Predictors of sexual satisfaction among patients with chronic pain.

Objectives: Sexual satisfaction is an important aspect of quality of life. Chronic pain, depression and anxiety, and relational problems correspond with higher risk for sexual difficulties. Less is known about how risk factors for sexual dysfunction and other problems-such as medical conditions, pain severity, and medication side effects-affect the sexual satisfaction of people with chronic pain. Using a biopsychosocial framework, this study explored factors related to sexual satisfaction among patients presenting for evaluation of chronic pain. Methods: Researchers used a hierarchical multiple regression analysis to model potential predictors of sexual satisfaction. Variables analyzed were demographic features, medical history, average pain severity, depressed mood, anxiety, and perceived significant other support. Data collection involved administration of retrospective questionnaires and chart review. The sample included male and female participants (N = 134) presenting for evaluation at a multidisciplinary pain rehabilitation clinic. Results: Medical history (i.e., medical conditions, surgical history, and medications) and clinical self-report variables (i.e., pain severity, depressed mood, anxiety, and perceived significant other support) were associated with sexual satisfaction. In this sample, antidepressant use and higher pain severity were unique predictors of lower sexual satisfaction. Married marital status and higher levels of perceived significant other support were predictive of greater sexual satisfaction. Discussion: Findings highlight the importance of understanding the unique impact of biopsychosocial variables on the sexual satisfaction of patients presenting for evaluation at a multidisciplinary pain rehabilitation clinic. Further exploration of protective factors that account for sexual satisfaction among individuals with chronic pain may help inform screening, referrals, and treatment.

Interdisciplinary pain rehabilitation and sexual functioning: Treatment outcomes and patient preferences.

BACKGROUND/OBJECTIVE: Sexual dysfunction is common for patients experiencing chronic pain. Prior research is limited on how treatment for chronic pain affects patients' sexual functioning. This study reports pre-/post-treatment measures of self-reported sexual functioning among individuals presenting for chronic pain treatment at an interdisciplinary pain rehabilitation program (IPRP) and reports patient treatment preferences. METHOD: This study uses detailed treatment measures across multiple domains of sexual functioning to describe the prevalence and correlates of self-reported sexual functioning among individuals with chronic pain presenting for and discharging from treatment at an IPRP (N = 71). Domains include sexual interest, satisfaction with sexual functioning, vaginal lubrication, vaginal discomfort, and erectile function. Patients also completed a multiple-choice treatment preferences questionnaire created for this study. RESULTS: Results from this study show a high prevalence of sexual dysfunction in chronic pain populations (51.5%) and show no significant difference in sexual functioning after completing outpatient treatment, except for a significant improvement in sexual satisfaction for males only. Results from the patient treatment preferences questionnaire indicate that most patients (83.3%) thought their pain was important to address within the context of an IPRP; however, many patients (58.7%) did not think their treatment addressed sexual functioning. In addition, many patients (34%) would prefer to discuss sexual functioning with their primary care provider or pelvic floor physical therapist. CONCLUSION: Findings demonstrate that usual multidisciplinary pain management treatment is not sufficient to address patients' concerns with sexual functioning. Additional creative strategies will need to be studied on how to best treat these overlapping problems. Implications and future research directions are discussed.

Sexual Functioning Among Adults with Chronic Pain: Prevalence and Association with Pain-Related Outcomes.

BACKGROUND: Prior research indicates that sexual functioning and chronic pain commonly coexist and impact each other; however, there are limitations in current research as to the prevalence and severity of sexual dysfunction in patients with chronic pain. METHOD: This study used detailed measures across multiple domains of sexual functioning to describe the prevalence and correlates of self-reported sexual functioning among individuals with chronic pain presenting for treatment at a multidisciplinary pain management center (N = 247). Domains included sexual interest, satisfaction with sexual functioning, vaginal lubrication, vaginal discomfort, and erectile function. Individuals with and without sexual dysfunction were compared on pain-related outcome variables. RESULTS: Results from this study showed a high prevalence of sexual dysfunction in populations with chronic pain and a positive association between sexual problems and pain severity and psychological concerns. Sex differences were noted, with female participants exhibiting significantly lower sexual satisfaction associated with higher levels of pain, pain-related life interference, depression, and anxiety, whereas these relationships were not significant for male participants. CONCLUSION: Findings demonstrated that patients with chronic pain experience significant sexual dysfunction, including lack of interest in sexual activity and low satisfaction with their sex lives. Compared with patients without sexual dysfunction, patients with sexual dysfunction reported higher average pain levels and higher depressive symptoms, along with greater anxiety in patients with at least one area of sexual dysfunction. Adding to these findings are the pain-relevant correlates of sexual functioning domains and sex differences in these relationships, with women experiencing additional pain-related problems. Limitations and future research directions are discussed.

The Helplessness Dimension of Pain Catastrophizing Mediates the Relation between PTSD Symptoms and Pain Rehabilitation Measures.

Background: Comorbid chronic pain and post-traumatic stress disorder (PTSD) complicate the treatment of both conditions. Previous research has identified pain catastrophizing as a potentially important variable contributing to the relationship between chronic pain and PTSD. However, little is known regarding how the different dimensions of pain catastrophizing-rumination, magnification, and helplessness-uniquely contribute to the relationship between PTSD symptomatology and measures of pain outcome. Methods: 491 treatment seeking participants were admitted to a three-week interdisciplinary pain rehabilitation program between July 2016 and March 2020. The patients completed measures of pain severity, pain interference, pain catastrophizing, depressive symptoms, quality of life (QOL), and PTSD symptoms at pretreatment. Results: Parallel mediation analyses were conducted to evaluate the mediating effect of the Pain Catastrophizing Scale subscales on the relationship between PTSD symptomatology and pain-relevant variables. The helplessness subscale accounted for significant unique variance in the relationship between PTSD symptomatology and pain severity (b = 0.010, SE = 0.002, 95% CI: 0.006, 0.014), pain interference (b = 0.004, SE = 0.002, 95% CI: 0.001, 0.008), and mental health QOL (b = -0.117, SE = 0.031, 95% CI: -0.179, -0.059), while the rumination and magnification subscales had no significant influence. Conclusions: Pain catastrophizing is a multifaceted construct. These results suggest that the helplessness dimension of pain catastrophizing may be the primary target when treating patients with comorbid chronic pain and PTSD symptoms. This study represents the first to evaluate the influence of the individual dimensions of pain catastrophizing on the relationship between PTSD symptomatology and chronic pain outcome.

Childhood Adversity Among Adults With Chronic Pain: Prevalence and Association With Pain-related Outcomes.

OBJECTIVES: Adverse childhood experiences (ACEs) have been linked to the development and impact of chronic pain in adulthood. The goal of this study was to investigate the prevalence of ACEs in a treatment-seeking sample of adults with chronic pain and the relationship between number and type(s) of ACEs and pain-related outcomes. METHODS: Adults (N=1794) presenting for treatment at a multidisciplinary pain management center completed self-report measures of childhood adversity, pain, functioning, emotional distress, and adjustment to pain. RESULTS: Participants endorsing ≥4 ACEs had significantly worse pain-related outcomes and lower quality of life compared with individuals reporting fewer ACEs. Having ≥3 ACEs was associated with higher anxiety and depression levels. Experiences of childhood neglect negatively affected mental health-related outcomes independent of the number of ACEs. Significant sex differences were found in the number and type of ACEs reported but not in the relationship between ACEs and outcome variables. CONCLUSION: Findings suggest that the number and the type of self-reported ACE(s) are associated with pain-related variables and psychosocial functioning in adults with chronic pain. The results highlight the importance of assessment of ACEs and trauma-informed care with patients with chronic pain.

Treatment of Insomnia within an Interdisciplinary Pain Rehabilitation Program: A Randomized Trial / Tratamiento del insomnio mediante un programa interdisciplinario de rehabilitación del dolor: ensayo aleatorizado

ResumenAntecedentes/Objetivo:Investigaciones indican que el nivel de cuidado habitual (UC, por siglas en inglés) de los programas interdisciplinarios de rehabilitación del dolor (IPRP, por si-glas en inglés) no abordan suficientemente los problemas del sueño entre personas que pa-decen dolor crónico comórbido con niveles clínicos de insomnio. La terapia cognitivo-conduc-tual para el insomnio (CBT-I, por siglas en inglés) es una intervención basada en la evidencia. Se investiga la translación de la CBT-I en un IPRP. Método: Se examinaron los resultados rela-cionados con insomnio y dolor en adultos que participaban en un IPRP de diez semanas (N = 79) asignados a CBT grupal de cuatro sesiones (IPRP+CBT-I) o nivel de cuidado habitual (IPRP-UC). Resultados:Los pacientes IPRP+CBT-I mostraron mejoría en síntomas de insomnio al final del estudio en comparación con el comienzo del grupo CBT-I; no hubo diferencias significativas en los resultados de IPRP en relación con la condición de IPRP-UC. Ambos grupos informaron reducciones en insomnio, gravedad del dolor, nivel de interferencia en la vida relacionada con el dolor y estado de ánimo deprimido. Menos de un tercio de los participan-tes informaron reducciones clínicamente significativas en síntomas de insomnio después de participar en IPRP. Conclusiones:Se necesitan mayores esfuerzos para trabajar con proble-mas del sueño en el entorno de los programas de rehabilitación del dolor.

AbstractBackground/Objective:Prior research indicates interdisciplinary pain rehabilitation program (IPRP) usual care (UC) does not sufficiently address sleep problems among individuals with comorbid chronic pain and clinical levels of insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based insomnia intervention. The current study investigates the translation of CBT-I into an IPRP. Method: In this single-site, prospective, randomized controlled pilot study, insomnia and pain-related outcomes were examined for adults participating in a 10-week IPRP (N = 79) who were allocated to a 4-session group-based CBT-I (IPRP+CBT-I) or usual care (IPRP-UC) condition. Results:Patients in the IPRP+CBT-I group showed improvements in insomnia symptoms at the end compared to the beginning of the CBT-I group; however, there were no IPRP outcome differences relative to the IPRP-UC condition. Both groups reported statistically significant reductions in insomnia, pain severity, pain-related life interference, and depressed mood. Fewer than one-third of participants reported clinically meaningful reductions in insomnia symptoms following IPRP participation. Conclusions:Further efforts are needed to address sleep problems in pain rehabilitation settings.

Mediators of change in depressed mood following pain rehabilitation among participants with mild, moderate, or severe depressive symptoms.

BACKGROUND: Prior research indicates that depression and chronic pain commonly co-exist and impact each other. Interdisciplinary pain rehabilitation programs (IPRPs) have been shown to lead to statistically and clinically significant improvements for patients who report both depressed mood and chronic pain, however there is a gap in the literature regarding the mechanisms by which these improvements occur. METHODS: This two-site, distinct sample study (Study 1: N = 303, 10-week, individual format, ACT-based program; Study 2: N = 406, 3-week, group format, CBT-based program) evaluated mediators of treatment improvement in depressive symptoms among adult IPRP participants who reported elevated depressive symptoms at program admission and examined treatment mechanisms for depressive symptoms. RESULTS: Self-reported pain self-efficacy and pain catastrophizing - particularly the helplessness domain - mediated the treatment-related change in depression among IPRP participants with elevated depressive symptoms across the two sites and samples. In one sample, full mediation was achieved while in the other sample, partial mediation was achieved. Participants in both samples showed improvement on all measures. LIMITATIONS: This study relied on self-report measures of depressive severity and not clinical diagnosis. Results may not generalize to other populations of patients with chronic pain. There was no control condition in either study. CONCLUSION: Increasing pain self-efficacy and decreasing a sense of helplessness are important treatment targets among IPRP participants who endorse symptoms of depression.

Treatment of Insomnia within an Interdisciplinary Pain Rehabilitation Program: A Randomized Trial.

Background/Objective: Prior research indicates interdisciplinary pain rehabilitation program (IPRP) usual care (UC) does not sufficiently address sleep problems among individuals with comorbid chronic pain and clinical levels of insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based insomnia intervention. The current study investigates the translation of CBT-I into an IPRP. Method: In this single-site, prospective, randomized controlled pilot study, insomnia and pain-related outcomes were examined for adults participating in a 10-week IPRP (N = 79) who were allocated to a 4-session group-based CBT-I (IPRP+CBT-I) or usual care (IPRP-UC) condition. Results: Patients in the IPRP+CBT-I group showed improvements in insomnia symptoms at the end compared to the beginning of the CBT-I group; however, there were no IPRP outcome differences relative to the IPRP-UC condition. Both groups reported statistically significant reductions in insomnia, pain severity, pain-related life interference, and depressed mood. Fewer than one-third of participants reported clinically meaningful reductions in insomnia symptoms following IPRP participation. Conclusions: Further efforts are needed to address sleep problems in pain rehabilitation settings.

Antecedentes/Objetivo: Investigaciones indican que el nivel de cuidado habitual (UC, por siglas en inglés) de los programas interdisciplinarios de rehabilitación del dolor (IPRP, por siglas en inglés) no abordan suficientemente los problemas del sueño entre personas que padecen dolor crónico comórbido con niveles clínicos de insomnio. La terapia cognitivo-conductual para el insomnio (CBT-I, por siglas en inglés) es una intervención basada en la evidencia. Se investiga la translación de la CBT-I en un IPRP. Método: Se examinaron los resultados relacionados con insomnio y dolor en adultos que participaban en un IPRP de diez semanas (N = 79) asignados a CBT grupal de cuatro sesiones (IPRP + CBT-I) o nivel de cuidado habitual (IPRP-UC). Resultados: Los pacientes IPRP + CBT-I mostraron mejoría en síntomas de insomnio al final del estudio en comparación con el comienzo del grupo CBT-I; no hubo diferencias significativas en los resultados de IPRP en relación con la condición de IPRP-UC. Ambos grupos informaron reducciones en insomnio, gravedad del dolor, nivel de interferencia en la vida relacionada con el dolor y estado de ánimo deprimido. Menos de un tercio de los participantes informaron reducciones clínicamente significativas en síntomas de insomnio después de participar en IPRP. Conclusiones: Se necesitan mayores esfuerzos para trabajar con problemas del sueño en el entorno de los programas de rehabilitación del dolor.

Sex differences in interdisciplinary pain rehabilitation outcomes: a systematic review.

OBJECTIVES: Interdisciplinary pain rehabilitation programs (IPRPs) are evidence-based treatments for chronic pain. Previous research has demonstrated that initial presentations of adult men and women admitted to IPRPs differ, but less is known about sex differences in IPRP treatment outcomes. To summarize and synthesize the current literature base on this topic, a systematic literature review was conducted that asked: are sex differences present in participant outcomes upon completion of interdisciplinary pain rehabilitation programs for cisgender patients? Four core domains of outcome measures were assessed: depression, pain catastrophizing, pain interference, and pain intensity/severity. METHODS: Relevant studies meeting inclusion criteria were identified using a computer-aided search of the following electronic bibliographic databases: PubMed (MEDLINE), EMBASE, PsycINFO, CENTRAL (via Wiley Online Library), and CINAHL (via EBSCOhost). The reference list of relevant studies identified in the electronic searches was also screened to identify further studies. RESULTS: This review concluded that most studies did not find any differences related to sex using the four outcome measures included in this review. This implies that specific considerations based on sex may not be needed when providing interdisciplinary pain rehabilitation. CONCLUSIONS: Future research directions include comparison of additional outcome measures and exploring sex and gender issues in IPRP treatment in other formats than as a simple dichotomous variable.

Patients with Clinically Elevated Depressive Symptoms Report Improvements in Mood, Pain, and Functioning Following Participation in Interdisciplinary Pain Rehabilitation.

OBJECTIVE: Chronic pain and depression frequently co-occur and exacerbate one another; therefore, it is important to treat both conditions to improve patient outcomes. The current study evaluates an interdisciplinary pain rehabilitation program (IPRP) with respect to the following questions: 1) How do clinically elevated depressive symptoms impact pain-related treatment outcomes? and 2) To what extent does IPRP participation yield reliable and clinically significant change in depressed mood? METHODS: Participants in this study included 425 adults who engaged in a 10-week IPRP and completed self-report measures of pain, mood, and functioning at intake and discharge. Participants were categorized into 4 groups based on self-reported depressive symptoms (PROMIS Depression): within normal limits (WNL; n = 121), Mild (n = 115), Moderate (n = 153), and Severe (n = 36). RESULTS: Participants reported significant improvement in pain, pain-related life interference, health-related quality of life, pain catastrophizing, and depressed mood regardless of initial symptom level. In addition, 43.4% of patients with Mild, Moderate, or Severe depressed mood reported reliable and clinically significant improvement in depressive symptoms and 30.3% were in remission at the end of treatment. CONCLUSIONS: These findings support the assertion that IPRPs represent an effective treatment for patients with comorbid chronic pain and depression and that participation is associated with improvement in both conditions.

Insomnia symptoms and chronic pain: Outcomes of an interdisciplinary pain rehabilitation program.

OBJECTIVES: Insomnia is a highly prevalent problem among patients with chronic pain. Interdisciplinary pain rehabilitation programs (IPRPs) are a leading treatment option for chronic pain; however, research is limited and existing findings are mixed on the impact of insomnia symptoms on IPRP outcomes and the extent to which insomnia symptoms improve as a result of IPRP treatment. METHODS: In this study, insomnia and pain-related outcomes following a 10-week IPRP were examined from a relatively large sample (N = 393) of adult patients with varying chronic pain conditions who completed the Insomnia Severity Index (ISI) at program admission and discharge. Both group- and individual-level changes in insomnia severity were examined to evaluate statistically and clinically significant changes in insomnia symptoms, along with the impact of insomnia symptoms on measures of pain, emotional distress, and functioning. Participants were categorized as having no clinically significant insomnia symptoms (NCSI), mild, moderate, or severe insomnia based on ISI scores. RESULTS: Higher levels of insomnia severity were associated with worse pain, functioning, and emotional distress. Most patients reporting mild, moderate, or severe insomnia symptoms at program admission moved to a lower insomnia symptom category at the time of discharge (62%); however, only 33% of these patients reported a meaningful score reduction (i.e., ISI change ≥8 points). In addition, insomnia symptoms had a negative impact on treatment gains related to pain interference and physical health-related quality of life. DISCUSSION: These findings suggest that usual IPRP care confers overall treatment benefit for individuals with chronic pain and insomnia. However, insomnia symptoms may negatively impact pain treatment outcomes and usual care appears insufficient to address elevated insomnia symptoms for many patients. Additional insomnia-specific treatment may be warranted for patients with comorbid chronic pain.

Cognitive behavioral therapy for depressive disorders: Outcomes from a multi-state, multi-site primary care practice.

BACKGROUND: Individuals with depressive disorders often present to and seek treatment in primary care. Integrated behavioral health services within this setting can improve access to evidence-based cognitive behavioral therapy (CBT). However, limited information exists on the effectiveness of CBT for depression in primary care. METHODS: Of the 1,302 participants with a primary depressive disorder referred by their primary care provider, 435 endorsed moderate to severe depression at baseline and engaged in at least one CBT session. A psychotherapy tracking database was used to collect relevant data, which included demographics, clinical characteristics, treatment outcomes, and CBT intervention use. RESULTS: Participants with moderate to severe depression who participated in CBT reported a significant decrease in depression and anxiety symptoms at the end of treatment (p ≤ .001, d = 0.52-0.78). Rates of reliable change, response, and remission and types of CBT interventions used differed between major and persistent depressive disorders. LIMITATIONS: Multiple limitations must be noted, which are related to the naturalistic study design, inclusion and exclusion criteria, sample operationalization, symptomatic measurement, time-limited and focused assessment, data collection strategies, and psychological services. Together, these temper the conclusions that can be drawn. CONCLUSION: Significant reductions in depression and anxiety symptoms were reported by participants with depressive disorders who engaged in short-term CBT within primary care. This study indicates that CBT can be implemented within primary care and suggests that primary care patients with depression can benefit from integrated psychological services, supporting population-based models of care.

Adverse Childhood Experiences and Chronic Pain Rehabilitation Treatment Outcomes in Adults.

OBJECTIVES: Adverse childhood experiences (ACEs) are commonly reported by individuals with chronic pain. However, little is known about how ACE exposure influences treatment outcomes. The goal of the current study was to evaluate group and treatment-related differences among adults with varying levels of ACE exposure participating in a pain rehabilitation treatment program. METHODS: Adult participants (N=269) were categorized as 0 ACEs (n=65), 1 to 2 ACEs (n=87), or ≥3 ACEs (n=117). Participants completed self-report measures of pain, physical functioning, and psychosocial functioning at intake and discharge from a 10-week interdisciplinary pain rehabilitation program. RESULTS: ACE exposure was frequently endorsed in this sample, with the majority of participants (78.5%) reporting at least 1 form of childhood adversity. Adults in the ≥3 ACEs group reported a greater level of impairment in mental health symptoms and adjustment to chronic pain; however, all groups endorsed treatment improvements and there were no differences in response to treatment. There were also no differences between groups on measures of pain or physical functioning at intake or discharge. DISCUSSION: ACE exposure appears common among treatment-seeking adults with chronic pain and is associated with increased clinical complexity. However, adults with and without exposure to ACEs endorsed significant improvements in pain and functioning following participation in an interdisciplinary pain rehabilitation program. This model of treatment may be especially well situated to address the biopsychosocial contributions to pain among those with a history of adversity.

Cognitive Behavioral Therapy for Anxiety Disorders: Outcomes From a Multi-State, Multi-Site Primary Care Practice.

BACKGROUND: Anxiety disorders are among the most common mental health conditions. Individuals with anxiety typically seek services in primary, rather than specialty, care. While there is significant evidence supporting the efficacy and effectiveness of cognitive behavioral therapy (CBT) for anxiety disorders, there have been no naturalistic studies reporting anxiety-specific treatment outcomes in primary care. METHODS: Participants (N = 1,589) were recruited from a multi-state, multi-site primary care practice, with 491 participants endorsing moderate to severe anxiety at baseline and engaging in at least one CBT session. Data was drawn from a psychotherapy tracking database. RESULTS: Among participants with moderate to severe anxiety who engaged in CBT, a significant decrease in anxiety and depression symptoms was observed over the course of psychotherapy (p< .001, d = 0.57-0.95). Rates of reliable change, response, and remission varied across diagnostic categories. The use of CBT interventions also varied across diagnoses in line with evidence-based treatment recommendations. DISCUSSION: Short-term CBT delivered in primary care is associated with significant improvements in anxiety and depression symptoms among participants with anxiety disorders. These findings support the use of a population-based approach to anxiety disorders treatment and suggest that evidence-based CBT can be implemented in the real-world setting.

Partner Abuse Among Treatment-Seeking Individuals with Chronic Pain: Prevalence, Characteristics, and Association with Pain-Related Outcomes.

OBJECTIVE: This study assessed the prevalence of abusive partner relationships among individuals presenting for chronic pain treatment. In addition, this study examined the association between partner abuse histories and pain-relevant outcome variables. DESIGN: Cross-sectional. SETTING: This study took place at a specialty pain rehabilitation treatment center in the Midwestern United States. SUBJECTS: Participants in this study (N = 108) included adults (Mage = 45.73 [15.95] years) presenting for chronic pain treatment who consented to participate in a research study on stress, relationships, and chronic pain. METHODS: Participants completed self-report measures about relationship and abuse histories, physical and mental health, and demographic information. Participants were categorized into the following groups: no intimate partner violence (IPV), past IPV (>12 months ago), or current/recent IPV (≤12 months ago). RESULTS: Results indicated that over half (56%) of the sample endorsed a history of partner abuse and around one-third (29%) of the sample had experienced abuse within the past year. Psychological/emotional abuse was the most common form of abuse reported. Those with current/recent abuse histories reported greater impairment in pain interference, post-traumatic stress symptoms, mental health functioning, and pain self-efficacy compared with those who had not experienced abuse in the past year. CONCLUSIONS: Partner abuse appears common among individuals with chronic pain and is associated with pain-relevant outcomes, warranting additional clinical attention and research in this area.

Examining the effectiveness of pain rehabilitation on chronic pain and post-traumatic symptoms.

Patients with co-morbid chronic pain and post-traumatic stress disorder (PTSD) pose significant treatment challenges. This study evaluated the effectiveness of an interdisciplinary pain rehabilitation program (IPRP) in improving pain and PTSD outcomes, as well as reducing medication use. In addition, the mediating effect of pain catastrophizing, which is theorized to underlie the pain and PTSD comorbidity, was examined. Participants included 83 completers of an IPRP with chronic pain and a provisional PTSD diagnosis. Significant improvements were found for pain outcomes, PTSD symptomatology, depressive symptoms, physical performance, and medication use (i.e., opioids and benzodiazepines). At discharge, 86.7% of participants reliably improved in at least one key measure of functioning and 50.6% demonstrated reliable improvement in PTSD symptomatology. Change in pain catastrophizing mediated improvements in pain interference and PTSD symptomatology. Results support the potential utility of an interdisciplinary pain treatment approach in the treatment of patients with comorbid pain and PTSD.

Treatment Outcomes and Mechanisms for an ACT-Based 10-Week Interdisciplinary Chronic Pain Rehabilitation Program.

BACKGROUND: Interdisciplinary pain rehabilitation programs are an evidence-based biopsychosocial treatment approach for chronic pain. The purpose of the current study is to assess outcomes for a 10-week interdisciplinary, acceptance and commitment therapy (ACT)-based, outpatient treatment model and to evaluate the relationship between psychological process variables (ie, pain catastrophizing, pain acceptance, pain self-efficacy) and treatment outcomes. METHODS: 137 adults with chronic pain completed an interdisciplinary pain rehabilitation program. Measures of pain, pain interference, health-related quality of life, anxiety, depressed mood, insomnia, pain catastrophizing, pain acceptance, and pain self-efficacy were completed at admission and discharge. Data were also collected on demographic and clinical variables, including opioid use. RESULTS: Results indicated significant changes in all measures at program discharge compared to admission. Opioid doses were also reduced. Results of within-subjects meditational analyses indicated that pain catastrophizing accounted for a significant portion of the treatment effect for pain severity, pain interference, and depressed mood. Pain acceptance was a mediator for change in depressed mood, whereas pain self-efficacy was a mediator for pain interference outcomes. CONCLUSIONS: This study supports a 10-week, ACT-based treatment model for interdisciplinary chronic pain rehabilitation. In addition, pain catastrophizing, pain acceptance, and pain self-efficacy were each found to be mechanisms by which individuals achieve successful treatment outcomes. This research provides further support for interdisciplinary rehabilitation approaches for chronic pain.

Outcomes of a 6-week Cognitive-Behavioral Therapy for Chronic Pain Group for veterans seen in primary care.

Primary Care Mental Health Integration (PC-MHI) visits are mandated to be brief, limited in number, and delivered in the primary care practice area. Current evidence-based protocols for Cognitive-Behavioral Therapy for Chronic Pain (CBT-CP) do not meet these PC-MHI requirements, however, and thus PC-MHI providers are often left with the daunting task of modifying these protocols for the primary care setting. The aims of the current study were to examine effectiveness for a brief CBT-CP Group (6, 50-min sessions) for patients seen in primary care with various chronic pain conditions and to assess whether opioid medication use was associated with treatment outcomes. The current study represents a single-arm treatment study in which outcomes were evaluated by comparing self-reported symptom levels at the beginning of treatment (Session 1) to the end of treatment (Session 6). Dependent variables included pain symptoms, physical function lower/upper body, family disability, emotional functioning, sleep problems, satisfactions with outcomes/care, pain-related anxiety, generalized anxiety, pain catastrophizing, and depressed mood. Seventy-seven participants were enrolled and completed the treatment group. They were 56.81 ± 13.11 years old, 61% male, 51.9% taking opioids, with 39% reporting multiple pain diagnoses. Results showed that participation in the Brief CBT-CP Group resulted in statistically significantly improvement across all dependent variables (except emotional functioning). Results also showed that there were no significant treatment-related differences between patients taking opioids compared with patients who were not on opioids. The current protocol for Brief CBT-CP is effective in a real-world setting and aligns with the PC-MHI model of care.

The Mediating Effect of Pain Catastrophizing on PTSD Symptoms and Pain Outcome.

OBJECTIVE: Coprevalence of chronic pain and posttraumatic stress disorder (PTSD) negatively impacts the course of both disorders. Patients diagnosed with both conditions report greater pain, affective distress, and disability when compared with those with either chronic pain or PTSD alone. While the prevalence and complexity of the comorbidity is widely acknowledged, there is a dearth of research examining potential mechanism variables that might account for the relationship between chronic pain and PTSD. The current study utilizes a series of mediation analyses to examine if pain catastrophizing mediates the relationship between PTSD symptomatology and chronic pain outcome. MATERIALS AND METHODS: A total of 203 treatment-seeking participants admitted to a 3-week interdisciplinary pain rehabilitation program completed a battery of psychometrically validated measures of pain severity, pain interference, pain catastrophizing, depressive symptoms, and PTSD symptoms at program admission. RESULTS: A series of multiple parallel mediation analyses revealed that pain catastrophizing fully mediated the relationships between PTSD symptoms and pain outcome (ie, pain severity and pain interference) above and beyond the influence of depressive symptoms. DISCUSSION: Results suggest that pain catastrophizing may represent an important cognitive mechanism through which PTSD symptoms influence the experience of chronic pain. Psychosocial treatment approaches that directly target tendency to catastrophize in response to pain may hold the potential to have salutary effects on both chronic pain and PTSD.

Initial outcomes of a real-world multi-site primary care psychotherapy program.

OBJECTIVE: Although anxiety, mood, and adjustment disorders are commonly treated in primary care, little evidence exists regarding psychotherapy outcomes within this setting. The primary objective of this study was to describe outcomes of a large-scale primary care psychotherapy program. METHODS: Patients (N = 2772) participated in cognitive behavioral therapy (CBT) as part of a multi-site primary care program. A tracking system was utilized to collect data on demographics, diagnoses, course of care, anxiety and depressive symptoms, and frequencies of psychotherapy principles used over the course of primary care CBT. RESULTS: Anxiety disorders were most frequent, often comorbid with depression. Over two-thirds of the sample participated in at least one CBT session. Case formulation, cognitive interventions, exposure, and behavioral activation were frequently utilized approaches. Significant improvements on the GAD-7 and PHQ-9 occurred for all groups, yielding medium effect sizes (d = 0.50-0.68). Rates of reliable change (48-80%), response (35-53%), and remission (21-36%) were noted for those scoring in the moderate range of severity. CONCLUSION: Patients suffering from anxiety, depression, and adjustment disorders can be effectively treated in primary care with CBT. Future efforts are needed to match patient characteristics with the types and timing of therapy interventions to improve clinical and functional outcomes.