Beth Darnall

All Publications

• Prescription opioid tapering practices and outcomes at a rural VA health care system. Pain medicine (Malden, Mass.) Courtney, R. E., Halsey, E., Patil, T., Mastronardi, K. V., Browne, H. S., Darnall, B. D. 2024

  View details for DOI 10.1093/pm/pnae013

  View details for PubMedID 38450417

• 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 reports Darnall, B. D., Burns, J. W., Hong, J., Roy, A., Slater, K., Poupore-King, H., Ziadni, M. S., You, D. S., Jung, C., Cook, K. F., Lorig, K., Tian, L., Mackey, S. C. 2024; 9 (1): e1116

  Abstract

  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.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.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.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.

  View details for DOI 10.1097/PR9.0000000000001116

  View details for PubMedID 38288134

  View details for PubMedCentralID PMC10824382

• Innovative treatment formats, technologies, and clinician trainings that improve access to behavioral pain treatment for youth and adults. Frontiers in pain research (Lausanne, Switzerland) Darnall, B. D., Edwards, K. A., Courtney, R. E., Ziadni, M. S., Simons, L. E., Harrison, L. E. 2023; 4: 1223172

  Abstract

  Chronic pain is prevalent across the life span and associated with significant individual and societal costs. Behavioral interventions are recommended as the gold-standard, evidence-based interventions for chronic pain, but barriers, such as lack of pain-trained clinicians, poor insurance coverage, and high treatment burden, limit patients' ability to access evidenced-based pain education and treatment resources. Recent advances in technology offer new opportunities to leverage innovative digital formats to overcome these barriers and dramatically increase access to high-quality, evidenced-based pain treatments for youth and adults. This scoping review highlights new advances. First, we describe system-level barriers to the broad dissemination of behavioral pain treatment. Next, we review several promising new pediatric and adult pain education and treatment technology innovations to improve access and scalability of evidence-based behavioral pain treatments. Current challenges and future research and clinical recommendations are offered.

  View details for DOI 10.3389/fpain.2023.1223172

  View details for PubMedID 37547824

• "My Surgical Success": Feasibility and Impact of a Single-Session Digital Behavioral Pain Medicine Intervention on Pain Intensity, Pain Catastrophizing, and Time to Opioid Cessation After Orthopedic Trauma Surgery-A Randomized Trial. Anesthesia and analgesia Ziadni, M. S., You, D. S., Keane, R., Salazar, B., Jaros, S., Ram, J., Roy, A., Tanner, N., Salmasi, V., Gardner, M., Darnall, B. D. 2022

  Abstract

  Behavioral pain treatments may improve postsurgical analgesia and recovery; however, effective and scalable options are not widely available. This study tested a digital perioperative behavioral medicine intervention in orthopedic trauma surgery patients for feasibility and efficacy for reducing pain intensity, pain catastrophizing, and opioid cessation up to 3 months after surgery.A randomized controlled clinical trial was conducted at an orthopedic trauma surgery unit at a major academic hospital to compare a digital behavioral pain management intervention ("My Surgical Success" [MSS]) to a digital general health education (HE) intervention (HE; no pain management skills). The enrolled sample included 133 patients; 84 patients were randomized (MSS, N = 37; HE, N = 47) and completed study procedures. Most patients received their assigned intervention within 3 days of surgery (85%). The sample was predominantly male (61.5%), White (61.9%), and partnered (65.5%), with at least a bachelor's degree (69.0%). Outcomes were collected at 1-3 months after intervention through self-report e-surveys and electronic medical record review; an intention-to-treat analytic framework was applied. Feasibility was dually determined by the proportion of patients engaging in their assigned treatment and an application of an 80% threshold for patient-reported acceptability. We hypothesized that MSS would result in greater reductions in pain intensity and pain catastrophizing after surgery and earlier opioid cessation compared to the digital HE control group.The engagement rate with assigned interventions was 63% and exceeded commonly reported rates for fully automated Internet-based e-health interventions. Feasibility was demonstrated for the MSS engagers, with >80% reporting treatment acceptability. Overall, both groups improved in the postsurgical months across all study variables. A significant interaction effect was found for treatment group over time on pain intensity, such that the MSS group evidenced greater absolute reductions in pain intensity after surgery and up to 3 months later (treatment × time fixed effects; F[215] = 5.23; P = .024). No statistically significant between-group differences were observed for time to opioid cessation or for reductions in pain catastrophizing (F[215] = 0.20; P = .653), although the study sample notably had subclinical baseline pain catastrophizing scores (M = 14.10; 95% confidence interval, 11.70-16.49).Study findings revealed that a fully automated behavioral pain management skills intervention (MSS) may be useful for motivated orthopedic trauma surgery patients and reduce postsurgical pain up to 3 months. MSS was not associated with reduced time to opioid cessation compared to the HE control intervention.

  View details for DOI 10.1213/ANE.0000000000006088

  View details for PubMedID 35696706

• Transforming Standard of Care for Spine Surgery: Integration of an Online Single-Session Behavioral Pain Management Class for Perioperative Optimization. Frontiers in pain research (Lausanne, Switzerland) Davin, S. A., Savage, J., Thompson, N. R., Schuster, A., Darnall, B. D. 2022; 3: 856252

  Abstract

  Estimates suggest that 10-40% of lumbar spine surgery patients experience persistent post-surgical pain (PPSP). PPSP is associated with 50% greater healthcare costs, along with risks of emotional distress and impaired quality of life. In 2019, U.S. Health and Human Services identified brief and digital behavioral treatments as important for pain management after surgery. Indeed, brief behavioral pain treatments delivered in the perioperative period may offer patients a low burden opportunity to acquire essential pain coping strategies for enhanced surgical recovery. Additionally, the COVID-19 pandemic has diminished in-person pain treatment access during extended perioperative time frames, thus underscoring the need for on-line options and home based care. This report describes the integration of an online, live-instructor delivered single-session pain self-management intervention (Empowered Relief) into the standard of care for lumbar spine surgery. Here, we apply the RE-AIM framework; describe systems implementation of the Empowered Relief intervention in a large, academic medical center during the COVID-19 pandemic; describe operational challenges and financial considerations; and present patient engagement data. Finally, we discuss the scalable potential of Empowered Relief and other single-session interventions in surgical populations, their importance during extended perioperative periods, practical and scientific limitations, and new directions for future research on this topic.

  View details for DOI 10.3389/fpain.2022.856252

  View details for PubMedID 35599968

• Comparison of a Single-Session Pain Management Skills Intervention With a Single-Session Health Education Intervention and 8 Sessions of Cognitive Behavioral Therapy in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA network open Darnall, B. D., Roy, A., Chen, A. L., Ziadni, M. S., Keane, R. T., You, D. S., Slater, K., Poupore-King, H., Mackey, I., Kao, M. C., Cook, K. F., Lorig, K., Zhang, D., Hong, J., Tian, L., Mackey, S. C. 2021; 4 (8): e2113401

  Abstract

  Chronic low back pain (CLBP), the most prevalent chronic pain condition, imparts substantial disability and discomfort. Cognitive behavioral therapy (CBT) reduces the effect of CLBP, but access is limited.To determine whether a single class in evidence-based pain management skills (empowered relief) is noninferior to 8-session CBT and superior to health education at 3 months after treatment for improving pain catastrophizing, pain intensity, pain interference, and other secondary outcomes.This 3-arm randomized clinical trial collected data from May 24, 2017, to March 3, 2020. Participants included individuals in the community with self-reported CLBP for 6 months or more and an average pain intensity of at least 4 (range, 0-10, with 10 indicating worst pain imaginable). Data were analyzed using intention-to-treat and per-protocol approaches.Participants were randomized to (1) empowered relief, (2) health education (matched to empowered relief for duration and format), or (3) 8-session CBT. Self-reported data were collected at baseline, before treatment, and at posttreatment months 1, 2, and 3.Group differences in Pain Catastrophizing Scale scores and secondary outcomes at month 3 after treatment. Pain intensity and pain interference were priority secondary outcomes.A total of 263 participants were included in the analysis (131 women [49.8%], 130 men [49.4%], and 2 other [0.8%]; mean [SD] age, 47.9 [13.8] years) and were randomized into 3 groups: empowered relief (n = 87), CBT (n = 88), and health education (n = 88). Empowered relief was noninferior to CBT for pain catastrophizing scores at 3 months (difference from CBT, 1.39 [97.5% CI, -∞ to 4.24]). Empowered relief and CBT were superior to health education for pain catastrophizing scores (empowered relief difference from health education, -5.90 [95% CI, -8.78 to -3.01; P < .001]; CBT difference from health education, -7.29 [95% CI, -10.20 to -4.38; P < .001]). Pain catastrophizing score reductions for empowered relief and CBT at 3 months after treatment were clinically meaningful (empowered relief, -9.12 [95% CI, -11.6 to -6.67; P < .001]; CBT, -10.94 [95% CI, -13.6 to -8.32; P < .001]; health education, -4.60 [95% CI, -7.18 to -2.01; P = .001]). Between-group comparisons for pain catastrophizing at months 1 to 3 were adjusted for baseline pain catastrophizing scores and used intention-to-treat analysis. Empowered relief was noninferior to CBT for pain intensity and pain interference (priority secondary outcomes), sleep disturbance, pain bothersomeness, pain behavior, depression, and anxiety. Empowered relief was inferior to CBT for physical function.Among adults with CLBP, a single-session pain management class resulted in clinically significant improvements in pain catastrophizing, pain intensity, pain interference, and other secondary outcomes that were noninferior to 8-session CBT at 3 months.ClinicalTrials.gov Identifier: NCT03167086.

  View details for DOI 10.1001/jamanetworkopen.2021.13401

  View details for PubMedID 34398206

• Clinical and neuroscience evidence supports the critical importance of patient expectations and agency in opioid tapering. Pain Darnall, B. D., Fields, H. L. 2021

  View details for DOI 10.1097/j.pain.0000000000002443

  View details for PubMedID 34382602

• Three-month follow-up results of a double-blind, randomized placebo-controlled trial of 8-week self-administered at-home behavioral skills-based virtual reality (VR) for chronic low back pain. The journal of pain Garcia, L. M., Birckhead, B. J., Krishnamurthy, P., Mackey, I., Sackman, J., Salmasi, V., Louis, R., Maddox, T., Darnall, B. D. 2021

  Abstract

  Prior work established post-treatment efficacy for an 8-week home-based therapeutic virtual reality (VR) program in a double-blind, parallel arm, randomized placebo-controlled study. Participants were randomized 1:1 to one of two 56-day VR programs: (1) a therapeutic immersive pain relief skills VR program; or (2) a Sham VR program within an identical commercial VR headset. Immediate post-treatment results demonstrated clinically meaningful and superior reduction for therapeutic VR compared to Sham VR for average pain intensity, indices of pain-related interference (activity, mood, stress but not sleep), physical function and sleep disturbance. The objective of the current report was to quantify treatment effects to post-treatment month 3 and describe durability of effects. Intention-to-treat analyses revealed sustained benefits for both groups and superiority for therapeutic VR for pain intensity and multiple indices of pain-related interference (activity, stress, and newly for sleep; effect sizes ranged from drm = 0.56 to 0.88) and physical function from pre-treatment to post-treatment month 3. The between-group difference for sleep disturbance was non-significant and pain-interference with mood did not survive multiplicity correction at 3 months. For most primary and secondary outcomes, treatment effects for therapeutic VR showed durability and maintained superiority to Sham VR in the 3-month post-treatment period.

  View details for DOI 10.1016/j.jpain.2021.12.002

  View details for PubMedID 34902548

• Efficacy of a Single-Session "Empowered Relief" Zoom-Delivered Group Intervention for Chronic Pain: Randomized Controlled Trial Conducted During the COVID-19 Pandemic. Journal of medical Internet research Ziadni, M. S., Gonzalez-Castro, L., Anderson, S., Krishnamurthy, P., Darnall, B. D. 2021; 23 (9): e29672

  Abstract

  Cognitive behavioral therapy-pain is an evidence-based treatment for chronic pain that can have significant patient burden, including health care cost, travel, multiple sessions, and lack of access in remote areas.The study aims to pilot test the efficacy of a single-session videoconference-delivered empowered relief (ER) intervention compared to waitlist control (WLC) conditions among individuals with chronic pain. We hypothesized that ER would be superior to WLC in reducing pain catastrophizing, pain intensity, and other pain-related outcomes at 1-3 months posttreatment.We conducted a randomized controlled trial involving a web-based sample of adults (N=104) aged 18-80 years with self-reported chronic pain. Participants were randomized (1:1) to 1 of 2 unblinded study groups: ER (50/104, 48.1%) and WLC (54/104, 51.9%). Participants allocated to ER completed a Zoom-delivered class, and all participants completed follow-up surveys at 2 weeks and 1, 2, and 3 months posttreatment. All the study procedures were performed remotely and electronically. The primary outcome was pain catastrophizing 1-month posttreatment, with pain intensity, pain bothersomeness, and sleep disruption as secondary outcomes. We also report a more rigorous test of the durability of treatment effects at 3 months posttreatment. Data were collected from September 2020 to February 2021 and analyzed using intention-to-treat analysis. The analytic data set included participants (18/101, 17.8% clinic patients; 83/101, 82.1% community) who completed at least one study survey: ER (50/101, 49.5%) and WLC (51/104, 49%).Participants (N=101) were 69.3% (70/101) female, with a mean age of 49.76 years (SD 13.90; range 24-78); 32.7% (33/101) had an undergraduate degree and self-reported chronic pain for 3 months. Participants reported high engagement (47/50, 94%), high satisfaction with ER (mean 8.26, SD 1.57; range 0-10), and high satisfaction with the Zoom platform (46/50, 92%). For the between-groups factor, ER was superior to WLC for all primary and secondary outcomes at 3 months posttreatment (highest P<.001), and between-groups Cohen d effect sizes ranged from 0.45 to 0.79, indicating that the superiority was of moderate to substantial clinical importance. At 3 months, clinically meaningful pain catastrophizing scale (PCS) reductions were found for ER but not for WLC (ER: PCS -8.72, 42.25% reduction; WLC: PCS -2.25, 11.13% reduction). ER resulted in significant improvements in pain intensity, sleep disturbance, and clinical improvements in pain bothersomeness.Zoom-delivered ER had high participant satisfaction and very high engagement. Among adults with chronic pain, this single-session, Zoom-delivered, skills-based pain class resulted in clinically significant improvement across a range of pain-related outcomes that was sustained at 3 months. Web-based delivery of ER could allow greater accessibility of home-based pain treatment and could address the inconveniences and barriers faced by patients when attempting to receive in-person care.ClinicalTrials.gov NCT04546685; https://clinicaltrials.gov/ct2/show/NCT04546685.

  View details for DOI 10.2196/29672

  View details for PubMedID 34505832

• "My Surgical Success": Effect of a Digital Behavioral Pain Medicine Intervention on Time to Opioid Cessation After Breast Cancer Surgery-A Pilot Randomized Controlled Clinical Trial PAIN MEDICINE Darnall, B. D., Ziadni, M. S., Krishnamurthy, P., Flood, P., Heathcote, L. C., Mackey, I. G., Taub, C., Wheeler, A. 2019; 20 (11): 2228–37

  View details for DOI 10.1093/pm/pnz094

  View details for Web of Science ID 000504316200017

• Patient-Centered Prescription Opioid Tapering in Community Outpatients With Chronic Pain. JAMA internal medicine Darnall, B. D., Ziadni, M. S., Stieg, R. L., Mackey, I. G., Kao, M. C., Flood, P. 2018; 178 (5): 707-708

  View details for DOI 10.1001/jamainternmed.2017.8709

  View details for PubMedID 29459978

  View details for PubMedCentralID PMC5876887

• To treat pain, study people in all their complexity. Nature Darnall, B. n. 2018; 557 (7703): 7

  View details for DOI 10.1038/d41586-018-04994-5

  View details for PubMedID 29717254

• Twelve-month results for a randomized sham-controlled effectiveness trial of an in-home skills-based virtual reality program for chronic low back pain. Pain reports Maddox, T., Oldstone, L., Sackman, J., Maddox, R., Adair, T., Ffrench, K., Sparks, C., Darnall, B. D. 2024; 9 (5): e1182

  Abstract

  Introduction: Low-risk, accessible, and long-term effective nonpharmacologic behavioral interventions for chronic low back pain (cLBP) are needed. Pain education and cognitive behavioral therapy (CBT) are recommended first-line treatments, but access is poor, treatment effectiveness is variable, and long-term effectiveness is inconsistent. In-home virtual reality (VR)-delivered therapies might address these shortcomings because therapeutic content can be delivered in a consistent and quality-controlled manner.Objective: To determine whether a 56-session, self-administered in-home, Skills-Based VR program for cLBP (RelieVRx) yields long-term reductions in pain intensity and pain interference 12 months posttreatment in a large demographically diverse and clinically severe real-world sample.Methods: Participants were 1,093 demographically diverse individuals with self-reported nonmalignant cLBP >3 months duration and average pain intensity and interference scores >4/10. Participants were randomized to Skills-Based VR or active Sham, and data were collected from January 31, 2022 to October 31, 2023. Pretreatment to 12-month posttreatment analyses were conducted.Results: From baseline to 12 months posttreatment, Skills-Based VR reductions for average pain intensity (1.7 ± 2.1) and pain interference (1.9 ± 2.3) were robust and significantly greater than those found for Sham. More than half of Skills-Based VR participants reported at least a 2-point reduction in pain intensity, pain interference, or both at 12 months posttreatment.Conclusions: A standardized, in-home Skills-Based VR therapy is effective for reducing pain intensity and pain interference, and these effects are maintained to 12 months posttreatment.

  View details for DOI 10.1097/PR9.0000000000001182

  View details for PubMedID 39239633

• Protocol for a randomised trial of a self-directed digital pain management intervention (Empowered Relief) tailored to adults with chronic pain and prescription opioid misuse/disorder: the MOBILE Relief study. BMJ open Edwards, K. A., Palenski, P., Perez, L., You, D. S., Ziadni, M. S., Jung, C., Adair, E., Tian, L., Mackey, S. C., Darnall, B. D. 2024; 14 (8): e086889

  Abstract

  Chronic pain increases the risk of prescription opioid misuse or opioid use disorder (OUD). Non-pharmacological treatments are needed to dually address pain and opioid risks. The purpose of the Mobile and Online-Based Interventions to Lessen Pain (MOBILE Relief) study is to compare a one-session, video-based, on-demand digital pain relief skills intervention for chronic pain ('Empowered Relief' (ER); tailored to people at risk for opioid misuse or with opioid misuse/OUD) to a one-session digital health education intervention ('Living Better'; no pain management skills).MOBILE Relief is an international online randomised controlled clinical trial. Study participants are adults with chronic, non-cancer pain (≥6 months) with daily pain intensity ≥3/10, taking ≥10 morphine equivalent daily dose and score ≥6 on the Current Opioid Misuse Measure. Participants are recruited through clinician referrals and clinic advertisements. Study procedures include electronic eligibility screening, informed consent, automated 1:1 randomisation to the treatment group, baseline measures, receipt of assigned digital treatment and six post-treatment surveys spanning 3 months. Study staff will call participants at baseline and 1-month and 3 months post-treatment to verify the opioid prescription. The main statistical analyses will include analysis of covariance and mixed effects model for repeated measurements regression.Primary outcomes are self-reported pain catastrophising, pain intensity, pain interference, opioid craving and opioid misuse at 1-month and 3 months post-treatment. We will determine the feasibility of ER (≥50% participant engagement, ≥70% treatment appraisal ratings). We hypothesise the ER group will be superior to the Living Better group in the reduction of multiprimary pain outcomes at 1-month post-treatment and opioid outcomes at 1-month and 3 months post-treatment.The study protocol was approved by the Stanford University School of Medicine Institutional Review Board (IRB 61643). We will publish results in peer-reviewed journals; National Institute of Drug Abuse (funder) and MOBILE Relief participants will receive result summaries.NCT05152134.

  View details for DOI 10.1136/bmjopen-2024-086889

  View details for PubMedID 39122392

• "Evidence-based" needs to be based on evidence - a response to Giddon's letter regarding Edwards et al., Is there an association between lateralization of chronic pain in the body and depression? The journal of pain Gilam, G., Darnall, B., Edwards, K. A., Lii, T., Mackey, S. C., Ziadni, M. S. 2024: 104617

  View details for DOI 10.1016/j.jpain.2024.104617

  View details for PubMedID 38945382

• Feasibility of Web-Based Single-Session Empowered Relief in Patients With Chronic Pain Taking Methadone or Buprenorphine: Protocol for a Single-Arm Trial. JMIR research protocols Klein, M. R., Darnall, B. D., You, D. S. 2024; 13: e53784

  Abstract

  BACKGROUND: Chronic pain affects tens of millions of US adults and continues to rise in prevalence. Nonpharmacologic behavioral pain treatments are greatly needed and yet are often inaccessible, particularly in settings where medication prescribing is prioritized.OBJECTIVE: This study aims to test the feasibility of a live-instructor, web-based 1-session pain relief skills class in an underserved and potentially at-risk population: people with chronic pain prescribed methadone or buprenorphine either solely for pain or for comorbid opioid use disorder (OUD).METHODS: This is a national, prospective, single-arm, uncontrolled feasibility trial. The trial is untethered from medical care; to enhance participants' willingness to join the study, no medical records or drug-monitoring records are accessed. At least 45 participants will be recruited from outpatient pain clinics and from an existing research database of individuals who have chronic pain and are taking methadone or buprenorphine. Patient-reported measures will be collected at 6 time points (baseline, immediately post treatment, 2 weeks, and months 1-3) via a web-based platform, paper, or phone formats to include individuals with limited internet or computer access and low literacy skills. At baseline, participants complete demographic questions and 13 study measures (Treatment Expectations, Body Pain Map, Medication Use, Pain Catastrophizing Scale [PCS], Patient-Reported Outcomes Measurement Information System [PROMIS] Measures, and Opioid Craving Scale). Immediately post treatment, a treatment satisfaction and acceptability measure is administered on a 0 (very dissatisfied) to 10 (completely satisfied) scale, with 3 of these items being the primary outcome (perceived usefulness, participant satisfaction, and likelihood of using the skills). At each remaining time point, the participants complete all study measures minus treatment expectations and satisfaction. Participants who do not have current OUD will be assessed for historical OUD, with presence of OUD (yes or no), and history of OUD (yes or no) reported separately. Feasibility threshold is set as an overall group treatment satisfaction rating of 8 of 10. In-depth qualitative interviews will be conducted with about 10 participants to obtain additional data on patient perceptions, satisfactions, needs, and wants. To assess preliminary efficacy, we will examine changes in pain catastrophizing, pain intensity, pain bothersomeness, sleep disturbance, pain interference, depression, anxiety, physical function, global impression of change, and opioid craving at 1 month post treatment.RESULTS: This project opened to enrollment in September 2021 and completed the recruitment in October 2023. The data collection was completed in February 2024. Results are expected to be published in late 2024.CONCLUSIONS: Results from this trial will inform the feasibility and preliminary efficacy of Empowered Relief in this population and will inform the design of a future randomized controlled trial testing web-based Empowered Relief in chronic pain and comorbid OUD.TRIAL REGISTRATION: ClinicalTrials.gov NCT05057988; https://clinicaltrials.gov/study/NCT05057988.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/53784.

  View details for DOI 10.2196/53784

  View details for PubMedID 38843513

• A digital health intervention to support patients with chronic pain during prescription opioid tapering: a pilot randomised controlled trial. Pain reports Gholamrezaei, A., Magee, M. R., McNeilage, A. G., Dwyer, L., Sim, A., Ferreira, M. L., Darnall, B. D., Brake, T., Aggarwal, A., Craigie, M., Hollington, I., Glare, P., Ashton-James, C. E. 2024; 9 (2): e1128

  Abstract

  Introduction: Recent changes in opioid prescribing guidelines have led to an increasing number of patients with chronic pain being recommended to taper. However, opioid tapering can be challenging, and many patients require support.Objectives: We evaluated the feasibility, acceptability, and potential efficacy of a codesigned digital health intervention to support patients with chronic pain during voluntary prescription opioid tapering.Methods: In a pilot randomised controlled trial, participants received a psychoeducational video and 28 days of text messages (2 SMS/day) in addition to their usual care (intervention) or usual care alone (control). The feasibility, acceptability, and potential efficacy of the intervention were evaluated. The primary outcome was opioid tapering self-efficacy. Secondary outcomes were pain intensity and interference, anxiety and depression symptom severity, pain catastrophising, and pain self-efficacy.Results: Of 28 randomised participants, 26 completed the study (13 per group). Text message delivery was high (99.2%), but fidelity of video delivery was low (57.1%). Most participants rated the messages as useful, supportive, encouraging, and engaging; 78.5% would recommend the intervention to others; and 64.2% desired a longer intervention period. Tapering self-efficacy (Cohen d = 0.74) and pain self-efficacy (d = 0.41) were higher, and pain intensity (d = 0.65) and affective interference (d = 0.45) were lower in the intervention group at week 4.Conclusion: First evidence supports the feasibility, acceptability, and potentially efficacy of a psychoeducational video and SMS text messaging intervention to support patients with chronic pain during voluntary prescription opioid tapering. Definitive trials with longer intervention duration are warranted.

  View details for DOI 10.1097/PR9.0000000000001128

  View details for PubMedID 38352024

• CONSIDERING SOCIOCULTURAL BIASES IN CHRONIC PAIN TREATMENT AND PAIN OUTCOMES Dildine, T., Edwards, K. A., Lannon, E., Darnall, B., Mackey, S. C. OXFORD UNIV PRESS INC. 2024: S127

  View details for Web of Science ID 001271352800255

• PROFILES OF CHRONIC PAIN STIGMA AND THEIR ASSOCIATION WITH HEALTH OUTCOMES Edwards, K. A., You, D. S., Mackey, S. C., Darnall, B. OXFORD UNIV PRESS INC. 2024: S127

  View details for Web of Science ID 001271352800254

• Predictors Of Opioid Misuse in A Sample of Patients with Chronic Pain Taking Daily Prescription Opioids Ziadni, M. S., You, D., Herrick, A., Darnall, B. CHURCHILL LIVINGSTONE. 2024: 71-72

  View details for Web of Science ID 001282167300320

• Impact of Childhood Trauma History on Treatment Responses to Psychosocial Interventions for Chronic Low Back Pain: A Randomized Controlled Trial Kim, S., You, D., Mackey, S. C., Darnall, B. D. CHURCHILL LIVINGSTONE. 2024: 33

  View details for Web of Science ID 001282167300150

• Fostering Diversity, Equity, and Inclusion: A Patient-Centric Framework and Multifaceted Strategy in a Nationwide Online Behavioral Pain Treatment Study Dorsonne, B., Hailu, A. Y., Cheung, M., Adair, E., Clifton, J., Heggan, E., Riazi, G., Andrews, W., Morais, C., Greer-Smith, R., Pun, T., Williams, N., King, H. P., Ziadni, M., Mackey, S., Darnall, B. CHURCHILL LIVINGSTONE. 2024: 33

  View details for Web of Science ID 001282167300149

• People Prescribed Opioids for Chronic Pain Face Multiple Barriers to Ongoing Opioid Therapy: Baseline Characteristics from the VALUE National, Observational, Study Perez, L., Bright, V., You, D. S., Palenski, P., Dorsonne, B., Hailu, A., Anderson, A., Darnall, B. D., Mackey, S. C. CHURCHILL LIVINGSTONE. 2024: 29

  View details for Web of Science ID 001282167300130

• The Problem of Pain in Lupus: Epidemiological Profiles of Patients Attending Multidisciplinary Pain Clinics. Pain management nursing : official journal of the American Society of Pain Management Nurses Jiang, T. E., Pascual, A. P., Le, N., Nguyen, T. B., Mackey, S., Darnall, B. D., Simard, J. F., Falasinnu, T. 2024

  Abstract

  Patients with systemic lupus erythematosus (SLE) bear a significant burden of pain. We aimed to identify factors that distinguish patients with SLE referred to comprehensive pain clinics and those who are not. Characterizing this patient population will identify unmet needs in SLE management and inform efforts to improve pain care in rheumatology.Among patients with SLE with ≥2 rheumatology clinic visits in a large hospital system from 1998 to 2023 (n = 1319), we examined factors that distinguished those who had at least one visit to multidisciplinary pain clinics (n = 77, 5.8%) from those who did not have any visits (n = 1242, 94.2%) with a focus on biopsychosocial and socioeconomic characteristics. We extracted demographic data and ICD-9/ICD-10 codes from the EHR.Patients with SLE attending the pain clinics exhibited characteristics including average older age (mean age ± SD: 54.1 ± 17.9 vs. 48.4 ± 19.9), a higher likelihood of relying on public health insurance (50.7% vs. 34.2%), and a greater representation of Black patients (9.1% vs. 4.4%) compared to SLE patients not seen in pain clinics. Nearly all patients seen at the pain clinics presented with at least one chronic overlapping pain condition (96.1% vs. 58.6%), demonstrated a higher likelihood of having a mental health diagnosis (76.7% vs. 42.4%), and exhibited a greater number of comorbidities (mean ± SD: 6.0 ± 3.0 vs. 2.9 ± 2.6) compared to those not attending the pain clinic.We found notable sociodemographic and clinical differences between these patient populations. Patients presenting with multiple comorbidities might benefit from further pain screening and referral to pain clinics to provide comprehensive care, and earlier referral could mitigate the development and progression of multimorbidities.

  View details for DOI 10.1016/j.pmn.2024.02.012

  View details for PubMedID 38494346

• Is there an association between lateralization of chronic pain in the body and depression? The journal of pain Edwards, K. A., Lii, T., Schouten, T. D., Kearney, K. M., Ziadni, M. S., Darnall, B. D., Mackey, S. C., Gilam, G. 2024

  Abstract

  Depression commonly co-occurs with chronic pain and can worsen pain outcomes. Recent theoretical work has hypothesized that pain localized to the left hemibody is a risk factor for worse depression due to overlap in underlying neural substrates. This hypothesis has not been tested a priori. Using a large sample of treatment-seeking adults with mixed-etiology chronic pain (N=1,185), our cross-sectional study tested whether patients with left-sided pain endorse worse depressive symptoms. We also examined differences in other pain-related functioning measures. We tested four comparisons based on painful body areas using the CHOIR bodymap: 1) only left-sided (OL) vs. any right-sided pain; 2) only right-sided (OR) vs. any left-sided pain; 3) OL vs. OR vs. bilateral pain; and 4) more left-sided vs. more right-sided vs. equal-sided pain. ANOVA models showed OL pain was not associated with worse depression (F=5.50, p=.019). Any left-sided pain was associated with worse depression, though the effect was small (F=8.58, p=.003, Cohens d=.29). Bilateral pain was associated with worse depression (F=8.05, p<.001, Cohens d=.24-.33). Regardless of pain location, more body areas endorsed was associated with greater depression. Although a more rigorous assessment of pain laterality is needed, our findings do not support the hypothesis that left lateralized pain is associated with worse depression. PERSPECTIVE: Pain lateralized to the left side of the body has been hypothesized as a risk factor for worse depression in chronic pain, despite never being tested in a large, real-world sample of patients with chronic pain. Findings showed that more widespread pain, not pain laterality, was associated with worse depression.

  View details for DOI 10.1016/j.jpain.2024.02.004

  View details for PubMedID 38341013

• The Problem of Pain in Rheumatology: Variations in Case Definitions Derived From Chronic Pain Phenotyping Algorithms Using Electronic Health Records. The Journal of rheumatology Falasinnu, T., Nguyen, T., En Jiang, T., Tamang, S., Chaichian, Y., Darnall, B. D., Mackey, S., Simard, J. F., Chen, J. H. 2023

  Abstract

  The aim of this study was to investigate and compare different case definitions for chronic pain to provide estimates of possible misclassification when researchers are limited by available electronic health record and administrative claims data, allowing for greater precision in case definitions.We compared the prevalence of different case definitions for chronic pain (N = 3042) in patients with autoimmune rheumatic diseases. We estimated the prevalence of chronic pain based on 15 unique combinations of pain scores, diagnostic codes, analgesic medications, and pain interventions.Chronic pain prevalence was lowest in unimodal pain phenotyping algorithms: 15% using analgesic medications, 18% using pain scores, 21% using pain diagnostic codes, and 22% using pain interventions. In comparison, the prevalence using a well-validated phenotyping algorithm was 37%. The prevalence of chronic pain also increased with the increasing number (bimodal to quadrimodal) of phenotyping algorithms that comprised the multimodal phenotyping algorithms. The highest estimated chronic pain prevalence (47%) was the multimodal phenotyping algorithm that combined pain scores, diagnostic codes, analgesic medications, and pain interventions. However, this quadrimodal phenotyping algorithm yielded a 10% overestimation of chronic pain compared to the well-validated algorithm.This is the first empirical study to our knowledge that shows that established common modes of phenotyping chronic pain can lead to substantially varying estimates of the number of patients with chronic pain. These findings can be a reference for biases in case definitions for chronic pain and could be used to estimate the extent of possible misclassifications or corrections in using datasets that cannot include specific data elements.

  View details for DOI 10.3899/jrheum.2023-0416

  View details for PubMedID 38101917

• Establishing the interpretability and utility of the 4-item BriefPCS. Scientific reports You, D. S., Cook, K. F., Lannon, E. W., Ziadni, M. S., Darnall, B. D., Mackey, S. C. 2023; 13 (1): 21272

  Abstract

  To reduce the patient burden associated with completing the 13-item Pain Catastrophizing Scale (PCS), the 4-item "BriefPCS" was developed. To date, no crosswalk has been developed that associates scores on the BriefPCS with PCS scores. Further, no study has compared the use of BriefPCS and PCS scores in a randomized clinical trial (RCT). We aimed to: (1) establish the interpretability of BriefPCS scores in reference to PCS scores, (2) compare the concurrent validity between the BriefPCS and PCS, and (3) asssess the use of BriefPCS in an RCT. First, we conducted equipercentile linking, created a crosswalk that associated scores of BriefPCS with PCS, and calculated differences between PCS and crosswalked PCS scores. Secondly, we compared Bootstrap correlation coefficients between PCS and self-reported measures of other domains. Lastly, we compared results from an RCT using BriefPCS scores versus PCS scores. Findings indicated that the correlation coefficient estimates with the BriefPCS and PCS scores were not significantly different. BriefPCS and PCS scores had similar ability to detect treatment-related changes. The BriefPCS scores validly, reliably, and accurately distinguish levels of pain catastrophizing. Additionally, the BriefPCS scores are sensitive to changes after behavioral interventions, with less respondent burden compared to the PCS scores.

  View details for DOI 10.1038/s41598-023-48433-6

  View details for PubMedID 38042937

  View details for PubMedCentralID 8369357

• Pain in U.S. Corrections Settings: The Promise of Digital Solutions for Better Data and Treatment Access. Pain medicine (Malden, Mass.) Banerjee, A., Mackey, S. C., Vest, N., Darnall, B. D. 2023

  View details for DOI 10.1093/pm/pnad150

  View details for PubMedID 37950495

• Text messaging intervention to support patients with chronic pain during prescription opioid tapering: protocol for a double-blind randomised controlled trial. BMJ open Gholamrezaei, A., Magee, M. R., McNeilage, A. G., Dwyer, L., Jafari, H., Sim, A. M., Ferreira, M. L., Darnall, B. D., Glare, P., Ashton-James, C. E. 2023; 13 (10): e073297

  Abstract

  Increases in pain and interference with quality of life is a common concern among people with chronic non-cancer pain (CNCP) who are tapering opioid medications. Research indicates that access to social and psychological support for pain self-management may help people to reduce their opioid dose without increasing pain and interference. This study evaluates the efficacy of a text messaging intervention designed to provide people with CNCP with social and psychological support for pain self-management while tapering long-term opioid therapy (LTOT) under the guidance of their prescriber.A double-blind randomised controlled trial will be conducted. Patients with CNCP (n=74) who are tapering LTOT will be enrolled from across Australia. Participants will continue with their usual care while tapering LTOT under the supervision of their prescribing physician. They will randomly receive either a psychoeducational video and supportive text messaging (two Short Message Service (SMS) per day) for 12 weeks or the video only. The primary outcome is the pain intensity and interference assessed by the Pain, Enjoyment of Life and General Activity scale. Secondary outcomes include mood, self-efficacy, pain cognitions, opioid dose reduction, withdrawal symptoms, and acceptability, feasibility, and safety of the intervention. Participants will complete questionnaires at baseline and then every 4 weeks for 12 weeks and will be interviewed at week 12. This trial will provide evidence for the efficacy of a text messaging intervention to support patients with CNCP who are tapering LTOT. If proven to be efficacious and safe, this low-cost intervention can be implemented at scale.The study protocol was reviewed and approved by the Northern Sydney Local Health District (Australia). Study results will be published in peer-reviewed journals and presented at scientific and professional meetings.ACTRN12622001423707.

  View details for DOI 10.1136/bmjopen-2023-073297

  View details for PubMedID 37879692

• Psychological Approaches for Migraine Management. Anesthesiology clinics Sturgeon, J. A., Ehde, D. M., Darnall, B. D., Barad, M. J., Clauw, D. J., Jensen, M. P. 2023; 41 (2): 341-355

  Abstract

  Migraine headaches are among the most prevalent and disabling pain conditions worldwide. Best-practice migraine management is multidisciplinary and includes the psychological approaches to address cognitive, behavioral, and affective factors that worsen pain, distress, and disability. The psychological interventions with the strongest research support are relaxation strategies, cognitive-behavioral therapy, and biofeedback, though the quality of clinical trials for all psychological interventions needs continued improvement. The efficacy of psychological interventions may be improved by validating technology-based delivery systems, developing interventions for trauma and life stress, and precision medicine approaches matching treatments to patients based on specific clinical characteristics.

  View details for DOI 10.1016/j.anclin.2023.02.002

  View details for PubMedID 37245946

• Recommendations for the development, implementation, and reporting of control interventions in efficacy and mechanistic trials of physical, psychological, and self-management therapies: the CoPPS Statement. BMJ (Clinical research ed.) Hohenschurz-Schmidt, D., Vase, L., Scott, W., Annoni, M., Ajayi, O. K., Barth, J., Bennell, K., Berna, C., Bialosky, J., Braithwaite, F., Finnerup, N. B., Williams, A. m., Carlino, E., Cerritelli, F., Chaibi, A., Cherkin, D., Colloca, L., Côté, P., Darnall, B. D., Evans, R., Fabre, L., Faria, V., French, S., Gerger, H., Häuser, W., Hinman, R. S., Ho, D., Janssens, T., Jensen, K., Johnston, C., Juhl Lunde, S., Keefe, F., Kerns, R. D., Koechlin, H., Kongsted, A., Michener, L. A., Moerman, D. E., Musial, F., Newell, D., Nicholas, M., Palermo, T. M., Palermo, S., Peerdeman, K. J., Pogatzki-Zahn, E. M., Puhl, A. A., Roberts, L., Rossettini, G., Tomczak Matthiesen, S., Underwood, M., Vaucher, P., Vollert, J., Wartolowska, K., Weimer, K., Werner, C. P., Rice, A. S., Draper-Rodi, J. 2023; 381: e072108

  View details for DOI 10.1136/bmj-2022-072108

  View details for PubMedID 37230508

• Durable Chronic Low Back Pain Reductions to 24-Months Post-Treatment for An Accessible, 8-Week, In-Home Behavioral Skills-Based Virtual Reality Program: A Randomized Controlled Trial. Pain medicine (Malden, Mass.) Maddox, T., Sparks, C., Oldstone, L., Maddox, R., Ffrench, K., Garcia, H., Krishnamurthy, P., Okhotin, D., Garcia, L. M., Birckhead, B. J., Sackman, J., Mackey, I., Louis, R., Salmasi, V., Oyao, A., Darnall, B. D. 2023

  Abstract

  ClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177.RR2-10.2196/25291.

  View details for DOI 10.1093/pm/pnad070

  View details for PubMedID 37220894

• A Longitudinal Investigation of the Impact of COVID-19 on Patients with Chronic Pain. The journal of pain Ziadni, M. S., Jaros, S., Anderson, S. R., You, D. S., Darnall, B. D., Mackey, S. C. 2023

  Abstract

  The COVID-19 pandemic prompted unexpected changes in the healthcare system. This current longitudinal study had two aims: 1) describe the trajectory of pandemic-associated stressors and patient-reported health outcomes among patients receiving treatment at a tertiary pain clinic over two years (May 2020 to June 2022); and 2) identify vulnerable subgroups. We assessed changes in pandemic-associated stressors and patient-reported health outcome measures. The study sample included 1,270 adult patients who were predominantly female (74.6%), White (66.2%), non-Hispanic (80.6%), married (66.1%), not on disability (71.2%), college-educated (59.45%), and not currently working (57.9%). We conducted linear mixed effect modeling to examine the main effect of time with controlling for a random intercept. Findings revealed a significant main effect of time for all pandemic-associated stressors except financial impact. Over time, patients reported increased proximity to COVID-19, but decreased pandemic-associated stressors. A significant improvement was also observed in pain intensity, pain catastrophizing, and PROMIS-pain interference, sleep, anxiety, anger, and depression scores. Demographic-based subgroup analyses for pandemic-associated stressors revealed that younger adults, Hispanics, Asians, and patients receiving disability compensation were vulnerable groups either during the initial visit or follow-up visits. We observed additional differential pandemic effects between groups based on participant sex, education level, and working status. In conclusion, despite unanticipated changes in pain care services during the pandemic, patients receiving pain treatments adjusted to pandemic-related stressors and improved their health status over time. As the current study observed differential pandemic impacts on patient subgroups, future studies should investigate and address the unmet needs of vulnerable subgroups. PERSPECTIVE: Over a two-year timeframe, the pandemic did not adversely influence physical and mental health among treatment-seeking patients with chronic pain. Patients reported small but significant improvements across indices of physical and psychosocial health. Differential impacts emerged among groups based on ethnicity, age, disability status, gender, education level, and working status.

  View details for DOI 10.1016/j.jpain.2023.05.010

  View details for PubMedID 37225065

  View details for PubMedCentralID PMC10201913

• A digital health intervention to support patients with chronic pain during prescription opioid tapering: a pilot randomised controlled trial. medRxiv : the preprint server for health sciences Gholamrezaei, A., Magee, M. R., McNeilage, A. G., Dwyer, L., Sim, A., Ferreira, M. L., Darnall, B. D., Brake, T., Aggarwal, A., Craigie, M., Hollington, I., Glare, P., Ashton-James, C. E. 2023

  Abstract

  Recent changes in opioid prescribing guidelines have led to an increasing number of patients with chronic pain being recommended to taper. However, opioid tapering can be challenging, and many patients require support.We evaluated the feasibility, acceptability, and potential efficacy of a co-designed psycho-educational video and SMS text messaging intervention to support patients with chronic pain during prescription opioid tapering.A pilot randomised controlled trial was conducted. In addition to their usual care, participants in the intervention group received a psycho-educational video and 28 days of text messages (two SMS/day). The control group received usual care. The feasibility, acceptability, and potential efficacy of the intervention were evaluated. The primary outcome was opioid tapering self-efficacy. Secondary outcomes were pain intensity and interference, anxiety and depression symptom severity, pain catastrophising, and pain self-efficacy.Of 28 randomised participants, 26 completed the study (13 in each group). Text message delivery was 99.2% successful. Most participants rated the messages as useful, supportive, encouraging, and engaging, 78.5% would recommend the intervention to others, and 64% desired a longer intervention period. Tapering self-efficacy (Cohen's d = 0.74) and pain self-efficacy (d = 0.41) were higher and pain intensity (d = 0.65) and affective interference (d = 0.45) lower in the intervention group at week 4.It is feasible, acceptable, and potentially efficacious to support patients with chronic pain during prescription opioid tapering with a psycho-educational video and SMS text messaging intervention. A definitive trial has been initiated to test a 12-week intervention.

  View details for DOI 10.1101/2023.05.10.23289771

  View details for PubMedID 37214982

  View details for PubMedCentralID PMC10197816

• On the importance of baseline pain intensity and measurement methods. Pain Darnall, B. D. 2023

  View details for DOI 10.1097/j.pain.0000000000002931

  View details for PubMedID 37288940

• The Impact Of Single-Session Behavioral Pain Management Class On Next Day Pain Intensity And Opioid Use Among People With Chronic Pain Taking Prescribed Daily Opioids: A Daily Dairy Study Edwards, K., Dildine, T., Herrick, A., You, D. S., Darnall, B., Ziadni, M. S. CHURCHILL LIVINGSTONE. 2023: 96-97

  View details for Web of Science ID 000995432100257

• Spontaneous self-affirmation: an adaptive coping strategy for people with chronic pain. Scandinavian journal of pain You, D. S., Hettie, G., Darnall, B. D., Ziadni, M. S. 2023

  Abstract

  OBJECTIVES: Self-affirmation may be a promising treatment strategy for improving clinical outcomes. This study examined the association between self-affirmation and self-reported health status among people with chronic pain.METHODS: In this cross-sectional study, 768 treatment seeking people (female 67.2%, mean age=50.4years with SD of 17.1, White/Caucasian 59.9%) completed surveys using a learning healthcare system. Measures included spontaneous self-affirmation (SSA) items, PROMIS outcome measures, and Pain Catastrophizing Scale (PCS). Multiple regressions were conducted to examine if strength-based SSA, value-based SSA, and their interaction would predict perceived health status and pain coping strategy. Sensitivity analysis was done by performing additional regressions with covariates (age, sex, race/ethnicity, and education). Lastly, exploratory analysis examined if average SSA scores would have a linear relationship with perceived health status.RESULTS: The strength x value-based SSA interaction significantly predicted the PROMIS-depression, anxiety, and social isolation T-scores (ps≤0.007), but not anger T-scores (p=0.067). Specifically, greater tendency to use both SSA styles predicted less symptoms of depression, anxiety and social isolation. This interaction remained significant when controlling for the covariates. The two SSA styles and their interaction did not significantly predict pain interference, sleep disturbance, fatigue, average pain rating and PCS scores (ps≥0.054). Exploratory analysis revealed SSA average scores did not have a significant linear relationship with perceived health status.CONCLUSIONS: The current study showed self-affirmation as being associated with better psychosocial health, but not associated with physical health and pain catastrophizing among patients with chronic pain. Our findings suggested the potential benefit of incorporating strength- and value-based affirmations in pain intervention approaches.

  View details for DOI 10.1515/sjpain-2022-0099

  View details for PubMedID 36935574

• Self-reported physical function is strongly related to pain behavior and pain interference and weakly related to physical capacity in people with chronic low back pain. Musculoskeletal science & practice Karayannis, N. V., Smuck, M., Law, C., Mackey, S. C., Gross, J. J., Darnall, B. D., Hush, J. 2023: 102721

  Abstract

  BACKGROUND: Inclusion of self-reported and capacity-based measures may help to further elucidate the interactive link between how people think and move.OBJECTIVE: To characterize the relationship between self-reported factors of physical function and pain with objective physical capacity measures.DESIGN: Cross-sectional study of 328 adults with chronic low back pain (CLBP).METHOD: Spearman correlations assessed the relationship between pairs of measures. Multiple linear regression models assessed the association between self-reported measures of physical function and the grouping of physical capacity measures. Self-reported measures included Roland Morris Disability Questionnaire (RMDQ), PROMIS Physical Function, Pain Behavior, and Pain Interference; Fear-Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), and Chronic Pain Acceptance Questionnaire (CPAQ). Capacity measures included walking speed and endurance, lower extremity functional strength, lumbopelvic range of motion, and trunk endurance.RESULTS: PROMIS Physical Function was directly and weakly correlated with walking speed (rho=0.26, 2-min walk) and inversely and weakly correlated with lower extremity strength (rho=-0.29, 5x sit-to-stand). RMDQ was not correlated with any of the capacity-based measures. PROMIS Physical Function was inversely and moderately correlated with Pain Interference (rho=-0.48) and Pain Behavior (rho=-0.43), PCS (rho=-0.36), and FABQ (rho=-0.31). The RMDQ was strongly correlated with PROMIS Physical Function (rho=-0.56), Pain Behavior (rho=0.51) and Pain Interference (rho=0.49); and moderately correlated with PCS (rho=0.37) and FABQ (rho=0.33). PROMIS Physical Function and RMDQ were not correlated with CPAQ. Lower scores on PROMIS Physical Function were weakly associated with lower measures of lower extremity strength (-0.30, 95% CI: -0.51 to -0.09, p=0.005). Higher scores on RMDQ were also weakly associated with lower measures of lower extremity strength (0.26, 95% CI: 0.11 to 0.41, p=0.001).CONCLUSIONS: A strong association emerged between self-reported limitations in physical function, pain behavior, and pain interference. A weak association emerged between self-reported physical function and lower extremity strength.

  View details for DOI 10.1016/j.msksp.2023.102721

  View details for PubMedID 36759316

• In-home virtual reality program for chronic low back pain: durability of a randomized, placebo-controlled clinical trial to 18 months post-treatment. Regional anesthesia and pain medicine Maddox, T., Garcia, H., Ffrench, K., Maddox, R., Garcia, L., Krishnamurthy, P., Okhotin, D., Sparks, C., Oldstone, L., Birckhead, B., Sackman, J., Mackey, I., Louis, R., Salmasi, V., Oyao, A., Darnall, B. 2022

  View details for DOI 10.1136/rapm-2022-104093

  View details for PubMedID 36427904

• A Digital Video and Text Messaging Intervention to Support People With Chronic Pain During Opioid Tapering: Content Development Using Co-design. JMIR formative research Magee, M. R., Gholamrezaei, A., McNeilage, A. G., Sim, A., Dwyer, L., Ferreira, M. L., Darnall, B. D., Glare, P., Ashton-James, C. E. 2022; 6 (11): e40507

  Abstract

  BACKGROUND: People living with chronic pain report that tapering prescribed opioids is challenging and more support is needed. In our formative research, consumers indicated that mobile health (mHealth) technology could be an acceptable form of support for opioid tapering and may improve tapering self-efficacy.OBJECTIVE: We aimed to evaluate and improve the content of an mHealth intervention before pilot-testing, based on consumer and clinician feedback.METHODS: Participants were 12 consumers and 12 clinicians who evaluated an initial draft of a video script and 90 SMS text messages. Consumers and clinicians rated the appropriateness and likely usefulness (consumers) or likely effectiveness (clinicians) of a video script and a random selection of 15 SMS text messages using a 5-point Likert-type scale (1=totally disagree; 5=totally agree). Each draft SMS text message was reviewed by 2 consumers and 2 clinicians. Texts were deemed acceptable for inclusion in the pilot intervention only if the summed participant ratings of text appropriateness and usefulness or effectiveness were ≥8. Participants were also invited to provide open-text feedback on the draft script and SMS text messages.RESULTS: Consumers generally agreed that the draft video script and text content were likely to be appropriate (video: mean 4.4, SD 0.52; text: mean 4.3, SD 0.79) and useful (video: mean 4.3, SD 0.65; text: mean 4.2, SD 0.84). Similarly, clinicians generally agreed that the draft video script and text content were likely to be appropriate (video: mean 4.5, SD 0.67; text: mean 4.4, SD 0.81) and effective (video: mean 4.0, SD 0.43; text: mean 4.3, SD 0.76). Overall, 77% (69/90) of the draft texts met the threshold rating for acceptability for inclusion in the pilot test of mHealth intervention by consumers, and 82% (74/90) met the threshold for acceptability by clinicians. Consumers' and clinicians' ratings were used to rank order the texts. The top 56 draft texts (all meeting the threshold levels of acceptability) were selected for inclusion in the pilot intervention. When consumer or clinician feedback was provided, the texts meeting the criteria for inclusion in the pilot were further revised and improved. Feedback on the video script was also used to further improve the acceptability of the video script before pilot-testing the intervention.CONCLUSIONS: This study describes the process by which a 28-day mHealth intervention to support patients with chronic pain to taper opioid medications was evaluated and improved before pilot-testing. The mHealth intervention consisted of a 10-minute psychoeducational video about pain and opioid tapering and 56 unique SMS text messages providing information and reassurance (texts delivered twice per day for 28 days). Having established that the content of the mHealth intervention is acceptable to both consumer and clinician groups, the mHealth intervention will be piloted in future research.

  View details for DOI 10.2196/40507

  View details for PubMedID 36355415

• Single-session interventions for pain PSYCHOLOGIST Darnall, B. 2022; 35: 38-41

  View details for Web of Science ID 000891644200023

• Patient Responses to the Term Pain Catastrophizing: Thematic Analysis of Cross-sectional International Data. The journal of pain Webster, F., Connoy, L., Longo, R., Ahuja, D., Amtmann, D., Anderson, A., Ashton-James, C. E., Boyd, H., Chambers, C. T., Cook, K. F., Cowan, P., Crombez, G., Feinstein, A. B., Fuqua, A., Gilam, G., Jordan, I., Mackey, S. C., Martins, E., Martire, L. M., O'Sullivan, P., Richards, D. P., Turner, J. A., Veasley, C., Würtzen, H., Yang, S. Y., You, D. S., Ziadni, M., Darnall, B. D. 2022

  Abstract

  Pain catastrophizing is understood as a negative cognitive and emotional response to pain. Researchers, advocates and patients have reported stigmatizing effects of the term in clinical settings and the media. We conducted an international study to investigate patient perspectives on the term pain catastrophizing. Open-ended electronic patient and caregiver proxy surveys were promoted internationally by collaborator stakeholders and through social media. 3,521 surveys were received from 47 countries (77.3% from the U.S.). The sample was mainly female (82.1%), with a mean age of 41.62 (SD 12.03) years; 95% reported ongoing pain and pain duration > 10 years (68.4%). Forty-five percent (n = 1,295) had heard of the term pain catastrophizing; 12% (n= 349) reported being described as a 'pain catastrophizer' by a clinician with associated high levels of feeling blamed, judged, and dismissed. We present qualitative thematic data analytics for responses to open-ended questions, with 32% of responses highlighting the problematic nature of the term. We present the patients' perspective on the term pain catastrophizing, its material effect on clinical experiences, and associations with negative gender stereotypes. Use of patient-centered terminology may be important for favorably shaping the social context of patients' experience of pain and pain care. PERSPECTIVE: : Our large international patient survey results show that 45% of the sample had heard of the term pain catastrophizing, about one-third spontaneously rated the term as problematic, and 12% reported having the term applied to them with most reporting this to be a negative experience. Clinician education regarding the use of patient-centered terminology may help to improve patients' experience of care and reduce stigma.

  View details for DOI 10.1016/j.jpain.2022.10.001

  View details for PubMedID 36241160

• Intensity of Chronic Low Back Pain and Activity Interference: A Daily Diary Study of the Moderating Role of Cognitive Pain Coping Strategies. Pain medicine (Malden, Mass.) Vertsberger, D., Talmon, A., Ziadni, M., Kong, J., Darnall, B. D., Manber, R., Mackey, S., Gross, J. J. 2022

  Abstract

  OBJECTIVE: Chronic low back pain (CLBP) has a significant negative impact on daily functioning, particularly for those with challenges coping adaptively with ongoing pain. However, the dynamics of pain coping in daily life remain understudied. Therefore, we examined the extent to which pain intensity interferes with daily activities, and assessed whether pain coping strategies (as assessed using daily diaries) moderated this link.METHOD: We analyzed diary data from a sample of 84 participants with CLBP who completed daily diaries for up to 30days rating pain intensity, pain interference with daily activities, and their use of pain coping strategies, including pain rumination (i.e., repetitive thinking about the pain and its causes), reappraisal (i.e., evaluating one's pain less negatively or more positively), and distraction (i.e., diverting attention from the pain). We hypothesized that these coping strategies would moderate the associations between pain and pain interference with daily activities, although in different directions.RESULTS: Results suggest that pain rumination strengthens the association between pain intensity and pain interference both on the person and day level, while pain reappraisal and distraction weaken this association, at the day and person levels, respectively.CONCLUSION: Our findings suggest that those who are more preoccupied with their pain and those who are less likely to reappraise their pain have more pain interference with daily activities. These findings build on prior work on pain coping by using daily diaries and highlight two pain coping strategies that have particular relevance for reducing the impact of CLBP in daily life.

  View details for DOI 10.1093/pm/pnac151

  View details for PubMedID 36214626

• Association of pain catastrophizing longitudinally with pain severity and interference in patients with chronic pain and cancer: A CHOIR study Azizoddin, D., Wilson, J., Mackey, S., Flowers, K., Darnall, B., Edwards, R., Schreiber, K. L. LIPPINCOTT WILLIAMS & WILKINS. 2022: 213

  View details for Web of Science ID 000891944700212

• Mindfulness-Based Stress Reduction, Cognitive Behavioral Therapy, and Acupuncture in Chronic Low Back Pain: Protocol for Two Linked Randomized Controlled Trials. JMIR research protocols Mackey, S., Gilam, G., Darnall, B., Goldin, P., Kong, J., Law, C., Heirich, M., Karayannis, N., Kao, M., Tian, L., Manber, R., Gross, J. 2022; 11 (9): e37823

  Abstract

  BACKGROUND: Nonpharmacologic mind-body therapies have demonstrated efficacy in low back pain. However, the mechanisms underlying these therapies remain to be fully elucidated.OBJECTIVE: In response to these knowledge gaps, the Stanford Center for Low Back Pain-a collaborative, National Institutes of Health P01-funded, multidisciplinary research center-was established to investigate the common and distinct biobehavioral mechanisms of three mind-body therapies for chronic low back pain: cognitive behavioral therapy (CBT) that is used to treat pain, mindfulness-based stress reduction (MBSR), and electroacupuncture. Here, we describe the design and implementation of the center structure and the associated randomized controlled trials for characterizing the mechanisms of chronic low back pain treatments.METHODS: The multidisciplinary center is running two randomized controlled trials that share common resources for recruitment, enrollment, study execution, and data acquisition. We expect to recruit over 300 chronic low back pain participants across two projects and across different treatment arms within each project. The first project will examine pain-CBT compared with MBSR and a wait-list control group. The second project will examine real versus sham electroacupuncture. We will use behavioral, psychophysical, physical measure, and neuroimaging techniques to characterize the central pain modulatory and emotion regulatory systems in chronic low back pain at baseline and longitudinally. We will characterize how these interventions impact these systems, characterize the longitudinal treatment effects, and identify predictors of treatment efficacy.RESULTS: Participant recruitment began on March 17, 2015, and will end in March 2023. Recruitment was halted in March 2020 due to COVID-19 and resumed in December 2021.CONCLUSIONS: This center uses a comprehensive approach to study chronic low back pain. Findings are expected to significantly advance our understanding in (1) the baseline and longitudinal mechanisms of chronic low back pain, (2) the common and distinctive mechanisms of three mind-body therapies, and (3) predictors of treatment response, thereby informing future delivery of nonpharmacologic chronic low back pain treatments.TRIAL REGISTRATION: ClinicalTrials.gov NCT02503475; https://clinicaltrials.gov/ct2/show/NCT02503475.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/37823.

  View details for DOI 10.2196/37823

  View details for PubMedID 36166279

• Agile development of a digital exposure treatment for youth with chronic musculoskeletal pain: protocol of a user-centred design approach and examination of feasibility and preliminary efficacy. BMJ open Harrison, L. E., Webster, S. N., Van Orden, A. R., Choate, E., Jehl, N., Stinson, J., Wicksell, R. K., Darnall, B. D., Simons, L. E. 2022; 12 (9): e065997

  Abstract

  INTRODUCTION: Chronic pain affects a significant number of children and impacts multiple domains including social, emotional and behavioural functioning, and negatively impacts family functioning. Roughly 5% of youth with chronic pain experience moderate to severe pain-related disability, with pain-related fear and avoidance of activities being identified as substantial barriers to treatment engagement. Evidence supports targeted psychological and physical interventions to address these barriers (eg, graded-exposure treatment), but accessibility to intervention is undermined by a shortage of services outside of urban areas, high treatment-related costs, and long provider waitlists; highlighting the need to develop digitally delivered behavioural intervention, using agile and iterative study designs that support rapid development and timely dissemination.METHODS AND ANALYSIS: This study seeks to develop an effective and scalable intervention for youth with chronic pain and their caregivers. This paper presents a user-centred protocol for the development and refinement of a digital exposure treatment for youth and caregivers, as well as the study design to examine feasibility and preliminary efficacy of the treatment using single-case experimental design (SCED). Assessments include daily diaries, completed from baseline and daily throughout the intervention (~6 weeks), and at 3-month follow-up, as well as self-report measures completed at baseline, end of intervention and 3-month follow-up. Primary outcomes include treatment satisfaction, treatment expectancy, adherence to daily dairies and functional disability. Secondary outcomes are pain-related fear and avoidance of activities, pain catastrophising and pain acceptance. We will present descriptive and model-based inference analyses, based on SCED reporting guidelines. We will calculate effect sizes for each individual on each outcome. We will examine mean treatment expectancy, credibility and satisfaction scores, and patient drop-out percentage.ETHICS AND DISSEMINATION: This study is approved by the Institutional Review Board at Stanford University (protocol #53323). Findings will be actively disseminated through peer-reviewed journals, conference presentations and social media.TRIAL REGISTRATION NUMBER: NCT05079984.

  View details for DOI 10.1136/bmjopen-2022-065997

  View details for PubMedID 36109029

• The Problem of Pain in Rheumatology: Clinical Profiles Associated with Concomitant Diagnoses with Chronic Overlapping Pain Conditions Falasinnu, T., Chaichian, Y., Simard, J. WILEY. 2022: 2392-2394

  View details for Web of Science ID 000877386502229

• Increased pain catastrophizing longitudinally predicts worsened pain severity and interference in patients with chronic pain and cancer: A CHOIR study. Psycho-oncology Wilson, J. M., Schreiber, K. L., Mackey, S., Flowers, K. M., Darnall, B. D., Edwards, R. R., Azizoddin, D. R. 2022

  Abstract

  OBJECTIVE: Little is known about how changes in psychosocial factors impact changes in pain outcomes among patients with cancer and chronic pain. This longitudinal cohort study of cancer patients investigated the relationships between changes in psychosocial factors and changes in pain severity and interference over time.METHODS: Data from patients with cancer and chronic pain (n=316) treated at a tertiary pain clinic were prospectively collected. At their baseline visit (Time 1), patients provided demographic and clinical information, and completed validated psychosocial and pain assessments. Psychosocial and pain assessments were repeated at a follow-up visit (Time 2), on average 4.9 months later. Change scores (Time 2-Time 1) were computed for psychosocial and pain variables. Multivariable hierarchical linear regressions assessed the associations between changes in psychosocial factors with changes in pain outcomes over time.RESULTS: Participants were an average age of 59 years, were 61% female, and 69% White. Overall, a decrease in pain severity (p≤.001), but not pain interference, was observed among the group over time. Increased pain catastrophizing was significantly associated with increased pain severity over time (beta=0.24, p≤.001). Similarly, increased pain catastrophizing (beta=0.21, p≤.001) and increased depression (beta=0.20, p≤.003) were significantly associated with increased pain interference over time. Demographic and clinical characteristics were not significantly related to changes in pain outcomes.CONCLUSIONS: Increased pain catastrophizing was uniquely associated with increased chronic pain severity and interference. Our findings indicate that cancer patients with chronic pain would likely benefit from the incorporation of nonpharmacological interventions, simultaneously address pain and psychological symptoms. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/pon.6020

  View details for PubMedID 35988161

• The Problem of Pain in Rheumatology: Clinical Profiles Associated With Concomitant Diagnoses With Chronic Overlapping Pain Conditions. ACR open rheumatology Falasinnu, T., Nguyen, T., Jiang, T. E., Chaichian, Y., Rector, A., Darnall, B. D., Mackey, S., Simard, J. F. 2022

  Abstract

  OBJECTIVE: The chronification of pain is heterogeneous in rheumatology. Chronic overlapping pain conditions (COPCs) such as fibromyalgia, endometriosis, migraine, and back pain may co-occur with one another and in rheumatic diseases. We describe the sociodemographic and clinical profiles associated with concomitant COPCs among patients with rheumatic diseases.METHODS: We retrospectively identified patients visiting rheumatology clinics at a single institution from 2010 to 2020 for five common rheumatic conditions: psoriatic arthritis (PsA), rheumatoid arthritis (RA), Sjogren syndrome (SjS), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc). We compared sociodemographic, clinical, and lifestyle factors by rheumatic condition and by COPC status. We also report sex-stratified diagnosis of COPCs. The primary outcome was diagnostic validation of one or more COPCs.RESULTS: We identified 5992 rheumatology patients: 846 with PsA, 2605 with RA, 956 with SjS, 975 with SLE, and 610 with SSc. Approximately 36-62% of patients had a concomitant COPC diagnosis. Patients with SjS had the highest prevalence (62%). Diagnosis of one or more COPCs was highest among Black patients and lowest among Asian patients. Patients using public insurance had a higher prevalence of one or more COPCs compared with those with private insurance. Patients with one or more COPCs had more depression and anxiety and more frequent emergency department visits, surgeries, and hospitalizations.CONCLUSION: Our findings suggest that COPCs are strikingly common among patients with rheumatic disease and are associated with lower quality of life and greater health care needs. Future research may elucidate drivers of chronic pain and how to best address the unique analgesic needs of this multimorbid population.

  View details for DOI 10.1002/acr2.11488

  View details for PubMedID 35872631

• Correction: Durability of the Treatment Effects of an 8-Week Self-administered Home-Based Virtual Reality Program for Chronic Low Back Pain: 6-Month Follow-up Study of a Randomized Clinical Trial. Journal of medical Internet research Garcia, L., Birckhead, B., Krishnamurthy, P., Mackey, I., Sackman, J., Salmasi, V., Louis, R., Castro, C., Maddox, R., Maddox, T., Darnall, B. D. 2022; 24 (6): e40038

  Abstract

  [This corrects the article DOI: 10.2196/37480.].

  View details for DOI 10.2196/40038

  View details for PubMedID 35675658

• Durability of the Treatment Effects of an 8-Week Self-administered Home-Based Virtual Reality Program for Chronic Low Back Pain: 6-Month Follow-up Study of a Randomized Clinical Trial (vol 24, e37480, 2022) JOURNAL OF MEDICAL INTERNET RESEARCH Garcia, L., Birckhead, B., Krishnamurthy, P., Mackey, I., Sackman, J., Salmasi, V., Louis, R., Castro, C., Maddox, R., Maddox, T., Darnall, B. D. 2022; 24 (6)

  View details for Web of Science ID 000966321600004

• Durability of the Treatment Effects of an 8-Week Self-administered Home-Based Virtual Reality Program for Chronic Low Back Pain: Follow-up Study of a Randomized Clinical Trial. Journal of medical Internet research Garcia, L., Birckhead, B., Krishnamurthy, P., Mackey, I., Sackman, J., Salmasi, V., Louis, R., Castro, C., Maddox, R., Maddox, T., Darnall, B. D. 2022; 24 (5): e37480

  Abstract

  BACKGROUND: We previously reported the efficacy of an 8-week home-based therapeutic immersive virtual reality (VR) program in a double-blind randomized placebo-controlled study. Community-based adults with self-reported chronic low back pain were randomized 1:1 to receive either (1) a 56-day immersive therapeutic pain relief skills VR program (EaseVRx) or (2) a 56-day sham VR program. Immediate posttreatment results revealed the superiority of therapeutic VR over sham VR for reducing pain intensity; pain-related interference with activity, mood, and stress (but not sleep); physical function; and sleep disturbance. At 3 months posttreatment, therapeutic VR maintained superiority for reducing pain intensity and pain-related interference with activity, stress, and sleep (new finding).OBJECTIVE: This study assessed between-group and within-group treatment effects 6 months posttreatment to determine the extended efficacy, magnitude of efficacy, and clinical importance of home-based therapeutic VR.METHODS: E-surveys were deployed at pretreatment, end-of-treatment, and posttreatment months 1, 2, 3, and 6. Self-reported data for 188 participants were analyzed in a mixed-model framework using a marginal model to allow for correlated responses across the repeated measures. Primary outcomes were pain intensity and pain-related interference with activity, mood, stress, and sleep at 6 months posttreatment. Secondary outcomes were Patient-Reported Outcome Measurement Information System (PROMIS) sleep disturbance and physical function.RESULTS: Therapeutic VR maintained significant and clinically meaningful effects 6 months posttreatment and remained superior to sham VR for reducing pain intensity and pain-related interference with activity, stress, and sleep (ds=0.44-0.54; P<.003). Between-group comparisons for physical function and sleep disturbance showed superiority of EaseVRx over sham VR (ds=0.34; P=.02 and ds=0.46; P<.001, respectively). Participants were encouraged to contact study staff with any problems experienced during treatment; however, no participants contacted study staff to report adverse events of any type, including nausea and motion sickness.CONCLUSIONS: Our 8-week home-based VR pain management program caused important reductions in pain intensity and interference up to 6 months after treatment. Additional studies are needed in diverse samples.TRIAL REGISTRATION: ClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/25291.

  View details for DOI 10.2196/37480

  View details for PubMedID 35612905

• Optimal opioid treatment requires a consensual approach. Pain Fields, H. L., Darnall, B. D. 2022; 163 (5): e689-e690

  View details for DOI 10.1097/j.pain.0000000000002494

  View details for PubMedID 34855648

• Optimal opioid treatment requires a consensual approach. Pain Fields, H. L., Darnall, B. D. 2022; 163 (5): e689-e690

  View details for DOI 10.1097/j.pain.0000000000002518

  View details for PubMedID 37595622

• Evaluating acceptability and feasibility of a mobile health intervention to improve self-efficacy in prescription opioid tapering in patients with chronic pain: protocol for a pilot randomised, single-blind, controlled trial. BMJ open Magee, M., Gholamrezaei, A., McNeilage, A. G., Dwyer, L., Sim, A., Ferreira, M., Darnall, B., Glare, P., Ashton-James, C. 2022; 12 (4): e057174

  Abstract

  INTRODUCTION: Opioid medications are no longer recommended as long-term therapy for chronic non-cancer pain, and many patients are advised to reduce or discontinue opioid medications. Many patients report difficulties in tapering opioid medications, necessitating supporting interventions. This protocol describes a pilot randomised controlled trial (RCT) to investigate the acceptability, feasibility and potential efficacy of a mobile health intervention to improve the opioid tapering self-efficacy of patients with chronic non-cancer pain.METHODS AND ANALYSIS: The trial will be a single-blind (clinician, data collector and statistician-blinded) pilot RCT with two parallel arms. Forty adult patients with chronic non-cancer pain who are voluntarily reducing their prescribed opioid medications under medical guidance will be recruited from two tertiary pain clinics (Start date 25 August 2021). Participants will be randomly assigned to an intervention or control group. Both groups will receive usual care, including multidisciplinary pain management. In addition to usual care, the intervention group will receive a short informational and testimonial video about opioid tapering and will receive two specifically text messages per day for 28 days. The intervention is codesigned with patients and clinicians to provide evidence-based informational, motivational and emotional support to patients with chronic pain to taper opioid medications. Feasibility of the intervention and a future definitive RCT will be evaluated by measuring patient acceptability, delivery of the intervention, rates and reasons of exclusions and drop-outs, completion rates and missing data in the study questionnaires, and obtaining estimates for sample size determination. Potential efficacy will be evaluated by comparing changes in opioid tapering self-efficacy between the two groups.ETHICS AND DISSEMINATION: The study protocol was reviewed and approved by the Northern Sydney Local Health District (Australia). Study results will be published in peer-reviewed journals and presented at scientific and professional meetings.TRIAL REGISTRATION NUMBER: ACTRN12621000795897.

  View details for DOI 10.1136/bmjopen-2021-057174

  View details for PubMedID 35473742

• The impact of COVID-19 on patients with chronic pain seeking care at a tertiary pain clinic. Scientific reports Ziadni, M. S., You, D. S., Cramer, E. M., Anderson, S. R., Hettie, G., Darnall, B. D., Mackey, S. C. 2022; 12 (1): 6435

  Abstract

  Empirical data on the health impacts of the COVID-19 pandemic remain scarce, especially among patients with chronic pain. We conducted a cross-sectional study matched by season to examine patient-reported health symptoms among patients with chronic pain pre- and post-COVID-19 pandemic onset. Survey responses were analyzed from 7535 patients during their initial visit at a tertiary pain clinic between April 2017-October 2020. Surveys included measures of pain and pain-related physical, emotional, and social function. The post-COVID-19 onset cohort included 1798 initial evaluations, and the control pre-COVID-19 cohort included 5737 initial evaluations. Patients were majority female, White/Caucasian, and middle-aged. The results indicated that pain ratings remained unchanged among patients after the pandemic onset. However, pain catastrophizing scores were elevated when COVID-19 cases peaked in July 2020. Pain interference, physical function, sleep impairment, and emotional support were improved in the post-COVID-19 cohort. Depression, anxiety, anger, and social isolation remained unchanged. Our findings provide evidence of encouraging resilience among patients seeking treatment for pain conditions in the face of the COVID-19 pandemic. However, our findings that pain catastrophizing increased when COVID-19 cases peaked in July 2020 suggests that future monitoring and consideration of the impacts of the pandemic on patients' pain is warranted.

  View details for DOI 10.1038/s41598-022-10431-5

  View details for PubMedID 35440688

• Clarification of Conflict of Interest Disclosures. JAMA internal medicine Darnall, B. D. 2022

  View details for DOI 10.1001/jamainternmed.2022.0809

  View details for PubMedID 35435929

• Features and methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: a Delphi expert consensus study. Pain Shraim, M. A., Sluka, K. A., Sterling, M., Arendt-Nielsen, L., Argoff, C., Bagraith, K. S., Baron, R., Brisby, H., Carr, D. B., Chimenti, R. L., Courtney, C. A., Curatolo, M., Darnall, B. D., Ford, J. J., Graven-Nielsen, T., Kolski, M. C., Kosek, E., Liebano, R. E., Merkle, S. L., Parker, R., Reis, F. J., Smart, K., Smeets, R. J., Svensson, P., Thompson, B. L., Treede, R., Ushida, T., Williamson, O. D., Hodges, P. W. 2022

  Abstract

  ABSTRACT: Classification of musculoskeletal pain based on underlying pain mechanisms (nociceptive, neuropathic, and nociplastic pain) is challenging. In the absence of a gold standard, verification of features that could aid in discrimination between these mechanisms in clinical practice and research depends on expert consensus. This Delphi expert consensus study aimed to: (1) identify features and assessment findings that are unique to a pain mechanism category or shared between no more than 2 categories and (2) develop a ranked list of candidate features that could potentially discriminate between pain mechanisms. A group of international experts were recruited based on their expertise in the field of pain. The Delphi process involved 2 rounds: round 1 assessed expert opinion on features that are unique to a pain mechanism category or shared between 2 (based on a 40% agreement threshold); and round 2 reviewed features that failed to reach consensus, evaluated additional features, and considered wording changes. Forty-nine international experts representing a wide range of disciplines participated. Consensus was reached for 196 of 292 features presented to the panel (clinical examination-134 features, quantitative sensory testing-34, imaging and diagnostic testing-14, and pain-type questionnaires-14). From the 196 features, consensus was reached for 76 features as unique to nociceptive (17), neuropathic (37), or nociplastic (22) pain mechanisms and 120 features as shared between pairs of pain mechanism categories (78 for neuropathic and nociplastic pain). This consensus study generated a list of potential candidate features that are likely to aid in discrimination between types of musculoskeletal pain.

  View details for DOI 10.1097/j.pain.0000000000002577

  View details for PubMedID 35319501

• Comparing Perceived Pain Impact Between Younger and Older Adults With High Impact Chronic Pain: A Cross-Sectional Qualitative and Quantitative Survey. Frontiers in pain research (Lausanne, Switzerland) You, D. S., Ziadni, M. S., Hettie, G., Darnall, B. D., Cook, K. F., Von Korff, M. R., Mackey, S. C. 2022; 3: 850713

  Abstract

  High impact chronic pain (HICP) is a recently proposed concept for treatment stratifying patients with chronic pain and monitoring their progress. The goal is to reduce the impact of chronic pain on the individual, their family, and society. The US National Pain Strategy defined HICP as the chronic pain associated with substantial restrictions on participation in work, social, and self-care activities for at least 6 months. To understand the meaning and characteristics of HICP from the younger (<65 years old) and older adults (≥65 years old) with chronic pain, our study examined patients' perceived pain impact between the two age groups. We also characterize the degree of pain impact, assessed with the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (PI), between adults and older adults with HICP. We recruited patients at a tertiary pain clinic. The survey included open-ended questions about pain impact, the Graded Chronic Pain Scale-Revised to identify patients' meeting criteria for HICP, and the Patient-Reported Outcomes Measurement Information System (PROMIS) 8-item PI short form (v.8a). A total of 55 younger adults (65.5% women, 72.7% HICP, mean age = 55.0 with SD of 16.2) and 28 older adults (53.6% women, 64.3% HICP, mean age = 72.6 with SD of 5.4) with chronic pain participated in this study. In response to an open-ended question in which participants were asked to list out the areas of major impact pain, those with HICP in the younger group most commonly listed work, social activity, and basic physical activity (e.g., walking and standing); for those in the older group, basic physical activity, instrumental activity of daily living (e.g., housework, grocery shopping), and participating in social or fun activity for older adults with HICP were the most common. A 2 * 2 ANOVA was conducted using age (younger adults vs. older adults) and HICP classification (HICP vs. No HICP). A statistically significant difference was found in the PROMIS-PI T-scores by HICP status (HICP: M = 58.4, SD = 6.3; No HICP: M = 67.8, SD = 6.3), but not by age groups with HICP. In conclusion, perceived pain impacts were qualitatively, but not quantitatively different between younger and older adults with HICP. We discuss limitations and offer recommendations for future research.

  View details for DOI 10.3389/fpain.2022.850713

  View details for PubMedID 35465295

• Psychological Treatment for Chronic Pain: Improving Access and Integration. Psychological science in the public interest : a journal of the American Psychological Society Darnall, B. D. 2021; 22 (2): 45-51

  View details for DOI 10.1177/15291006211033612

  View details for PubMedID 34541966

• Engagement in Prescription Opioid Tapering Research: the EMPOWER Study and a Coproduction Model of Success. Journal of general internal medicine Mardian, A., Perez, L., Pun, T., Cheung, M., Porter, J., De Bruyne, K., Kao, M., Flood, P., Moore, N., Colloca, L., Cramer, E., Ashton-James, C. E., Lorig, K., Mackey, S. C., Darnall, B. D. 2021

  Abstract

  Patients with chronic pain experience stigma within the healthcare system. This stigma is compounded for those taking long-term prescription opioids. Often, public messaging and organizational policies have telegraphed that opioid treatment is a problem to be solved by focusing only on medication reduction efforts. Lack of data has contributed to misperceptions and poor opioid policies. In part, data collection remains poor because patients feel fractured from systems of care and are often not interested in engaging with opioid reduction mandates and research. Similarly, clinicians may fail to engage with opioid stewardship and research due to complexities that exceed their training or capacities. The EMPOWER study applies a coproduction model that engages researchers, patients, clinicians, managers, and other health system users. Key stakeholders shaped the design of the study to best ensure acceptability and engagement of the "end users"-patients who enroll in the study and the clinicians who implement the opioid tapers. Targeting the needs of any stakeholder group in isolation is suboptimal. Accordingly, we detail the EMPOWER patient-centered opioid tapering clinical research framework and specific strategies to address stakeholder concerns. We also discuss how this framework may be applied to enhance engagement in healthcare research broadly.

  View details for DOI 10.1007/s11606-021-07085-w

  View details for PubMedID 34389937

• Lack of Premeditation Predicts Aberrant Behaviors Related to Prescription Opioids in Patients with Chronic Pain: A Cross-Sectional Study. Substance use & misuse Hettie, G., Nwaneshiudu, C., Ziadni, M. S., Darnall, B. D., Mackey, S. C., You, D. S. 2021: 1-6

  Abstract

  OBJECTIVE: In light of the opioid epidemic, there is a need to identify factors that predict aberrant opioid behaviors including misuse and abuse. Impulsivity has been extensively studied in addiction literature, but not in the context of opioid misuse. Hence, this study aimed to identify which of the impulsivity facets (negative urgency, positive urgency, sensation seeking, lack of perseverance, and lack of premeditation) would predict current aberrant opioid-related behaviors in patients with chronic pain.METHODS: Data were collected through an online survey from patients with chronic pain who visited a tertiary pain clinic. Patients were predominately female (74%), middle aged (M=55years), and White/Caucasian (84%). Upon consent, they completed a series of surveys including UPPS-P Impulsive Behavior Scale, the Current Opioid misuse Measure, Pain Catastrophizing Scale, PROMIS-anxiety, depression, and physical function, and a 0-10 numerical pain rating scale. Ordinal regression analyses were conducted to test study hypotheses.RESULTS: Contrary to expectations, only lack of premeditation predicted higher odds of aberrant opioid-related behaviors in the past 30days, after controlling for known covariates, and explained 26% of variance. Interestingly, lack of premeditation together with pain catastrophizing as a covariate explained 56% of the variance in aberrant opioid-related behaviors.DISCUSSION: The current study is the first to identify a potential role of lack of premeditation as an impulsivity facet predicting aberrant opioid-related behaviors among patients with chronic pain.

  View details for DOI 10.1080/10826084.2021.1958853

  View details for PubMedID 34369839

• Chronic pain severity, impact, and opioid use among patients with cancer: An analysis of biopsychosocial factors using the CHOIR learning health care system. Cancer Azizoddin, D. R., Schreiber, K., Beck, M. R., Enzinger, A. C., Hruschak, V., Darnall, B. D., Edwards, R. R., Allsop, M. J., Tulsky, J. A., Boyer, E., Mackey, S. 2021

  Abstract

  BACKGROUND: Despite the biopsychosocial underpinnings of chronic noncancer pain, relatively little is known about the contribution of psychosocial factors to chronic cancer pain. The authors aimed to characterize associations between biopsychosocial factors and pain and opioid use among individuals with chronic pain and cancer.METHODS: The authors conducted a retrospective, cross-sectional study of 700 patients with chronic pain and cancer seeking treatment at an academic tertiary pain clinic. Patients completed demographic questionnaires and validated psychosocial and pain measures. Multivariable, hierarchical linear and logistic regressions assessed the relative contributions of biopsychosocial factors to the primary dependent variables of pain severity, pain interference, and opioid use.RESULTS: Participants were 62% female and 66% White with a mean age of 59 ± 15 years, and 55% held a college degree or higher. Older age, African American or "other" race, sleep disturbance, and pain catastrophizing were significantly associated with higher pain severity (F(5,657) = 22.45; P ≤ .001; R2 = 0.22). Depression, sleep disturbance, pain catastrophizing, lower emotional support, and higher pain severity were significantly associated with pain interference (F(5,653) = 9.47; P ≤ .001; R2 = 0.44). Lastly, a poor cancer prognosis (Exp(B) = 1.62) and sleep disturbance (Exp(B) = 1.02) were associated with taking opioids, whereas identifying as Asian (Exp(B) = 0.48) or Hispanic (Exp(B) = 0.47) was associated with lower odds of using opioids.CONCLUSIONS: Modifiable psychological factors-specifically sleep disturbance, depression, and pain catastrophizing-were uniquely associated with pain and opioid use in patients with chronic pain and diverse cancer diagnoses. Future behavioral pain interventions that concurrently target sleep may improve pain among patients with cancer.LAY SUMMARY: Feeling depressed, worrying about pain, and bad sleep are related to higher pain symptoms in individuals with chronic pain and cancer. Specifically, those who struggle to sleep have worse pain and use more opioids. Also, individuals who have a bad prognosis for their cancer are more likely to be using opioid pain medications. Although race and cancer are related to chronic pain in patients, psychological well-being is also strongly related to this same pain.

  View details for DOI 10.1002/cncr.33645

  View details for PubMedID 34061975

• Comparative efficacy of a single-session "Empowered Relief" videoconference-delivered group intervention for chronic pain: study protocol for a randomized controlled trial. Trials Ziadni, M. S., Anderson, S. R., Gonzalez-Castro, L., Darnall, B. D. 2021; 22 (1): 358

  Abstract

  BACKGROUND: Chronic pain is naturally aversive and often distressing for patients. Pain coping and self-regulatory skills have been shown to effectively reduce pain-related distress and other symptoms. In this trial, the primary goal is to pilot test the comparative efficacy of a single-session videoconference-delivered group pain education class to a waitlist control among patients with chronic pain.METHODS: Our study is a randomized clinical trial pilot testing the superiority of our 2-h single-session videoconference-delivered group pain education class against a waitlist control. We will enroll 120 adult patients with mixed etiology chronic pain and randomize 1:1 to one of the two study arms. We hypothesize superiority for the pain education class for bolstering pain and symptom management. Team researchers masked to treatment assignment will assess the outcomes up to 3 months post-treatment.DISCUSSION: This study aims to test the utility of a single-session videoconference-delivered group pain education class to improve self-regulation of pain and pain-related outcomes. Findings from our project have the potential to significantly reduce barriers to effective psychological treatment for pain, optimizing the delivery of increasingly vital online and remote-delivered intervention options.TRIAL REGISTRATION: ClinicalTrials.gov NCT04546685 . Registered on 04 September 2020.

  View details for DOI 10.1186/s13063-021-05303-8

  View details for PubMedID 34022930

• Customizing CAT administration of the PROMIS Misuse of Prescription Pain Medication Item Bank for patients with chronic pain. Pain medicine (Malden, Mass.) You, D. S., Cook, K. F., Domingue, B. W., Ziadni, M. S., Hah, J. M., Darnall, B. D., Mackey, S. C. 2021

  Abstract

  OBJECTIVE: The 22-item PROMIS-Rx Pain Medication Misuse item bank (Bank-22) imposes a high response burden. This study aimed to characterize the performance of the Bank-22 in a computer adaptive testing (CAT) setting based on varied stopping rules.METHODS: The 22 items were administered to 288 patients. We performed a CAT simulation using default stopping rules (CATPROMIS). In 5 other simulations, a "best health" response rule was added to decrease response burden. This rule stopped CAT administration when a participant selected "never" to a specified number of initial Bank-22 items (2-6 in this study, designated CATAlt2-Alt6). The Bank-22 and 7-item short form (SF-7) scores were compared to scores based on CATPROMIS, and the 5 CAT variations.RESULTS: Bank-22 scores correlated highly with the SF-7 and CATPROMIS, Alt5, Alt6 scores (rs=.87-.95) and moderately with CATAlt2- Alt4 scores (rs=.63-.74). In all CAT conditions, the greatest differences with Bank-22 scores were at the lower end of misuse T-scores. The smallest differences with Bank-22 and CATPROMIS scores were observed with CATAlt5 and CATAlt6. Compared to the SF-7, CATAlt5 and CATAlt6 reduced overall response burden by about 42%. Finally, the correlations between PROMIS-Rx Misuse and Anxiety T-scores remained relatively unchanged across the conditions (rs=.31-.43, ps < .001).CONCLUSIONS: Applying a stopping rule based on number of initial "best health" responses reduced response burden for respondents with lower levels of misuse. The tradeoff was less measurement precision for those individuals, which could be an acceptable tradeoff when the chief concern is in discriminating higher levels of misuse.

  View details for DOI 10.1093/pm/pnab159

  View details for PubMedID 33944948

• Association between the Number of Prescribers of Concurrent Opioid and Benzodiazepine Medications and the Risk of Overdose: A Retrospective Analysis Rishel, C. A., Shah, S., Zhang, Y., Darnall, B., Sun, E. LIPPINCOTT WILLIAMS & WILKINS. 2021: 643-644

  View details for Web of Science ID 000752526600281

• THE TEMPORAL RELATIONSHIP BETWEEN NEGATIVE AFFECT AND SLEEP BRUXISM IN PATIENTS WITH CHRONIC BACK PAIN Hettie, G., You, D. S., Ziadni, M., Kong, J., Law, C., Gross, J., Manber, R., Darnall, B. D., Mackey, S. OXFORD UNIV PRESS INC. 2021: S478

  View details for Web of Science ID 000648922701161

• PSYCHOSOCIAL AND SOCIODEMOGRAPHIC MECHANISMS IN PAIN AND OPIOID USE AMONG CHRONIC PAIN AND CANCER Azizoddin, D. R., Schreiber, K., Hruschak, V., Beck, M., Enzinger, A. C., Allsop, M. J., Edwards, R. R., Darnall, B. D., Kizildag, D., Tulsky, J. A., Boyer, E. W., Mackey, S. OXFORD UNIV PRESS INC. 2021: S381

  View details for Web of Science ID 000648922700770

• Self-Administered Behavioral Skills-Based At-Home Virtual Reality Therapy for Chronic Low Back Pain: Protocol for a Randomized Controlled Trial. JMIR research protocols Garcia, L., Darnall, B., Krishnamurthy, P., Mackey, I., Sackman, J., Louis, R., Maddox, T., Birckhead, B. 2021; 10 (1): e25291

  Abstract

  BACKGROUND: Chronic pain is one of the most common and debilitating health conditions. Treatments for chronic low back pain typically focus on biomedical treatment approaches. While psychosocial treatments exist, multiple barriers prevent broad access. There is a significant unmet need for integrative, easily accessible, non-opioid solutions for chronic pain. Virtual reality (VR) is an immersive technology allowing innovation in the delivery of behavioral pain treatments. Behavioral skills-based VR is effective at facilitating pain management and reducing pain-related concerns. Continued research on these emerging approaches is needed.OBJECTIVE: In this randomized controlled trial, we seek to test the efficacy of a self-administered behavioral skills-based VR program as a nonpharmacological home-based pain management treatment for people with chronic low back pain (cLBP).METHODS: We will randomize 180 individuals with cLBP to 1 of 2 VR programs: (1) EaseVRx (8-week skills-based VR program); or (2) Sham VR (control condition). All participants will receive a VR headset to minimize any biases related to the technology's novelty. The Sham VR group had 2D neutral content in a 3D theater-like environment. Our primary outcome is average pain intensity and pain-related interference with activity, stress, mood, and sleep. Our secondary outcomes include patient-reported physical function, sleep disturbance, pain self-efficacy, pain catastrophizing, pain acceptance, health utilization, medication use, and user satisfaction. We hypothesize superiority for the skills-based VR program in all of these measures compared to the control condition. Team statisticians blinded to treatment assignment will assess outcomes up to 6 months posttreatment using an approach suitable for the longitudinal nature of the data.RESULTS: The study was approved by the Western Institutional Review Board on July 2, 2020. The protocol (NCT04415177) was registered on May 27, 2020. Recruitment for this study was completed in July 2020, and data collection will remain active until March 2021. In total, 186 participants were recruited. Multiple manuscripts will be generated from this study. The primary manuscript will be submitted for publication in the winter of 2020.CONCLUSIONS: Effectively delivering behavioral treatments in VR could overcome barriers to care and provide scalable solutions to chronic pain's societal burden. Our study could help shape future research and development of these innovative approaches.TRIAL REGISTRATION: ClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/25291.

  View details for DOI 10.2196/25291

  View details for PubMedID 33464215

• Double-blind, randomized placebo-controlled trial of 8-week self-administered at-home behavioral skills-based virtual reality (VR) for chronic low back pain (during COVID-19). Journal of medical Internet research Darnall, B. n., Garcia, L. n., Birckhead, B. n., Krishnamurthy, P. n., Mackey, I. n., Sackman, J. n., Louis, R. n., Maddox, T. n. 2021

  Abstract

  Background: Chronic low back pain is the most prevalent chronic pain condition worldwide and access to behavioral pain treatment is limited. Virtual reality (VR) is an immersive technology that may provide effective behavioral therapeutics for chronic pain.Objective: To conduct a double-blind, parallel arm, single cohort, remote, randomized placebo-controlled trial for a self-administered behavioral skills-based VR program in community-based individuals with self-reported chronic low back pain during the COVID-19 pandemic.Methods: A national online convenience sample of individuals with self-reported non-malignant low back pain > 6 months duration and with average pain intensity > 4/10 was enrolled and randomized 1:1 to one of two daily (56-day) VR programs: (1) EaseVRx (immersive pain relief skills VR program); or (2) Sham VR (2D nature content delivered in a VR headset). Objective device use data and self-reported data were collected. The primary outcomes were the between-group effect of EaseVRx versus Sham VR across time points, and the between-within interaction effect representing the change in average pain intensity and pain-related interference with activity, stress, mood, and sleep over time (baseline to end-of-treatment at day 56). Secondary outcomes were global impression of change and change in physical function, sleep disturbance, pain self-efficacy, pain catastrophizing, pain acceptance, pain medication use, and user satisfaction. Analytic methods included intention-to-treat and a mixed-model framework.The study sample was 179 adults (female: 77%; Caucasian: 91%; at least some college education: 92%; mean age: 51.5 years, SD=13.1; average pain intensity: 5/10, SD=1.2; back pain duration >5 years: 67%). No group differences were found for any baseline variable or treatment engagement. User satisfaction ratings were higher for EaseVRx vs. Sham VR (p<0.0001). For the between-groups factor, EaseVRx was superior to Sham VR for all primary outcomes (highest p-value = .0090), and between-groups Cohen's d effect sizes ranged from 0.40 to 0.49 indicating superiority was moderately clinically meaningful. For EaseVRx, large pre-post effect sizes ranged from 1.17-1.3 and met moderate to substantial clinical importance for reduced pain intensity and pain-related interference with activity, mood, and stress. Between group comparisons for physical function and sleep disturbance showed superiority for the EaseVRx group vs. the Sham VR group (p=0.0224 and p=.0132, respectively). Pain catastrophizing, pain self-efficacy, pain acceptance, prescription opioid use (morphine milligram equivalent; MME) did not reach statistical significance for either group. Use of over-the-counter analgesic use was reduced for EaseVRx (p<0.01) but not for ShamVR.EaseVRx had high user satisfaction and superior and clinically meaningful symptom reduction for average pain intensity and pain-related interference with activity, mood, and stress compared to sham VR. Additional research is needed to determine durability of treatment effects and to characterize mechanisms of treatment effects. Home-based VR may expand access to effective and on-demand non-pharmacologic treatment for chronic low back pain.ClinicalTrials.gov, NCT04415177.RR2-25291.

  View details for DOI 10.2196/26292

  View details for PubMedID 33484240

• Association between temporal summation and conditioned pain modulation in chronic low back pain: baseline results from 2 clinical trials. Pain reports Kong, J. T., You, D. S., Law, C. S., Darnall, B. D., Gross, J. J., Manber, R., Mackey, S. 2021; 6 (4): e975

  Abstract

  Temporal summation (TS) and conditioned pain modulation (CPM) represent different aspects of central pain processing. Their relationship and differential performance within distinct body locations are not well understood.To examine the association between TS and CPM in chronic low back pain and the influence of testing location on this relationship.We analyzed baseline data from 2 clinical trials on participants with chronic low back pain (n = 264; 47.3% female; mean age = 41 years, SD = 12; mean pain = 5.3/10, SD = 1.4). Measures used included questionnaires assessing pain and negative affect, phasic thermal TS at the hand (thenar) and the lower back (lumbar), followed by CPM that included a thermal testing stimulus (Heat-6, the temperature where pain rating is 6/10) and a cold-pressor conditioning stimulus. Nonparametric, proportional odds logistic regression was used to model thenar, and separately, lumbar TS, using CPM, Heat-6, negative affect, and demographics.Our models revealed a small association (βs = 0.17, P = 0.01) between reduced CPM and heightened TS at both testing sites, regardless of demographics or negative affect.Results suggest a modest association between TS and CPM, irrespective of anatomical testing location, demographics, and negative affect. These findings will help improve the methodology and interpretation of TS and CPM measurement in clinical pain populations.

  View details for DOI 10.1097/PR9.0000000000000975

  View details for PubMedID 34901679

  View details for PubMedCentralID PMC8660006

• Beyond pain, distress, and disability: the importance of social outcomes in pain management research and practice. Pain Ashton-James, C. E., Anderson, S. R., Mackey, S. C., Darnall, B. D. 2021

  View details for DOI 10.1097/j.pain.0000000000002404

  View details for PubMedID 34252908

• The factor structure and subscale properties of the pain catastrophizing scale: are there differences in the distinctions? Pain reports Cook, K. F., Mackey, S., Jung, C., Darnall, B. D. 2021; 6 (1): e909

  Abstract

  Increasingly, studies have documented the negative impact of pain catastrophizing on health outcomes. The Pain Catastrophizing Scale (PCS) has been the measure of choice for many of these studies. The PCS provides 3 subscales for measuring pain catastrophizing: rumination, magnification, and helplessness. Factor analytic investigations of these factors have been limited by the sample size and relevance, and results have been inconsistent. No study has directly estimated the added value of subscale scoring of the PCS compared with scoring it as a single measure.Objective: The purpose of this study was to evaluate the dimensionality of PCS responses in a sample of patients with chronic pain (N = 8370).Methods: Data were randomly halved, and results were cross-validated. Both traditional factor analysis and traditional factor analyses were conducted.Results: Findings based on common factor analyses and on bifactor analyses supported the essential unidimensionality of PCS responses. In the bifactor analyses, the general factor accounted for 96% of the explained common variance in the modeling sample. After extracting the general factor, helplessness, magnification, and rumination subscales accounted for 7.0%, 0.0%, and 15%, respectively.Conclusion: The results do not necessarily disconfirm helplessness, magnification, and rumination as clinically meaningful theoretical distinctions. However, the PCS (at least as presently constructed) fails to discriminate these distinctions. Joint efforts in theory and measurement science could illuminate the role that posited "kinds" of pain catastrophizing play in individuals' pain experiences.

  View details for DOI 10.1097/PR9.0000000000000909

  View details for PubMedID 33981933

• A Brief Screening Tool for Opioid Use Disorder: EMPOWER Study Expert Consensus Protocol. Frontiers in medicine You, D. S., Mardian, A. S., Darnall, B. D., Chen, C. A., De Bruyne, K., Flood, P. D., Kao, M., Karnik, A. D., McNeely, J., Porter, J. G., Schwartz, R. P., Stieg, R. L., Mackey, S. C. 2021; 8: 591201

  Abstract

  Growing concerns about the safety of long-term opioid therapy and its uncertain efficacy for non-cancer pain have led to relatively rapid opioid deprescribing in chronic pain patients who have been taking opioid for years. To date, empirically supported processes for safe and effective opioid tapering are lacking. Opioid tapering programs have shown high rates of dropouts and increases in patient distress and suicidal ideation. Therefore, safe strategies for opioid deprescribing that are more likely to succeed are urgently needed. In response to this demand, the EMPOWER study has been launched to examine the effectiveness of behavioral medicine strategies within the context of patient-centered opioid tapering in outpatient settings (https://empower.stanford.edu/). The EMPOWER protocol requires an efficient process for ensuring that collaborative opioid tapering would be offered to the most appropriate patients while identifying patients who should be offered alternate treatment pathways. As a first step, clinicians need a screening tool to identify patients with Opioid Use Disorder (OUD) and to assess for OUD severity. Because such a tool is not available, the study team composed of eight chronic pain and/or addiction experts has extended a validated screening instrument to develop a brief and novel consensus screening tool to identify OUD and assess for OUD severity for treatment stratification. Our screening tool has the potential to assist busy outpatient clinicians to assess OUD among patients receiving long-term opioid therapy for chronic pain.

  View details for DOI 10.3389/fmed.2021.591201

  View details for PubMedID 33869240

• Development and validation of the Collaborative Health Outcomes Information Registry body map. Pain reports Scherrer, K. H., Ziadni, M. S., Kong, J., Sturgeon, J. A., Salmasi, V., Hong, J., Cramer, E., Chen, A. L., Pacht, T., Olson, G., Darnall, B. D., Kao, M., Mackey, S. 2021; 6 (1): e880

  Abstract

  Introduction: Critical for the diagnosis and treatment of chronic pain is the anatomical distribution of pain. Several body maps allow patients to indicate pain areas on paper; however, each has its limitations.Objectives: To provide a comprehensive body map that can be universally applied across pain conditions, we developed the electronic Collaborative Health Outcomes Information Registry (CHOIR) self-report body map by performing an environmental scan and assessing existing body maps.Methods: After initial validation using a Delphi technique, we compared (1) pain location questionnaire responses of 530 participants with chronic pain with (2) their pain endorsements on the CHOIR body map (CBM) graphic. A subset of participants (n = 278) repeated the survey 1 week later to assess test-retest reliability. Finally, we interviewed a patient cohort from a tertiary pain management clinic (n = 28) to identify reasons for endorsement discordances.Results: The intraclass correlation coefficient between the total number of body areas endorsed on the survey and those from the body map was 0.86 and improved to 0.93 at follow-up. The intraclass correlation coefficient of the 2 body map graphics separated by 1 week was 0.93. Further examination demonstrated high consistency between the questionnaire and CBM graphic (<10% discordance) in most body areas except for the back and shoulders (15-19% discordance). Participants attributed inconsistencies to misinterpretation of body regions and laterality, the latter of which was addressed by modifying the instructions.Conclusions: Our data suggest that the CBM is a valid and reliable instrument for assessing the distribution of pain.

  View details for DOI 10.1097/PR9.0000000000000880

  View details for PubMedID 33490848

• Correction: Self-Administered Behavioral Skills-Based At-Home Virtual Reality Therapy for Chronic Low Back Pain: Protocol for a Randomized Controlled Trial. JMIR research protocols Garcia, L. M., Darnall, B. D., Krishnamurthy, P. n., Mackey, I. G., Sackman, J. n., Louis, R. G., Maddox, T. n., Birckhead, B. J. 2021; 10 (2): e27652

  Abstract

  [This corrects the article DOI: 10.2196/25291.].

  View details for DOI 10.2196/27652

  View details for PubMedID 33577465

• Validation of CARE Scale-7 in treatment-seeking patients with chronic pain: measurement of sex invariance. Pain reports Ziadni, M., You, D. S., Chen, A., Wilson, A. C., Darnall, B. D. 2020; 5 (6): e862

  Abstract

  Objectives: Social and interpersonal factors impact the trajectory of chronic pain. We previously developed and validated a 2-factor, 7-item measure to assess interpersonal factors, including relationship guilt and worry and difficulty prioritizing self-care in chronic pain. Here, we confirm the factor structure and examine the sex invariance of the two-factor structure of the CARE Scale-7.Methods: Data were collected as part of routine clinical care at a tertiary pain clinic using the Collaborative Health Outcomes Information Registry. Patient participants (67% women) were predominantly middle-aged (M = 50.9 years, SD = 17.8), married (55.2%), and White/non-Hispanic (55.7%). Data included demographics, pain characteristics, CARE Scale-7, pain catastrophizing, and Patient-Reported Outcomes Measurement Information System psychological and physical function measures. Confirmatory factor analysis was conducted to validate the factor structure of the CARE Scale, and a stepwise approach to measurement invariances by sex examined configural, metric, and scalar invariance.Results: Internal consistency of the scale items ensured suitability for factor analyses. Confirmatory factor analysis findings revealed an overall good fit of the 2-factor model among males and females and that CARE Scale-7 is in fact sex invariant. Finally, CARE Scale-7 showed convergent validity with pain-related outcomes.Discussion: The CARE Scale is the first validated instrument to assess self-care in both sexes among patients with chronic pain. The subscale of difficulty prioritizing self-care emerged as a potentially unique factor that should be integrated in clinical assessment. CARE Scale may facilitate standardized measurement in research and clinical contexts, which may inform a comprehensive treatment focus that integrates individualized self-care planning.

  View details for DOI 10.1097/PR9.0000000000000862

  View details for PubMedID 33204930

• Daily pain catastrophizing predicts less physical activity and more sedentary behavior in older adults with osteoarthritis. Pain Zhaoyang, R., Martire, L. M., Darnall, B. D. 2020

  Abstract

  Musculoskeletal disorders such as knee osteoarthritis (OA) are the primary cause of chronic pain in older adults. Recommended self-management strategies for knee OA include staying physically active in the face of pain, but many patients avoid activities they are capable of doing. The overall purpose of this study was to examine the extent to which daily pain catastrophizing, a maladaptive coping strategy, could influence OA patients' physical activity and sedentary behavior. The current study utilized data from 143 older knee OA patients who completed electronic daily diaries for 22 days and wore an accelerometer to capture physical activity and sedentary behavior. At the beginning of each day, patients reported their pain catastrophizing regarding the day ahead. Results from multilevel models demonstrated that on mornings when patients catastrophized more than usual about their pain in the day ahead, they spent more time in sedentary behavior and engaged in fewer minutes of moderate to vigorous physical activity that day. Cross-day lagged analyses further showed that the effect of morning pain catastrophizing on subsequent sedentary behavior extended to the next day. More time spent in sedentary behavior, in turn, contributed to greater pain catastrophizing the next morning. These findings support the mechanistic role of daily pain catastrophizing in the avoidance of physical activity for older OA patients, and suggest that effective interventions for pain catastrophizing may also reduce sedentary behavior and enhance physical activity, with longer-term benefits for pain management, physical function, and overall health.

  View details for DOI 10.1097/j.pain.0000000000001959

  View details for PubMedID 32569091

• Out of office hours: scalable, on-demand, digital support for patients tapering prescription opioids. Pain Ashton-James, C. E., Glare, P., Darnall, B. D. 2020

  View details for DOI 10.1097/j.pain.0000000000001947

  View details for PubMedID 32501860

• Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: A Randomized Controlled Pilot Study. JMIR formative research Darnall, B. D., Krishnamurthy, P., Tsuei, J., Minor, J. D. 2020

  Abstract

  BACKGROUND: Background: Patients with chronic pain often have limited access to comprehensive care that includes behavioral pain management strategies. Virtual reality (VR) is an immersive technology and emerging digital behavioral pain therapeutic with analgesic efficacy for acute pain. We found no scientific literature on skills-based VR behavioral programs for chronic pain populations.OBJECTIVE: Objectives: The primary goal of this study was to evaluate the feasibility of a self-administered VR program that included content and skills informed by evidence-based behavioral treatment for chronic pain. The secondary goal was to determine the preliminary efficacy of the VR program in terms of average pain intensity and pain-related interference with activity, stress, mood, and sleep, and its impact on pain-related cognition and self-efficacy. The tertiary goal was to conduct a randomized controlled trial (RCT) and compare the VR treatment to an audio-only treatment; this comparison isolated the immersive effects of the VR program, thereby informing potential mechanisms of effect.METHODS: Methods: We conducted an RCT involving an online convenience sample of adults (N=97) 18-65 years of age with self-reported chronic non-malignant chronic low back pain or fibromyalgia with an average pain intensity > 4 over the past month, and chronic pain duration > 6 months. Enrolled participants were randomly assigned to one of two unblinded treatments: (1) VR: a 21-day, skills-based VR program for chronic pain; and (2) Audio: an audio-only version of the 21-day VR program. The analytic dataset included participants who completed at least one of eight surveys administered during the intervention period: VR (n=39) and Audio (n=35).RESULTS: Results: The VR group launched a total of 1067 sessions vs. 1048 sessions for Audio group. The majority of VR participants (19 of 25; 76%) reported no nausea or motion sickness. High satisfaction ratings were reported for VR (24 of 29; 83%) and Audio (26 of 33; 72%). For VR efficacy, symptom improvement over time was found for each pain variable (all P<.001) with results strengthening after two weeks. Importantly, significant time x group effects were found in favor of the VR group for average pain intensity (P=.036), and pain-related inference with activity (P=.005), sleep (P<.001), mood (P<.001), and stress (P=.003). For pain-catastrophizing and pain self-efficacy, we found a significant declining trend for both treatment groups.CONCLUSIONS: Conclusions: High engagement and satisfaction combined with low levels of adverse effects support the feasibility and acceptability for at-home skills-based VR for chronic pain. Significant reduction in pain outcomes over the course of the 21-day treatment both within VR group and compared to an audio-only version suggests VR has the potential to provide enhanced treatment and greater improvement across a range of pain outcomes. These findings provide a foundation for future research on VR behavioral interventions for chronic pain.CLINICALTRIAL: Our CT.gov is in progress and will be received this week (clearly retrospective). The efficacy aim of our pilot study was exploratory and we applied appropriate statistical corrections for multiple comparisons.

  View details for DOI 10.2196/17293

  View details for PubMedID 32374272

• PERCEIVED INJUSTICE MEDIATES THE RELATIONSHIP BETWEEN CHILDHOOD NEGLECT AND CURRENT FUNCTION IN PATIENTS WITH CHRONIC PAIN Ziadni, M., You, D. S., Mackey, S., Darnall, B. D. OXFORD UNIV PRESS INC. 2020: S92

  View details for Web of Science ID 000546262400190

• ASSOCIATION BETWEEN PAIN CATASTROPHIZING AND FREQUENT CRAVING FOR PRESCRIPTION OPIOIDS IN PATIENTS WITH CHRONIC PAIN You, D. S., Ziadni, M., Hah, J., Darnall, B. D., Mackey, S. OXFORD UNIV PRESS INC. 2020: S89

  View details for Web of Science ID 000546262400184

• Baseline Characteristics of a Dyadic Cohort of Mothers with Chronic Pain and Their Children. The Clinical journal of pain Wilson, A. C., Stone, A. L., Poppert Cordts, K. M., Holley, A. L., Mackey, S. n., Darnall, B. D., Palermo, T. M. 2020

  Abstract

  A growing body of research has demonstrated a robust link between parental chronic pain and child pain and psychological function. Although the association between parent and child pain is strong, there are limited data to understand environmental and behavioral processes that account for the association and how this develops over time. This longitudinal cohort study was designed to understand potential mechanisms that confer risk or resilience for chronic pain among child offspring of mothers with chronic pain.The current paper presents baseline data on the cohort to describe pain and psychosocial characteristics of mothers with chronic pain and their 8-12-year old children. 400 mothers with chronic pain and their children were enrolled into the longitudinal study and completed measures of pain, physical, and psychosocial functioning.Mothers reported a range of pain and pain-related disability, and were grouped into four pain grades representing different pain and disability levels. Mothers in these groups differed on rates of widespread pain and opioid use. Maternal pain grades also differed by physical function, fatigue, sleep disturbance, and psychological function. Most children in this sample reported pain and psychosocial symptoms in the non-clinical range, and child variables did not differ by maternal pain grade. Maternal disability and function were concurrently associated with child psychosocial function.While maternal pain grades map broadly onto several dimensions of maternal functioning, they were not significantly related to child pain or function. Results may help identify potential protective factors in the intergenerational transmission of risk for chronic pain.

  View details for DOI 10.1097/AJP.0000000000000864

  View details for PubMedID 32701524

• Emotions Matter: The Role of Emotional Approach Coping in Chronic Pain. European journal of pain (London, England) Ziadni, M. S., You, D. S., Johnson, L. n., Lumley, M. A., Darnall, B. D. 2020

  Abstract

  Emotional approach coping (EAC) is a potentially adaptive emotion-focused coping style that involves understanding or processing one's emotions and expressing them appropriately. Although EAC has been studied in various populations, little is known about this construct among people with chronic pain, including potential mediators such as negative affect, which might link EAC to pain-related variables, and moderators of these relationships.Participants (N = 670; 76% women; 30% older adults-age 60 or over) with chronic pain completed online the Emotional Approach Coping Scale and measures of pain severity, pain interference, and negative affect. Analyses correlated EAC to pain severity and interference and tested whether gender and age group (older adults vs. young/middle-age adults) moderated the mediated relationships of EAC with pain-related variables through negative affect.Findings reveal that higher EAC was associated with lower pain intensity through lower negative affect in the young/middle-age portion of the sample, but not older adults. Also, higher EAC was associated with lower pain interference through lower negative affect among women in the sample, but not men. The associations of EAC to pain intensity and interference are small in magnitude, however, and should be considered preliminary.EAC is associated with lower pain intensity in young/middle-age adults and lower pain interference in women, and lower negative affect mediates these relationships. These results suggest the potential value of assessing and bolstering emotional approach coping processes in some people with chronic pain.

  View details for DOI 10.1002/ejp.1625

  View details for PubMedID 32603553

• Pain and Psychological Factors "I Need More Pain Medication, Not Less!" PRACTICAL STRATEGIES IN GERIATRIC MENTAL HEALTH: CASES AND APPROACHES Darnall, B. D., Dunn, L. B., CassidyEagle, E. L. 2020: 95–115

  View details for Web of Science ID 000555001100007

• Promoting Patient-Centeredness in Opioid Deprescribing: a Blueprint for De-implementation Science. Journal of general internal medicine Kertesz, S. G., McCullough, M. B., Darnall, B. D., Varley, A. L. 2020

  Abstract

  A downward trend in opioid prescribing between 2011 and 2018 has brought per-capita opioid prescriptions below the levels of 2006, the earliest year for which the Centers for Disease Control and Prevention has published data. That trend has affected roughly ten million patients who previously received long-term opioid therapy. Any effort to reduce or replace a prior health practice is termed de-implementation. We suggest that the evaluation of opioid prescribing de-implementation has been misdirected, within US policy and health research, resulting in detrimental impacts on patients, their families and clinicians. Policymakers and implementation scientists can address these deficiencies in how we study and how we perform opioid de-implementation by applying an implementation science framework: the Consolidated Framework for Implementation Research. The Consolidated Framework lays out relevant domains of activity (internal, external, etc.) that influence implementation processes and outcomes. It can deepen our understanding of how policies are chosen, communicated, and carried out. Policymakers and researchers who embrace this framework will need a better approach to measuring success and failure in health care where both pain and opioids are concerned. This would involve shifting from a reductive focus on opioid prescription counts toward measures that are more effective, holistic, and patient-centered.

  View details for DOI 10.1007/s11606-020-06254-7

  View details for PubMedID 33145692

• Perceived Injustice Mediates the Relationship Between Perceived Childhood Neglect and Current Function in Patients with Chronic Pain: A Preliminary Pilot Study. Journal of clinical psychology in medical settings Ziadni, M. S., You, D. S., Sturgeon, J. A., Mackey, S. C., Darnall, B. D. 2020

  Abstract

  Cumulative evidence supports the association between perceived childhood neglect and adulthood psychological and physical health. To date, pathways mediating this association remain largely unknown, though other evidence suggests that negative patterns of appraisal, including injustice perception related to pain, may be shaped by prior adverse social experiences. Consequently, the current study examined perceived injustice about chronic pain as a possible factor connecting childhood neglect and pain-related outcomes, given its relevance for both adaptation to chronic pain and to prior adverse life experiences. Patients (n = 742) visiting a tertiary pain clinic completed a survey administered via the Collaborative Health Outcomes Information Registry. Path modeling analyses were used to examine perceived injustice as a mediator of the relationships between childhood neglect and affective distress and physical function, after controlling for pain intensity and pain catastrophizing. Patients endorsing childhood neglect reported higher levels of perceived injustice and worse affective distress and physical function. Further, inclusion of perceived injustice as a mediator fully accounted for the relationship between neglect and current levels of physical function, and accounted for a significant proportion of the relationship between neglect and current levels of affective distress. These preliminary findings suggest that perceived injustice appears to be a more proximal factor by which prior experiences of neglect may adversely affect adaptation to chronic pain. Given the single-item assessment of childhood neglect and cross-sectional nature of the current findings, further research may focus on replicating these findings in longitudinal studies with validated measures and examining other adverse social experiences (e.g., abuse, social disparities) that may contribute to injustice perception and poor pain-related outcomes.

  View details for DOI 10.1007/s10880-020-09722-8

  View details for PubMedID 32382872

• Self-reported traumatic etiology of pain and psychological function in tertiary care pain clinic patients: a collaborative health outcomes information registry (CHOIR) study. Scandinavian journal of pain Taub, C. J., Sturgeon, J. A., Chahal, M. K., Kao, M. C., Mackey, S. C., Darnall, B. D. 2020

  Abstract

  Background and aims A sizable body of research has elucidated the significant role of psychological reactions to trauma on pain coping and outcomes. In order to best inform intervention development and clinical care for patients with both trauma and pain at the tertiary care level, greater clarity is needed regarding the magnitude of these effects and the specific pathways through which they may or may not function at the time of first presentation to such a treatment setting. To achieve this, the current study examined the cross-sectional relationships between traumatic etiology of pain, psychological distress (anger, depressive symptoms, and PTSD symptoms), and pain outcomes (pain catastrophizing, physical function, disability status). Methods Using a structural path modeling approach, analyses were conducted using a large sample of individuals with chronic pain (n = 637) seeking new medical evaluation at a tertiary pain management center, using the Collaborative Health Outcomes Information Registry (CHOIR). We hypothesized that the relationships between traumatic etiology of pain and poorer pain outcomes would be mediated by higher levels of psychological distress. Results Our analyses revealed modest relationships between self-reported traumatic etiology of pain and pain catastrophizing, physical function, and disability status. In comparison, there were stronger relationships between indices of psychological distress and pain catastrophizing, but a weaker pattern of associations between psychological distress and physical function and disability measures. Conclusions To the relatively small extent that self-reported traumatic etiology of pain correlates with pain-related outcomes, these relationships appear to be due primarily to the presence of psychiatric symptoms and manifest most notably in the context of psychological responses to pain (i.e. catastrophizing about pain). Implications Findings from this study highlight the need for early intervention for patients with traumatic onset of pain and for clinicians at tertiary pain centers to include more detailed assessments of psychological distress and trauma as a component of comprehensive chronic pain treatment.

  View details for DOI 10.1515/sjpain-2019-0154

  View details for PubMedID 32191626

• Patient-centered prescription opioid tapering in community outpatients with chronic pain: 2- to 3-year follow-up in a subset of patients Pain Reports Ziadni, M. S., A, C. L., Krishnamurthy, P., Flood, P., Stieg, R. L., Darnall, B. D. 2020; 5 (5): e851

  View details for DOI 10.1097/PR9.0000000000000851

• Efficacy and mechanisms of a single-session behavioral medicine class among patients with chronic pain taking prescription opioids: study protocol for a randomized controlled trial. Trials Ziadni, M. S., Chen, A. L., Winslow, T. n., Mackey, S. C., Darnall, B. D. 2020; 21 (1): 521

  Abstract

  Independent of pain intensity, pain-specific distress is highly predictive of pain treatment needs, including the need for prescription opioids. Given the inherently distressing nature of chronic pain, there is a need to equip individuals with pain education and self-regulatory skills that are shown to improve adaptation and improve their response to medical treatments. Brief, targeted behavioral medicine interventions may efficiently address the key individual factors, improve self-regulation in the context of pain, and reduce the need for opioid therapy. This highlights the critical need for targeted, cost-effective interventions that efficiently address the key psychological factors that can amplify the need for opioids and increased risk for misuse. In this trial, the primary goal is to test the comparative efficacy of a single-session skills-based pain management class to a health education active control group among patients with chronic pain who are taking opioids.Our study is a randomized, double-blind clinical trial testing the superiority of our 2-h, single-session skills-based pain management class against a 2-h health education class. We will enroll 136 adult patients with mixed-etiology chronic pain who are taking opioid prescription medication and randomize 1:1 to one of the two treatment arms. We hypothesize superiority for the skills-based pain class for pain control, self-regulation of pain-specific distress, and reduced opioid use measured by daily morphine equivalent. Team researchers masked to treatment assignment will assess outcomes up to 12 months post treatment.This study aims to test the utility of a single-session, 2-h skills-based pain management class to improve self-regulation of pain and reduce opioid use. Findings from our project have the potential to shift current research and clinical paradigms by testing a brief and scalable intervention that could reduce the need for opioids and prevent misuse effectively, efficiently, and economically. Further, elucidation of the mechanisms of opioid use can facilitate refinement of more targeted future treatments.ClinicalTrials.gov, ID: NCT03950791. Registered on 10 May 2019.

  View details for DOI 10.1186/s13063-020-04415-x

  View details for PubMedID 32532346

• Adverse Childhood Experiences in Mothers With Chronic Pain and Intergenerational Impact on Children JOURNAL OF PAIN Dennis, C. H., Clohessy, D. S., Stone, A. L., Darnall, B. D., Wilson, A. C. 2019; 20 (10): 1209–17

  View details for DOI 10.1016/j.jpain.2019.04.004

  View details for Web of Science ID 000492459600009

• Daily and bidirectional linkages between pain catastrophizing and spouse responses. Pain Martire, L. M., Zhaoyang, R., Marini, C. M., Nah, S., Darnall, B. D. 2019

  Abstract

  Pain catastrophizing has been shown to predict greater pain and less physical function in daily life for chronic pain sufferers, but its effects on close social partners have received much less attention. The overall purpose of the present study was to examine the extent to which pain catastrophizing is an interpersonal coping strategy that is maladaptive for patients and their spouses. A total of 144 older knee osteoarthritis patients and their spouses completed baseline interviews and a 22-day diary assessment. Multilevel lagged models indicated that, on days when patients reported greater catastrophizing in the morning, their spouses experienced more negative affect throughout the day. In addition, a higher level of punishing responses from the spouse predicted greater pain catastrophizing the next morning, independent of patient pain and negative affect. Multilevel mediation models showed that patients' morning pain catastrophizing was indirectly associated with spouses' negative affect and punishing responses via patients' own greater negative affect throughout the day. There was no evidence that spouses' empathic or solicitous responses either followed or preceded patients' catastrophizing. These findings suggest that cognitive-behavioral interventions that reduce pain catastrophizing should be modified for partnered patients to address dyadic interactions and the spouse's role in pain catastrophizing.

  View details for DOI 10.1097/j.pain.0000000000001673

  View details for PubMedID 31408052

• The National Imperative to Align Practice and Policy with the Actual CDC Opioid Guideline. Pain medicine (Malden, Mass.) Darnall, B. D. 2019

  View details for DOI 10.1093/pm/pnz152

  View details for PubMedID 31334761

• Managing Cancer Pain, Monitoring for Cancer Recurrence, and Mitigating Risk of Opioid Use Disorders: A Team-Based, Interdisciplinary Approach to Cancer Survivorship. Journal of palliative medicine Goodlev, E. R., Discala, S., Darnall, B. D., Hanson, M., Petok, A., Silverman, M. 2019

  Abstract

  Background: Palliative care (PC) teams increasingly care for patients with cancer into survivorship. Cancer survivorship transcends distinctions between acute, chronic, malignant, and nonmalignant pain. Partnering with oncologists, PC teams manage pain that persists after disease-directed treatment, evaluate changing symptoms as possible signs of cancer recurrence, taper opioids and mitigate risk of opioid misuse, and manage comorbid opioid use disorder (OUD). While interdisciplinary guidelines exist for pain management in survivorship, there is a need to develop a conceptual model that fully translates the biopsychosocial framework of PC into survivorship pain management. Objective: This review frames a model for pain management in cancer survivorship that balances analgesia with the imperative to minimize risk of OUD, recognizes signs of disease recurrence, and provides whole-person care. Methods: Comprehensive narrative review of the literature. Results: Little guidance exists for co-management of pain, psychological distress, and opioid misuse in survivorship. We identified themes for whole-person pain management in survivorship: use of opioids and co-analgesic medications to prevent recurrent pain from residual tissue damage following cancer treatment, opioid tapering to the lowest effective dose, utilization of nonpharmacologic psychological interventions shown to reduce pain, screening for and management of OUD in partnership with addiction medicine specialists, maintaining vigilance for disease recurrence, and engaging in shared medical decision making. Conclusions: The management of pain in cancer survivorship is complex and requires interdisciplinary care that balances analgesia with the imperative to reduce long-term inappropriate opioid use and manage OUD, while maintaining therapeutic presence with patients in the spirit of PC.

  View details for DOI 10.1089/jpm.2019.0171

  View details for PubMedID 31329500

• Conclusion. Pain medicine (Malden, Mass.) Sullivan, M. D., Darnall, B. D. 2019; 20 (2): 212

  View details for DOI 10.1093/pm/pny147_3

  View details for PubMedID 31505658

• On the Importance of Using the Right Metrics for Patient Outcomes and Payment: Pain, Pain Interference, and Physical Function PAIN MEDICINE Darnall, B. D., Sullivan, M. D. 2019; 20 (2): 209

  View details for DOI 10.1093/pm/pny147

  View details for Web of Science ID 000460637900026

• Negative Affect-Related Factors Have the Strongest Association with Prescription Opioid Misuse in a Cross-Sectional Cohort of Patients with Chronic Pain. Pain medicine (Malden, Mass.) Gilam, G. n., Sturgeon, J. A., You, D. S., Wasan, A. D., Darnall, B. D., Mackey, S. C. 2019

  Abstract

  Increased opioid prescription to relieve pain among patients with chronic pain is associated with increased risk for misuse, potentially leading to substance use disorders and overdose death. We aimed to characterize the relative importance and identify the most significant of several potential risk factors for the severity of self-reported prescribed opioid misuse behaviors.A sample of 1,193 patients (mean age ± SD = 50.72 ± 14.97 years, 64.04% female) with various chronic pain conditions completed a multidimensional registry assessing four pain severity measures and 14 physical, mental, and social health status factors using the National Institutes of Health's Patient-Reported Outcomes Measurement Information System (PROMIS). A validated PROMIS measure of medication misuse was completed by 692 patients who endorsed currently taking opioid medication. Patients taking opioid medications were compared across all measures with those who do not take opioid medications. Subsequently, a data-driven regression analysis was used to determine which measures best explained variability in severity of misuse. We hypothesized that negative affect-related factors, namely anxiety, anger, and/or depression, would be key predictors of misuse severity due to their crucial role in chronic pain and substance use disorders.Patients taking opioid medications had significantly greater impairment across most measures. Above and beyond demographic variables, the only and most significant predictors of prescribed opioid misuse severity were as follows: anxiety (β = 0.15, P = 0.01), anger (β = 0.13, P = 0.02), Pain Intensity-worst (β = 0.09, P = 0.02), and depression (β = 0.13, P = 0.04).Findings suggest that anxiety, anger, and depression are key factors associated with prescribed opioid misuse tendencies in patients with chronic pain and that they are potential targets for therapeutic intervention.

  View details for DOI 10.1093/pm/pnz249

  View details for PubMedID 31617916

• Pain and Psychological Factors in Older Adults Practical Strategies in Geriatric Mental Health: Cases and Approaches. Darnall, B. American Psychiatric Press . 2019: 95–116
• Enhanced Recovery Before Surgery: Preoperative Optimization of the Chronic Pain Patient McAnnally, H., Freeman, L., Darnall, B. Oxford University Press. 2019
• Comparative Effectiveness of Cognitive Behavioral Therapy for Chronic Pain and Chronic Pain Self-Management within the Context of Voluntary Patient-Centered Prescription Opioid Tapering: The EMPOWER Study Protocol. Pain medicine (Malden, Mass.) Darnall, B. D., Mackey, S. C., Lorig, K. n., Kao, M. C., Mardian, A. n., Stieg, R. n., Porter, J. n., DeBruyne, K. n., Murphy, J. n., Perez, L. n., Okvat, H. n., Tian, L. n., Flood, P. n., McGovern, M. n., Colloca, L. n., King, H. n., Van Dorsten, B. n., Pun, T. n., Cheung, M. n. 2019

  Abstract

  Evidence to date, while sparse, suggests that patients taking long-term opioids require special considerations and protections to prevent potential iatrogenic harms from opioid de-prescribing, such as increased pain or suffering. Following this study protocol, the EMPOWER study seeks to address multiple unmet needs of patients with chronic pain who desire to reduce long-term opioid therapy, and provide the clinical evidence on effective methodology.EMPOWER applies patient-centered methods for voluntary prescription opioid reduction conducted within a comprehensive, multi-state, 3-arm randomized controlled comparative effectiveness study of three study arms (1) group cognitive behavioral therapy for chronic pain; (2) group chronic pain self-management; and (3) usual care (taper only). Specialized electronic data capture systems collect patient reported symptoms and satisfaction data weekly and monthly during the taper, with real-time clinical alerts and electronic feedback loops informing, documenting, and steering needed care actions.The EMPOWER study seeks to provide granular evidence on patient response to voluntary opioid tapering, and will provide evidence to inform clinical systems changes, clinical care, patient satisfaction, and patient outcomes for opioid reduction.

  View details for DOI 10.1093/pm/pnz285

  View details for PubMedID 31876947

• Evaluation of Candidate Items for Severe PTSD Screening for Patients with Chronic Pain: Pilot Data Analysis with IRT Approach. Pain practice : the official journal of World Institute of Pain You, D. S., Ziadni, M. S., Gilam, G. n., Darnall, B. D., Mackey, S. C. 2019

  Abstract

  Post-traumatic Stress Disorder (PTSD) commonly co-occurs with chronic pain. Although PTSD symptoms are associated with negative health outcomes in patients with chronic pain, PTSD is typically under-detected and under-treated in outpatient pain settings. There is a need for rapid, brief screening tools to identify those at greatest risk for severe PTSD symptoms. To achieve that goal, our aim was to use item response theory (IRT) to identify the most informative PTSD symptoms characterizing severe PTSD in patients with chronic pain.Fifty-six patients (71% female, 61% White) with mixed etiology chronic pain completed the PTSD Checklist Civilian Version (PCL-C) as part of their appointment with a pain psychologist at a tertiary outpatient pain clinic. We used an IRT approach to evaluate each item's discriminant (a) and severity (b) parameters.Findings revealed that 'feeling upset at reminders' (a = 3.67, b = 2.44) and 'avoid thinking or talking about it' (a = 3.61, b = 2.17) as being highly discriminant for severe PTSD.We identified two candidate items for a brief PTSD screener as they were associated with severe PTSD symptoms. These two items may provide clinical utility in outpatient pain treatment settings to identify those suffering from severe PTSD enabling physicians to refer them to trauma-specific evaluation or therapy. Future research is needed to further validate and confirm these candidate PTSD items in a larger clinic sample.

  View details for DOI 10.1111/papr.12848

  View details for PubMedID 31646748

• Central mechanisms of real and sham electroacupuncture in the treatment of chronic low back pain: study protocol for a randomized, placebo-controlled clinical trial TRIALS Kong, J., MacIsaac, B., Cogan, R., Ng, A., Law, C., Helms, J., Schnyer, R., Karayannis, N., Kao, M., Tian, L., Darnall, B. D., Gross, J. J., Mackey, S., Manber, R. 2018; 19

  View details for DOI 10.1186/s13063-018-3044-2

  View details for Web of Science ID 000453069900001

• International Stakeholder Community of Pain Experts and Leaders Call for an Urgent Action on Forced Opioid Tapering. Pain medicine (Malden, Mass.) Darnall, B. D., Juurlink, D., Kerns, R. D., Mackey, S., Van Dorsten, B., Humphreys, K., Gonzalez-Sotomayor, J. A., Furlan, A., Gordon, A. J., Gordon, D. B., Hoffman, D. E., Katz, J., Kertesz, S. G., Satel, S., Lawhern, R. A., Nicholson, K. M., Polomano, R. C., Williamson, O. D., McAnally, H., Kao, M., Schug, S., Twillman, R., Lewis, T. A., Stieg, R. L., Lorig, K., Mallick-Searle, T., West, R. W., Gray, S., Ariens, S. R., Sharpe Potter, J., Cowan, P., Kollas, C. D., Laird, D., Ingle, B., Julian Grove, J., Wilson, M., Lockman, K., Hodson, F., Palackdharry, C. S., Fillingim, R. B., Fudin, J., Barnhouse, J., Manhapra, A., Henson, S. R., Singer, B., Ljosenvoor, M., Griffith, M., Doctor, J. N., Hardin, K., London, C., Mankowski, J., Anderson, A., Ellsworth, L., Davis Budzinski, L., Brandt, B., Harkootley, G., Nickels Heck, D., Zobrosky, M. J., Cheek, C., Wilson, M., Laux, C. E., Datz, G., Dunaway, J., Schonfeld, E., Cady, M., LeDantec-Boswell, T., Craigie, M., Sturgeon, J., Flood, P., Giummarra, M., Whelan, J., Thorn, B. E., Martin, R. L., Schatman, M. E., Gregory, M. D., Kirz, J., Robinson, P., Marx, J. G., Stewart, J. R., Keck, P. S., Hadland, S. E., Murphy, J. L., Lumley, M. A., Brown, K. S., Leong, M. S., Fillman, M., Broatch, J. W., Perez, A., Watford, K., Kruska, K., Sophia You, D., Ogbeide, S., Kukucka, A., Lawson, S., Ray, J. B., Wade Martin, T., Lakehomer, J. B., Burke, A., Cohen, R. I., Grinspoon, P., Rubenstein, M. S., Sutherland, S., Walters, K. R., Lovejoy, T. 2018

  View details for PubMedID 30496540

• Characterizing chronic pain in late adolescence and early adulthood: prescription opioids, marijuana use, obesity, and predictors for greater pain interference. Pain reports Anastas, T., Colpitts, K., Ziadni, M., Darnall, B. D., Wilson, A. C. 2018; 3 (6): e700

  Abstract

  Introduction: Chronic pain in late adolescence and young adults is understudied and poorly characterized.Objectives: We sought to characterize key variables that may impact pain interference in late adolescents and young adults with chronic pain, including prescription opioid use, marijuana use, psychological symptoms, and obesity.Methods: Retrospective, cross-sectional medical chart review for patients aged 17 to 23 years (N = 283; 61% Females) seeking care at a tertiary care pain clinic. Data on pain characteristics, health behaviors, and mental health distress were examined, in addition to self-reported pain intensity and interference.Results: Overlapping pain conditions were common in this young adult sample (mean ≥ 2 pain conditions). Back pain was the most commonly cited pain condition, and the majority of pain was of unknown etiology. Results revealed high rates for current opioid prescription, overweight or obese status, and mental health problems. Those using prescription opioids were more likely to endorse tobacco use and had greater pain interference. Importantly, the presence of mental health distress and opioid use were predictive of higher levels of pain-related interference.Conclusion: Treatment-seeking adolescents and young adults with chronic pain evidence complex care needs that include pain and mental comorbidities, as well as risky health behaviors. Pain and mental health distress were associated with poorer physical health, opioid prescription and marijuana use, and pain-related interference. Findings underscore the need for additional research on pain, treatment patterns, and health behaviors and their impact on developmental trajectories, as well as the need to develop and apply effective early interventions in this at-risk population.

  View details for PubMedID 30706040

• Characterizing chronic pain in late adolescence and early adulthood: prescription opioids, marijuana use, obesity, and predictors for greater pain interference PAIN REPORTS Anastas, T., Colpitts, K., Ziadni, M., Darnall, B. D., Wilson, A. C. 2018; 3 (6)

  View details for DOI 10.1097/PR9.0000000000000700

  View details for Web of Science ID 000660773100002

• The factor structure and subscale properties of the pain catastrophizing scale: are there differences in the distinctions? Cook, K., Darnall, B., Mackey, S. SPRINGER. 2018: S38

  View details for Web of Science ID 000445248500093

• On the Importance of Using the Right Metrics for Patient Outcomes and Payment: Pain, Pain Interference, and Physical Function. Pain medicine (Malden, Mass.) Darnall, B. D., Sullivan, M. D. 2018

  View details for PubMedID 30247692

• The Impact of Perceived Injustice on Pain-related Outcomes: A Combined Model Examining the Mediating Roles of Pain Acceptance and Anger in a Chronic Pain Sample. The Clinical journal of pain Carriere, J. S., Sturgeon, J. A., Yakobov, E., Kao, M. C., Mackey, S. C., Darnall, B. D. 2018; 34 (8): 739-747

  Abstract

  Perceived injustice (PI) has been identified as an important risk factor for pain-related outcomes. To date, research has shown that pain acceptance and anger are mediators of the association between PI and pain-related outcomes. However, a combined conceptual model that addresses the interrelationships between these variables is currently lacking. Therefore, the current study aimed to examine the potential mediating roles of pain acceptance and anger on the association between PI and adverse pain-related outcomes (physical function, pain intensity, opioid use status).This cross-sectional study used a sample of 354 patients with chronic pain being treated at a tertiary pain treatment center. Participants completed measures of PI, pain acceptance, anger, physical function, pain intensity, and opioid use status. Mediation analyses were used to examine the impact of pain acceptance and anger on the association between PI and pain-related outcomes.Examination of the specific indirect effects revealed that pain acceptance fully mediated the relationship between PI and physical function, as well as the relationship between PI and opioid use status. Pain acceptance emerged as a partial mediator of the relationship between PI and pain intensity.This is the first study to provide a combined conceptual model investigating the mediating roles of pain acceptance and anger on the relationship between PI and pain outcomes. On the basis of our findings, low levels of pain acceptance associated with PI may help explain the association between PI and adverse pain outcomes. Clinical and theoretical implications are discussed.

  View details for DOI 10.1097/AJP.0000000000000602

  View details for PubMedID 29485535

• An experimental method for assessing whether marijuana use reduces opioid use in patients with chronic pain. Addiction (Abingdon, England) Darnall, B. D., Humphreys, K. N. 2018

  View details for PubMedID 29882256

• Voluntary Opioid Tapering-Reply. JAMA internal medicine Darnall, B. D., Ziadni, M. S., Stieg, R. L. 2018; 178 (6): 875

  View details for PubMedID 29868754

• Voluntary Opioid Tapering-Barriers to Delivering Care Reply JAMA INTERNAL MEDICINE Darnall, B. D., Ziadni, M. S., Stieg, R. L. 2018; 178 (6): 875

  View details for DOI 10.1001/jamainternmed.2018.2112

  View details for Web of Science ID 000434133500056

• CARE Scale - 7: Development and Preliminary Validation of a Measure to Assess Factors Impacting Self-care in Chronic Pain. The Clinical journal of pain Ziadni, M., You, D. S., Wilson, A. C., Darnall, B. D. 2018

  Abstract

  Social and interpersonal factors may impact chronic pain self-care and self-management; however, no integrated measure exists to assess the interplay of these factors. We developed and tested a measure designed to assess salient interpersonal factors, including relationship guilt and worry, and difficulty prioritizing self-care in chronic pain.We tested self-report items broadly relevant to locus of care, limit-setting capacity, and worry/guilt about relationships in 3 discrete chronic pain samples (total N=1,452): (1) online sample of chronic pain clinic patients (N=729; 21 candidate CARE items, sociodemographics, and measures of psychological and physical functioning). Analytic results supported a final 7-item CARE Scale which was next tested in (2) an anonymous online sample of 578 adults with chronic pain. (3) Finally, preliminary validation of the CARE Scale was performed in a tertiary pain clinic sample (N=145).Exploratory factor analysis revealed a 7-item, 2-factor solution (difficulty prioritizing self-care and guilt/worry) that accounted for a combined total of 58% of the variance. CARE Scale-7 had modest convergent validity with pain intensity, pain-related interference, and emotional distress. Extreme difficulty with both factors was reported by about one-third of the total sample, suggesting that relationship factors significantly impact pain management and self-care.Social factors are gaining attention for their influence on the trajectory of chronic pain. The CARE Scale is a brief, integrated measure that may be used to reveal specific interpersonal and personal impediments to self-care, and identify important therapeutic targets to optimize self-management behaviors.

  View details for DOI 10.1097/AJP.0000000000000606

  View details for PubMedID 29554031

• Comparative Efficacy and Mechanisms of a Single-Session Pain Psychology Class in Chronic Low Back Pain: Study Protocol for a Randomized Controlled Trial. Trials Darnall, B. D., Ziadni, M. S., Roy, A., Kao, M. C., Sturgeon, J. A., Cook, K. F., Lorig, K., Burns, J. W., Mackey, S. C. 2018; 19 (1): 165

  Abstract

  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.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.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.ClinicalTrials.gov, NCT03167086 . Registered on 22 May 2017.

  View details for DOI 10.1186/s13063-018-2537-3

  View details for PubMedID 29510735

  View details for PubMedCentralID PMC5838852

• Comparative Efficacy and Mechanisms of a Single-Session Pain Psychology: Protocol for a Randomized Controlled Trial in Chronic Low Back Pain Trials Darnall, B., Ziadni, M., Roy, A., Kao, M., Sturgeon, J., Cook, K., Lorig, K., Burns, J., Sean, M. 2018; 19 (165)
• Optimizing Placebo and Minimizing Nocebo to Reduce Pain, Catastrophizing, and Opioid Use: A Review of the Science and an Evidence-Informed Clinical Toolkit NEUROBIOLOGY OF THE PLACEBO EFFECT, PT II Darnall, B. D., Colloca, L., Colloca, L. 2018; 139: 129-157

  View details for DOI 10.1016/bs.irn.2018.07.022

  View details for Web of Science ID 000452403500007

• Pain Psychology in the Perioperative and Chronic Pain Contexts Anesthesiology Darnall, B. D., Sturgeon, J. A. McGraw Hill. 2018; 3: 1501–1505
• Facilitating Patient Resilience: Mindfulness-Based Stress Reduction, Acceptance, and Positive Social and Emotional Interventions Psychological Approaches to Pain Management John, S. A., Darnall, B. D. Guilford Press. 2018; 3: 250–263
• Psychological Treatment for Patients with Chronic Pain Darnall, B. D. American Psychological Association. 2018
• Optimizing Placebo and Minimizing Nocebo to Reduce Pain, Catastrophizing, and Opioid Use: A Review of the Science and an Evidence-Informed Clinical Toolkit. International review of neurobiology Darnall, B. D., Colloca, L. 2018; 139: 129–57

  Abstract

  Pain, a noxious psychosensory experience, motivates escape behavior to assure protection and survival. Psychological factors alter the experience and trajectory of pain, as well as behavior and treatment response. In the context of pain, the placebo effect (expectation for pain relief) releases endogenous opioids and facilitates analgesia from exogenously administered opioids. Nocebo hyperalgesia (expectation for persistent or worsening pain) opposes endogenous opioid analgesia and patient engagement in prescription opioid tapering. Reductions in nocebo hyperalgesia and pain catastrophizing may enhance descending modulation of pain, mediate adaptive structural brain changes and promote patient engagement in opioid tapering. Interventions that minimize nocebo and optimize placebo may adaptively shape the central nervous system toward pain relief and potentially opioid reduction. Here we provide a critical description of catastrophizing and its impact on pain, placebo and nocebo effects. We also consider the importance of minimizing nocebo and optimizing placebo effects during prescription opioid tapering, and offer a clinical toolkit of resources to accomplish these goals clinically.

  View details for PubMedID 30146045

• Comparative Efficacy and Mechanisms of a Single-Session Pain Psychology Class in Chronic Low Back Pain: Study Protocol for a Randomized Controlled Trial Trials Darnall, B., Siadni, M., Roy, A., Kao, M., Sturgeon, J., Cook, K., Lorig, K., Burns, J., Mackey, S. 2018: 165

  Abstract

  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.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.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.ClinicalTrials.gov, NCT03167086 . Registered on 22 May 2017.

  View details for DOI 10.1186/s13063-018-2537-3

  View details for PubMedCentralID PMC5838852

• Pain catastrophizing, perceived injustice, and pain intensity impair life satisfaction through differential patterns of physical and psychological disruption. Scandinavian journal of pain Sturgeon, J. A., Ziadni, M. S., Trost, Z., Darnall, B. D., Mackey, S. C. 2017; 17: 390-396

  Abstract

  Previous research has highlighted the importance of cognitive appraisal processes in determining the nature and effectiveness of coping with chronic pain. Two of the key variables implicated in appraisal of pain are catastrophizing and perceived injustice, which exacerbate the severity of pain-related distress and increase the risk of long-term disability through maladaptive behavioural responses. However, to date, the influences of these phenomena have not been examined concurrently, nor have they been related specifically to quality of life measures, such as life satisfaction.Using data from an online survey of 330 individuals with chronic pain, structural path modelling techniques were used to examine the independent effects of pain catastrophizing, perceived injustice, and average pain intensity on life satisfaction. Two potential mediators of these relationships were examined: depressive symptoms and pain-related interference.Results indicated that depressive symptoms fully mediated the relationship between pain catastrophizing and life satisfaction, and pain interference fully mediated the relationship between pain intensity and life satisfaction. Both depressive symptoms and pain interference were found to significantly mediate the relationship between perceived injustice and life satisfaction, but perceived injustice continued to demonstrate a significant and negative relationship with life satisfaction, above and beyond the other study variables.The current findings highlight the distinct affective and behavioural mediators of pain and maladaptive cognitive appraisal processes in chronic pain, and highlight their importance in both perceptions of pain-related interference and longer-term quality of life.

  View details for DOI 10.1016/j.sjpain.2017.09.020

  View details for PubMedID 29074199

  View details for PubMedCentralID PMC5726907

• Pain Catastrophizing Moderates Relationships between Pain Intensity and Opioid Prescription: Nonlinear Sex Differences Revealed Using a Learning Health System. Anesthesiology Sharifzadeh, Y., Kao, M. C., Sturgeon, J. A., Rico, T. J., Mackey, S., Darnall, B. D. 2017; 127 (1): 136-146

  Abstract

  Pain catastrophizing is a maladaptive response to pain that amplifies chronic pain intensity and distress. Few studies have examined how pain catastrophizing relates to opioid prescription in outpatients with chronic pain.The authors conducted a retrospective observational study of the relationships between opioid prescription, pain intensity, and pain catastrophizing in 1,794 adults (1,129 women; 63%) presenting for new evaluation at a large tertiary care pain treatment center. Data were sourced primarily from an open-source, learning health system and pain registry and secondarily from manual review of electronic medical records. A binary opioid prescription variable (yes/no) constituted the dependent variable; independent variables were age, sex, pain intensity, pain catastrophizing, depression, and anxiety.Most patients were prescribed at least one opioid medication (57%; n = 1,020). A significant interaction and main effects of pain intensity and pain catastrophizing on opioid prescription were noted (P < 0.04). Additive modeling revealed sex differences in the relationship between pain catastrophizing, pain intensity, and opioid prescription, such that opioid prescription became more common at lower levels of pain catastrophizing for women than for men.Results supported the conclusion that pain catastrophizing and sex moderate the relationship between pain intensity and opioid prescription. Although men and women patients had similar Pain Catastrophizing Scale scores, historically "subthreshold" levels of pain catastrophizing were significantly associated with opioid prescription only for women patients. These findings suggest that pain intensity and catastrophizing contribute to different patterns of opioid prescription for men and women patients, highlighting a potential need for examination and intervention in future studies.

  View details for DOI 10.1097/ALN.0000000000001656

  View details for PubMedID 28614083

  View details for PubMedCentralID PMC5478434

• Development and Validation of a Daily Pain Catastrophizing Scale. journal of pain Darnall, B. D., Sturgeon, J. A., Cook, K. F., Taub, C. J., Roy, A., Burns, J. W., Sullivan, M., Mackey, S. C. 2017

  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.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.

  View details for DOI 10.1016/j.jpain.2017.05.003

  View details for PubMedID 28528981

• Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis BMJ-BRITISH MEDICAL JOURNAL Sun, E. C., Dixit, A., Humphreys, K., Darnall, B. D., Baker, L. C., Mackey, S. 2017; 356

  Abstract

  Objectives To identify trends in concurrent use of a benzodiazepine and an opioid and to identify the impact of these trends on admissions to hospital and emergency room visits for opioid overdose.Design Retrospective analysis of claims data, 2001-13.Setting Administrative health claims database.Participants 315 428 privately insured people aged 18-64 who were continuously enrolled in a health plan with medical and pharmacy benefits during the study period and who also filled at least one prescription for an opioid.Interventions Concurrent benzodiazepine/opioid use, defined as an overlap of at least one day in the time periods covered by prescriptions for each drug. Main outcome measures Annual percentage of opioid users with concurrent benzodiazepine use; annual incidence of visits to emergency room and inpatient admissions for opioid overdose.Results 9% of opioid users also used a benzodiazepine in 2001, increasing to 17% in 2013 (80% relative increase). This increase was driven mainly by increases among intermittent, as opposed to chronic, opioid users. Compared with opioid users who did not use benzodiazepines, concurrent use of both drugs was associated with an increased risk of an emergency room visit or inpatient admission for opioid overdose (adjusted odds ratio 2.14, 95% confidence interval 2.05 to 2.24; P<0.001) among all opioid users. The adjusted odds ratio for an emergency room visit or inpatient admission for opioid overdose was 1.42 (1.33 to 1.51; P<0.001) for intermittent opioid users and 1.81 (1.67 to 1.96; P<0.001) chronic opioid users. If this association is causal, elimination of concurrent benzodiazepine/opioid use could reduce the risk of emergency room visits related to opioid use and inpatient admissions for opioid overdose by an estimated 15% (95% confidence interval 14 to 16).Conclusions From 2001 to 2013, concurrent benzodiazepine/opioid use sharply increased in a large sample of privately insured patients in the US and significantly contributed to the overall population risk of opioid overdose.

  View details for DOI 10.1136/bmj.j760

  View details for Web of Science ID 000397014900002

  View details for PubMedID 28292769

• The Effect of Pain Catastrophizing on Outcomes: A Developmental Perspective Across Children, Adolescents, and Young Adults With Chronic Pain. journal of pain Feinstein, A. B., Sturgeon, J. A., Darnall, B. D., Dunn, A. L., Rico, T., Kao, M. C., Bhandari, R. P. 2017; 18 (2): 144-154

  Abstract

  Pain catastrophizing is one of the most powerful predictors of poor outcomes in youth and adults with pain; however, little is known about differential effects of pain catastrophizing on outcomes as a function of age. The current study examined the predictive value of pain catastrophizing on pain interference and pain intensity across children, adolescents, and 2 age groups of young adults with chronic pain. Cross-sectional data are presented from the adult and pediatric Collaborative Health Outcomes Information Registry (CHOIR), including measures of pain catastrophizing, pain intensity, pain interference, and emotional distress from 1,028 individuals with chronic pain. Results revealed that age moderated the relation between pain catastrophizing and pain interference, with the strength of these effects declining with age. The effect of pain catastrophizing on pain interference was strongest in adolescents and relatively weak in all 3 other groups. Emotional distress was the strongest predictor of pain interference for children, whereas pain intensity was the strongest predictor for both adult groups. Pain catastrophizing was found to predict pain intensity and, although age was a significant moderator, statistical findings were weak. Developmental considerations and clinical implications regarding the utility of the construct of pain catastrophizing across age groups are discussed.This article explores differences in pain catastrophizing as predictors of pain interference and pain intensity across cohorts of children, adolescents, and 2 age groups of young adults. This work may stimulate further research on chronic pain from a developmental perceptive and inform developmentally tailored treatment interventions that target catastrophizing, emotional distress, and pain intensity.

  View details for DOI 10.1016/j.jpain.2016.10.009

  View details for PubMedID 27825857

• Pain behavior mediates the relationship between perceived injustice and opioid prescription for chronic pain: a Collaborative Health Outcomes Information Registry study JOURNAL OF PAIN RESEARCH Carriere, J. S., Martel, M., Kao, M., Sullivan, M. J., Darnall, B. D. 2017; 10

  Abstract

  Perceived injustice has been defined as an appraisal regarding the severity and irreparability of loss associated with pain, blame and a sense of unfairness. Recent findings have identified perceived injustice as an important risk factor for pain-related outcomes. Studies suggest that perceived injustice is associated with opioid prescription in patients with pain conditions. However, the mechanisms by which perceived injustice is linked to opioid prescription are not well understood. The primary objective of this study was to examine the potential mediating roles of pain intensity, depressive symptoms and pain behavior in the association between perceived injustice and opioid prescription among patients with chronic pain.This cross-sectional study used a sample of 344 patients with chronic pain being treated at a tertiary pain treatment center. Participants completed measures of perceived injustice, pain intensity, depressive symptoms, pain behavior and opioid prescription. Bootstrapped multiple mediation analyses were used to examine the mediating role of patients' pain intensity, depressive symptoms and pain behavior in the association between perceived injustice and opioid prescription.Consistent with previous research, we found a significant association between perceived injustice and opioid prescription. Interestingly, results revealed that pain behavior was the only variable that mediated the association between perceived injustice and opioid prescription.This study was the first to examine the mechanisms by which perceived injustice is associated with opioid prescription in patients with chronic pain. We found that pain behavior, rather than pain intensity and depressive symptoms, mediated the association between perceived injustice and opioid prescription. Future research in this area should employ a longitudinal research design in order to arrive at clearer causal conclusions about the relationships between pain behavior, perceived injustice and opioid prescription.

  View details for DOI 10.2147/JPR.S128184

  View details for Web of Science ID 000396321100001

  View details for PubMedID 28331358

• The relationship between negative metacognitive thoughts, pain catastrophizing, and adjustment to chronic pain Eur J Pain Ziadni, M., Sturgeon, J., Darnall, B. 2017

  View details for DOI 10.1002/ejp.1160

• Effects of a Pain Catastrophizing Induction on Sensory Testing in Women with Chronic Low Back Pain: A Pilot Study PAIN RESEARCH & MANAGEMENT Taub, C. J., Sturgeon, J. A., Johnson, K. A., Mackey, S. C., Darnall, B. D. 2017

  Abstract

  Pain catastrophizing, a pattern of negative cognitive-emotional responses to actual or anticipated pain, maintains chronic pain and undermines response to treatments. Currently, precisely how pain catastrophizing influences pain processing is not well understood. In experimental settings, pain catastrophizing has been associated with amplified pain processing. This study sought to clarify pain processing mechanisms via experimental induction of pain catastrophizing. Forty women with chronic low back pain were assigned in blocks to an experimental condition, either a psychologist-led 10-minute pain catastrophizing induction or a control (10-minute rest period). All participants underwent a baseline round of several quantitative sensory testing (QST) tasks, followed by the pain catastrophizing induction or the rest period, and then a second round of the same QST tasks. The catastrophizing induction appeared to increase state pain catastrophizing levels. Changes in QST pain were detected for two of the QST tasks administered, weighted pin pain and mechanical allodynia. Although there is a need to replicate our preliminary results with a larger sample, study findings suggest a potential relationship between induced pain catastrophizing and central sensitization of pain. Clarification of the mechanisms through which catastrophizing affects pain modulatory systems may yield useful clinical insights into the treatment of chronic pain.

  View details for DOI 10.1155/2017/7892494

  View details for Web of Science ID 000395018300001

  View details for PubMedID 28348505

• Perturbed connectivity of the amygdala and its subregions with the central executive and default mode networks in chronic pain. Pain Jiang, Y., Oathes, D., Hush, J., Darnall, B., Charvat, M., Mackey, S., Etkin, A. 2016; 157 (9): 1970-1978

  Abstract

  Maladaptive responses to pain-related distress, such as pain catastrophizing, amplify the impairments associated with chronic pain. Many of these aspects of chronic pain are similar to affective distress in clinical anxiety disorders. In light of the role of the amygdala in pain and affective distress, disruption of amygdalar functional connectivity in anxiety states, and its implication in the response to noxious stimuli, we investigated amygdala functional connectivity in 17 patients with chronic low back pain and 17 healthy comparison subjects, with respect to normal targets of amygdala subregions (basolateral vs centromedial nuclei), and connectivity to large-scale cognitive-emotional networks, including the default mode network, central executive network, and salience network. We found that patients with chronic pain had exaggerated and abnormal amygdala connectivity with central executive network, which was most exaggerated in patients with the greatest pain catastrophizing. We also found that the normally basolateral-predominant amygdala connectivity to the default mode network was blunted in patients with chronic pain. Our results therefore highlight the importance of the amygdala and its network-level interaction with large-scale cognitive/affective cortical networks in chronic pain, and help link the neurobiological mechanisms of cognitive theories for pain with other clinical states of affective distress.

  View details for DOI 10.1097/j.pain.0000000000000606

  View details for PubMedID 27168362

• Pediatric-Collaborative Health Outcomes Information Registry (Peds-CHOIR): a learning health system to guide pediatric pain research and treatment. Pain Bhandari, R. P., Feinstein, A. B., Huestis, S. E., Krane, E. J., Dunn, A. L., Cohen, L. L., Kao, M. C., Darnall, B. D., Mackey, S. C. 2016; 157 (9): 2033-2044

  Abstract

  The pediatric adaptation of the Collaborative Health Outcomes Information Registry (Peds-CHOIR) is a free, open-source, flexible learning health care system (LHS) that meets the call by the Institute of Medicine for the development of national registries to guide research and precision pain medicine. This report is a technical account of the first application of Peds-CHOIR with 3 aims: (1) to describe the design and implementation process of the LHS; (2) to highlight how the clinical system concurrently cultivates a research platform rich in breadth (eg, clinic characteristics) and depth (eg, unique patient- and caregiver-reporting patterns); and (3) to demonstrate the utility of capturing patient-caregiver dyad data in real time, with dynamic outcomes tracking that informs clinical decisions and delivery of treatments. Technical, financial, and systems-based considerations of Peds-CHOIR are discussed. Cross-sectional retrospective data from patients with chronic pain (N = 352; range, 8-17 years; mean, 13.9 years) and their caregivers are reported, including National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) domains (mobility, pain interference, fatigue, peer relations, anxiety, and depression) and the Pain Catastrophizing Scale. Consistent with the literature, analyses of initial visits revealed impairments across physical, psychological, and social domains. Patients and caregivers evidenced agreement in observable variables (mobility); however, caregivers consistently endorsed greater impairment regarding internal experiences (pain interference, fatigue, peer relations, anxiety, and depression) than patients' self-report. A platform like Peds-CHOIR highlights predictors of chronic pain outcomes on a group level and facilitates individually tailored treatment(s). Challenges of implementation and future directions are discussed.

  View details for DOI 10.1097/j.pain.0000000000000609

  View details for PubMedID 27280328

• Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period. JAMA internal medicine Sun, E. C., Darnall, B. D., Baker, L. C., Mackey, S. 2016; 176 (9): 1286-1293

  Abstract

  Chronic opioid use imposes a substantial burden in terms of morbidity and economic costs. Whether opioid-naive patients undergoing surgery are at increased risk for chronic opioid use is unknown, as are the potential risk factors for chronic opioid use following surgery.To characterize the risk of chronic opioid use among opioid-naive patients following 1 of 11 surgical procedures compared with nonsurgical patients.Retrospective analysis of administrative health claims to determine the association between chronic opioid use and surgery among privately insured patients between January 1, 2001, and December 31, 2013. The data concluded 11 surgical procedures (total knee arthroplasty [TKA], total hip arthroplasty, laparoscopic cholecystectomy, open cholecystectomy, laparoscopic appendectomy, open appendectomy, cesarean delivery, functional endoscopic sinus surgery [FESS], cataract surgery, transurethral prostate resection [TURP], and simple mastectomy). Multivariable logistic regression analysis was performed to control for possible confounders, including sex, age, preoperative history of depression, psychosis, drug or alcohol abuse, and preoperatice use of benzodiazepines, antipsychotics, and antidepressants.One of the 11 study surgical procedures.Chronic opioid use, defined as having filled 10 or more prescriptions or more than 120 days' supply of an opioid in the first year after surgery, excluding the first 90 postoperative days. For nonsurgical patients, chronic opioid use was defined as having filled 10 or more prescriptions or more than 120 days' supply following a randomly assigned "surgery date."The study included 641 941 opioid-naive surgical patients (169 666 men; mean [SD] age, 44.0 [12.8] years), and 18 011 137 opioid-naive nonsurgical patients (8 849 107 men; mean [SD] age, 42.4 [12.6] years). Among the surgical patients, the incidence of chronic opioid in the first preoperative year ranged from 0.119% for Cesarean delivery (95% CI, 0.104%-0.134%) to 1.41% for TKA (95% CI, 1.29%-1.53%) The baseline incidence of chronic opioid use among the nonsurgical patients was 0.136% (95% CI, 0.134%-0.137%). Except for cataract surgery, laparoscopic appendectomy, FESS, and TURP, all of the surgical procedures were associated with an increased risk of chronic opioid use, with odds ratios ranging from 1.28 (95% CI, 1.12-1.46) for cesarean delivery to 5.10 (95% CI, 4.67-5.58) for TKA. Male sex, age older than 50 years, and preoperative history of drug abuse, alcohol abuse, depression, benzodiazepine use, or antidepressant use were associated with chronic opioid use among surgical patients.In opioid-naive patients, many surgical procedures are associated with an increased risk of chronic opioid use in the postoperative period. A certain subset of patients (eg, men, elderly patients) may be particularly vulnerable.

  View details for DOI 10.1001/jamainternmed.2016.3298

  View details for PubMedID 27400458

• Pain Psychology and the Biopsychosocial Model of Pain Treatment: Ethical Imperatives and Social Responsibility. Pain medicine Darnall, B. D., Carr, D. B., Schatman, M. E. 2016

  View details for PubMedID 27425187

• Social Disruption Mediates the Relationship Between Perceived Injustice and Anger in Chronic Pain: a Collaborative Health Outcomes Information Registry Study. Annals of behavioral medicine Sturgeon, J. A., Carriere, J. S., Kao, M. J., Rico, T., Darnall, B. D., Mackey, S. C. 2016: -?

  Abstract

  Perceptions of pain as unfair are a significant risk factor for poorer physical and psychological outcomes in acute injury and chronic pain. Chief among the negative emotions associated with perceived injustice is anger, arising through frustration of personal goals and unmet expectations regarding others' behavior. However, despite a theoretical connection with anger, the social mediators of perceived injustice have not been demonstrated in chronic pain.The current study examined two socially based variables and a broader measure of pain interference as mediators of the relationships between perceived injustice and both anger and pain intensity in a sample of 302 patients in a tertiary care pain clinic setting.Data from the Collaborative Health Outcomes Information Registry (CHOIR) were analyzed using cross-sectional path modeling analyses to examine social isolation, satisfaction with social roles and activities, and pain-related interference as potential mediators of the relationships between perceived injustice and both anger and pain intensity.When modeled simultaneously, ratings of social isolation mediated the relationship between perceived injustice and anger, while pain-related interference and social satisfaction did not. Neither social variable was found to mediate the relationship between perceived injustice and pain intensity, however.The current findings highlight the strongly interpersonal nature of perceived injustice and anger in chronic pain, though these effects do not appear to extend to the intensity of pain itself. Nevertheless, the results highlight the need for interventions that ameliorate both maladaptive cognitive appraisal of pain and pain-related disruptions in social relationships.

  View details for PubMedID 27325314

• (321) Enhanced secondary hyperalgesia following a pain catastrophizing induction in women with chronic low back pain. journal of pain Taub, C., Darnall, B., Johnson, K., Mackey, S. 2016; 17 (4S): S56-?

  View details for DOI 10.1016/j.jpain.2016.01.228

  View details for PubMedID 28162559

• (418) A novel glial cell inhibitor, low dose naltrexone, reduces pain and depression, and improves function in chronic pain: A CHOIR study. journal of pain Noon, K., Sturgeon, J., Kao, M., Darnall, B., Mackey, S. 2016; 17 (4S): S79-?

  View details for DOI 10.1016/j.jpain.2016.01.395

  View details for PubMedID 28162662

• (527) An internet-based perioperative pain psychology treatment program: results of a randomized controlled trial in breast oncology surgery patients. journal of pain Darnall, B., Wheeler, A., Taub, C., MACKEY, I., Wapnir, I., Schultz, C., RICO, T., Flood, P. 2016; 17 (4S): S106-?

  View details for DOI 10.1016/j.jpain.2016.01.334

  View details for PubMedID 28162332

• (489) An examination of the roles of perceived injustice and pain acceptance on pain interference and pain intensity in patients with chronic pain: A Collaborative Health Outcomes Information Registry (CHOIR) Study. journal of pain Carriere, J., Darnall, B., Kao, M., Mackey, S. 2016; 17 (4S): S97-?

  View details for DOI 10.1016/j.jpain.2016.01.296

  View details for PubMedID 28162741

• (162) Social disruption, but not pain interference, mediates the relationship between perceived injustice and anger in chronic pain: A Collaborative Health Outcomes Information Registry (CHOIR) study. journal of pain Sturgeon, J., Carriere, J., Darnall, B., Mackey, S. 2016; 17 (4S): S16-?

  View details for DOI 10.1016/j.jpain.2016.01.065

  View details for PubMedID 28162384

• (448) Perceived injustice, pain behavior and opioid prescriptions: a vicious circle? A Collaborative Health Outcomes Information Registry (CHOIR) Study. journal of pain Carriere, J., Darnall, B., Sullivan, M., Kao, M., Mackey, S. 2016; 17 (4S): S86-?

  View details for DOI 10.1016/j.jpain.2016.01.425

  View details for PubMedID 28162695

• (180) Development and validation of a Daily Pain Catastrophizing Scale (Daily PCS) measure. journal of pain Darnall, B., Sturgeon, J., Cook, K., Taub, C., Kao, M., RICO, T., Mackey, S. 2016; 17 (4S): S20-S21

  View details for DOI 10.1016/j.jpain.2016.01.083

  View details for PubMedID 28162404

• (163) Pain catastrophizing, perceived injustice, and pain intensity impair life satisfaction through differential patterns of physical and psychological disruption. journal of pain Sturgeon, J., Dixon, E., Darnall, B., Mackey, S. 2016; 17 (4S): S16-?

  View details for DOI 10.1016/j.jpain.2016.01.066

  View details for PubMedID 28162385

• Pain Psychology: A Global Needs Assessment and National Call to Action PAIN MEDICINE Darnall, B. D., Scheman, J., Davin, S., Burns, J. W., Murphy, J. L., Wilson, A. C., Kerns, R. D., Mackey, S. C. 2016; 17 (2): 250-263

  Abstract

  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.Prospective, observational, cross-sectional.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).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.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.

  View details for DOI 10.1093/pm/pnv095

  View details for PubMedID 26803844

• Pain Psychology and Pain Catastrophizing in the Perioperative Setting: A Review of Impacts, Interventions, and Unmet Needs. Hand clinics Darnall, B. D. 2016; 32 (1): 33-39

  Abstract

  This article provides a brief overview of the literature on perioperative pain psychology in terms of relevant factors and treatments. Where possible, the content emphasizes hand surgery or hand trauma populations, although this literature is notably limited, as well as the relevant musculoskeletal surgery literature. In addition, gaps in understanding and patient care are identified and discussed.

  View details for DOI 10.1016/j.hcl.2015.08.005

  View details for PubMedID 26611387

  View details for PubMedCentralID PMC4662774

• Conflict of Interest, Part II: Pain Society Leadership and Industry Pain Medicine Schatman, M. E., Darnall, B. D. 2016; 17: 217-8

  View details for DOI 10.1093/pm/pnv041

• The Impact of Pain Catastrophizing on Outcomes: A Developmental Perspective across Children, Adolescents and Young Adults with Chronic Pain Journal of Pain Feinstein, A. B., Sturgeon, J. A., Bhandari, R. P., Dunn, A., Rico, T., Kao, M. C., Darnall, B. D. 2016

  Abstract

  Pain catastrophizing is one of the most powerful predictors of poor outcomes in youth and adults with pain; however, little is known about differential effects of pain catastrophizing on outcomes as a function of age. The current study examined the predictive value of pain catastrophizing on pain interference and pain intensity across children, adolescents, and 2 age groups of young adults with chronic pain. Cross-sectional data are presented from the adult and pediatric Collaborative Health Outcomes Information Registry (CHOIR), including measures of pain catastrophizing, pain intensity, pain interference, and emotional distress from 1,028 individuals with chronic pain. Results revealed that age moderated the relation between pain catastrophizing and pain interference, with the strength of these effects declining with age. The effect of pain catastrophizing on pain interference was strongest in adolescents and relatively weak in all 3 other groups. Emotional distress was the strongest predictor of pain interference for children, whereas pain intensity was the strongest predictor for both adult groups. Pain catastrophizing was found to predict pain intensity and, although age was a significant moderator, statistical findings were weak. Developmental considerations and clinical implications regarding the utility of the construct of pain catastrophizing across age groups are discussed.This article explores differences in pain catastrophizing as predictors of pain interference and pain intensity across cohorts of children, adolescents, and 2 age groups of young adults. This work may stimulate further research on chronic pain from a developmental perceptive and inform developmentally tailored treatment interventions that target catastrophizing, emotional distress, and pain intensity.

  View details for DOI 10.1016/j.jpain.2016.10.009

• Social Disruption Mediates the Relationship Between Perceived Injustice and Anger in Chronic Pain: a Collaborative Health Outcomes Information Registry Study Annals of Behavioral Medicine Sturgeon, J. A., Carriere, J. S., Kao, M. J., Rico, T. J., Darnall, B. D., Mackey, S. C. 2016: 802–12

  Abstract

  Perceptions of pain as unfair are a significant risk factor for poorer physical and psychological outcomes in acute injury and chronic pain. Chief among the negative emotions associated with perceived injustice is anger, arising through frustration of personal goals and unmet expectations regarding others' behavior. However, despite a theoretical connection with anger, the social mediators of perceived injustice have not been demonstrated in chronic pain.The current study examined two socially based variables and a broader measure of pain interference as mediators of the relationships between perceived injustice and both anger and pain intensity in a sample of 302 patients in a tertiary care pain clinic setting.Data from the Collaborative Health Outcomes Information Registry (CHOIR) were analyzed using cross-sectional path modeling analyses to examine social isolation, satisfaction with social roles and activities, and pain-related interference as potential mediators of the relationships between perceived injustice and both anger and pain intensity.When modeled simultaneously, ratings of social isolation mediated the relationship between perceived injustice and anger, while pain-related interference and social satisfaction did not. Neither social variable was found to mediate the relationship between perceived injustice and pain intensity, however.The current findings highlight the strongly interpersonal nature of perceived injustice and anger in chronic pain, though these effects do not appear to extend to the intensity of pain itself. Nevertheless, the results highlight the need for interventions that ameliorate both maladaptive cognitive appraisal of pain and pain-related disruptions in social relationships.

  View details for DOI 10.1007/s12160-016-9808-6

  View details for PubMedCentralID PMC5127748

• "The Opioid-Free Pain Relief Kit: 10 Simple Steps to Ease Your Pain" Darnall, B. D. Bull Publishing. 2016
• Contributions of physical function and satisfaction with social roles to emotional distress in chronic pain: a Collaborative Health Outcomes Information Registry (CHOIR) study PAIN Sturgeon, J. A., Dixon, E. A., Darnall, B. D., Mackey, S. C. 2015; 156 (12): 2627-2633

  Abstract

  Individuals with chronic pain show a greater vulnerability to depression or anger than those without chronic pain, and also show greater interpersonal difficulties and physical disability. The current study examined data from 675 individuals with chronic pain during their initial visits to a tertiary care pain clinic using assessments from Stanford University's Collaborative Health Outcomes Information Registry (CHOIR). Using a path modeling analysis, the mediating roles of PROMIS Physical Function and PROMIS Satisfaction with Social Roles and Activities were tested between pain intensity and PROMIS Depression and Anger. Pain intensity significantly predicted both depression and anger, and both physical function and satisfaction with social roles mediated these relationships when modeled in separate 1-mediator models. Notably, however, when modeled together, ratings of satisfaction with social roles mediated the relationship between physical function and both anger and depression. Our results suggest that the process by which chronic pain disrupts emotional well-being involves both physical function and disrupted social functioning. However, the more salient factor in determining pain-related emotional distress appears to be disruption of social relationships, rather than global physical impairment. These results highlight the particular importance of social factors to pain-related distress, and highlight social functioning as an important target for clinical intervention in chronic pain.

  View details for DOI 10.1097/j.pain.0000000000000313

  View details for Web of Science ID 000365598300028

  View details for PubMedID 26230739

• "Compassion Cultivation in Chronic Pain May Reduce Anger, Pain, and Increase Acceptance: Study Review and Brief Commentary". Health care. Current reviews Darnall, B. D. 2015; 3 (2)

  View details for PubMedID 26985456

• Toward the Healthiest Symbiosis. Pain medicine Darnall, B. D., Schatman, M. E. 2015; 16 (7): 1254-1255

  View details for DOI 10.1111/pme.12828_3

  View details for PubMedID 26133016

• The Relationship Between Industry and Pain Societies, Part 1: Demystification and Legitimization of Continuing Medical Education PAIN MEDICINE Darnall, B. D., Schatman, M. E. 2015; 16 (7): 1251-1251

  View details for DOI 10.1111/pme.12828

  View details for Web of Science ID 000358017000004

  View details for PubMedID 26138746

• Protecting the infant from unknown risks. Pain medicine Darnall, B. D., Schatman, M. E. 2015; 16 (4): 631-632

  View details for DOI 10.1111/pme.12718_4

  View details for PubMedID 25832321

• Sub-clinical range of pain catastrophizing moderates the effect of pain intensity on opioid prescription Sharifzadeh, Y., Darnall, B., Kao, M., Mackey, S. CHURCHILL LIVINGSTONE. 2015: S16–S16

  View details for Web of Science ID 000352748600065

• Opioid use and lactation: protecting the child in the context of maternal pain care. Pain medicine Darnall, B. D., Schatman, M. E. 2015; 16 (4): 628-?

  View details for DOI 10.1111/pme.12718

  View details for PubMedID 25766069

• Physical and psychological correlates of fatigue and physical function: a Collaborative Health Outcomes Information Registry (CHOIR) study. journal of pain Sturgeon, J. A., Darnall, B. D., Kao, M. J., Mackey, S. C. 2015; 16 (3): 291-8 e1

  Abstract

  Fatigue is a multidimensional construct that has significant implications for physical function in chronic non-cancer pain populations but remains relatively understudied. The current study characterized the independent contributions of self-reported ratings of pain intensity, sleep disturbance, depression, and fatigue to ratings of physical function and pain-related interference in a diverse sample of treatment-seeking individuals with chronic pain. Methods: These relationships were examined as a path modeling analysis of self-report scores obtained from 2,487 individuals with chronic pain from a tertiary care outpatient pain clinic.Our analyses revealed unique relationships of pain intensity, sleep disturbance, and depression with self-reported fatigue. Further, fatigue scores accounted for significant proportions of the relationships of both pain intensity and depression with physical function and pain-related interference, and accounted for the entirety of the unique statistical relationship between sleep disturbance and both physical function and pain-related interference.Fatigue is a complex construct with relationships to both physical and psychological factors that has significant implications for physical functioning in chronic non-cancer pain. The current results identify potential targets for future treatment of fatigue in chronic pain, and may provide directions for future clinical and theoretical research in the area of chronic non-cancer pain.Fatigue is an important physical and psychological variable that factors prominently in the deleterious consequences of pain intensity, sleep disturbance, and depression for physical function in chronic non-cancer pain.

  View details for DOI 10.1016/j.jpain.2014.12.004

  View details for PubMedID 25536536

• Physical and Psychological Correlates of Fatigue and Physical Function: A Collaborative Health Outcomes Information Registry (CHOIR) Study. journal of pain Sturgeon, J. A., Darnall, B. D., Kao, M. J., Mackey, S. C. 2015; 16 (3): 291-298 e1

  Abstract

  Fatigue is a multidimensional construct that has significant implications for physical function in chronic non-cancer pain populations but remains relatively understudied. The current study characterized the independent contributions of self-reported ratings of pain intensity, sleep disturbance, depression, and fatigue to ratings of physical function and pain-related interference in a diverse sample of treatment-seeking individuals with chronic pain. Methods: These relationships were examined as a path modeling analysis of self-report scores obtained from 2,487 individuals with chronic pain from a tertiary care outpatient pain clinic.Our analyses revealed unique relationships of pain intensity, sleep disturbance, and depression with self-reported fatigue. Further, fatigue scores accounted for significant proportions of the relationships of both pain intensity and depression with physical function and pain-related interference, and accounted for the entirety of the unique statistical relationship between sleep disturbance and both physical function and pain-related interference.Fatigue is a complex construct with relationships to both physical and psychological factors that has significant implications for physical functioning in chronic non-cancer pain. The current results identify potential targets for future treatment of fatigue in chronic pain, and may provide directions for future clinical and theoretical research in the area of chronic non-cancer pain.Fatigue is an important physical and psychological variable that factors prominently in the deleterious consequences of pain intensity, sleep disturbance, and depression for physical function in chronic non-cancer pain.

  View details for DOI 10.1016/j.jpain.2014.12.004

  View details for PubMedID 25536536

• Compassion Cultivation in Chronic Pain May Reduce Anger, Pain, and Increase Acceptance: Review and Commentary Health Care: Current Reviews Darnall, B. D. 2015; 3 (1)
• Reader Responses to the Ethics Forum: Room for Multiple Perspectives PAIN MEDICINE Schatman, M. E., Darnall, B. D. 2015; 16 (1): 18

  View details for DOI 10.1111/pme.12684

  View details for Web of Science ID 000348732200004

  View details for PubMedID 25597435

• Urine drug screening: necessary or alienating? Pain medicine Darnall, B. D., Schatman, M. E. 2014; 15 (12): 1999-?

  View details for DOI 10.1111/pme.12604

  View details for PubMedID 25376375

• Urine drug screening: opioid risks preclude complete patient autonomy. Pain medicine Darnall, B. D., Schatman, M. E. 2014; 15 (12): 2001-2002

  View details for DOI 10.1111/pme.12604_4

  View details for PubMedID 25376661

• Intrathecal Opioids for Chronic Nonmalignant Pain: A Case Study and the Search for Balance PAIN MEDICINE Schatman, M. E., Darnall, B. D. 2014; 15 (8): 1268-1268

  View details for DOI 10.1111/pme.12494

  View details for Web of Science ID 000342630800005

  View details for PubMedID 25091712

• Intrathecal Opioids: Hardly a Panacea PAIN MEDICINE Schatman, M. E., Darnall, B. D. 2014; 15 (8): 1270-1271

  View details for DOI 10.1111/pme.12494_4

  View details for Web of Science ID 000342630800008

  View details for PubMedID 25092110

• Minimize opioids by optimizing pain psychology. Pain management Darnall, B. D. 2014; 4 (4): 251-253

  View details for DOI 10.2217/pmt.14.18

  View details for PubMedID 25300380

  View details for PubMedCentralID PMC4549152

• Compassion meditation training for people living with chronic pain and their significant others: a pilot study and mixed-methods analysis Ruchelli, G., Chapin, H., Darnall, B., Seppala, E., Doty, J., Mackey, S. CHURCHILL LIVINGSTONE. 2014: S117–S117

  View details for Web of Science ID 000334648700465

• The Needle and the Damage Done? PAIN MEDICINE Schatman, M. E., Darnall, B. D. 2014; 15 (4): 546-547

  View details for DOI 10.1111/pme.12414_4

  View details for Web of Science ID 000334111300006

  View details for PubMedID 24635998

• Stanford-NIH Pain Registry: open source platform for large-scale longitudinal assessment and tracking of modern patient-reported outcomes Kao, M., Weber, S., Cook, K., Garrick, O., Pacht, T., Darnall, B., Mackey, S. CHURCHILL LIVINGSTONE. 2014: S40–S40

  View details for Web of Science ID 000334648700158

• Stanford-NIH Pain Registry: catalyzing the rate limited step of psychometrics with modern patient-reported outcomes Kao, M., Cook, K., Olson, G., Pacht, T., Darnall, B., Weber, S., Mackey, S. CHURCHILL LIVINGSTONE. 2014: S3–S3

  View details for Web of Science ID 000334648700012

• Less Pain, Fewer Pills: Avoid the dangers of prescription opioids and gain control over chronic pain Darnall, B. D. Bull Publishing. 2014
• Pilot study of a compassion meditation intervention in chronic pain. Journal of compassionate health care Chapin, H. L., Darnall, B. D., Seppala, E. M., Doty, J. R., Hah, J. M., Mackey, S. C. 2014; 1

  Abstract

  The emergence of anger as an important predictor of chronic pain outcomes suggests that treatments that target anger may be particularly useful within the context of chronic pain. Eastern traditions prescribe compassion cultivation to treat persistent anger. Compassion cultivation has been shown to influence emotional processing and reduce negativity bias in the contexts of emotional and physical discomfort, thus suggesting it may be beneficial as a dual treatment for pain and anger. Our objective was to conduct a pilot study of a 9-week group compassion cultivation intervention in chronic pain to examine its effect on pain severity, anger, pain acceptance and pain-related interference. We also aimed to describe observer ratings provided by patients' significant others and secondary effects of the intervention.Pilot clinical trial with repeated measures design that included a within-subjects wait-list control period. Twelve chronic pain patients completed the intervention (F= 10). Data were collected from patients at enrollment, treatment baseline and post-treatment; participant significant others contributed data at the enrollment and post-treatment time points.In this predominantly female sample, patients had significantly reduced pain severity and anger and increased pain acceptance at post-treatment compared to treatment baseline. Significant other qualitative data corroborated patient reports for reductions in pain severity and anger.Compassion meditation may be a useful adjunctive treatment for reducing pain severity and anger, and for increasing chronic pain acceptance. Patient reported reductions in anger were corroborated by their significant others. The significant other corroborations offer a novel contribution to the literature and highlight the observable emotional and behavioral changes in the patient participants that occurred following the compassion intervention. Future studies may further examine how anger reductions impact relationships with self and others within the context of chronic pain.

  View details for PubMedID 27499883

• Proinflammatory cytokines and DHEA-S in women with fibromyalgia: impact of psychological distress and menopausal status JOURNAL OF PAIN RESEARCH Sturgeon, J. A., Darnall, B. D., Zwickey, H. L., Wood, L. J., Hanes, D. A., Zava, D. T., Mackey, S. C. 2014; 7: 707-716

  Abstract

  Though fibromyalgia is not traditionally considered an inflammatory disorder, evidence for elevated inflammatory processes has been noted in this disorder in multiple studies. Support for inflammatory markers in fibromyalgia has been somewhat equivocal to date, potentially due to inattention to salient patient characteristics that may affect inflammation, such as psychiatric distress and aging milestones like menopause. The current study examined the relationships between proinflammatory cytokines and hormone levels, pain intensity, and psychological distress in a sample of 34 premenopausal and postmenopausal women with fibromyalgia. Our results indicated significant relationships between interleukin-8 and ratings of pain catastrophizing (r=0.555, P<0.05), pain anxiety (r=0.559, P<0.05), and depression (r=0.551, P<0.05) for postmenopausal women but not premenopausal women (r,0.20 in all cases). Consistent with previous studies, ratios of interleukin-6 to interleukin-10 were significantly lower in individuals with greater levels of depressive symptoms (r=-0.239, P<0.05). Contrary to previous research, however, dehydroepiandrosterone sulfate did not correlate with pain intensity or psychological or biological variables. The results of the current study highlight the importance of psychological functioning and milestones of aging in the examination of inflammatory processes in fibromyalgia.

  View details for DOI 10.2147/JPR.S71344

  View details for Web of Science ID 000364591400001

  View details for PubMedID 25506243

• From Catastrophizing to Recovery: a pilot study of a single-session treatment for pain catastrophizing JOURNAL OF PAIN RESEARCH Darnall, B. D., Sturgeon, J. A., Kao, M., Hah, J. M., Mackey, S. C. 2014; 7: 219-226

  Abstract

  Pain catastrophizing (PC) - a pattern of negative cognitive-emotional responses to real or anticipated pain - maintains chronic pain and undermines medical treatments. Standard PC treatment involves multiple sessions of cognitive behavioral therapy. To provide efficient treatment, we developed a single-session, 2-hour class that solely treats PC entitled "From Catastrophizing to Recovery" [FCR].To determine 1) feasibility of FCR; 2) participant ratings for acceptability, understandability, satisfaction, and likelihood to use the information learned; and 3) preliminary efficacy of FCR for reducing PC.Uncontrolled prospective pilot trial with a retrospective chart and database review component. Seventy-six patients receiving care at an outpatient pain clinic (the Stanford Pain Management Center) attended the class as free treatment and 70 attendees completed and returned an anonymous survey immediately post-class. The Pain Catastrophizing Scale (PCS) was administered at class check-in (baseline) and at 2, and 4 weeks post-treatment. Within subjects repeated measures analysis of variance (ANOVA) with Student's t-test contrasts were used to compare scores across time points.All attendees who completed a baseline PCS were included as study participants (N=57; F=82%; mean age =50.2 years); PCS was completed by 46 participants at week 2 and 35 participants at week 4. Participants had significantly reduced PC at both time points (P<0001) and large effect sizes were found (Cohen's d=0.85 and d=1.15).Preliminary data suggest that FCR is an acceptable and effective treatment for PC. Larger, controlled studies of longer duration are needed to determine durability of response, factors contributing to response, and the impact on pain, function and quality of life.

  View details for DOI 10.2147/JPR.S62329

  View details for Web of Science ID 000364587600005

  View details for PubMedID 24851056

  View details for PubMedCentralID PMC4008292

• Pain CME: Misguided Direction? PAIN MEDICINE Schatman, M. E., Darnall, B. D. 2013; 14 (12): 1824-1825

  View details for DOI 10.1111/pme.12285_4

  View details for Web of Science ID 000328349400006

• "Just Saying No" to Mandatory Pain CME: How Important Is Physician Autonomy? PAIN MEDICINE Schatman, M. E., Darnall, B. D. 2013; 14 (12): 1821

  View details for DOI 10.1111/pme.12285

  View details for Web of Science ID 000328349400003

• Upscheduling of Hydrocodone: Convenience and Access vs Patient Safety Measures PAIN MEDICINE Schatman, M. E., Darnall, B. D. 2013; 14 (11): 1627-1627

  View details for DOI 10.1111/pme.12257

  View details for Web of Science ID 000327011600004

  View details for PubMedID 24238351

  View details for PubMedCentralID PMC4800973

• Among Disparate Views, Scales Tipped by the Ethics of System Integrity PAIN MEDICINE Schatman, M. E., Darnall, B. D. 2013; 14 (11): 1629-1630

  View details for DOI 10.1111/pme.12257_4

  View details for Web of Science ID 000327011600007

  View details for PubMedID 24238354

• Medical marijuana: a viable tool in the armamentaria of physicians treating chronic pain? A case study and commentary. Pain medicine Schatman, M. E., Darnall, B. D. 2013; 14 (6): 799-?

  View details for DOI 10.1111/pme.12137

  View details for PubMedID 23647910

• Ethical Pain Care in a Complex Case PAIN MEDICINE Schatman, M. E., Darnall, B. D. 2013; 14 (6)

  View details for DOI 10.1111/pme.12137_2

  View details for Web of Science ID 000320730000006

• A Pendulum Swings Awry: Seeking the Middle Ground on Opioid Prescribing for Chronic Non-Cancer Pain PAIN MEDICINE Schatman, M. E., Darnall, B. D. 2013; 14 (5)

  View details for Web of Science ID 000319279800032

  View details for PubMedID 23581746

• Commentary and Rapprochement PAIN MEDICINE Schatman, M. E., Darnall, B. D. 2013; 14 (5)

  View details for Web of Science ID 000319279800035

• Medical and Psychological Risks and Consequences of Long-Term Opioid Therapy in Women PAIN MEDICINE Darnall, B. D., Stacey, B. R., Chou, R. 2012; 13 (9): 1181-1211

  Abstract

  Long-term opioid use has increased substantially over the past decade for U.S. women. Women are more likely than men to have a chronic pain condition, to be treated with opioids, and may receive higher doses. Prescribing trends persist despite limited evidence to support the long-term benefit of this pain treatment approach.To review the medical and psychological risks and consequences of long-term opioid therapy in women.Scientific literature containing relevant keywords and content were reviewed.Long-term opioid use exposes women to unique risks, including endocrinopathy, reduced fertility, neonatal risks, as well as greater risk for polypharmacy, cardiac risks, poisoning and unintentional overdose, among other risks. Risks for women appear to vary by age and psychosocial factors may be bidirectionally related to opioid use. Gaps in understanding and priorities for future research are highlighted.

  View details for DOI 10.1111/j.1526-4637.2012.01467.x

  View details for PubMedID 22905834

• Pain Characteristics and Pain Catastrophizing in Incarcerated Women with Chronic Pain JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED Darnall, B. D., Sazie, E. 2012; 23 (2): 543-556

  Abstract

  Chronic pain in incarcerated women is understudied and poorly described. Study objectives were to describe pain characteristics, correlates, and predictors in a convenience sample of incarcerated women with chronic pain. A survey packet that included the Brief Pain Inventory Short Form (BPI-SF) and the Pain Catastrophizing Scale (PCS) was distributed to all inmates at a state prison for women. Those who self-identified as having chronic pain ≥4 on a 0-10 numeric rating scale were invited to complete the survey. Demographics and medical and psychiatric diagnoses were abstracted by chart review. Participants (N=159) rated their current and average pain intensity as severe. Pain catastrophizing was found to predict average pain intensity and level of pain-related interference in functioning. Pain catastrophizing is treatable with behavioral intervention in the general population. Findings suggest that pain catastrophizing may be an important target for research and treatment in incarcerated women with chronic pain.

  View details for PubMedID 22643606

• Sex Differences in Long-term Opioid Use Cautionary Notes for Prescribing in Women ARCHIVES OF INTERNAL MEDICINE Darnall, B. D., Stacey, B. R. 2012; 172 (5): 431-432

  View details for PubMedID 22412108

• HOME-BASED SELF-DELIVERED MIRROR THERAPY FOR PHANTOM PAIN: A PILOT STUDY JOURNAL OF REHABILITATION MEDICINE Darnall, B. D., Li, H. 2012; 44 (3): 254-260

  Abstract

  To test the feasibility and preliminary efficacy of self-delivered home-based mirror therapy for phantom pain.Uncontrolled prospective treatment outcome pilot study.Forty community-dwelling adults with unilateral amputation and phantom pain > 3 on a 0-10 numeric rating scale enrolled either during a one-time study visit (n = 30) or remotely (n = 10).Participants received an explanation of mirror therapy and were asked to self-treat for 25 min daily. Participants completed and posted back sets of outcomes questionnaires at months 1 and 2 post-treatment. Main outcome was average phantom pain intensity at post-treatment.A significant reduction in average phantom pain intensity was found at month 1 (n = 31, p = 0.0002) and at month 2 (n = 26, p = 0.002). The overall median percentage reduction at month 2 was 15.4%. Subjects with high education (> 16 years) compared with low education (< 16 years) (37.5% vs 4.1%) had greater reduction in pain intensity (p = 0.01).These findings support the feasibility and efficacy of home-based self-delivered mirror therapy; this low-cost treatment may defray medical costs, therapy visits, and the patient travel burden for people with motivation and a high level of education. More research is needed to determine methods of cost-effective support for people with lower levels of education.

  View details for DOI 10.2340/16501977-0933

  View details for PubMedID 22378591

• Hysterectomy and Predictors for Opioid Prescription in a Chronic Pain Clinic Sample PAIN MEDICINE Darnall, B., Li, H. 2011; 12 (2): 196-203

  Abstract

  To describe the prevalence of hysterectomy for women aged 18-45 seeking treatment at a chronic pain clinic, to describe patient characteristics (pain intensity, age, smoking status, hormone replacement status, and psychosocial factors) based on opioid and hysterectomy status, and to determine whether hysterectomy status predicted receipt of opioid prescription.Retrospective cross-sectional chart review.Total 323 new female patients aged 18-45 who completed the Brief Pain Inventory-Short Form at initial evaluation at a chronic pain clinic during a 12-month period (July 2008-June 2009).Data were collected from the Brief Pain Inventory and medical charts. Variables included opioid prescription, average pain intensity, pain type, age, hysterectomy status, smoking status, and pain-related dysfunction across domains measured by the Brief Pain Inventory. The association of opioid prescription with hysterectomy and other factors were determined by logistic regression.Prevalence of hysterectomy was 28.8%. Average pain intensity was not associated with either hysterectomy or opioid prescription status. However, hysterectomy and high levels of pain-related dysfunction were significantly and independently associated with opioid prescription after adjusting for age and pain intensity. More than 85% of women with hysterectomy and high pain-related dysfunction had opioid prescription.Hysterectomy may confer risk for pain-related dysfunction and opioid prescription in women 45 and younger. More research is needed to understand 1) how patient characteristics influence prescribing patterns and 2) the specific medical risks and consequences of chronic opioid therapy in this population.

  View details for DOI 10.1111/j.1526-4637.2010.01038.x

  View details for PubMedID 21223499

• Pilot Study of Inflammatory Responses Following a Negative Imaginal Focus in Persons With Chronic Pain: Analysis by Sex/Gender GENDER MEDICINE Darnall, B. D., Aickin, M., Zwickey, H. 2010; 7 (3): 247-260

  Abstract

  Recent evidence suggests that differential stress and immune responses may play a role in the sex/gender disparity for pain. Pain pathology and psychological stress are both associated with elevated levels of proinflammatory cytokines.This pilot study tested a negative imaginal focus to assess whether it would elicit a proinflammatory cytokine response and whether responses would vary by sex/gender.Adults with chronic musculoskeletal pain were recruited from an outpatient, multidisciplinary pain clinic in Portland, Oregon, between 2007 and 2008. All participants underwent a psychologist-guided 10-minute focus on the negative aspects of their pain condition and the imagined worsening of their pain; no control group was used. Serum collected at baseline and postfocus (1, 2, and 2.5 hours) was assayed for interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha). Cortisol was assayed at each time point and at 15 minutes postfocus.Thirty-six outpatients (aged 26-62 years; 23 women, 13 men) participated in the study. Compared with men, women displayed greater negative emotional expression during the experiment, and this in turn mediated their IL-6 inflammatory responses. Relative to men, the IL-6 response trajectory was delayed for women. The IL-6 and TNF-a findings suggest women's maximal cytokine responses were not captured by the final time point.This pilot study provides preliminary evidence that women with chronic pain may experience increased and delayed inflammatory responses following negative emotional expression induced by thinking negatively about their pain condition. The findings have implications for pain catastrophizing research. This early-phase research suggests that the timing and duration of the cytokine response are critical factors to consider in future pain research.

  View details for DOI 10.1016/j.genm.2010.06.003

  View details for PubMedID 20638630

• Sex and gender in psychoneuroimmunology research: Past, present and future BRAIN BEHAVIOR AND IMMUNITY Darnall, B. D., Suarez, E. C. 2009; 23 (5): 595-604

  Abstract

  To date, research suggests that sex and gender impact pathways central to the foci of psychoneuroimmunology (PNI). This review provides a historical perspective on the evolution of sex and gender in psychoneuroimmunology research. Gender and sexually dimorphic pathways may have synergistic effects on health differences in men and women. We provide an overview of the literature of sex and gender differences in brain structure and function, sex steroids, gender role identification, hypothalamic-pituitary-adrenal axis function, genetics, immunology and cytokine response. Specific examples shed light on the importance of attending to sex and gender methodology in PNI research and recommendations are provided.

  View details for DOI 10.1016/j.bbi.2009.02.019

  View details for PubMedID 19272440

• Self-Delivered Home-Based Mirror Therapy for Lower Limb Phantom Pain AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION Darnall, B. D. 2009; 88 (1): 78-81

  Abstract

  Home-based patient-delivered mirror therapy is a promising approach in the treatment of phantom limb pain. Previous studies and case reports of mirror therapy have used a therapist-guided, structured protocol of exercises. No case report has described treatment for either upper or lower limb phantom pain by using home-based patient-delivered mirror therapy. The success of this case demonstrates that home-based patient-delivered mirror therapy may be an efficacious, low-cost treatment option that would eliminate many traditional barriers to care.

  View details for DOI 10.1097/PHM.0b013e318191105b

  View details for PubMedID 19096290

• Depressive symptoms and mental health service utilization among persons with limb loss: results of a national survey. Archives of physical medicine and rehabilitation Darnall, B. D., Ephraim, P., Wegener, S. T., Dillingham, T., Pezzin, L., Rossbach, P., MacKenzie, E. J. 2005; 86 (4): 650-658

  Abstract

  To describe the prevalence of depressive symptoms, risk factors, and mental health service utilization in a national limb-loss sample.Cross-sectional survey.Participants were interviewed by telephone.A stratified sample by etiology of 914 persons with limb loss, derived from people who contacted the Amputee Coalition of America from 1998 to 2000.Not applicable.Center for Epidemiologic Study Depression Scale (CES-D 10-item), pain bothersomeness, characteristics of the amputation, sociodemographics, and mental health service utilization.Prevalence for significant depressive symptoms (CES-D score, >/=10) was 28.7%. Risk factors included being divorced or separated, living at the near-poverty level, having comorbid conditions, being somewhat bothered or extremely bothered by back pain and phantom limb pain, and having residual limb pain for persons aged 18 to 54. Having higher education was a buffer against depressive symptoms. Almost 22% of the sample and 44.6% of persons with significant depressive symptoms received mental health service in the previous year. For persons with significant depressive symptoms, 32.9% reported needing mental health service but not receiving them, and 67.1% reported not needing mental health service.Depressive symptoms are prevalent among persons with limb loss. Proper management of pain and medical comorbidity may mitigate depressive symptoms. Education about depressive symptoms and treatment options may improve receipt of mental health service among persons with limb loss reporting significant levels of depressive symptoms.

  View details for PubMedID 15827913

• Depressive symptoms among persons with and mental health service utilization limb loss: Results of a national survey Rehabilitation Psychology Winter Conference Darnall, B. D., Ephraim, P., Wegener, S. T., Dillingham, T., Pezzin, L., Rossbach, P., MacKenzie, E. J. W B SAUNDERS CO-ELSEVIER INC. 2005: 650–58

  View details for DOI 10.1016/j.apmr.2004.10.028

  View details for Web of Science ID 000228237300006

• Modification of the cognitive model for bulimia via path analysis on a Brazilian adolescent sample ADDICTIVE BEHAVIORS Darnall, B. D., Smith, J. E., Craighead, L. W., Lamounier, J. A. 1999; 24 (1): 47-57

  Abstract

  Eating disturbances in middle-class Brazilian adolescents attending three high schools (one Military, two Private schools) were investigated. Participants from both Private schools were similar to U.S. samples on the EAT-26. Path analysis on the Private schools revealed the following. Higher body weight leads to weight concerns most strongly through greater discrepancy from the ideal, but it also leads directly to weight concern. Thus, both the reality of being heavier and the perception that one is larger than ideal (which could be due to being heavier and/or having a thin ideal) contribute to weight concern. Greater weight concern is associated most directly with lower self-esteem, which in turn is associated with endorsing greater importance of weight and shape. Importance of weight and shape contributes most powerfully to eating pathology through dieting, but this variable has a modest direct effect as well. These paths were not significant for the Military school sample in which participants reported lower levels of weight concern, dieting, body dissatisfaction, and a larger ideal figure. However, the Military sample rated importance of weight and shape as high as did Private-school participants. The results provide support for variables identified as important in the cognitive model of bulimia and suggest the model may be enhanced by including body weight and one's perceived ideal body shape as additional variables.

  View details for Web of Science ID 000077732100004

  View details for PubMedID 10189972