A network analysis on biopsychosocial factors and pain-related outcomes assessed during a COVID-19 lockdown.

Psychological stress, social isolation, physical inactivity, and reduced access to care during lockdowns throughout a pandemic negatively impact pain and function. In the context of the first COVID-19 lockdown in Spain, we aimed to investigate how different biopsychosocial factors influence chiropractic patients' pain-related outcomes and vice-versa. A total of 648 chiropractic patients completed online questionnaires including variables from the following categories: demographics, pain outcomes, pain beliefs, impact of the COVID-19 pandemic, stress/anxiety and self-efficacy. Twenty-eight variables were considered in a cross-sectional network analysis to examine bidirectional associations between biopsychosocial factors and pain outcomes. Subgroup analyses were conducted to estimate differences according to gender and symptom duration. The greatest associations were observed between pain duration and pain evolution during lockdown. Participants' age, pain symptoms' evolution during lockdown, and generalized anxiety were the variables with the strongest influence over the whole network. Negative emotions evoked by the pandemic were indirectly associated with pain outcomes, possibly via pain catastrophizing. The network structure of patients reporting acute pain showed important differences when compared to patients with chronic pain. These findings will contribute to identify which factors explain the deleterious effects of both the pandemic and the restrictions on patients living with pain.

Negative interpretation of ambiguous bodily symptoms among illness-anxious individuals: Exploring the role of developmental and maintenance constructs.

Background: Cognitive factors play an essential role in the development and maintenance of anxiety problems. Among individuals with illness anxiety problems, their interpretation of bodily symptoms is a crucial factor in the determination of their ability to regulate their emotions. The catastrophic interpretation of ambiguous bodily symptoms and changes, known as interpretation bias, in line with the failure to reappraise the symptoms in safer ways, is supposed to increase the levels of anxiety in illness-anxious individuals. Methods: This study aimed to address the statistical limitations of the direct (self-report) measure of interpretation bias, using an indirect (online interpretation bias task) measure for assessing biased interpretations of bodily symptoms. In addition, we examined the contribution of self-report anxiety sensitivity (AS), intolerance of uncertainty (IU), interpretation bias, and reappraisal to illness anxiety problems in a subclinical population and compared it with controls with low levels of illness anxiety. Findings: Illness-anxious individuals made more negative interpretations of ambiguous, potentially health-threatening information. They used less reappraisal to regulate their emotion. Among the measures, the physical subscale of AS and the reaction time to the safe resolution of ambiguous information were the best factors that could contribute to the differentiation between the illness-anxious individuals and non-anxious individuals. Conclusion: Our findings provided further support for the biased processing of information related to physical symptoms among individuals with illness anxiety. AS-physical and safe resolutions for ambiguous situations could differentiate the illness-anxious and the control groups better than other factors. These findings suggest that a change of interpretation of ambiguous bodily symptoms among individuals suffering from chronic conditions can be a possible intervention to target anxiety and improve patients' lives.

Enhancing neutralizing antibodies against receptor binding domain of SARS-CoV-2 by a safe natural adjuvant system.

The receptor binding domain (RBD) plays a pivotal role in the viral entry as it enables the engagement of severe acute respiratory syndrome 2 (SARS-CoV-2) with the human angiotensin-converting enzyme 2 (ACE2) receptor for host cell entry. RBD is the major target for developing viral inhibitors and vaccines. Expression of recombinant RBD in E.coli is highly scalable with a low-cost procedure despite its high expression level compared to expression in mammalian and yeast cells. Using an alternative natural adjuvant system instead of alum adjuvant, increased immunogenicity of RBD antigen in serological assay including direct ELISA and surrogate Virus Neutralization Test (sVNT) was demonstrated with high levels of IgGs and neutralizing antibodies in mice sera immunized with RBD:AlSa (Alum and Sodium alginate) formulation. The sVNT is a simple and fast test that can be used instead of the conventional virus neutralization test requiring live virus and BSL3 laboratory to detect total neutralizing antibodies against RBD. Additionally, results showed a safety profile for sodium alginate which supported using it as an alternative natural adjuvant.

From hands-on to remote: Moderators of response to a novel self-management telehealth programme during the COVID-19 pandemic.

BACKGROUND: In March 2020, state-wide lockdowns were declared in many countries, including Spain. Citizens were confined to their homes and remotely supported activities were prioritized as an alternative to in-person interactions. Previous data suggest that remote and self-management interventions may be successful at reducing pain and related psychological variables. However, individual factors influencing the effectiveness of these interventions remain to be identified. We aimed to investigate the psychological and motivational factors moderating changes in pain observed in chiropractic patients undertaking a novel telehealth self-management programme. METHODS: A cohort of 208 patients from a chiropractic teaching clinic was recruited to participate in the study. Patients received telehealth consultations and individualized self-management strategies tailored for their current complaint. They were encouraged to make use of these strategies daily for 2-4 weeks, whilst rating their pain intensity, motivation and adherence. Validated questionnaires were completed online to assess catastrophizing, kinesiophobia and anxiety. RESULTS: A total of 168 patients completed the first 2 weeks of the programme, experiencing significant reductions in all variables. Kinesiophobia emerged as a key factor influencing pain reduction and moderating the association between motivation and pain relief. In turn, adherence to the programme was associated with lower pain intensity, although moderated by the degree of motivation. CONCLUSIONS: In the context of COVID-19, when introducing remote and self-management strategies, pain cognitions and motivational factors should be taken into consideration to foster adherence and yield better pain outcomes.

Suppression May Improve Adaptation to Worry When Facing Uncertainty: Studying COVID-19 Pandemic.

The COVID-19 pandemic has been associated with increased uncertainty, fear and worry in everyone's life. The effect of changes in daily life has been studied widely, but we do not know how emotion-regulation strategies influence adaptation to a new situation to help them overcome worry in the face of uncertainty. Here, 1,064 self-selected Farsi speaking participants completed an online battery of questionnaires that measured fear of virus and illness, worry, intolerance of uncertainty, and emotion regulation (two subscales: reappraisal, suppression). We also documented the number of daily COVID-19 cases and deaths due to COVID-19 on the day in which participants completed the questionnaire. Our findings suggest a correlation between contamination fear and the number of daily-confirmed cases (r = 0.11), and the number of reported deaths due to COVID-19 (r = 0.09). Worry mediated the relationship between intolerance of uncertainty and fear of virus and illness (b = 0.16, 0.1141 < CI < 0.2113). In addition, suppression moderated the relationship between intolerance of uncertainty and worry (p < 0.01). Our results suggest that suppression (at least in the short term) can be an adaptive response to the worry associated with uncertainty. Suppression can reduce worry, which in turn can decrease fear of contamination and improve adaptation to social distancing requirements. Although, the observed correlations were significant, but considering the sample size, they are not strong, and they should be interpreted cautiously.

Pain catastrophizing mediates rapid benefits of accessing in-person chiropractic care during the COVID-19 lockdown.

BACKGROUND: In March 2020, the COVID-19 pandemic forced the Spanish government to declare a state of emergency. A stringent lockdown was enforced, restricting access to healthcare services, including chiropractic. Reduced access to care provision in combination with psychological stress, social isolation and physical inactivity during the lockdown were shown to negatively influence pain conditions. However, data on strategies to mitigate the impact of the pandemic on these conditions are lacking. METHODS: Upon easing of restrictions in May 2020, 51 chiropractic clinics throughout Spain pseudo-randomly invited patients, recruiting a total of 385 participants. During a 14-day period, participants were exposed to in-person chiropractic care in either one (n = 177) or multiple encounters (n = 109) or to no care (n = 99). The effects of access to chiropractic care on patients' pain-related and psychological outcomes were assessed online through validated self-reported questionnaires before and after the period of care. Coprimary outcomes included pain intensity, pain interference and pain cognitions. RESULTS: When comparing to participants without access to care, pain intensity and interference were significantly decreased at follow-up, irrespective of the number of encounters. Kinesiophobia was also significantly reduced at follow-up, though only after multiple encounters. The relationship between fear of movement, changes in pain intensity and interference was mediated by catastrophizing. CONCLUSION: Access to in-person chiropractic care may provide pain relief, associated with reductions in interference and pain cognitions. Prioritizing in-person care for patients with maladaptive pain cognitions may help dampen the detrimental consequences of the pandemic on physical and psychological well-being.