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Objectives: The COVID‐19 pandemic has had substantial impacts for both people using pain services and healthcare professionals delivering them. While the effects on service users have been studied, less is known about the effects for service providers. This study aimed to assess the impact of the pandemic on providers and the evolving role of telemedicine in treatment. Design & Methods: An electronic survey was distributed to the professional membership of the European Pain Federation (EFIC). The survey evaluated impact and adjustment to the COVID‐19 pandemic separately across two pandemic years (March 2020–February 2021 and March 2021 to February 2022) and assessed worry about COVID‐19, disruption and adjustment of pain services, and use of telehealth services. The change between the first and second pandemic years and the degree to which telehealth services were adopted was evaluated. Results: From 149 respondents, 131 (88%) participants provided sufficient data to be included in the analysis. Both providers worry about the pandemic and service disruption decreased significantly from the first to the second year of the pandemic. Prior to the pandemic, only 30% of providers offered telehealth appointments but this increased to 64% and 83%, respectively, in the first and second years of the pandemic. Conclusions: Although provider worry and disruption to delivery of pain services decreased during the second year of COVID‐19 pandemic, waiting times for appointments continued to lengthen. The pandemic has hastened the adoption of telemedicine in pain services and plans to continue telehealth services seem common. [ABSTRACT FROM AUTHOR]

The dramatic increase in opioid misuse, opioid use disorder (OUD), and opioid‐related overdose deaths in the United States has led to public outcry, policy statements, and funding initiatives. Meanwhile, alcohol misuse and alcohol use disorder (AUD) are a highly prevalent public health problem associated with considerable individual and societal costs. This study provides a critical review of alcohol and opioid misuse, including issues of prevalence, morbidity, and societal costs. We also review research on interactions between alcohol and opioid use, the influence of opioids and alcohol on AUD and OUD treatment outcomes, respectively, the role of pain in the co‐use of alcohol and opioids, and treatment of comorbid OUD and AUD. Heavy drinking, opioid misuse, and chronic pain individually represent significant public health problems. Few studies have examined co‐use of alcohol and opioids, but available data suggest that co‐use is common and likely contributes to opioid overdose‐related morbidity and mortality. Co‐use of opioids and alcohol is related to worse outcomes in treatment for either substance. Finally, chronic pain frequently co‐occurs with use (and co‐use) of alcohol and opioids. Opioid use and alcohol use are also likely to complicate the treatment of chronic pain. Research on the interactions between alcohol and opioids, as well as treatment of the comorbid disorders is lacking. Currently, most alcohol research excludes patients with OUD and there is lack of measurement in both AUD and OUD research in relation to pain‐related functioning. Research in those with chronic pain often assesses opioid use, but rarely assesses alcohol use or AUD. New research to examine the nexus of alcohol, opioids, and pain, as well as their treatment, is critically needed. [ABSTRACT FROM AUTHOR]

Objective: A key issue in chronic pain treatment concerns the changes necessary for improved physical and emotional functioning. Traditionally, reducing pain intensity and pain-related distress have been viewed as a prerequisite for these improvements. Alternatively, acceptance and commitment therapy, a behavior change approach, theorizes that pain and distress reduction are not necessary for improvement, rather responses must change, such that functioning improves in clearly specified areas (e.g., engagement in valued activities, decreased disability in social activity) even when pain and distress persist. Method: This study sought to directly examine aspects of change in pain and distress over the course of an interdisciplinary program of acceptance and commitment therapy in relation to functioning at treatment's conclusion and a 3-month follow-up in 174 treated patients. Latent change trajectories of pain intensity and pain-related distress were assessed weekly over 4 weeks of treatment and analyzed via latent growth curve and growth mixture modeling. Results: A single latent trajectory with a decreasing quadratic slope was indicated for pain, while 2 separate trajectories were identified for pain-related distress 1 of linear decrease and the other an early increase followed by a decrease to initial level. Overall, and with only 3 exceptions across multiple tests, results indicated that trajectories of pain and distress during treatment were not significantly associated with improvements in functioning at treatment's conclusion and follow-up. Conclusions: This pattern of findings suggests that significant improvements in functioning may not require decreases in pain intensity and pain-related distress during treatment for chronic pain. [ABSTRACT FROM AUTHOR]

Engagement in valued activities is an important outcome, particularly in treatments that aim to enhance quality of life in those with chronic conditions. The present study describes the initial evaluation of the Values Tracker (VT), a two-item measure of values engagement, in 302 treatment-seeking adults with chronic pain. Hierarchical regression analyses were conducted to examine the utility of the VT in the statistical prediction of pain-related functioning, after controlling for demographic variables, pain intensity, and pain-related distress. Across analyses, pain intensity accounted for significant variance (range ΔR2 = .06-.09) with pain-related distress adding additional unique variance (range ΔR2 = .07-.19). The VT accounted for additional unique variance (range ΔR2 = .02-.17) for all variables with the exception of physical disability. These findings provide initial support for the utility of the VT in those with chronic pain. Given the VT’s brevity, it may be particularly useful for tracking changes in engagement in values across sessions. [ABSTRACT FROM AUTHOR]

Objectives. Encouraging individuals with chronic pain to focus on nonpain-related goals that are consistent with personal values is a goal of most psychosocial pain interventions. A valid and reliable measure of goal-related variables would be useful to evaluate the importance of these to patient quality of life and as factors that may explain treatment outcome. Design. We developed items for a measure (the Valued Living Scale, VLS) to assess goal importance, success, and confidence with respect to eight value domains and 26 specific values-related goals, and administered these items to individuals with three chronic pain conditions (low back pain, N558; fibromyalgia, N555; headache, N561). Results. Analyses supported: 1) a two-factor model of the VLS items assessing goal-related variables associated with a) health and productivity and b) social relations; 2) VLS scale score reliability, with Cronbach's alphas greater than 0.70; and 3) VLS scale score validity, as indicated by significant associations with pain intensity, depression, and pain interference in the expected directions. Conclusions. The VLS items can be administered and scored to assess: 1) the importance of as well as 2) confidence in and 3) success in achieving values-consistent goals. The measure can be used by clinicians to monitor and track changes in patient's perceptions about their goals with treatment. Researchers can use the VLS to test theoretical models of the roles that patient perceptions about goal importance, confidence, and success play in chronic pain treatment outcome. [ABSTRACT FROM AUTHOR]

The therapeutic model underlying Acceptance and Commitment Therapy (ACT) is reasonably well-established as it applies to chronic pain. Several studies have examined measures of single ACT processes, or subsets of processes, and have almost uniformly indicated reliable relations with patient functioning. To date, however, no study has performed a comprehensive examination of the entire ACT model, including all of its component processes, as it relates to functioning. The present study performed this examination in 274 individuals with chronic pain presenting for an assessment appointment. Participants completed a battery of self-report questionnaires, assessing multiple aspects of the ACT model, as well as pain intensity, disability, and emotional distress. Initial exploratory factor analyses examined measures of the ACT model and measures of patient functioning separately with each analysis identifying three factors. Next, the fit of a model including ACT processes on the one hand and patient functioning on the other was examined using Structural Equation Modeling. Overall model fit was acceptable and indicated moderate correlations among the ACT processes themselves, as well as significant relations with pain intensity, emotional distress, and disability. These analyses build on the existing literature by providing, to our knowledge, the most comprehensive evaluation of the ACT theoretical model in chronic pain to date. [ABSTRACT FROM AUTHOR]

The article offers updates on the development of cognitive behavioral therapy (CBT) in treatment of chronic pain as of February 2014. Acceptance and commitment therapy (ACT), one of the areas of development within CBT is discussed. Information on mindfulness-based approaches in treatment of chronic pain is also offered.

Abstract: Recent developments in CBT emphasize the promotion of psychological flexibility to improve daily functioning for people with a wide range of health conditions. In particular, one of these approaches, Acceptance and Commitment Therapy (ACT), has been studied for treatment of chronic pain. While trials have provided good support for treatment effectiveness through follow-ups of as long as seven months, the longer-term impact is not known. The present study of 108 participants with chronic pain examined outcomes three years after treatment completion and included analyses of two key treatment processes, acceptance of pain and values-based action. Overall, results indicated significant improvements in emotional and physical functioning relative to the start of treatment, as well as good maintenance of treatment gains relative to an earlier follow-up assessment. Effect size statistics were generally medium or large. At the three-year follow-up, 64.8% of patients had reliably improved in at least one key domain. Improvements in acceptance of pain and values-based action were associated with improvements in outcome measures. A “treatment responder” analysis, using variables collected at pre-treatment and shorter term follow-up, failed to identify any salient predictors of response. This study adds to the growing literature supporting the effectiveness of ACT for chronic pain and yields evidence for both statistical and clinical significance of improvements over a three-year period. [Copyright &y& Elsevier]

Abstract: Emerging evidence has indicated that adolescent chronic pain is a significant healthcare issue, the impact of which is determined by a complex interplay of biological, emotional, social, and familial factors. Recently, progress has been made in assessment of pain and functioning in adolescents with chronic pain. A next step is to evaluate whether discrete subgroups of patients exist and whether assessment measures can be used to determine subgroup membership for individual pain sufferers. The present study sought to address these two issues. A battery of questionnaires, including the bath adolescent pain questionnaire, was completed by 209 adolescents with chronic pain presenting for an assessment appointment. Results from cluster analyses indicated the presence of four distinct subgroups. Three clusters differed from one another along a single continuum of severity and the fourth was characterized by good family cohesion, moderate emotional difficulties, and significant difficulties with physical functioning. Follow-up analyses indicated significant differences among the clusters across eight of nine measures of functioning including pain intensity, healthcare utilization, school attendance, amount of weekly exercise, depression, disability, social functioning, and catastrophic thinking. A discriminant analysis was able to correctly classify over 95% of participants into the correct cluster. These results provide strong support for the derived four cluster solution, which may be useful in both clinical and research settings, as it allows for individual adolescent pain sufferers to be classified into groupings according to the severity and type of difficulties being experienced. [Copyright &y& Elsevier]

Abstract: Cognitive-behavioral therapy has a substantial evidence base with regard to its effectiveness for individuals with chronic pain. Historically, although there has been some investigation in to the processes by which treatment succeeds or fails, few data are available regarding the unique contributions of processes from distinct cognitive behavioral approaches and how these processes may interact to affect patient functioning. The present investigation sought to evaluate three proposed process variables that have garnered empirical support within chronic pain settings, namely: pain intensity, catastrophizing, and acceptance. Participants were 252 consecutive patients who completed treatment on an interdisciplinary pain management unit. Using multiple regression, the contributions of changes in process variables to changes in treatment outcomes were assessed. In general, changes in both acceptance and catastrophizing accounted for significant variance independent of, and larger than, that accounted for by change in pain intensity. Changes in acceptance and catastrophizing accounted for roughly equivalent amounts of variance when entered immediately following changes in pain, and when entered following one another. The potential impact of these results is discussed in relation to the particular treatment delivered. Issues relating to change at the level of frequency or content of psychological experiences are considered relative to change in the functions of these experiences. [Copyright &y& Elsevier]

Chronic pain and opioid misuse occur in pediatric populations and can be associated with a range of negative adverse outcomes that may persist into adulthood. While the association between chronic pain, opioid prescribing, and opioid-related adverse consequences is reasonably well established in adults, the relation in pediatric patients is not well understood and the long-term impact of opioid exposure during childhood is yet to be fully revealed. The present review draws from the available literature on chronic and acute pediatric pain prevalence and treatment, opioid misuse, and adolescent substance use to address knowns and unknowns of comorbid pediatric chronic pain and opioid misuse. Additionally, gaps in knowledge regarding the prevalence and etiology of co-occurring chronic pain and opioid misuse in youth are identified. Hypothesized, modifiable risk factors associated with both pediatric pain and opioid misuse are considered. Due to a lack of empirically supported integrated treatments for comorbid chronic pain and opioid misuse in youth, this review examines the evidence base and best practices from both the chronic pain and opioid treatment literature to guide treatment recommendations for these comorbid conditions in youth. Recommendations are then provided to promote screening and mitigate risk of chronic pain and opioid misuse across a range of pediatric settings. Lastly, a comprehensive agenda to prevent and treat chronic pain and opioid misuse in adolescents and young adults is discussed. Public Significance Statement: This review draws from the literature on chronic and acute pediatric pain, opioid misuse, and adolescent substance use to summarize knowns and unknowns of comorbid pediatric chronic pain and opioid misuse in order to inform prevention and intervention development for patients with chronic pain who also misuse opioids. [ABSTRACT FROM AUTHOR]