neurostimulation.

The article presents the discussion on understanding the role of pulsed radiofrequency in the early management of chronic postsurgical groin pain. Topics include post-inguinal herniorrhaphy patients experiencing dysesthesia, allodynia, hyperalgesia, or hyperpathia, contributing to the challenge and complexity of the condition; and suggesting spinal cord stimulators, transcutaneous electrical nerve stimulation, nerve blocks, as well as neurectomy.

Objective This study examined factors influencing lay perceptions of a provider's clinical burden in providing care to a person with chronic pain. Design In a between-subjects design that varied three levels of pain severity (4, 6, or 8 out of 10) with two levels of medical evidence (low/high), participants rated the credibility of pain reported by a hypothetical patient and the psychosocial factors expected to mediate the effects of evidence and severity on a provider's burden of care. Setting A randomized vignette study in which community participants were recruited via Amazon Mechanical Turk. Subjects 337 community participants. Methods Using a Qualtrics platform, participants read one of six vignettes describing a hypothetical patient with varying levels of medical evidence and pain severity and then rated perceived pain severity, pain credibility, psychosocial variables, and burden. Results Serial mediation models accounted for all effects of medical evidence and pain severity on burden. Low medical evidence was associated with increased burden, as mediated through lower pain credibility and greater concerns about patient depression, opioid abuse, and learning pain management. Higher levels of reported pain severity were associated with increased burden, as mediated through greater pain discounting and concerns about opioid abuse. Conclusions The lay public is skeptical of chronic pain that is not supported by medical evidence or is reported at high levels of severity, raising concerns about psychosocial complications and drug seeking and expectations of higher burden of care. Such negative stereotypes can pose obstacles to people seeking necessary care if they or others develop a chronic pain condition. [ABSTRACT FROM AUTHOR]

Measures are lacking that assess the clinical burden that healthcare providers perceive in treating chronic conditions. This study presents a preliminary psychometric evaluation of a novel self-report measure of provider burden in the treatment of chronic pain. Data for eight burden items were available from vignette studies examining the effects of patient pain severity and medical evidence on clinical burden and judgments for chronic pain. Participants (N  =   922) were 109 physicians and 813 non-physicians, all acting in the role of physician (232 community members without chronic pain, 105 community members with chronic pain, and 476 American Chronic Pain Association members with chronic pain). Factor analyses of burden items yielded one-factor solutions in all samples, with high factor loadings and adequate explained variance. Internal consistency reliability was uniformly high (≥ 0.87). Burden scores were significantly higher among physicians compared to nonphysicians; nonphysician groups did not differ on any burden score. Significant correlations of burden score with indicators of psychosocial complications in patient care supported scale validity. Burden score was not associated with gender, age, or education. Results provide initial support for the psychometric properties of a Healthcare Provider Burden Scale (HPBS). Research utilizing larger and representative healthcare provider groups is needed. [ABSTRACT FROM AUTHOR]

Objective Neuropathic pain is complex and often refractory. Clinical hypnosis has emerged as a viable treatment for pain. This scoping review is the first comprehensive review of hypnosis for chronic neuropathic pain. It critically assesses available evidence noting practice implications, literature gaps, and future research opportunities. Subjects Individuals with chronic neuropathic pain treated with hypnosis. Methods Following PRISMA guidelines, we searched PubMed, CINAHL, Embase, and PsycInfo for studies for which the intervention and primary outcome(s) were associated with hypnosis and neuropathic pain, respectively. Included studies were empirical, in English, and published from January 1996 to August 2021. Results Nine articles with 301 total participants were reviewed. Neuropathic pain included, for example, complex regional pain syndrome (CRPS), brachial neuralgia, and spinal cord injury. Hypnosis dose varied with administration and format. Six studies used comparators. Every trial demonstrated pain and quality-of-life benefits, with several controlled trials indicating hypnosis as superior to active comparator or standard of care. CRPS-specific studies showed notable improvements but had significant study limitations. Methodological weaknesses involved trial design, endpoints, and recruitment strategies. Conclusions The evidence is weak because of poor study design, yet encouraging both for analgesia and functional restoration in hard-to-treat chronic neuropathic pain conditions. We highlight and discuss key knowledge gaps and identify particular diagnoses with promising outcomes after hypnosis treatment. This review illustrates the need for further empirical controlled research regarding hypnosis for chronic neuropathic pain and provides suggestions for future studies. [ABSTRACT FROM AUTHOR]

Objective Psychosocial factors are known to predict chronic pain, and the use of complementary and integrative health (CIH) therapies to address pain is emerging among the military population. However, conflicting results on pain outcomes warrant additional research. This study aimed to 1) evaluate the benefit of adding a CIH pain management program to standard rehabilitative care (SRC), as compared with SRC alone, as a precursor to an intensive functional restoration (FR) program; 2) identify factors that predict improvement in pain outcomes after treatment; and 3) determine the proportion of participants who experience a clinically meaningful response. Design Pragmatic randomized controlled clinical trial. Participants were randomized to a 3-week course of either SRC alone or SRC+CIH (stage 1), followed by a 3- to 6-week course of FR (stage 2). Subjects Active duty service members with chronic pain. Methods Participants completed either SRC alone or SRC+CIH (stage 1), followed by a course of FR (stage 2). Patient-reported and provider-determined outcomes were collected at baseline, after stage 1, and after stage 2. A covariance pattern model with an unstructured residual covariance matrix was used to compare treatment arms while accounting for dependency due to repeated measurements. Results A total of 210 service members participated. Most were in the Army (82%) and were male (84%). Participants randomized to the SRC+CIH intervention had greater improvement in the pain impact score than did those in the SRC-alone group. Predictors of outcomes were baseline impact score, anger, depression, and educational status. Conclusions This study found that military service members with the highest pain impact benefit the most from interdisciplinary pain care. [ABSTRACT FROM AUTHOR]

Objective Chronic musculoskeletal pain (CMP) outcomes are affected by numerous variables, including the clinical conversation. When good therapeutic/working alliances are formed, congruent clinical conversations can lead to improved CMP outcomes. Identifying patient/provider attitudes, beliefs, and biases in CMP that can influence the clinical conversation, and thus clinical management decisions, is foundationally important. Design The aims of this systematic review were to 1) summarize the evidence of the attitudes and beliefs of patients and health care providers (HCPs) involved in the clinical conversation about CMP, and 2) examine whether and how these perceptions impacted the process of care. Methods A systematic search of CINAHL, PubMed, Scopus, Sociology Database in ProQuest, and Web of Science used the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Included studies were those investigating vulnerable adult populations with chronic pain. Study bias was examined with the Downs and Black tool. Results Seven retrospective studies were included. When making pharmaceutical management decisions, HCPs demonstrated negative implicit biases toward minorities and women. When making referrals to multidisciplinary care, HCPs demonstrated negative implicit biases toward women with lower educational attainment. Unmet patient expectations resulted in higher dropout rates at multidisciplinary pain management programs. Patients' trust was influenced by the health care setting, and patients often had limited options secondary to health insurance type/status. Conclusion These findings suggest that patients with CMP may experience a marginalized process of care due to HCPs' negative implicit biases, unmet patient expectations, and the health care setting. Results suggest several factors may contribute to inequitable care and the recalcitrant nature of CMP, particularly in vulnerable populations with limited health care choices. [ABSTRACT FROM AUTHOR]

Objective This study was designed to assess whether using pulse dosing (PD) (regularly cycled intermittent stimulation) of high-frequency 10-kHz spinal cord stimulation (10-kHz SCS) can reduce device recharge time while maintaining efficacy in patients with chronic intractable back pain with or without leg pain. Design Prospective, multicenter, observational study. Methods Patients successfully using 10-kHz SCS at 100%ON (i.e. continuously with no PD) for >3 months were consecutively enrolled. After a 1-week baseline period of documenting their pain twice daily on a 0–10 numerical rating scale (NRS) using 100%ON of their "favorite" program, all subjects were reprogrammed to 14%PD for 10–14 days. If subjects preferred 14%PD to 100%ON, they were programmed to 3%PD; otherwise, they were programmed to 50%PD. Subjects used this next program for another 10–14 days. Subjects then entered a 3-month observational period during which they were requested to use but not limited to their most preferred %PD program. Toward the end of 3 months, subjects completed a 7-day NRS diary and indicated a final %PD program preference. Study endpoints included %PD preference, mean diary NRS by %PD, and daily minutes and patterns of charging. Results Of 31 subjects completing the study, 81% preferred less than 100%ON. Among the subjects, 39% preferred 3%PD, 32% preferred 14%PD, 10% preferred 50%PD, and 19% preferred 100%ON. Average daily charge durations were 8.3 ± 3.1 minutes for 3%PD, 13.9 ± 4.9 minutes for 14%PD, 26.2 ± 7.4 minutes for 50%PD, and 43.8 ± 10.9 minutes for 100%ON. Regression modeling suggested that pain relief was weighted as more than twice as influential as charging in preference for reduced %PD. Conclusions This prospective study suggests that 10-kHz SCS therapy with PD may be successfully used in a large majority of 10-kHz SCS responders, maintaining efficacy while reducing device charging time by nearly two thirds. [ABSTRACT FROM AUTHOR]

Objective Although positive psychology interventions (PPIs) are increasingly popular in chronic pain treatment their efficacy is still unclear. The objective is to summarize evidence on the effect of PPIs on pain, physical functioning, and emotional functioning in adults with chronic pain. Methods Four electronic databases and additional references were searched for randomized controlled trials (RCTs) published between 1990 and 2020. Findings from included studies were qualitatively and quantitatively synthesized, and study quality was assessed for risk of bias. A random effects meta-analysis model was applied for outcomes with more than four findings. Results Of 16 included RCTs, almost half delivered PPIs as self-help online interventions, and half conducted guided face-to-face interventions which lasted mostly eight weeks. Results from meta-analysis showed beneficial effects of PPIs compared to the control group on pain intensity and emotional functioning (i.e. less depressive symptoms, pain catastrophizing, negative affect; more positive affect) post-intervention. At 3-month follow-up, beneficial effects were maintained for depressive symptoms and positive and negative affect, but not for pain catastrophizing. However, the evidence on the long-term efficacy of PPIs and the efficacy of PPIs on physical functioning remains limited. Conclusions This review supports the notion that PPIs are beneficial to chronic pain treatment, although further, high quality research is needed to support this conclusion. [ABSTRACT FROM AUTHOR]

Objective Although virtual reality is shown to have short-term analgesic effects in acute pain settings, its long-term efficacy in chronic pain conditions has not been established. This scoping review aims to provide a summary of virtual reality approaches explored in chronic primary and secondary pain conditions as defined by the International Association for the Study of Pain. Methods A systematic literature search in Ovid PubMed and Ovid Embase was conducted between January 5 and January 10, 2021, with the use of the Arksey and O'Malley six-step scoping review criteria. Articles were searched via search terms and keywords relating to International Classification of Diseases –defined primary and secondary chronic pain conditions, virtual reality, virtual illusion, distraction, and effects on levels of pain. Results Of the 2,118 articles located, 44 were included, which covered a range of primary and secondary chronic pain conditions and used a variety of different computer screen and headset protocols, including gaming, mindfulness, exercise, relaxation, and proprioceptive skills. Conclusions Studies show virtual reality to be an effective analgesic intervention for people with chronic pain. Given user satisfaction, a lack of side effects such as cybersickness, and relief of comorbid symptoms, virtual reality has potential as a worthwhile adjunct to chronic pain management programs, thus enabling patients to take control of their symptoms. [ABSTRACT FROM AUTHOR]

Background Pre-outpatient interventions in chronic pain have the potential to improve patient self-management earlier in primary or secondary care, which may minimize pain chronicity and negative health outcomes. The literature for this is sparse, and there are no existing systematic reviews on this topic. Methods The purpose of this systematic review is to examine the evidence for pre-outpatient group interventions in chronic pain. Results We identified four studies that looked at this: two randomized control trials, one prospective observational study, and one descriptive study. We identified high-quality evidence that a pre-outpatient group intervention reduces waiting times, moderate-quality evidence that it results in reduced costs per patient, very low-quality evidence that it reduces health care utilization, and very low-quality evidence that it improves service throughput. There were moderate-to-low levels of participant engagement with the initiative, which varied across the included studies. For patient outcome measures, we found no evidence that a pre-outpatient group intervention improves pain intensity, very low-quality evidence that it improves pain-related interference, low-quality evidence that it increases use of pain management strategies and produces high satisfaction levels, low-quality evidence that it improves pain self-efficacy, and no evidence that it improves psychological distress. Conclusions Group interventions before individual appointments have the potential to provide important improvements in service delivery, including improvements in waiting times and cost per patient. Benefits for patient outcome measures are less clear. Clinical heterogeneity and high levels of bias existed in the included studies. Further research is required so that meaningful conclusions can be made about these interventions. [ABSTRACT FROM AUTHOR]

The article examines that the World Health Organization (WHO) definition of pandemic is an infectious disease that affects a large number of people scattered around the world. Topics include reports that in March 2020, with the confirmation of several positive cases the WHO declared COVID-19, the disease caused by the new coronavirus SARS-CoV-2, a pandemic.

Objective This study sought to evaluate if actively informing new chronic pain patients about treatment options and setting realistic expectations for care, through the use of a pre-visit informational handout prior to the first clinic visit, improved patient satisfaction with subsequently proposed treatment plans. Methods The study was divided into two 3-month periods. During the first 3 months, with our current pain clinic practices in place, new patients (n = 147) were given surveys to establish a baseline of patient satisfaction with treatment plans proposed on their first visit. During the second 3 months, a different group of new patients (n = 156) was given a detailed informational handout which described our clinic's multimodal approach to pain management and therapeutic expectations prior to their visit with a provider. Patient satisfaction with subsequently proposed treatment plans was then assessed and compared with the baseline group. Results The average patient satisfaction score for the group of patients given the informational handout was 4.21 (on a 5-point Likert scale), compared to an average score of 3.25 for the baseline group (P  < .0001, unpaired t -test). 77.6% of patients given the informational handout said their proposed treatment plan met their expectations compared to 46.3% of patients in the baseline group (χ2= 31.61, two-tailed P  < .0001). Conclusions Patient satisfaction with proposed chronic pain treatment plans was improved when clinic approaches to pain were explicitly outlined and therapeutic expectations were clearly established in the form of an informational handout at the outset of the first visit. [ABSTRACT FROM AUTHOR]

Spinal cord stimulation (SCS) is used to treat a variety of chronic pain conditions refractory to more conservative management including refractory angina pectoris. We identified 31 patients who underwent SCS implantation for the indication of refractory angina at a single institution from 2003 through 2018. Sixteen patients were male, and 15 were female. Average age was 53.9 years. Prior to SCS implantation, all patients had at least one coronary angiogram. Ten (32.3%) patients had undergone percutaneous coronary intervention, and four (12.9%) had undergone coronary artery bypass grafting. Thirty patients (96.7%) were currently using anti-angina medications. Twenty-six patients (83.9%) were on antiplatelet or anticoagulant agents at the time of SCS evaluation. Spinal cord stimulation implanters must perform a comprehensive evaluation incorporating appropriate multidisciplinary care particularly in patients with refractory angina given their cardiovascular comorbidities. It is important to have baseline data (e.g. pain scores, nitroglycerin consumption, frequency of angina episodes, and a questionnaire, such as the Seattle Angina Questionnaire) to compare with follow-up data to help define treatment success. We report a single institution's pre-operative experience for patients undergoing SCS for refractory angina to illustrate unique pre-operative SCS considerations in this chronic pain population. [ABSTRACT FROM AUTHOR]

Objective Numerous studies support the effectiveness of acceptance and commitment therapy (ACT) for chronic pain, yet little research has been conducted about its underlying mechanisms of change, especially regarding patients with comorbid mental disorders. The present investigation addressed this issue by examining associations of processes targeted by ACT (pain acceptance, mindfulness, psychological flexibility) and clinical outcomes (pain intensity, somatic symptoms, physical health, mental health, depression, general anxiety). Subjects Participants were 109 patients who attended an ACT-based interdisciplinary treatment program for chronic pain and comorbid mental disorders in a routine care psychiatric day hospital. Methods Pre- to posttreatment differences in processes and outcomes were examined with Wilcoxon signed-rank tests and effect size r. Associations between changes in processes and changes in outcomes were analyzed with correlation and multiple regression analyses. Results Pre- to posttreatment effect sizes were mostly moderate to large (r between 0.21 and 0.62). Associations between changes in processes and changes in outcomes were moderate to large for both, bivariate correlations (r between 0.30 and 0.54) and shared variances accounting for all three processes combined (R2 between 0.21 and 0.29). Conclusion The present investigation suggests that changes in pain acceptance, mindfulness, and psychological flexibility are meaningfully associated with changes in clinical outcomes. It provides evidence on particular process-outcome associations that had not been investigated in this way before. The focus on comorbid mental disorders informs clinicians about a population of chronic pain patients who often have a severe course of illness and have seldom been studied. [ABSTRACT FROM AUTHOR]

Background Neuroscience education therapy (NET) has been successfully used for numerous overlapping pain conditions, but few studies have investigated NET for migraine. Objective We sought to 1) review the literature on NET used for the treatment of various pain conditions to assess how NET has been studied thus far and 2) recommend considerations for future research of NET for the treatment of migraine. Design/Methods Following the PRISMA guideline for scoping reviews, co-author (TR), a medical librarian, searched the MEDLINE, PsychInfo, Embase, and Cochrane Central Clinical Trials Registry databases for peer-reviewed articles describing NET to treat migraine and other chronic pain conditions. Each citation was reviewed by two trained independent reviewers. Conflicts were resolved through consensus. Results Overall, a NET curriculum consists of the following topics: pain does not equate to injury, pain is generated in the brain, perception, genetics, reward systems, fear, brain plasticity, and placebo/nocebo effects. Delivered through individual, group, or a combination of individual and group sessions, NET treatments often incorporate exercise programs and/or components of other evidence-based behavioral treatments. NET has significantly reduced catastrophizing, kinesiophobia, pain intensity, and disability in overlapping pain conditions. In migraine-specific studies, when implemented together with traditional pharmacological treatments, NET has emerged as a promising therapy by reducing migraine days, pain intensity and duration, and acute medication intake. Conclusion NET is an established treatment for pain conditions, and future research should focus on refining NET for migraine, examining delivery modality, dosage, components of other behavioral therapies to integrate, and migraine-specific NET curricula. [ABSTRACT FROM AUTHOR]

Objective This study explored factors that underpin decisions to seek emergency department (ED) care for chronic noncancer pain in patients identifying as culturally and linguistically diverse (CALD) or Australian born. Design and Methods This mixed-methods study was underpinned by the Behavioral Model of Health Services Use conceptual framework. Consenting consecutive patients attending the ED for a chronic pain condition were recruited to a CALD (n = 45) or Australian-born (n = 45) cohort. Statistical comparisons compared the demographic, pain, health literacy, and episode of care profiles of both cohorts. Twenty-three CALD and 16 Australian-born participants consented to an audio-recorded semi-structured interview (n = 24) or focus group (n = 5 focus groups) conducted in their preferred language. Interviews were translated and transcribed into English for analysis using applied thematic analysis, guided by the conceptual framework. Data were triangulated to investigate the patterns of ED utilization and contributing factors for both cohorts. Results ED attendance was a product of escalating distress, influenced by the degree to which participants' perceived needs outweighed their capacity to manage their pain. This interaction was amplified by the presence of predisposing factors, including constrained social positions, trauma exposure, and biomedical health beliefs. Importantly, experiences varied between the two cohorts with higher degrees of pain catastrophizing, lower health literacy, and greater social challenges present for the CALD cohort. Conclusion This study highlights the role contextual factors play in amplifying pain-related distress for CALD and Australian-born patients with chronic pain. The findings support a need for health care providers to recognize features of higher vulnerability and consider streamlining access to available support services. [ABSTRACT FROM AUTHOR]

The article focuses on the relationship between neurological disorders, chronic pain, and the use of neuromodulation, particularly spinal cord stimulation, to manage pain in patients with neurological conditions. It discusses the complexity of pain in neurological diseases and the potential benefits of neuromodulation. It emphasizes the need for further research in this field and ethical considerations related to neuromodulation in patients with cognitive impairment and chronic pain.

Objective Evidence suggests that blunted reward responsiveness may account for poor clinical outcomes in both opioid use disorder (OUD) and chronic pain. Understanding how individuals with OUD and comorbid chronic pain (OUD+CP) respond to rewards is, therefore, of clinical interest because it may reveal a potential point of behavioral intervention. Methods Patients with OUD (n = 28) and OUD+CP (n = 19) on opioid agonist treatment were compared on: 1) the Probabilistic Reward Task (an objective behavioral measure of reward response bias) and 2) ecological momentary assessment of affective responses to pleasurable events. Results Both the OUD and the OUD+CP groups evidenced an increase in reward response bias in the Probabilistic Reward Task. The rate of change in response bias across blocks was statistically significant in the OUD group (B  = 0.06, standard error [SE] = 0.02, t  = 3.92, P  < 0.001, 95% confidence interval [CI]: 0.03 to 0.09) but not in the OUD+CP group (B  = 0.03, SE = 0.02, t  = 1.90, P  = 0.07, 95% CI: −0.002 to 0.07). However, groups did not significantly differ in the rate of change in response bias across blocks (B  = 0.03, SE = 0.02, t  = 1.21, P  = 0.23, 95% CI: −0.02 to 0.07). Groups did not significantly differ on state measures of reward responsiveness (P' s ≥0.50). Conclusions Overall, findings across objective and subjective measures were mixed, necessitating follow-up with a larger sample. The results suggest that although there is a reward response bias in patients with OUD+CP treated with opioid agonist treatment relative to patients with OUD without CP, it is modest and does not appear to translate into patients' responses to rewarding events as they unfold in daily life. [ABSTRACT FROM AUTHOR]

Objectives Biopsychosocial, integrated pain care models are increasingly implemented in the Veterans Health Administration to improve chronic pain care and reduce opioid-related risks, but little is known about how well these models address women veterans' needs. Design Qualitative, interview-based study. Setting San Francisco VA Health Care System Integrated Pain Team (IPT), an interdisciplinary team that provides short-term, personalized chronic pain care emphasizing functional goals and active self-management. Subjects Women with chronic pain who completed ≥3 IPT sessions. Methods Semistructured phone interviews focused on overall experience with IPT, perceived effectiveness of IPT care, pain care preferences, and suggested changes for improving gender-sensitive pain care. We used a rapid approach to qualitative thematic analysis to analyze interviews. Results Fourteen women veterans (mean age 51 years; range 33–67 years) completed interviews. Interviews revealed several factors impacting women veterans' experiences: 1) an overall preference for receiving both primary and IPT care in gender-specific settings, 2) varying levels of confidence that IPT could adequately address gender-specific pain issues, 3) barriers to participating in pain groups, and 4) barriers to IPT self-management recommendations due to caregiving responsibilities. Conclusions Women veterans reported varied experiences with IPT. Recommendations to improve gender-sensitive pain care include increased provider training; increased knowledge of and sensitivity to women's health concerns; and improved accommodations for prior trauma, family and work obligations, and geographic barriers. To better meet the needs of women veterans with chronic pain, integrated pain care models must be informed by an understanding of gender-specific needs, challenges, and preferences. [ABSTRACT FROM AUTHOR]

Objective To examine the benefits of an integrated psychosocial group treatment (IPGT) model for patients with chronic pain at risk of opioid misuse. Design This study was a small-scale, single-blinded, two-group randomized controlled trial. Setting Outpatient. Subjects Adults with chronic pain of >3 months' duration who were currently prescribed opioid medication and were at risk of opioid misuse. Methods Patients with chronic pain who were at risk of opioid misuse (n = 30) were randomly assigned to IPGT or treatment as usual. IPGT consists of six group sessions of psychoeducation, motivational interviewing, cognitive behavioral therapy, mindfulness, and peer support. Participants were assessed at baseline, first follow-up at 6 weeks, and a posttreatment follow-up at 9 weeks. Outcomes included feasibility, acceptability, and preliminary efficacy. Data were analyzed with descriptive and multivariate analyses. Results All intervention components were delivered to 87% of the participants, and IPGT recipients reported a high level of satisfaction. Results of the multivariate analyses demonstrated nonsignificant improvements in pain severity (β = 0.22, 95% CI: –0.24 to 0.66, P  = 0.35). However, we observed significant treatment × time interactions on pain interference (β = 3.32, 95% confidence interval [CI]: 0.01 to 6.65, P  = 0.05) and pain catastrophizing (β = 2.74, 95% CI: 0.49 to 4.99, P  = 0.02). Lastly, we detected no significant differences in opioid misuse (adjusted odds ratio = 0.69, 95% CI: –0.26 to 1.64, P  = 0.16). Conclusion This study provides support for the IPGT intervention being acceptable and feasible for delivery in patients with chronic pain at risk of opioid misuse. Efficacy was achieved in pain interference and pain catastrophizing. [ABSTRACT FROM AUTHOR]

The article presents Long-Term Results with Adjuvant Ozone Therapy in the Management of Chronic Pelvic Pain Secondary to Cancer Treatment. Topics discussed include Management of local pain after pelvic tumor treatment requires excluding the possibility of tumor relapse and, at the same time, starting analgesic and opioid treatment as needed; and patients with potentially prolonged life expectancy, high doses of opioids are controversial because their long-term safety and effectiveness.

Objective Psychological treatments for chronic low back pain (CLBP) are effective. However, limited research has investigated their neurophysiological mechanisms. This study examined electroencephalography- (EEG-) assessed brain oscillation changes as potential mechanisms of cognitive therapy (CT), mindfulness-meditation (MM), and mindfulness-based cognitive therapy (MBCT) for CLBP. The a priori bandwidths of interest were changes in theta, alpha and beta power, measured at pre- and post-treatment. Design A secondary analysis of a clinical trial. Setting University of Queensland Psychology Clinic. Subjects Adults (N = 57) with CLBP who completed pre- and post-treatment EEG and pain outcome assessments. Methods EEG data were examined for five regions of interest (ROIs); the primary outcome was pain intensity. Results A significant reduction in theta (P =.015) and alpha (P =.006) power in the left frontal ROI across all treatments was found, although change in theta and alpha power in this region was not differentially associated with outcome across treatments. There were significant reductions in beta power in all five ROIs across all treatments (P ≤.013). Beta power reduction in the central ROI showed a significant association with reduced pain intensity in MBCT only (P =.028). Changes in other regions were not statistically significant. Conclusions These findings provide support for the capacity of psychological CLBP treatments to induce changes in brain activity. The reduced beta power in all five ROIs indicated that all three treatments engendered a state of lowered cortical arousal. The growing body of research in this area could potentially inform novel directions towards remedying central nervous system abnormalities associated with CLBP. [ABSTRACT FROM AUTHOR]

Objective Chronic pain is a prevalent and disabling condition. Reboot Online was developed as a multidisciplinary and widely accessible online treatment program for chronic pain. It has been shown to be effective in clinical trials, but the effectiveness of this program in routine care settings remains unknown. This study aimed to examine program adherence and effectiveness in a real-world sample of participants completing Reboot Online in the community. Design and subjects A retrospective cohort study was conducted using real-world data from participants referred the Reboot Online program by clinicians as part of their routine care, from April 2017 to April 2019. Methods Routinely collected data on program adherence, participant demography and clinical outcomes were included in the analyses. Measures included the Pain Self Efficacy Questionnaire, Brief Pain Inventory, Tampa Scale of Kinesiophobia, Pain-Disability Index, and Patient Health Questionnaire 9-item (depression). Logistic regression was used to investigate whether certain factors predict program adherence (completion versus noncompletion), and linear mixed models were used to examine effectiveness. Results In total, 867 participants were included in the analyses, and 583 engaged with at least one Reboot Online lesson. Of these, 42% (n = 247) completed the course in its entirety, with rurality and lower Tampa scores being significant predictors of adherence. Completers demonstrated significant improvements across all outcome measures (effect sizes ranging from 0.22 to 0.51). Conclusions Reboot Online is an effective treatment for chronic pain in the routine care setting. Adherence was variable (overall 42%), and could be predicted by rurality and less fear of movement at baseline. [ABSTRACT FROM AUTHOR]

Objectives The treatment for neuropathic pain is still a big challenge. Pulsed radiofrequency technique has been widely used to relieve neuropathic pain in recent years. The purpose of this study is to optimize the temperature for pulsed radiofrequency therapy. Design Animal, experimental study. Methods Seventy-five male SD rats were randomly divided into five groups: Sham operation group (Sham group), chronic constriction injury group (CCI group), PRF 42°C group (P42 group), PRF 50°C group (P50 group), and PRF 60°C group (P60 group). The hindpaw withdrawal threshold (HWT), paw thermal withdrawal latency (PTWL), sciatic nerve structure, and the concentration of spinal methionine enkephalin(M-ENK) were detected to identify which temperature is the best for PRF treatment. Results PRF at 42°C, 50°C and 60°C significantly alleviated the pain in CCI rats. The therapeutic effects of 50°C and 60°C were similar, and both were better than 42°C. In addition, PRF using 42°C, 50°C, and 60°C mediated nerve injury to sciatic nerve were grade 1, 1, and 2, respectively. The concentration of M-ENK in spinal cord increased accompanying with the increasing of the temperature of PRF. Conclusions PRF using 50°C could induce less damage while achieving better improvement of mechanical and thermal pain threshold than 42°C and 60°C in CCI rats, which may be achieved by promoting the expression of M-ENK in spinal cord. [ABSTRACT FROM AUTHOR]

Objective Although evidence-based psychological interventions improve chronic pain, many patients do not engage in behavioral health services. Offering a brief intervention in a medical setting may provide benefits to patients with chronic pain. The purpose of this study was to examine preliminary outcomes of a brief psychological intervention for chronic pain delivered in primary care. Design Pilot randomized controlled trial. Setting Primary care clinic. Subjects Sixty participants with chronic pain were randomized to a 5-session psychological intervention or treatment-as-usual control group. Methods Participants completed pre- and post-intervention measures assessing pain severity, pain interference, pain catastrophizing, depression, and anxiety. Results Most participants (76.7%) randomized to the intervention completed all sessions. Compared to the control group, those in the intervention had decreases in pain severity (P =.048), pain catastrophizing (P =.04), and depression (P =.01) from pre- to post-intervention. Within the intervention group, there was a significant improvement in pain interference scores (P = 0.02). Within the intervention group, effect sizes were medium to large for changes in pain severity, pain interference, pain catastrophizing, and depression scores. There were no significant changes in anxiety scores. Conclusion Results suggest that delivery of a brief psychological intervention for chronic pain in primary care appears to offer improvements in pain severity, pain interference, pain catastrophizing, and depression. Findings suggest that shorter-term psychological interventions may offer similar benefits as longer-term ones. Furthermore, offering a brief intervention in primary care may increase access and engagement in behavioral pain management services. Future research should examine this through a fully-powered trial with longer-term outcomes. [ABSTRACT FROM AUTHOR]