Feasibility of a pain informed movement program for people with symptomatic knee osteoarthritis

Purpose: Disability in knee osteoarthritis (KOA) is known to be largely due to pain, the mechanism of which is complex and multidimensional with alterations in nociceptive processing in the peripheral and central nervous system (CNS) leading to persistent pain. Current clinical practice guidelines for KOA provide strong recommendations for education and exercise including land-based or mind-body approaches. However, individually these strategies are only moderately effective. One potential reason for this is a lack of understanding of their underlying mechanisms and how their combination might impact nervous system modulation. Neuromuscular exercise is known to improve lower extremity strength. Mind-body approaches as well as pain neuroscience education (PNE) are uniquely positioned to potentially reverse CNS adaptations by inducing positive neuroplastic changes and improving descending modulation of pain resulting in decreased pain. To our knowledge, neuromuscular exercise, mind-body techniques, and PNE have not been studied in combination. We therefore aimed to establish the feasibility of an intervention consisting of these three elements referred to as Pain Informed Movement (PIM). The results of this study will inform necessary modifications for a two-arm pilot randomized controlled trial (RCT). Method(s): This study was a single-arm feasibility trial with a nested qualitative component and the primary feasibility outcome of complete follow up. Inclusion criteria: age >= 40 years, KOA clinical diagnosis or people fulfilling the NICE diagnostic criteria, and average pain intensity >=3/10 on the numeric pain rating scale. PIM consisted of twice weekly in-person exercise sessions and a third home exercise session for 8 weeks. In addition, PNE, provided as online videos, covered the following topics: purpose of pain, neurophysiological changes associated with pain, movement guidelines when pain persists, mind-body techniques to impact neurophysiology and support moving with ease that included breath awareness and regulation, muscle tension regulation, awareness of pain related thoughts and emotions, and relaxation. The mind-body techniques and the PNE topics were implemented during the group exercise sessions that included evidence-based neuromuscular exercises aimed at improving sensorimotor control and functionality of the knee joint. Participants completed questionnaires and in-person assessments at baseline and at program completion. Assessments included weight and height, chair stands as a measure of functional leg strength, and conditioned pain modulation to assess efficiency of the descending modulatory pathways. Participants also had their blood drawn to monitor changes in brain derived neurotrophic factor (BDNF), a marker of neuroplasticity. Questionnaires included the Pain Catastrophizing Scale, Hospital Anxiety and Depression Scale, the Knee Injury and Osteoarthritis Outcome Score - function and pain subscales, Chronic Pain Self Efficacy scale, pain intensity rated in the past 24 hours, the past week, and worst pain in the past 24 hours. Secondary feasibility outcomes included acceptability of the intervention, burden of assessments, recruitment rate, compliance rate, adherence rate, and self-reported adverse events. Feasibility findings were evaluated against a-priori success criteria. In the qualitative component, participants were invited to an online focus group and were asked about their experience and perceptions of the program. Interview recordings were analyzed using thematic content analysis to identify suggestions for program modification. Result(s): In total, 19 participants (mean age 63.3 years (SD 10.5), 73% female) were enrolled, with a complete follow up rate of 74% (n=14) for our primary objective, indicating that modifications would be needed to proceed. Of the 5 dropouts, only one was study related. We will be adding additional inclusion criteria of: ability to get up and down from the floor independently, and no use of mobility aids. Adherence to in-person treatment sessions was 91%, hich indicates proceeding with the protocol for the next phase (i.e., pilot RCT). Some absences were due to unmodifiable factors (e.g., COVID-19). We will make protocol amendments for the purpose of improving the adherence rate to include 'no planned absences'. All other success criteria were met: recruitment rate, compliance to exercise sessions, program acceptability, duration, frequency, and delivery, likelihood of recommending the program to others and taking the program again, burden, and adverse events (Table 1). Analysis of the focus groups revealed that the video content pertaining to the mind-body techniques would benefit from on screen demonstrations by the instructor to assist with participants' execution of breath and muscle tension regulation. The majority of participants improved in most of the physical assessment outcomes and questionnaires (Table 2). Conclusion(s): The PIM program is feasible, acceptable, not burdensome, does not cause adverse events, and had an excellent compliance rate. Minor modifications are needed to optimize enrolment and adherence rates. Although improvements in pain, function, and psychological measures were observed, the feasibility nature of this study precludes any conclusions regarding efficacy. A pilot two-arm RCT will be conducted to establish the feasibility and explore potential effects of PIM when compared to conventional neuromuscular exercise and standard OA education. [Formula presented] [Formula presented]Copyright © 2023

Catastrophizing life's problems: On the relationship between attachment anxiety and belief in conspiracy theories

Research has shown that attachment anxiety predicts higher agreement with conspiracy theories. In this research, we aimed to examine this relationship further. Specifically, we investigated the importance of catastrophizing-viewing situations as considerably worse than they are-in explaining the relationship between attachment anxiety and belief in conspiracy theories. Chapter 1 provides an overview of the literature on the psychology of conspiracy theories and adult attachment theory. Then, across six studies (Chapter 2), we found that catastrophizing (regarding pain, stress, and social situations) explained the relationship between attachment anxiety and conspiracy beliefs. In two further studies (Chapter 3), we found that attachment anxiety and conspiracy beliefs were associated with communal orientation (the desire that one's needs should be met by others versus the desire to meet the needs of others), which was moderated by catastrophizing, across two studies. Finally, in two studies (Chapter 4), we found attachment anxiety to be partially associated with COVID-19 powerlessness and COVID-19 conspiracy beliefs, whereas attachment avoidance was shown to be consistently associated with them. Implications and recommendations for future research are discussed (Chapter 5), including the need for more experimental or longitudinal designs, and interventions that reduce catastrophic thinking with the aim of reducing the appeal of conspiracy theories. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Low back pain (LBP) affected disability and pain catastrophizing in subacute inpatient rehabilitation during COVID-19 pandemic

Objectives: To examine disability and catastrophizing strategies before and during COVID-19 pandemic among patients with LBP in subacute rehabilitation practice in Latvia. Material(s) and Method(s): In this study were used four research tools: Demographic questionnaire, Visual analog scale (VAS), The Oswestry Low Back Disability Questionnaire, Pain Catastrophizing Scale. The statistical analysis was performed using SPSS software version 22.0. Result(s): In this study 78 patients participated for rehabilitation before COVID-19 pandemic and 70 patients during COVID-19 pandemic (total of 148 patients for rehabilitation), aged from 23 to 81 years with median age 56. Pain intensity by Visual analogue scale before pandemic mean scores were 30, but during COVID-19 pandemic mean scores for pain were 40. According to modified disability questionnaire 40% of LBP patients were with moderate disability, 26% minimal disability whereas 24% severe disability and 10% crippled before COVID-19 pandemic, but during pandemic 60% of LBP minimal disability and 40% were with moderate disability. Results showed statistical correlation between disability and pain intensity (p < 0.01), maladaptive catastrophizing thinking (p < 0.05), such as rumination and helplessness (p < 0.01). There are statistically significant correlations between low back pain disability and rumination (r = 0.489 before pandemic, and r = during pandemic), Magnification (r = 0.326) and Helplessness (r = 0.519). Conclusion(s): Our results point out the importance of pain catastrophizing strategies in determining disability. It is very important to use results for adapting biopsychosocial pain management model in rehabilitation practice. Necessary to continue research work to identify all possible aspects of factors that influence low back pain in multidisciplinary care and cure for better target interventions.

The Effect of Emotion Regulation on Predicting Depressive Symptoms in Students

Background: Many people around the world have been affected by depression, which causes a great deal of problems. Emotion regulation refers to processes influencing emotion, experiences, and expresses. Objective(s): This study aimed to evaluate the role of emotion regulation to predict depressive symptoms among Kermanshah University of Medical Sciences students. Method(s): This descriptive-analytical study was conducted on 305 students at Kermanshah University of Medical Sciences, Iran, who were randomly selected by convenient sampling method. The informed consent forms were signed by the participants. Then the Beck Depression Inventory-Second Edition (BDI-II) and the Cognitive Emotion Regulation Scale (CERQ-18) were completed in a virtual/face-to-face manner due to the COVID-19 pandemic. The data were analyzed with SPSS software version 26. A total of 296 participants were analyzed, of whom 198 (66.9%) were female, and 98 (33.1%) were male. Result(s): The self-blame strategies (beta = 0.31, P <= 0.001), positive reassessment (beta =-0.26, P <= 0.001), catastrophic (beta = 0.26, P <= 0.001), numerical importance (beta =-0.12, P <= 0.001) and positive refocus (beta =-0.10, P <= 0.001) predict 40% of the variance of depression in five steps. Inconsistent strategies such as self-blame and catastrophe directly predict depression. Further, depression is inversely related to positive reassessment, insignificance, and positive refocus. Conclusion(s): According to the results, there was a significant direct relationship between self-blame and catastrophic thinking as maladaptive cognitive emotion regulation strategies with depression. In addition, positive refocusing and positive reassessment had a significant negative correlation with depression among adaptive emotion regulation strategies. Copyright © 2022 Journal of Kermanshah University of Medical Sciences.

Impact of the Covid-19 Pandemic on Abdominal Pain, Emotional Distress, Quality of Life, Sleep, and Disability in Children with Functional Abdominal Pain Disorders

Purpose: The COVID-19 pandemic has the potential to influence the well-being of families and children with Functional Abdominal Pain Disorders (FAPDs). Given the known relationship between stress and abdominal pain in children with FAPDs, we hypothesized pandemic-related changes (e.g., reductions in family finances, social interactions) could affect health outcomes. Our aim was to examine the potential impact of the pandemic on abdominal pain, quality of life, psychological and physiological symptoms, and functional disability in children with FAPDs. Method(s): Ninety-one parents of children ages 7-12 who met the Rome IV criteria for a FAPD completed baseline questionnaires as part of an ongoing randomized controlled intervention trial on their child's Quality of life (PedsQL), Pain Behavior and Response (PBQ, PBCL, PRI), Pain Catastrophizing (PCS), Psychological Symptoms (SCL-90), Functional Disability (FDI), and sleep habits (CSHQ). Heart rate was also measured. Participants were categorized into two groups, based on the date of entry into the original study, as before or during the COVID-19 pandemic, allowing us to take advantage of a naturally occurring opportunity to assess potential impacts of the pandemic. Result(s): Sixty-one participants were consented before, and 30 participants were consented during the COVID-19 pandemic. Parents in the latter group reported their children to have more days of abdominal pain, higher pain frequency, pain behavior, disability, helplessness, and depression, and significantly lower quality of life, compared to the before COVID group (Table 1). Finally, child sleep anxiety and overall sleep difficulty were significantly higher during COVID. Children also had a significantly higher mean heart rate during the COVID-19 pandemic. Conclusion(s): Our findings suggest that the COVID-19 pandemic has impacted children with FAPDs in multiple domains. Of concern, parents of children with FAPDs reported greater child pain frequency, disability, and pain behaviors during the pandemic than before the pandemic. Parents also reported significant increased child emotional distress during the COVID-19 pandemic and impacts on quality of life during COVID-19;in fact, most scores on the PedsQL were lower than those previously reported for children receiving cancer treatment. Child sleep anxiety and overall disordered sleep also worsened during the pandemic. Additionally, physiological changes (mean heart rate) were observed during the pandemic (Figure 1). Possible explanations for these findings could include increases in child and family stress, and greater parental awareness of child symptoms due to increased time at home together, or parents' own increased stress levels. Clinicians and researchers should be aware of the potential impact of COVID-19 pandemic on these areas to inform research as well as treatment of children with FAPDs.

Loneliness and Pain Catastrophizing Among Individuals with Chronic Pain: The Mediating Role of Depression.

Purpose: Loneliness increased during the COVID-19 pandemic and social distancing guidelines, potentially exacerbating negative cognitions about pain. The present study investigated the longitudinal relationship between loneliness, assessed during the early weeks of the pandemic, and pain catastrophizing, assessed after living in the pandemic for approximately 1 year, among chronic pain patients. We also examined whether severity of depressive symptoms mediated this association. Methods: This prospective longitudinal study recruited individuals with chronic pain (N=93) from Massachusetts using an online convenience sampling method via the platform Rally. Participants completed an initial survey early after the onset of social distancing (4/28/20-6/17/20; Time 1) and a follow-up survey 1 year later (5/21/21-6/7/21; Time 2). Participants completed validated assessments of loneliness (T1), pain catastrophizing (T2), and depression (T2). Spearman correlations and Mann-Whitney U-tests were used to explore associations among psychosocial, pain, and participant characteristics. A mediation analysis was conducted to test whether the association between loneliness and pain catastrophizing was mediated by depression. Results: Participants had a mean age of 40.6 years and were majority female (80%) and White (82%). Greater loneliness was associated with subsequent higher pain catastrophizing (b=1.23, 95% CI [0.03, 2.44]). Mediation analysis showed a significant indirect effect (b=0.57, 95% CI [0.10, 1.18) of loneliness (T1) on catastrophizing (T2) through depression (T2) while accounting for several important covariates. The direct effect of loneliness on catastrophizing was no longer significant when depression was included in the model (b=0.66, 95% CI [-0.54, 1.87]). Conclusion: Findings suggest that greater loneliness during the pandemic was associated with higher pain catastrophizing 1 year later, and severity of depression after living in the pandemic mediated this association. As loneliness, depression, and catastrophizing can all be modified with behavioral interventions, understanding the temporal associations among these variables is important for the employment of future empirically supported treatments.

INVESTIGATION of the EFFECT of the HISTORY of COVID-19 on COGNITIVE LEVEL, PAIN CATASTROPHIZATION, and PHYSICAL ACTIVITY LEVEL in INDIVIDUALS with CHRONIC LOW BACK and NECK PAIN

Background: Low back and neck pain is one of the most common health problems in society and one of the top reasons for admission to the hospital (1). Studies show that the level of physical activity decreases in individuals with chronic pain, and the cognitive level and quality of life are negatively affected (2). There are studies examining the effects of the Covid-19 pandemic process on the level of physical activity and cognitive level in various groups. However, the number of studies on how the history of Covid-19 affects individuals with low back and neck pain is limited. Objectives: The aim of this study is to examine the effect of Covid-19 history on cognitive level, pain catastrophe and physical activity level in individuals with chronic low back and neck pain in individuals. Methods: A total of 25 individuals with chronic pain, including 16 with low back pain and 9 with neck pain, were included in the study. Demographic data such as age, gender and body mass index (BMI) were obtained from all individuals. The education levels of the individuals were recorded. Cognitive level was assessed by the Montreal Cognitive Assessment (MoCA)[3], pain severity was assessed by the Visual Analog Scale (VAS), pain catastrophization was assessed by the Pain Catastrophizing Scale (PCS)[4], and physical activity level was assessed by the International Physical Activity Questionnaire-Short Form (IPAQ-SF)[5]. Results: Table 1. Demographic data, VAS, MoCA, PCS, and IPAQ-SF scores are given in Table 1. 7 of the participants had history of Covid-19, 18 did not. The MoCA scores and education levels of individuals with Covid-19 were higher than individuals without history of Covid-19 (p<0.05). There was no difference in physical activity, pain and pain catastrophization levels between the 2 groups (p> 0.05). Conclusion: Surprisingly, individuals who had a history of Covid-19 had higher cognitive levels than individuals without a history of Covid-19. In addition, there was no difference between physical activity and pain catastrophization levels. This may be due to the higher education level of individuals with a history of Covid-19. There is a need for further studies in which education levels are similar, and hospitalization and the Covid-19 positivity process are examined in more detail.

Feasibility and effect of mindfulness approach by web for chronic migraine and high-frequency episodic migraine without aura at in adolescents during and after COVID emergency: preliminary findings.

BACKGROUND: Migraine disorders are common among adolescents: however, the efficacy of medical prophylaxis is limited in this population. This study reports preliminary findings on the feasibility and effect of a mindfulness-based intervention delivered via web for adolescents with chronic migraine (CM) and high-frequency episodic migraine (HFEM) without aura. METHODS: Patients with CM or HFEM received six session of a mindfulness-based treatment and were followed-up for 6 months as part of a larger study. Repeated measure analyses were carried out to test the effect of this behavioral intervention. RESULTS: A total of 12 patients were included in this analysis. A significant improvement was observed up to 6 months for headache frequency, symptoms of depression, and catastrophizing, and up to 3 months for patients' disability. No change was detected for patients' anxiety level. CONCLUSIONS: The results of our study provides initial support to the hypothesis that patients' education and mindfulness-based programs can be very useful in populations of adolescents with CM or HFEM.

IMPACT OF THE COVID-19 PANDEMIC ON ABDOMINAL PAIN, EMOTIONAL DISTRESS, QUALITY OF LIFE, SLEEP, AND DISABILITY IN CHILDREN WITH FUNCTIONAL ABDOMINAL PAIN DISORDERS

Purpose: The COVID-19 pandemic has the potential to influence the well-being of families and children with Functional Abdominal Pain Disorders (FAPDs). Given the known relationship between stress and abdominal pain in children with FAPDs, we hypothesized pandemicrelated changes (e.g., reductions in family finances, social interactions) could affect health outcomes. Our aim was to examine the potential impact of the pandemic on abdominal pain, quality of life, psychological and physiological symptoms, and functional disability in children with FAPDs. Methods: Ninety-one parents of children ages 7-12 who met the Rome IV criteria for a FAPD completed baseline questionnaires as part of an ongoing randomized controlled intervention trial on their child's Quality of life (PedsQL), Pain Behavior and Response (PBQ, PBCL, PRI), Pain Catastrophizing (PCS), Psychological Symptoms (SCL-90), Functional Disability (FDI), and sleep habits (CSHQ). Heart rate was also measured. Participants were categorized into two groups, based on the date of entry into the original study, as before or during the COVID-19 pandemic, allowing us to take advantage of a naturally occurring opportunity to assess potential impacts of the pandemic. Results: Sixty-one participants were consented before, and 30 participants were consented during the COVID-19 pandemic. Parents in the latter group reported their children to have more days of abdominal pain, higher pain frequency, pain behavior, disability, helplessness, and depression, and significantly lower quality of life, compared to the before COVID group (Table 1). Finally, child sleep anxiety and overall sleep difficulty were significantly higher during COVID. Children also had a significantly higher mean heart rate during the COVID- 19 pandemic. Conclusions: Our findings suggest that the COVID-19 pandemic has impacted children with FAPDs in multiple domains. Of concern, parents of children with FAPDs reported greater child pain frequency, disability, and pain behaviors during the pandemic than before the pandemic. Parents also reported significant increased child emotional distress during the COVID-19 pandemic and impacts on quality of life during COVID-19;in fact, most scores on the PedsQL were lower than those previously reported for children receiving cancer treatment. Child sleep anxiety and overall disordered sleep also worsened during the pandemic. Additionally, physiological changes (mean heart rate) were observed during the pandemic (Figure 1). Possible explanations for these findings could include increases in child and family stress, and greater parental awareness of child symptoms due to increased time at home together, or parents' own increased stress levels. Clinicians and researchers should be aware of the potential impact of COVID-19 pandemic on these areas to inform research as well as treatment of children with FAPDs.(Table Presented) (Figure Presented)

The Influence of Adverse Childhood Experiences in Pain Management: Mechanisms, Processes, and Trauma-Informed Care.

Adverse childhood experiences (ACEs) increase the likelihood of reduced physical and psychological health in adulthood. Though understanding and psychological management of traumatic experiences is growing, the empirical exploration of ACEs and physical clinical outcomes remains under-represented and under-explored. This topical review aimed to highlight the role of ACEs in the experience of chronic pain, pain management services and clinical decision making by: (1) providing an overview of the relationship between ACEs and chronic pain; (2) identifying biopsychosocial mechanisms through which ACEs may increase risk of persistent pain; (3) highlighting the impact of ACEs on patient adherence and completion of pain management treatment; and (4) providing practical clinical implications for pain management. Review findings demonstrated that in chronic pain, ACEs are associated with increased pain complications, pain catastrophizing and depression and the combination of these factors further heightens the risk of early treatment attrition. The pervasive detrimental impacts of the COVID-19 pandemic on ACEs and their cyclical effects on pain are discussed in the context of psychological decline during long treatment waitlists. The review highlights how people with pain can be further supported in pain services by maintaining trauma-informed practices and acknowledging the impact of ACEs on chronic pain and detrimental health outcomes. Clinicians who are ACE-informed have the potential to minimize the negative influence of ACEs on treatment outcomes, ultimately optimizing the impact of pain management services.

The impact of COVID-19 pandemic on mental and physical wellbeing in women with fibromyalgia: a longitudinal mixed-methods study.

OBJECTIVE: The COVID-19 pandemic has strongly influenced psychological and physical health worldwide. The aim of this study was to examine the impact of the pandemic on women with fibromyalgia. METHODS: This mixed methods pilot study explored measures of pain severity and interference, as well as pain catastrophizing and level of fibromyalgia impact among women with fibromyalgia before and during the COVID-19 pandemic in the USA. Fibromyalgia patients completed demographic, pain-related, and other validated psychosocial questionnaires prior to the onset of the COVID-19 pandemic, and then were re-assessed with those questionnaires, as well as a pandemic-related questionnaire assessing the impact of the pandemic on the patients' life, during the pandemic. RESULTS: When comparing data reported before the pandemic to data collected 3-6 months into the pandemic, women with fibromyalgia reported a general worsening of their pain and pain-related symptoms. During the pandemic, pain catastrophizing (p ≤ 0.05) and fibromyalgia impact (p ≤ 0.05) increased significantly compared to before the pandemic. The increase in pain catastrophizing scores was highly correlated with the impact of the pandemic on the participants' ability to cope with pain and on their mental health. Qualitative analysis corroborated the significant impact of the pandemic on patients' mental health, with the vast majority reporting a worsening of their mood. Other impacted domains included anxiety, level of activity and sleep. CONCLUSIONS: Collectively, the pandemic appears to have produced a substantive worsening of pain-related symptomatology among women with fibromyalgia, which should be addressed by targeted interventions.

Pulsatile Tinnitus after Covid-19 Affection Case Report

After being affected by Covid-19 a month before, a patient presented with ongoing symptoms of extreme headache, pain in the region of the neck and a very disturbing, pulse-synchronous (pulsatile) tinnitus (NRS 6-7/10). In the course of physiotherapeutic assessment, it transpires that the patient should not receive any physiotherapeutic treatment without previous medical clearance. After clearance is given to go ahead with physiotherapy, a treatment plan is developed, focusing primarily on the patient's stress coping strategies. This is supported by educational measures as well as manual therapy techniques directed at the cervical spine and the mandibular region. Owing to a fruitful collaboration between medical clearance, physiotherapy and psychotherapy as well as good patient communication, the patient can be treated successfully and his symptoms are reduced significantly.

Event centrality and post-traumatic stress symptoms among college students during the COVID-19 pandemic: the roles of attention to negative information, catastrophizing, and rumination.

Background: The coronavirus disease 2019 (COVID-19) pandemic has affected college students' mental health and caused post-traumatic stress symptoms (PTSS). Event centrality is thought to play a key role in the development of PTSS, but it is not yet clear by what mechanism. Theoretically, event centrality may affect the retrieval of traumatic memories and further prompt post-traumatic cognitions to understand events, and so may in turn be associated with PTSS in college students. However, few empirical studies have examined the mediating role of post-traumatic cognitions in the relationship between event centrality and PTSS, especially among college students during the COVID-19 pandemic. Objectives: The objective of this study was to examine the mediating roles of post-traumatic cognitive factors (e.g. attention to negative information, catastrophizing, and rumination) in the relationship between event centrality and PTSS among college students during the COVID-19 pandemic. Methods: We recruited 1153 college students who completed the pandemic experiences scale, the centrality of event scale, the attention to positive and negative information scale, the cognitive emotion regulation questionnaire, and the PTSD Checklist for DSM-5 during the COVID-19 pandemic in May 2020. Results: In this sample of college students, event centrality directly predicted PTSS, and PTSS was also indirectly predicted by event centrality through attention to negative information, catastrophizing, and rumination. Conclusions: These findings support the existing literature on the relationship between event centrality, proposed cognitive variables, and PTSS, and shed light on the mechanisms underlying PTSS. Our findings also highlight the importance and applicability of targeted cognitive interventions for PTSS in college students during the COVID-19 pandemic. HIGHLIGHTS: The COVID-19 pandemic has caused post-traumatic stress symptoms among college students.Event centrality is a risk factor of post-traumatic stress symptoms among college students during the COVID-19 pandemic.Attention to negative information, catastrophizing and rumination mediate the relationship between event centrality and post-traumatic stress symptoms.

Antecedentes: La pandemia de enfermedad coronavirus 2019 (COVID-19) ha afectado la salud mental de los estudiantes universitarios y causado síntomas de estrés postraumático (PTSS por sus siglas en ingles). Se cree que la centralidad del evento juega un rol importante en el desarrollo de PTSS, pero aún no está claro por qué mecanismo. Teóricamente, la centralidad del evento podría afectar la recuperación de los recuerdos traumáticos y estimular cogniciones postraumáticas para comprender los eventos y así su vez, podría estar asociada con PTSS en estudiantes universitarios. Sin embargo, pocos estudios empíricos han examinado el rol mediador de las cogniciones postraumáticas en la relación entre centralidad del evento y PTSS, especialmente entre estudiantes universitarios durante la pandemia de COVID-19.Objetivos: El objetivo de este estudio fue examinar los roles mediadores de los factores cognitivos postraumáticos (ej.: atención a información negativa, catastrofización y rumiación) en la relación entre centralidad del evento y PTSS entre los estudiantes universitarios durante la pandemia de COVID 19. Método: Reclutamos 1.153 estudiantes universitarios que completaron la escala de experiencias pandémicas, la escala de centralidad del evento, la escala de atención a la información positiva y negativa, el cuestionario de regulación cognitiva de las emociones y la lista de chequeo de TEPT para el DSM-5 durante la pandemia de COVID-19 en mayo del 2020.Resultados: En esta muestra de estudiantes universitarios, la centralidad del evento predijo directamente PTSS, y PTSS fueron tambien predichos indirectamente tambien por la centralidad del evento través de la atención a la información negativa, catastrofización y rumiación.Conclusiones: Estos hallazgos apoyan la literatura existente en la relación entre centralidad del evento, las variables cognitivas propuestas y PTSS y arrojan luz sobre los mecanismos subyacentes a PTSS. Nuestros hallazgos destacan tambien la importancia y aplicabilidad de las intervenciones cognitivas dirigidas a los PTSS en estudiantes universitarios durante la pandemia de COVID-19.

Profiles of Resilience and Risk in Chronic Pain: Loneliness, Mindfulness, and Optimism Coming Out of the Pandemic

Individuals experience variable degrees of severity and interference from chronic pain. While clinical diagnosis and pain symptomology may importantly inform treatment options, person-level characteristics may also impact treatment efficacy. The biopsychosocial model of pain includes several pain-modulatory factors which may inform meaningful categorization, or clustering, of individuals with chronic pain, and help predict pain outcomes. In this observational, longitudinal study conducted approximately shortly after the onset of social distancing, patients with chronic pain (N=94) completed validated assessments of known psychosocial (depression, stress, sleep, catastrophizing) pain modulators and pain intensity, which were used to empirically cluster patients into 3 groups using a two-step hierarchical approach. Subsequently, at 1 year later, degree of pain interference, loneliness, social support, mindfulness, and optimism were compared between these 3 groups using ANOVAs. Participants clustered empirically into three groups: 1) Global Elevation Symptoms (GES), characterized by high psychological distress and moderate pain intensity;2) Pain Intensity Predominant (PIP), characterized by high pain intensity, but average psychological distress;and 3) Less Elevated Symptoms (LES), characterized by low pain intensity and psychological distress. At the 1-year follow-up, patients in the GES cluster reported significantly greater pain interference than the other two clusters, as well as greater feelings of loneliness and lower mindfulness and optimism compared to the LES cluster. This study supports prior research suggesting that psychosocial-based clustering of patients can be used to identify distinct groups of chronic pain patients. In particular, patients identified as belonging to the GES cluster (high psychological distress, high pain intensity early after onset of social distancing) were at greater risk of suffering from pain a year later, as well as loneliness and less mindfulness and optimism. Patient clustering techniques may help identify high risk patients and suggest behavioral interventions to improve pain by addressing psychosocial modulators of pain. Grant support from 5R35GM128691-02.

Trajectories and Individual Differences in Pain, Emotional Distress, and Prescription Opioid Misuse During the COVID-19 Pandemic: A One-Year Longitudinal Study.

Recent studies suggest that the COVID-19 pandemic can serve as a unique psychosocial stressor that can negatively impact individuals with chronic pain. Using a large online sample in the U.S., the present study sought to investigate the impact of the pandemic on the trajectories of pain severity and interference, emotional distress (ie, anxiety and depressive symptoms), and opioid misuse behaviors across one year. Potential moderating effects of socio-demographic factors and individual differences in pain catastrophizing, pain acceptance, and sleep disturbance on outcome trajectories were also examined. Adults with chronic pain were surveyed three times across 1 year (April/May 2020 [N = 1,453]; June/July 2020 [N = 878], and May 2021 [N = 813]) via Amazon's Mechanical Turk online crowdsourcing platform. Mixed-effects growth models revealed that pain severity and interference, emotional distress, and opioid misuse behaviors did not significantly deteriorate across one year during the pandemic. None of the socio-demographic factors, pain catastrophizing, or sleep disturbance moderated outcome trajectories. However, individuals with higher pain acceptance reported greater improvement in pain severity (P< .008, 95% CI: -.0002, -.00004) and depressive symptoms (P< .001, 95% CI: -.001, -.0004) over time. Our findings suggest that the negative impact of the pandemic on pain, emotional distress, and opioid misuse behaviors is quite small overall. The outcome trajectories were also stable across different socio-demographic factors, as well as individual differences in pain catastrophizing and sleep disturbance. Nevertheless, interventions that target improvement of pain acceptance may help individuals with chronic pain be resilient during the pandemic. PERSPECTIVE: Individuals with chronic pain overall did not experience significant exacerbation of pain, emotional distress, and opioid misuse across one year during the COVID-19 pandemic. Individuals with higher pain acceptance showed greater improvement in pain severity and depressive symptoms over time during the pandemic.

Evaluating the Relationship Between Depression and Pain Anxiety with Pain Catastrophizing in Patients with COVID-19.

Background: This study aimed to investigate the relationship between depression and pain anxiety with pain catastrophizing in patients with coronavirus disease 2019 (COVID-19). Methods: In this descriptive, correlational study, 180 patients with COVID-19 in Akhtar and Imam Hossein hospitals in Tehran, Iran, were included from March 2019 to April 2020. All participants completed three questionnaires, including the Pain Catastrophizing Scale (PCS), Pain Anxiety Symptoms Scale (PASS), and Beck's Depression Inventory (BDI). The data were analyzed using Pearson correlation coefficient and multivariate regression. Results: There was a positive and significant relationship between the dimensions of rumination, magnification, and helplessness with total score of pain catastrophizing, as well as moderate to severe dimensions with total pain anxiety and depression in patients with COVID-19. Conclusions: According to the results of regression analysis, pain anxiety based on pain catastrophizing dimensions was statistically significant, so that rumination, magnification, and helplessness could predict pain anxiety and explain a total of 15.1% of changes in pain anxiety. Also, depression was statistically significant based on dimensions of pain catastrophizing, so rumination, magnification, and helplessness could predict the patients' depression and explain 13.6% of depression changes.

Prevention of Posttraumatic Contractures with Ketotifen II (PERK2)

Regulatory approvals - US Food and Drug Administration, USAMRMC Human Research Protections Office (HRPO), Health Canada - have been completed for 14 participating sites. Remaining 3sites are poised for approval during Q1 of year 4. 14 of the participating sites have received ethics approval. Site initiation visits were completed at 6 sites, with 11 actively recruiting before COVID-19 lockdown. Bay Area Research Logistics (BARL) has completed shipment of medication to 11 sites, with plans on shipping medication to 3 more sites duringQ1 or year 4. These efforts have led to active sites successfully recruiting and randomizing51 participants. Screening/recruitment efforts have been limited due to COVID-19 restrictions at all sites of interest. Only 6 sites have been approved for trial restart by the local operating officials. However, all sites with active participants were able to safely continue data collection efforts. Site contract negotiations have been completed at 16 sites, with the last remaining to be done during Q1 of Year 4. Bi-weekly safety summary meetings are being held with local Research Monitor to review AE/SAEs. Updated versions of charters for Data Monitoring Committee (DMC), Trial Steering Committee (TSC), and Trial Management Group (TMG)were finalized. Monthly TMG meetings are being held, with TSC meetings occurring every three months. DMC membership has been finalized, with plans of holding first meeting during Q1 of Year 4. One manuscript was published during this reporting period.

Initial Adjustment to the COVID-19 Pandemic and the Associated Shutdown in Children and Adolescents With Chronic Pain and Their Families.

Objectives: Youth with chronic pain often struggle to function in multiple domains due to pain and associated psychosocial distress. In 2020, schools and businesses shut down and people were encouraged to remain at home due to the COVID-19 pandemic, eliminating or reducing stress due to functional difficulties. This study assessed whether pain and associated psychosocial outcomes improved in youth with chronic pain during the shutdown, compared with before the pandemic. Methods: Patients who completed clinical outcome measures during a multidisciplinary evaluation before the pandemic were readministered the same measures (PROMIS Anxiety, Depression, Sleep Disturbance, PCS, PedsQL) during the shutdown. At follow-up, patients also completed measures of adjustment to COVID-19 and their parents completed a measure of pandemic effects. Results: Participants included 47 patients ages 8-18 and a parent/guardian. The pandemic impacted families in both positive (e.g., more quality time with family) and negative ways (e.g., social isolation, disruption in care). Pain intensity and pain catastrophizing significantly decreased during the shutdown (ps <0.01). Change in pain catastrophizing was correlated positively with change in psychological stress (p = 0.004) and anxiety (p = 0.005) and negatively with change in quality of life (p = 0.024). Discussion: Pain and pain catastrophizing decreased initially during the shutdown related to the COVID-19 pandemic. Change in catastrophizing was associated with change in stress and anxiety. It may be that the reduction in functional demands contributed to this change. Functional difficulties should be addressed in treatment, including pain coping and also environmental modification to support optimal functioning in youth with chronic pain.

Do bio-psycho-social self-reported factors distinguish rotator cuff tendinopathy from other shoulder problems and explain shoulder severity? A case–control study

Keywords: Tendinopathy;Rotator cuff;Digital transformation Purpose: Similar associations between self-reported bio-psycho-social factors and the presentation of people with various shoulder disorders and rotator cuff (RC) tendinopathy have been reported;however, only limited numbers of variables have been assessed, often in small cohorts. We aimed to test whether RC tendinopathy could be distinguished from other shoulder problems using a range of bio-psycho-social self-reported factors and the degree to which they explain severity. Methods: Self-reported bio-psycho-social factors were collected via an online survey battery from an international sample. The dependent variables were diagnosis (having RC tendinopathy or other shoulder problems) and severity. After group comparison and univariate regression analyses, multivariable logistic and linear regression analyses were used to construct explanatory models for group differences and severity. Results: 82 people with RC tendinopathy (42.8 ± 13.9 years, 50 female) and 54 people with other shoulder problems (40.2 ± 14.1 years, 33 female) were recruited and found not to differ in severity on four patient-reported PROMs (Shoulder Pain and Disability Index (SPADI) = 37.3 ± 24.5 vs 33.7 ± 22.5, Western Ontario Rotator Cuff Index (WORCI) = 56.2 ± 22.0 vs 60.3 ± 22.2, Single Assessment Numeric Evaluation = 56.6 ± 25.3 vs 56.5 ± 28.7 and Patient Acceptable Symptomatic State (yes:no) 51:31 vs 23:22, respectively). Eight self-reported factors individually distinguished RC tendinopathy from other shoulder problems, with the model distinguishing tendinopathy from other shoulder problems including 4 variables;having a previous injury in the shoulder (OR (95% CI) = 0.30 (0.13–0.69)), activity effect on pain (OR (95% CI) = 2.24 (1.02–4.90)), General Self-Efficacy Score (OR (95% CI) = 1.12 (1.02–1.22)) and activity level according to Global Physical Activity Questionnaire (moderately active OR (95% CI) = 3.97 (1.29–12.18) and highly active OR (95% CI) = 3.66 (1.41–9.48)), with acceptable overall model accuracy. Univariate linear regression analysis showed that 32 variables were associated with RC tendinopathy severity with a multivariable model consisting of quality of life (β coefficient = −0.38), having night pain (β = 0.19), having unilateral morning stiffness (β = 0.25), BMI (β = 0.29), FABQ (work) score (β = 0.25);and pain catastrophising (β = 0.21) explaining 68% of the variance in severity. Conclusion(s): Well validated patient-reported outcomes to explain severity do not distinguish RC tendinopathy from other shoulder problems however self-reported bio-psycho-social factors do, so may be useful for clinical evaluation. Further, these factors were strongly associated with severity, reinforcing the potential to improve patient assessment, for example, using pre-consultation online data collection in usual care. The models warrant prospective validation and consideration alongside data from physical and imaging assessment. Impact: Online survey including self-reported bio-psycho-social factors may help augment diagnosis and, more importantly, provide some of the detail needed for holistic assessment by complementing physical examination and imaging. Therefore, the online survey may be useful to minimise the clinical time commitment and optimising safety during the Covid-19 pandemic. Funding acknowledgements: The review is a part of Mehmet Delen's Ph.D., which is sponsored by the Turkish Ministry of National Education. The sponsors had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Information seeking and health anxiety during the COVID-19 pandemic: The mediating role of catastrophic cognitions.

Cognitive-behavioural models of health anxiety propose a positive association between information seeking and health anxiety; however, it is unclear the extent to which cognitive mechanisms may mediate this relationship. Catastrophic cognitions are one type of cognition that may mediate this relationship, and the COVID-19 pandemic has presented an opportunity to examine these relationships within the context of a global health catastrophe. The current study investigated both cross-sectional (N = 797) and longitudinal (n = 395) relationships between information seeking, health anxiety and catastrophizing during the pandemic. Data were collected using Amazon Mechanical Turk during April and May 2020. Information seeking and health anxiety were positively associated both cross-sectionally and longitudinally (rs = .25-.29). Catastrophic cognitions significantly mediated the relationship between information seeking and health anxiety both cross-sectionally and longitudinally. Developing effective methods of reducing information seeking and catastrophizing may serve to reduce health anxiety during global health crises such as the current pandemic.