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AbstractPain anticipation during conditions of uncertainty can unveil intrinsic biases, and understanding these biases can guide pain treatment interventions. This study used machine learning and functional magnetic resonance imaging to predict anticipatory responses in a pain anticipation experiment. One hundred forty-seven participants that included healthy controls (n = 57) and individuals with current and/or past mental health diagnosis (n = 90) received cues indicating upcoming pain stimuli: 2 cues predicted high and low temperatures, while a third cue introduced uncertainty. Accurate differentiation of neural patterns associated with specific anticipatory conditions was observed, involving activation in the anterior short gyrus of the insula and the nucleus accumbens. Three distinct response profiles emerged: subjects with a negative bias towards high pain anticipation, those with a positive bias towards low pain anticipation, and individuals whose predictions during uncertainty were unbiased. These profiles remained stable over one year, were consistent across diagnosed psychopathologies, and correlated with cognitive coping styles and underlying insula anatomy. The findings suggest that individualized and stable pain anticipation occurs in uncertain conditions.

Copyright of Plastic Surgery is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVE: To examine the validity and reliability of the Turkish version of the Breathlessness Catastrophizing Scale (BCS) in patients with chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: Seventy patients with COPD (55 male/15 female, mean age: 68.7±7.3 years, FEV1%: 45.4±19.5) were included in this methodological study. Internal consistency was measured using Cronbach's α, and intra-rater reliability was assessed using the intraclass correlation coefficient (ICC). Correlations between the BCS and Modified Medical Research Council Dyspnea Scale (mMRCS), COPD Assessment Test (CAT), Hospital Anxiety and Depression Scale (HADS), Breathlessness Beliefs Questionnaire (BBQ), and St. the George Respiratory Questionnaire (SGRQ) scores were assessed for convergent validity. Known-group comparisons were performed according to COPD stage and dyspnea severity using the independent sample t-test. RESULTS: Internal consistency was excellent (Cronbach's α=0.941), and the ICC for reliability was 0.955. The BCS score was correlated with the mMRCS (r=0.745), CAT (r=0.652), HADS anxiety (r=0.556) and depression (r=0.588), the BBQ (r=-0.567), and SGRQ (r=0.550-0.634) scores (P < 0.05). The BCS score was higher in patients with advanced COPD (P = 0.003) and those with severe dyspnea (P < 0.001). CONCLUSION: The Turkish version of the BCS is a valid and reliable tool for evaluating catastrophic dyspnea in patients with COPD. [ABSTRACT FROM AUTHOR]

In Parkinson's disease (PD), a large number of individuals are confronted with pain. This issue has been receiving increasing attention in literature in recent years, as the complexity of pain in this disease makes its evaluation and treatment challenging. However, psychological variables related to the pain experience have received limited attention, especially when it comes to the exploration of beliefs regarding pain which, to our knowledge, remains unexplored in PD. Pain beliefs are defined as a subset of a patient's belief system which represents a personal understanding of the pain experience. Four dimensions of pain beliefs have been isolated in literature: mystery, pain permanence, pain constancy and self-blame. Thus, the goal of this study was first to describe pain beliefs in individuals with PD and second, to explore the relationships between pain beliefs and clinical and psychological variables. One hundred and sixty-nine international individuals with PD completed an online survey with socio-demographic and medical data. Participants completed self-report instruments to assess their pain (King's Parkinson's Disease Pain Questionnaire, McGill Pain Questionnaire and Brief Pain Inventory), psychological distress (Beck Depression Inventory, short-form and Parkinson Anxiety Scale), pain catastrophizing (Pain Catastrophizing Scale) and pain beliefs catastrophizing (Pain Beliefs and Perception Inventory). The study's findings revealed that most participants' beliefs are marked by the dimension of permanence, suggesting that individuals with PD perceive the pain experience as chronic and enduring. Meanwhile, pain is minimally perceived as constant, mysterious, or a source of guilt. Our finding concerning the permanence dimension deserves specific attention: even though this belief is prevalent in our population, it is not, or only weakly, associated with an impact on mood or pain catastrophizing. These results bring forth several hypotheses for understanding, highlighting the role of acceptance, and offer new perspectives toward improving clinical practices in terms of assessing and managing pain in PD. [ABSTRACT FROM AUTHOR]

Background Dyspareunia, defined as pain before, during or after intercourse, is a subset of female sexual dysfunction with overlapping gynecologic, urologic and psychosocial etiologies. Aim This study aimed to evaluate the impact of menstrual pain and visceral hypersensitivity on sexual function and to identify risk factors for sexual pain in healthy reproductive-age females. Methods In this prospective cohort study, we evaluated gynecologic and psychologic self-reported histories, validated sexual function questionnaires, and conducted a standardized gynecologic examination enhanced by quantitative sensory testing in reproductive-aged females with menstrual pain versus pain-free controls. Correlation analysis was conducted between the Female Sexual Function Index (FSFI) pain subdomain score and a priori hypothesized risk factors for dyspareunia: menstrual pain severity, experimentally provoked bladder sensitivity, anxiety, depression, pain catastrophizing, and vaginal pressure-pain sensitivity. Outcomes The primary outcome was severity of sexual pain as measured by the FSFI, comparing participants with moderate-to-severe dysmenorrhea (n = 99), dysmenorrhea with bladder hypersensitivity (n = 49) identified on non-invasive oral water challenge, and pain-free controls (n = 37). Results In our young (median age 22 [IQR 19, 29]), nulliparous, predominantly heterosexual cohort (78.3%, 144/185), 64.3% (119/185) engaged in sexual intercourse within the four-week recall period. The median total FSFI score was 27.2 (22.0, 30.2). Across groups, only the dysmenorrhea with bladder hypersensitivity phenotype met the threshold for sexual dysfunction as measured by total FSFI score (24.6 [20.0, 28.1], p  = 0.008). Dysfunction was driven by difficulties with lubrication and higher pain levels during and after intercourse. On physical examination, those with and without dyspareunia were largely indistinguishable, with little to no tenderness of the pelvic floor, bladder, uterus and uterosacral ligaments. Amongst the six hypothesized risk factors for sexual pain, only experimentally provoked bladder pain was significantly associated with the severity of dyspareunia (r = 0.41, corrected p  < 0.001). Clinical Implications Young, otherwise healthy individuals with dysmenorrhea and occult visceral hypersensitivity exhibit signs of sexual dysfunction and significantly higher rates of dyspareunia in the absence of reliable clinical examination findings. Strengths and Limitations Strengths include the use of a nonclinical sample of almost exclusively nulliparous females with no co-morbid pelvic pain diagnoses and prospective diary confirmation of dysmenorrhea severity. The study is limited by the narrow heteronormative, cisnormative sexual experience of penile-vaginal intercourse captured by the FSFI. Conclusion Sexual pain is more prevalent in those with dysmenorrhea with bladder hypersensitivity than isolated dysmenorrhea, suggesting visceral hypersensitivity may be a non-structural mechanistic driver for dyspareunia. [ABSTRACT FROM AUTHOR]

Background It is well established that catastrophic thinking about pain modulates clinical pain severity, but it may also relate to interindividual differences in the pain experience during procedures. This mixed-methods study investigated the relationship between ratings of situational pain catastrophizing and reported pain sensitivity in the context of receiving a nerve block without sedation, and explored participants' experiences. Methods Healthy volunteers (n  = 42) completed baseline psychosocial questionnaires, underwent quantitative sensory testing, and received a lower extremity nerve block, followed by further psychosocial assessment and interviews. Associations of catastrophizing scores with pain sensitivity and procedural site pain were assessed using Spearman correlations. Interviews were reviewed using an immersion/crystallization approach to identify emergent themes. Results Greater situational catastrophizing scores were associated with higher pain sensitivity, measured as lower pain threshold and tolerance. Although females exhibited greater pain sensitivity generally, moderation analysis revealed a significant association between situational catastrophizing scores and pain sensitivity only among male participants. Qualitative interviews revealed the importance of participants' emotional responses to pain, and a mismatch of expectation and experience with procedural pain. Males also reported more negative comments about procedural pain. Conclusions Examination of the variable subjective experience while receiving a nerve block in this experimental lab-based study revealed an important relationship between situational pain catastrophizing scores and pain sensitivity, which was more prominent among male participants. These findings reinforce how insight into individual expectations, emotions, and thought processes may impact pain sensitivity during procedures, and may inform strategies to personalize care, improving patient satisfaction and procedural acceptance. [ABSTRACT FROM AUTHOR]

Perseverative thinking and catastrophizing have well established associations with fear and distress. However, less is known about the impact of interpersonal dynamics, such as co‐rumination, on these intrapersonal cognitive processes and subsequent stress. The present study addresses this knowledge gap. A sample of 433 adults from across the United States was recruited online and completed measures of co‐rumination, perseverative thinking, catastrophizing, and demographic characteristics early in the COVID‐19 pandemic, and the COVID Stress Scales (CSS) at six month follow up. Co‐rumination, perseverative thinking, catastrophizing, and CSS scores were correlated in the expected direction. Regression analyses revealed all three independently predicted CSS worry about the dangerousness of COVID‐19 subscale. Co‐rumination was the strongest predictor of CSS worry about the socioeconomic impact and CSS compulsive checking scales. Perseverative thinking and catastrophizing predicted CSS traumatic stress symptoms subscale. Finally, perseverative thinking was the strongest predictor of CSS xenophobia subscale. Structural equation modelling indicated that co‐rumination had a significant indirect effect on CSS scores through perseverative thinking and catastrophizing. Interpersonal dynamics, such as co‐rumination, are relevant for understanding stress and are promising targets for intervention research to prevent or attenuate fears and distress, in addition to traditional intrapersonal cognitive processes such as perseverative thinking and catastrophizing. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the relationship between pain and functional levels with pain catastrophizing, rumination, decision-making, and critical thinking in people with chronic neck pain. The study included 62 patients with chronic neck pain who had presented to a physiotherapy center with pain complaints for at least 3 months. The visual analog scale for pain severity, the Neck Disability Index for functional level, the Pain Catastrophizing Scale, the Ruminative Thinking Scale, the Melbourne Decision-Making Scale I-II, and the Marmara Critical Thinking Inventory were used for assessments. Activity pain, night pain, and disability were positively correlated with rumination (rho: 0.368, p =.003; rho: 0.423, p = <.001; rho = 0.334, p =.008). There was a positive correlation between night pain, disability, and pain catastrophizing (rho = 0.298, p =.019; rho =.434 p <.001). A negative correlation was observed between patients' pain severity and disability with critical thinking scores (rho = –0.393, p =.002; rho = –0.377 p =.003, rho = –0.428 p <.001, rho = –0.441 p <.001). The study suggested that there were positive correlations between pain severity and disability with rumination and pain catastrophizing. Additionally, chronic neck pain was found to have negative correlations with critical thinking scores, indicating potential impacts on cognitive processes. These findings may provide insights into the complex interplay between chronic pain and psychological factors, which can inform the development of interventions to enhance chronic pain management. [ABSTRACT FROM AUTHOR]

To identify the range of evidence for relationships between psychological factors using the Fear Avoidance Model (FAM) as a guiding framework and relevant clinical outcomes in adult patients with persisting symptoms after concussion (PSaC), develop a comprehensive understanding of psychological factors that have been identified as predictors of clinical outcomes for PSaC, and contribute to the theoretical framework of the FAM for PSaC. Six databases (CINAHL, Embase, PsycINFO, PubMed, SportDiscus, and Web of Science) were searched by a librarian for empirical and theoretical publications and experimental and quasi-experimental study designs. The literature search was not limited by publication date restrictions. Gray literature, with the exception of doctoral dissertations, was excluded. We included studies in the English language consisting of human participants aged ≥18 years. Articles must have included both outcomes pertaining to PSaC (≥3mo after injury) and psychological constructs. One reviewer extracted data from the resulting studies using a standardized data extraction form designed for this review. Two reviewers independently assessed risk of bias using the Quality in Prognosis Studies tool. This review found numerous psychological constructs, some directly linked to the FAM, that have potential prognostic relationships with PSaC. However, research remains limited and some psychological factors central to FAM were only identified in a small number of studies (catastrophizing, cogniphobia, and avoidance), whereas other psychological factors were studied more extensively (anxiety and depression). There is the need for additional evidence, and this integrative review provides an adaptation of the FAM for PSaC to be used as a guiding preliminary framework for future research. Future research should aim to include psychological factors proposed in this modified FAM to fully understand PSaC. [ABSTRACT FROM AUTHOR]

Abstract Mindfulness is well-established as a viable treatment for job burnout. However, the mechanisms underlying mindfulness’s burnout-reducing effect remain unclear. Drawing on mindfulness-to-meaning theory, the purpose of this study was to explore two potential mediators of the mindfulness-burnout relationship: positive reappraisal and catastrophizing. Participants were 325 Amazon Mechanical Turk workers who completed the Five Facet Mindfulness Questionnaire, the Positive Reappraisal and Catastrophizing subscales of the Cognitive Emotion Regulation Questionnaire, and the Oldenburg Burnout Inventory. Using a cross-sectional design, we tested six mediation models in which the effect of mindfulness or one of its five facets on burnout was mediated by positive reappraisal and catastrophizing. As expected, burnout correlated with mindfulness (r = − 0.60, p

Background and Objective We aim to assess the role of affective temperaments, insomnia severity, sleep quality, and depressive anxiety symptoms in predicting catastrophizing insomnia in patients with major depressive disorder (MDD). Methods Our study employed a case-control design, involving 90 drug-free MDD patients and 90 healthy controls (HCs) with identical sociodemographic characteristics. Participants completed a comprehensive set of assessments, including the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Insomnia Catastrophizing Scale (ICS), and Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionnaire (TEMPS-A). Results Among the 90 MDD patients, 80% were female (n = 72), with a mean age of 32.2 ± 13.6 years. The MDD group exhibited significantly higher scores on the BDI, BAI, ISI, PSQI, ICS night, ICS daytime, and ICS total scores, along with depressive, cyclothymic, irritable, and anxious temperament scores, compared to the HCs (p < 0.001). Notably, the hyperthymic temperament showed no correlation with insomnia catastrophizing in either group. Our findings revealed that the ISI score was a predictive factor for the ICS night; age and ISI were predictive factors for the ICS daytime; and age, anxious temperament, and ISI were predictive factors for the ICS total in the MDD group. Conclusions The severity of insomnia, young age, and an anxious temperament were identified as positive predictors of insomnia catastrophizing.

Mindfulness is well-established as a viable treatment for job burnout. However, the mechanisms underlying mindfulness's burnout-reducing effect remain unclear. Drawing on mindfulness-to-meaning theory, the purpose of this study was to explore two potential mediators of the mindfulness-burnout relationship: positive reappraisal and catastrophizing. Participants were 325 Amazon Mechanical Turk workers who completed the Five Facet Mindfulness Questionnaire, the Positive Reappraisal and Catastrophizing subscales of the Cognitive Emotion Regulation Questionnaire, and the Oldenburg Burnout Inventory. Using a cross-sectional design, we tested six mediation models in which the effect of mindfulness or one of its five facets on burnout was mediated by positive reappraisal and catastrophizing. As expected, burnout correlated with mindfulness (r = − 0.60, p < 0.001), positive reappraisal (r = − 0.59, p < 0.001), and catastrophizing (r = 0.36, p < 0.001), while mindfulness correlated with positive reappraisal (r = 0.58, p < 0.001) and catastrophizing (r = − 0.47, p < 0.001). Positive reappraisal mediated the mindfulness-burnout relationship for all six mindfulness predictors, while catastrophizing mediated the link for two. Planned contrasts indicated that, for all mindfulness predictors, positive reappraisal had significantly stronger indirect effects on burnout than did catastrophizing. These mediation results suggest multiple pathways by which mindfulness acts to reduce burnout. Thus, individuals experiencing burnout may have flexibility in choosing which mindfulness skills to develop to reduce symptoms. However, positive reappraisal better explained the mindfulness-burnout relationship than did catastrophizing. Future research could focus on mindfulness interventions that target positive reappraisal. [ABSTRACT FROM AUTHOR]

Knee osteoarthritis (KOA) is a chronic disease accompanied by debilitating symptoms including pain, stiffness, and limited physical functionality, which have been shown to be associated with pain catastrophizing. Previous studies have revealed racial discrepancies in pain catastrophizing, notably between Hispanics and non-Hispanics while pointing to potential health disparities. Using a conceptual model, this study aimed to investigate racial differences in associations between KOA symptoms with specific pain catastrophizing domains (rumination, magnification, and helplessness). Patients with KOA (n = 253; 147 Hispanics, 106 non-Hispanic Whites) completed a survey that included measures of knee symptoms, pain catastrophizing, and demographic variables. Structural equation modeling revealed that among Hispanics, each pain catastrophizing domain (rumination, magnification, and helplessness) was associated with at least two symptomatic experiences, including pain severity and difficulty in physical function. Specifically, pain severity was associated with (a) rumination: β = 0.48, p < 0.001, (b) magnification: β = 0.31, p = 0.003; and (c) helplessness: β = 0.39, p < 0.001). Additionally, a lower score in physical function was associated with higher magnification (β = 0.26, p = 0.01), and helplessness (β = 0.25, p = 0.01). Among non-Hispanic White patients, pain severity was further associated with two domains of pain catastrophizing, including rumination (β = 0.39, p < 0.001) and helplessness (β = 0.35, p = 0.01). In addition, association pathways for demographic variables revealed that older Hispanics experienced greater challenges with higher pain severity (β = 0.26, p = 0.01) and greater difficulty with physical function (β = 0.31, p < 0.001) while Hispanics females experienced higher pain (β = 0.19, p = 0.03). These findings highlight the importance of designing tailored interventions that consider key demographic factors such as age, and gender, to improve physical function that might alleviate pain catastrophizing among Hispanics with KOA. [ABSTRACT FROM AUTHOR]

Background: Music-based intervention has been advocated as a nonpharmacologic approach for the perioperative control of pain and anxiety in surgical patients. However, its impact on patients with preoperative anxiety has not been clearly established. Our study aimed to examine the impact of music-based intervention administered before, during, and after surgery on postoperative opioid consumption and pain levels, as well as preoperative anxiety, depression, and pain catastrophizing. We hypothesized that, compared to a control group, music-based intervention would be effective in reducing opioid requirements and mood disorders. Methods: This study was a single-center, prospective, single-blinded, randomized controlled trial. Inclusion criteria isame-day or observation surgery. Exclusion criteria included American Society of Anesthesiologists physical status IV, use of spinal anesthesia, PROMIS Anxiety T-scores ≤ 57.4 and ≥74.1, preoperative chronic opioid use, transgender surgery, and history of drug or alcohol abuse. Music-based intervention was developed by a certified music therapist. Each patient was randomized to receive standard of care (SC) or SC plus music-based intervention before, during, and after surgery. The primary end point was postoperative oral morphine equivalents (OMEs) over 5 days following surgery using the area under the curve (AUC)Secondary end points were PROMIS Anxiety, PROMIS Depression scores Pain Catastrophizing Scale scores, postoperative nausea and vomiting, time of hospital discharge, and patient satisfaction (0 = totally unsatisfied to 10 = completely satisfied). Results: A total of 75 patients were randomized to a music-based intervention (n = 33) or control (n = 42) group. Patients in the music-based intervention group consumed 56.7% less opioids than those in the control group (AUC was 2.8 in the music-based intervention group vs. 6.4 in the control group, absolute standardized mean difference (aSMD) = 0.34 (−0.17, 0.85)). No difference in pain scores was recorded between groups. Music-based intervention also reduced anxiety on postoperative day (POD)2 (aSMD = 0.38 (−0.16, 0.91)), depression on POD2 (aSMD = 0.31 (−0.23, 0.84)) and POD4 (aSMD = 0.24 (−0.29, 0.77)), and pain catastrophizing on POD1 (aSMD = 0.24 (−0.3, 0.77)). Conclusions: Our data support the use of music-based intervention to reduce postoperative opioid requirements. Music-based intervention may also reduce anxiety, depression, and pain catastrophizing. [ABSTRACT FROM AUTHOR]

Anxiety-based cognitive distortions pertaining to somatic perception (ABCD-SPs)—primarily catastrophizing, fear avoidance, and kinesiophobia—have been repeatedly linked to worsening chronic, non-cancer pain (CNCP) outcomes of increased disability, amplified pain, ineffective opioid use, and opioid misuse. Several studies have suggested that treating ABCD-SPs can improve pain outcomes, yet identification and targeting of ABCD-SPs are not part of the standard medical pain assessment and treatment plan. Utilizing a narrative review of proposed mechanisms, published patient perspectives, and study correlations connecting these cognitive distortions with CNCP outcomes, an approach for better practice in the delivery of standard medical CNCP care can be deduced and formulated into a Belief and Behavior Action Plan (BBAP) for medical clinicians treating CNCP to implement into initial and maintenance care planning. These recommendations require relatively few resources to implement and have the potential to disseminate more effective CNCP treatment on a large scale now and in the future with the new frontier of cognitive computing in medicine. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to examine the role of pain catastrophizing and pain self-efficacy as possible mediators of race-based differences in pain intensity and to evaluate the possible moderating role of race on the relationship between pain catastrophizing and pain self-efficacy with pain outcomes among persons with chronic spinal pain receiving physical therapy. Methods This study was a secondary analysis of a cluster-randomized trial. Participants were persons with chronic spinal pain in outpatient physical therapy clinics who consented to complete assessments at baseline and after 2 weeks and 12 weeks. Assessments included pain intensity, physical function, pain catastrophizing, and self-efficacy. Baseline comparisons between Black and non-Hispanic White participants were made. Mediation analyses used a regression-based framework to examine whether baseline pain catastrophizing and self-efficacy mediated the association between race and pain intensity. Moderation analyses used multiple linear regression to evaluate the role of race in the relationship of baseline pain catastrophizing and self-efficacy with 12-week pain intensity outcomes. Results A total of 274 participants were included (51 [18.6%] Black and 223 [81.4%] non-Hispanic White; mean age = 51.6 years [standard deviation = 14.9]; 180 [65.7%] female). At baseline, Black participants had higher pain intensity scores (mean difference = 0.80; 95% CI =1.5 to 0.12). Both pain catastrophizing and self-efficacy mediated the relationship between race and baseline pain intensity. Race moderated the relationships between baseline pain catastrophizing and self-efficacy and 12-week pain intensity scores. Conclusion Pain catastrophizing and self-efficacy had differential impacts on pain intensity based on race for both cross-sectional and longitudinal analyses among persons receiving physical therapy for chronic spinal pain. Impact Improved understanding of the differences in pain experience based on factors such as race, ethnicity, cultural background, and experience with the health care system may help reduce disparities in pain management. [ABSTRACT FROM AUTHOR]

The way individuals handle daily stressors can significantly influence their mental health. Those who struggle with emotion regulation are especially vulnerable to the negative effects of stress. This study explored the role of catastrophizing, a maladaptive emotion regulation strategy, in shaping the relationships between daily stress responses and depressive symptoms. A total of 75 healthy college students participated in the study. We adopted an Ecological Momentary Assessment protocol over 14 consecutive days to capture the day‐to‐day dynamics of stress reactivity and recovery. Our findings indicate that individuals with higher levels of catastrophizing exhibited increased daily stress reactivity and delayed daily stress recovery, consequently raising their likelihood of experiencing amplified depressive symptoms. In contrast, those with lower levels of catastrophizing did not experience the same negative effects of increased daily stress reactivity on their mental health. These results enhance understanding of how real‐life stressors contribute to the development of mental health issues and underscore the importance of adaptive emotion regulation for improved overall health and well‐being. [ABSTRACT FROM AUTHOR]

Purpose: Dysphagia, a serious symptom of oral cancer, is also the most common. Further, patients who are more uncertain regarding their illness tend to catastrophize, which may affect their rehabilitation and long-term survival rate. Considering this relationship, this study aimed to investigate the occurrence of dysphagia in Chinese patients with oral cancer and explore the correlation between catastrophic cognition, illness uncertainty, and dysphagia. Methods: Applying a cross-sectional design, convenience sampling was used to recruit 180 patients with oral cancer. Advanced statistical methods were employed to analyze the mediating effects of catastrophic cognition on illness uncertainty and dysphagia. Results: Chinese patients with oral cancer had a mean dysphagia score of 52.88 ± 10.95. Catastrophic cognition and illness uncertainty in patients with oral cancer were significantly positively correlated (r = 0.447, P < 0.001). There was a significant negative correlation between dysphagia score and catastrophic cognition (r = -0.385, P < 0.001), and between dysphagia and illness uncertainty (r = -0.522, P < 0.001). Bootstrapping results indicated that the mediating effect of catastrophic cognition between illness uncertainty and dysphagia was -0.07 (95% CI: [-0.15, -0.03]) and significant, and the mediation effect accounted for 15.6% of the total effect. Conclusions: Chinese patients with oral cancer have poor swallowing function. Results suggest that catastrophic cognition partially mediated the relationship between illness uncertainty and dysphagia in patients with oral cancer. Medical staff can improve patients’ swallowing function by reducing the level of catastrophic cognition via decreasing the level of illness uncertainty. [ABSTRACT FROM AUTHOR]

Copyright of Journal der Deutschen Dermatologischen Gesellschaft is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Background: Dermatosurgical procedures are predominantly performed under local anesthesia, yet there are few studies on perioperative pain management for extensive or staged procedures under local anesthesia. The purpose of this study was to assess pain during dermatologic surgery, describe perioperative pain management, and identify factors that influence pain perception. Patients and methods: This prospective, monocentric study included inpatients undergoing dermatologic surgery under local anesthesia from April to December 2021. Preoperative demographic data, a pain questionnaire, and four psychometric questionnaires (PCS, LOT‐R, SFQ, PHQ‐9) were collected. Postoperative pain and analgesic use during the first 24 hours were recorded. Results: A total of 120 patients (with a total of 191 interventions) were included in the study. Mean postoperative pain was reported to be very low (NRS < 2). Preoperative pain and expected postoperative pain were found to be predictive of postoperative pain. There was a strong correlation between catastrophizing and preoperative anxiety (r = 0.65) and a moderate correlation between depression and preoperative anxiety (r = 0.46). Conclusions: Dermatologic surgery under local anesthesia is generally considered painless. During preoperative counseling and assessment, attention should be paid to patients who fear surgery, report pain, or anticipate postoperative pain, as they have an increased risk of experiencing postoperative pain. [ABSTRACT FROM AUTHOR]

The purpose of this study was to analyze the influence of pain and no pain expectation on pupil diameter and the cognitive assessment of pain using pupillometry and the visual analog scale (VAS). This was an experimental cross-sectional study in which painful stimulation of the muscle masseter was produced by palpation with an algometer in a sample of 30 healthy participants. Before the painful stimulation, pain expectation and no pain expectation situations were induced by employing instructional videos. Cognitive and physiological pain responses were measured by the VAS and by pupillometry. Visual analog scale score was assessed at the end of each experimental condition, and pupillometry measurements were recorded at different moments of the experimental process (events). The pain score and larger pupil diameter for all events (except, as expected, for the initial baseline), were statistically significant for the pain expectation condition compared with the no pain expectation. Within the conditions of this study, pain expectation modulated both cognitive assessment of pain (VAS) and pupil diameter. These findings suggest that pupil diameter may be a useful and complementary tool with the VAS for pain assessment. Furthermore, the findings support models postulating that emotion and cognition are important aspects involved in pain perception, which is in line with the recent International Association for the Study of Pain definition of pain. [ABSTRACT FROM AUTHOR]

Objective: This study aims to examine the available evidence regarding the effect of the total duration in minutes of Pain Neuroscience Education (PNE) on pain catastrophizing and kinesiophobia in patients with chronic low back pain (CLBP). Methods: A systematic literature search was conducted on PubMed/MEDLINE, Web of Science, Scopus, and PeDro databases covering the last 5 years up to February 2024. No meta-analysis was performed, and qualitative analysis was conducted in narrative and tabular form. Results: Six randomized controlled trials were included in this systematic review. All studies included patients with chronic low back pain aged over 18. PNE was provided either as a standalone intervention or in combination with other therapies such as exercise, with total duration ranging from 100 to 240 minutes. Primary outcome measures focused on pain catastrophizing and kinesiophobia, while secondary outcomes included pain and functional disability. Conclusions: No significant correlation was established between the total duration of PNE and improvement in primary outcome measures. However, findings suggest that combining PNE with exercise in the treatment of chronic low back pain leads to greater improvements in kinesiophobia and pain catastrophizing compared to exercise alone. [ABSTRACT FROM AUTHOR]

Introduction: Non-suicidal self-injury (NSSI) is when a person harms themselves without the intention of suicide. The Emotional Cascade Model describes how NSSI could be a behavioral response to a cycle of negative affect and rumination, a form of repetitive negative thinking (RNT). However, there is limited research on other forms of RNT (i.e., anger rumination, sadness rumination, worry, catastrophizing) in relation to NSSI. Five Factor Model (FFM) domains and facets are predictive of NSSI history. However, continued research is warranted to assess reliability and generalizability of previous work. It was hypothesized that elevated neuroticism facets, elevated openness facets, lower levels of conscientiousness facets, and each type of RNT would predict a higher engagement in NSSI. Methods A community sample (N = 382) and college sample (N = 167) were tested with correlations and multiple regressions. Results Depressiveness and aesthetics positively predicted NSSI within the student sample. Impulsiveness and self-discipline positively predicted NSSI within the community sample. Worry positively predicted NSSI in both samples. Sadness rumination positively predicted NSSI and catastrophizing negatively predicted NSSI, but only within the student sample. Conclusion This study increased our understanding of precursors to NSSI, which could influence assessment and treatment. Continued research is warranted. [ABSTRACT FROM AUTHOR]

The link between pain severity, depressive symptomatology and catastrophizing among women with endometriosis is still under-investigated. The aim of this study was to (i) evaluate differences in depressive symptomatology between women with and without endometriosis; (ii) investigate if pain severity is associated with depressive symptoms; and (iii) test if catastrophizing moderates the link between these two variables. A total of 172 women with a diagnosis of endometriosis and 62 healthy controls volunteered for this cross-sectional study. Depressive symptomatology, pain severity, and catastrophizing were assessed. Compared to healthy controls, women with endometriosis were more likely to score above the cutoff for depressive symptomatology, with 60.5% of the latter being classified as having a subthreshold depression or minor depression and 15.7% as having moderate or severe major depression. Pain severity was significantly associated with depressive symptoms even after controlling for several covariates. Finally, the moderation model suggested that among patients with endometriosis, the relationship between pain severity and depressive symptomatology depended on the level of catastrophizing, with this association being stronger for high levels of the moderator. Mental health practitioners working with women with endometriosis may consider those who report high levels of pain severity and of catastrophizing at high risk of depression and are advised to promote adaptive coping strategies among patients to foster a better adaptation to this chronic disease [ABSTRACT FROM AUTHOR]

Previous research has linked self-harm to adverse childhood experiences (i.e. abuse and neglect). Despite the extensive literature on self-harm, it remains of high importance to examine psychological predictors of repetitive self-harming behaviors in those who report childhood trauma. This study explored the role of maladaptive emotion regulation strategies, dissociation proneness, and borderline personality (BP) features. An international sample with n = 374 participants (N = 287, 77%, reporting intentional use of self-harm), was recruited online via relevant mental health platforms and research sites. Within an anonymous survey, participants completed the Self-harm Inventory, Childhood Trauma Questionnaire, Dissociative Experience Scale, Cognitive Emotion Regulation Questionnaire, and Personality Assessment Inventory-Borderline Personality Features Scale. Structural equation modeling (SEM) was used to explore direct and indirect effects. Self-harm was positively correlated to severity of childhood trauma, maladaptive emotion regulation strategies, dissociation, and BP features. In the path-analytical model, independent indirect effects of childhood trauma severity via self-blame, catastrophizing, dissociation, as well as BP features on self-harm were found. Maladaptive emotion regulation, dissociation proneness, and BP features all seem to be important intermediary agents in the close association between childhood trauma and self-harm. [ABSTRACT FROM AUTHOR]

Abstract Objective The clinical efficacy of cognitive behavioral therapy (CBT) after Total knee arthroplasty (TKA) is still controversial, and the purpose of this meta-analysis was to evaluate the effect of CBT on pain, knee function, and psychological status of patients after TKA. Methods We systematically searched electronic databases such as CNKI, CBM, VIP, PubMed, Cochrane Library, and EMBASE for randomized controlled studies up to February 30, 2023. Screening against inclusion criteria to select valid studies and extract data. The quality of included studies was evaluated by the Cochrane Collaboration risk-of-bias 2 (RoB 2) tool for randomized trials. Statistical analysis of the data from this study was carried out using Stata 15.1 software. Results Finally, our meta-analysis incorporated seven randomized controlled studies of high quality, including 608 patients. The findings of the meta-analysis demonstrated a noteworthy decrease in kinesiophobia levels during the early postoperative phase in the CBT group as compared to the usual care group (WMD = -6.35, 95% CI: -7.98 to -4.72, Z = 7.64, P

The aim of this study is to compare the use of pain coping strategies and pain catastrophizing in youth with and without cerebral palsy (CP), and to examine how these two groups differ with respect to the associations between pain coping, catastrophizing, and measures of psychological function and sleep disturbance.

Abstract Catastrophizing is a transdiagnostic construct that has been suggested to precipitate and maintain a multiplicity of psychiatric disorders, including anxiety, depression, post‐traumatic stress disorder, and obsessive‐compulsive disorder. However, the underlying cognitive mechanisms that result in catastrophizing are unknown. Relating reinforcement learning model parameters to catastrophizing may allow us to further understand the process of catastrophizing. Using a modified four‐armed bandit task, we aimed to investigate the relationship between reinforcement learning parameters and self‐report catastrophizing questionnaire scores to gain a mechanistic understanding of how catastrophizing may alter learning. We recruited 211 participants to complete a computerized four‐armed bandit task and tested the fit of six reinforcement learning models on our data, including two novel models which both incorporated a scaling factor related to a history of negative outcomes variable. We investigated the relationship between self‐report catastrophizing scores and free parameters from the overall best‐fitting model, along with the best‐fitting model to include history, using Pearson's correlations. Subsequently, we reassessed these relationships using multiple regression analyses to evaluate whether any observed relationships were altered when relevant IQ and mental health covariates were applied. Model‐agnostic analyses indicated there were effects of outcome history on reaction time and accuracy, and that the effects on accuracy related to catastrophizing. The overall model of best fit was the Standard Rescorla–Wagner Model and the best‐fitting model to include history was a model in which learning rate was scaled by history of negative outcome. We found no effect of catastrophizing on the scaling by history of negative outcome parameter (r = 0.003, p = 0.679), the learning rate parameter (r = 0.026, p = 0.703), or the inverse temperature parameter (r = 0.086, p = 0.220). We were unable to relate catastrophizing to any of the reinforcement learning parameters we investigated. This implies that catastrophizing is not straightforwardly linked to any changes to learning after a series of negative outcomes are received. Future research could incorporate further exploration of the space of models which include a history parameter.

This study examined coping and pain responses using a behavioural inhibition (BIS) – behavioural activation (BAS) framework in 489 student athletes (M(age) = 20, SD = 4; 69% female). Two samples of athletes (226 pain-free athletes and 232 athletes with current pain) completed surveys assessing BIS- and BAS-related cognitions, emotions, and behaviours. Distinct groupings of BAS-related variables were identified in both samples, evidenced by significant positive correlations within BAS-related variables (positive affect, pain openness, approach thoughts and behaviours). Most BIS-related variables (depression, anxiety, harm beliefs, pain catastrophizing and avoidance behaviours) were also correlated in the sample of athletes with pain; however, this was not observed in pain-free athletes. In athletes with pain, BIS-related variables were significantly associated with pain variables, with this association stronger than that found for BAS-related variables. Regression analyses highlighted the pivotal role of pain catastrophizing as a predictor of pain unpleasantness and intensity. Findings shed light on the factors shaping athletes' coping, pain perception and decisions as to whether to pause or push through. Future investigations to explore these dynamics in more depth may aid in the development of targeted interventions that enhance athletes' ability to cope and to manage pain more effectively. [ABSTRACT FROM AUTHOR]

This cross-sectional study investigates the association between the main symptoms of Bipolar disorder (BD) and emotional regulation difficulties in adaptive and maladaptive emotional regulation strategies (ERS). In addition, this study examines the possible mediating effects of ERS with dispositional mindfulness and bipolar symptoms. Method. Twenty-four adults diagnosed with BD completed the Mindful Attention Awareness Scale (MAAS), the Beck Depression Inventory (BDI-II), the Altman Mania Self-Assessment Scale (ARSM), the Trait Anxiety Inventory (STAI-R), and the Cognitive Emotional Regulation Questionnaire (CERQ). Results. First, multiple regression analysis showed how depression was significantly positively related to self-blame, whereas trait anxiety was positively associated with self-blame and catastrophizing. Second, the results of the mediation analysis have shown a significant mediation effect for the self-blame in the relationship between mindfulness and depression (a*b = -.15; BCI 95% [-.36, - .03]) and between mindfulness and trait anxiety (a*b = -.09; BCI 95% [-.27, - .01]). Conclusions. Our results report the role of self-blame and catastrophizing in BD and how these might significantly mediate between dispositional mindfulness and symptoms of depression and anxiety. These results suggest that a meditation practice focused on reducing catastrophizing and selfblame may be especially helpful for symptoms of depression and anxiety in bipolar patients. [ABSTRACT FROM AUTHOR]

While preoperative psychological distress is known to predict risk for worse total knee arthroplasty (TKA) outcomes, distress may be too broad and nonspecific a predictor in isolation. We tested whether there are distinct preoperative TKA patient types based jointly on psychological status and measures of altered pain processing that predict adverse clinical outcomes. In 112 TKA patients, we preoperatively assessed psychological status (depression, anxiety, and catastrophizing) and altered pain processing via a simple quantitative sensory testing protocol capturing peripheral and central pain sensitization. Outcomes (pain, function, opioid use) were prospectively evaluated at 6 weeks and 6 months after TKA. Cluster analyses were used to empirically identify TKA patient subgroups. There were 3 distinct preoperative TKA patient subgroups identified from the cluster analysis. A low-risk (LR) group was characterized by low psychological distress and low peripheral and central sensitization. In addition, 2 subgroups with similarly elevated preoperative psychological distress were identified, differing by pain processing alterations observed: high-risk centralized pain and high-risk peripheral pain. Relative to LR patients, high-risk centralized pain patients displayed significantly worse function and greater opioid use at 6 months after TKA (P values <.05). The LR and high-risk peripheral pain patient subgroups had similar 6-month outcomes (P values >.05). Among patients who have psychological comorbidity, only patients who have central sensitization were at elevated risk for poor functional outcomes and increased opioid use. Central sensitization may be the missing link between psychological comorbidity and poor TKA clinical outcomes. Preoperative testing for central sensitization may have clinical utility for improving risk stratification in TKA patients who have psychosocial risk factors. [ABSTRACT FROM AUTHOR]

Objective: The clinical efficacy of cognitive behavioral therapy (CBT) after Total knee arthroplasty (TKA) is still controversial, and the purpose of this meta-analysis was to evaluate the effect of CBT on pain, knee function, and psychological status of patients after TKA. Methods: We systematically searched electronic databases such as CNKI, CBM, VIP, PubMed, Cochrane Library, and EMBASE for randomized controlled studies up to February 30, 2023. Screening against inclusion criteria to select valid studies and extract data. The quality of included studies was evaluated by the Cochrane Collaboration risk-of-bias 2 (RoB 2) tool for randomized trials. Statistical analysis of the data from this study was carried out using Stata 15.1 software. Results: Finally, our meta-analysis incorporated seven randomized controlled studies of high quality, including 608 patients. The findings of the meta-analysis demonstrated a noteworthy decrease in kinesiophobia levels during the early postoperative phase in the CBT group as compared to the usual care group (WMD = -6.35, 95% CI: -7.98 to -4.72, Z = 7.64, P < 0.001). However, no statistically significant difference between the CBT and usual care groups in terms of postoperative pain as well as knee function. Conclusion: CBT may effectively reduce the level of kinesiophobia in the short term after TKA, but did not significantly relieve knee pain or improve knee function. [ABSTRACT FROM AUTHOR]

Introduction: The use of spinal cord stimulation (SCS) therapy to treat chronic pain continues to rise. Optimal patient selection remains one of the most important factors for SCS success. However, despite increased utilization and the existence of general indications, predicting which patients will benefit from neuromodulation remains one of the main challenges for this therapy. Therefore, this study aims to identify the variables that may correlate with nonresponders to high‐frequency (10 kHz) SCS to distinguish the subset of patients less likely to benefit from this intervention. Materials and Methods: This was a retrospective single‐center observational study of patients who underwent 10 kHz SCS implant. Patients were divided into nonresponders and responders groups. Demographic data and clinical outcomes were collected at baseline and statistical analysis was performed for all continuous and categorical variables between the two groups to calculate statistically significant differences. Results: The study population comprised of 237 patients, of which 67.51% were responders and 32.49% were nonresponders. There was a statistically significant difference of high levels of kinesiophobia, high self‐perceived disability, greater pain intensity, and clinically relevant pain catastrophizing at baseline in the nonresponders compared to the responders. A few variables deemed potentially relevant, such as age, gender, history of spinal surgery, diabetes, alcohol use, tobacco use, psychiatric illness, and opioid utilization at baseline were not statistically significant. Conclusion: Our study is the first in the neuromodulation literature to raise awareness to the association of high levels of kinesiophobia preoperatively in nonresponders to 10 kHz SCS therapy. We also found statistically significant differences with greater pain intensity, higher self‐perceived disability, and clinically relevant pain catastrophizing at baseline in the nonresponders relative to responders. It may be appropriate to screen for these factors preoperatively to identify patients who are less likely to respond to SCS. If these modifiable risk factors are present, it might be prudent to consider a pre‐rehabilitation program with pain neuroscience education to address these factors prior to SCS therapy, to enhance successful outcomes in neuromodulation. [ABSTRACT FROM AUTHOR]

Problematic Internet Use (PIU) is a growing problem among children. Insecure attachment has been associated with PIU and emotion dysregulation. Furthermore, there is evidence suggesting that maladaptive Cognitive Emotion Regulation Strategies (CERS), such as Self-blame, Rumination, Catastrophizing and Other-blame, lead to PIU, nevertheless, the mediating role of CERS between attachment and PIU has not been explored. A sample of 641 children (M = 10.15; SD =.89) participated in the study. The findings showed that there were significant differences between problematic and non-problematic users in terms of secure attachment and emotion dysregulation. Results show a negative association between attachment security and PIU and a negative association between attachment and maladaptive CERS, whilst maladaptive CERS were positively related with PIU. Finally, maladaptive CERS, particularly Rumination, were found to mediate the relationship between attachment security and PIU. However, Catastrophizing and Other Blame partially mediated the relationship between maternal attachment, but not the relationship between Father attachment and PIU. Limitations and implications are discussed, motivating the promotion of prevention and intervention programs. [ABSTRACT FROM AUTHOR]

Introduction: Engaging in physical activity has many positive effects on both maternal and infant health in pregnant women with lumbopelvic pain (LPP). The level of physical activity is influenced by various factors, especially during periods marked by notable changes in lifestyle, such as pregnancy. This study aims to explore the effect of pregnancy-related psychosocial factors and distress, catastrophizing, and pain self-efficacy, which affect pain perception, on physical activity levels in pregnant women with LPP. Materials and methods: The study was conducted with 60 pregnant women aged 20-36 in their second or third trimester, and with lumbopelvic pain lasting more than one week. The following surveys were delivered to the participants electronically: Antenatal Psychosocial Health Assessment Scale, Tilburg Pregnancy Distress Scale, Pain Catastrophizing Scale, and Pain Self-Efficacy Questionnaire. In addition, the Pregnancy Physical Activity Questionnaire was used to measure physical activity levels. Results: No significant correlation was found between physical activity and pregnancy-related psychosocial factors (p = 0.787), pregnancy-related distress (p = 0.295), catastrophizing (p = 0.150) or pain self-efficacy (p = 0.153). Conclusions: No significant relationship was found between psychosocial factors that have been shown to have an impact on pain perception in pregnant women with LPP and their physical activity levels. Hence, psychosocial factors do not appear to be an effective barrier to the physical activity levels of pregnant women with LPP, and other factors should be examined to increase physical activity levels. [ABSTRACT FROM AUTHOR]

Background: Discovery of modifiable factors influencing subjective withdrawal experience might advance opioid use disorder (OUD) research and precision treatment. This study explores one factor – withdrawal catastrophizing – a negative cognitive and emotional orientation toward withdrawal characterized by excessive fear, worry or inability to divert attention from withdrawal symptoms.Objectives: We define a novel concept – withdrawal catastrophizing – and present an initial evaluation of the Withdrawal Catastrophizing Scale (WCS).Methods: Prospective observational study (n = 122, 48.7% women). Factor structure (exploratory factor analysis) and internal consistency (Cronbach’s α) were assessed. Predictive validity was tested via correlation between WCS and next-day subjective opiate withdrawal scale (SOWS) severity. The clinical salience of WCS was evaluated by correlation between WCS and withdrawal-motivated behaviors including risk taking, OUD maintenance, OUD treatment delay, history of leaving the hospital against medical advice and buprenorphine-precipitated withdrawal.Results: WCS was found to have a two-factor structure (distortion and despair), strong internal consistency (α = .901), and predictive validity – Greater withdrawal catastrophizing was associated with next-day SOWS (rs (99) = 0.237, p = .017). Withdrawal catastrophizing was also correlated with risk-taking behavior to relieve withdrawal (rs (119) = 0.357, p < .001); withdrawal-motivated OUD treatment avoidance (rs (119) = 0.421, p < .001), history of leaving the hospital against medical advice (rs (119) = 0.373, p < .001) and buprenorphine-precipitated withdrawal (rs (119) = 0.369, p < .001).Conclusion: This study provides first evidence of withdrawal catastrophizing as a clinically important phenomenon with implications for the future study and treatment of OUD. [ABSTRACT FROM AUTHOR]

To study whether pain empathy and theory of mind (ToM) are related to pain indices and trauma experience, we studied opioid users receiving methadone maintenance treatment (MMT), a population with a history of traumas and a high prevalence of chronic pain. MMT patients (n = 53), substance abuse-free, with no impaired cognition (Montreal Cognitive Assessment (MoCA) ≥24), were compared to healthy controls (HC) matched by age and gender (n = 66). All participants were assessed using Reading the Mind in the Eyes (RMET) for ToM, empathy (Interpersonal Reactivity Index [IRI], Empathy Quotient Scale for Adults [EQ60]), and Pain Empathy [PE task]). An algometer was used for pain pressure threshold, and supra-pain threshold was rated using a visual analog scale (VAS). Catastrophizing, McGill pain, Negative life events (NLE), and MoCA questionnaires were administered. Substance abuse was tested in the urine of MMT patients and self-reported by HC. MMT, compared to HC, were less educated with more NLE and a lower RMET (logistic regression). Groups had comparable empathy and pain indices, except for higher supra-threshold VAS rating and catastrophizing in univariate analyses. Pain empathy (PE) correlated with NLE in HC, and in MMT, with catastrophizing, which correlated with NLE, perceived stress, and pain intensity. Higher empathy was observed in 18 participants with a history of sexual abuse (83.3 % belong to the MMT group). Pain Empathy was found to be associated with personal suffering experience in both groups, as reflected by correlations with NLE in HC and with catastrophizing, which correlates with NLE, stress, and pain intensity, in MMT. [ABSTRACT FROM AUTHOR]

Trauma and posttraumatic stress are highly comorbid with chronic pain and are often antecedents to developing chronic pain conditions. Pain and trauma are associated with greater utilization of medical services, greater use of psychiatric medication, and increased total cost of treatment. Despite the high overlap in the clinic, the neural mechanisms of pain and trauma are often studied separately. In this study, resting-state functional magnetic resonance imaging (rs-fMRI) scans were completed among a diagnostically heterogeneous sample of veterans with a range of back pain and trauma symptoms. Using Group Iterative Multiple Model Estimation (GIMME), an effective functional connectivity analysis, we explored an unsupervised model deriving subgroups based on path similarity in a priori defined regions of interest (ROIs) from brain regions implicated in the experience of pain and trauma. Three subgroups were identified by patterns in functional connection and differed significantly on several psychological measures despite similar demographic and diagnostic characteristics. The first subgroup was highly connected overall, was characterized by functional connectivity from the nucleus accumbens (NAc), the anterior cingulate cortex (ACC), and the posterior cingulate cortex (PCC) to the insula and scored low on pain and trauma symptoms. The second subgroup did not significantly differ from the first subgroup on pain and trauma measures but was characterized by functional connectivity from the ACC and NAc to the thalamus and from ACC to PCC. The third subgroup was characterized by functional connectivity from the thalamus and PCC to NAc and scored high on pain and trauma symptoms. Our results suggest that, despite demographic and diagnostic similarities, there may be neurobiologically dissociable biotypes with different mechanisms for managing pain and trauma. These findings may have implications for the determination of appropriate biotype-specific interventions that target these neurological systems.

Abstract Negative pain expectation including pain catastrophizing is a well-known clinical phenomenon whereby patients amplify the aversive value of a painful or oftentimes even a similar, non-painful stimulus. Mechanisms of pain catastrophizing, however, remain elusive. Here, we modeled pain catastrophizing behavior in rats, and found that rats subjected to repeated noxious pin pricks on one paw demonstrated an aversive response to similar but non-noxious mechanical stimuli delivered to the contralateral paw. Optogenetic inhibition of pyramidal neuron activity in the anterior cingulate cortex (ACC) during the application of repetitive noxious pin pricks eliminated this catastrophizing behavior. Time-lapse calcium (Ca2+) imaging in the ACC further revealed an increase in spontaneous neural activity after the delivery of noxious stimuli. Together these results suggest that the experience of repeated noxious stimuli may drive hyperactivity in the ACC, causing increased avoidance of subthreshold stimuli, and that reducing this hyperactivity may play a role in treating pain catastrophizing.

This study aimed to clarify the reliability and validity of the Japanese version of the Insomnia Catastrophizing Scale (ICS) and to examine the relationship between insomnia severity and insomnia-related cognitive factors. A total of 786 participants were recruited via an online survey and classified into the insomnia group (n = 342) and healthy group (n = 444). The insomnia group comprised individuals who self-reported meeting the diagnostic criteria for chronic insomnia disorder in the third edition of the International Classification of Sleep Disorders. The ICS is used to independently assess nighttime (ICS–N) and daytime (ICS-D) catastrophic thoughts, and item response theory revealed that each ICS-N and ICS-D item can adequately assess catastrophic thoughts during the night and day, respectively. The internal consistency and test-retest reliability of the ICS-N and ICS-D were good. Further, the ICS-N and ICS-D had a significant positive correlation with insomnia severity, hyperarousal, sleep-related safety behaviors, dysfunctional beliefs about sleep, and anxiety symptoms. Multiple regression analyses with insomnia severity as the dependent variable in the insomnia group demonstrated that catastrophic thoughts were more strongly associated with insomnia severity than sleep-related safety behaviors and dysfunctional beliefs about sleep. The interaction between nighttime catastrophic thoughts and sleep-related safety behaviors increased insomnia severity. The Japanese versions of ICS-N and ICS-D were found to be superior in measuring insomnia-related catastrophic thoughts and to have high reliability and validity. Furthermore, these findings more clearly demonstrate that the catastrophic thoughts may be an important associated factor of insomnia. • Using item response theory, ICS was confirmed to have high structure validity. • Internal consistency and retest reliability are good, ICS is reliable. • Catastrophic thought is important among insomnia-related cognitive factors. [ABSTRACT FROM AUTHOR]

Objective Greater preoperative depression, anxiety, and pain catastrophizing are associated with more severe long-term pain following total knee arthroplasty (TKA). In a secondary analysis of previously reported data, we tested the hypothesis that these associations are mediated by oxidative stress (OS). Design A mixed between/within-subjects longitudinal cohort design. Setting A single academic medical center. Subjects Osteoarthritis patients (n  = 91; 62.6% female) undergoing unilateral TKA. Methods We assessed depression, anxiety, and catastrophizing, as well as markers of central sensitization (widespread pain, temporal summation of pain) preoperatively. Blood samples were then obtained immediately prior to intraoperative tourniquet placement for quantification of in vivo biomarkers of systemic OS, F2-isoprostanes and isofurans. Post-TKA pain intensity (numeric rating scale worst pain [NRS], McGill Pain Questionnaire-2 [MPQ-2]) and function (PROMIS Pain Interference) were assessed at 6 months following TKA. Results Greater preoperative depression, catastrophizing, and widespread pain were associated with higher intraoperative combined OS (F2-isoprostanes+isofurans/2), which was in turn associated with higher post-TKA pain intensity and worse function (P  < .05). All preoperative phenotype predictors except anxiety were correlated positively with post-TKA pain and/or function (P  < .05). Bootstrapped mediation analyses revealed significant (P  < .05) indirect (mediated) effects of depression (NRS Worst Pain, MPQ-2, PROMIS Pain Interference), anxiety (MPQ-2, PROMIS Pain Interference), and catastrophizing (PROMIS Pain Interference) on adverse long-term post-TKA outcomes via elevated OS. Central sensitization-related predictors demonstrated only direct effects (P  < .05) on post-TKA outcomes that were independent of OS mechanisms. Conclusions Results suggest that the adverse impact of depression, anxiety, and pain catastrophizing on post-TKA pain and functional outcomes are mediated in part by elevated OS. [ABSTRACT FROM AUTHOR]

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Clinical Scenario: Kinesiophobia is a common psychological phenomenon that occurs following injury involving fear of movement. These psychological factors contribute to the variability among patients' perceived disability scores following injury. In addition, the psychophysiological, behavioral, and cognitive factors of kinesiophobia have been shown to be predictive of a patient's self-reported disability and pain. Previous kinesiophobia research has mostly focused on lower-extremity injuries. There are fewer studies that investigate upper-extremity injuries despite the influence that upper-extremity injuries can have on an individual's activities of daily living and, therefore, disability scores. The lack of research calls for a critical evaluation and appraisal of available evidence regarding kinesiophobia and its contribution to perceived disability for the upper-extremity. Focused Clinical Question: How does kinesiophobia in patients with upper-extremity injuries influence perceptions of disability and quality of life measurements? Summary of Key Findings: Two cross-sectional studies and one cohort study were included. The first study found a positive relationship between kinesiophobia and a high degree of perceived disability. Another study found that kinesiophobia and catastrophic thinking scores were the most important predictors of perceived upper-extremity disability. The third study found that kinesiophobia contributes to self-reported disability in the shoulder. Clinical Bottom Line: There is moderate evidence that supports the relationship between kinesiophobia and perceived disability, and the relationship between elevated perceptions of disability and increased kinesiophobia scores in patients with an upper-extremity injury. Clinicians should evaluate and monitor kinesiophobia in patients following injury, a condition that can enhance perceptions of disability. An elevated perception of disability can create a cycle of fear that leads to hypervigilance and fear-avoidance behavior. Strength of Recommendation: Consistent findings from reviewed studies suggest there is grade B evidence to support that kinesiophobia is related to an increased perceived disability following upper-extremity injuries. [ABSTRACT FROM AUTHOR]