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Purpose The coronavirus disease 2019 (COVID-19) pandemic has affected the lives of people worldwide. The first declaration of a state of emergency in Japan, based on the Act on Special Measures for the Prevention and Control of the Novel Coronavirus, was issued from 16 April 2020 to 14 May 2020 to reduce person-to-person contact. Restrictions on going out, participating in community activities, and visiting hospitals were in place. This study investigates the short-term effects of the COVID-19 pandemic on patients with chronic pain. Methods This study included outpatients with chronic pain undergoing treatment at the Pain Center of Nara Medical University Hospital. The patients had completed questionnaires for a disability during the study period, from 1 July to 30 September 2019 (baseline), 1 October to 31 December 2019 (pre-pandemic), and 1 July to 30 September 2020 (during the pandemic). The questionnaire covered changes in disability, pain intensity, health-related quality of life (QOL), anxiety, depression, catastrophic thinking, and the presence/absence of exercise habits at baseline, pre-pandemic, and during the pandemic. Results Of the 245 eligible patients, there was no significant disability difference between baseline, pre-pandemic, and during the pandemic (p = 0.14). Similarly, pain intensity, health-related QOL, anxiety, depression, and the presence/absence of exercise habits did not significantly differ between baseline, pre-pandemic, and during the pandemic either. The current study observed significant differences in terms of catastrophic thinking (p = 0.02). Conclusion The effects of the COVID-19 pandemic on patients with chronic pain were not apparent in the short-term. Clinical trail registration: UMIN000043174, Author(s): Aki Fujiwara [sup.1], Keisuke Watanabe [sup.1], Mitsuru Ida [sup.1], Hideaki Kawanishi [sup.1], Katsuhiro Kimoto [sup.1], Kie Yoshimura [sup.1], Kozue Shinohara [sup.1], Masahiko Kawaguchi [sup.1] Author Affiliations: (1) grid.410814.8, 0000 [...]

We examined the effectiveness and safety of a walking program offered as part of cognitive behavioral therapy for chronic pain (CBT-CP). Participants were randomized to 10 weeks of CBT-CP, delivered either in person or by interactive voice response. Participants reported pedometer-measured step counts daily throughout treatment and received a weekly goal to increase their steps by 10% over the prior week's average. Walking-related adverse events (AEs) were assessed weekly. Participants (n = 125) were primarily male (72%), and white (80%) with longstanding pain (median: 11 years). There was no significant difference between treatment groups in rate of change in daily steps, but there was a significant increase in steps from baseline to treatment termination in the combined study sample (1648 steps (95% CI 1063-2225)). Participants classified as active doubled. AEs were mostly minor and temporary. Treatment was effective and safe whether the program was delivered in-person or remotely. Trial registration number: clinicaltrials.gov identifier: NCT01025752., Author(s): Alicia A. Heapy [sup.1] [sup.2] , Hallie Tankha [sup.3] , Diana M. Higgins [sup.4] [sup.5] , Mary Driscoll [sup.1] [sup.2] , Kathryn M. LaChappelle [sup.1] , Joseph L. Goulet [...]

Author(s): Satoshi Tanaka [sup.1] Author Affiliations: (1) grid.263518.b, 0000 0001 1507 4692, Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, , Matsumoto, Nagano, Japan Introduction > The outbreak [...]

Context: Chronic pain has been long recognised as a defining feature among the wide range of health-related problems exhibited in women belonging to refugee backgrounds. Insights into the health and socio-cultural experiences of refugee women seeking care for chronic pain may help inform practice protocols and reduce health inequalities in populations that are systematically marginalised. Objective: To explore the health-seeking narratives of Assyrian refugee women and the factors that influence their care for chronic pain in Australia. Study Design and Analysis: A qualitative study using a phenomenological perspective to understand the lived experience of Assyrian refugee women seeking care for chronic pain. Analysis involved reflexive thematic analysis based in identifying meaningful patterns and organising these into themes. Setting: The study was set in Melbourne, Victoria where recruitment began by approaching Iraqi Assyrian refugee community leaders, acting as key informants, through pre-existing partnerships with settlement services. Purposive sampling and a snowballing approach was used to identify eligible participants. Population Studied: Ten Assyrian refugee women who identified as having chronic pain. Women were aged between 19 to 85 years and had lived in Australia for four years or longer. Instrument: Semi-structured, in-depth interviews lasting between 30 to 90 minutes were conducted in English or in Arabic with an interpreter present. Outcome Measured: The lived experience of refugee women receiving care for chronic pain in Australia. Results: Overall, experiences such as their culture and family caregiver role in their homeland heavily influenced their experiences seeking healthcare in Australia. Five key themes emerged from this, including 1) Trust in health care systems 2) Accessibility to care 3) Perceptions of pain 4) Support seeking mechanisms and 5) Health knowledge. These themes played a significant role on shaping and forming their models of thought around accessing health care and living life with chronic pain. Conclusions: Refugee women arriving in Australia were confronted with social and cultural conditions and health systems that were radically different to their past experiences. This study provides rich insights into the health needs of refugee women, and highlights a need for an evidence base for better patient advocacy around chronic pain management and practice protocols to support refugee women resettling in Australia., Presenters Areni Altun, Helen Brown, Liz Sturgiss, MD, PhD, BMed, MPH, FRACGP, Grant Russell, MD, PhD, MBBS, FRACGP [...]

Context: Chronic pain (CP) and depression are comorbid conditions that are commonly seen in primary care settings, but guidance for management is very limited. In recent years, there has been an increase in measuring depression outcomes in CP clinical trials, but it is unknown how often these studies include people with depression. Previous research has demonstrated that people with comorbid mental illness are often excluded from clinical trials, limiting the application of this research to primary care settings Objective: To (1) investigate the proportion of CP clinical trials with depression outcomes that included participants with depression at baseline, and (2) examine variations in inclusion proportion by pain type, intervention type, gender, country, and time. Study Design: A secondary analysis of studies identified in a recent umbrella review of interventions for depression in CP. Methods: Randomized control trials (RCTs) captured by systematic reviews in an umbrella review were reviewed. RCTs with at least 50% adult participants and which used validated depression scales were eligible for this analysis. Study screening and data extraction were completed by two independent authors and in duplicate. Conflicts were resolved by a third author. RCTs with populations that met commonly cited minimum thresholds at baseline were considered to have included participants with depression. Preliminary Findings: From 67 systematic reviews, 437 studies were identified, of which 346 RCTs were selected for analysis. A total of 142 (41%) RCTs included participants with depression. RCTs investigating fibromyalgia and mixed CP had the highest depression inclusion proportion, whereas studies of arthritis pain had amongst the lowest. US RCTs had a significantly lower inclusion proportion compared to non-US studies, especially for arthritis studies. Significant trends over time and across gender were attenuated when fibromyalgia studies were excluded. Conclusions: Existing CP research often excludes participants with depression and subsequent guidance developed from these findings should be considered with caution. Systemic biases around psychological conditions and gender are important drivers of differences in the study of depression in fibromyalgia compared to other common pain conditions such as arthritis. Future research must intentionally include individuals with comorbid depression in trials of common CP conditions to better inform clinical practice., Presenters Darren Cheng, BSc, MSc, Maarij Ullah, Henry Gage, Rahim Moineddin, PhD, Golale Modarresi, MD, Abhimanyu [...]

The innate immune regulator STING is a critical sensor of self- and pathogen-derived DNA. DNA sensing by STING leads to the induction of type-I interferons (IFN-I) and other cytokines, which promote immune-cell-mediated eradication of pathogens and neoplastic cells.sup.1,2. STING is also a robust driver of antitumour immunity, which has led to the development of STING activators and small-molecule agonists as adjuvants for cancer immunotherapy.sup.3. Pain, transmitted by peripheral nociceptive sensory neurons (nociceptors), also aids in host defence by alerting organisms to the presence of potentially damaging stimuli, including pathogens and cancer cells.sup.4,5. Here we demonstrate that STING is a critical regulator of nociception through IFN-I signalling in peripheral nociceptors. We show that mice lacking STING or IFN-I signalling exhibit hypersensitivity to nociceptive stimuli and heightened nociceptor excitability. Conversely, intrathecal activation of STING produces robust antinociception in mice and non-human primates. STING-mediated antinociception is governed by IFN-Is, which rapidly suppress excitability of mouse, monkey and human nociceptors. Our findings establish the STING-IFN-I signalling axis as a critical regulator of physiological nociception and a promising new target for treating chronic pain. Studies using mouse and non-human primate models identify the innate immune regulator STING--acting via type I interferons--as a key regulator of nociception, suggesting new targets for the treatment of chronic pain., Author(s): Christopher R. Donnelly [sup.1] , Changyu Jiang [sup.1] , Amanda S. Andriessen [sup.1] , Kaiyuan Wang [sup.1] , Zilong Wang [sup.1] , Huiping Ding [sup.2] , Junli Zhao [sup.1] [...]

The opioid epidemic is a significant public health concern in the United States, particularly among adults with chronic pain. Considerable research suggests that people with mental health problems, including anxiety and depression, may experience more opioid-related problems in the context of chronic pain. Yet, little work has examined potential mechanisms underyling these relations. Emotion dysregulation is one mechanistic factor that may link anxiety and depression and opioid-related problems among persons with chronic pain. Therefore, the current study examined the explanatory role of emotion dysregulation in the cross-sectional relationship between anxiety and depression problems and current opioid misuse and severity of opioid dependence among 431 adults with chronic pain who reported currently using opioid medications (74% female, M.sub.age=38.32 years, SD = 11.11). Results indicated that emotion dysregulation explained, in part, the relationship between anxiety and depression symptoms and opioid-related problems. These findings highlight the need to further consider the role of emotion dysregulation among adults with chronic pain who use prescription opioids and experience symptoms of anxiety or depression. Future prospective research will be needed to further establish emotion dysregulation as a mechanism in anxiety/depression-opioid misuse/dependence processes., Author(s): Andrew H. Rogers [sup.1] , Michael F. Orr [sup.1] , Justin M. Shepherd [sup.1] , Jafar Bakhshaie [sup.2] , Joseph W. Ditre [sup.3] , Julia D. Buckner [sup.4] , [...]

There is now a consensus in the literature that future improvements in outcomes obtained from cognitive behavioral therapy (CBT) for chronic pain will require research to identify patient and treatment variables that help explain outcomes. The first aim of this study was to assess whether pre-treatment scores on measures of psychological (in)flexibility, acceptance, committed action, cognitive (de)fusion, and values-based action predict outcomes in a multidisciplinary, multicomponent, group-based CBT program for adults with chronic pain. The second aim was to assess whether change scores on these same measures mediate outcomes in the treatment program. Participants were 232 people attending treatment for chronic pain. Of the psychological flexibility measures, only pre-treatment scores on the psychological inflexibility scale predicted outcomes; higher scores on this measure were associated with worse outcomes. However, change scores on each of the psychological flexibility measures separately mediated outcomes. The efficacy of CBT for chronic pain may be improved with a greater focus on methods that increase psychological flexibility., Author(s): Sophia Åkerblom [sup.1] [sup.2] , Sean Perrin [sup.2] , Marcelo Rivano Fischer [sup.1] [sup.3] , Lance M. McCracken [sup.4] Author Affiliations: (1) grid.411843.b, 0000 0004 0623 9987, Department of [...]

Like morphine, methadone is a pure agonist at the [micro] opioid receptor. However, in distinction to morphine which has an elimination half-life of 2-3 h, methadone has an elimination half-life of 24-36 h. In addition to its effects at the [micro] opioid receptor, methadone is an antagonist at the n-methyl-d-aspartate (NMDA) receptor and also inhibits the reuptake of the neurotransmitters, serotonin and norepinephrine, in the central nervous system. Given its long half-life and high oral bioavailability, methadone has had a primary role in the outpatient treatment of patients with a history of opioid abuse or addiction. However, its unique pharmacology and cellular effects make it a valuable agent in the treatment of both acute and chronic pain of various etiologies. The following manuscript reviews the pharmacologic properties of methadone and discusses its clinical applications in the practice of pediatric anesthesiology and pediatric critical care medicine., Author(s): Joseph D. Tobias [sup.1] Author Affiliations: (1) grid.240344.5, 0000 0004 0392 3476, Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital and The Ohio State University, , 700 Children's [...]