Troy Christopher Dildine

All Publications

• 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