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Telomere length, a measure of cellular aging, is negatively associated with chronic pain severity and serves as an indicator of overall system functioning. While psychological resilience factors such as optimism, acceptance, positive affect and active coping have been associated with lower levels of clinical pain and greater physical functioning, it is unknown whether resilience may buffer against telomere shortening in individuals with chronic pain. Additionally, a broader conceptualization of resilience that includes biobehavioral and social factors may improve our understanding of the relationship between resilience, chronic pain, and health outcomes. We hypothesized that: 1) psychological resilience factors would be associated with longer telomere length, and 2) a combined biobehavioral/psychosocial composite would strengthen the association. A total of 79 individuals (34% Male, 66% Female) with/without knee pain completed psychological/psychosocial resilience (optimism, affect, active coping, perceived stress and social support) and biobehavioral measures (smoking status, and waist/hip ratio). Clinical cut points for each measure were established based on previously published normative data or means where applicable and used to create summative psychological (optimism, affect, coping, perceived stress) and biobehavioral/psychosocial (psychological resilience + social support, smoking, waist/hip ratio), resilience composites. Blood samples were collected and telomere length determined. Regression analyses were completed with sex, race, age, and GCPS characteristic pain intensity as additional predictors. A positive relationship emerged such that greater psychological resilience and biobehavioral/psychosocial resilience were associated with longer telomeres (p =.0295 and p =.0116, respectively). When compared with psychological resilience alone, the biobehavioral/psychosocial composite was significantly more predictive of telomere length than the psychological resilience composite (p <.0001). Findings indicate that the combination of psychosocial and biobehavioral resilience factors may protect against accelerated cellular aging in individuals with musculoskeletal chronic pain conditions. Prospective research is needed to determine a causal, protective role in individuals with chronic pain. [ABSTRACT FROM AUTHOR]

Chronic low back pain (CLBP) is among the most pervasive, painful conditions in the United States. For most patients with CLBP, the cause is "non-specific" – meaning, there is no clear association between pain and identifiable pathology of the spine or associated tissues. Research has shown that laypersons and providers alike are less inclined to help, feel less sympathy, dislike patients more, suspect deception, and attribute lower pain severity to patients whose pain does not have an objective basis in tissue pathology. Because of these stigmatizing responses from others, patients with CLBP may feel their pain is particularly unjust, which in turn could contribute to greater CLBP severity. Further, emerging evidence suggests that pain-related injustice perception is a risk factor for poor CLBP outcomes. The purpose of this study was to examine whether perceived injustice mediates the relationship between chronic pain stigma and pain severity among individuals with CLBP. Study participants with CLBP (N = 44) completed the Internalized Chronic Pain Stigma Scale, the Injustice Experience Questionnaire, the Center for Epidemiological Studies – Depression Scale, and the Brief Pain Inventory – Short Form. In a regression-based model adjusted for depressive symptoms, findings revealed that perceived injustice significantly mediated the association between chronic pain stigma and CLBP severity [Indirect Effect = 1.28, 95% CI: 0.06 to 3.08]. Specifically, greater chronic pain stigma was associated with greater perceived injustice (p =.0002), which in turn was associated with greater CLBP severity (p =.047). This study is the first to examine associations among chronic pain stigma, perceived injustice, and CLBP severity. Our findings suggest that injustice perception may be a mechanism through which stigma impacts CLBP severity. These findings reinforce the importance of further examining stigma and injustice appraisals as targets for intervention, especially among individuals with CLBP. [ABSTRACT FROM AUTHOR]

In adults with osteoarthritis, clinical pain and disability have been shown to differ across sex and ethnicity/race. Recent evidence also indicates changes in pain-related brain structure across these groups. Resilience is associated with lower pain and greater functioning. However, the relationship between resilience and the brain is not well understood. We investigated if resilience was associated with pain-related brain structure in individuals with/without knee pain and if patterns differed by sex and ethnicity/race. Study participants included 171 individuals (mean age 57.97±8.50; 62 male/109 female; 72 Non-Hispanic Black (NHB)/99 Non-Hispanic White (NHW) with and without knee pain. Participants completed measures of resilience: biobehavioral (tobacco use and waist/hip ratio) and psychosocial (optimism, affect, coping, perceived stress, and social support). Responses were dichotomized based on published norms/means and summed, creating a composite resilience score. High and low resilience was defined by median split. T1-weighted MRI data were processed using FreeSurfer for a priori region analyses. Potential covariates included age, sex, race, study site, education level, body mass index, and chronic pain severity based on the FITT index (frequency, intensity, time/duration, and total pain sites). MANCOVAs were completed for analyses. The high and low resilience groups differed in amygdala volume (p=0.021) with trends for medial prefrontal cortex (MPFC; p=0.064) and thalamus (p=0.094). Males with high resilience had thicker MPFC than low resilience males (p=0.037). Females with high resilience had larger amygdala than low resilience females (p=0.005). NHB with high resilience had larger amygdala (p=0.025) and a trend for thicker somatosensory cortex (p=0.064). NHW with high resilience had a trend for thicker insula (p=0.081). Preliminary findings indicate resilience may be associated with pain-related brain structure. Sex and ethnic/race group differences were also observed. Prospective research is needed to elucidate the influence of resilience on the experience of pain, neurobiological underpinnings, and sex and ethnicity/race differences. [ABSTRACT FROM AUTHOR]

While conventional socioeconomic status measures such as education, income, and occupation are often important predictors of health, subjective social status is also a critical determinant of physical and mental health among adults. Subjective social status takes into account perceived standing on multiple dimensions of socioeconomic status and social position. What remains unclear is whether subjective social status is similarly associated with health for individuals from different racial backgrounds. The aim of this ongoing study was to examine the association between subjective social status and depressive symptoms, and whether the nature of this association differed between Black and White adults with chronic low back pain (cLBP). Participants included 44 adults with cLBP (24 Black and 20 White) recruited from an academic pain treatment center in Birmingham Alabama. Subjective social status was measured using a symbolic ladder with 10 rungs that asked participants to place themselves in comparison with others in the U.S., with consideration for what it means to be at the top and bottom of society (e.g., the top have the most money and education and the best jobs). Participants also provided sociodemographic data (e.g., ethnicity/race) and completed the Center for Epidemiological Studies – Depression Scale. Results revealed that the association between subjective social status and depressive symptoms was significantly moderated by racial background (t = -5.56, p <.001). Specifically, higher subjective social status was associated with less depressive symptoms for Whites with cLBP (t = -4.66, p <.001). Conversely, higher subjective social status was associated with greater depressive symptoms for Blacks with cLBP (t = 3.07, p =.004). Previous research has shown that when a Black family climbs the social ladder, discriminatory organizational structures often hold them back by giving them smaller economic and health returns for their investment. This realization is likely to be depressing. [ABSTRACT FROM AUTHOR]

Chronic pain in persons living with HIV (PLWH) may be related to alterations in endogenous pain modulatory processes (e.g., high facilitation and low inhibition of nociception) that promote exaggerated pain responses, known as hyperalgesia and central nervous system sensitization. This observational study examined differences in endogenous pain modulatory processes between 59 PLWH with chronic pain, 51 PLWH without chronic pain, and 50 controls without HIV or chronic pain. Quantitative sensory testing for temporal summation (TS) of mechanical and heat pain as well as conditioned pain modulation (CPM) were used to assess endogenous pain facilitatory and inhibitory processes, respectively. Associations among TS, CPM, and self-reported clinical pain severity (Brief Pain Inventory-Short Form) were also examined in PLWH with chronic pain. Findings demonstrated significantly greater TS of mechanical (p <.05) and heat pain (p <.001) for PLWH with chronic pain compared to PLWH without chronic pain and controls. CPM effects were present in controls (p <.05), but not in either PLWH with or without chronic pain. Among PLWH with chronic pain, greater TS of mechanical pain was significantly associated with greater average clinical pain severity (p <.05). Results of this study suggest that enhanced facilitation and diminished inhibition characterizes the pronociceptive endogenous pain modulatory balance of persons living with HIV and chronic pain. Taken together, our results lend support to the idea that alterations in endogenous pain modulatory processes may be an important contributor to the development and/or experience of chronic pain for PLWH. [ABSTRACT FROM AUTHOR]

Intersectional health-related stigma (IHRS) refers to stigma that arises at the convergence of multiple health conditions. People living with HIV (PLWH) and chronic pain have two highly stigmatized health conditions, and thus may be at especially high risk for internalizing these stigmas and consequently experiencing reduced health-related quality of life (QOL). This study examined the intersectionality of internalized HIV and chronic pain stigma in relation to mental QOL and physical QOL in a sample of PLWH and chronic pain. Participants (N = 66) were recruited from an HIV clinic in the Southeastern United States. Chronic pain was defined as pain that has been present for at least three consecutive months, and that has been an ongoing problem for at least half the days in the past six months. All participants completed the HIV Stigma Mechanisms Scale, Internalized Chronic Pain Stigma Scale, and the Short Form 36 Health Survey (SF-36). An intersectional HIV and chronic pain stigma composite variable was created and participants were categorized as either high (29%), moderate (35%), or low (36%). Results from two unadjusted ANOVAs revealed that intersectional HIV and chronic pain stigma was significantly associated with poor mental QOL (F 2,65 = 3.09, p =.05) and poor physical health QOL (F 2,65 = 8.74, p <.001). Pairwise contrasts revealed that participants with high intersectional stigma reported significantly poorer physical (p <.001) and mental (p <.001) QOL compared to those with low intersectional stigma. Participants who reported the highest levels of both internalized HIV and chronic pain stigma reported the absolute poorest mental and physical QOL. This suggests that the experience of both HIV and chronic pain stigma (i.e., IHRS) among PLWH and chronic pain may synergistically promote poor QOL in a more profound manner than experiencing either one stigma alone. [ABSTRACT FROM AUTHOR]