Psychological profiles and prescription opioid misuse, craving, and withdrawal in people with chronic pain

BACKGROUND

The negative consequences of prescription opioid misuse and opioid use disorder make it relevant to identify factors associated with this problem in individuals with chronic pain. This cross-sectional study aimed at identifying subgroups of people with chronic pain based on their psychological profiles, prescription opioid misuse, craving, and withdrawal.

METHODS

The sample comprised 185 individuals with chronic pain. We performed hierarchical cluster analysis on impulsivity, anxiety sensitivity, pain acceptance, pain intensity, opioid misuse, craving, and withdrawal.

RESULTS

The four-cluster solution was the optimal one. Misuse, craving, and anxiety sensitivity were higher among people in the Severe-problems cluster than among people in the other three clusters. Withdrawal was the highest in the High-withdrawal cluster. Impulsivity was higher among people in the Severe-problems and High-withdrawal clusters than those in the Moderate-problems and Mild-problems clusters. Pain acceptance was higher among people in the Mild-problems cluster than among people in the other three clusters. Anxiety sensitivity and misuse were higher among people in the Moderate-problems cluster than among people in the Mild-problems cluster.

CONCLUSIONS

These results support that impulsivity, anxiety sensitivity, and pain acceptance are useful constructs to identify subgroups of people with chronic pain according to their level of prescription opioid misuse, craving, and withdrawal. The results of this study may help in selecting the early intervention most suitable for each of the identified profiles.

SIGNIFICANCE

The psychological profile of individuals with chronic pain, prescription opioid misuse, craving, and withdrawal is characterized by fearing anxiety-related symptoms due to the catastrophic interpretation of such symptoms and reacting impulsively to negative moods. In contrast, participants with high pain acceptance had less prescription opioid misuse, craving, and withdrawal. The profiles identified in this study could help clinicians select targets for intervention among profiles with similar needs and facilitate early interventions to prevent opioid misuse onset or aggravation.

P-208 Embryo assessment at the click of a button is now possible: evaluation of a deep-learning algorithm integrated directly with the time-lapse platform

Study question

Is the embryo scoring function based on deep learning of specific time-lapse systems clinically useful for classifying human blastocyst?

Summary answer

Blastocyst grading according to iDAScore® is directly associated with conventional morphology and implantation potential, at least in treatments without preimplantation genetic testing for aneuploidy (PGT-A).

What is known already

The conventional approach of embryo evaluation in the time-lapse systems is for embryologists to manually annotate a number of morphological and/or morphokinetic parameters. These values are then used in models of clinical outcome prediction. Embryo selection can be automated by using artificial intelligence (AI) to predict morphokinetic and morphology parameters. In this case, AI is employed in an indirect way to optimize the daily workflow based on existing traditional parameters. Finally, the most innovative approach is the use of AI to directly predict pregnancy, implantation or even live birth by using only time-lapse images.

Study design, size, duration

A retrospective cohort study including 518 patients who underwent IVF treatments and whose embryos (n = 3,406) were cultured in EmbryoScope Plus® time-lapse systems. Blastocysts were routinely evaluated by senior embryologists according to the ASEBIR morphological criteria. Then, embryos were scored using the iDAScore algorithm whose values range from 1 to 9.9.

Participants/materials, setting, methods

Embryo evaluation was performed automatically by iDAScore with the use of deep learning and a neural network. The algorithm was developed considering the entire embryo development to rank embryos according to likelihood of implantation. Embryo score was compared with conventional morphological quality, euploidy rate and the subsequent implantation outcome of 567 single blastocyst transfers. Then, we quantified the contribution of the automatic embryo score to implantation with multivariate logistic regression analysis in different patient populations.

Main results and the role of chance

The comparison between the embryo score provided by the iDAScore and the morphological category (A, B, C or D) assigned by embryologists showed a direct association*. The mean and standard deviation was 9.2 ± 0.4 for A; 8.2 ± 1.2 for B; 6.9 ± 1.6 for C and 4.0 ± 1.8 for D. The euploidy rate increased when embryos showed higher automatic scores*: 45.9% for score ≤ 8.0 (n = 354), 55.6% for score 8.1-8.8 (n = 169) and 62.8% for score >8.8 (n = 180). The implantation rate increased as the embryo score improved*: 37.8% for score ≤ 7.8 (n = 127), 50.9% for score 7.9-8.9 (n = 163), 65.7% for score >8.9 (n = 277). The logistic regression analysis of iDAScore took into account possible confounding factors: oocyte origin (donated vs. autologous); type of embryo transfer (fresh vs. frozen); oocyte age; patient body mass index; PGT-A (tested vs. non-tested embryos) and day of embryo transfer (fifth vs. sixth day of embryo development). iDAScore value was related to the odds of implantation in the oocyte donation program (OR = 1.61; 95%CI [1.19-2.19]; p < 0.001; n = 265) and in conventional treatments with autologous oocytes (OR = 1.52; 95%CI [1.22-1.90]; p < 0.001; n = 192). There was no significant association of embryo score with implantation in treatments involving PGT-A (n = 110).

*p<.05

Limitations, reasons for caution

This study is limited by its retrospective nature. The single-center design should be taken into account when considering the universal application of the model. Although our clinic was not involved in the development of iDAScore, and therefore this study should be considered as an external validation.

Wider implications of the findings

Our findings confirm that embryo evaluation can be performed automatically allowing embryologists to utilize their time more efficiently in other tasks of the IVF process that are more complex and require high precision and attention.

Trial registration number

This research has been funded by a grant from The Ministry of Science, Innovation and Universities FIS (PI21/00283) awarded to M.M.

Demonstration of Single-Barium-Ion Sensitivity for Neutrinoless Double-Beta Decay Using Single-Molecule Fluorescence Imaging

A new method to tag the barium daughter in the double-beta decay of ^{136}Xe is reported. Using the technique of single molecule fluorescent imaging (SMFI), individual barium dication (Ba^{++}) resolution at a transparent scanning surface is demonstrated. A single-step photobleach confirms the single ion interpretation. Individual ions are localized with superresolution (∼2  nm), and detected with a statistical significance of 12.9σ over backgrounds. This lays the foundation for a new and potentially background-free neutrinoless double-beta decay technology, based on SMFI coupled to high pressure xenon gas time projection chambers.

The Key Role of Pain Catastrophizing in the Disability of Patients with Acute Back Pain

PURPOSE

This study investigated the role of anxiety sensitivity, resilience, pain catastrophizing, depression, pain fear-avoidance beliefs, and pain intensity in patients with acute back pain-related disability.

METHOD

Two hundred and thirty-two patients with acute back pain completed questionnaires on anxiety sensitivity, resilience, pain catastrophizing, fear-avoidance beliefs, depression, pain intensity, and disability.

RESULTS

A structural equation modelling analysis revealed that anxiety sensitivity was associated with pain catastrophizing, and resilience was associated with lower levels of depression. Pain catastrophizing was positively associated with fear-avoidance beliefs and pain intensity. Depression was associated with fear-avoidance beliefs, but was not associated with pain intensity. Finally, catastrophizing, fear-avoidance beliefs, and pain intensity were positively and significantly associated with acute back pain-related disability.

CONCLUSION

Although fear-avoidance beliefs and pain intensity were associated with disability, the results showed that pain catastrophizing was a central variable in the pain experience and had significant direct associations with disability when pain was acute. Anxiety sensitivity appeared to be an important antecedent of catastrophizing, whereas the influence of resilience on the acute back pain experience was limited to its relationship with depression.

An examination of the structural link between post-traumatic stress symptoms and chronic pain in the framework of fear-avoidance models

BACKGROUND

The tendency to respond with fear and avoidance can be seen as a shared vulnerability contributing to the development of post-traumatic stress disorder (PTSD) and chronic pain. Although several studies have examined which specific symptoms of PTSD (re-experiencing, avoidance, emotional numbing and hyperarousal) are associated with chronic pain, none has considered this association within the framework of fear-avoidance models.

METHODS

Seven hundred fourteen patients with chronic musculoskeletal pain were assessed. Of these, 149 patients were selected for the study based upon the following inclusion criteria: exposure to a traumatic event before the onset of pain (with scores equal to or higher than 8 points on the fear and hopelessness scales of the Stressful Life Event Screening Questionnaire Revised) and scores equal to or higher than 30 on the Davidson Trauma Scale.

RESULTS

Structural equation modelling was used to test the association between PTSD symptoms and pain outcomes (pain intensity and disability) using the mediating variables considered in the fear-avoidance models. The results show that emotional numbing and hyperarousal symptoms, but neither re-experiencing nor avoidance, affected pain outcome via anxiety sensitivity (AS), catastrophizing and fear of pain. PTSD symptoms increased the levels of AS, which predisposes to catastrophizing and, in turn, had an effect on the tendency of pain patients to respond with more fear and avoidance.

CONCLUSIONS

This study provides empirical support for the potential role of PTSD symptoms in fear-avoidance models of chronic pain and suggests that AS is a relevant variable in the relationship between both disorders.

Children's pain perspectives

BACKGROUND

Previous studies on children's pain perspectives remain limited to English-speaking populations.

METHODS

An exploratory cross-sectional descriptive design was used to investigate the developmental progression of children's pain perspectives, including their pain experience, its definition and attributes, causality and coping. The Children's Pain Perspectives Inventory was applied to 180 healthy Spanish children. A coding system was developed following the content analysis method. Three age groups were compared: 4-6 years, corresponding to the Piagetian pre-operational stage of cognitive development; 7-11 years, corresponding to stage of concrete operations; and 12-14 years, corresponding to the period of early formal operations.

RESULTS

In children between 4 and 6, the predominant narratives related to physical injuries, the notion of causality and the definition of pain. In children between 7 and 11, the predominant narratives were those in which pain was described as a sensation in one part of the body. The view of pain as having an emotional basis significantly increased with age and was more frequent in adolescents. In contrast, children between 4-6 and 7-11 indicated that pain occurs spontaneously. The denial of any positive aspects of pain significantly decreased with age; some children between 7 and 11 referred to the 'possibility of relief', while the view that pain is a 'learning experience' was significantly more frequent among adolescents aged between 12 and 14 years. The use of cognitive strategies to control pain significantly increased with age. Between 12 and 14 years of age, adolescents communicate pain by non-verbal behaviour and reported that they do not express demands for relief.

CONCLUSIONS

There was a progression from concrete to more complex notions of pain as age increased. These results may be of use to health professionals and parents to understand how children at various developmental stages express and cope with pain and to develop tools that effectively assess and manage pain in children.

Empirical evidence of the validity of the Spanish version of the pain vigilance awareness questionnaire

BACKGROUND

The Spanish version of the Pain Vigilance and Awareness Questionnaire has not been validated.

PURPOSE

The aims of this study were to examine the factor structure of the Spanish version of the Pain Vigilance and Awareness Questionnaire and present empirical evidence regarding its validity.

METHOD

A sample of 468 chronic back pain patients completed a battery of instruments to assess fear-avoidance beliefs, pain anxiety, pain catastrophizing, pain vigilance and awareness, pain acceptance, depression, anxiety, disability, and pain intensity.

RESULTS

Confirmatory factor analysis supported the validity of a nine-item version with two subscales: Active Vigilance and Passive Awareness. Both subscales and the total score were positively and significantly correlated with other fear-related constructs: fear-avoidance beliefs, pain anxiety, and pain catastrophizing. Regression analyses showed that Active Vigilance and the two subscales of the Fear-Avoidance Beliefs Questionnaire were significantly associated with higher anxiety and that the Acceptance Activity Engagement subscale was significantly associated with lower anxiety. The Fear-Avoidance Beliefs Questionnaire-Physical subscale was associated with higher disability and the Acceptance Pain Willingness subscale was associated with lower disability. The Fear-Avoidance Beliefs Questionnaire-Work subscale was significantly associated with higher pain intensity and depression; the Acceptance Activity Engagement and Pain Willingness subscales were significantly associated with lower pain intensity and depression.

CONCLUSION

The Spanish version of the Pain Vigilance and Awareness Questionnaire is a reliable and valid instrument. Pain Acceptance and Fear Avoidance beliefs are better predictors of adjustment to pain than pain hypervigilance.

Experiential avoidance and anxiety sensitivity as dispositional variables and their relationship to the adjustment to chronic pain

Anxiety sensitivity has been included in the fear-avoidance model as a vulnerability factor to explain individual differences in fear of pain. Several studies have suggested that the relationship between anxiety sensitivity and some psychopathological disorders is mediated by experiential avoidance, an affect-related regulatory process that involves unwillingness to endure private experiences. The role of these constructs as vulnerability variables has not been investigated in chronic pain patients. The aim of this study was to investigate the role of anxiety sensitivity and experiential avoidance as dispositional variables in pain fear-avoidance. Two alternative hypothetical models were tested: one in which anxiety sensitivity and experiential avoidance would be independently associated with pain fear-avoidance; and second, one in which experiential avoidance would mediate the relationship between anxiety sensitivity and pain fear-avoidance. The sample was composed of 299 patients with chronic back pain. The postulated relationships were tested using LISREL 8.20 software (Scientific Software International, Chicago, IL, USA) and the generally weighted least squares. The structural equation modelling analyses showed that experiential avoidance and anxiety sensitivity were independently associated with pain fear-avoidance and that anxiety sensitivity had a stronger association with pain fear-avoidance than experiential avoidance. The alternative model, in which experiential avoidance mediates the relationship between anxiety sensitivity and pain fear-avoidance, gave a much worse fit. These results highlight the importance of both anxiety sensitivity and experiential avoidance as variables which could explain individual differences in pain fear-avoidance. Thus, in terms of prevention, it should be a priority to identify patients with increased anxiety sensitivity and experiential avoidance during the first stages of the development of chronic pain conditions.

Deciding the Adequacy of a Set of Tests for an Specific Assessment Situation. Decision-making Strategies

The aim of the present paper was to test the effects of response mode (choice vs. judgment) on decision-making strategies when subjects were faced with the task of deciding the adequacy of a set of tests for a specific assessment situation. Compared with choice, judgment was predicted to lead to more information sought, more time spent on the task, a less variable pattern of search, and a greater amount of interdimensional search. Three variables hypothesized as potential moderators of the response mode effects are also studied: time pressure, information load and decision importance. Using an information board, 300 subjects made decisions (choices and judgments) on tests for a concrete assessment situation, under high or low time pressure, high or low information load, and high or low decision importance. Response mode produced strong effects on all measures of decision behavior except for pattern of search. Moderator effects occurred for time pressure and information load.