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Sarah N Miller,1 Michelle Nichols,1 Ronald J Teufel II,2 Erin P Silverman,3 Marta Walentynowicz4 1College of Nursing, Medical University of South Carolina, Charleston, South Carolina, SC, USA; 2College of Medicine, Medical University of South Carolina, Charleston, South Carolina, SC, USA; 3Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL, USA; 4Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, BelgiumCorrespondence: Sarah N Miller, Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, Charleston, SC, 29425, USA, Tel +18437921692, Email millesar@musc.eduAbstract: Dyspnea is an unpredictable and distressing symptom of chronic obstructive pulmonary disease (COPD). Dyspnea is challenging to measure due to the heterogeneity of COPD and recall bias associated with retrospective reports. Ecological Momentary Assessment (EMA) is a technique used to collect symptoms in real-time within a natural environment, useful for monitoring symptom trends and risks of exacerbation in COPD. EMA can be integrated into mobile health (mHealth) platforms for repeated data collection and used alongside physiological measures and behavioral activity monitors. The purpose of this paper is to discuss the use of mHealth and EMA for dyspnea measurement, consider clinical implications of EMA in COPD management, and identify needs for future research in this area.Keywords: COPD, ecological momentary assessment, mobile health, dyspnea, mHealth, telehealth

Bethany D Pester,1,2,* Jolin B Yamin,2,3,* Maria J Cabrera,2,3 Shivani Mehta,2,3 Jeremy Silverman,2,3 Anne V Grossestreuer,2,3 Patricia Howard,2,3 Robert R Edwards,1,2 Michael W Donnino2,3 1Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA; 2Harvard Medical School, Boston, MA, USA; 3Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA*These authors contributed equally to this workCorrespondence: Michael W Donnino, Center for Resuscitation Science, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Rosenberg 2, Boston, MA, Boston, USA, +1-617-754-2295, Email mdonnino@bidmc.harvard.eduPurpose: Widely used therapeutic approaches, such as cognitive-behavioral and mindfulness-based therapies, can improve pain and functioning in people with chronic back pain, but the magnitude and duration of their effects are limited. Our team developed a novel 12-week program, psychophysiologic symptom relief therapy (PSRT), to substantially reduce or eliminate pain and disability. This study examined whether PSRT helped more patients achieve large-magnitude (≥ 30%, ≥ 50%, ≥ 75%) reductions in back pain-related disability compared to mindfulness-based stress reduction (MBSR) and usual care (UC), and if the beneficial effects of PSRT were explained by reductions in pain-related anxiety following treatment.Patients and Methods: Data from a three-armed randomized controlled trial were used (N=35 adults with chronic back pain). Change scores (baseline to 4-, 8-, 13-, and 26-weeks post-enrollment) were computed for back pain disability (RDQ) and pain-related anxiety (PASS-20). Fisher’s exact tests and mediation analyses were conducted.Results: Compared to MBSR and UC, PSRT helped significantly more patients achieve ≥ 75% reductions in back pain disability at all timepoints and in pain anxiety at all timepoints except 13-weeks. Change in pain anxiety significantly mediated the relationship between treatment group and change in back pain disability from baseline to 26-weeks.Conclusion: PSRT helped more patients achieve substantial reductions in disability than an established treatment (MBSR) and usual care. Findings indicate reduced pain anxiety may be a mechanism by which PSRT confers long-term benefits on disability. Importantly, this work aims to move the field toward more precise and effective treatment for chronic back pain.Keywords: chronic back pain, mind-body therapies, back pain disability, pain-related anxiety

Matthew Silverman,1 Nicholas Zwolinski,1 Ethan Wang,2 Nishita Lockwood,1 Michael Ancuta,1 Evan Jin,1 Jinlei Li1 1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA; 2Yale University School of Medicine, New Haven, CT, USACorrespondence: Jinlei Li, Yale University School of Medicine, Department of Anesthesiology, 333 Cedar Street, P.O. Box 208051, New Haven, CT, 06520-8051, USA, Email Jinlei.li@yale.eduIntroduction: With the current surge on peripheral nerve blocks in post-cesarean pain management and the historical lack of unequivocal evidence supporting its universal use, this review intended to re-examine the extended scope of literature on regional anesthesia and postoperative analgesia in low-transverse cesarean section.Methods: A literature search was conducted up to April 2023 using PubMed to identify articles relevant to our search words “cesarean section”, “neuraxial morphine”, “post-cesarean analgesia”, as well as the name of each individual nerve block. The literature search was ultimately narrowed to systematic reviews and randomized controlled trials published between 2012 and 2023. We define, describe, and discuss the evidence surrounding each individual regional anesthetic technique in the presence and absence of intrathecal morphine, which is used as the gold standard when appropriate.Results: In the absence of neuraxial morphine, all regional anesthetic techniques have some level of analgesic benefit in the post-cesarean analgesia. Transversus Abdominis Plane blocks continue to have the most studies in their use. Newer fascia plane blocks including the anterior Quadratus Lumborum, and Erector Spinae Plane blocks provide significant analgesia. In addition, direct comparison among peripheral nerve blocks consistently favors the more proximal, centralized techniques. Conversely, in the presence of neuraxial morphine, no peripheral anesthetic technique has reliably and reproducibly demonstrated an added analgesic benefit regardless of the peripheral nerve block technique or location of local anesthetic injection in the post-cesarean population.Conclusion: Neuraxial morphine continues to be the gold standard for post-cesarean section analgesia, the benefit of additional single injection regional anesthetic is currently not evidence supported. In cases where neuraxial opioids have not or cannot be given, there is overwhelming evidence that regional anesthetic techniques improve post-cesarean section analgesia and decrease post-operative opioid consumption. Even though there is no consensus on the optimal peripheral nerve block, emerging evidence suggests more centralized abdominal fascia plane block trends towards better analgesia.Keywords: cesarean section, peripheral nerve block, neuraxial morphine, erector spinae plane block, quadratus lumborum block, transversus abdominis plane block