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The high prevalence of depression among chronic pain populations is well-established: however, treatments for both depression and chronic pain remain only moderately effective. Previous research has indicated that mindfulness is a promising treatment pathway for both depression and chronic pain, however, the mechanisms of change underlying mindfulness are unclear. The purpose of this study was to examine the effects of the mindfulness facets on depression and pain, using two pain measures; severity and interference. One hundred and fifty-eight Australian females and 32 males with chronic pain participated in the study. Higher levels of mindfulness were associated with lower depression as well as lower pain. Path models using depression as a mediator, found that the mindfulness facets observing and describing had a direct effect on pain, while non-judgement, non-reactivity and describing showed indirect effects on pain through depression. Greater effects were seen for pain interference compared to pain severity, highlighting its importance as a potential treatment outcome. Future research should continue to analyse the effects of the mindfulness facets and consider using pain interference as a core treatment outcome. [ABSTRACT FROM AUTHOR]

Chronic pain rehabilitation helps to reduce pain and restore valued life roles. Patients may have more positive outcomes when they perceive rehabilitation to be personally meaningful. This study examined associations between self-reported, personally meaningful rehabilitation and well-being. A pilot study was conducted using an online survey of people with chronic pain and experiences of rehabilitation. The PROMIS Pain Interference Short Form 8a and The Flourishing Scale were used to explore well-being. A modified self-report measure, the Meaningfulness in Rehabilitation Scale, was pilot-tested for construct validity and used in the survey. Of the 48 participants (81% female; 19% male), most attended a generalist therapy practice (62%) once per week (33%) or once per fortnight (29%). No statistically significant relationship was found between self-reported meaningfulness in rehabilitation and pain interference or other patient and therapy characteristics (duration of chronic pain category, type of therapy practice, resolution of rehabilitation category, and frequency of appointments). The nonparametric analysis identified a statistically significant moderate positive correlation between self-reported meaningfulness in rehabilitation and the flourishing aspect of well-being. This raises important questions and suggests that patients' perception of rehabilitation as meaningful warrants further research. This pilot study provides valuable guidance to inform a larger investigation. [ABSTRACT FROM AUTHOR]

Introduction. Patients with chronic pain (CP) are frequent users of general practitioners (GPs). Aim. This study aimed to assess factors associated with the rate of GP visits related to pain in patients with CP. Methods. This study used data collected by adult specialist pain management services (SPMS) that participated in the electronic Persistent Pain Outcomes Collaboration (ePPOC) in Australia. Adult patients (18 years or older) with CP (duration greater than 3 months) who were referred to SPMS from the calendar year 2015–2021 were included (N = 84 829). Results. Patients who reported severe anxiety, stress, pain, pain interference, pain catastrophising and severely impaired pain self-efficacy were more likely to seek help from a GP. Patients with longer pain duration had a lower rate of GP visits. The rate of GP visits was 1.22 (IRR = 1.22, 95% CI: 1.19, 1.26) times higher in patients with severe pain severity, compared to patients with mild pain severity. Patients who used opioids were more likely to visit a GP (IRR = 1.32, 95% CI: 1.30, 1.34) than those who were not using opioids. Discussions. More than half of the adult CP patients had greater than three GP visits in the 3 months before referral. This study would indicate that some patients may attend their GP to seek an opioid prescription. Given the rising use of opioids nationally, future study is required on opioid users’ GP visitation practices. Additionally, the inverse association between pain duration and the rate of GP visits warrants further exploration. [ABSTRACT FROM AUTHOR]

The article focuses on the impact of pain self-management programs (PSMP) on chronic pain in cancer survivors. Topics include improvements in pain interference, mood, and pain self-efficacy among participants, the effectiveness of cognitive behavioral therapy (CBT) techniques, and reductions in opioid use.

Objective Multidisciplinary pain clinics have an established role in the management of persistent pain, but there is little evidence to support this approach in an older population. This study describes the characteristics and pain outcomes of patients attending a pain clinic designed exclusively for older people. Methods A retrospective audit was performed of outcomes of the Pain Clinic for Older People (PCOP) in 2015–2019. Response to treatment was determined by change in Brief Pain Inventory (BPI) scores at initial attendance and after a treatment program. Clinically meaningful improvement was defined by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) consensus criteria of ≥30% improvement in average pain and one-point improvement in pain interference. Results were compared with the national benchmark collated by the electronic Persistent Pain Outcomes Collaboration (ePPOC), which reports the combined results from 67 participating Australian and New Zealand pain services. Results Patients attending the PCOP had a mean age of 80.5 years and had high rates of frailty (84%), cognitive impairment (30%), and multimorbidity. Significant reductions in BPI average pain and BPI pain interference scores were achieved. Clinically meaningful improvement in BPI average pain was achieved in 63% of patients attending the PCOP who were 65–74 years of age and in 46% of patients who were ≥75 years of age, which met the national benchmark set by ePPOC of 40% for both age groups. Clinically meaningful improvement in BPI pain interference was achieved in 69% of those attending the PCOP who were 65–74 years of age and in 66% of those who were ≥75 years of age, comparable to the ePPOC benchmark of 71% and 65% for the respective age groups. Conclusion PCOP clients achieved significant and meaningful improvements in their pain outcomes that satisfied the national benchmark. Advanced age, cognitive impairment, frailty and multimorbidity should not be regarded as barriers to benefit from a pain clinic specifically designed for older people. [ABSTRACT FROM AUTHOR]

Background: There is considerable interest in determining whether later-in-life depression is associated with lifetime history of concussions or the duration of a career in professional contact and collision sports. Rugby league is a high-intensity collision sport involving a large number of tackles per game and a high rate of concussions. We examined predictors and correlates of depression in retired elite level rugby league players in Australia. Methods: Retired elite level rugby league players (N = 141, age: M = 52.6, SD = 13.8; Range = 30–89 years) completed the Depression, Anxiety, and Stress Scale (DASS), Brief Pain Inventory, Connor-Davidson Resilience Scale (CD-RISC), and Epworth Sleepiness Scale; they also reported on lifetime history of concussions. The DASS depression score was regressed on age, total number of self-reported concussions, years played professionally, CD-RISC score, BPI pain interference score, and ESS score. Results: The retired players reported a median of 15 total lifetime concussions [interquartile range (IQR) = 6–30], and a median of 8 years playing professional sports (IQR = 3.5–11). The proportion of the sample endorsing at least mild current depression was 29%. The DASS depression score was positively correlated with the DASS anxiety (r = 0.54) and DASS stress scores (r = 0.58). The CD-RISC score was negatively correlated with the depression score (r = −0.53). Depression scores were not significantly correlated with pain severity (r = 0.14), and were weakly correlated with life interference due to pain (r = 0.20) and years playing professional sports (r = −0.17). Depression scores were not significantly correlated with lifetime history of concussions (r = 0.14). A multiple regression model, with age, total number of self-reported concussions, years played professionally, the CD-RISC, Brief Pain Inventory-pain interference score, and Epworth Sleepiness Scale score as predictors was significant, with 35% of the variance in DASS depression accounted for. The two significant independent predictors of depression were lower resilience and greater life interference due to pain. Conclusions: This is the first large study of depression in retired rugby league players. Depression in these retired players was not meaningfully associated with lifetime history of concussions or number of years playing elite level collision sport. Depression was associated with current anxiety, stress, resilience, and life interference due to chronic pain. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To identify factors associated with psychosocial, physical and practical difficulties of daily living and distress among cancer survivors from a regional area in Australia. Design: Cross‐sectional study. Setting: Riverina region of southern New South Wales. Participants: The sample included 134 patients who completed treatment for breast, colorectal, lung or cancer at the Riverina Cancer Care Centre. Main outcome measures: Distress was assessed by the Distress Thermometer. Psychosocial, physical and practical difficulties of daily living were assessed by the Patient‐Reported Outcomes Measurement Information System questionnaires. Results: A high proportion of cancer survivors had abnormal scores for physical function, sleep disturbance, satisfaction with role, fatigue and pain interference, with many also displaying abnormal scores for anxiety, depression and distress. Survivors living in rural areas and those who had undergone surgery had higher odds of having abnormal scores for sleep disturbance than their counterparts. Living without a partner increased the odds of anxiety and depression. Having advanced disease increased the odds of anxiety and pain. Colorectal cancer and higher education were associated with depression. Conclusion: Monitoring for abnormal physical and psychosocial issues after cancer treatment is essential to maintain or improve psychosocial well‐being during survivorship. When developing survivorship care plans for patients residing in regional centres, health professionals should consider availability of high‐quality and accessible support services in regional areas of Australia. [ABSTRACT FROM AUTHOR]

To validate the Period ImPact and Pain Assessment (PIPPA) self-screening tool for menstrual disturbance in teenagers. Cross-sectional study. Three senior high schools in the Australian Capital Territory (ACT), Australia. A total of 1066 girls between 15 and 19 years of age. A quantitative paper survey collected self-reports of menstrual bleeding patterns, typical and atypical symptoms, morbidities, and interference with daily activities. Multiple correspondence analysis was used to examine associations between PIPPA questions. Generalized linear models compared total score and subscores by validation criteria: pain, school absence, and body mass index (BMI). Receiver operating characteristic curves were used to evaluate the predictiveness of menstrual disturbance indicators by total PIPPA score. Reports of pain, interference, and concern within the PIPPA items and between both the MDOT and PIPPA questionnaires were significantly correlated (P <.0001). The indicator "missing school" was highly associated (P <.0001) with pain and interference. Obesity (BMI ≥30) was associated with higher PIPPA scores, as was underweight (BMI≤18.4). Where 0 = no disturbance, 5 = high disturbance, aggregated PIPPA scores found 75% scoring 0-2 (out of 5) and 25% scoring 3-5 (257/1037). High scores of 4 or 5 (out of 5) were 7% (72/1037) and 3.7% (38/1037), respectively. PIPPA is a valid screening tool for pain-related menstrual disturbance that affects functioning in young women. PIPPA subdomains of pain/interference have good validity relative to indicators of pain and interference and are responsive to age, BMI, and school absence differences. [ABSTRACT FROM AUTHOR]

Background Pain on the day after caesarean section is often treated with controlled-release oxycodone to supplement the decline in analgesia from intrathecal opioids. Evidence suggests that caesarean birth is a biopsychosocial experience where a comprehensive approach is needed that promotes control and participation in pain management. Objectives This study compared immediate-release oxycodone integrated with supportive educational strategies to controlled-release oxycodone. A follow-up phase aimed to explore pain over three months. Design This study was a two-group parallel randomised controlled trial. Setting A metropolitan hospital in Australia with a birthing suite, operating rooms, and a postnatal unit. Participants English-speaking women scheduled for elective caesarean section were mailed trial information. Exclusion criteria included contraindications to intrathecal analgesia, herpes simplex infection, a history of chronic pain, opioid tolerance, or substance abuse. A total of 131 participants were recruited and randomised out of 298 eligible participants. Methods Group allocation was undertaken using sequentially numbered opaque sealed envelopes. The nurse practitioner intervention commenced on the day after surgery with immediate-release oxycodone alongside supportive strategies. The control group received scheduled doses of controlled-release oxycodone. All participants could request additional oxycodone or tramadol. Primary outcomes were pain intensity and secondary outcomes included patient global impression of change, pain interference, opioid consumption, and maternal perception of control. A follow-up phase evaluated pain outcomes over three months. Results The final sample size was 122, with 61 participants in each group. Pain intensity scores were analysed by linear mixed regression models. There were no statistical differences over 24 h between the control and intervention groups at rest ( p = 0.40, 95% CI – 4.8 mm, 11.9 mm) or on sitting or moving ( p = 0.561, 95% CI –15.2 mm, 8.3 mm). Patient global impression of change was significant over three hours ( p = 0.014, OR = 2.5, 95% CI 1.2, 5.3). The intervention group reported less pain interference while consuming less oxycodone ( p < 0.05). There was no difference between groups in terms of perceived control over pain management ( p = 0.273, 95% CI –16.2 mm, 4.6 mm). The follow-up analysis graded 5.9% of participants as experiencing severe pain interference. Chronic pain following caesarean was associated with postnatal depression ( p < 0.001). Conclusions The research showed that a nurse practitioner intervention can improve pain management following caesarean section. The results underscore the influence of biological, psychological, and social factors on acute pain. Hence, this study reinforces the need for a biopsychosocial approach to acute pain management following caesarean delivery. [ABSTRACT FROM AUTHOR]

There is a high prevalence of persistent pain following SCI yet insights into its impact and the quality of pain care are limited. We aimed to explore, in-depth, the problem of persistent pain in Australian community-dwelling adults with a spinal cord injury (SCI). Our objectives were to investigate (i) how individuals experience persistent pain, (ii) how they experience pain care and (iii) the concordance between clinical practice guidelines for managing pain and reported care practices. We conducted a mixed-methods convergent parallel study. Adults with SCI and persistent pain completed a survey (n = 43); a subset of participants completed interviews (n = 10). We analysed the data from each method separately and then integrated the findings. Results indicated that the life impact of persistent pain is variable but it can be more disabling than physical impairments and compound a sense of isolation and despair. Community-based management was reported to predominantly have a pharmacological focus, with occurrences of opioid misuse apparent in the data. Access to expert, comprehensive and individualised care was frequently reported as inadequate. While some people with SCI and persistent pain can effectively self-manage their pain, for others the impact on quality of life is profound and complex care needs are commonly unmet. Persistent pain is a common consequence of SCI and profoundly impacts quality of life. Complex pain care needs are commonly unmet. Individuals require regular, comprehensive, biopsychosocial assessment. The effectiveness of pain management strategies must be monitored on an ongoing basis. Opportunities for personal self-management support must be available long-term. [ABSTRACT FROM AUTHOR]

Objective Metaphor, frequently used in chronic pain, can function as a communicative tool, facilitating understanding and empathy from others. Previous research has demonstrated that specific linguistic markers exist for areas such as pain catastrophizing, mood, as well as diagnostic categories. The current study sought to examine potential associations between the types of pain metaphors used and diagnostic category, disability, and mood. Design Online cross-sectional survey in Sydney, Australia. Subjects People with chronic pain (n = 247, age 19–78 years, M  = 43.69). Methods The data collected included demographics, pain metaphors, the Brief Pain Inventory (BPI) and the Depression, Anxiety, and Stress Scales (DASS-21). Associations between metaphor source domains, obtained via Systematic Metaphor Analysis, and scores on the BPI, DASS-21, as well as diagnostic group were considered using binary logistic analysis. Results Use of different pain metaphors was not associated with pain intensity, however the extent to which pain interfered with daily life did have a relationship with use of metaphorical language. Preliminary support was found for an association between the use of certain pain metaphors and self-reported diagnostic categories, notably Endometriosis, Complex Regional Pain Syndrome, and Neuropathic pain. Conclusions There may be specific linguistic metaphorical markers to indicate pain interference and for particular diagnoses. Appreciation of pain metaphors has potential to facilitate communication and enhance understanding in interactions between clinicians and people with chronic pain. [ABSTRACT FROM AUTHOR]

Abstract: Although multimodal management of chronic noncancer pain (CNCP) is recommended, long-term treatment utilization patterns among people using opioids are not well known. The Pain and Opioids IN Treatment study recruited Australian adults receiving opioids for CNCP for more than 6 weeks from community pharmacies. Pharmacological (opioid and nonopioid analgesics and psychotropic medicines) and nonpharmacological (physical, mental health, and specialized) treatments used in the previous 12 months and 30 days were collected annually over 4 years (2015-2018). Associations were explored between 30-day treatment use and sociodemographic characteristics and pain measures. Overall, 1334 participants completed at least one annual follow-up. The median pain severity (5.0, interquartile range [IQR] 3.8 to 6.3) and pain interference scores (5.7, IQR 3.9-7.3) indicated moderate pain throughout the study period, despite most participants reporting the use of nonopioid pharmacological (12 month: 97.6% and 30 day: 96.8%) and nonpharmacological treatments (12 month: 91.8% and 30 day: 66.1%). Some treatment use was inconsistent with guidelines: ongoing nonsteroidal anti-inflammatory drugs and sedative-hypnotic use were common, whereas fewer people engaged with pain management programs (12 month: 22.3%). Private health insurance was associated with using physical (adjusted odds ratio 1.61, 99.5% confidence intervals 1.15-2.24) and specialized nonpharmacological treatments (adjusted odds ratio 1.47, 99.5% confidence intervals 1.14-1.91). This study demonstrates that many Australians taking opioids long-term for CNCP also use nonopioid pharmacological and nonpharmacological treatments. The use of pharmacological treatments including nonsteroidal anti-inflammatory drugs, psychotropic medicines, and gabapentinoids, outside guidelines, warrants review. Furthermore, despite Australia's universal healthcare scheme subsidising some nonpharmacological treatments, overall use of these treatments was associated with having private health insurance, highlighting a need for more equitable service provision. [ABSTRACT FROM AUTHOR]

Metabolic-associated fatty liver disease (MAFLD) is the most prevalent chronic liver disease worldwide, affecting 25% of people globally and up to 80% of people with obesity. MAFLD is characterised by fat accumulation in the liver (hepatic steatosis) with varying degrees of inflammation and fibrosis. MAFLD is strongly linked with cardiometabolic disease and lifestyle-related cancers, in addition to heightened liver-related morbidity and mortality. This position statement examines evidence for exercise in the management of MAFLD and describes the role of the exercise professional in the context of the multi-disciplinary care team. The purpose of these guidelines is to equip the exercise professional with a broad understanding of the pathophysiological underpinnings of MAFLD, how it is diagnosed and managed in clinical practice, and to provide evidence- and consensus-based recommendations for exercise therapy in MAFLD management. The majority of research evidence indicates that 150–240 min per week of at least moderate-intensity aerobic exercise can reduce hepatic steatosis by ~ 2–4% (absolute reduction), but as little as 135 min/week has been shown to be effective. While emerging evidence shows that high-intensity interval training (HIIT) approaches may provide comparable benefit on hepatic steatosis, there does not appear to be an intensity-dependent benefit, as long as the recommended exercise volume is achieved. This dose of exercise is likely to also reduce central adiposity, increase cardiorespiratory fitness and improve cardiometabolic health, irrespective of weight loss. Resistance training should be considered in addition to, and not instead of, aerobic exercise targets. The information in this statement is relevant and appropriate for people living with the condition historically termed non-alcoholic fatty liver disease (NAFLD), regardless of terminology. [ABSTRACT FROM AUTHOR]

Background: The factors that influence transition from suicidal ideation to a suicide attempt or remission of suicidal thoughts are poorly understood. Despite an abundance of research on risk factors for suicidal ideation, no large-scale longitudinal population-based studies have specifically recruited people with suicidal ideation to examine the mechanisms underlying critical transitions to either suicide attempt or recovery from suicidal ideation. Without longitudinal data on the psychological, behavioural, and social determinants of suicide attempt and the remission of suicidal ideation, we are unlikely to see major gains in the prevention of suicide. Aim: The LifeTrack Project is a population-based longitudinal cohort study that aims to identify key modifiable risk and protective factors that predict the transition from suicidal ideation to suicide attempt or remission of suicidal ideation. We will assess theory-informed risk and protective factors using validated and efficient measures to identify distinct trajectories reflecting changes in severity of suicidal ideation and transition to suicide attempt over three years. Methods: A three-year prospective population-based longitudinal cohort study will be conducted with adults from the general Australian population who initially report suicidal ideation (n = 842). Eligibility criteria include recent suicidal ideation (past 30 days), aged 18 years or older, living in Australia and fluent in English. Those with a suicide attempt in past 30 days or who are unable to participate in a long-term study will be excluded. Participants will be asked to complete online assessments related to psychopathology, cognition, psychological factors, social factors, mental health treatment use, and environmental exposures at baseline and every six months during this three-year period. One week of daily measurement bursts (ecological momentary assessments) at yearly intervals will also capture short-term fluctuations in suicidal ideation, perceived burdensomeness, thwarted belongingness, capability for suicide, and distress. Conclusion: This study is intended to identify potential targets for novel and tailored therapies for people experiencing suicidal ideation and improve targeting of suicide prevention programs. Even modest improvements in current treatments may lead to important reductions in suicide attempts and deaths. Study Registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12623000433606. [ABSTRACT FROM AUTHOR]

Purpose: Many generic patient-reported instruments are available for the measurement of health outcomes, including EQ-5D-5L, and the Patient-Reported Outcome Measurement Information System (PROMIS). Assessing their measurement characteristics informs users about the consistency between, and limits of, evidence produced. The aim was to assess the measurement relationship between the EQ-5D-5L descriptive system and value sets, the PROMIS-29 and PROPr (PROMIS value set). Methods: Data were extracted from a cross-sectional survey administering measures of quality of life online in Australia. Descriptive analysis, agreement and construct validity assessment methods were used to compare instruments at the item, domain and value set level. Results: In total, 794 Australians completed the survey. Convergent validity analysis found that similar dimensions across instruments were highly correlated (> 0.50), but the PROMIS-29 assesses additional health concepts not explicitly covered by EQ-5D (sleep and fatigue). Known-group assessment found that EQ-5D-5L and PROPr were able to detect those with and without a condition (ES range 0.78–0.83) but PROPr could more precisely detect differing levels of self-reported health. Both instruments were sensitive to differences in levels of pain. Discussion: There is some consistency in what the EQ-5D-5L, PROMIS-29 and PROPr measure. Differences between value set characteristics can be linked to differences what is measured and the valuation approaches used. This has implications for the use of each in assessing health outcomes, and the results can inform decisions about which instrument should be used in which context. [ABSTRACT FROM AUTHOR]

Background: Collecting data using paediatric health-related quality of life (HRQoL) instruments is complex, and there is a paucity of evidence regarding the comparative performance of paediatric HRQoL instruments. The Australian Paediatric Multi-Instrument Comparison (P-MIC) study was conducted to address this paucity of evidence. This study aims to understand the (1) feasibility of collecting data using paediatric HRQoL instruments in a research setting and (2) acceptability and feasibility for children and their caregivers to complete common paediatric HRQoL instruments using data from the Australian P-MIC study. Methods: Data were from children aged 5–18 years from the Australian P-MIC study. Demographics, cost and time for data collection, dropout rates, and inconsistent responses were used to assess Aim 1. Participant-reported difficulty and completion time were used to assess Aim 2. Subgroup analyses included child age, report type (self/proxy), sample recruitment pathway (hospital/online), and online panel sample type (general population/condition groups). Results: Overall, 5945 P-MIC participants aged 5–18 years completed an initial survey, of these, 2346 also completed the follow-up survey (39.5% response rate). Compared with online panel recruitment, hospital recruitment was more costly and time-consuming and had higher follow-up completion (33.5% versus 80.4%) (Aim 1). Data were of similar good quality (based on inconsistent responses) for both recruitment pathways (Aim 1). Participants completed each instrument in <3 min, on average, and >70% reported each instrument as easy to complete (Aim 2). Conclusions: The Australian P-MIC study was able to collect good-quality data using both online panel and hospital recruitment pathways. All instruments were acceptable and feasible to children and their caregivers. [ABSTRACT FROM AUTHOR]

Background: Pain at multiple sites is prevalent among older people. However, studies investigating the relationship between pain and falls focus largely on single‐site pain. Aim: To examine the association between pain at multiple sites and falls among community‐dwelling older Australians. Methods: Participants aged >60 years were randomly selected from the electoral roll. Falls were recorded prospectively over 12 months. Pain at multiple sites was assessed using a questionnaire. The total number of painful sites was calculated. Widespread pain was defined as pain in the upper limb, lower limb and in the axial skeletal region, with moderate to severe pain in at least one region. Log multinomial regression, with adjustment for confounders, was used to estimate whether widespread pain or number of painful sites increased the risk of a single (one fall) and multiple falls (≥2 falls). Results: There were 299 participants (43% women; mean age 72 ± 7.0 years). The mean (standard deviation) of falls was 0.8 ± 1.5. The frequencies of single and multiple falls were 23% (n = 68) and 16% (n = 49) respectively. A higher number of painful sites was associated with an elevated risk of a single fall (relative risk (RR) = 1.08; 95% confidence interval (CI): 0.96–1.27) and multiple falls (RR = 1.20; 95% CI: 1.02–1.41). However, the risk of multiple, but not single fall was substantial and statistically significant. Furthermore, compared with those without pain, individuals with widespread pain had an elevated risk of single (RR = 1.87; 95% CI: 0.80–5.09) and multiple falls (RR = 3.94; 95% CI: 1.15–13.51). However, the magnitude of effects of single fall was smaller and not statistically significant. Conclusions: Falls risk should be ascertained for older people with pain, irrespective of whether they present with a single or multiple sites pain. Nevertheless, older adults with multisite pain may require additional attention as they appear to have a significantly elevated risk of multiple falls. [ABSTRACT FROM AUTHOR]

Introduction: Globally, chronic pain affects more than 30% of people worldwide and is the leading cause of disability and health care utilisation. Access to timely, person-centred, cost-effective programs is unattainable for most. People living in regional, rural and remote areas are disproportionately affected due to scarcity of services and qualified, multidisciplinary health and medical professionals. Caring and supporting people with chronic pain involves a range of interventions that incorporate a multifaceted bio-psychosocial approach. Tertiary and primary chronic pain services are optimally placed to deliver integrated models of care. This pilot study explored the effectiveness of an integrated Guided Self-Help (GSH) program within a multidisciplinary tertiary pain unit in a public hospital in Australia. Methods: A service delivery evaluation was undertaken and a pilot study implemented to determine feasibility and useability of an integrated GSH program for people with chronic pain. A single-group pre–post evaluation was provided to a convenience sample of 42 people referred to the Flinders Medical Centre Pain Management Unit (FMC PMU). Delivered via telehealth or in person by postgraduate students, a manualised GSH workbook was utilised to support adherence and fidelity. Content included goal setting, pain conceptualisation, psychoeducation, activity scheduling, pacing and cognitive strategies. The purpose of the integrated GSH pilot program was to support participants in gaining increased pain literacy, knowledge of effective physical and psychological strategies and enhance self-management of their chronic pain. Levels of psychological distress (PHQ-9 and GAD-7), pain catastrophising (PCS), and pain severity/interference (BPI) were assessed at the beginning and end of support. Integrating the program within a multidisciplinary pain unit intended to facilitate and provide participants with an understanding of their pain through a psychosocial lens, build self-efficacy, and recognise the benefits of other non-medical supports to manage their chronic pain in the future. Outcome data were routinely collected as part of FMC PMU usual practice for clinical and quality assurance purposes, then analysed retrospectively. Thus, under the National Health and Medical Research Council (NHMRC) Ethical Considerations in Quality Assurance and Evaluation Activities guidelines (NHMRC, 2014), and verified by the Southern Adelaide Local Health Network (SALHN) Research Committee (our institutional review board) via email (dated 10/09/2020), ethical review and approval were not required for this project as it constituted a quality improvement activity – specifically, a service delivery evaluation. This project is registered with the SALHN Quality Library (for quality assurance activities that are exempt from ethical approval) (Quality Register ID 3390). Results: Participants showed statistically significant improvements on the PHQ-9 [i.e., mean drop of 2.85 (t = 3.16)], GAD [mean drop of 2.52 (t = 2.71)], and PCS [mean drop of 7.77 (t = 3.47)] with small-to-moderate effect sizes. BPI scores did not change. Results were similar when stratifying analyses by those who completed 2–5 versus 6–12 sessions. Conclusion: Integrating a GSH program for people with chronic pain into a multidisciplinary tertiary pain clinic is an efficacious and scalable way to increase access to effective strategies that can increase self-efficacy and self-management. Novel, scalable, and effective solutions are needed to improve quality of life and address disparities for people with chronic pain. The psychological shifts and benefits observed support efficacy towards self-management strategies that can increase autonomy and quality of life. Plain Language Summary: Globally, chronic pain affects more than 30% of people worldwide and is the leading cause of disability and healthcare use. Access to available, effective, and individualised programs is unattainable. People living in regional, rural and remote areas are disproportionately affected due to scarcity of services and qualified, multidisciplinary health and medical professionals. Scalable solutions are needed to increase access to effective, evidence-based care options and reduce inequities for people with chronic pain. Caring and supporting people with chronic pain requires effective, multifaceted bio-psychosocial approaches that are tailored to individual needs. Using 'coaches', a manualised Guided Self-Help (GSH) program was integrated within a multidisciplinary tertiary pain unit in a public hospital in Australia, which showed promising solutions to increasing access and availability of timely, cost-effective supports that can be delivered via mobile devices. This pilot study explored the effectiveness of offering a GSH program to people with chronic pain integrated into a hospital-based, public, pain management unit to see if it increased people's understanding of their pain and strategies that would support self-management. Coaches working in multidisciplinary teams can support people with information and strategies for their chronic pain, which can free up higher-trained health and medical professionals to care for people with greater complexity and ensure that timely access to support is received by matching need to level and type of support. [ABSTRACT FROM AUTHOR]

Inconsistent and inadequate pain assessment practices in cerebral palsy (CP) have resulted from a lack of standardisation of pain assessment, limited use of appropriate tools and failure to integrate disability and biopsychosocial models. To assist with improving consistency, this study aimed to establish consensus from key stakeholders regarding domains considered essential for measuring chronic pain in children and young people with CP. A modified electronic Delphi study was conducted on 83 stakeholders, including clinicians, researchers, people with CP and parents of children with CP. Participants rated 18 domains sourced from existing literature as either "core", "recommended", "exploratory" or "not required". After two rounds of surveys, 12 domains were considered core: pain location, pain frequency, pain intensity, changeable factors, impact on emotional wellbeing, impact on participation, pain communication, influence on quality of life, physical impacts, sleep, pain duration and pain expression. These domains reflect the complexity of pain in a heterogeneous population where medical comorbidities are common and communication and intellectual limitations impact significantly on the ability of many to self-report. The domains will be utilised to build a framework of pain assessment specific to children and young people with CP guided by the biopsychosocial model. Chronic pain is under-identified and poorly assessed in the cerebral palsy (CP) population. The perspectives of clinicians, researchers and consumers are vital for developing a framework for chronic pain assessment in CP. Consensus of key stakeholders found 12 domains considered essential to incorporate into a chronic pain assessment model in CP. [ABSTRACT FROM AUTHOR]

Background: Low back pain is the largest cause of years lived with a disability in Australia, and there is an urgent need for innovations to address global gaps between evidence and practice. Methods: This study was a phase 1, single-group, pre–post pilot trial of My Back My Plan, a primary care program for acute low back pain. The trial was conducted at MQ Health Primary Care at Macquarie University in Sydney, Australia. The primary outcomes were feasibility and acceptability. Results: Fourteen participants were recruited to the study, with 79% and 93% followed up at 1 and 3 months respectively. Ten general practitioners and four physiotherapists at MQ Health Primary Care delivered the intervention. Although the rate of patient recruitment to the trial was low, other aspects of feasibility (such as intervention adherence and safety) were high. Participating clinicians reported that the program was useful for patients, and the majority stated that the program facilitated person-centred care. Patients rated My Back My Plan as highly acceptable, indicating that they had a better understanding of their low back pain, they were given personalised care and were more confident in self-managing their low back pain. At the 3 month follow-up, 85% of participants stated they were very likely to recommend the program to others. Conclusions: This study suggests that the co-designed, contextually refined MBMP program for MQ Health Primary Care is acceptable to people with acute onset low back pain and warrants further evaluation. Low back pain is the largest cause of years lived with a disability in Australia, and there is an urgent need for innovations to address global gaps between evidence and practice. Our study evaluated the feasibility and acceptability of My Back My Plan, a primary care program for acute low back pain. My Back My Plan facilitates delivery of person-centred care and was rated as highly acceptable to people with acute onset low back pain, and thereby warrants further evaluation. [ABSTRACT FROM AUTHOR]

Background There is increasing debate about cannabis use for medical purposes, including for symptomatic treatment of chronic pain. We investigated patterns and correlates of cannabis use in a large community sample of people who had been prescribed opioids for chronic non-cancer pain. Methods The POINT study included 1514 people in Australia who had been prescribed pharmaceutical opioids for chronic non-cancer pain. Data on cannabis use, ICD-10 cannabis use disorder and cannabis use for pain were collected. We explored associations between demographic, pain and other patient characteristics and cannabis use for pain. Results One in six (16%) had used cannabis for pain relief, 6% in the previous month. A quarter reported that they would use it for pain relief if they had access. Those using cannabis for pain on average were younger, reported greater pain severity, greater interference from and poorer coping with pain, and more days out of role in the past year. They had been prescribed opioids for longer, were on higher opioid doses, and were more likely to be non-adherent with their opioid use. Those using cannabis for pain had higher pain interference after controlling for reported pain severity. Almost half (43%) of the sample had ever used cannabis for recreational purposes, and 12% of the entire cohort met criteria for an ICD-10 cannabis use disorder. Conclusions Cannabis use for pain relief purposes appears common among people living with chronic non-cancer pain, and users report greater pain relief in combination with opioids than when opioids are used alone. [ABSTRACT FROM AUTHOR]

Aim: To evaluate and document the impacts of re-scheduling codeine to a prescriptiononly medication in Australia in February 2018. Design: Prospective cohort study. Participants completed an on-line survey with a range of outcome measures at four time-points, once before codeine was re-scheduled (November 2017) and three times after the event: 1 month after (February 2018), 4 months after (June 2018) and 12 months after (February 2019). Setting: Australia. Participants: Participants were 260 Australians aged 18 years and above who reported regular over-the-counter (OTC) codeine use and, at the time of the study, were not engaged in treatment for codeine dependence. Measurements: Survey measures included estimates of daily average codeine use (mg) and overall daily average opioid use [calculated using an oral morphine equivalent daily dose (OMEDD, mg)], opioid use disorder with regard to codeine use (using a modified Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV), pain and pain self-efficacy, anxiety and depression and health service use. Findings: A reduction in total daily codeine use (mg) from 64.3 mg [95% confidence interval (CI) = 46.7-81.9] in November 2017 (baseline) to 27.6 mg (95% CI = 19.2-36.0) in February 2019 (final time-point) was observed. A decline in the proportion of participants who met criteria for an opioid use disorder was also evident, with 51.2% (n = 133) at baseline relative to 33.3% (n = 58) at the 12-month follow-up. This study had an overall participant retention rate of 67% at the final time-point. Conclusion: Re-scheduling codeine in Australia has been accompanied by significant reductions in codeine use and prevalence rates of opioid use disorder in a cohort of individuals who regularly use the medication, without apparent adverse impacts on pain or measures of anxiety and depression. [ABSTRACT FROM AUTHOR]

Background: Pain is a common, debilitating, and feared symptom, including among cancer survivors. However, large-scale population-based evidence on pain and its impact in cancer survivors is limited. We quantified the prevalence of pain in community-dwelling people with and without cancer, and its relation to physical functioning, psychological distress, and quality of life (QoL)., Methods: Questionnaire data from participants in the 45 and Up Study (Wave 2, n = 122,398, 2012-2015, mean age = 60.8 years), an Australian population-based cohort study, were linked to cancer registration data to ascertain prior cancer diagnoses. Modified Poisson regression estimated age- and sex-adjusted prevalence ratios (PRs) for bodily pain and pain sufficient to interfere with daily activities (high-impact pain) in people with versus without cancer, for 13 cancer types, overall and according to clinical, personal, and health characteristics. The relation of high-impact pain to physical and mental health outcomes was quantified in people with and without cancer., Results: Overall, 34.9% (5,436/15,570) of cancer survivors and 31.3% (32,471/103,604) of participants without cancer reported bodily pain (PR = 1.07 [95% CI = 1.05-1.10]), and 15.9% (2,468/15,550) versus 13.1% (13,573/103,623), respectively, reported high-impact pain (PR = 1.13 [1.09-1.18]). Pain was greater with more recent cancer diagnosis, more advanced disease, and recent cancer treatment. High-impact pain varied by cancer type; compared to cancer-free participants, PRs were: 2.23 (1.71-2.90) for multiple myeloma; 1.87 (1.53-2.29) for lung cancer; 1.06 (0.98-1.16) for breast cancer; 1.05 (0.94-1.17) for colorectal cancer; 1.04 (0.96-1.13) for prostate cancer; and 1.02 (0.92-1.12) for melanoma. Regardless of cancer diagnosis, high-impact pain was strongly related to impaired physical functioning, psychological distress, and reduced QoL., Conclusions: Pain is common, interfering with daily life in around one-in-eight older community-dwelling participants. Pain was elevated overall in cancer survivors, particularly for certain cancer types, around diagnosis and treatment, and with advanced disease. However, pain was comparable to population levels for many common cancers, including breast, prostate and colorectal cancer, and melanoma., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: This protocol describes a study of the effectiveness of cognitive behaviour therapy (CBT) for reducing depressive symptoms in older adults living in residential aged care (RAC) facilities in Australia. Depressive symptoms are highly prevalent in this population, yet the benefits of CBT for reducing such symptoms in RAC facilities have not been widely investigated. Elders at Ease (ELATE) is a 16-session CBT intervention designed for implementation in RAC facilities. The intervention includes cognitive, behavioural and reminiscence strategies and is delivered by mental health trainees (MHTs) in collaboration with RAC facility staff and residents' family., Methods and Analysis: ELATE will be evaluated using a cluster randomised trial comparing outcomes for residents who participate in the intervention with those living in usual care control facilities. The participants are RAC residents aged 65 years or above, with depressive symptoms (Patient Health Questionnaire-2 ≥ 3) and normal cognition or mild cognitive impairment (Standardised Mini Mental Status Examination ≥ 21). They are assessed at four time points: baseline prior to randomisation (T1), mid-treatment (T2; 2.5 months post randomisation), post-treatment (T3; 5 months post-randomisation) and 3-month follow-up (T4; 8 months post randomisation). The primary outcome is change in depressive symptoms between T1 and T3. Secondary outcomes are depressive symptoms at T4, anxiety, suicide ideation, sleep problems, quality of life, staff and family knowledge of late-life depression, stress levels and efficacy in caring for residents, and MHT levels of geropsychology competencies. Residents receiving the intervention are hypothesised to report a greater decrease in depressive symptoms between T1 and T3 compared to residents receiving usual care. The primary analysis is a regression, clustered over site to account for correlated readings, and independent variables are condition and depressive symptoms at T1. A cost-utility analysis is also undertaken., Discussion: ELATE is a comprehensive CBT intervention for reducing depressive symptoms in RAC residents. It is designed to be implemented in collaboration with facility staff and residents' families, individually tailored to residents with normal cognition to mild cognitive impairment and delivered by trainee therapists. ELATE offers a model that may be widely applicable across the RAC sector., Trial Registration: Trial registered with the Australian and New Zealand Clinical Trial Registry (ANZCTR) Number ACTRN12619001037190, prospectively registered on 22 July 2019., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective: Rugby league is an international full-contact sport, with frequent concussive injuries. Participation in other full-contact sports such as American football has been considered to be a risk factor for neuropsychiatric sequelae later-in-life, but little research has addressed the mental and cognitive health of retired professional rugby league players. We examined predictors and correlates of perceived (self-reported) cognitive decline in retired National Rugby League (NRL) players. Methods: Participants were 133 retired male elite level rugby league players in Australia. Participants completed clinical interviews, neuropsychological testing, and self-report measures. The Informant Questionnaire on Cognitive Decline in the Elderly, self-report (IQCODE-Self), measured perceived cognitive decline. Results: The median age of the sample was 55.0 (M = 53.1, SD = 13.9, range = 30–89) and the median years of education completed was 12.0 (M = 11.9, SD = 2.6, range = 7–18). The retired players reported a median of 15.0 total lifetime concussions (M = 28.0, SD = 36.6, range = 0–200). The mean IQCODE-Self score was 3.2 (SD = 0.5; Range = 1.3–5.0); 10/133 (7.5%) and 38/133 (28.6%) scored above conservative and liberal cutoffs for cognitive decline on the IQCODE-Self, respectively. Perceived cognitive decline was positively correlated with current depressive symptoms, negatively correlated with years of professional sport exposure and resilience, and unrelated to objective cognition and number of self-reported concussions. A multiple regression model with perceived cognitive decline regressed on age, concussion history, professional rugby league exposure, depression, resilience, objective cognitive functioning, daytime sleepiness, and pain severity showed depression as the only significant predictor. Conclusion: This is the first large study examining subjectively experienced cognitive decline in retired professional rugby league players. Similar to studies from the general population and specialty clinics, no relationship was found between objective cognitive test performance and perceived cognitive decline. Depressive symptoms emerged as the strongest predictor of perceived cognitive decline, suggesting that subjective reports of worsening cognition in retired elite rugby league players might reflect psychological distress rather than current cognitive impairment. [ABSTRACT FROM AUTHOR]

To explore the self-perceived preparedness and clinical proficiency in headache diagnosis and management of Australian chiropractic students in senior years of study. Australian chiropractic students in the 4th (n = 134) and 5th year (n = 122) of 2 chiropractic university programs were invited to participate in an online cross-sectional survey. Descriptive analyses were conducted for all variables. Post hoc analyses were performed using simple linear regression to evaluate the relationship between self-perceived preparedness and correctness of headache diagnosis and management scores. Australian chiropractic students in senior years demonstrated moderate overall levels of self-perceived preparedness and proficiency in their ability to diagnose and manage headache disorders. Final-year students had a slightly higher self-perceived preparedness and proficiency in headache diagnosis and management compared to those students in the 4th year of study. There was no relationship between self-perceived preparedness and correctness of headache diagnosis and management for either 4th- or 5th-year chiropractic students. Our findings suggest that there may be gaps in graduate chiropractic student confidence and proficiency in headache diagnosis and management. These findings call for further research to explore graduate chiropractic student preparedness and proficiency in the diagnosis and management of headache disorders. [ABSTRACT FROM AUTHOR]

Background: The objective is to determine whether body mass index is associated with patient-reported expectations and well-being before primary total hip or total knee arthroplasty, and patient-reported outcomes 6 months after surgery., Methods: Data were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Outcome measures included pre-operative expectations for post-operative mobility, joint pain and health, pre- and post-operative EQ-5D-5L, EQ-VAS, Oxford Hip/Knee Scores and joint pain scales, and post-operative perceived change and perceived satisfaction. Associations with BMI were assessed using chi-square tests, analysis of variance and Linear Mixed Models equations., Results: Data were available for 12 816 primary THA patients and 20 253 primary TKA patients. Pre-operatively, patients in higher BMI categories were significantly more likely to expect ongoing problems with mobility, more joint pain and poorer health following surgery (P<0.01 for all analyses). For arthroplasty patients, higher BMI was associated with poorer pre-operative and post-operative scores for all measures. BMI was positively associated with improvements in EQ-5D, OHS/KS and joint pain. While between-group differences were statistically significant, many were small in magnitude. There was no association between BMI and patient-perceived change or satisfaction after arthroplasty., Conclusion: Patients undergoing THA/TKA, higher BMI was associated with lower pre-operative expectations, poorer well-being before surgery, and worse scores after surgery. Patients who were obese demonstrated comparable satisfaction with their operated joint, compared with non-obese patients. BMI was associated with greater pre- to post-operative improvements in outcome scores for EQ-5D, VAS knee, OHS/OKS and joint pain but these differences may not be clinically important., (© 2023 Royal Australasian College of Surgeons.)

Background: Endometriosis is the presence of tissue similar to that of the endometrium outside the uterine cavity and is the most common cause of chronic pelvic pain. Current non-surgical treatments such as non-steroidal anti-inflammatories, oral contraceptive pills and hormonal treatments have limited effectiveness, and the side effect profile is bothersome. This study will evaluate the efficacy of Gynoclear™ by change in endometriosis-related pain based on the Endometriosis Pain Daily Diary (EPPD) scores.Methods: This randomised, double-blind, placebo-controlled trial will recruit a minimum of 90 adult participants across Australia who have a laparoscopic visualisation/confirmation of endometriosis in the last 5 years and have current moderate or greater pelvic pain. Participants will be randomly allocated in a 1:1 ratio to receive either Gynoclear™ (active) or placebo. Gyncolear's active ingredients are Carthamus tinctorius (Safflower), Cinnamomum cassia (Chinese cinnamon), Poria cocos (Hoelen), Paeonia suffriticosa (Tree peony), Paeonia lactiflora (Peony) and Salvia miltiorrhiza (Red sage). Participants are asked to complete a total of 5 months' worth of pain diary entries via the EPDD v3, including 1-month screening, 2-month treatment period and 1-month post-treatment follow-up. The primary outcome variable is change in endometriosis-related pain based on the EPDD v3 scores. Secondary outcomes include change in health-related quality of life via the Endometriosis Health Profile (EHP-30), SF-12 and EQ-5D scores as well as changes in rescue analgesic usage, dyspareunia and fatigue via the EPDD.Discussion: This study will determine the safety and efficacy of Gynoclear™ to reduce the severity and duration of non-cyclical pelvic pain, dysmenorrhoea, dyspareunia and other symptoms of endometriosis. Study outcomes will be of interest to health professionals and members of the public who suffer from endometriosis.Trial Registration: Australia and New Zealand Clinical Trials Registry ACTRN12619000807156 . Registered on 3 June 2019. [ABSTRACT FROM AUTHOR]

Introduction: Multidisciplinary pain management programs incorporating a cognitive-behavioral therapy (CBT) approach have been reported to be helpful for elderly people with chronic pain. However, it is unclear whether the same program for elderly people with chronic pain would translate to different cultures. This study investigated whether a multidisciplinary program based on that of Nicholas et al. (Pain 154(6):824–835, 2013) in Australia would be effective for elderly people with chronic pain in Japan. Methods: Twenty-seven community-dwelling elderly people with chronic pain were enrolled to confirm changes (effect size d = 0.5) in pain disability, which were previously reported by Nicholas et al. The multidisciplinary program consisted of eight sessions (2 sessions a week for 4 weeks). Pain disability was assessed using the Pain Disability Assessment Scale (PDAS) as the primary outcome at the baseline, the beginning and the end of the program, and the 1- and 3-month (final) follow-up. We also assessed the pain severity, catastrophizing, pain self-efficacy, and physical function with the Timed Up and Go test (TUG) and the two-step test as secondary outcomes. Results: PDAS, pain catastrophizing, and pain self-efficacy were significantly improved immediately after the program compared with baseline, and these effects were maintained at 3-month follow-up. The effect size (d) for the PDAS score was a medium size (0.54) from baseline to 3-month follow-up. Those who showed improvements in TUG immediately after the program tended to report improved psychometric measures at 3-month follow-up. Conclusion: These results suggest that the Japanese multidisciplinary program has a similar effect on pain disability as that reported by Nicholas et al. This finding has important implications for the development of pain services in community-dwelling elderly Japanese. [ABSTRACT FROM AUTHOR]

Introduction: Type 2 diabetes (T2DM) is a major health concern with significant personal and healthcare system costs. There is growing interest in using shared medical appointments (SMAs) for management of T2DM. We hypothesize that adding mindfulness to SMAs may be beneficial. This study aimed to assess the feasibility and acceptability of SMAs with mindfulness for T2DM within primary care in Australia. Materials and Methods: We conducted a single-blind randomized controlled feasibility study of SMAs within primary care for people with T2DM living in Western Sydney, Australia. People with T2DM, age 21 years and over, with HbA1c > 6.5% or fasting glucose >7.00 mmol/L within the past 3 months were eligible to enroll. The intervention group attended six 2-h programmed SMAs (pSMAs) which were held fortnightly. pSMAs included a structured education program and mindfulness component. The control group received usual care from their healthcare providers. We collected quantitative and qualitative data on acceptability as well as glycemic control (glycated hemoglobin and continuous glucose monitoring), lipids, anthropometric measures, blood pressure, self-reported psychological outcomes, quality of life, diet, and physical activity using an ActiGraph accelerometer. Results: Over a 2-month period, we enrolled 18 participants (10 females, 8 males) with a mean age of 58 years (standard deviation 9.8). We had 94.4% retention. All participants in the intervention group completed at least four pSMAs. Participants reported that attending pSMAs had been a positive experience that allowed them to accept their diagnosis and empowered them to make changes, which led to beneficial effects including weight loss and better glycemic control. Four pSMA participants found the mindfulness component helpful while two did not. All of the seven participants who contributed to qualitative evaluation reported improved psychosocial wellbeing and found the group setting beneficial. There was a significant difference in total cholesterol levels at 12 weeks between groups (3.86 mmol/L in intervention group vs. 4.15 mmol/L in the control group; p = 0.025) as well as pain intensity levels as measured by the PROMIS-29 (2.11 vs. 2.38; p = 0.034). Conclusion: pSMAs are feasible and acceptable to people with T2DM and may result in clinical improvement. A follow-up fully-powered randomized controlled trial is warranted. Clinical Trial Registration: Australia and New Zealand Clinical Trial Registry, identifier ACTRN12619000892112. [ABSTRACT FROM AUTHOR]

Despite many patients waiting more than 2 years for treatment at publicly funded multidisciplinary chronic pain services, waitlist studies rarely examine beyond 6 months. We investigated psychological adjustment and health-care utilisation of individuals (N = 339) waiting ≤30 months for appointments at an Australian tertiary pain unit. Outcomes were relatively stable during the first 6 months, but long-term deteriorations in pain-related interference, distress and pain acceptance were evident, albeit with sex differences. Sexes also differed in uptake of new treatments. Medication use increased over time, but pain severity and medication relief did not. Results suggest that early intervention is important, especially for women. [ABSTRACT FROM AUTHOR]

Background: The five facets mindfulness questionnaire-short form (FFMQ-SF) is a new, brief measure for the assessment of mindfulness skills in clinical and nonclinical samples. The construct validity of the FFMQ-SF has not been previously assessed in community samples. Aims: The present study investigated the factor structure of the Italian version of the FFMQ-SF. Method: Structured equation modeling was used to test the fit of three alternative models in a sample of highly educated adults (n = 211). Results: A hierarchical model with a single second-order factor loaded by observing, describing, and acting with awareness (i.e. the mindfulness "what" skills) performed slightly better than both a five-factor model with correlated factors and a hierarchical model with a general second-order factor. The FFMQ-SF scores were significantly higher than those reported in both Dutch depressed patients and Australian undergraduate students for all facets (but nonreactivity for the Australian sample). Conclusions: Data support the multifaceted nature of mindfulness skills. Because of its brevity and simplicity of use, the FFMQ-SF is a promising questionnaire in longitudinal and clinical research. This questionnaire can serve as a guideline to help clinicians assess and monitor mindfulness skills acquisition, strengthening, and generalization, and prioritize mindfulness skills that need immediate attention. [ABSTRACT FROM AUTHOR]

Background: Life satisfaction is a component of the subjective well-being construct. Research consistently suggests that life satisfaction is associated with enhanced social benefits and improved health outcomes. However, its relationship to musculoskeletal health outcomes is underexplored. This study evaluates the life satisfaction of a patient population presenting with musculoskeletal complaints, and the relationship of life satisfaction with other health demographics and behaviours. Method: The study used a consecutive sampling design. Patients attending the Victoria University Osteopathy Clinic (Melbourne, Australia) were invited to complete the PROMIS® General Life Satisfaction scale (GLSS) along with questions related to health demographics and behaviours. Results: The GLSS T-score was not significantly different for gender, being born outside of Australia, speaking English at home, or complaint chronicity. Conclusions: Life satisfaction did not appear to be related to a range of health and demographic variables in the current musculoskeletal pain cohort. The PROMIS® General Life Satisfaction scale could prove useful to explore the relationship between life satisfaction and treatment outcomes for musculoskeletal complaints. [ABSTRACT FROM AUTHOR]

Introduction and Aims: The opioid-related behaviours in treatment (ORBIT) scale are a measure of recent indicators of potential extra-medical opioid use. Indicators of potential extra-medical opioid use are divergent practices among people prescribed opioids that may place them at risk of harm. This study aimed to examine the correlates of indicators of potential extra-medical opioid use in people prescribed opioids for chronic non-cancer pain (CNCP).Design and Methods: The Pain and Opioids IN Treatment (POINT) study is a prospective cohort study of people prescribed opioids for CNCP in Australia. People prescribed opioids solely for opioid dependence were excluded. This cross-sectional study utilised logistic regression to determine the characteristics associated with reporting any indicators of potential extra-medical opioid use.Results: Of the 1505 participants, 38% reported at least one indicator of potential extra-medical opioid use, most commonly asking for an increase in prescribed opioid dose (21%) and early prescription renewal (12%). Indicators of potential extra-medical opioid use were associated with younger age (adjusted odds ratio [AOR] = 0.98; 95% confidence interval [CI] = 0.92, 0.99), male sex (AOR = 1.53; 95% CI = 1.15, 2.04), lifetime pharmaceutical opioid use disorder (AOR = 1.87; 95% CI = 1.31, 2.66) and lifetime illicit drug use disorder (AOR = 1.72; 95% CI = 1.18, 2.52).Discussion and Conclusions: Over one-third of the POINT cohort reported one or more indicators of potential extra-medical opioid use. Lifetime substance use disorders were associated these divergent practices, highlighting the importance of clinical monitoring and patient education for this patient group. Longitudinal studies are needed to investigate whether indicators of potential extra-medical opioid use predict opioid use disorders in this population. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe the location and severity of pain during Functional Movement Screen (FMS) testing in junior Australian football players and to investigate its effect on FMS composite score and injury risk. DESIGN: Prospective cohort study. METHODS: Junior male Australian football players (n = 439) completed preseason FMS testing. Pain location and severity (on a O-to-10 numeric pain-rating scale [NPRS]) were assessed for painful subtests. The FMS composite score was calculated using 3 scoring approaches: "traditional," a score of zero on painful subtests; "moderate," a score of zero on painful subtests if an NPRS pain severity was greater than 4; and "raw," did not adjust painful FMS subtest scores. Players were monitored throughout the competitive season and considered injured when 1 or more matches were missed due to injury RESULTS: One hundred seventy players reported pain during FMS testing. The pain-scoring approach affected mean composite score values (raw, 14.9; moderate, 14.5; traditional, 13.6; P<.001). Sixty-eight percent of pain was mildly severe (NPRS of 4 or less). Back pain (50%) was more common than upper-limb (24%) or lower-limb (26%) pain (P<.001). Upper-limb pain was associated with a small increase in injury risk (hazard ratio = 1.59, P = .023). No other FMS pain location influenced injury risk, nor did pain severity (P>.280). The FMS composite score was not associated with injury risk, regardless of pain-scoring approach (P≥.500). CONCLUSION: Pain was common during FMS testing in junior Australian football players and had a notable effect on the FMS composite score, but minimal effect on subsequent injury risk. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the temporal relationship of posttraumatic stress disorder (PTSD) symptoms and physical symptoms in a non-treatment-seeking deployed military sample., Methods: Data were from a longitudinal study of Australian Defence Force personnel deployed to the Middle East Area of Operations between 2010 and 2012 ( n = 1871). Predeployment assessment was conducted 4 months before deployment (T1). Of these, 1324 (70.8% retention rate) participated in assessment within 4 months after deployment (T2), and 1122 (60.0%) completed the third time point at 4 years after deployment (T3). PTSD symptoms were assessed with the posttraumatic stress checklist and physical symptoms with a 67-item self-report Health Symptom Checklist. To explore directional influences between symptoms over time, longitudinal cross-lagged association between the modeled latent factors for PTSD symptoms and physical symptoms was estimated using structural equation modeling., Results: From T1 to T2, there was a significant bidirectional effect with higher physical symptom count at T1 predicting higher PTSD symptom severity at T2 ( β = 0.17, p < .001) and higher PTSD symptom severity at T1 predicting higher physical symptom count at T2 ( β = 0.13, p < .001). The effect of T2 on T3 was unidirectional. PTSD symptom severity at T2 had no effect on physical symptom count at T3, but physical symptom count at T2 predicted an increase in PTSD symptom severity at T3 ( β = 0.11, p = .013)., Conclusions: Considering early physical symptoms and their physiological underpinnings after traumatic exposures could help identify those at risk of later PTSD., (Copyright © 2022 by the American Psychosomatic Society.)

Asians immigrants (AIs) are one of the fastest growing racial groups in many countries globally. Despite pain prevalence, studies on chronic pain management among AIs is limited in the literature. An integrative review was conducted exploring the current state of science on chronic pain management among AIs. Several databases were used to identify related articles and 15 studies met the inclusion criteria. Two major themes emerged: (a) self-management, pertaining to how AIs take responsibility for their pain, and (b) resilience, their adaptive behaviors indicating low levels of pain-related dysfunction and burden despite chronic pain severity. Resilience plays a significant role in the mechanism by which self-management works in pain among AIs. Chronic pain management is a complex process where challenges to effective treatments exist. Findings have significant implications to healthcare providers and the general pain population. Future research directions include the necessity for increased participation of AIs in studies. [ABSTRACT FROM AUTHOR]

Background: A range of psychological constructs, including perceived pain, self-efficacy, and pain avoidance, have been proposed to account for the comorbidity of chronic pain and affective disorder symptoms. Despite the likely inter-relation among these constructs, few studies have explored these predictors simultaneously. As such, the relative contributions of these psychological influences remain an open question. Purpose: The present study uses a novel, network model approach to help to identify the key psychological contributors to the pain-affective disorder link. Method: A cross-sectional design was implemented. The sample comprised 169 individuals with chronic pain (Mage 49.82; range 22–80 years; 58% female) admitted to a metropolitan chronic pain clinic in Victoria, Australia. Participants completed self-report measures of anxiety, depressive, and pain symptoms, pain self-efficacy, fear avoidance beliefs, perceived control, and pain-related disability. Results: Network analysis identified self-efficacy, fear avoidance, and perceived disability as key constructs in the relationship between pain and affective disorder symptoms, albeit in different ways. While self-efficacy appeared to have direct links to other constructs in the network model, fear avoidance and perceived disability seemed to function more as mediators, linking other constructs in the model. Perceived control and anxiety were found to be less influential in the model. Conclusions: Present findings identify self-efficacy, fear avoidance, and perceived disability as plausible candidate variables to target to disrupt the link between pain experience and affective disorder symptoms. However, further testing with longitudinal designs is needed to confirm this. [ABSTRACT FROM AUTHOR]

Background: General practitioners' (GPs) views about deprescribing prescription opioid analgesics (POAs) may influence the care provided for patients experiencing chronic noncancer pain (CNCP). There are limited data addressing GPs' beliefs about deprescribing, including their decisions to deprescribe different types of POAs. Aim: To determine the proportion of GPs who hold attitudes congruent with local pain stewardship, describe their deprescribing decisions, and determine whether type of POA influences deprescribing. Design and setting: In 2016, a cross-sectional survey of all GPs (n=1,570) in one mixed urban and regional primary health network (PHN) in Australia was undertaken. Methods: A mailed self-report questionnaire assessed agreement with local guidelines for treating CNCP; influences on deprescribing POAs and likelihood of deprescribing in a hypothetical case involving either oral codeine or oxycodone. Results: A response rate of 46% was achieved. Approximately half (54%) of GPs agreed POAs should be reserved for people with acute, cancer pain or palliative care and a third (32%) did not agree that a medication focus has limited benefits for peoples' long-term quality of life and function. Most (77%) GPs were less likely to deprescribe when effective alternate treatments were lacking, while various patient factors (eg, fear of weaning) were reported to decrease the likelihood of deprescribing for 25% of GPs. A significantly higher proportion of GPs reported being very likely to deprescribe codeine compared to the equivalent opioid dose of oxycodone for a hypothetical patient. Conclusions: Many GPs in the PHN hold attitudes at odds with local guidance that opioids are a nonsuperior treatment for CNCP. Attitudinal barriers to deprescribing include: a lack of consistent approach to deprescribing opioids as a class of drugs, perceived lack of effective treatment alternatives and patient fear of deprescribing. Therefore, the next step in this target population is to appropriately train and support GPs in how to apply the evidence in practice and how to support patients appropriately. [ABSTRACT FROM AUTHOR]

Background: Multiple health conditions are increasingly a problem for adults with musculoskeletal conditions. However, multimorbidity research has focused primarily on the elderly and those with a limited subset of musculoskeletal disorders. We sought to determine whether associations between multimorbidity and additional burden differ with specific forms of musculoskeletal conditions among working-age adults.Methods: Data were sourced from a nationally representative Australian survey. Specific musculoskeletal conditions examined were osteoarthritis; inflammatory arthritis; other forms of arthritis or arthropathies; musculoskeletal conditions not elsewhere specified; gout; back pain; soft tissue disorders; or osteoporosis. Multimorbidity was defined as the additional presence of one or more of the Australian National Health Priority Area conditions. Burden was assessed by self-reported measures of: (i) self-rated health (ii) musculoskeletal-related healthcare and medicines utilisation and, (iii) general healthcare utilisation. Associations between multimorbidity and additional health or healthcare utilisation burden among working-age adults (aged 18 - 64 years of age) with specific musculoskeletal conditions were estimated using logistic regression, adjusting for confounders. Interaction terms were fitted to identify whether there were specific musculoskeletal conditions where multimorbidity was more strongly associated with poorer health or greater healthcare utilisation than in the remaining musculoskeletal group.Results: Among working-age adults, for each of the specified musculoskeletal conditions, multimorbidity was associated with similar, increased likelihood of additional self-rated health burden and certain types of healthcare utilisation. While there were differences in the relationships between multimorbidity and burden for each of the specific musculoskeletal conditions, no one specific musculoskeletal condition appeared to be consistently associated with greater additional health burden in the presence of multimorbidity across the majority of self-rated health burden and healthcare use measures.Conclusions: For working-age people with any musculoskeletal conditions examined here, multimorbidity increases self-reported health and healthcare utilisation burden. As no one musculoskeletal condition appears consistently worse off in the presence of multimorbidity, there is a need to better understand and identify strategies that acknowledge and address the additional burden of concomitant conditions for working-age adults with a range of musculoskeletal conditions. [ABSTRACT FROM AUTHOR]

Characterizing how physical and psychological symptoms interact in heart transplant recipients may lead to advances in therapeutic options. This study examined associations between pain and major depression. Method: A cross-sectional study was conducted with adult heart transplant recipients. Pain was measured with the bodily pain domain of the Short Form-36 Health Survey and psychological distress with the Kessler Psychological Distress Scale (K-10). The Mini International Neuropsychiatric Interview, version 6.0, was used to identify participants meeting the criteria for major depression. Hierarchical linear regression was used to determine if there was an association between pain and major depression, controlling for pharmacological treatment of depression, severity of psychological distress, and clinical characteristics including immunosuppression medication which may induce pain as a side effect. Results: Average pain score of the 48 heart transplant recipients was 43 (SD ± 10, range 0–100, lower scores indicate worse pain), with moderate pain reported by 39% (n = 19). Major depression was associated with worse pain (R2 change = 36%, β = −16, 95% confidence interval [CI] = [−30, −4], p = .012). Pharmacological treatment for depression was associated with better pain scores (R2 change = 1.5%, β = 13, 95% CI [4, 23], p = .006). Conclusions: Heart transplant recipients with major depression had worse pain after controlling for pharmacological treatment of depression, severity of psychological distress, and clinical characteristics. Thus, it is imperative that clinicians devising a treatment regimen for pain in heart transplant recipients take into account co-occurring depression and vice versa. [ABSTRACT FROM AUTHOR]

The article presents abstracts on medical topics which include education and training in behavioral medicine, e-health interventions in public health, and advanced concepts in high quality randomized clinical trials.

BACKGROUND: Work-related musculoskeletal pain is a major occupational problem. Those with pain in multiple sites usually report worse health outcomes than those with pain in one site. OBJECTIVE: This study explored prevalence and associated predictors of multi-site pain in health care sector employees. METHOD:Survey responses from 1348 health care sector employees across three organisations (37% response rate) collected data on job satisfaction, work life balance, psychosocial and physical hazards, general health andwork ability. Musculoskeletal discomfort was measured across 5 body regions with pain inὅ2 sites defined as multi-site pain. Generalized linear models were used to identify relationships between work-related factors and multi-site pain. RESULTS: Over 52% of the employees reported pain in multiple body sites and 19% reported pain in one site. Poor work life balance (PRR = 2.33, 95% CI = 1.06-5.14). physical (PRR = 7.58, 95% CI = 4.89-11.77) and psychosocial (PRR = 1.59, 95% CI = 1.00-2.57) hazard variables were related to multi-site pain (after controlling for age, gender, health and work ability. Older employees and females were more likely to report multi-site pain. CONCLUSION: Effective risk management of work related multi-site pain must include identification and control of psychosocial and physical hazards. [ABSTRACT FROM AUTHOR]