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Burns JW, Gerhart J, Smith DA, Porter L, Rye B, Keefe F. Concurrent and lagged associations among pain medication use, pain, and negative affect: a daily diary study of people with chronic low back pain. Pain 2024:00006396-990000000-00523. [PMID: 38334493 DOI: 10.1097/j.pain.0000000000003162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/04/2023] [Indexed: 02/10/2024]
Abstract
ABSTRACT People with chronic pain often attempt to manage pain and concurrent emotional distress with analgesic substances. Habitual use of such substances-even when not opioid-based-can pose side effect risks. A negative reinforcement model has been proposed whereby relief of pain and emotional distress following medication consumption increases the likelihood that the experience of elevated pain and distress will spur further medication use. People with chronic low back pain (N = 105) completed electronic diary assessments 5 times/day for 14 consecutive days. Lagged and cross-lagged analyses focused on links between time 1 pain and negative affect (NA) and time 2 analgesic medication use and vice versa. Sex differences were also explored. Primary results were as follows: (1) participants on average reported taking analgesic medication during 41.3% of the 3-hour reporting epochs (29 times over 14 days); (2) time 1 within-person increases in pain and NA predicted time 2 increases in the likelihood of ingesting analgesic medications; (3) time 1 within-person increases in medication use predicted time 2 decreases in pain and NA; and (4) lagged associations between time 1 pain/NA and time 2 medication use were strongest among women. Findings suggest that the use of analgesic medications for many people with chronic pain occurs frequently throughout the day. Results support the validity of a negative reinforcement model where pain and distress lead to pain medication use, which in turn leads to relief from pain and distress.
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Affiliation(s)
- John W Burns
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - James Gerhart
- Department of Psychology, Central Michigan University, Mt. Pleasant, MI, United States
| | - David A Smith
- Department of Psychology, University of Notre Dame, Notre Dame, IN, United States
| | - Laura Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Bonny Rye
- Department of Psychology, Central Michigan University, Mt. Pleasant, MI, United States
| | - Francis Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
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Kovacevic M, Montes M, Tirone V, Pridgen S, Smith DL, Burns JW, Held P. Treating a common comorbidity: Pain outcomes following a 3-week cognitive processing therapy-based intensive treatment for posttraumatic stress disorder address. J Trauma Stress 2024; 37:47-56. [PMID: 38091254 DOI: 10.1002/jts.22979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/15/2023] [Accepted: 09/28/2023] [Indexed: 02/13/2024]
Abstract
Posttraumatic stress disorder (PTSD) commonly co-occurs with pain and has been implicated in the maintenance of chronic pain. However, limited research has examined whether intervening for PTSD can hinder or optimize treatment outcomes for co-occurring pain and PTSD. In the present study, we examined changes in pain, PTSD, and depressive symptoms among 125 veterans completing a 3-week cognitive processing therapy (CPT)-based intensive treatment program (ITP) for PTSD. We also explored whether pretreatment pain interference predicted changes in PTSD and depressive symptom severity and whether larger changes in pain interference over the course of treatment were associated with larger changes in PTSD and depressive symptom severity. Linear mixed models revealed that participants' pain interference decreased throughout treatment, d = 0.15, p = .039. Higher levels of pretreatment pain interference were associated with higher PTSD, p = .001, and depressive symptom severity, p = .014, over time. Larger reductions in pain interference corresponded to more improvement in PTSD symptoms, β = -.03; p < .001, but not depressive symptoms. These findings indicate that ITPs for PTSD can reduce pain interferences, albeit to a small degree, and that reductions in pain interference can contribute to reductions in PTSD symptom severity. Future studies should examine which treatment components contribute to larger changes in symptom severity for veterans with co-occurring pain and PTSD.
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Affiliation(s)
- Merdijana Kovacevic
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Mauricio Montes
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Vanessa Tirone
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Sarah Pridgen
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Dale L Smith
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - John W Burns
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Philip Held
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
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Burns JW, Jensen MP, Thorn BE, Lillis TA, Carmody J, Gerhart J, Keefe F. Cognitive Therapy, Mindfulness-Based Stress Reduction, and Behavior Therapy for the Treatment of Chronic Pain: Predictors and Moderators of Treatment Response. J Pain 2024:104460. [PMID: 38199593 DOI: 10.1016/j.jpain.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
Psychosocial interventions for people with chronic pain produce significant improvements in outcomes, but these effects on average are modest with much variability in the benefits conferred on individuals. To enhance the magnitude of treatment effects, characteristics of people that might predict the degree to which they respond more or less well could be identified. People with chronic low back pain (N = 521) participated in a randomized controlled trial which compared cognitive therapy, mindfulness-based stress reduction, behavior therapy and treatment as usual. Hypotheses regarding predictors and/or moderators were based on the Limit, Activate, and Enhance model; developed to predict and explain moderators/predictors of psychosocial pain treatments. Results were: 1) low levels of cognitive/behavioral function at pre-treatment predicted favorable pre- to post-treatment outcomes; 2) favorable expectations of benefit from treatment and sound working alliances predicted favorable pre- to post-treatment outcomes; 3) women benefited more than men. These effects emerged without regard to treatment condition. Of note, high levels of cognitive/behavioral function at pre-treatment predicted favorable outcomes only for people in the treatment as usual condition. Analyses identified a set of psychosocial variables that may act as treatment predictors across cognitive therapy, mindfulness-based stress reduction and behavior therapy, as hypothesized by the Limit, Activate, and Enhance model if these 3 treatments operate via similar mechanisms. Findings point toward people who may and who may not benefit fully from the 3 psychosocial treatments studied here, and so may guide future research on matching people to these kinds of psychosocial approaches or to other (eg, forced-based interventions) non-psychosocial approaches. TRIAL REGISTRATION: The ClinicalTrials.gov Identifier is NCT02133976. PERSPECTIVE: This article examines potential predictors/moderators of response to psychosocial treatments for chronic pain. Results could guide efforts to match people to the most effective treatment type or kind.
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Affiliation(s)
- John W Burns
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington
| | | | - Teresa A Lillis
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
| | - James Carmody
- Department of Preventive and Behavioral Medicine, University of Massachusetts Medical School
| | - James Gerhart
- Department of Psychology Central Michigan University
| | - Francis Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
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Darnall BD, Burns JW, Hong J, Roy A, Slater K, Poupore-King H, Ziadni MS, You DS, Jung C, Cook KF, Lorig K, Tian L, Mackey SC. Empowered Relief, cognitive behavioral therapy, and health education for people with chronic pain: a comparison of outcomes at 6-month Follow-up for a randomized controlled trial. Pain Rep 2024; 9:e1116. [PMID: 38288134 PMCID: PMC10824382 DOI: 10.1097/pr9.0000000000001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/14/2023] [Accepted: 10/09/2023] [Indexed: 01/31/2024] Open
Abstract
Introduction We previously conducted a 3-arm randomized trial (263 adults with chronic low back pain) which compared group-based (1) single-session pain relief skills intervention (Empowered Relief; ER); (2) 8-session cognitive behavioral therapy (CBT) for chronic back pain; and (3) single-session health and back pain education class (HE). Results suggested non-inferiority of ER vs. CBT at 3 months post-treatment on an array of outcomes. Methods Here, we tested the durability of treatment effects at 6 months post-treatment. We examined group differences in primary and secondary outcomes at 6 months and the degree to which outcomes eroded or improved from 3-month to 6-month within each treatment group. Results Empowered Relief remained non-inferior to CBT on most outcomes, whereas both ER and CBT remained superior to HE on most outcomes. Outcome improvements within ER did not decrease significantly from 3-month to 6-month, and indeed ER showed additional 3- to 6-month improvements on pain catastrophizing, pain bothersomeness, and anxiety. Effects of ER at 6 months post-treatment (moderate term outcomes) kept pace with effects reported by participants who underwent 8-session CBT. Conclusions The maintenance of these absolute levels implies strong stability of ER effects. Results extend to 6 months post-treatment previous findings documenting that ER and CBT exhibit similarly potent effects on outcomes.
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Affiliation(s)
- Beth D. Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - John W. Burns
- Department of Psychiatry and Behavioral Science, Rush University Medical Center, Chicago, IL, USA
| | - Juliette Hong
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Anuradha Roy
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kristin Slater
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Heather Poupore-King
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Maisa S. Ziadni
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Dokyoung S. You
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Corinne Jung
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Kate Lorig
- Department of Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Lu Tian
- Department of Biomedical Data Science and (by courtesy) Statistics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sean C. Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Burgess HJ, Bahl S, Wilensky K, Spence E, Jouppi RJ, Rizvydeen M, Goldstein C, Kim HM, Williams DA, Burns JW. A 4-week morning light treatment with stable sleep timing for individuals with fibromyalgia: a randomized controlled trial. Pain Med 2023; 24:787-795. [PMID: 36715638 PMCID: PMC10321765 DOI: 10.1093/pm/pnad007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/11/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Fibromyalgia is characterized by chronic widespread pain, mood, and sleep disturbance. Pharmacological treatments have modest efficacy and are associated with negative side effects, and alternative approaches are needed. Morning bright light treatment may assist in the management of fibromyalgia as it can reduce depressive symptoms, improve sleep, and advance circadian timing. METHODS Sixty people with fibromyalgia (58 women, mean age 41.8 ± 13.3 years) were enrolled in a study comparing 4 weeks of a 1-hour daily morning bright light treatment (active treatment) to a morning dim light treatment (comparison treatment). Both light treatments included behavioral procedures to stabilize sleep timing. The morning bright light treatment was expected to produce larger improvements in pain and function than the dim light treatment and larger improvements in potential mediators (mood, sleep, and circadian timing). RESULTS Both the bright and dim light treatment groups achieved significant but similar levels of improvement in pain intensity, pain interference, physical function, depressive symptoms, and sleep disturbance. Overall, the sample on average displayed a clinically meaningful improvement in the Fibromyalgia Impact Questionnaire-Revised score (mean reduction of 11.2 points), comparable to that reported following physical exercise treatments. Minimal side effects were observed. CONCLUSIONS Findings indicate that the effects of a morning bright light treatment did not exceed those of a comparison dim light treatment; yet the changes on average in both conditions revealed clinically meaningful improvements. Future research is warranted to identify what elements of this trial may have contributed to the observed effects.
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Affiliation(s)
- Helen J Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Sonal Bahl
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Katelyn Wilensky
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Emily Spence
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Riley J Jouppi
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Muneer Rizvydeen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Cathy Goldstein
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Hyungjin Myra Kim
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, United States
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, United States
| | - John W Burns
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL 60612, United States
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Burns JW, Jensen MP, Gerhart J, Thorn BE, Lillis TA, Carmody J, Keefe F. Cognitive therapy, mindfulness-based stress reduction, and behavior therapy for people with chronic low back pain: A comparative mechanisms study. J Consult Clin Psychol 2023; 91:171-187. [PMID: 36848061 DOI: 10.1037/ccp0000801] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Cognitive therapy (CT), mindfulness-based stress reduction (MBSR), and behavior therapy (BT) for chronic pain treatment produce outcome improvements. Evidence also suggests that changes in putative therapeutic mechanisms are associated with changes in outcomes. Nonetheless, methodological limitations preclude clear understanding of how psychosocial chronic pain treatments work. In this comparative mechanism study, we examined evidence for specific and shared mechanism effects across the three treatments. METHOD CT, MBSR, BT, and treatment as usual (TAU) were compared in people with chronic low back pain (N = 521). Eight individual sessions were administered with weekly assessments of "specific" mechanisms (pain catastrophizing, mindfulness, behavior activation) and outcomes. RESULTS CT, MBSR, and BT produced similar pre- to posttreatment effects on all mechanism variables, and all three active treatments produced greater improvements than TAU. Participant ratings of expectations of benefit and working alliance were similar across treatments. Lagged and cross-lagged analyses revealed that prior week changes in both mechanism and outcome factors predicted next week changes in their counterparts. Analyses of variance contributions suggested that changes in pain catastrophizing and pain self-efficacy were consistent unique predictors of subsequent outcome changes. CONCLUSIONS Findings support the operation of shared mechanisms over specific ones. Given significant lagged and cross-lagged effects, unidirectional conceptualizations-mechanism to outcome-need to be expanded to include reciprocal effects. Thus, prior week changes in pain-related cognitions could predict next week changes in pain interference which in turn could predict next week changes in pain-related cognitions, in what may be an upward spiral of improvement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- John W Burns
- Department of Psychiatry and Behavioral Sciences
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Gerhart J, Ramos K, Porter LS, Ravyts S, Malhotra S, Mossman B, Eaton England A, Alonzi S, Peyser T, Kim S, O'Mahony S, Burns JW, Hoerger M. Top Ten Tips Palliative Care Clinicians Should Know About Behavioral Pain Management for Persistent Pain. J Palliat Med 2023. [PMID: 36706441 PMCID: PMC10398738 DOI: 10.1089/jpm.2022.0571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Seriously ill patients often experience persistent pain. As a part of a comprehensive repertoire of pain interventions, palliative care clinicians can help by using behavioral pain management. Behavioral pain management refers to evidence-based psychosocial interventions to reduce pain intensity and enhance functional outcomes and quality of life. Conceptualized using the biopsychosocial model, techniques involve promoting helpful behaviors (e.g., activity pacing, stretching, and relaxation exercises) and modifying underlying patterns of thinking, feeling, and communicating that can exacerbate pain. The authors have expertise in pain management, clinical health psychology, geropsychology, behavioral science, and palliative medicine. The article reviews the current evidence for behavioral interventions for persistent pain and provides 10 recommendations for behavioral pain management.
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Affiliation(s)
- James Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Katherine Ramos
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Scott Ravyts
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sonia Malhotra
- Department of Palliative and Supportive Medicine, University Medical Center, New Orleans, Louisiana, USA
| | - Brenna Mossman
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Ashley Eaton England
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Sarah Alonzi
- Department of Psychology, University of California-Los Angeles, Los Angeles, California, USA
| | - Tristen Peyser
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Seowoo Kim
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Sean O'Mahony
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - John W Burns
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Hoerger
- Department of Palliative and Supportive Medicine, University Medical Center, New Orleans, Louisiana, USA.,Department of Psychology, Tulane University, New Orleans, Louisiana, USA.,Department of Psychiatry and Medicine, Tulane University, New Orleans, Louisiana, USA
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Post KM, Smith DA, Burns JW, Porter LS, Keefe FJ. A Dyadic Investigation of Depressed Affect and Interspousal Behavior in Couples With Chronic Back Pain. Ann Behav Med 2021; 56:1002-1013. [PMID: 34849529 DOI: 10.1093/abm/kaab100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression and marital discord are characteristic not only of individuals with chronic low back pain (ICPs) but also of their spouses. PURPOSE We examined actor-partner interdependence models to evaluate associations among depressed affect and criticism and support of partners at the same time point (concurrent effects) and 3 hr later (lagged effects). Fully dyadic models were used to account for both within-person and cross-spouse associations among depressed affect, criticism, and support for ICPs and spouses. We also examined the direction of the relationships (depressed affect predicting behavior and behavior predicting depressed affect) all while controlling for pain intensity, pain behavior, and the prior dependent variable. METHODS ICPs (n = 105) and their spouses completed electronic diary measures of depressed affect and behavior (criticism and support) five times a day for 2 weeks. Hierarchical linear modeling with person-mean centering was used for data analysis. RESULTS Within the same 3 hr epoch, more depressed affect was related to higher criticism and generally less support. Lagged analyses suggested bidirectional relationships between spouse's own depressed affect and spouse's own criticism of ICPs. Spouse depressed affect was also associated with decreased support received from ICPs. Pain behavior and pain intensity were also related to depressed affect, criticism, and support especially concurrently. CONCLUSIONS Theories and interventions need to address not only ICP depressed affect but also spouse depressed affect, as spouse depressed affect may be a stress generating precursor to criticism and support.
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Affiliation(s)
- Kristina M Post
- Department of Psychology, University of La Verne, 1950 Third Street, Hoover Building, La Verne, CA 91750, USA
| | - David A Smith
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - John W Burns
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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Bruehl S, Burns JW, Koltyn K, Gupta R, Buvanendran A, Edwards D, Chont M, Wu YH, Stone A. Does aerobic exercise training alter responses to opioid analgesics in individuals with chronic low back pain? A randomized controlled trial. Pain 2021; 162:2204-2213. [PMID: 33394881 PMCID: PMC8203753 DOI: 10.1097/j.pain.0000000000002165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT We tested whether aerobic exercise training altered morphine analgesic responses or reduced morphine dosages necessary for adequate analgesia. Patients with chronic back pain were randomized to an 18-session aerobic exercise intervention (n = 38) or usual activity control (n = 45). Before and after the intervention, participants underwent 3 laboratory sessions (double-blinded, crossover) to assess effects of saline placebo, i.v. morphine (0.09 mg/kg), and i.v. naloxone (12 mg) on low back pain and evoked heat pain responses. Differences in evoked and back pain measures between the placebo and morphine conditions indexed morphine analgesia, with pre-post intervention changes the primary outcome. Endogenous opioid analgesia was indexed by differences in evoked and low back pain measures between the naloxone and placebo conditions. A Sex X Intervention interaction on the analgesic effects of morphine on visual analogue scale back pain intensity was observed (P = 0.046), with a similar trend for evoked pain threshold (P = 0.093). Male exercisers showed reduced morphine analgesia pre-post intervention, whereas male controls showed increased analgesia (with no differences in females). Of clinical significance were findings that relative to the control group, aerobic exercise produced analgesia more similar to that observed after receiving ≈7 mg morphine preintervention (P < 0.045). Greater pre-post intervention increases in endogenous opioid function (from any source) were significantly associated with larger pre-post intervention decreases in morphine analgesia (P < 0.046). The overall pattern of findings suggests that regular aerobic exercise has limited direct effects on morphine responsiveness, reducing morphine analgesia in males only.
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Affiliation(s)
- Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John W. Burns
- Department of Psychiatry, Rush University, Chicago, IL, USA
| | - Kelli Koltyn
- Department of Kinesiology, University of Wisconsin, Madison, WI, USA
| | - Rajnish Gupta
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - David Edwards
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melissa Chont
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yung Hsuan Wu
- Department of Psychiatry, Rush University, Chicago, IL, USA
| | - Amanda Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
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Burns JW, Gerhart J, Rizvydeen M, Kimura M, Burgess HJ. Morning Bright Light Treatment for Chronic Low Back Pain: Potential Impact on the Volatility of Pain, Mood, Function, and Sleep. Pain Med 2021; 21:1153-1161. [PMID: 31816075 DOI: 10.1093/pm/pnz235] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Most treatment outcome studies for people with chronic low back pain (CLBP) have based analyses on and reported only the mean levels of these factors. However, high levels of pain, mood, function, and sleep volatility may represent unique factors contributing to diminished quality of life. Our goal was to determine whether bright light treatment affected both mean levels of pain, mood, function, and sleep and reduced volatility in these outcomes. METHODS US military veterans with CLBP (N = 22) underwent an open trial with a seven-day baseline, followed by 13 days of a one-hour morning bright light treatment self-administered at their home and a 30-day follow-up. Participants completed daily diary measures at 12 Pm and 6 Pm every day during the three study epochs. RESULTS Using location scale modeling, results suggested that, in addition to being associated with changes in mean levels of pain intensity, pain interference, negative affect, and sleep quality, bright light treatment was also related to reductions in the volatility of pain intensity and negative affect, reductions that were largely maintained during follow-up. CONCLUSIONS Changes in mean levels and volatility were independent factors, suggesting that bright light treatment was related to participants experiencing fewer "pain flares." These findings underscore the potential importance of volatility as a future treatment target.
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Affiliation(s)
- John W Burns
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - James Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan
| | - Muneer Rizvydeen
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Momoko Kimura
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Helen J Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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Buvanendran A, Sremac AC, Merriman PA, Della Valle CJ, Burns JW, McCarthy RJ. Preoperative cognitive-behavioral therapy for reducing pain catastrophizing and improving pain outcomes after total knee replacement: a randomized clinical trial. Reg Anesth Pain Med 2021; 46:313-321. [PMID: 33452201 DOI: 10.1136/rapm-2020-102258] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Cognitive-behavioral therapy (CBT) can reduce preoperative pain catastrophizing and may improve postsurgical pain outcomes. We hypothesized that CBT would reduce pain catastrophizing more than no-CBT controls and result in improved pain outcomes. METHODS The study was a randomized controlled trial of patients undergoing elective total knee arthroplasty between January 2013 and March 2020. In phase 1, the change in pain catastrophizing scores (PCS) among 4-week or 8-week telehealth, 4-week in person and no-CBT sessions was compared in 80 patients with a PCS >16. In phase 2, the proportion of subjects that achieved a 3-month decrease in Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain subscale >4 following 4-week telehealth CBT with no-CBT controls were compared in 80 subjects. RESULTS In phase 1, 4-week telehealth CBT had the highest completion rate 17/20 (85%), demonstrated an adjusted median reduction in PCS of -9 (95% CI -1 to -14, p<0.01) compared with no-CBT and was non-inferior to 8-week telehealth CBT at a margin of 2 (p=0.02). In phase 2, 29 of 35 (83%) in the 4-week telehealth CBT and 26 of 33 (79%) subjects in the no-CBT demonstrated a decrease in the WOMAC pain subscale >4 at 3 months, difference 4% (95% CI -18% to 26%, p=0.48), despite a median decrease in the PCS for the 4-week CBT and no-CBT group of -6 (-10 to -2, p=0.02). CONCLUSIONS Our findings demonstrate that CBT interventions delivered prior to surgery in person or via telehealth can reduced PCS scores; however, this reduction did not lead to improved 3-month pain outcomes. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT01772329, registration date 21 January 2013).
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Affiliation(s)
| | - Amanda C Sremac
- Anesthesiology, Rush Medical College of Rush University, Chicago, Illinois, USA
| | - Patricia A Merriman
- Anesthesiology, Rush Medical College of Rush University, Chicago, Illinois, USA
| | - Craig J Della Valle
- Orthopedic Surgery, Rush Medical College of Rush University, Chicago, Illinois, USA
| | - John W Burns
- Behavioral Sciences, Rush Medical College of Rush University, Chicago, Illinois, USA
| | - Robert J McCarthy
- Anesthesiology, Rush Medical College of Rush University, Chicago, Illinois, USA
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12
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Bruehl S, France CR, Stone AL, Gupta R, Buvanendran A, Chont M, Burns JW. Greater Conditioned Pain Modulation Is Associated With Enhanced Morphine Analgesia in Healthy Individuals and Patients With Chronic Low Back Pain. Clin J Pain 2021; 37:20-27. [PMID: 33086239 PMCID: PMC7708406 DOI: 10.1097/ajp.0000000000000887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Conditioned pain modulation (CPM) protocols index magnitude of descending pain inhibition. This study evaluated whether the degree of CPM, controlling for CPM expectancy confounds, was associated with analgesic and subjective responses to morphine and whether chronic pain status or sex moderated these effects. MATERIALS AND METHODS Participants included 92 individuals with chronic low back pain and 99 healthy controls, none using daily opioid analgesics. In a cross-over design, participants attended 2 identical laboratory sessions during which they received either intravenous morphine (0.08 mg/kg) or saline placebo before undergoing evoked pain assessment. In each session, participants engaged in ischemic forearm and heat pain tasks, and a CPM protocol combining ischemic pain (conditioning stimulus) and heat pain (test stimulus). Placebo-controlled morphine outcomes were derived as differences in pain and subjective effects across drug conditions. RESULTS In hierarchical regressions controlling for CPM expectancies, greater placebo-condition CPM was associated with less subjective morphine unpleasantness (P=0.001) and greater morphine analgesia (P's<0.05) on both the ischemic pain task (Visual Analog Scale Pain Intensity and Unpleasantness) and heat pain task (Visual Analog Scale Pain Intensity, McGill Pain Questionnaire-Sensory, and Present Pain Intensity subscales). There was no moderation by sex or chronic low back pain status, except for the ischemic Present Pain Intensity outcome for which a significant 2-way interaction (P<0.05) was noted, with men showing a stronger positive relationship between CPM and morphine analgesia than women. DISCUSSION Results suggest that CPM might predict analgesic and subjective responses to opioid administration. Further evaluation of CPM as an element of precision pain medicine algorithms may be warranted.
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Affiliation(s)
- Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Amanda L. Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rajnish Gupta
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Melissa Chont
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John W. Burns
- Department of Behavioral Science, Rush University, Chicago, IL, USA
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13
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Burns JW, Van Dyke BP, Newman AK, Morais CA, Thorn BE. Cognitive behavioral therapy (CBT) and pain education for people with chronic pain: Tests of treatment mechanisms. J Consult Clin Psychol 2020; 88:1008-1018. [PMID: 33136422 DOI: 10.1037/ccp0000612] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The goals of the study were to determine to what degree changes in pain-related cognition during cognitive behavioral treatment (CBT) and pain education (EDU) represented treatment mechanisms and whether these cognitive changes worked to a larger extent to produce favorable outcomes in CBT than in EDU. METHOD Reported here are secondary analyses of a randomized control trial (N = 290) comparing CBT, EDU, and treatment as usual for low-literacy, low-socioeconomic-status people with chronic pain. We excluded the treatment as usual condition from these analyses and included measures collected at a midtreatment epoch. Treatment was 10 weekly group sessions. RESULTS Linear mixed models revealed nonsignificant differences in pre- to mid- to posttreatment changes in pain catastrophizing and pain self-efficacy between CBT and EDU. The same was true for outcome measures. Cross-lagged analyses revealed significant relationships between pre- to midtreatment changes in catastrophizing and self-efficacy and mid- to posttreatment changes in outcomes. However, relationships between pre- to midtreatment changes in outcomes and mid- to posttreatment changes in catastrophizing and self-efficacy were also significant. CONCLUSIONS Results suggest a complex set of mechanistic relationships. Instead of a unidirectional path from designated mechanism to designated outcome, our results suggest reciprocal influences whereby cognitive changes may beget outcome improvements and vice versa. Results also suggest that cognitive changes do not occur solely in a treatment that uses cognitive restructuring to foster such changes but may occur as a function of providing people with detailed information regarding the biopsychosocial nature of chronic pain. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- John W Burns
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center
| | | | | | - Calia A Morais
- Department of Community Dentistry and Behavioral Science, Pain Research and Intervention Center of Excellence, University of Florida
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14
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Burns JW, Janssen I, Lillis T, Mulcahy M, Purim-Shem-Tov YA, Bruehl S, Burgess HJ, Fischer A, Rim K, Aranda F, Pinkerton L, Hobfoll S. The transition from acute to persistent pain: the identification of distinct trajectories among women presenting to an emergency department. Pain 2020; 161:2511-2519. [PMID: 32569094 PMCID: PMC10853846 DOI: 10.1097/j.pain.0000000000001960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Posttraumatic stress disorder (PTSD) symptoms and other negative psychosocial factors have been implicated in the transition from acute to persistent pain. Women (N = 375) who presented to an inner-city emergency department (ED) with complaints of acute pain were followed up for 3 months. They completed a comprehensive battery of questionnaires at an initial visit and provided ratings of pain intensity at the site of pain presented in the ED during 3 monthly phone calls. Latent class growth analyses were used to detect possible trajectories of change in pain intensity from the initial visit to 3 months later. A 3-trajectory solution was found, which identified 3 groups of participants. One group (early recovery; n = 93) had recovered to virtually no pain by the initial visit, whereas a second group (delayed recovery; n = 120) recovered to no pain only after 1 month. A third group (no recovery; n = 162) still reported elevated pain at 3 months after the ED visit. The no recovery group reported significantly greater PTSD symptoms, anger, sleep disturbance, and lower social support at the initial visit than both the early recovery and delayed recovery groups. Results suggest that women with high levels of PTSD symptoms, anger, sleep disturbance, and low social support who experience an acute pain episode serious enough to prompt an ED visit may maintain elevated pain at this pain site for at least 3 months. Such an array of factors may place women at an increased risk of developing persistent pain following acute pain.
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Affiliation(s)
- John W Burns
- Rush University Medical Center, Chicago, IL, United States
| | - Imke Janssen
- Rush University Medical Center, Chicago, IL, United States
| | - Teresa Lillis
- Rush University Medical Center, Chicago, IL, United States
| | - Morgan Mulcahy
- Rush University Medical Center, Chicago, IL, United States
| | | | - Stephen Bruehl
- Vanderbilt University Medical Center, Nashville, TN, United States
| | | | | | - Katie Rim
- University of Maryland, College Park MD, United States
| | - Frances Aranda
- University of Illinois at Chicago, Chicago, IL, United States
| | - Linzy Pinkerton
- Northwestern University, Feinberg School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Stevan Hobfoll
- Star-Stress Anxiety and Resilience Consultants, Salt Lake City, UT, United States
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15
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Greenberg J, Mace RA, Popok PJ, Kulich RJ, Patel KV, Burns JW, Somers TJ, Keefe FJ, Schatman ME, Vranceanu AM. Psychosocial Correlates of Objective, Performance-Based, and Patient-Reported Physical Function Among Patients with Heterogeneous Chronic Pain. J Pain Res 2020; 13:2255-2265. [PMID: 32982388 PMCID: PMC7498493 DOI: 10.2147/jpr.s266455] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/13/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Improving all aspects of physical function is an important goal of chronic pain management. Few studies follow recent guidelines to comprehensively assess physical function via patient-reported, performance-based, and objective/ambulatory measures. PURPOSE To test 1) the interrelation between the 3 types of physical function measurement and 2) the association between psychosocial factors and each type of physical function measurement. METHODS Patients with chronic pain (N=79) completed measures of: 1) physical function (patient-reported disability; performance-based 6-minute walk-test; objective accelerometer step count); 2) pain and non-adaptive coping (pain during rest and activity, pain-catastrophizing, kinesiophobia); 3) adaptive coping (mindfulness, general coping, pain-resilience); and 4) social-emotional dysfunction (anxiety, depression, social isolation and emotional support). First, we tested the interrelation among the 3 aspects of physical function. Second, we used structural equation modeling to test associations between psychosocial factors (pain and non-adaptive coping, adaptive coping, and social-emotional dysfunction) and each measurement of physical function. RESULTS Performance-based and objective physical function were significantly interrelated (r=0.48, p<0.001) but did not correlate with patient-reported disability. Pain and non-adaptive coping (β=0.68, p<0.001), adaptive coping (β=-0.65, p<0.001) and social-emotional dysfunction (β=0.65, p<0.001) were associated with patient-reported disability but not to performance-based or objective physical function (ps>0.1). CONCLUSION Results suggest that patient-reported physical function may provide limited information about patients' physical capacity or ambulatory activity. While pain and non-adaptive reactions to it, adaptive coping, and social-emotional dysfunction may potentially improve patient-reported physical function, additional targets may be needed to improve functional capacity and ambulatory activity. TRIAL REGISTRATION ClinicalTrials.gov NCT03412916.
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Affiliation(s)
- Jonathan Greenberg
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ryan A Mace
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Paula J Popok
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Ronald J Kulich
- Harvard Medical School, Boston, MA, USA
- Center for Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kushang V Patel
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
| | - John W Burns
- Division of Behavioral Sciences, Rush Medical College, Chicago, IL, USA
| | - Tamara J Somers
- Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Francis J Keefe
- Department of Medicine, Duke University School of Medicine, Durham, NC, US
| | - Michael E Schatman
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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16
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Langer SL, Ghosh N, Todd M, Randall AK, Romano JM, Bricker JB, Bolger N, Burns JW, Hagan RC, Porter LS. Usability and Acceptability of a Smartphone App to Assess Partner Communication, Closeness, Mood, and Relationship Satisfaction: Mixed Methods Study. JMIR Form Res 2020; 4:e14161. [PMID: 32628614 PMCID: PMC7381078 DOI: 10.2196/14161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/14/2020] [Indexed: 01/29/2023] Open
Abstract
Background Interpersonal communication is critical for a healthy romantic relationship. Emotional disclosure, coupled with perceived partner responsiveness, fosters closeness and adjustment (better mood and relationship satisfaction). On the contrary, holding back from disclosure is associated with increased distress and decreased relationship satisfaction. Prior studies assessing these constructs have been cross-sectional and have utilized global retrospective reports of communication. In addition, studies assessing holding back or perceived partner responsiveness have not taken advantage of smartphone ownership for data collection and have instead required website access or use of a study-provided device. Objective This study aimed to examine the (1) usability and acceptability of a smartphone app designed to assess partner communication, closeness, mood, and relationship satisfaction over 14 days and (2) between-person versus within-person variability of key constructs to inform the utility of their capture via ecological momentary assessment using the participants’ own handheld devices. Methods Adult community volunteers in a married or cohabiting partnered relationship received 2 smartphone prompts per day, one in the afternoon and one in the evening, for 14 days. In each prompt, participants were asked whether they had conversed with their partner either since awakening (afternoon prompt) or since the last assessment (evening prompt). If yes, a series of items assessed enacted communication, perceived partner communication, closeness, mood, and relationship satisfaction (evening only). Participants were interviewed by phone, 1 week after the end of the 14-day phase, to assess perceptions of the app. Content analysis was employed to identify key themes. Results Participants (N=27; mean age 36, SD 12 years; 24/27, 89% female; 25/27, 93% white and 2/27, 7% Hispanic) responded to 79.2% (555/701) of the total prompts sent and completed 553 (78.9%) of those assessments. Of the responded prompts, 79.3% (440/555) were characterized by a report of having conversed with one’s partner. The app was seen as highly convenient (mean 4.15, SD 0.78, scale: 1-5) and easy to use (mean 4.39, SD 0.70, scale: 1-5). Qualitative analyses indicated that participants found the app generally easy to navigate, but the response window too short (45 min) and the random nature of receiving notifications vexing. With regard to the variability of the app-delivered items, intraclass correlation coefficients were generally <0.40, indicating that the majority of the variability in each measure was at the within-person level. Notable exceptions were enacted disclosure and relationship satisfaction. Conclusions The findings of this study support the usability and acceptability of the app, with valuable user input to modify timing windows in future work. The findings also underscore the utility of an intensive repeated-measures approach, given the meaningful day-to-day variation (greater within-person vs between-person variability) in communication and mood.
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Affiliation(s)
- Shelby L Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Neeta Ghosh
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Michael Todd
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Ashley K Randall
- Counseling and Counseling Psychology, College of Integrative Sciences and Arts, Arizona State University, Phoenix, AZ, United States
| | - Joan M Romano
- Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Department of Psychology, University of Washington, Seattle, WA, United States
| | - Niall Bolger
- Department of Psychology, Columbia University, New York, NY, United States
| | - John W Burns
- Psychiatry and Behavioral Sciences, Rush Medical College, Rush University, Chicago, IL, United States
| | - Rachel C Hagan
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Laura S Porter
- Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, United States
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17
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Day MA, Thorn BE, Ehde DM, Burns JW, Barnier A, Mattingley JB, Matthews N, Jensen MP. Moderators of Mindfulness Meditation, Cognitive Therapy, and Mindfulness-Based Cognitive Therapy for Chronic Low Back Pain: A Test of the Limit, Activate, and Enhance Model. The Journal of Pain 2020; 21:161-169. [DOI: 10.1016/j.jpain.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 06/11/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
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18
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Burgess HJ, Rizvydeen M, Kimura M, Pollack MH, Hobfoll SE, Rajan KB, Burns JW. An Open Trial of Morning Bright Light Treatment Among US Military Veterans with Chronic Low Back Pain: A Pilot Study. Pain Med 2019; 20:770-778. [PMID: 30204903 DOI: 10.1093/pm/pny174] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine the feasibility, acceptability, and effects of a home-based morning bright light treatment on pain, mood, sleep, and circadian timing in US veterans with chronic low back pain. DESIGN An open treatment trial with a seven-day baseline, followed by 13 days of a one-hour morning bright light treatment self-administered at home. Pain, pain sensitivity, mood, sleep, and circadian timing were assessed before, during, and after treatment. SETTING Participants slept at home, with weekly study visits and home saliva collections. PARTICIPANTS Thirty-seven US veterans with medically verified chronic low back pain. METHODS Pain, mood, and sleep quality were assessed with questionnaires. Pain sensitivity was assessed using two laboratory tasks: a heat stimulus and an ischemia stimulus that gave measures of threshold and tolerance. Sleep was objectively assessed with wrist actigraphy. Circadian timing was assessed with the dim light melatonin onset. RESULTS Morning bright light treatment led to reduced pain intensity, pain behavior, thermal pain threshold sensitivity, post-traumatic stress disorder symptoms, and improved sleep quality (P < 0.05). Phase advances in circadian timing were associated with reductions in pain interference (r = 0.55, P < 0.05). CONCLUSIONS Morning bright light treatment is a feasible and acceptable treatment for US veterans with chronic low back pain. Those who undergo morning bright light treatment may show improvements in pain, pain sensitivity, and sleep. Advances in circadian timing may be one mechanism by which morning bright light reduces pain. Morning bright light treatment should be further explored as an innovative treatment for chronic pain conditions.
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Affiliation(s)
- Helen J Burgess
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Muneer Rizvydeen
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Momoko Kimura
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Mark H Pollack
- Department of Psychiatry, Rush University Medical Center, Chicago, Illinois, USA
| | - Stevan E Hobfoll
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Kumar B Rajan
- Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - John W Burns
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
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19
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Burgess HJ, Burns JW, Buvanendran A, Gupta R, Chont M, Kennedy M, Bruehl S. Associations Between Sleep Disturbance and Chronic Pain Intensity and Function: A Test of Direct and Indirect Pathways. Clin J Pain 2019; 35:569-576. [PMID: 30913041 PMCID: PMC6551250 DOI: 10.1097/ajp.0000000000000711] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Sleep disturbance and chronic pain are related. The present study evaluated both direct and indirect (mediated) pathways through which sleep disturbance might be related to chronic pain intensity and function. METHODS In total, 87 individuals (64% female) with chronic low back pain but not using opioids daily completed questionnaires assessing their sleep disturbance, chronic pain intensity, function, depression, anxiety, positive affect, and catastrophizing. RESULTS Greater sleep disturbance was associated with greater pain intensity, worse function, greater emotional distress, lower positive affect, and higher levels of catastrophizing. Cross-sectional mediation analyses revealed that the positive associations between sleep disturbance and chronic pain intensity were conveyed statistically not only by significant indirect effects of elevated emotional distress, lower positive affect, and greater catastrophizing associated with sleep disturbance, but also by significant direct effects of sleep disturbance on chronic pain intensity. Similarly, we found that the associations between sleep disturbance and impaired function were conveyed statistically not only by significant indirect effects of elevated chronic pain intensity associated with sleep disturbance, but also by significant direct effects of sleep disturbance on function. DISCUSSION Sleep disturbance was related significantly with chronic pain intensity and function by both direct and indirect pathways. These results are consistent with an emerging literature highlighting the potential significance of sleep disturbance in chronic pain patients, and provide further support for addressing sleep disturbance in the assessment and management of chronic pain.
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Affiliation(s)
- Helen J. Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - John W. Burns
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | | | - Rajnish Gupta
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melissa Chont
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mary Kennedy
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
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20
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Burns JW, Post KM, Smith DA, Porter LS, Buvanendran A, Fras AM, Keefe FJ. Spouse and Patient Beliefs and Perceptions About Chronic Pain: Effects on Couple Interactions and Patient Pain Behavior. J Pain 2019; 20:1176-1186. [PMID: 30954540 DOI: 10.1016/j.jpain.2019.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/28/2019] [Accepted: 04/02/2019] [Indexed: 11/30/2022]
Abstract
Patient beliefs and perceptions about the causes and meaning of their chronic pain are related to their psychosocial functioning. Beliefs and perceptions about chronic pain held by spouses may also be related to patient functioning. We used a laboratory procedure to evaluate whether spouse beliefs about and perceptions of chronic pain were related to spouse negative responses toward patients with chronic low back pain during a conflictual discussion and to their attributions about patient pain behavior during a subsequent pain-induction task. Patients (n = 71) and their spouses (n = 71) participated in a 10-minute discussion followed by the patient undergoing a 10-minute structured pain behavior task. Findings were that a) spouse perceptions that patient's pain was a mystery were significantly related to greater patient perceived spouse critical/invalidating responses toward the patient during the discussion; and b) spouse perceptions that patient's pain was a mystery were related to internal and negative attributions spouses made while observing patients display pain behaviors during the structured pain behavior task. Inasmuch as both spouse critical/invalidating speech toward patients and negative attributions regarding the cause of patient behavior are related to poor patient functioning, spouse uncertainty about the source and potential legitimacy of their partner's pain may play crucial roles in affecting patient well-being. PERSPECTIVE: Spouse beliefs about and perceptions of patient chronic pain were related to spouse behavior toward patients during a discussion and to attributions explaining patient pain during physical activity. If spouse confusion and doubt about patient pain is related to negative behavior and attributions, then modifying these perceptions may be a fundamental intervention target.
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Affiliation(s)
- John W Burns
- Department of Psychiatry and Behavioral Science, Rush University Medical Center, Chicago, Illinois.
| | - Kristina M Post
- Department of Psychology, University of La Verne, La Verne, California
| | - David A Smith
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana
| | - Laura S Porter
- Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, North Carolina
| | | | - Anne Marie Fras
- Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, North Carolina
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, North Carolina
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21
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Bruehl S, Olsen RB, Tronstad C, Sevre K, Burns JW, Schirmer H, Nielsen CS, Stubhaug A, Rosseland LA. Chronic pain-related changes in cardiovascular regulation and impact on comorbid hypertension in a general population: the Tromsø study. Pain 2019; 159:119-127. [PMID: 28953193 DOI: 10.1097/j.pain.0000000000001070] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Heart rate variability (HRV) and baroreflex sensitivity (BRS) are indexes reflecting the ability to maintain cardiovascular homeostasis amidst changing conditions. Evidence primarily from small studies suggests that both HRV and BRS may be reduced in individuals with chronic pain (CP), with potential implications for cardiovascular risk. We compared HRV and BRS between individuals with CP (broadly defined) and pain-free controls in a large unselected population sample. Participants were 1143 individuals reporting clinically meaningful CP and 5640 pain-free controls who completed a 106-second cold pressor test (CPT). Participants self-reported hypertension status. Resting HRV and BRS were derived from continuous beat-to-beat blood pressure recordings obtained before and after the CPT. Hierarchical regressions for the pre-CPT period indicated that beyond effects of age, sex, and body mass index, the CP group displayed significantly lower HRV in both the time domain (SDNN and rMSSD) and frequency domain (high-frequency HRV power), as well as lower BRS. Results were somewhat weaker for the post-CPT period. Mediation analyses indicated that for 6 of 7 HRV and BRS measures tested, there were significant indirect (mediated) effects of CP status on the presence of comorbid hypertension via reduced HRV or BRS. Results confirm in the largest and broadest sample tested to date that the presence of CP is linked to impaired cardiovascular regulation and for the first time provide support for the hypothesis that links between CP and comorbid hypertension reported in previous population studies may be due in part to CP-related decrements in cardiovascular regulation.
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Affiliation(s)
- Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Knut Sevre
- Cardiology, Oslo University Hospital, Oslo, Norway
| | - John W Burns
- Department of Behavioral Science, Rush University, Chicago, IL, USA
| | - Henrik Schirmer
- Division of Medicine and Laboratory Sciences, Akershus University Hospital, Lørenskog, Norway.,Department of Clinical Medicine, University of Tromsø, The Arctic University, Tromsø, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christopher Sivert Nielsen
- Department of Aging, Norwegian Institute of Public Health, Oslo, Norway.,Departments of Pain Management and Research and
| | - Audun Stubhaug
- Departments of Pain Management and Research and.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Leiv Arne Rosseland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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22
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Bruehl S, Stone AL, Palmer C, Edwards DA, Buvanendran A, Gupta R, Chont M, Kennedy M, Burns JW. Self-reported cumulative medical opioid exposure and subjective responses on first use of opioids predict analgesic and subjective responses to placebo-controlled opioid administration. Reg Anesth Pain Med 2019; 44:92-99. [PMID: 30640659 PMCID: PMC10853921 DOI: 10.1136/rapm-2018-000008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/11/2018] [Accepted: 05/16/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVES To expand the evidence base needed to enable personalized pain medicine, we evaluated whether self-reported cumulative exposure to medical opioids and subjective responses on first opioid use predicted responses to placebo-controlled opioid administration. METHODS In study 1, a survey assessing cumulative medical opioid exposure and subjective responses on first opioid use was created (History of Opioid Medical Exposure (HOME)) and psychometric features documented in a general sample of 307 working adults. In study 2, 49 patients with chronic low back pain completed the HOME and subsequently rated back pain intensity and subjective opioid effects four times after receiving saline placebo or intravenous morphine (four incremental doses) in two separate double-blinded laboratory sessions. Placebo-controlled morphine effects were derived for all outcomes. RESULTS Two HOME subscales were supported: cumulative opioid exposure and euphoric response, both demonstrating high test-retest reliability (Intraclass Correlation Coefficients > 0.93) and adequate internal consistency (Revelle's Omega Total = 0.73-0.77). In study 2, higher cumulative opioid exposure scores were associated with significantly greater morphine-related reductions in back pain intensity (p=0.02), but not with subjective drug effects. Higher euphoric response subscale scores were associated with significantly lower overall perceived morphine effect (p=0.003), less sedation (p=0.04), greater euphoria (p=0.03) and greater desire to take morphine again (p=0.02). DISCUSSION Self-reports of past exposure and responses to medical opioid analgesics may have utility for predicting subsequent analgesic responses and subjective effects. Further research is needed to establish the potential clinical and research utility of the HOME. TRIAL REGISTRATION NUMBER NCT02469077.
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Affiliation(s)
- Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amanda L Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Cassandra Palmer
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David A Edwards
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Rajnish Gupta
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melissa Chont
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mary Kennedy
- Department of Behavioral Science, Rush University, Chicago, Illinois, USA
| | - John W Burns
- Department of Behavioral Science, Rush University, Chicago, Illinois, USA
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23
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Gaffey AE, Aranda F, Burns JW, Purim-Shem-Tov YA, Burgess HJ, Beckham JC, Bruehl S, Hobfoll SE. Race, psychosocial vulnerability and social support differences in inner-city women's symptoms of posttraumatic stress disorder. Anxiety Stress Coping 2019; 32:18-31. [PMID: 30306795 PMCID: PMC6269211 DOI: 10.1080/10615806.2018.1532078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND/OBJECTIVES Inner-city Black women may be more susceptible to posttraumatic stress disorder (PTSD) than White women, although mechanisms underlying this association are unclear. Living in urban neighborhoods distinguished by higher chronic stress may contribute to racial differences in women's cognitive, affective, and social vulnerabilities, leading to greater trauma-related distress including PTSD. Yet social support could buffer the negative effects of psychosocial vulnerabilities on women's health. METHODS/DESIGN Mediation and moderated mediation models were tested with 371 inner-city women, including psychosocial vulnerability (i.e., catastrophizing, anger, social undermining) mediating the pathway between race and PTSD, and social support moderating psychosocial vulnerability and PTSD. RESULTS Despite comparable rates of trauma, Black women reported higher vulnerability and PTSD symptoms, and lower support compared to White Hispanic and non-Hispanic women. Psychosocial vulnerability mediated the pathway between race and PTSD, and social support moderated vulnerability, reducing negative effects on PTSD. When examining associations by race, the moderation effect remained significant for Black women only. CONCLUSIONS Altogether these psychosocial vulnerabilities represent one potential mechanism explaining Black women's greater risk of PTSD, although cumulative psychosocial vulnerability may be buffered by social support. Despite higher support, inner-city White women's psychosocial vulnerability may actually outweigh support's benefits for reducing trauma-related distress.
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Affiliation(s)
- Allison E. Gaffey
- Yale School of Medicine, Department of Internal Medicine 330 Cedar Street, New Haven, CT 06520
| | - Frances Aranda
- Rush University Medical Center, Dept. of Behavioral Sciences, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL 60612
| | - John W. Burns
- Rush University Medical Center, Dept. of Behavioral Sciences, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL 60612
| | - Yanina A. Purim-Shem-Tov
- Rush University Medical Center, Dept. of Emergency Medicine, 1653 W. Congress Parkway, Chicago, IL 60612
| | - Helen J. Burgess
- Rush University Medical Center, Dept. of Behavioral Sciences, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL 60612
| | - Jean C. Beckham
- Department of Psychiatry, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC 27710
- Durham Veterans Affairs Health System, 508 Fulton St, Durham, NC 27705
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232
| | - Stevan E. Hobfoll
- Rush University Medical Center, Dept. of Behavioral Sciences, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL 60612
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24
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Burns JW, Gerhart J, Post KM, Smith DA, Porter LS, Buvanendran A, Fras AM, Keefe FJ. Spouse Criticism/Hostility Toward Partners With Chronic Pain: The Role of Spouse Attributions for Patient Control Over Pain Behaviors. The Journal of Pain 2018; 19:1308-1317. [DOI: 10.1016/j.jpain.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/02/2018] [Accepted: 05/21/2018] [Indexed: 10/14/2022]
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25
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Langer SL, Romano JM, Todd M, Strauman TJ, Keefe FJ, Syrjala KL, Bricker JB, Ghosh N, Burns JW, Bolger N, Puleo BK, Gralow JR, Shankaran V, Westbrook K, Zafar SY, Porter LS. Links Between Communication and Relationship Satisfaction Among Patients With Cancer and Their Spouses: Results of a Fourteen-Day Smartphone-Based Ecological Momentary Assessment Study. Front Psychol 2018; 9:1843. [PMID: 30364167 PMCID: PMC6191515 DOI: 10.3389/fpsyg.2018.01843] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/10/2018] [Indexed: 11/13/2022] Open
Abstract
Cancer treatment poses significant challenges not just for those diagnosed with the disease but also for their intimate partners. Evidence suggests that couples' communication plays a major role in the adjustment of both individuals and in the quality of their relationship. Most descriptive studies linking communication to adjustment have relied on traditional questionnaire methodologies and cross-sectional designs, limiting external validity and discernment of temporal patterns. Using the systemic-transactional model of dyadic coping as a framework, we examined intra- and inter-personal associations between communication (both enacted and perceived) and relationship satisfaction (RS) among patients with stage II-IV breast or colorectal cancer and their spouses (N = 107 couples). Participants (mean age = 51, 64.5% female patients, and 37.4% female spouses) independently completed twice-daily ecological momentary assessments (EMA) via smartphone for 14 consecutive days. Items assessed RS and communication (expression of feelings, holding back from expression, support and criticism of partner, and parallel ratings of partner behavior). Linear mixed models employing an Actor Partner Interdependence Model were used to examine concurrent, time-lagged, and cross-lagged associations between communication and RS. Expressing one's feelings was unassociated with RS. Holding back from doing so, in contrast, was associated with lower RS for both patients and spouses in concurrent models. These effects were both intrapersonal and interpersonal, meaning that when individuals held back from expressing their feelings, they reported lower RS and so too did their partner. Giving and receiving support were associated with one's own higher RS for both patients and spouses in concurrent models, and for patients in lagged models. Conversely, criticizing one's partner and feeling criticized were maladaptive, associated with lower RS (own and in some cases, partner's). Cross-lagged analyses (evening RS to next-day afternoon communication) yielded virtually no effects, suggesting that communication may have a stronger influence on short-term RS than the reverse. Findings underscore the importance of responsive communication, more so than expression per se, in explaining both concurrent and later relationship adjustment. In addition, a focus on holding back from expressing feelings may enhance the understanding of RS for couples coping with cancer.
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Affiliation(s)
- Shelby L Langer
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Joan M Romano
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Michael Todd
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | | | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Jonathan B Bricker
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Neeta Ghosh
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - John W Burns
- Department of Behavioral Sciences, Rush Medical College, Rush University, Chicago, IL, United States
| | - Niall Bolger
- Department of Psychology, Columbia University, New York, NY, United States
| | - Blair K Puleo
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Julie R Gralow
- Medical Oncology, University of Washington School of Medicine, Seattle, WA, United States
| | - Veena Shankaran
- Medical Oncology, University of Washington School of Medicine, Seattle, WA, United States
| | - Kelly Westbrook
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - S Yousuf Zafar
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
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26
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Burgess HJ, Kikyo F, Valdespino-Hayden Z, Rizvydeen M, Kimura M, Pollack MH, Hobfoll SE, Rajan KB, Zalta AK, Burns JW. Do the Morningness-Eveningness Questionnaire and Munich ChronoType Questionnaire Change After Morning Light Treatment? Sleep Sci Pract 2018; 2. [PMID: 31289751 DOI: 10.1186/s41606-018-0031-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The Morningness-Eveningness Questionnaire (MEQ) and Munich ChronoType Questionnaire (MCTQ) are sometimes used to estimate circadian timing. However, it remains unclear if they can reflect a change in circadian timing after a light treatment. In this study, 31 participants (25-68 years) completed both questionnaires before and after a 13-28 day morning light treatment. The dim light melatonin onset (DLMO), a physiological marker of circadian timing, was also assessed in a subsample of 16 participants. The DLMO phase advanced on average by 47 minutes (p<0.001). The MEQ score increased by 1.8 points (p=0.046). The MSFsc measure derived from the MCTQ advanced by 8.7 minutes (p=0.17). The shift towards morningness observed in both questionnaires correlated with the phase advance observed in the DLMO (MEQ r=-0.46, p=0.036; MSFsc r=0.81, p<0.001). Results suggest that these circadian questionnaires can change in response to a light treatment, indicating they can reflect underlying changes in circadian timing.
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Affiliation(s)
- Helen J Burgess
- Department of Behavioral Sciences, Rush University Medical Center, Chicago IL
| | - Fumitaka Kikyo
- Department of Behavioral Sciences, Rush University Medical Center, Chicago IL
| | | | - Muneer Rizvydeen
- Department of Behavioral Sciences, Rush University Medical Center, Chicago IL
| | - Momoko Kimura
- Department of Behavioral Sciences, Rush University Medical Center, Chicago IL
| | - Mark H Pollack
- Department of Psychiatry, Rush University Medical Center, Chicago IL
| | - Stevan E Hobfoll
- Department of Behavioral Sciences, Rush University Medical Center, Chicago IL
| | - Kumar B Rajan
- Department of Internal Medicine, Rush University Medical Center, Chicago IL
| | - Alyson K Zalta
- Department of Behavioral Sciences, Rush University Medical Center, Chicago IL.,Department of Psychiatry, Rush University Medical Center, Chicago IL
| | - John W Burns
- Department of Behavioral Sciences, Rush University Medical Center, Chicago IL
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27
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Gaffey AE, Burns JW, Aranda F, Purim-Shem-Tov YA, Burgess HJ, Beckham JC, Bruehl S, Hobfoll SE. Social support, social undermining, and acute clinical pain in women: Mediational pathways of negative cognitive appraisal and emotion. J Health Psychol 2018; 25:2328-2339. [PMID: 30146929 DOI: 10.1177/1359105318796189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Women may be disproportionately vulnerable to acute pain, potentially due to their social landscape. We examined whether positive and negative social processes (social support and social undermining) are associated with acute pain and if the processes are linked to pain via negative cognitive appraisal and emotion (pain catastrophizing, hyperarousal, anger). Psychosocial variables were assessed in inner-city women (N = 375) presenting to an Emergency Department with acute pain. The latent cognitive-emotion variable fully mediated social undermining and support effects on pain, with undermining showing greater impact. Pain may be alleviated by limiting negative social interactions, mitigating risks of alternative pharmacological interventions.
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Affiliation(s)
- Allison E Gaffey
- Yale School of Medicine, USA.,Rush University Medical Center, USA
| | | | | | | | | | - Jean C Beckham
- Duke University School of Medicine, USA.,Durham VA Health Care System, USA
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28
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Pegram SE, Lumley MA, Jasinski MJ, Burns JW. Psychological Trauma Exposure and Pain-Related Outcomes Among People with Chronic Low Back Pain: Moderated Mediation by Thought Suppression and Social Constraints. Ann Behav Med 2018; 51:316-320. [PMID: 27752992 DOI: 10.1007/s12160-016-9838-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sheri E Pegram
- Department of Psychology, Wayne State University, 5057 Woodward Ave, Detroit, MI, 48202, USA
| | - Mark A Lumley
- Department of Psychology, Wayne State University, 5057 Woodward Ave, Detroit, MI, 48202, USA.
| | - Matthew J Jasinski
- Department of Psychology, Wayne State University, 5057 Woodward Ave, Detroit, MI, 48202, USA
| | - John W Burns
- Rush University, 600 S Paulina St, Chicago, IL, 60612, USA
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29
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Abstract
OBJECTIVES Pain-related cognitive content (what people think about pain) and cognitive processes (how people think about pain; what they do with their pain-related thoughts) and their interaction are hypothesized to play distinct roles in patient function. However, questions have been raised regarding whether it is possible or practical to assess cognitive content and cognitive process as distinct domains. The aim of this study was to determine the extent to which measures that seem to assess mostly pain-related cognitive content, cognitive processes, and content and process, are relatively independent from each other and contribute unique variance to the prediction of patient function. MATERIALS AND METHODS Individuals with chronic low back pain (N=165) participating in an ongoing RCT were administered measures of cognitions, pain, and function (depressive symptoms and pain interference) pretreatment. RESULTS Analyses provided support for the hypothesis that cognitive content and cognitive process, while related, can be assessed as distinct components. However, the measure assessing a cognitive process-mindfulness-evidenced relatively weak associations with function, especially compared with the stronger and more consistent findings for the measures of content (catastrophizing and self-efficacy). DISCUSSION The results provide preliminary evidence for the possibility that mindfulness could have both benefits and costs. Research to evaluate this possibility is warranted.
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Affiliation(s)
- Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Beverly E. Thorn
- Department of Psychology, University of Alabama, Tuscaloosa, Alabama
| | - James Carmody
- University of Massachusetts Medical School, 55N. Lake Avenue, Worcester, MA 01655, USA
| | - Francis J. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - John W. Burns
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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30
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Affiliation(s)
- R A Shellhaas
- Pediatric Neurology, University of Michigan, Ann Arbor, MI
| | - J D Barks
- Neonatal-Perinatal Medicine, University of Michigan, Ann Arbor, MI
| | - J W Burns
- Michigan Tech Research Institute, Ann Arbor, MI
| | - F Hassan
- Sleep Disorders Center, Pediatric Pulmonology, University of Michigan, Ann Arbor, MI
| | - R D Chervin
- Sleep Disorders Center, University of Michigan, Ann Arbor, MI
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31
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Fischer A, Aranda F, Lillis TA, Burgess HJ, Burns JW, Purim-Shem-Tov Y, Hobfoll SE. 0709 Racial Differences in Objective and Subjective Sleep Parameters: A Sample of Inner-City Women. Sleep 2018. [DOI: 10.1093/sleep/zsy061.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Fischer
- Rush University Medical Center, Chicago, IL
| | - F Aranda
- Rush University Medical Center, Chicago, IL
| | - T A Lillis
- Rush University Medical Center, Chicago, IL
| | | | - J W Burns
- Rush University Medical Center, Chicago, IL
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32
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Gliske SV, Burns JW, Chervin RD. 0755 Behavioral Improvement After Adenotonsillectomy For Pediatric OSA: Can The Predictive Value Of PSG Be Improved With Novel Computational Approaches? Sleep 2018. [DOI: 10.1093/sleep/zsy061.754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S V Gliske
- Sleep Disorders Clinic, Department of Neurology, University of Michigan, Ann Arbor, MI
| | - J W Burns
- Michigan Tech Research Institute, Michigan Technological University, Ann Arbor, MI
| | - R D Chervin
- Sleep Disorders Clinic, Department of Neurology, University of Michigan, Ann Arbor, MI
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33
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Thorn BE, Eyer JC, Van Dyke BP, Torres CA, Burns JW, Kim M, Newman AK, Campbell LC, Anderson B, Block PR, Bobrow BJ, Brooks R, Burton TT, Cheavens JS, DeMonte CM, DeMonte WD, Edwards CS, Jeong M, Mulla MM, Penn T, Smith LJ, Tucker DH. Literacy-Adapted Cognitive Behavioral Therapy Versus Education for Chronic Pain at Low-Income Clinics: A Randomized Controlled Trial. Ann Intern Med 2018; 168:471-480. [PMID: 29482213 DOI: 10.7326/m17-0972] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Chronic pain is common and challenging to treat. Although cognitive behavioral therapy (CBT) is efficacious, its benefit in disadvantaged populations is largely unknown. OBJECTIVE To evaluate the efficacy of literacy-adapted and simplified group CBT versus group pain education (EDU) versus usual care. DESIGN Randomized controlled trial. (ClinicalTrials.gov: NCT01967342). SETTING Community health centers serving low-income patients in Alabama. PATIENTS Adults (aged 19 to 71 years) with mixed chronic pain. INTERVENTIONS CBT and EDU delivered in 10 weekly 90-minute group sessions. MEASUREMENTS Self-reported, postintervention pain intensity (primary outcome) and physical function and depression (secondary outcomes). RESULTS 290 participants were enrolled (70.7% of whom were women, 66.9% minority group members, 72.4% at or below the poverty level, and 35.8% reading below the fifth grade level); 241 (83.1%) participated in posttreatment assessments. Linear mixed models included all randomly assigned participants. Members of the CBT and EDU groups had larger decreases in pain intensity scores between baseline and posttreatment than participants receiving usual care (estimated differences in change scores-CBT: -0.80 [95% CI -1.48 to -0.11]; P = 0.022; EDU: -0.57 [CI, -1.04 to -0.10]; P = 0.018). At 6-month follow-up, treatment gains were not maintained in the CBT group but were still present in the EDU group. With regard to physical function, participants in the CBT and EDU interventions had greater posttreatment improvement than those receiving usual care, and this progress was maintained at 6-month follow-up. Changes in depression (secondary outcome) did not differ between either the CBT or EDU group and the usual care group. LIMITATIONS Participants represented a single health care system. Self-selection bias may have been present. CONCLUSION Simplified group CBT and EDU interventions delivered at low-income clinics significantly improved pain and physical function compared with usual care. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute.
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Affiliation(s)
- Beverly E Thorn
- University of Alabama, Tuscaloosa, Alabama (B.E.T., J.C.E., B.P.V., C.A.T., A.K.N., P.R.B., M.M.M.)
| | - Joshua C Eyer
- University of Alabama, Tuscaloosa, Alabama (B.E.T., J.C.E., B.P.V., C.A.T., A.K.N., P.R.B., M.M.M.)
| | - Benjamin P Van Dyke
- University of Alabama, Tuscaloosa, Alabama (B.E.T., J.C.E., B.P.V., C.A.T., A.K.N., P.R.B., M.M.M.)
| | - Calia A Torres
- University of Alabama, Tuscaloosa, Alabama (B.E.T., J.C.E., B.P.V., C.A.T., A.K.N., P.R.B., M.M.M.)
| | - John W Burns
- Rush University Medical Center, Chicago, Illinois (J.W.B.)
| | - Minjung Kim
- Ohio State University, Columbus, Ohio (M.K., J.S.C.)
| | - Andrea K Newman
- University of Alabama, Tuscaloosa, Alabama (B.E.T., J.C.E., B.P.V., C.A.T., A.K.N., P.R.B., M.M.M.)
| | - Lisa C Campbell
- East Carolina University, Greenville, North Carolina (L.C.C.)
| | - Brian Anderson
- University of Alabama, Tuscaloosa, Alabama, and Integrated Psychology Solutions, Little Rock, Arkansas (B.A.)
| | - Phoebe R Block
- University of Alabama, Tuscaloosa, Alabama (B.E.T., J.C.E., B.P.V., C.A.T., A.K.N., P.R.B., M.M.M.)
| | - Bentley J Bobrow
- Arizona Emergency Medicine Research Center, Tucson, Arizona (B.J.B.)
| | - Regina Brooks
- Whatley Health Services, Tuscaloosa, Alabama (R.B., T.T.B., C.S.E., D.H.T.)
| | - Toya T Burton
- Whatley Health Services, Tuscaloosa, Alabama (R.B., T.T.B., C.S.E., D.H.T.)
| | | | - Colette M DeMonte
- University of Alabama, Tuscaloosa, Alabama, and Pacific Rehabilitation Centers, Bellevue, Washington (C.M.D.)
| | - William D DeMonte
- University of Alabama, Tuscaloosa, Alabama, and CHI Franciscan Medical Group, Tacoma, Washington (W.D.D.)
| | - Crystal S Edwards
- Whatley Health Services, Tuscaloosa, Alabama (R.B., T.T.B., C.S.E., D.H.T.)
| | - Minjeong Jeong
- University of California, Los Angeles, Los Angeles, California (M.J.)
| | - Mazheruddin M Mulla
- University of Alabama, Tuscaloosa, Alabama (B.E.T., J.C.E., B.P.V., C.A.T., A.K.N., P.R.B., M.M.M.)
| | - Terence Penn
- University of Alabama, Tuscaloosa, and University of Alabama at Birmingham, Birmingham, Alabama (T.P.)
| | - Laura J Smith
- Virginia Commonwealth University, Richmond, Virginia (L.J.S.)
| | - Deborah H Tucker
- Whatley Health Services, Tuscaloosa, Alabama (R.B., T.T.B., C.S.E., D.H.T.)
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34
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Gerhart JI, Burns JW, Post KM, Smith DA, Porter LS, Burgess HJ, Schuster E, Buvanendran A, Fras AM, Keefe FJ. Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects. Ann Behav Med 2018; 51:365-375. [PMID: 27844327 DOI: 10.1007/s12160-016-9860-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Poor sleep quality among people with chronic low back pain appears to be related to worse pain, affect, poor physical function, and pain catastrophizing. The causal direction between poor sleep and pain remains an open question, however, as does whether sleep quality exerts effects on low back pain differently across the course of the day. PURPOSE This daily diary study examined lagged temporal associations between prior night sleep quality and subsequent day pain, affect, physical function and pain catastrophizing, the reverse lagged temporal associations between prior day pain-related factors and subsequent night sleep quality, and whether the time of day during which an assessment was made moderated these temporal associations. METHODS Chronic low back pain patients (n = 105) completed structured electronic diary assessments five times per day for 14 days. Items included patient ratings of their pain, affect, physical function, and pain catastrophizing. RESULTS Collapsed across all observations, poorer sleep quality was significantly related to higher pain ratings, higher negative affect, lower positive affect, poorer physical function, and higher pain catastrophizing. Lagged analyses averaged across the day revealed that poorer prior night sleep quality significantly predicted greater next day patient ratings of pain, and poorer physical function and higher pain catastrophizing. Prior poorer night sleep quality significantly predicted greater reports of pain, and poorer physical function, and higher pain catastrophizing, especially during the early part of the day. Sleep quality × time of day interactions showed that poor sleepers reported high pain, and negative mood and low function uniformly across the day, whereas good sleepers reported relatively good mornings, but showed pain, affect and function levels comparable to poor sleepers by the end of the day. Analyses of the reverse causal pathway were mostly nonsignificant. CONCLUSIONS Sleep quality appears related not only to pain intensity but also to a wide range of patient mood and function factors. A good night's sleep also appears to offer only temporary respite, suggesting that comprehensive interventions for chronic low back pain not only should include attention to sleep problems but also focus on problems with pain appraisals and coping.
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Affiliation(s)
- James I Gerhart
- Rush University Medical Center, 1725 W. Harrison, Chicago, IL, 606012, USA.
| | - John W Burns
- Rush University Medical Center, 1725 W. Harrison, Chicago, IL, 606012, USA
| | | | | | | | - Helen J Burgess
- Rush University Medical Center, 1725 W. Harrison, Chicago, IL, 606012, USA
| | - Erik Schuster
- Rush University Medical Center, 1725 W. Harrison, Chicago, IL, 606012, USA
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Darnall BD, Ziadni MS, Roy A, Kao MC, Sturgeon JA, Cook KF, Lorig K, Burns JW, Mackey SC. Comparative Efficacy and Mechanisms of a Single-Session Pain Psychology Class in Chronic Low Back Pain: Study Protocol for a Randomized Controlled Trial. Trials 2018; 19:165. [PMID: 29510735 PMCID: PMC5838852 DOI: 10.1186/s13063-018-2537-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 02/08/2018] [Indexed: 01/07/2023] Open
Abstract
Background The Institute of Medicine (IOM) reported that chronic pain affects about 100 million U.S. adults, with chronic low back pain (CLBP) cited as the most prevalent type. Pain catastrophizing is a psychological construct shown to predict the development and trajectory of chronic pain and patient response to pain treatments. While effective treatment for pain catastrophizing typically includes eight-session groups of cognitive behavioral therapy (CBT), a single-session targeted treatment class yielded promising results which, if replicated and extended, could prove to efficiently and cost-effectively reduce pain catastrophizing. In this trial, we seek to determine the comparative efficacy of this novel single-session pain catastrophizing class to an eight-session course of pain CBT and a single-session back pain health education class. We will also explore the psychosocial mechanisms and outcomes of pain catastrophizing treatment. Methods In this trial we will randomize 231 individuals with CLBP to one of three treatment arms: (1) pain-CBT (eight weekly 2-h group sessions with home exercises and readings); (2) a single 2-h pain catastrophizing class; or (3) a single 2-h back pain health education class (active control). For the primary outcome of pain catastrophizing, the trial is designed as a non-inferiority test between pain-CBT and the single-session pain catastrophizing class, and as a superiority test between the single-session pain catastrophizing class and the health education class. Team researchers masked to treatment assignment will assess outcomes up to six months post treatment. Discussion If the single-session targeted pain catastrophizing class is found to be an effective treatment for patients with CLBP, this low cost and low burden treatment could dismantle many of the current barriers and burdens of effective pain care. Further, elucidation of the mechanisms of pain catastrophizing treatments will facilitate future research on the topic as well as further development and refinement of treatments. Trial registration ClinicalTrials.gov, NCT03167086. Registered on 22 May 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2537-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA.
| | - Maisa S Ziadni
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA
| | - Anuradha Roy
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA
| | - Ming-Chih Kao
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA
| | - John A Sturgeon
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA
| | - Karon F Cook
- Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Kate Lorig
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA
| | - John W Burns
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford Systems Neuroscience and Pain Lab, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, USA
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France CR, Burns JW, Gupta RK, Buvanendran A, Chont M, Schuster E, Orlowska D, Bruehl S. Expectancy Effects on Conditioned Pain Modulation Are Not Influenced by Naloxone or Morphine. Ann Behav Med 2017; 50:497-505. [PMID: 26809850 DOI: 10.1007/s12160-016-9775-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Recent studies suggest that participant expectations influence pain ratings during conditioned pain modulation testing. The present study extends this work by examining expectancy effects among individuals with and without chronic back pain after administration of placebo, naloxone, or morphine. PURPOSE This study aims to identify the influence of individual differences in expectancy on changes in heat pain ratings obtained before, during, and after a forearm ischemic pain stimulus. METHODS Participants with chronic low back pain (n = 88) and healthy controls (n = 100) rated heat pain experience (i.e., "test stimulus") before, during, and after exposure to ischemic pain (i.e., "conditioning stimulus"). Prior to testing, participants indicated whether they anticipated that their heat pain would increase, decrease, or remain unchanged during ischemic pain. RESULTS Analysis of the effects of expectancy (pain increase, decrease, or no change), drug (placebo, naloxone, or morphine), and group (back pain, healthy) on changes in heat pain revealed a significant main effect of expectancy (p = 0.001), but no other significant main effects or interactions. Follow-up analyses revealed that individuals who expected lower pain during ischemia reported significantly larger decreases in heat pain as compared with those who expected either no change (p = 0.004) or increased pain (p = 0.001). CONCLUSIONS The present findings confirm that expectancy is an important contributor to conditioned pain modulation effects, and therefore significant caution is needed when interpreting findings that do not account for this individual difference. Opioid mechanisms do not appear to be involved in these expectancy effects.
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Affiliation(s)
- Christopher R France
- Department of Psychology, Ohio University, 251 Porter Hall, Athens, OH, 45701, USA.
| | - John W Burns
- Department of Behavioral Science, Rush University, Chicago, IL, USA
| | - Rajnish K Gupta
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Melissa Chont
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Erik Schuster
- Department of Behavioral Science, Rush University, Chicago, IL, USA
| | - Daria Orlowska
- Department of Behavioral Science, Rush University, Chicago, IL, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA
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Darnall BD, Sturgeon JA, Cook KF, Taub CJ, Roy A, Burns JW, Sullivan M, Mackey SC. Development and Validation of a Daily Pain Catastrophizing Scale. J Pain 2017; 18:1139-1149. [PMID: 28528981 PMCID: PMC5581222 DOI: 10.1016/j.jpain.2017.05.003] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 12/12/2022]
Abstract
To date, there is no validated measure for pain catastrophizing at the daily level. The Pain Catastrophizing Scale (PCS) is widely used to measure trait pain catastrophizing. We sought to develop and validate a brief, daily version of the PCS for use in daily diary studies to facilitate research on mechanisms of catastrophizing treatment, individual differences in self-regulation, and to reveal the nuanced relationships between catastrophizing, correlates, and pain outcomes. After adapting the PCS for daily use, we evaluated the resulting 14 items using 3 rounds of cognitive interviews with 30 adults with chronic pain. We refined and tested the final daily PCS in 3 independent, prospective, cross-sectional, observational validation studies conducted in a combined total of 519 adults with chronic pain who completed online measures daily for 14 consecutive days. For study 1 (N = 131), exploratory factor analysis revealed adequate fit and-unexpectedly-unidimensionality for item responses to the daily PCS. Study 2 (N = 177) correlations indicated adequate association with related constructs (anger, anxiety, pain intensity, depression). Similarly, results for study 3 (N = 211) revealed expected correlations for daily PCS and measures of daily constructs including physical activity, sleep, energy level, and positive affect. Results from complex/multilevel confirmatory factor analysis confirmed good fit to a unidimensional model. Scores on the daily PCS were statistically comparable with and more parsimonious than the full 14-item version. Next steps include evaluation of score validity in populations with medical diagnoses, greater demographic diversity, and in patients with acute pain. PERSPECTIVE This article describes the development and validation of a daily PCS. This daily measure may facilitate research that aims to characterize pain mechanisms, individual differences in self-regulation, adaptation, and nuanced relationships between catastrophizing, correlates, and pain outcomes.
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Affiliation(s)
- Beth D Darnall
- Stanford Systems Neuroscience and Pain Lab, Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.
| | - John A Sturgeon
- Stanford Systems Neuroscience and Pain Lab, Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Karon F Cook
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Chloe J Taub
- Stanford Systems Neuroscience and Pain Lab, Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Anuradha Roy
- Stanford Systems Neuroscience and Pain Lab, Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - John W Burns
- Department of Behavioral Sciences, Rush University, Chicago, Illinois
| | - Michael Sullivan
- Recover Injury Research Centre, Health and Behavioural Sciences, The University of Queensland, Herston, Queensland, Australia
| | - Sean C Mackey
- Stanford Systems Neuroscience and Pain Lab, Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
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Gerhart JI, Sanchez Varela V, Burns JW. Brief Training on Patient Anger Increases Oncology Providers' Self-Efficacy in Communicating With Angry Patients. J Pain Symptom Manage 2017; 54:355-360.e2. [PMID: 28760523 DOI: 10.1016/j.jpainsymman.2017.07.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 11/26/2022]
Abstract
CONTEXT Anger is a common reaction to pain and life-limiting and life-threatening illness, is linked to higher levels of pain, and may disrupt communication with medical providers. Anger is understudied compared with other emotions in mental health and health care contexts, and many providers have limited formal training in addressing anger. OBJECTIVES The objective of this study was to assess if a brief provider training program is a feasible method for increasing providers' self-efficacy in responding to patient anger. METHODS Providers working in stem cell transplant and oncology units attending a brief training session on responding to patient anger. The program was informed by cognitive behavioral models of anger and included didactics, discussion, and experiential training on communication and stress management. RESULTS Provider-rated self-efficacy was significantly higher for nine of 10 skill outcomes (P < .005) including acknowledging patient anger, discussing anger, considering solutions, and using relaxation to manage their own distress. All skill increases were large in magnitude (Cohen's d = 1.18-2.22). CONCLUSION Providers found the program to be useful for increasing their confidence in addressing patient anger. Discussion, didactics, and experiential exercises can support provider awareness of anger, shape adaptive communication, and foster stress management skills.
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Affiliation(s)
- James I Gerhart
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
| | | | - John W Burns
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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Braley TJ, Burns JW, Kratz AL, Kaplish N, Persad C, Chervin RD. 1167 DO SLEEP DYNAMICS AFFECT COGNITIVE FUNCTION IN PATIENTS WITH MULTIPLE SCLEROSIS? Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shellhaas RA, Burns JW, Hassan F, Carlson MD, Barks JD, Chervin RD. 0909 NEONATAL SLEEP-WAKE ANALYSES PREDICT 18-MONTH NEURODEVELOPMENTAL OUTCOMES. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jasinski MJ, Lumley MA, Latsch DV, Schuster E, Kinner E, Burns JW. Assessing Anger Expression: Construct Validity of Three Emotion Expression-Related Measures. J Pers Assess 2016; 98:640-8. [PMID: 27248355 PMCID: PMC5053333 DOI: 10.1080/00223891.2016.1178650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Self-report measures of emotional expression are common, but their validity to predict objective emotional expression, particularly of anger, is unclear. We tested the validity of the Anger Expression Inventory (AEI; Spielberger et al., 1985 ), Emotional Approach Coping Scale (EAC; Stanton, Kirk, Cameron, & Danoff-Burg, 2000 ), and Toronto Alexithymia Scale-20 (TAS-20; Bagby, Taylor, & Parker, 1994 ) to predict objective anger expression in 95 adults with chronic back pain. Participants attempted to solve a difficult computer maze by following the directions of a confederate who treated them rudely and unjustly. Participants then expressed their feelings for 4 min. Blinded raters coded the videos for anger expression, and a software program analyzed expression transcripts for anger-related words. Analyses related each questionnaire to anger expression. The AEI Anger-Out scale predicted greater anger expression, as expected, but AEI Anger-In did not. The EAC Emotional Processing scale predicted less anger expression, but the EAC Emotional Expression scale was unrelated to anger expression. Finally, the TAS-20 predicted greater anger expression. Findings support the validity of the AEI Anger-Out scale but raise questions about the other measures. The assessment of emotional expression by self-report is complex and perhaps confounded by general emotional experience, the specificity or generality of the emotion(s) assessed, and self-awareness limitations. Performance-based or clinician-rated measures of emotion expression are needed.
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Affiliation(s)
| | | | | | - Erik Schuster
- Department of Behavioral Sciences, Rush University Medical Center
| | - Ellen Kinner
- Department of Behavioral Sciences, Rush University Medical Center
| | - John W. Burns
- Department of Behavioral Sciences, Rush University Medical Center
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Darnall BD, Scheman J, Davin S, Burns JW, Murphy JL, Wilson AC, Kerns RD, Mackey SC. Pain Psychology: A Global Needs Assessment and National Call to Action. Pain Med 2016; 17:250-63. [PMID: 26803844 PMCID: PMC4758272 DOI: 10.1093/pm/pnv095] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The Institute of Medicine and the draft National Pain Strategy recently called for better training for health care clinicians. This was the first high-level needs assessment for pain psychology services and resources in the United States. DESIGN Prospective, observational, cross-sectional. METHODS Brief surveys were administered online to six stakeholder groups (psychologists/therapists, individuals with chronic pain, pain physicians, primary care physicians/physician assistants, nurse practitioners, and the directors of graduate and postgraduate psychology training programs). RESULTS 1,991 responses were received. Results revealed low confidence and low perceived competency to address physical pain among psychologists/therapists, and high levels of interest and need for pain education. We found broad support for pain psychology across stakeholder groups, and global support for a national initiative to increase pain training and competency in U.S. therapists. Among directors of graduate and postgraduate psychology training programs, we found unanimous interest for a no-cost pain psychology curriculum that could be integrated into existing programs. Primary barriers to pain psychology include lack of a system to identify qualified therapists, paucity of therapists with pain training, limited awareness of the psychological treatment modality, and poor insurance coverage. CONCLUSIONS This report calls for transformation within psychology predoctoral and postdoctoral education and training and psychology continuing education to include and emphasize pain and pain management. A system for certification is needed to facilitate quality control and appropriate reimbursement. There is a need for systems to facilitate identification and access to practicing psychologists and therapists skilled in the treatment of pain.
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Affiliation(s)
- Beth D Darnall
- *Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Palo Alto, California
| | - Judith Scheman
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Sara Davin
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - John W Burns
- Department of Behavioral Sciences, Rush University, Chicago, Illinois
| | - Jennifer L Murphy
- Chronic Pain Rehabilitation Program, James A. Haley Veterans' Hospital, Tampa, Florida
| | - Anna C Wilson
- Institute on Development & Disability, IDD Division of Psychology, Oregon Health & Science University
| | - Robert D Kerns
- Pain Research, Informatics, Multi-Morbidities and Education (PRIME) Center, VA Connecticut Healthcare System, Departments of Psychiatry, Neurology and Psychology, Yale University, West Haven, CT, USA
| | - Sean C Mackey
- *Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Palo Alto, California
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Burns JW, Gerhart JI, Bruehl S, Post KM, Smith DA, Porter LS, Schuster E, Buvanendran A, Fras AM, Keefe FJ. Anger arousal and behavioral anger regulation in everyday life among people with chronic low back pain: Relationships with spouse responses and negative affect. Health Psychol 2016; 35:29-40. [PMID: 26030307 PMCID: PMC10839786 DOI: 10.1037/hea0000221] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the degree to which anger arousal and anger regulation (expression, inhibition) in the daily lives of people with chronic pain were related to spouse support, criticism, and hostility as perceived by patients and as reported by spouses. METHOD Married couples (N = 105, 1 spouse with chronic low back pain) completed electronic daily diaries, with assessments 5 times/day for 14 days. On these diaries, patients completed items on their own anger arousal, anger expression, and inhibition, and on perceived spouse support, criticism, and hostility. Spouses reported on their responses toward patients and their negative affect. Hierarchical linear modeling tested concurrent and lagged relationships. RESULTS Patient-reported increases in anger arousal and anger expression were predominantly related to concurrent decreases in patient-perceived and spouse-reported spouse support, concurrent increases in patient-perceived and spouse-reported spouse criticism and hostility, and increases in spouse-reported negative affect. Relationships for anger expression remained significant with anger arousal controlled. These effects were especially strong for male patients. Spouses reported greater negative affect when patients were present than when they were not. CONCLUSIONS Social support may facilitate adjustment to chronic pain, with declining support and overt criticism and hostility possibly adversely impacting pain and function. Results suggest that patient anger arousal and expression may be related to a negative interpersonal environment for married couples coping with chronic low back pain.
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Affiliation(s)
- John W Burns
- Department of Behavioral Sciences, Rush University Medical Center
| | - James I Gerhart
- Department of Behavioral Sciences, Rush University Medical Center
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center
| | | | | | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Erik Schuster
- Department of Behavioral Sciences, Rush University Medical Center
| | | | - Anne Marie Fras
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
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Burns JW, Gerhart JI, Post KM, Smith DA, Porter LS, Schuster E, Buvanendran A, Fras AM, Keefe FJ. The Communal Coping Model of Pain Catastrophizing in Daily Life: A Within-Couples Daily Diary Study. J Pain 2015; 16:1163-75. [PMID: 26320945 DOI: 10.1016/j.jpain.2015.08.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 06/08/2015] [Accepted: 07/27/2015] [Indexed: 01/22/2023]
Abstract
UNLABELLED The Communal Coping Model characterizes pain catastrophizing as a coping tactic whereby pain expression elicits assistance and empathic responses from others. Married couples (N = 105 couples; 1 spouse with chronic low back pain) completed electronic daily diary assessments 5 times/day for 14 days. In these diaries, patients reported pain catastrophizing, pain, and function, and perceived spouse support, perceived criticism, and perceived hostility. Non-patient spouses reported on their support, criticism, and hostility directed toward patients, as well as their observations of patient pain and pain behaviors. Hierarchical linear modeling tested concurrent and lagged (3 hours later) relationships. Principal findings included the following: a) within-person increases in pain catastrophizing were positively associated with spouse reports of patient pain behavior in concurrent and lagged analyses; b) within-person increases in pain catastrophizing were positively associated with patient perceptions of spouse support, criticism, and hostility in concurrent analyses; c) within-person increases in pain catastrophizing were negatively associated with spouse reports of criticism and hostility in lagged analyses. Spouses reported patient behaviors that were tied to elevated pain catastrophizing, and spouses changed their behavior during and after elevated pain catastrophizing episodes. Pain catastrophizing may affect the interpersonal environment of patients and spouses in ways consistent with the Communal Coping Model. PERSPECTIVE Pain catastrophizing may represent a coping response by which individuals' pain expression leads to assistance or empathic responses from others. Results of the present study support this Communal Coping Model, which emphasizes interpersonal processes by which pain catastrophizing, pain, pain behavior, and responses of significant others are intertwined.
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Affiliation(s)
- John W Burns
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois.
| | - James I Gerhart
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Kristina M Post
- Department of Psychology, University of La Verne, La Verne, California
| | - David A Smith
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Erik Schuster
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Asokumar Buvanendran
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Anne Marie Fras
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
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Bruehl S, Burns JW, Passik SD, Gupta R, Buvanendran A, Chont M, Schuster E, Orlowska D, France CR. The Contribution of Differential Opioid Responsiveness to Identification of Opioid Risk in Chronic Pain Patients. J Pain 2015; 16:666-75. [PMID: 25892658 DOI: 10.1016/j.jpain.2015.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/16/2015] [Accepted: 04/10/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) predicts increased risk of opioid misuse in chronic pain patients. We evaluated whether higher SOAPP-R scores are associated with greater opioid reinforcing properties, potentially contributing to their predictive utility. Across 2 counterbalanced laboratory sessions, 55 chronic low back pain sufferers completed the SOAPP-R at baseline and measures of back pain intensity, evoked pain responsiveness (thermal, ischemic), and subjective opioid effects after receiving intravenous morphine (.08 mg/kg) or saline placebo. Morphine effect measures were derived for all outcomes, reflecting the difference between morphine and placebo condition values. Higher SOAPP-R scores were significantly associated with greater desire to take morphine again, less feeling down and feeling bad, and greater reductions in sensory low back pain intensity following morphine administration. This latter effect was due primarily to SOAPP-R content assessing medication-specific attitudes and behavior. Individuals exceeding the clinical cutoff (18 or higher) on the SOAPP-R exhibited significantly greater morphine liking, desire to take morphine again, and feeling sedated; less feeling bad; and greater reductions in sensory low back pain following morphine. The SOAPP-R may predict elevated opioid risk in part by tapping into individual differences in opioid reinforcing effects. PERSPECTIVE Based on placebo-controlled morphine responses, associations were observed between higher scores on a common opioid risk screener (SOAPP-R) and greater desire to take morphine again, fewer negative subjective morphine effects, and greater analgesia. Opioids may provide the best analgesia in those patients at greatest risk of opioid misuse.
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Affiliation(s)
- Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
| | - John W Burns
- Department of Behavioral Science, Rush University, Chicago, Illinois
| | | | - Rajnish Gupta
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Melissa Chont
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Erik Schuster
- Department of Behavioral Science, Rush University, Chicago, Illinois
| | - Daria Orlowska
- Department of Behavioral Science, Rush University, Chicago, Illinois
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Burns JW, Quartana PJ, Bruehl S, Janssen I, Dugan SA, Appelhans B, Matthews KA, Kravitz HM. Chronic pain, body mass index and cardiovascular disease risk factors: tests of moderation, unique and shared relationships in the Study of Women's Health Across the Nation (SWAN). J Behav Med 2015; 38:372-83. [PMID: 25427423 PMCID: PMC4496954 DOI: 10.1007/s10865-014-9608-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 11/10/2014] [Indexed: 12/16/2022]
Abstract
Chronic pain may be related to cardiovascular disease (CVD) risk. The current study examined whether persistent bodily pain was related to cardiovascular disease risk factors, whether these effects were moderated by body mass index (BMI), and, if not, whether chronic pain accounted for unique variance in CVD risk factors. Participants were women (N = 2,135) in the Study of Women's Health Across the Nation. A high pain frequency variable (high pain in 0 through 4 assessments) was coded to reflect the frequency of high levels of bodily pain across the first 3 years of the study. Six CVD risk factors and BMI were measured at follow-up year 3. High pain frequency and BMI were correlated significantly with risk factors, although effects for the former were small. Hierarchical multiple regressions revealed high pain frequency × BMI interactions for 5 of 6 CVD risk factors. Dissecting the interactions revealed a similar pattern across 4 risk factors: for women with normal BMI, there was a "dose-response" in which increasing frequency of high pain revealed increasingly worse CVD risk factor levels, whereas for women with obese BMI, high pain frequency was unrelated to risk factors. For obese women, increasing frequency of high pain was associated with higher blood glucose. Although BMI is a well-established CVD risk factor, evaluation of CVD risk level may be improved by considering the incidence of persistent pain, particularly in normal weight women (BMI < 25 kg/m(2)) lower BMI.
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Affiliation(s)
- John W Burns
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson Blvd., Chicago, IL, 60612, USA,
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Appelhans BM, Segawa E, Janssen I, Nackers LM, Kazlauskaite R, Baylin A, Burns JW, Powell LH, Kravitz HM. Meal preparation and cleanup time and cardiometabolic risk over 14 years in the Study of Women's Health Across the Nation (SWAN). Prev Med 2015; 71:1-6. [PMID: 25490602 PMCID: PMC4329067 DOI: 10.1016/j.ypmed.2014.11.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 11/26/2014] [Accepted: 11/29/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether baseline levels and longitudinal changes in meal preparation and cleanup time are associated with changes in cardiometabolic risk factors in midlife women. METHODS Subjects were 2755 midlife women enrolled in the Study of Women's Health Across the Nation, a multi-ethnic, longitudinal cohort study in the United States. The five diagnostic components of the metabolic syndrome and meal preparation/cleanup time were assessed repeatedly across 14 years of follow-up (spanning 1996-2011) at seven U.S. sites. Mixed-effects logistic and ordered logistic models tested associations between meal preparation/cleanup time and odds of meeting criteria for metabolic syndrome and its individual diagnostic components. RESULTS Women who spent more time preparing and cleaning up meals at baseline, or demonstrated greater increases in this activity, had greater increases over time in their odds of having metabolic syndrome and in the number of metabolic syndrome components for which they met criteria. Adjusted associations were observed between meal preparation/cleanup time and hypertension, impaired fasting glucose, hypertriglyceridemia, and low high-density lipoprotein cholesterol, but not abdominal obesity. CONCLUSIONS In midlife women, greater meal preparation/cleanup time is associated with the development of an adverse cardiometabolic risk profile. Public health interventions should place greater emphasis on cooking healthfully, not just cooking frequently.
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Affiliation(s)
- Bradley M Appelhans
- Department of Preventive Medicine, Rush University Medical Center, 1700W. Van Buren St., Suite 470, Chicago, IL 60612, USA; Department of Behavioral Sciences, Rush University Medical Center, 1645W. Jackson Blvd. Suite 400, Chicago, IL 60612, USA.
| | - Eisuke Segawa
- Department of Preventive Medicine, Rush University Medical Center, 1700W. Van Buren St., Suite 470, Chicago, IL 60612, USA
| | - Imke Janssen
- Department of Preventive Medicine, Rush University Medical Center, 1700W. Van Buren St., Suite 470, Chicago, IL 60612, USA
| | - Lisa M Nackers
- Department of Preventive Medicine, Rush University Medical Center, 1700W. Van Buren St., Suite 470, Chicago, IL 60612, USA
| | - Rasa Kazlauskaite
- Department of Preventive Medicine, Rush University Medical Center, 1700W. Van Buren St., Suite 470, Chicago, IL 60612, USA; Department of Internal Medicine, Rush University Medical Center, 1653W. Congress Parkway, Suite 301, Chicago, IL 60612, USA
| | - Ana Baylin
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, SPHI room 1858, Ann Arbor, MI 48109, USA
| | - John W Burns
- Department of Behavioral Sciences, Rush University Medical Center, 1645W. Jackson Blvd. Suite 400, Chicago, IL 60612, USA
| | - Lynda H Powell
- Department of Preventive Medicine, Rush University Medical Center, 1700W. Van Buren St., Suite 470, Chicago, IL 60612, USA; Department of Behavioral Sciences, Rush University Medical Center, 1645W. Jackson Blvd. Suite 400, Chicago, IL 60612, USA; Department of Internal Medicine, Rush University Medical Center, 1653W. Congress Parkway, Suite 301, Chicago, IL 60612, USA; Department of Pharmacology, Rush University Medical Center, 1735W. Harrison Street, Suite 406, Chicago, IL 60612, USA
| | - Howard M Kravitz
- Department of Preventive Medicine, Rush University Medical Center, 1700W. Van Buren St., Suite 470, Chicago, IL 60612, USA; Department of Psychiatry, Rush University Medical Center, 2150 West Harrison Street, Chicago, IL 60612, USA
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Gerhart JI, Sanchez Varela V, Burns JW, Hobfoll SE, Fung HC. Anger, provider responses, and pain: Prospective analysis of stem cell transplant patients. Health Psychol 2015; 34:197-206. [DOI: 10.1037/hea0000095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tomey K, Greendale GA, Kravitz HM, Bromberger JT, Burns JW, Dugan SA, de Leon CFM. Associations between aspects of pain and cognitive performance and the contribution of depressive symptoms in mid-life women: a cross-sectional analysis. Maturitas 2014; 80:106-12. [PMID: 25466300 DOI: 10.1016/j.maturitas.2014.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/20/2014] [Accepted: 10/21/2014] [Indexed: 11/17/2022]
Abstract
Pain has been associated with cognitive problems in pain patients. This study evaluated the extent to which experiences of pain are associated with cognitive performance in a community sample of mid-life women, and the contribution of depressive symptoms to this association. A cross-sectional analysis was used with data from the Study of Women's Health Across the Nation (SWAN). Associations between aspects of pain and cognitive performance were evaluated using statistical models with and without depressive symptoms. The cognitive performance score was a composite of three cognitive tests, the Digit Span Backward Test, the Symbol Digit Modalities Test and the East Boston Memory Test. Greater pain experiences that interfered with daily work were independently associated with poorer cognitive performance, [β (SE) -0.074 (0.021); p value<0.01] and this association was partially explained by depressive symptoms [β (SE) -0.061 (0.022); p value<0.01 after adjusting for depressive symptoms]. Additionally, an independent association between a greater composite pain score and poorer cognitive performance was identified without adjusting for depressive symptoms, [β (SE) -0.002 (0.0009); p value<0.05] but was no longer significant after adjusting for depressive symptoms. Our results suggest that in mid-life women, greater pain is associated with poorer cognitive performance, and depressive symptoms play an important role in this association. Clinicians should be aware of these relationships when evaluating patients.
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Affiliation(s)
- Kristin Tomey
- University of Michigan, School of Public Health, 1415 Washington Heights, Room 2667, SPH Tower, Ann Arbor, MI 48109-2029, United States.
| | - Gail A Greendale
- Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, United States.
| | - Howard M Kravitz
- Rush University Medical Center , 1653W Congress Pkwy, Chicago, IL 60612, United States.
| | - Joyce T Bromberger
- University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, United States.
| | - John W Burns
- Rush University Medical Center , 1653W Congress Pkwy, Chicago, IL 60612, United States.
| | - Sheila A Dugan
- Rush University Medical Center , 1653W Congress Pkwy, Chicago, IL 60612, United States.
| | - Carlos F Mendes de Leon
- University of Michigan, School of Public Health, 1415 Washington Heights, Room 2667, SPH Tower, Ann Arbor, MI 48109-2029, United States.
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Burns JW, Gerhart JI, Bruehl S, Peterson KM, Smith DA, Porter LS, Schuster E, Kinner E, Buvanendran A, Fras AM, Keefe FJ. Anger arousal and behavioral anger regulation in everyday life among patients with chronic low back pain: Relationships to patient pain and function. Health Psychol 2014; 34:547-55. [PMID: 25110843 DOI: 10.1037/hea0000091] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective of this study was to determine the degree to which patient anger arousal and behavioral anger regulation (expression, inhibition) occurring in the course of daily life was related to patient pain and function as rated by patients and their spouses. METHOD Married couples (N = 105) (one spouse with chronic low back pain) completed electronic daily diaries, with assessments 5 times/day for 14 days. Patients completed items on their own state anger, behavioral anger expression and inhibition, and pain-related factors. Spouses completed items on their observations of patient pain-related factors. Hierarchical linear modeling was used to test concurrent and lagged relationships. RESULTS Patient-reported increases in state anger were related to their reports of concurrent increases in pain and pain interference and to spouse reports of patient pain and pain behavior. Patient-reported increases in behavioral anger expression were related to lagged increases in pain intensity and interference and decreases in function. Most of these relationships remained significant with state anger controlled. Patient-reported increases in behavioral anger inhibition were related to concurrent increases in pain interference and decreases in function, which also remained significant with state anger controlled. Patient-reported increases in state anger were related to lagged increases in spouse reports of patient pain intensity and pain behaviors. CONCLUSIONS Results indicate that in patients with chronic pain, anger arousal and behavioral anger expression and inhibition in everyday life are related to elevated pain intensity and decreased function as reported by patients. Spouse ratings show some degree of concordance with patient reports.
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Affiliation(s)
- John W Burns
- Department of Behavioral Sciences, Rush University Medical Center
| | - James I Gerhart
- Department of Behavioral Sciences, Rush University Medical Center
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center
| | | | | | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Erik Schuster
- Department of Behavioral Sciences, Rush University Medical Center
| | - Ellen Kinner
- Department of Behavioral Sciences, Rush University Medical Center
| | | | - Anne Marie Fras
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
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