Troy Christopher Dildine

All Publications

• Empowered Relief vs Cognitive Behavioral Therapy for Patients With Systemic Lupus Erythematosus and Chronic Pain: Study Protocol for a National, Randomized, Noninferiority Trial. JMIR research protocols Falasinnu, T., Hailu, A. Y., Monson, E. A., Clifton, J., Torres, C., Dildine, T. C., Dorsonne, B., Heggan, E., Riazi, G., Slater, K., Poupore-King, H., Perez, L., Hellewell, J., Tian, L., Denton, S., DeVries, A., Miefert, J., Mackey, S. C., Cheung, M., Darnall, B. D. 2026; 15: e100104

  Abstract

  Systemic lupus erythematosus (SLE) presents substantial life challenges, reflecting the complex and heterogeneous nature of the disease. Pain is common and often one of the earliest manifestations. Skill-based behavioral pain treatments are often inaccessible to patients with SLE, and no SLE-specific evidence exists to guide patient and clinician treatment choices. To fill a pressing evidence gap for SLE pain treatment, the Lupus PROGRESS (Pain Relief With Online Groups That Empower Skill-Based Symptom Reduction) trial will compare a lower-burden evidence-based behavioral pain treatment with online multisession cognitive behavioral therapy (CBT; the gold standard behavioral treatment for chronic pain) while also enhancing diversity and representativeness among patient advisors and study participants.Lupus PROGRESS is a national, pragmatic, randomized noninferiority trial comparing the effectiveness of 2 evidence-based behavioral pain treatments (online 8-session CBT vs 1 session the Empowered Relief program; Stanford University) in adults with SLE and chronic pain in the United States for reducing pain intensity and pain interference at 3 months after treatment (multiple primary end points).In total, 150 adults with SLE and pain (≥3 months, intensity of ≥3/10) will be enrolled from academic medicine, community health network, and insurance payer study sites. Participants are randomized 1:1 to either 1-session Empowered Relief or 8-session CBT, with both treatments delivered online to groups. Mixed-model repeated measures and intention-to-treat analytic approaches will be used to test comparative effectiveness aims from baseline to 3 months after treatment (the primary end point). Multiple primary outcomes are pain intensity and pain interference; priority secondary outcomes are sleep disturbance, pain catastrophizing, pain bothersomeness, and anxiety; and other secondary outcomes are satisfaction with roles and responsibilities and global impression of change, anger, fatigue, and depression. Durability of effects will be tested at 6 months after treatment. Empowered Relief is hypothesized to have superior treatment completion and adherence and lower treatment burden ratings than CBT. In exploratory analyses, we will compare health care use through medical record and claims data 3 months prior to enrollment to the last 3 study months, hypothesizing reduced noninferiority in reduced use. The study also incorporates a multilevel patient engagement infrastructure to improve accessibility, recruitment, and study relevance.As of May 2026, we have enrolled 130 participants. Enrollment is anticipated to end in November 2026, with treatments completed by April 2027 and full analyses completed by February 2028.Lupus PROGRESS will provide real-world pragmatic evidence on whether a 1-session online group skill-based treatment is noninferior to 8-session CBT. Results from this patient-centered study will inform more accessible, equitable, and patient-centered chronic pain care for people living with lupus.ClinicalTrials.gov NCT05612750; https://clinicaltrials.gov/study/NCT05612750.DERR1-10.2196/100104.

  View details for DOI 10.2196/100104

  View details for PubMedID 42641149

• Assessing Pain Catastrophizing Through Free-Text Responses: A Validation of Large Language Models. medRxiv : the preprint server for health sciences Lee, A., You, D. S., Dildine, T. C. 2026

  Abstract

  Validated measures of pain catastrophizing primarily assess catastrophizing as a stable trait. However, emerging evidence suggests catastrophizing fluctuates with context, highlighting a need for ecologically valid methods to capture it. This study evaluated large language models (LLMs) as implicit markers of catastrophizing from free-text responses from ninety-one adults with chronic pain receiving long-term opioid therapy (57.3% Female; mean age = 60.5 years). Patients completed baseline measures, including the trait pain catastrophizing scale (PCS), followed by a 10-minute writing task after random assignment to a negative, positive, or neutral pain-coping condition. State affect and pain were assessed before and after writing tasks and again after a cold pressor task (4°C; ≤ 2 minutes). A state PCS followed the cold pressor task. Free-text responses were analyzed using four LLMs (Claude Opus 4; GPT Mini 4o; Llama 4 Maverick; and Gemini 2.5 Pro). ANOVA-based results supported discriminant validity, as all four LLM-derived pain catastrophizing scores differentiated negative from positive and neutral pain-coping conditions. Convergent validity was model-dependent; only Gemini-derived scores correlated with state catastrophizing (r = .22) and pain unpleasantness (r = .23). Divergent validity was mixed. LLM-derived scores were unrelated to pain intensity, but Gemini and Claude-derived scores showed small correlations with trait PCS (r's = .21; 28, respectively). All LLM-derived scores also correlated with negative affect (r's = .29-.41), comparable in magnitude to state PCS, suggesting limited specificity. These findings provide preliminary evidence that certain LLMs may serve as implicit markers of state pain catastrophizing, but further study is needed.

  View details for DOI 10.64898/2026.07.22.26358710

  View details for PubMedID 42539054

  View details for PubMedCentralID PMC13419553

• Latent Classes of Pain Treatment Utilization at a Tertiary Pain Clinic: A Cross-Sectional Study. Pain medicine (Malden, Mass.) You, D. S., Dildine, T. C., Lannon, E., Kim, S., Chike, O., Weber, K. A., Falasinnu, T., Mackey, S. C. 2026

  Abstract

  Chronic pain, particularly high-impact chronic pain (HICP), poses substantial health burdens for older adults. Multimodal and multidisciplinary treatments (MMT) are recommended for chronic pain, yet their utilization across age and HICP status remains unclear. This study examined current treatment utilization patterns and associated health status among younger (< 65) and older (≥ 65) adults, with and without HICP, at a tertiary pain clinic.Cross-sectional data (N = 347; 34% older adults; 57% HICP) were analyzed. HICP was defined using the Graded Chronic Pain Scale-Revised. Health status was assessed using PROMIS measures. Latent class analysis identified treatment utilization subgroups. Logistic regression examined whether age, HICP, or their interaction predicted group membership. One-way ANOVAs compared health status across classes.Three treatment patterns emerged: Class 1 (60%), primarily using non-opioid medication; Class 2 (29%), primarily using opioid medication; and Class 3 (11%), utilizing MMT (movement-based therapy, pain psychology, and other modalities). Older age and HICP were associated with an increased likelihood of Class 2 membership, but not with Class 3 membership. The age by HICP interaction was not significant. Compared to Class 1, Class 2 reported worse pain, pain interference, and physical function, while Class 3 reported greater pain interference, fatigue, and psychosocial distress.MMT uptake was low and unrelated to age or HICP status. Patients using MMT exhibited greater symptom burden, suggesting that those with complex presentations are more likely to engage in MMT. Longitudinal studies are needed to determine whether MMT reduces symptom burden over time.

  View details for DOI 10.1093/pm/pnag085

  View details for PubMedID 42429543

• Applying an Intersectional Framework to Characterize Chronic Pain Disparities One Year Following Traumatic Spinal Cord Injury. The journal of pain Fundaun, J., Falasinnu, T., Pfyffer, D., Dildine, T. C., Kolski, M., Heinemann, A. W., Tharin, S., Smith, A. C., Dirlikov, B., Mackey, S., Crew, J., Weber, K. A. 2026: 106371

  Abstract

  Chronic pain affects nearly 70% of individuals following traumatic spinal cord injury (SCI) and is frequently reported as a disabling and undertreated complication. While disparities in SCI recovery are well-documented, evidence in chronic pain remains limited, with prior studies involving smaller cohorts and evaluating isolated social determinants rather than their intersectional contributions. We conducted a retrospective cohort study using the US Spinal Cord Injury Model Systems database, including 3,514 adults with traumatic SCI. Exposures were race/ethnicity (non-Hispanic White, non-Hispanic Black), annual income (<$25,000 vs ≥$25,000), and education (high school or less vs higher). Outcomes were pain severity (0-10 numeric rating) and pain interference (SF-12; severe[3-4] vs minimal/moderate[0-2]). Models adjusted for demographic and injury characteristics. Intersectional analyses quantified the combined effects of multiple social disadvantages, and causal mediation analyses estimated average causal mediation effects (ACME). Non-Hispanic Black, lower-income, and lower-education participants had higher pain severity and more frequent severe pain interference than their counterparts (all p<0.0001). Non-Hispanic Black participants, low-income, low-education participants had +2.43 points (95%CI 2.06-2.79) higher pain severity and 2.96-fold (95%CI 2.15-4.07) higher odds of severe pain interference than non-Hispanic White, higher-income, higher-education participants (q<0.0001). Mobility scores, days out-of-the-house, private health insurance, and perceived health status significantly mediated disparities in pain severity (ACME 0.158-0.312) and pain interference (ACME 0.017-0.043; all q<0.001). Chronic pain after traumatic SCI disproportionately affects socially disadvantaged groups. These findings highlight intersectional disparities and identify modifiable mediators as targets for interventions to reduce inequitable pain outcomes following traumatic SCI. PERSPECTIVE: This retrospective multicenter cohort study quantified intersectional disparities in chronic pain one year following spinal cord injury and characterized modifiable individual and structural mediators that account for these inequities.

  View details for DOI 10.1016/j.jpain.2026.106371

  View details for PubMedID 42409205

• Pain Catastrophizing, Pain Self-Efficacy, and their Interaction as Predictors of Health Outcomes in Chronic Pain. medRxiv : the preprint server for health sciences Raney, E., Dildine, T. C., Kim, S., Mackey, S. C., You, D. S. 2026

  Abstract

  Pain catastrophizing and pain self-efficacy are well-established predictors of health outcomes in chronic pain. Higher pain catastrophizing, a maladaptive cognitive process, predicts worse health outcomes, whereas higher pain self-efficacy, an adaptive cognitive process, predicts better health outcomes. This study examined whether pain catastrophizing and pain self-efficacy interactions predict physical and psychosocial health outcomes at 3 months and their change over 3-months among patients with chronic pain who sought care at a tertiary pain clinic.Adults with chronic pain (N = 181; 66.7% female; Mage = 58.7) completed baseline assessments of the Pain Catastrophizing Scale (PCS), Chronic Pain Self-Efficacy Scale (CPSS), and PROMIS measures of physical (pain intensity, pain interference, physical function) and psychosocial health (depression, anxiety, anger, loneliness). PROMIS measures were repeated at 3 months. Hierarchical multiple regression analyses tested PCS, CPSS, and their interaction as predictors of outcomes at 3 months and change scores from baseline to 3 months.The PCS×CPSS interaction significantly improved prediction for physical function (ΔR2 = 0.02, p = .02). Higher baseline self-efficacy predicted better physical function (β = 0.65, p < .001), but this effect weakened with higher levels of pain catastrophizing. The interaction also predicted change scores in physical function (p = .025) but was marginal after false discovery rate correction (p = .059). Additionally, a significant interaction emerged for loneliness change scores (p = .01): higher self-efficacy predicted greater reductions in loneliness, attenuated by higher catastrophizing.Pain self-efficacy interacted with pain catastrophizing to predict physical function and loneliness at 3 months. Greater self-efficacy was associated with better outcomes, with associations diminished with higher levels of pain catastrophizing. Findings highlight the moderating role of adaptive and maladaptive cognitions and suggest interventions should address both processes to optimize recovery in physical and social functioning.

  View details for DOI 10.64898/2026.06.15.26355697

  View details for PubMedID 42396293

  View details for PubMedCentralID PMC13320926

• Ten simple rules for turning your qualifying exam into an NIH-style fellowship proposal: A guide for graduate students. PLoS computational biology Peña-Lima, C., Bader, C. S., Ball, B. K., Dildine, T. C., Dissanayake, M. V., van 't Erve, I., Ibrayeva, A., Nippert, A., Quinn, M. K., Spinner, C., Thompson, S., Tomasso, A., Botham, C. M. 2026; 22 (6): e1014420

  Abstract

  Qualifying exams, often referred to as "quals" or candidacy exams, are an important milestone in doctoral programs. Although the style of quals varies greatly by program and institution, it is usually a proposal that requires students to develop research ideas as well as their scientific writing skills. Many quals are modeled after funding mechanisms that graduate students can apply to and on a topic that the student will pursue in their dissertation. This paper offers graduate students a step-by-step guide on how to turn their quals into a fellowship-style research proposal, using National Institutes of Health (NIH) mechanisms as a benchmark, as this is the norm within US research institutions. This paper will be most useful for students who have completed or are in the process of completing proposal-based qualifying exams, usually in the second year of a doctoral program.

  View details for DOI 10.1371/journal.pcbi.1014420

  View details for PubMedID 42313819

  View details for PubMedCentralID PMC13278402

• A multiverse approach to heat-evoked skin conductance analysis: evaluating the influence of analytic pipeline on associations between skin conductance and pain. Pain Delity, M. J., Barhoum, S., Yu, Q., Sherwood, K., Mischkowski, D., Necka, E. A., Lee, I., Dildine, T. C., Pereira, F., Atlas, L. Y. 2026

  Abstract

  ABSTRACT: Indices of physiological arousal and sympathetic nervous system activity provide important information about pain that can supplement verbal reports. Numerous studies focus on electrodermal activity, which is easy to measure and can provide insights on relationships between pain and arousal through the quantification of skin-conductance response (SCR). Despite SCR's value, there is no standard way to quantify SCR in response to noxious stimulation, and conclusions may vary depending on analytic approaches. We used a multiverse analysis to evaluate associations between SCR and pain across 8 studies of thermal pain in healthy volunteers (total n = 567). For each data set, SCRs were quantified using 5 common analysis approaches (preprocessing only; manual scoring; automated scoring; model-based analysis; physiological pain classifier), leading to 18 distinct SCR measures. Associations with pain and temperature were strongest when automated scoring was combined with manual artifact detection, regardless of model comparison approach, study type, and whether pain was rated continuously or categorically. More specifically, Bayesian and model-based comparisons revealed the strongest associations with pain when the software Ledalab quantified the sum of amplitudes on each trial and we excluded trials with artifacts. We apply these findings across data sets both with and without psychological interventions to show that subjective pain statistically mediates associations between temperature and heat-evoked SCR, and that SCR is modulated by pain-predictive cues regardless of verbal instruction. This work advances a simple analysis pipeline that can be adopted in future pain studies to improve efficiency and reproducibility and aid the development of objective pain biomarkers.

  View details for DOI 10.1097/j.pain.0000000000003996

  View details for PubMedID 42152694

• Characterizing Loneliness and Health in US Adults: An analysis of 2024 National Health Interview Survey. medRxiv : the preprint server for health sciences Dildine, T. C., Burke, C., Kapos, F. P. 2026

  Abstract

  Loneliness is common and deleterious to health. Yet little is known about its population burden and health correlates in the US. We aimed to determine the prevalence of loneliness and characterize its health and social functioning correlates among US adults.With data from the National Health Interview Study (2024), we used survey-weighted Poisson regression to estimate relative risks (RR) and 95% confidence intervals (CI) for frequent loneliness by levels of self-reported general health, social/emotional support, social functioning, and healthcare utilization, adjusted for age, sex, race/ethnicity, number of people in household, marital status, and psychological distress.12 million US adults reported usually or always feeling lonely, which was associated with worse general health and social/emotional support, work and social participation limitations, and healthcare disengagement.Loneliness affects millions of US adults, with substantial health and social functioning burden.

  View details for DOI 10.64898/2026.04.16.26351034

  View details for PubMedID 42064939

  View details for PubMedCentralID PMC13127538

• Single Session Behavioral Interventions for Chronic Pain A Systematic Review and Meta Analysis of Randomized Controlled Trials. The journal of pain Ziadni, M. S., Dildine, T. C., Edwards, K. A., Herrick, A., You, D. S., Darnall, B. D. 2026: 106220

  Abstract

  Single session interventions (SSIs) for chronic pain are a novel and scalable intervention approach that are far less burdensome than typical 8-session behavioral treatments, and have demonstrated improvements in pain outcomes. Therefore, the current review focuses on systematically summarizing evidence from randomized controlled trials (RCTs) on behavioral SSIs for chronic pain. The review was prospectively registered (PROSPERO CRD42023447224), and the search strategy included seven electronic databases up until 11/2024. Title, abstract, and full text review was conducted with 17 RCTs identified and summarized. Eligible studies were RCTs testing a psychological SSI that targeted pain among adults with chronic pain. Study quality was analyzed using National Institute of Health (NIH)'s Quality Assessment Tool for RCTs. The review focused on synthesizing: 1) the main contents, mode, frequency and duration of interventions for patients with chronic pain; and 2) the effects of SSIs on psychological and physical outcomes. Overall, we found that various SSIs demonstrated efficacy in improving pain outcomes. Specifically, small but significant effects of SSIs were observed for pain intensity (Standardized mean difference [SMD]=0.17) and pain interference (SMD=0.27) compared to control conditions. SSIs also demonstrated significant reductions in pain catastrophizing, anxiety, and depression (SMD = 0.37, 0.29, and 0.25 respectively). Of the 17 RCTs, 13 (76%) had good internal validity, and 4 (24%) had fair internal validity. SSIs can be low burden and improve behavioral pain care access. Finally, we discuss design and methodology recommendations for future research on SSIs for chronic pain. PERSPECTIVE: Findings suggest that SSIs are generally effective in improving pain and other health outcomes across various types of chronic pain conditions. SSIs can be low burden and improve behavioral pain care access, especially in settings where longer-course behavioral treatments are infeasible or not offered.

  View details for DOI 10.1016/j.jpain.2026.106220

  View details for PubMedID 41833852

• Differential Encoding of Noxious Heat and Self-Reported Pain Along Corticospinal Networks: A Simultaneous Brain-Spinal Cord Functional Magnetic Resonance Imaging Study Pfyffer, D., Wang, Y., Kaptan, M., Fundaun, J., Dildine, T., Oliva, V., Indriolo, T., Ii, K., Glover, G., Law, C., Mackey, S. CHURCHILL LIVINGSTONE. 2026

  View details for DOI 10.1016/j.jpain.2025.106020

  View details for Web of Science ID 001746783200041

• Differential encoding of noxious heat and self-reported pain along corticospinal networks: a simultaneous spinal cord-brain fMRI study. bioRxiv : the preprint server for biology Pfyffer, D., Wang, Y., Kaptan, M., Fundaun, J., Dildine, T. C., Oliva, V., Indriolo, T., Skare, S., Sprenger, T., Lee, P. K., Truong, M., Weber, K. A., Glover, G. H., Law, C. S., Mackey, S. 2025

  Abstract

  Chronic pain poses a substantial public health burden. Elucidating how the healthy central nervous system (CNS) differentially encodes objective stimulus intensity and subjective experiences of pain perception may offer key insights into the central mechanisms contributing to chronic pain. Functional MRI (fMRI) combined with controlled noxious stimulation provides a powerful means to explore neural representations of nociception and pain perception. Here, we applied noxious heat at three intensities (46 °C, 47 °C, 48 °C, 8 trials each randomized) to the right forearm of 28 healthy women during simultaneous spinal cord-brain fMRI to investigate how distributed corticospinal activity and connectivity encode stimulus intensity and subjective pain. Activity increased with stimulus temperature across regions involved in pain processing-including somatosensory, motor, prefrontal, insular, and subcortical areas-as well as in the ipsilateral dorsal and ventral spinal cord. Spinal-brain functional connectivity was observed between the right dorsal horn and pain-related brain regions such as primary and secondary somatosensory cortex, insula, anterior cingulate cortex, thalamus, and periaqueductal gray, and was positively associated with individual pain ratings. Using representational similarity analysis (RSA), we found that multivoxel activation patterns in the brain and spinal cord, as well as corticospinal connectivity patterns, reliably tracked stimulus temperature, while only subsets of cortical regions (e.g., insula, sensorimotor, and frontal cortices) encoded subjective pain. Notably, spinal cord representations were primarily organized by stimulus temperature rather than perceived pain intensity. These findings demonstrate that simultaneous spinal cord-brain fMRI combined with multivariate modeling can identify sensory and perceptual components of nociceptive processing across the neuroaxis. Such approaches advance mechanistic understanding of pain and may inform the development of CNS-based biomarkers for chronic pain assessment and intervention.

  View details for DOI 10.1101/2025.10.24.684476

  View details for PubMedID 41280069

  View details for PubMedCentralID PMC12633297

• The "External Validity Crisis": now is the time to address the attack on diversity, equity, and inclusion in pain science. Pain Dildine, T. C., Janevic, M. R., Hood, A. M., Meints, S. M., Booker, S. Q., Mathur, V. A. 2025

  View details for DOI 10.1097/j.pain.0000000000003788

  View details for PubMedID 40893021

• Impact of Pain Self-Efficacy on Health Outcomes in High-Impact Chronic Pain: A Longitudinal Study. The Clinical journal of pain You, D. S., Lannon, E., Kim, S., Dildine, T. C., Weber, K. A., Raney, E., Mackey, S. C. 2025

  Abstract

  High-impact chronic pain (HICP), affecting 36.4% of individuals with chronic pain, significantly limits work, social, and self-care activities. Effective treatments for HICP remain elusive. In addition to pain catastrophizing, growing evidence suggests that pain self-efficacy may be a treatment target for HICP. Our study examines the relative contributions of pain self-efficacy and catastrophizing to health outcomes in patients with HICP.A total of 259 patients with chronic pain (154 with HICP; 105 without HICP) completed validated measures at baseline and three months later. These included the Chronic Pain Self-Efficacy Scale (CPSS), the Pain Catastrophizing Scale (PCS), and Patient-Reported Outcomes Measurement Information System (PROMIS) domains for physical health (i.e., pain interference, physical function, fatigue, and sleep disturbance) and psychosocial health (i.e., depression, anxiety, anger, and social isolation).Repeated measures MANOVA showed a significant group effect (HICP vs. No-HICP), but no significant time or group by time interaction effect. The HICP group reported significantly lower CPSS scores and higher PCS scores than the No-HICP group, alongside worse physical and psychosocial health outcomes (η²=0.076~0.445). Pain self-efficacy explained a greater proportion of group differences in health outcomes (52.9-71.7%) compared to pain catastrophizing (10.1-43.3%). Especially, self-efficacy in activity engagement accounted for the largest health disparities between the groups.Findings highlight pain self-efficacy as a critical treatment target for HICP, with greater predictive utility than pain catastrophizing. Enhancing self-efficacy through tailored interventions may reduce the burden of HICP. Future studies should prioritize self-efficacy-based interventions and explore their scalability and long-term impact.

  View details for DOI 10.1097/AJP.0000000000001295

  View details for PubMedID 40325564

• Beyond pain intensity: Validating single-item pain bothersomeness measures. The journal of pain Edwards, K. A., You, D. S., Lannon, E. W., Dildine, T. C., Darnall, B. D., Mackey, S. C. 2025; 31: 105395

  Abstract

  Chronic pain is a complex and multifaceted health condition, rendering pain intensity alone insufficient for comprehensively understanding the impact of pain. Pain bothersomeness scales have been developed to measure pain's impact on life, however lack adequate validation. Our study examines the validity of two single-item measures (5-point and 11-point response scales) for pain bothersomeness. We collected data from 633 treatment-seeking adults with mixed-etiology chronic pain. Pearson correlations were conducted to examine the relationships between each pain bothersomeness item and 20 general and pain-related functioning measures. ANOVAs examined the ability of pain bothersomeness scores to discriminate between eight groupings based on general and pain-related functioning. Linear regressions analyzed pain bothersomeness as a predictor of 14 measures of general and pain-related functioning three months later. Both pain bothersomeness items correlated significantly with 19 functioning measures and discriminated between eight groupings. Controlling for covariates, both items were consistently predictive of worse pain interference (Total adj r² =.34), pain catastrophizing (Total adj r² =.21-.22), depression (Total adj r² =.25-.26), and satisfaction with social roles (Total adj r² =.13-.16) three months later. Both single-item pain bothersomeness items demonstrated consistent concurrent, discriminant, and predictive validity. These low-burden assessments provide valuable information about patient functioning in clinical settings, suggesting their utility in improving chronic pain care. PERSPECTIVE: Both single-item pain bothersomeness measures demonstrated consistent concurrent and discriminant validity. Both items predicted worse pain interference, pain catastrophizing, depression, and social functioning 3-months later.

  View details for DOI 10.1016/j.jpain.2025.105395

  View details for PubMedID 40228688

• Expanding Access to Pain Relief Treatments for Chronic Pain: Inclusive Recruitment Methods in the PROGRESS Study Dorsonne, B., Hailu, A. Y., Saxena, K., Clifton, J., Adair, E., Cheung, M., Torres, C., Andrews, W., Heggan, E., Mierfert, J., Riazi, G., Dildine, T. C., Spears, S., Greer-Smith, R., Pun, T., Williams, N., Perez, L., Poupore-King, H., Ziadni, M. S., Mackey, S., Darnall, B. D. CHURCHILL LIVINGSTONE. 2025

  View details for DOI 10.1016/j.jpain.2025.105062

  View details for Web of Science ID 001504694300034

• Predicting High Impact Chronic Pain Diagnosis Using Psychological and Sociocultural Patient Characteristics Dildine, T. C., Falasinnu, T., Telusca, N., Kahn, J., Darnall, B., Mackey, S. CHURCHILL LIVINGSTONE. 2025

  View details for DOI 10.1016/j.jpain.2025.105066

  View details for Web of Science ID 001504694300096

• Zoom-Delivered Empowered Relief for Chronic Pain: Observational Longitudinal Pilot Study Exploring Feasibility and Pain-Related Outcomes in Patients on Long-Term Opioids. JMIR formative research Edwards, K. A., Dildine, T. C., You, D. S., Herrick, A. M., Darnall, B. D., Mackey, S. C., Ziadni, M. S. 2025; 9: e68292

  Abstract

  Patients with chronic pain on long-term opioid therapy often face barriers to accessing effective nonpharmacological treatments, including the burden of multiple sessions, lack of trained clinicians, and travel time. Empowered Relief (ER), a 2-hour, single-session pain relief skills class, can improve pain and quality of life among patients with chronic pain when delivered in person or virtually.This study examined the impact of Zoom-delivered ER among people with chronic pain on long-term opioid therapy. We assessed (1) the feasibility and acceptability of Zoom-delivered ER; (2) changes in pain and opioid use outcomes at 3 and 6 months after treatment; and (3) daily associations among pain, opioid dose, and the Pain Catastrophizing Scale (PCS) before and after treatment.During the early COVID-19 pandemic, we conducted an uncontrolled pilot study of a Zoom-delivered ER among 60 adults (n=45, 76% female participants; n=52, 88% White participants) experiencing chronic pain who were receiving daily prescribed opioids (≥10 morphine-equivalent daily dose). Participants completed assessments at enrollment, before class, after class, 3 months after treatment, and 6 months after treatment. Furthermore, participants completed 2 daily assessment periods (spanning 14 consecutive days) before and after the class. We used a multilevel modeling approach to examine (1) the raw changes in PCS, average pain intensity, pain interference, and self-reported opioid dose at 3 and 6 months after treatment and (2) daily-level changes in average pain intensity and opioid dose before and after the class.Of the 60 participants enrolled, 41 (68%) attended the class and 24 (59% of the 41 class attendees) reported satisfaction with the Zoom-delivered class. PCS score was significantly reduced at 3 months (β=-3.49, P=.01; Cohen d=0.35) and 6 months after treatment (β=-3.61, P=.01; Cohen d=0.37), and pain intensity was significantly reduced at 3 months (β=-0.56, P=.01; Cohen d=0.39) compared to enrollment. There were no significant reductions in pain interference or opioid dose. Across daily assessments, higher daily pain catastrophizing was associated with worse daily pain (β=.42, P<.001) and higher self-reported opioid use (β=3.14, P<.001); daily pain intensity significantly reduced after the class (β=-.50, P<.001). People taking prescribed opioids as needed trended toward decreasing their daily opioid use after the class (β=-9.31, P=.02), although this result did not survive correction for multiplicity.Improvements to future Zoom-delivered ER iterations are needed to improve feasibility and acceptability among people with chronic pain and daily prescribed opioid use. Despite this, findings show a promising preliminary impact of the intervention on pain outcomes. A larger randomized controlled trial of Zoom-delivered ER among this patient population is currently under way.

  View details for DOI 10.2196/68292

  View details for PubMedID 40068160

• Trends in patient representation in low back pain pharmacological randomized clinical trials, 2011-2020: A systematic review. The journal of pain Jiang, T. E., Edwards, K. A., Dildine, T. C., You, D. S., Nguyen, T., Pascual, A. P., Falasinnu, T. 2024

  Abstract

  Low back pain (LBP) significantly affects global health, with associated detrimental outcomes such as physical impairment, emotional distress, and exacerbated mental health symptoms. This study evaluated the representation of marginalized groups, including racialized, gender minority, pregnant/lactating, and elderly individuals in randomized controlled trials (RCTs) for pharmacological interventions treating LBP from 2011 to 2020. We searched Embase, MEDLINE, and CINAHL in December 2021, and 139 studies were eligible. Most trials (n = 113, 81%) reported participant sex; however, no study collected data on sexual and gender minorities, and the majority (n = 99, 71%) excluded pregnant/lactating individuals. Most trials (n = 105, 76%) reported no data on participant race or ethnicity. We limited within-country analyses of race and ethnicity to US-based trials because US-based trials were more likely to report race and/or ethnicity (48%) compared to non-US-based trials (8%). Black participants were the only racialized group whose composition were comparable to US Census estimates. About half (n = 73, 53%) of all trials had an upper age limit for eligibility (range: 40-85 years old) and 24% (n = 33) excluded adults aged > 65 years. Our findings confirm that trials for pharmacological LBP interventions underreport demographic data, and the trials that include this data have unrepresentative samples. There is an urgent need for more inclusive and representative patient samples to ensure generalizability and equitable benefits. Standardizing demographic data reporting and integrating community-based participatory research methods can help foster inclusive research practices. This review was registered with PROSPERO, ID 296017. PERSPECTIVE: This systematic review investigates patient representation in pharmacological-based clinical trials for low back pain, the most prevalent pain condition worldwide. Improvements in reporting demographic data and recruiting diverse participant populations-across different racialized, gender and sexual minority, and age groups- will help clinical research generalizability and provide equitable benefits. DATA AVAILABILITY: Please contact Tiffany Jiang (tjiang8@stanford.edu) for requests for extraction tool and extracted data.

  View details for DOI 10.1016/j.jpain.2023.12.013

  View details for PubMedID 38185211

• 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

• Test-Retest Reliability of an Adaptive Thermal Pain Calibration Procedure in Healthy Volunteers JOURNAL OF PAIN Amir, C., Rose-McCandlish, M., Weger, R., Dildine, T. C., Mischkowski, D., Necka, E. A., Lee, I., Wager, T. D., Pine, D. S., Atlas, L. Y. 2022; 23 (9): 1543-1555

  Abstract

  Quantitative sensory testing (QST) allows researchers to evaluate associations between noxious stimuli and acute pain in clinical populations and healthy participants. Despite its widespread use, our understanding of QST's reliability is limited, as reliability studies have used small samples and restricted time windows. We examined the reliability of pain ratings in response to noxious thermal stimulation in 171 healthy volunteers (n = 99 female, n = 72 male) who completed QST on multiple visits ranging from 1 day to 952 days between visits. On each visit, participants underwent an adaptive pain calibration in which they experienced 24 heat trials and rated pain intensity after stimulus offset on a 0 to 10 Visual Analog Scale. We used linear regression to determine pain threshold, pain tolerance, and the correlation between temperature and pain for each session and examined the reliability of these measures. Threshold and tolerance were moderately reliable (Intra-class correlation = .66 and .67, respectively; P < .001), whereas temperature-pain correlations had low reliability (Intra-class correlation = .23). In addition, pain tolerance was significantly more reliable in female participants than male participants, and we observed similar trends for other pain sensitive measures. Our findings indicate that threshold and tolerance are largely consistent across visits, whereas sensitivity to changes in temperature vary over time and may be influenced by contextual factors. PERSPECTIVE: This article assesses the reliability of an adaptive thermal pain calibration procedure. We find that pain threshold and tolerance are moderately reliable whereas the correlation between pain rating and stimulus temperature has low reliability. Female participants were more reliable than male participants on all pain sensitivity measures.

  View details for DOI 10.1016/j.jpain.2022.01.011

  View details for Web of Science ID 000862887200006

  View details for PubMedID 35189353

  View details for PubMedCentralID PMC9644806

• Expectations about pain and analgesic treatment are shaped by medical providers' facial appearances: Evidence from five online clinical simulation experiments SOCIAL SCIENCE & MEDICINE Necka, E. A., Amir, C., Dildine, T. C., Atlas, L. Y. 2021; 281: 114091

  Abstract

  There is a robust link between patients' expectations and clinical outcomes, as evidenced by the placebo effect. Expectations depend in large part on the context surrounding treatment, including the patient-provider interaction. Prior work indicates that providers' behavior and characteristics, including warmth and competence, can shape patient outcomes. Yet humans rapidly form trait impressions of others before any in-person interaction. It is unknown whether these first impressions influence subsequent health care choices and expectations.Our goal was to test whether trait impressions of hypothetical medical providers, based exclusively on facial images, influence the choice of medical providers and expectations about pain and analgesia following hypothetical painful medical procedures.Across five online experiments, participants (total N = 1108) viewed and made judgments about hypothetical healthcare providers. Experiments 1-4 included computer-generated faces that varied in features associated with competence, while experiment 5 included real faces. We measured how apparent competence affected expectations about pain and anticipated analgesic use in all studies. We also measured warmth and similarity.Across five online studies, participants selected providers who appeared more competent, based on facial visual information alone. Further, providers' apparent competence predicted participants' expectations about post-procedural pain and medication use. Participants' perception of their similarity to providers also shaped expectations about pain and treatment outcomes.Results from our experimental simulations suggest that humans develop expectations about pain and health outcomes before even setting foot in the clinic, based exclusively on first impressions. These findings have strong implications for health care, as individuals increasingly rely on digital services to select healthcare providers and even receive treatment, a trend that is exacerbated as the world embraces telemedicine.

  View details for DOI 10.1016/j.socscimed.2021.114091

  View details for Web of Science ID 000664160900009

  View details for PubMedID 34126294

  View details for PubMedCentralID PMC8262518

• Ethnic Differences in Experimental Pain Responses Following a Paired Verbal Suggestion With Saline Infusion: A Quasiexperimental Study ANNALS OF BEHAVIORAL MEDICINE Letzen, J. E., Dildine, T. C., Mun, C., Colloca, L., Bruehl, S., Campbell, C. M. 2021; 55 (1): 55-64

  Abstract

  Ethnic differences in placebo and nocebo responses are an important, yet underresearched, patient factor that might contribute to treatment disparities.The purpose of this study was to examine ethnic differences in pain trajectories following a verbal suggestion paired with a masked, inert substance (i.e., saline).Using a quasiexperimental design, we examined differences between 21 non-Hispanic Black (NHB) participants and 20 non-Hispanic White (NHW) participants in capsaicin-related pain rating trajectories following a nondirectional verbal suggestion + saline infusion. All participants were told that the substance would "either increase pain sensation, decrease it, or leave it unchanged." A spline mixed model was used to quantify the interaction of ethnicity and time on ratings.There was a significant Ethnicity × Time interaction effect (β = -0.28, p = .002); NHB individuals reported significantly greater increases in pain following, but not before, the verbal suggestion + saline infusion. Sensitivity analyses showed no change in primary results based on differences in education level, general pain sensitivity, or condition order.The present results showed ethnic differences in pain response trajectories following a verbal suggestion + saline infusion and suggest that future research rigorously examining possible ethnic differences in placebo/nocebo responses is warranted.

  View details for DOI 10.1093/abm/kaaa032

  View details for Web of Science ID 000636978000005

  View details for PubMedID 32421193

  View details for PubMedCentralID PMC7880220

• The Confidence Database. Nature human behaviour Rahnev, D., Desender, K., Lee, A. L., Adler, W. T., Aguilar-Lleyda, D., Akdoğan, B., Arbuzova, P., Atlas, L. Y., Balcı, F., Bang, J. W., Bègue, I., Birney, D. P., Brady, T. F., Calder-Travis, J., Chetverikov, A., Clark, T. K., Davranche, K., Denison, R. N., Dildine, T. C., Double, K. S., Duyan, Y. A., Faivre, N., Fallow, K., Filevich, E., Gajdos, T., Gallagher, R. M., de Gardelle, V., Gherman, S., Haddara, N., Hainguerlot, M., Hsu, T. Y., Hu, X., Iturrate, I., Jaquiery, M., Kantner, J., Koculak, M., Konishi, M., Koß, C., Kvam, P. D., Kwok, S. C., Lebreton, M., Lempert, K. M., Ming Lo, C., Luo, L., Maniscalco, B., Martin, A., Massoni, S., Matthews, J., Mazancieux, A., Merfeld, D. M., O'Hora, D., Palser, E. R., Paulewicz, B., Pereira, M., Peters, C., Philiastides, M. G., Pfuhl, G., Prieto, F., Rausch, M., Recht, S., Reyes, G., Rouault, M., Sackur, J., Sadeghi, S., Samaha, J., Seow, T. X., Shekhar, M., Sherman, M. T., Siedlecka, M., Skóra, Z., Song, C., Soto, D., Sun, S., van Boxtel, J. J., Wang, S., Weidemann, C. T., Weindel, G., Wierzchoń, M., Xu, X., Ye, Q., Yeon, J., Zou, F., Zylberberg, A. 2020; 4 (3): 317-325

  Abstract

  Understanding how people rate their confidence is critical for the characterization of a wide range of perceptual, memory, motor and cognitive processes. To enable the continued exploration of these processes, we created a large database of confidence studies spanning a broad set of paradigms, participant populations and fields of study. The data from each study are structured in a common, easy-to-use format that can be easily imported and analysed using multiple software packages. Each dataset is accompanied by an explanation regarding the nature of the collected data. At the time of publication, the Confidence Database (which is available at https://osf.io/s46pr/) contained 145 datasets with data from more than 8,700 participants and almost 4 million trials. The database will remain open for new submissions indefinitely and is expected to continue to grow. Here we show the usefulness of this large collection of datasets in four different analyses that provide precise estimations of several foundational confidence-related effects.

  View details for DOI 10.1038/s41562-019-0813-1

  View details for PubMedID 32015487

  View details for PubMedCentralID PMC7565481

• The need for diversity in research on facial expressions of pain PAIN Dildine, T. C., Atlas, L. Y. 2019; 160 (8): 1901-1902

  View details for DOI 10.1097/j.pain.0000000000001593

  View details for Web of Science ID 000480764500023

  View details for PubMedID 31335658

  View details for PubMedCentralID PMC6687404

• Pain or nociception? Subjective experience mediates the effects of acute noxious heat on autonomic responses - corrected and republished PAIN Misohkowski, D., Palados-Barrios, E. E., Banker, L., Dildine, T. C., Atlas, L. Y. 2019; 160 (6): 1469-1481

  Abstract

  Nociception reliably elicits an autonomic nervous system (ANS) response. Because pain and ANS circuitry interact on multiple spinal, subcortical, and cortical levels, it remains unclear whether autonomic responses are simply a reflexive product of noxious stimulation regardless of how stimulation is consciously perceived or whether the experience of pain mediates ANS responses to noxious stimulation. To test these alternative predictions, we examined the relative contribution of noxious stimulation and individual pain experience to ANS responses in healthy volunteers who underwent 1 or 2 pain assessment tasks. Participants received 8 seconds of thermal stimulation of varied temperatures and judged pain intensity on every trial. Skin conductance responses and pupil dilation responses to stimulation served as measures of the heat-evoked autonomic response. We used multilevel modelling to examine trial-by-trial relationships between heat, pain, and ANS response. Although both pain and noxious heat stimulation predicted skin conductance response and pupil dilation response in separate analyses, the individual pain experience statistically mediated effects of noxious heat on both outcomes. Furthermore, moderated mediation revealed that evidence for this process was stronger when stimulation was perceived as painful compared with when stimulation was perceived as nonpainful, although this difference emerged late, in the 4-second period after thermal stimulation. These findings suggest that pain appraisal regulates the heat-evoked autonomic response to noxious stimulation, documenting the flexibility of the autonomic pain response to adjust to perceived or actual changes in environmental affordances above and beyond nociceptive input.

  View details for DOI 10.1097/j.pain.0000000000001573

  View details for Web of Science ID 000480762400021

  View details for PubMedID 31107415

  View details for PubMedCentralID PMC6553960

• Anticipatory Effects on Perceived Pain: Associations With Development and Anxiety PSYCHOSOMATIC MEDICINE Michalska, K. J., Feldman, J. S., Abend, R., Gold, A. L., Dildine, T. C., Palacios-Barrios, E. E., Leibenluft, E., Towbin, K. E., Pine, D. S., Atlas, L. Y. 2018; 80 (9): 853-860

  Abstract

  Naturalistic studies suggest that expectation of adverse experiences such as pain exerts particularly strong effects on anxious youth. In healthy adults, expectation influences the experience of pain. The current study uses experimental methods to compare the effects of expectation on pain among adults, healthy youth, and youth with an anxiety disorder.Twenty-three healthy adults, 20 healthy youth, and 20 youth with an anxiety disorder underwent procedures in which auditory cues were paired with noxious thermal stimulation. Through instructed conditioning, one cue predicted low-pain stimulation and the other predicted high-pain stimulation. At test, each cue was additionally followed by a single temperature calibrated to elicit medium pain ratings. We compared cue-based expectancy effects on pain across the three groups, based on cue effects on pain elicited on medium heat trials.Across all groups, as expected, participants reported greater pain with increasing heat intensity (β = 2.29, t(41) = 29.94, p < .001). Across all groups, the critical medium temperature trials were rated as more painful in the high- relative to low-expectancy condition (β = 1.72, t(41) = 10.48, p < .001). However, no evidence of between-group differences or continuous associations with age or anxiety was observed.All participants showed strong effects of expectancy on pain. No influences of development or anxiety arose. Complex factors may influence associations among anxiety, development, and pain reports in naturalistic studies. Such factors may be identified using experiments that employ more complex, yet controlled manipulations of expectancy or assess neural correlates of expectancy.

  View details for DOI 10.1097/PSY.0000000000000608

  View details for Web of Science ID 000450088900009

  View details for PubMedID 29851868

  View details for PubMedCentralID PMC7675786

• Pain or nociception? Subjective experience mediates the effects of acute noxious heat on autonomic responses PAIN Mischkowski, D., Palacios-Barrios, E. E., Banker, L., Dildine, T. C., Atlas, L. Y. 2018; 159 (4): 699-711

  Abstract

  Nociception reliably elicits an autonomic nervous system (ANS) response. Because pain and ANS circuitry interact on multiple spinal, subcortical, and cortical levels, it remains unclear whether autonomic responses are simply a reflexive product of noxious stimulation regardless of how stimulation is consciously perceived or whether the experience of pain mediates ANS responses to noxious stimulation. To test these alternative predictions, we examined the relative contribution of noxious stimulation and individual pain experience to ANS responses in healthy volunteers who underwent 1 or 2 pain assessment tasks. Participants received 8 seconds of thermal stimulation of varied temperatures and judged pain intensity on every trial. Skin conductance responses and pupil dilation responses to stimulation served as measures of the heat-evoked autonomic response. We used multilevel modelling to examine trial-by-trial relationships between heat, pain, and ANS response. Although both pain and noxious heat stimulation predicted skin conductance response and pupil dilation response in separate analyses, the individual pain experience statistically mediated effects of noxious heat on both outcomes. Furthermore, moderated mediation revealed that evidence for this process was stronger when stimulation was perceived as painful compared with when stimulation was perceived as nonpainful. These findings suggest that pain appraisal regulates the heat-evoked autonomic response to noxious stimulation, documenting the flexibility of the autonomic pain response to adjust to perceived or actual changes in environmental affordances above and beyond nociceptive input.

  View details for DOI 10.1097/j.pain.0000000000001132

  View details for Web of Science ID 000451219000010

  View details for PubMedID 29251663

  View details for PubMedCentralID PMC5901905