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Background: Fibromyalgia (FM) is characterized by widespread pain, sleep disturbance, negative affect, and stress and is notably difficult to treat. Individuals with FM have lower physical activity and endorse fears that exercise may worsen pain. Gentle daily yoga practice may allow a gradual increase in activity and positively impact many of these FM symptoms. This qualitative study investigated the impact of participation in a pilot trial of group and daily individual home yoga intervention on women with FM. Materials and Methods: Fifteen individuals participated in telephone interviews after participating in the yoga intervention, which included semi-structured questions to elicit insights and impressions of their experience. Responses were systematically coded and themes identified. Results: Five themes were identified: (1) physical/body perceptual changes, (2) practices affecting pain, (3) emotional changes, (4) practice motivators and barriers, and (5) group effect. Participants not only reported reductions in FM symptoms, including pain and stress, but also a positive impact on mood, sleep, and self-confidence. Conclusions: Participants enumerated both physical and psychological impact of starting yoga practice. Specific helpful poses and practices and important barriers were identified. Group practice and social connection with others with other FM patients was an important benefit to participants.

Posttraumatic stress disorder (PTSD) and pain often co-occur, introducing clinical challenges and economic burden. Psychological treatments are considered effective for each condition, yet it is not known which therapies have the potential to concurrently address PTSD and pain-related symptoms.To conduct a systematic review and meta-analysis, databases were searched for articles published between January 2007 and December 2017 describing results from clinical trials of interventions addressing PTSD and pain-related symptoms in adults. Two independent reviewers finalized data extraction and risk of bias assessments. A random-effects model was used for meta-analysis and to calculate pooled and subgroup effect sizes (ESs) of psychological-only (single modality) and multimodal interventions.Eighteen trials (7 uncontrolled, 11 randomized controlled trials, RCTs), totaling 1583 participants, were included in the systematic review. RCT intervention types included exposure-based, cognitive-behavioral, and mindfulness-based therapies. Data from 10 RCTs (N=1, 35) were available for meta-analysis, which demonstrated moderate effect for reduced PTSD severity (ES=-0.55, confidence interval [CI]: -0.83, -0.26) and nonsignificant effect for pain intensity (ES=-0.14, CI: -0.43, 0.15) and pain interference (ES=-0.07, CI: -0.35, 0.20) outcomes. Findings from uncontrolled trials supported meta-analytic results from RCTs. Using GRADE assessment, the quality of evidence was deemed as moderate for RCTs and low for non-RCTs.Findings indicated that the majority of the interventions appeared to have a greater impact on reducing PTSD rather than pain-related symptoms. There remains a need to further develop interventions that consistently impact PTSD and pain-related outcomes when these 2 conditions co-occur.

Patients who reported significant medication-related side effects reported greater activity interference, negative affect, catastrophizing, and opioid misuse risk compared with those with fewer side effects., Background: There is increasing concern among primary care practitioners about the use of opioids for chronic pain, including their adverse effects, but little attention has been given to how reports of side effects from prescription medication can contribute to outcomes among patients with chronic pain. The aim of this study was to investigate the impact of frequently reported side effects on mood, disability, and opioid misuse in patients with chronic pain prescribed opioids within primary care. Methods: Two hundred (N = 200) patients with chronic pain taking opioids for pain were recruited into the study. All patients completed baseline measures and a monthly side effects checklist once a month for 6 months. Patients were divided evenly based on a median split of the number of endorsed side effects over 6 months. The subjects repeated the baseline measures at the end of the study period. Results: Over time, reports of medication side effects tended to decrease, but differences in frequency of reported side effects from baseline to follow-up (6-month time) were not significant, and the order of the frequency of the reported side effects remained similar. Patients who reported significant medication-related adverse effects reported significantly greater activity interference, negative affect, and catastrophizing compared with those with fewer side effects (P < 0.01). In addition, those patients with pain who reported more side effects showed significantly higher scores on opioid misuse risk (P < 0.001). Discussion: This study demonstrates the important role of monitoring medication-related side effects among patients with chronic pain who are prescribed opioid medication for pain within primary care.

Fibromyalgia (FM) is characterized by chronic widespread pain, sleep disturbance, fatigue, and catastrophizing. This pilot study explored whether gentle, daily yoga-based exercise practice could improve pain and sleep quality, and whether certain patient phenotypes were associated with greater improvement. Fibromyalgia patients (n = 36) attended a six-week yoga program, with weekly, in-person, pain-tailored group yoga classes, and were sent daily yoga videos to practice for 30 minutes at home. Participants completed the Brief Pain Inventory (BPI), Revised Fibromyalgia Impact Questionnaire (FIQR), Promis-29 scales, Pittsburgh Sleep Quality Index (PSQI), and the Pain Catastrophizing Scale (PCS). Additionally, they completed daily electronic diaries and wore a wrist actigraph to measure sleep efficiency during 3 weeks, at baseline, 2nd, and 6th week of yoga. Pain, fatigue, and sleep quality, although improved overall, varied among participants. Multilevel modeling analysis of daily ratings in week 6 revealed no main effect for baseline anxiety and catastrophizing on pain, fatigue and sleep efficiency. However, a significant interaction between these was observed for all three outcomes (fatigue: B=.060±.022, p=0.01, sleep efficiency: B=-.40±.015, p = 0.01, pain: B=.055±.020, p=0

Prescription opioid misuse in the USA has become a serious public health concern and has contributed to an opioid crisis. However, how psychosocial factors are associated to opioid misuse remains unclear. In this study we assessed the association between pain catastrophizing and opioid misuse and examined whether mindfulness mediated this association. In this cross-sectional study, participants (291 chronic low back pain (CLBP) completed self-report measures of mindfulness (MAAS), pain (BPI) and opioid misuse (COMM). Pearson's correlations examined the associations between study variables in CLBP patients and controls. Bootstrapping mediation analyses assessed the mediating role of mindfulness on the association between pain catastrophizing and opioid misuse. Pain catastrophizing was significantly associated with mindfulness (r = -.02) and opioid misuse (r = .22) in CLBP patients. Results of mediation analyses revealed that pain catastrophizing mediated the relationship between pain catastrophizing and opioid misuse in CLBP patients (ab = .28, 95% CI = .21 - .35). The findings from this study suggest that mindfulness may be the mechanism by which pain catastrophizing can lead to opioid misuse in CLBP patients prescribed opioids.

Million patients with chronic pain are treated with opioids and chronic low back pain (CLBP) is the top chronic non-cancer condition for which opioids are prescribed. There are very limited data on the psychosocial factors that can lead to opioid misuse. A multiple linear regression model was used to assess the association of opioid misuse (COMM) with pain severity (BPI), pain catastrophizing (PCS), mindfulness (MAAS) and disability (ODI) at baseline among subjects with low back pain (N = 191) prescribed opioids. Controlling for opioid dose, the overall model was significant for perceived disability (F[4, 187] = 25.33; p .05). These results highlight the need to create a clinical profile assessing psychosocial factors (e.g mindfulness, catastrophizing, disability) among chronic pain patients receiving prescribed opioids.

(1) Background: This paper presents a review of the evidence regarding the efficacy and impact of yoga and meditation-based interventions among patients with Rheumatoid Arthritis (RA). Patients who suffer from RA express a variety of symptoms that negatively impact their physical functioning and performance in social roles. Yoga and meditation-based therapies have been previously used to treat chronic pain conditions and other persisting disorders in affected populations. The suitability and effectiveness of these practices in RA should be thoroughly reviewed and assessed to suggest a successful implementation. (2) Methods: Systematic search of highly recognized medical and alternative therapy databases was conducted. Relevant research papers were screened and selected for review based on a strict set of criteria developed by the authors. (3) Results: Thirteen articles were included in the review: nine randomized controlled trials and four single-arm trials. All studies revealed promising outcomes for the effectiveness of meditation-based interventions in RA. Improvements were identified in pain symptoms, joint inflammation, fatigue, disease activity, and numerous psychological parameters. The lack of standardized research procedures made conclusions across studies challenging to compare. (4) Conclusions: Yoga and meditation-based interventions seem to be beneficial for patients who suffer from chronic physical and psychological RA symptoms. Future research assessing the effects of long term practice is needed to determine the suitability of yoga and meditation-based therapies in RA.

The objective of this study was to examine the association between facets of trait mindfulness, pain catastrophizing, and pain severity in a sample of patients with fibromyalgia. Patients with fibromyalgia completed validated baseline and diary assessments of clinical pain, mindfulness, and pain catastrophizing. Multilevel modeling analyses indicated that the daily association between catastrophizing and pain intensity was moderated by certain mindfulness facets. Our findings suggest that various aspects of mindfulness may interact differently with pain and catastrophizing, which may have implications for the design and testing of interventions targeting mindfulness and catastrophizing in fibromyalgia patients.