Co-occurrence of chronic pain and anxiety/depression symptoms in U.S. adults: prevalence, functional impacts, and opportunities

Diagnostic and Clinical Utility of the Generalised Anxiety Disorder-2 (GAD-2) for Screening Anxiety Symptoms in Individuals With Persistent Musculoskeletal Pain Attending Physiotherapy

INTRODUCTION

This cross-sectional study assesses the diagnostic and clinical utility of the 2-item Generalised Anxiety Disorder Scale (GAD-2) for screening anxiety symptoms in individuals with persistent musculoskeletal pain attending physiotherapy.

METHODS

In total, 450 patients (mean age = 53.3 ± 12.2 years; 109 male; mean illness duration = 0.5 ± 8.8 years) with persistent musculoskeletal pain were recruited in 84 private physiotherapy practices. Patients completed the Generalised Anxiety Disorder-7 (GAD-7) and GAD-2. Internal consistency was calculated for both measures. Area under the receiver operating characteristics curve (AUC) and Youden's J were calculated to determine the optimal GAD-2 cutoff score for identifying clinically significant anxiety symptoms, as defined by the previously validated GAD-7 cutoff score of ≥ 11 for persistent pain patients.

RESULTS

Internal consistency was good for the GAD-7 (Cronbach α = 0.89) and acceptable for the GAD-2 (α = 0.71). Both measures were moderately correlated (r = 0.39, p < 0.001). GAD-2 had moderate overall accuracy for identifying clinically significant anxiety (AUC = 0.70; 95% confidence interval, 0.66-0.74). A GAD-2 cutoff score of ≥ 3 provided the most optimal balance of sensitivity (59%) and specificity (75%). Alternatively, a cutoff score of ≥ 2 provided a better sensitivity (70%) but worse specificity (56%).

DISCUSSION

The GAD-2 is a clinically useful and psychometrically acceptable tool for screening anxiety symptoms in patients with persistent pain attending physiotherapy.

CONCLUSION

The GAD-2 has the potential to identify patients with persistent pain who are at risk of anxiety disorders and who may benefit from additional mental health support.

"How Do You Live the Best Life You Can With This Pain?" A Qualitative Study of Adults Living With CF and Pain in the Modulator ERA

BACKGROUND

Despite pain's high prevalence and impact on quality of life and health outcomes, no studies have examined psychosocial approaches for treating pain in CF. We interviewed adults with CF and pain about their experiences to inform development of a CF-specific psychosocial pain management intervention.

METHODS

We partnered with CF Community Voice to recruit 14 adults with CF and pain for 1.5 h individual qualitative interviews and conducted a hybrid inductive-deductive thematic analysis (NVivo 14).

RESULTS

Participants' age ranged from 23 to 64 years; Seven were taking a modulator, 4 eligible/not taking, 3 ineligible. Pain sources included lung/chest, head/sinus, joint, bone, back, neuropathic, GI; 100% reported multiple sources. Pain experience: A major theme was the close interrelationship of pain and CF. Subthemes included pain being part of life with CF, having CF leads to high pain tolerance and effects of aging with CF. Participants described CFTR modulators effect pain experiences with 3 noting improvement and 4 worsening pain. Pain centralization was common: fatigue, difficulties with cognition/sleep, increased sensitivity to nonpainful stimuli. Pain impact: Pain has a widespread negative impact on quality of life and especially mental health. Resiliency was a theme: the need for coping strategies, support and strong self-advocacy. Advice for CF Care Teams: Participants endorsed a need for increased acknowledgment of pain experiences and co-development of a treatment plan.

CONCLUSIONS

Pain remains a prominent, burdensome symptom in the modulator era, necessitating a multi-component management approach. Results informed the development and pilot of a mind-body pain intervention for adults with CF.

Is the association between graded sickness absence and return to work confounded by health? A longitudinal cohort study from the Norwegian neck and back registry

BACKGROUND

Musculoskeletal disorders (MSD) are among the leading causes of sickness absence (SA) and disability. Graded sickness absence (GSA) as an alternative to full time sickness absence (FSA) has been implemented in the Nordic countries to promote return to work (RTW) and prevent disability, similar to the Fit Note in the UK. However, the evidence of the effects of GSA on RTW is limited. FSA is plausibly associated with more health problems than GSA. The aim is to investigate if the hypothesized benefits of GSA over FSA on RTW is confounded by health in a cohort of sick listed patients referred to secondary care due to MSD.

METHODS

Data was obtained from the Norwegian Neck and Back Register and the Norwegian Labour and Welfare Administration. Poisson regression was used to estimate the association of GSA versus FSA on RTW at 12 months after assessment, with and without adjustment for measures of symptom severity.

RESULTS

A total of 3371 patients were on GSA (n = 1671, 49.6%) or FSA (n = 1700, 50.4%) at baseline. Patients on FSA reported more severe symptoms than those on GSA on all measures, and detailed analysis of GSA indicated more severe symptoms with higher SA levels. Patients on GSA had higher rates of RTW at 12 months follow up than patients on FSA (unadjusted RR = 1.29, 95% CI 1.22-1.37), and the association remained in the fully adjusted model (RR = 1.19, 95% CI 1.12-1.26). We found an association between levels of GSA and RTW rates, with more work being associated with higher RR for RTW.

CONCLUSIONS

Among sick listed patients referred to secondary care due to MSD, GSA is associated with higher rates of RTW than FSA. Some of the beneficial association between GSA and RTW is confounded by higher symptom levels in FSA than GSA patients, but most of the benefit remains after adjusting for symptom severity. Mechanisms for the benefit of GSA remains unknown.

Prevalence of Depression and Anxiety Among Adults With Chronic Pain: A Systematic Review and Meta-Analysis

Importance

Depression and anxiety are common among adults with chronic pain, but their prevalence is unclear.

Objectives

To evaluate the prevalence of depression and anxiety among adults with chronic pain and identify factors that moderate prevalence.

Data Sources

A literature search was conducted of MEDLINE, Embase, PsycINFO, and Cochrane Library from January 2013 to October 2023.

Study Selection

Studies reporting the prevalence of depression or anxiety using a validated assessment tool among adults with chronic pain (excluding chronic headache disorders).

Data Extraction and Synthesis

A total of 31 159 initial records were identified, and 5177 full texts were screened. Data were extracted per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline using Covidence. Two independent reviewers completed abstract screening, full-text review, and data extraction and rated risk of bias. Random-effects meta-analyses were applied to pool prevalence, assess moderation, and compare prevalence of depression or anxiety among samples with chronic pain vs control samples.

Main Outcomes and Measures

Prevalence of depression and anxiety based on clinically significant symptoms or diagnosis. The moderators of prevalence identified were pain condition, recruitment setting, continent, age, percentage female, and pain duration.

Results

The search identified 376 studies from 50 countries comprising 347 468 individuals (mean [SD] age, 51.3 [9.5] years; 70.0% female) with chronic pain. Among adults with chronic pain, clinical symptoms of depression were present in 39.3% (95% CI, 37.3%-41.1%; I2 = 98.9%), and clinical symptoms of anxiety were present in 40.2% (95% CI, 38.0%-42.4%; I2 = 99.0%). Prevalence differed by pain condition (highest among samples of people with fibromyalgia [depression, 54.0% (95% CI, 48.5%-59.4%); anxiety, 55.5% (95% CI, 50.4%-60.4%)]; lowest among samples of people with arthritis conditions [eg, osteoarthritis: depression, 29.1% (95% CI, 20.3%-39.7%); anxiety, 17.5% (95% CI, 6.6%-38.8%)]) and was highest among younger people (depression, β = -0.02 [95% CI, -0.03 to -0.01]; anxiety, β = -0.02 [95% CI, -0.03 to -0.01]) and women (depression, β = 0.69 [95% CI, 0.31-1.08]; anxiety, β = 0.90 [95% CI, 0.48-1.33]). With regard to diagnoses, 36.7% (95% CI, 29.0%-45.1%) had a major depressive disorder, and 16.7% (95% CI, 11.8%-23.2%) had generalized anxiety disorder. Women, younger people, and people with nociplastic pain (ie, pain arising from altered nociception without tissue damage) were most likely to have depression and anxiety.

Conclusions and Relevance

In this systematic review and meta-analysis of depression and anxiety among individuals with chronic pain, approximately 40% of adults had clinically significant depression and anxiety. Women, younger people, and people with nociplastic pain were most likely to have depression and anxiety. The co-occurrence of chronic pain with depression and anxiety is a significant public health concern necessitating routine screening in clinical settings, equitable access to specialty care, and innovative treatment development.

Trajectories of mHealth-Tracked Mental Health and Their Predictors in Female Chronic Pelvic Pain Disorders

Background

Female chronic pelvic pain disorders (CPPDs) affect 1 in 7 women worldwide and are characterized by psychosocial comorbidities, including a reduced quality of life and 2-10-fold increased risk of depression and anxiety. Despite its prevalence and morbidity, CPPDs are often inadequately managed with few patients experiencing relief from any medical intervention. Characterizing mental health symptom trajectories and lifestyle predictors of mental health is a starting point for enhancing patient self-efficacy in managing symptoms. Here, we investigate the association between mental health, pain, and physical activity (PA) in females with CPPD and demonstrate a method for handling multi-modal mobile health (mHealth) data.

Methods

The study sample included 4270 person-level days and 799 person-level weeks of data from CPPD participants (N=76). Participants recorded PROMIS global mental health (GMH) and physical functioning and pain weekly for 14 weeks using a research mHealth app, and moderate-to-vigorous PA (MVPA) was passively collected via activity trackers.

Data Analysis

We used penalized functional regression (PFR) to regress weekly GMH-T (GMH-T) on MVPA and weekly pain outcomes while adjusting for baseline measures, time in study, and the random intercept of the individual. We converted 7-day MVPA data into a single smooth using spline basis functions to model the potential non-linear relationship.

Results

MVPA was a significant, curvilinear predictor of GMH-T (F=18.989, p<0.001), independent of pain measures and prior psychiatric diagnosis. Physical functioning was positively associated with GMH-T, while pain was negatively associated with GMH-T (B=2.24, B=-1.16, respectively; p<0.05).

Conclusion

These findings suggest that engaging in MVPA is beneficial to the mental health of females with CPPD. Additionally, this study demonstrates the potential of ambulatory mHealth-based data combined with functional models for delineating inter-individual and temporal variability.

Monitoring Chronic Non-Cancer Pain in Denmark Over Two Decades: Prevalence, Mental Health and Loneliness

BACKGROUND

Epidemiological surveys have monitored chronic non-cancer pain (CNCP) and investigated associated factors in Denmark for more than 20 years. This study aimed to analyse CNCP prevalence in the Danish population from 2000 to 2023 and its associations with mental health status and loneliness.

METHODS

Population-based surveys were conducted between 2000 and 2023. In all waves, residents aged ≥ 16 years were randomly selected to complete a self-administered questionnaire. Samples included 10,089 respondents in 2000, 5292 in 2005, 14,330 in 2010, 13,429 in 2013, 13,050 in 2017, 10,384 in 2021 and 9303 in 2023. CNCP was defined as pain lasting ≥ 6 months. Mental status was assessed by Mental Component Summary score of Short Form-12 and severe loneliness by the Three-Item Loneliness Scale. Calibration weighting was applied to reduce potential non-response bias.

RESULTS

The prevalence of CNCP increased steadily by 9.4 percentage points from 2000 (19.5%) to 2023 (28.9%), but with a downward tick during the COVID-19 pandemic in 2021 (25.3%). Women aged 45 years or older had the highest prevalence in all waves. Results showed a worsening of mental health over time in both individuals with and without CNCP; however, the lowest scores were reported by individuals with CNCP. Severe loneliness seemed to be a substantial problem in individuals with CNCP (17.3% in 2021).

CONCLUSIONS

In summary, CNCP was highly prevalent over the given period and associated with mental health status and severe loneliness in recent years.

SIGNIFICANCE

This study demonstrated alarming trend on chronic non-cancer pain prevalence over time in Denmark. The high estimates of prevalence and related issues, such as mental health and severe loneliness deserve further investigation and prioritisation in the public health agenda.

Exploring the Pain Situation, Pain Impact, and Educational Preferences of Pain Among Adults in Mainland China, a Cross-Sectional Study

OBJECTIVES

This study aimed to investigate the pain situation, functional limitations, treatment used, care-seeking behaviors, and educational preferences of adults with pain in mainland China.

METHODS

An online questionnaire was developed through expert validation, and participants were recruited via social media platforms. Inclusion criteria required having access to the Internet and smartphones, while individuals with significant cognitive impairments or severe mental illness were excluded.

RESULTS

1566 participants, predominantly male (951) with a mean age of 30.24, were included. A total of 80.1% of the respondents reported experiencing pain, with over half suffering from chronic pain. Pain primarily affects the neck, lower back, and upper back, especially chronic low back pain. Pain significantly impacted various aspects of life, including mood, physical activity, work performance, family dynamics, and social relationships, particularly among chronic pain sufferers (p-value: < 0.001). Analgesics (66.9%) and self-management (80-94.3%) were the most used pain management strategies, with respondents with chronic pain reporting higher usage and effectiveness of medication than those with acute pain (p-value: < 0.001). Participants also expressed a greater interest in online education and psychotherapy interventions, especially through mobile applications.

CONCLUSIONS

Chronic pain is highly prevalent in mainland China, leading to emotional distress, decreased work competency, and social isolation, with a strong demand for pain education through smartphone applications.

Chronic postsurgical pain increases postoperative depression risk

PURPOSE

This retrospective cohort study aimed to investigate the association between chronic postsurgical pain (CPSP) and the risk of postoperative depression in patients undergoing major surgery.

METHODS

Data from Taiwan's National Health Insurance Research Database were analysed for patients aged over 20 years who underwent major surgery between 2004 and 2018. CPSP was defined as the use of prescribed analgesics for over 3 months postsurgery, with a prescription exceeding 90 cumulative defined daily doses. Propensity score matching (PSM) was employed to match patients with and without CPSP. Cox regression analysis and competing risk analysis were conducted to evaluate the risk of postoperative depression in the CPSP group compared with the no CPSP group.

RESULTS

Before PSM, 141 466 patients were included, with 37 303 (26.37%) experiencing CPSP. After PSM, 74 606 patients were matched in both groups. The incidence of depression was significantly higher in the CPSP group compared with the no CPSP group (p<0.0001). Cox regression analysis revealed a significantly elevated risk of depression in the CPSP group (adjusted HR: 1.41; 95% CI 1.35 to 1.48; p<0.0001), which persisted across various adjustment models and competing risk analysis. The cumulative depression risk increased over the follow-up period.

CONCLUSIONS

This study demonstrates a strong association between CPSP and postoperative depression risk. Addressing CPSP may offer a promising approach to reducing the incidence of postoperative depression and its socioeconomic and familial burdens. Further research is needed to elucidate underlying mechanisms and optimise preventive interventions.

Poor control of pain increases the risk of depression: a cross-sectional study

Background

Inadequate pain management not only results in prolonged physical discomfort but also causes a range of psychological and social issues, such as anxiety, depression, social withdrawal, and diminished work performance. This study aims to investigate the relationship between the duration of pain and depression.

Methods

This study utilized data on pain and depression from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014. Participants with a health questionnaire score ≥10 were considered to have depressive symptoms. Weighted univariate, multivariate logistic regression analysis, sensitivity analysis, and restricted cubic spline (RCS) analysis were used to examine the relationship between pain duration and the risk of depression. Additionally, subgroup analysis was conducted to identify potential confounding factors that might affect this relationship.

Results

Among the 2,248 participants, 442 (19.6%) were diagnosed with depressive symptoms, with an average age of 52 years, 69% of whom were female. After adjusting for all confounding factors, our results show a significant association between pain duration (in months) and depression. Individuals in the highest quartile of pain duration had a 154% higher likelihood of developing depression compared to those in the lowest quartile (OR = 3.375, 95% CI 2.329-4.886, P < 0.001), and the trend test was also significant (P for trend < 0.001). The RCS analysis indicated a linear relationship between pain duration and depression (P for nonlinearity = 0.427).

Conclusion

This study's results indicate that inadequate pain control, resulting in extended pain duration, places patients at a higher risk for depression.

The unmet mental health needs of U.S. adults living with chronic pain

ABSTRACT

Previous research suggests that individuals with mental health needs and chronic pain may be less likely to use mental health treatment compared with those with mental health needs only. Yet, few studies have investigated the existence of population-level differences in mental health treatment use. We analyzed data from the National Health Interview Survey (n = 31,997) to address this question. We found that chronic pain was associated with end-to-end disparities in the mental health journeys of U.S. adults: (1) Those living with chronic pain are overrepresented among U.S. adults with mental health needs; (2) among U.S. adults with mental health needs, those living with chronic pain had a lower prevalence of mental health treatment use; (3) among U.S. adults who used mental health treatment, those living with chronic pain had a higher prevalence of screening positive for unremitted anxiety or depression; (4) among U.S. adults living with both chronic pain and mental health needs, suboptimal mental health experiences were more common than otherwise-just 44.4% of those living with mental health needs and co-occurring chronic pain reported use of mental health treatment and screened negative for unremitted anxiety and depression, compared with 71.5% among those with mental health needs only. Overall, our results suggest that U.S. adults with chronic pain constitute an underrecognized majority of those living with unremitted anxiety/depression symptoms and that the U.S. healthcare system is not yet adequately equipped to educate, screen, navigate to care, and successfully address their unmet mental health needs.

Musculoskeletal pain among Chinese women during the menopausal transition: findings from a longitudinal cohort study

ABSTRACT

The profiles of muscle and joint pain throughout the menopausal transition and the factors associated with these symptoms have not been determined. A total of 609 participants from a longitudinal cohort study conducted in an urban Chinese community were enrolled in this study. We assessed the prevalence of musculoskeletal symptoms at different menopausal stages and explored the factors associated with these symptoms. The prevalence and severity of muscle and joint pain increase as menopausal stages progress, and late menopausal transition may be a crucial timepoint that triggers the onset of musculoskeletal pain. The results of the multivariate analysis revealed that poor health status (OR = 2.245, 95% CI = 1.714-2.94, P < 0.001), body mass index (BMI) (OR = 1.046, 95% CI = 1.01-1.084, P = 0.011), the presence of anxiety (OR = 1.601, 95% CI = 1.211-2.117, P < 0.001), and depression (OR = 1.368, 95% CI = 1.143-1.639, P < 0.001) were independently associated with muscle and joint pain. In addition, the severity of musculoskeletal pain was related to poor health status (OR = 2.738, 95% CI = 1.91-3.924, P < 0.001) and depression (OR = 1.371, 95% CI = 1.095-1.718, P = 0.006). Musculoskeletal symptoms are frequent somatic symptoms experienced by Chinese middle-aged women. Women with poor health status, high BMI, anxiety, and depression were at heightened risk of experiencing musculoskeletal pain. The severity of pain increased over time.

Chronic Pain Resilience Across Clinical Populations: A Concept Analysis

BACKGROUND

Chronic pain resilience is a concept that is frequently used in research but lacks theoretical clarity. Understanding chronic pain resilience is germane to developing interventions to improve it and the overall quality of life among individuals with chronic pain.

AIMS

To uncover and clarify the unique characteristics of the concept of chronic pain resilience.

DESIGN

A concept analysis using Rodgers' evolutionary method.

METHODS

Full-text articles published after 2000 in English were used to inform the concept analysis. Scopus, PubMed, PsychINFO, Embase, and CINAHL Plus with Full Text were utilized for literature searches. Rodgers' evolutionary approach was used to clarify the attributes, antecedents, and consequences.

RESULTS

The search yielded 31 articles that were used in the analysis. The key attributes of chronic pain resilience included engagement in meaningful activities despite pain, maintaining positive psychological homeostasis, buffering against negative mental outcomes, seeking support, and self-empowerment. After considering surrogate terms, antecedents, attributes, and consequences, chronic pain resilience may be defined as the development of the capacity to successfully adapt to chronic pain. This adaptation results in a move toward optimal social, physical, mental, and behavioral functioning by balancing negative and positive psychosocial factors, despite the additional challenges brought about by living with chronic pain.

Effect of a controlled diaphragmatic breathing session on perceived pain and state anxiety in people with chronic pain

Chronic pain conditions are frequently comorbid with anxiety problems. The controlled diaphragmatic breathing technique has been applied in both conditions. However, few studies have examined its efficacy in reducing perceived pain and state anxiety in the population with both pathologies. Thus, the study objective was to investigate the immediate effects of a single-session diaphragmatic breathing intervention on perceived pain and state anxiety in a group of people with chronic pain. We analyzed the influence of sociodemographic variables, dispositional anxiety, average pain during the last week, respiratory rate, and inhalation/exhalation ratio. The sample comprised 169 people with chronic pain from Spain and Poland who were evaluated before and after performing an online controlled diaphragmatic breathing task. The Wilcoxon test showed significant decreases in state anxiety and perceived pain. Linear regression analyses revealed an association between dispositional anxiety and pretest/posttest differences in state anxiety, as well as an association between both average pain in the last week and nationality and pretest/posttest differences in perceived pain. We conducted an exploratory analysis of the differences between both countries in the study variables. We discuss the results and the relevance of further studies on the efficacy of this technique in reducing perceived pain and state anxiety.

Examining the Relationship Between Chronic Pain and Mortality in U.S. Adults

Chronic pain (CP) significantly impacts quality of life and increases noncommunicable disease risk, with recent U.S. data showing a 6.3% incidence rate, surpassing diabetes, depression, and hypertension. International studies suggest higher mortality in CP populations, yet prior U.S. data are inconclusive. To investigate CP's mortality risk, we analyzed National Health Interview Survey and National Death Index data. We hypothesized that individuals with CP and high-impact CP (HICP [≥1 activity limitation]) would exhibit higher mortality rates. National Health Interview Survey provided demographics, pain reporting, lifestyle, and psychosocial data matched with National Death Index mortality records. Chi-square analyses explored the relationships between CP/HICP and demographics, lifestyle factors, psychosocial variables, and mortality. Cox proportional hazards models assessed mortality risk between groups. The weighted sample was 245,899,776; 20% reported CP and 8% HICP, both groups exhibiting higher mortality rates than pain-free individuals (CP: 5.55%, HICP: 8.79%, total: 2.82%). Hazard ratios indicated nearly double the mortality risk for CP and 2.5 times higher risk for HICP compared to those without these conditions. Adjusting for lifestyle and psychosocial factors reduced mortality risk but remained elevated compared with non-CP individuals. Heart disease, malignant neoplasms, and chronic lower respiratory diseases accounted for a higher percentage of deaths in CP cases. CP individuals showed higher rates of smoking, alcohol consumption, obesity, inactivity, depression, anxiety, emotional problems, and sleep disturbances. CP and HICP significantly influence mortality outcomes, leading to excess deaths compared with pain-free individuals. Given the relationship between pain, lifestyle, psychosocial variables, and mortality, further investigations are needed into CP causation and prevention strategies. PERSPECTIVE: This article presents evidence regarding the relationship between CP, HICP, and mortality. Additional findings are discussed regarding the impact of demographics, lifestyle, and psychosocial variables on mortality in those with versus without CP and HICP. These findings are crucial for informing future research, prevention, and healthcare management strategies.

Assessing Gender Differences in Neuropathic Pain Management: Findings from a Real-Life Clinical Cross-Sectional Observational Study

Introduction: Neuropathic pain is defined as pain induced by a lesion or disease of the somatosensory nervous system. Pharmacological and non-pharmacological treatments are frequently employed. In the current clinical investigation, we assessed the effects of sex on the safety and effectiveness of medications used to treat neuropathic pain. Methods: We conducted a prospective analysis between 1 February 2021 and 20 April 2024, involving patients with neuropathic pain referred to the Ambulatory of Pain Medicine of "Renato Dulbecco" University Hospital in Catanzaro (Calabria, Italy). Patients over 18 years old with signs of neuropathic pain (Douleur Neuropathique en 4 questionnaire ≥ 4) were included. Exclusion criteria comprised patients with Alzheimer's disease; patients with nociplastic or nociceptive pain; and patients with neoplasms. Patients with fewer than two accesses to ambulatory care were excluded, as were those who did not sign the informed consent. Clinical data were collected from each enrolled patient and subsequently analyzed, considering clinical outcomes. Sex and gender differences in efficacy were estimated using multivariate linear modeling and propensity-score matching. Results: During the study, 531 patients were screened, and 174 were enrolled (33.5%, mean age 61.5 ± 13.1; 64 males and 110 females, mean age 60.6 ± 13.4 and 61.96 ± 13.0) in accordance with the inclusion and exclusion criteria. Only minor differences in treatment prescription were observed based on age, body mass index, and comorbidities. Smoking, sex, educational level, and body mass index did not induce a significant change in pain perception. Males required slightly higher, though not significantly, doses of drugs for pain control than females. The treatment was not significantly more effective for females than for males. Females did not exhibit a significantly lower number of adverse drug reactions compared to males. Conclusions: The current study found that there are no appreciable differences between the sexes when it comes to the treatment of neuropathic pain.

Using Multimodal Assessments to Reevaluate Depression Designations for Spine Surgery Candidates

BACKGROUND

Depression is common in spine surgery candidates and may influence postoperative outcomes. Ecological momentary assessments (EMAs) can overcome limitations of existing depression screening methods (e.g., recall bias, inaccuracy of historical diagnoses) by longitudinally monitoring depression symptoms in daily life. In this study, we compared EMA-based depression assessment with retrospective self-report (a 9-item Patient Health Questionnaire [PHQ-9]) and chart-based depression diagnosis in lumbar spine surgery candidates. We further examined the associations of each depression assessment method with surgical outcomes.

METHODS

Adult patients undergoing lumbar spine surgery (n = 122) completed EMAs quantifying depressive symptoms up to 5 times daily for 3 weeks preoperatively. Correlations (rank-biserial or Spearman) among EMA means, a chart-based depression history, and 1-time preoperative depression surveys (PHQ-9 and Psychache Scale) were analyzed. Confirmatory factor analysis was used to categorize PHQ-9 questions as somatic or non-somatic; subscores were compared with a propensity score-matched general population cohort. The associations of each screening modality with 6-month surgical outcomes (pain, disability, physical function, pain interference) were analyzed with multivariable regression.

RESULTS

The association between EMA Depression scores and a depression history was weak (r rb = 0.34 [95% confidence interval (CI), 0.14 to 0.52]). Moderate correlations with EMA-measured depression symptoms were observed for the PHQ-9 (r s = 0.51 [95% CI, 0.37 to 0.63]) and the Psychache Scale (r s = 0.68 [95% CI, 0.57 to 0.76]). Compared with the matched general population cohort, spine surgery candidates endorsed similar non-somatic symptoms but significantly greater somatic symptoms on the PHQ-9. EMA Depression scores had a stronger association with 6-month surgical outcomes than the other depression screening modalities did.

CONCLUSIONS

A history of depression in the medical record is not a reliable indication of preoperative depression symptom severity. Cross-sectional depression assessments such as PHQ-9 have stronger associations with daily depression symptoms but may conflate somatic depression symptoms with spine-related disability. As an alternative to these methods, mobile health technology and EMAs provide an opportunity to collect real-time, longitudinal data on depression symptom severity, potentially improving prognostic accuracy.

LEVEL OF EVIDENCE

Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Assessing suicide risk in chronic pain management: a narrative review across drug classes

INTRODUCTION

Chronic pain presents a multifaceted challenge in clinical practice, necessitating a nuanced understanding of pharmacological interventions to optimize treatment outcomes. This review provides an outline of various pharmacological agents commonly used in chronic pain management and highlights their safety considerations, particularly regarding suicide risk.

AREAS COVERED

This review discusses the role of antidepressants, anticonvulsants, GABA receptor agonists, NMDA receptor antagonists, corticosteroids, cannabis and cannabinoids, bisphosphonates, calcitonin, and alpha-2 adrenergic receptor agonists in chronic pain management. It assesses their therapeutic benefits, potential for misuse, and psychiatric adverse effects, including the risk of suicide. Each pharmacological class is evaluated in terms of its efficacy, safety profile, and considerations for clinical practice. We searched peer-reviewed English literature on the topic using the MEDLINE database without time restrictions.

EXPERT OPINION

While pharmacological interventions offer promise in alleviating chronic pain, healthcare providers must carefully weigh their benefits against potential risks, including the risk of exacerbating psychiatric symptoms and increasing suicide risk. Individualized treatment approaches, close monitoring, and multidisciplinary collaboration are essential for optimizing pain management strategies while mitigating adverse effects. Ongoing research efforts are crucial for advancing our understanding of these pharmacological interventions and refining pain management practices.

Factors associated with depression in patients undergoing rehabilitation for chronic pain: a cross-sectional analytical study at a referral hospital in Peru

Despite the well-known impact of depression on patients with chronic pain and its association, few studies have evaluated its related factors in Physical Medicine and Rehabilitation settings. The objective of the present study was to assess the factors associated with depression in adult patients undergoing rehabilitation for chronic pain at Hospital Rebagliati (HNERM) in Peru. A cross-sectional analytical study was conducted between June and August 2023, involving 212 adult patients with chronic pain undergoing rehabilitation at HNERM. Data were collected through a survey, including sociodemographic information, pain characteristics, and depression assessment using the Patient Health Questionnaire-9 (PHQ-9). Statistical analysis included descriptive statistics and generalized linear models to identify factors associated with depression. Among 212 participants, 17.9% had a depression diagnosis based on the PHQ-9 (cutoff score: 10 points). Factors associated with a higher frequency of depression included a time since pain diagnosis of 3-6 months [adjusted prevalence ratios (aPR): 1.15, 95% confidence interval (CI): 1.04-1.27], severe pain (aPR: 1.17, 95% CI: 1.04-1.32), comorbidities (for 1: aPR: 1.21, 95% CI: 1.08-1.35; for 2: aPR: 1.17, 95% CI: 1.06-1.29; for ≥3: aPR: 1.27, 95% CI: 1.10-1.47), use of ≥2 medications for pain management (aPR: 1.27, 95% CI: 1.13-1.42), and receipt of psychological therapy (aPR: 1.26, 95% CI: 1.09-1.46). Nonpharmacological interventions did not show an association with an increased prevalence of depression. These findings underscore the significance of adopting a comprehensive approach to chronic pain management, including the screening, assessment, and treatment of associated depression.

Psychometric Properties of the Arabic Version of the Pain Resilience Scale among Lebanese Adults with Chronic Musculoskeletal Pain

Background

The Pain Resilience Scale (PRS), which measures behavioral perseverance and the ability to regulate emotions and cognition despite ongoing pain, lacks an Arabic version.

Objectives

This study aimed to translate, culturally adapt, and validate an Arabic version of the Pain Resilience Scale (PRS-A) among Lebanese adults.

Methods

Phase 1 involved translation and cross-cultural adaptation of the PRS into Arabic. Phase 2 examined the reliability and validity of the PRS-A. A convenience sample of 154 Lebanese adults with chronic musculoskeletal pain completed the PRS-A and self-report measures of pain catastrophizing, pain self-efficacy, pain intensity and interference, depression and anxiety, and quality of life.

Results

The PRS-A yielded a two-factor structure with factor 1 representing "cognitive/affective positivity" and factor 2 representing "behavioral perseverance," accounting for 41.93% and 15.15% of the variance in pain resilience, respectively. Total PRS-A score (M = 33.20 and SD = 9.90) showed significant correlations with pain catastrophizing (M = 27.65, SD = 13.03, and r = -0.52), pain self-efficacy (median = 9.00, IQR = 4, and rho = 0.61), pain intensity (M = 4.50, SD = 2.25, and r = -0.28), pain interference (M = 4.30, SD = 2.89, and r = -0.56), physical (M = 34.95, SD = 9.52, and r = 0.34) and mental (M = 40.08, SD = 12.49, and r = 0.58) health functioning, anxiety (median = 7.00, IQR = 7, and rho = -0.57), and depression (median = 4.00, IQR = 6, and rho = -0.58). PRS-A subscale was also significantly related to all measures except pain intensity, which was correlated with cognitive/affective positivity (r = -0.33) but not behavioral perseverance (r = -0.09). Cronbach's alpha for the PRS-A was 0.87.

Conclusion

The PRS-A demonstrated validity and acceptable reliability among Arab-speaking individuals with chronic musculoskeletal pain, suggesting its potential utility for assessing pain resilience within this population.

Adolescent-onset cannabis use and parenting young children: an investigation of differential effectiveness of a digital parenting intervention

Introduction

There is scant empirical work on associations between current and past cannabis use and parenting skills in parents of young children. As recreational cannabis use is now legal in nearly half of states in the U.S., cannabis use is becoming more ubiquitous.

Methods

In the current study, parents of toddler and pre-school age children were randomly assigned to participate in an app-based parenting skills program that included telehealth coaching (Family Check-Up Online; FCU-O), with a focus on parenting in the context of substance use. We aimed to test associations between adolescent-onset and current cannabis use and parent mental health and parenting skills, as well as whether effects of the FCU-O on parent mental health outcomes varied as a function of past cannabis use. Participants were 356 parents of children ages 1.5-5 participating in a randomized controlled trial of the FCU-O. Parents screened into the study if they reported current or past substance misuse or current depressive symptoms. After completing a baseline assessment, parents were randomly assigned to the FCU-O or control group and completed a follow-up assessment 3 months later. Parents retrospectively reported on the age when they initially used substances, as well as their current use.

Results

After accounting for current cannabis use, adolescent-onset cannabis use was significantly associated with higher symptoms of anxiety and depression, but not with parenting skills. Adolescent-onset cannabis use was found to significantly moderate the effect of the FCU-O on parents' anxiety symptoms. Specifically, the FCU-O was particularly effective in reducing anxiety symptoms for parents with adolescent-onset regular cannabis use, after accounting for current cannabis use.

Discussion

Adolescent-onset regular cannabis use may be a risk factor for later mental health challenges in parents of children under 5. An app-based parenting intervention may be particularly helpful in reducing symptoms of anxiety for parents who used cannabis regularly as adolescents. The findings have significant implications for the prevention of multigenerational risk for substance use and mental health challenges.

Assessing Risk Factors and Comorbidities in the Treatment of Chronic Pain: A Narrative Review

PURPOSE OF REVIEW

Chronic pain affects a significant portion of the population globally, making it a leading cause of disability. Understanding the multifaceted nature of chronic pain, its various types, and the intricate relationship it shares with risk factors, comorbidities, and mental health issues like depression and anxiety is critical for comprehensive patient care. Factors such as socioeconomic status (SES), age, gender, and obesity collectively add layers of complexity to chronic pain experiences and pose management challenges.

RECENT FINDINGS

Low SES presents barriers to effective pain care, while gender differences and the prevalence of chronic pain in aging adults emphasize the need for tailored approaches. The association between chronic pain and physical comorbidities like cardiovascular disease, chronic obstructive pulmonary disease (COPD), and diabetes mellitus reveals shared risk factors and further highlights the importance of integrated treatment strategies. Chronic pain and mental health are intricately linked through biochemical mechanisms, profoundly affecting overall quality of life. This review explores pharmacologic treatment for chronic pain, particularly opioid analgesia, with attention to the risk of substance misuse and the ongoing opioid epidemic. We discuss the potential role of medical cannabis as an alternative treatment with a nuanced perspective on its impact on opioid use. Addressing the totality and complexity of pain states is crucial to individualizing chronic pain management. With different types of pain having different underlying mechanisms, considerations should be made when approaching their treatment. Moreover, the synergistic relationship that pain states can have with other comorbidities further complicates chronic pain conditions.

Scoping Review: The Role of Psychedelics in the Management of Chronic Pain

Introduction

Amid a lack of effective chronic pain treatments, psychedelics have gained attention as a potential solution, although their Schedule 1 classification poses challenges. Psychedelics, such as lysergic acid diethylamide (LSD) and psilocybin, have gained popularity as alternatives and adjuncts for chronic pain treatment. Studies suggest that they may modulate pain processing through agonism primarily at the serotonin receptor, 5-HT2A. One of the first of its nature, we present an artificial intelligence (AI)-powered scoping review primarily focusing on evaluating psychedelics for chronic pain conditions such as cluster headache, phantom limb pain, and fibromyalgia.

Methods

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we used an AI-powered comprehensive search strategy utilizing the ChatGPT4.0 Bing chat to search Medline, Embase, Cochrane, and Google Scholar for articles addressing chronic pain. The query was performed on June 1, 2023, focusing on psychedelics for chronic, non-cancer pain including headache disorders. Inclusion criteria were English-only, peer-reviewed articles involving human participants >18 years, focusing on chronic pain conditions (eg, phantom limb pain and cluster headache), using LSD, 2.5-dimethoxy-4-bromophenethylamine (2C-B), N, N-dimethyltryptamine (DMT), psilocybin, or mescaline. Exclusion criteria were reviews, editorials, and opinion articles and studies focusing on tetrahydrocannabinol/cannabis and/or ketamine.

Results

A total of 186 unique database entries were retrieved, of which nine studies were included in the scoping review. These included four case reports/series, an open-label study, a cohort study, two online surveys, and a randomized, double-blind, placebo-controlled trial. They comprised three studies addressing phantom limb pain, four addressing cluster headaches, and two addressing fibromyalgia, spinal cord injury, complex regional pain syndrome, and lumbar radiculopathy.

Conclusion

Psychedelics may have potential in alleviating pain symptoms secondary to a multitude of chronic pain conditions. However, further randomized, double-blind, placebo-controlled trials are needed to further explore and evaluate the role of psychedelics in chronic, non-cancer pain.

Neuropsychological Symptoms and Functional Capacity in Older Adults with Chronic Pain

The impact of chronic pain on neuropsychological functioning of older adults is under-studied. The present study examined the relationship between chronic pain, depression, anxiety, cognition, and functional capacity in community-dwelling older adults (ages 60-89) who completed an outpatient neuropsychological evaluation (N = 452). Psychometrically sound and validated measures were used to assess depression (Geriatric Depression Scale [GDS]), anxiety (Beck Anxiety Inventory [BAI]), cognitive functioning (the Mini Mental Status Exam [MMSE] and the Repeatable Battery for the Assessment of Neuropsychological Status [RBANS]), and functional capacity (Texas Functional Living Scale [TFLS] and Instrumental Activities of Daily Living Questionnaire [IADL]). Multivariate analyses of covariance (MANCOVA) were conducted to examine differences between individuals with and without chronic pain, adjusting for age, education, gender, marital status, and other medical conditions. Results indicated that participants endorsing chronic pain displayed significantly higher levels of depression and anxiety, as well as lower levels of cognitive functioning and functional capacity, than those without chronic pain. Additionally, results of hierarchical multiple regressions indicated that chronic pain explained unique variance in all outcome variables, beyond demographic characteristics and health status. Chronic pain management may be an important intervention target for clinicians to help address cognitive and psychological functioning in older adults.

Exploring the outcome "days with bothersome pain" and its association with pain intensity, disability, and quality of life

OBJECTIVES

The aim of this study is to investigate the criterion validity, specifically the concurrent validity of the measure of days with bothersome pain, by investigating its association with measures of pain intensity, disability, and quality of life.

METHODS

We used two separate cohorts to study the concurrent validity of "days with bothersome pain," by investigating its association with pain intensity, disability, and quality of life: (1) 321 patients with low back pain (LBP), using follow-up data at 1 year, and (2) 170 pregnant women with pelvic girdle pain (PGP), using data at 12 and 30 weeks of their pregnancy. In both studies, weekly text messages asked for the number of days with bothersome pain the previous week. Pearson's correlation, univariable, and multivariable linear regression were used to assess the association between days with bothersome pain per week and pain intensity, disability, and quality of life. Non-linear associations were explored.

RESULTS

Days with bothersome pain were moderately and inversely correlated with quality of life (r = -0.45, p < 0.001), and moderately correlated with pain intensity (r = 0.70, p < 0.001) and disability ( r = 0.51, p < 0.001), among patients with LBP, and to a lesser degree among pregnant women with PGP (corresponding values at 18 weeks of pregnancy for quality of life; r = -0.27, p = 0.005, for pain intensity r = 0.41, p < 0.001, and for disability r = 0.41, p < 0.001). Furthermore, it was best explained by pain intensity for LBP patients, and by pain intensity and disability for pregnant women with pelvic pain. For the latter cohort, non-linear analyses suggested that days with bothersome pain could not distinguish between individuals with different high pain intensities and disabilities and low quality of life.

CONCLUSIONS

We consider the concurrent validity of "days with bothersome pain" to be moderate in the correlations with pain intensity, disability, and quality of life in patients with LBP and in pregnant women with PGP. Ceiling effects may be an issue in populations with high pain severity. The differences between the cohorts suggested that also other constructs are involved in the concept of days with bothersome pain.

To speak or not to speak? A secondary data analysis to further explore the context-insensitive avoidance scale

OBJECTIVES

Inflexibly relying on avoidance of expression may increase and perpetuate pain-related emotional distress in patients with chronic pain. The context-insensitive avoidance (CIA) scale was recently developed to measure the degree to which patients avoid expressing their pain and distress in social situations. This study explored the psychometric properties of the CIA scale in a new sample.

METHODS

This study uses baseline data from a treatment trial for n = 115 patients with chronic pain and co-occurring emotional distress. Reliability and construct and criteria validity were studied using the same instruments as in the original psychometric study and further explored in two new measures. A series of multiple regression analyses were conducted to assess the relationship between the CIA scale and criteria variables compared to the other psychological constructs.

RESULTS

The CIA scale showed good reliability. Significant correlations between high scores on the CIA scale and low scores on self-compassion and activity engagement could be replicated. Significant correlations between high scores on the CIA scale and high scores of pain intensity and pain interference could also be replicated. In the exploring part of this study, validity was extended to general problems with emotion regulation and to satisfaction with life in general and contact with friends but not to satisfaction with family, partner, or sexual life. Avoidance of expression was the only significant predictor of pain intensity.

CONCLUSION

This study could replicate acceptable psychometric properties of a scale measuring CIA of expression. As in the original study, avoidance of expression was associated with increased suffering. Clinically, this instrument may be used to identify patients who may otherwise remain in aggravating silence. Theoretically, it introduces the important concept of context sensitivity to the field of chronic pain. Limitations include uncertainty about causal relationships, and that several important social situations were not examined.

Transformer encoder with multiscale deep learning for pain classification using physiological signals

Pain, a pervasive global health concern, affects a large segment of population worldwide. Accurate pain assessment remains a challenge due to the limitations of conventional self-report scales, which often yield inconsistent results and are susceptible to bias. Recognizing this gap, our study introduces PainAttnNet, a novel deep-learning model designed for precise pain intensity classification using physiological signals. We investigate whether PainAttnNet would outperform existing models in capturing temporal dependencies. The model integrates multiscale convolutional networks, squeeze-and-excitation residual networks, and a transformer encoder block. This integration is pivotal for extracting robust features across multiple time windows, emphasizing feature interdependencies, and enhancing temporal dependency analysis. Evaluation of PainAttnNet on the BioVid heat pain dataset confirm the model's superior performance over the existing models. The results establish PainAttnNet as a promising tool for automating and refining pain assessments. Our research not only introduces a novel computational approach but also sets the stage for more individualized and accurate pain assessment and management in the future.