Chronic pain patients low in social connectedness report higher pain and need deeper pressure for pain relief

The experience of rejection and disconnection reliably amplifies pain. Yet, little is known about the impact of enduring feelings of closeness, or social connectedness, on experiences of chronic pain. The current secondary analysis tested the hypothesis that greater social connectedness would predict lower chronic pain ratings, mediated by lower depression and anxiety. In addition, based on the social-affective effects of deeper pressure, and our previous finding that deeper pressure from a weighted blanket reduced chronic pain ratings, we examined whether deeper pressure from a weighted blanket would induce greater pain relief in socially disconnected chronic pain patients. We assessed social connectedness, anxiety, and depression at baseline and pain levels before and after a remote, 7-day randomized-controlled trial of a heavy or light (control) weighted blanket in a predominately White (86%) and female (80%) sample of 95 chronic pain patients. Results revealed that lower social connectedness was associated with higher chronic pain ratings, which was mediated by anxiety, but not depression. Pressure level (light vs. deep) moderated associations between social connectedness and pain reductions, such that deeper pressure was necessary for pain relief in the most socially disconnected participants. Our findings suggest a close relationship between social connectedness and chronic pain through a mechanistic pathway of anxiety. Furthermore, our findings demonstrate that sensory-affective interventions such as a weighted blanket may be a beneficial tool for chronic pain sufferers who are prone to social disconnection, potentially by activating embodied representations of safety and social support. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Tertiary prevention and treatment of rheumatic heart disease: a National Heart, Lung, and Blood Institute working group summary

Although entirely preventable, rheumatic heart disease (RHD), a disease of poverty and social disadvantage resulting in high morbidity and mortality, remains an ever-present burden in low-income and middle-income countries (LMICs) and rural, remote, marginalised and disenfranchised populations within high-income countries. In late 2021, the National Heart, Lung, and Blood Institute convened a workshop to explore the current state of science, to identify basic science and clinical research priorities to support RHD eradication efforts worldwide. This was done through the inclusion of multidisciplinary global experts, including cardiovascular and non-cardiovascular specialists as well as health policy and health economics experts, many of whom also represented or closely worked with patient-family organisations and local governments. This report summarises findings from one of the four working groups, the Tertiary Prevention Working Group, that was charged with assessing the management of late complications of RHD, including surgical interventions for patients with RHD. Due to the high prevalence of RHD in LMICs, particular emphasis was made on gaining a better understanding of needs in the field from the perspectives of the patient, community, provider, health system and policy-maker. We outline priorities to support the development, and implementation of accessible, affordable and sustainable interventions in low-resource settings to manage RHD and related complications. These priorities and other interventions need to be adapted to and driven by local contexts and integrated into health systems to best meet the needs of local communities.

Widespread Pressure Delivered by a Weighted Blanket Reduces Chronic Pain: A Randomized Controlled Trial

Pleasant sensation is an underexplored avenue for modulation of chronic pain. Deeper pressure is perceived as pleasant and calming, and can improve sleep. Although pressure can reduce acute pain, its effect on chronic pain is poorly characterized. The current remote, double-blind, randomized controlled trial tested the hypothesis that wearing a heavy weighted blanket - providing widespread pressure to the body - relative to a light weighted blanket would reduce ratings of chronic pain, mediated by improvements in anxiety and sleep. Ninety-four adults with chronic pain were randomized to wear a 15-lb. (heavy) or 5-lb. (light) weighted blanket during a brief trial and overnight for one week. Measures of anxiety and chronic pain were collected pre- and post-intervention, and ratings of pain intensity, anxiety, and sleep were collected daily. After controlling for expectations and trait anxiety, the heavy weighted blanket produced significantly greater reductions in broad perceptions of chronic pain than the light weighted blanket (Cohen's f = .19, CI [-1.97, -.91]). This effect was stronger in individuals with high trait anxiety (P = .02). However, weighted blankets did not alter pain intensity ratings. Pain reductions were not mediated by anxiety or sleep. Given that the heavy weighted blanket was associated with greater modulation of affective versus sensory aspects of chronic pain, we propose that the observed reductions are due to interoceptive and social/affective effects of deeper pressure. Overall, we demonstrate that widespread pressure from a weighted blanket can reduce the severity of chronic pain, offering an accessible, home-based tool for chronic pain. The study purpose, targeted condition, study design, and primary and secondary outcomes were pre-registered in ClinicalTrials.gov (NCT04447885: "Weighted Blankets and Chronic Pain"). Perspective: This randomized-controlled trial showed that a 15-lb weighted blanket produced significantly greater reductions in broad perceptions of chronic pain relative to a 5-lb weighted blanket, particularly in highly anxious individuals. These findings are relevant to patients and providers seeking home-based, nondrug therapies for chronic pain relief.

The influence of thrombus components in mediating bacterial adhesion to biomaterials

Thrombosis and infection represent the two largest limiting factors determining the long term success of implanted biomaterials. Infections associated with biomaterials are difficult to treat, and appear to evade the host defense systems. Mechanisms relating infection to thrombosis are described. Investigations into the role of receptors in mediating adhesion to thrombi are also discussed, in addition to strategies to reduce bacterial adhesion to biomaterial surfaces.

Influence of thrombus components in mediating Staphylococcus aureus adhesion to polyurethane surfaces

The role of protein and cellular components of thrombi in mediating bacterial adhesion on artificial surfaces was investigated in this study. The attachment of Staphylococcus aureus on polyurethane surfaces was observed directly using an automated video microscopy system. Surfaces were preconditioned with components of platelet-fibrin thrombi, including fibrinogen, thrombin, plasma, and isolated platelets. Experiments were performed in a radial flow chamber, and attachment rate constants were compared on the preconditioned surfaces in an effort to understand the complex relationship that exists between bacterial infection and thrombosis on synthetic biomaterials. Preadsorption of fibrinogen to surfaces significantly increased S. aureus adhesion compared to those preadsorbed with albumin alone while the presence of fibrin dramatically increased bacterial attachment compared to plasma preadsorbed surfaces. While the presence of adherent platelets also increased bacterial attachment, fibrin appeared to play a larger role in mediating bacterial adhesion on polyurethane surfaces. Striking results were obtained on the zwitterionic phosphonated polyurethane for a number of pretreatment conditions with regard to decreased bacterial adhesion and fibrinogen deposition.

Physical property analysis and bacterial adhesion on a series of phosphonated polyurethanes

Glycerophosphorylcholine (GPC) was incorporated as the chain extender in a series of poly(tetramethylene oxide)-based polyurethane block copolymers. In order to determine the feasibility of use of these polyurethanes in biomedical devices, the effects of GPC incorporation on physical properties were studied. The effect of soft-segment molecular weight was also investigated. Biocompatibility of these materials was studied with regard to bacterial adhesion and protein deposition. Tensile testing showed that as GPC content increased, elongation at break decreased, while Young's modulus increased. Differential scanning calorimetry (DSC) results showed slightly decreased glass transition temperatures (Tgs) with increasing GPC content, indicating increased phase separation. Dynamic mechanical analysis (DMA) confirmed the decrease in Tg and the increase in rubbery plateau modulus with increasing GPC content. Water absorption was also increased with GPC content. Decreased bacterial adhesion was found on the GPC-containing materials compared to other functionalized polyurethanes. These experiments were carried out in a radial flow chamber utilizing automated video microscopy. Bacterial attachment was found to be lower on the GPC-containing polyurethanes both in the absence of and after pre-adsorption with plasma proteins.

Bacterial adhesion on polyurethane surfaces conditioned with thrombus components

Thrombosis and infection are two major complications associated with cardiovascular devices such as ventricular assist devices, total artificial hearts, vascular grafts, and catheters. When blood contacts an artificial biomaterial, protein deposition occurs, as do activation of the blood coagulation cascade, platelet adhesion, activation, and aggregation, all of which lead to thrombus formation. An increased incidence of bacterial infection also has been seen clinically with indwelling biomaterial devices. Some evidence suggests a possible association between thrombosis and infection, in that adherent bacteria may provide a nidus for thrombus formation, or adherent thrombi composed of platelets and fibrin may form sheltered sites for bacterial adhesion. In the current study, the authors examined Staphylococcus aureus adhesion to sulfonated, aminated, and phosphonated polyurethane surfaces that had been pre-adsorbed with solutions of increasing complexity, in an effort to approach and simulate clot formation on the surface. These solutions included various combinations of fibrinogen, albumin, plasma, thrombin, and isolated platelets. Bacterial adhesion was observed in a radial flow chamber mounted on the motorized stage of a video microscopy system, with image processing software used to perform automated data collection and image analysis. Scanning electron microscopy also was used to visualize cross-linked fibrin and bacterial adhesion on these surfaces. Bacterial adhesion was found to be lowest on the phosphonated polyurethane. The presence of fibrin or isolated platelets significantly increased bacterial adhesion compared to surfaces pre-adsorbed with albumin.