Relationship of Morphometrics and Symptom Severity in Female Type I Chiari Malformation Patients with Biological Resilience.

In the present study we report the relationship among MRI-based skull and cervical spine morphometric measures as well as symptom severity (disability-as measured by Oswestry Head and Neck Pain Scale and social isolation-as measured by the UCLA Loneliness scale) on biomarkers of allostatic load using estrogen, interleukin-6, C-reactive protein, and cortisol in a sample of 46 CMI patients. Correlational analyses showed that McRae line length was negatively associated with interleukin-6 and C-reactive protein levels, and Analysis of Variance (ANOVA) showed joint effects of morphometric measures (McRae line length, anterior CSF space) and symptom severity (disability and loneliness) on estrogen and intereukin-6 levels. These results are consistent with allostatic load. That is, when the combination of CSF crowding and self-report symptom (disability and loneliness) severity exceed the capacity of biological resilience factors, then biomarkers such as neuroprotective estrogen levels drop, rather than rise, with increasing symptom severity.

A pre- and post-implantable pain device procedure assessment model: psychiatric symptoms, functioning, and goals.

Aim: Implantable device treatment may improve psychosocial and pain-specific outcomes. This paper reports outcomes following receipt of an implantable pain device in a population of military veterans. Materials/methods: 120 veterans completed a pre-implantable pain device psychological evaluation of mood, anxiety, pain disability and intensity, cognition, functional goals, walking tolerance, substance use and sleep. Of those evaluated, 25/120 (20.8%) received a pain device in the 12 months following their evaluation and repeated the evaluation to assess changes. Results: Veterans receiving pain devices endorsed significant improvements in pain intensity and pain disability. Pre-to-post-implant changes on psychosocial characteristics varied substantially. Conclusion: Veterans evaluated for implantable pain devices frequently endorsed symptoms of psychological distress and functional impairment and showed highly varied psychosocial changes with treatment.

Spinal column stimulation (SCS) is a treatment for chronic pain involving the surgical placement of a medical device used to reduce pain symptoms. Although SCS is known to reduce pain intensity, recent research suggests that SCS may also improve physical function, quality of life and perhaps even mental health. This study tested the potential for broader benefits of SCS among 120 US military veterans. Each veteran completed a set of measures during their spinal column stimulation treatment process about pain, function, quality of life, mental health and treatment goals. Those obtaining an SCS were contacted up to a year later to retake the measures to identify improvements they experienced. Before SCS treatment, veterans often reported problems with pain, disability, sleep, quality of life and mental health. Furthermore, among those veterans who completed their follow-up visit, many reported improvements in these areas.

Impact of Surgical Status, Loneliness, and Disability on Interleukin 6, C-Reactive Protein, Cortisol, and Estrogen in Females with Symptomatic Type I Chiari Malformation.

Chiari malformation type I (CMI) provides an opportunity for examining possible moderators of allostatic load. CMI patients who had (n = 43) and had not (n = 19) undergone decompression surgery completed questionnaires regarding pain, disability, and loneliness, and provided serum samples for IL-6, CRP, estrogen, and free estradiol assays, and saliva samples to assess diurnal cortisol curves. ANOVAs examining surgical status (decompressed versus non-decompressed), loneliness (high vs. low), and disability (high vs. low) as independent variables and biomarker variables as dependent factors found that loneliness was associated with higher levels of cortisol, F(1, 37) = 4.91, p = .04, η2P = .11, and lower levels of estrogen, F(1, 36) = 7.29, p = .01, η2P = .17, but only in decompressed patients. Results highlight the possible impact of loneliness on biological stress responses and the need to intervene to reduce loneliness in patients with symptomatic CMI.

The mediating impact of PTSD symptoms on cortisol awakening response in the context of intimate partner violence.

Multi-level modeling examined the association between cortisol awakening responses (CAR) and different PTSD symptom clusters in a sample of 158 female participants presenting with intimate partner violence-related PTSD. Results revealed that arousal over the past week and month, respectively ([ß = -0.124, z = -2.33, p = .028; ß = -.147, z = -2.19, p = .028]) significantly moderated the trajectory of cortisol levels, and emotional numbing symptom severity (over the past week [ß = -0.122, z = -2.07, p = .076]) was found to be trending toward significance. In each case higher symptom severity was associated with flatter CAR slopes compared to those with lower symptom severity. Assessing PTSD symptom clusters in relation to cortisol may better inform future interventions compared to studies that assess PTSD globally. Our findings suggest a subtype of PTSD patients displaying higher levels of arousal may be more likely to experience alterations in HPA axis functioning.

An examination of pain, disability, and the psychological correlates of Chiari Malformation pre- and post-surgical correction.

BACKGROUND: 50% of patients with Chiari Malformation (CM) report a history of depression; however, rates of other psychological symptoms are unknown. Further, it is unclear whether surgical correction impacts pain, disability, and psychological symptoms. OBJECTIVE: /Hypothesis: We examined rates of symptoms in a nationwide sample of CM patients who had (n = 639) and had not (n = 551) undergone surgical correction. We hypothesized lower symptom severity in the latter group. METHODS: Participants completed assessments and submitted pre-surgical MRI scans online (n = 286). Informed by the Fear-Avoidance Model of pain, we controlled for psychological symptoms when assessing pain/disability, and pain/disability when assessing psychological symptoms. RESULTS: Overall, high rates of depression (44% moderate-severe) and anxiety (60% moderate-severe) were reported. Groups (surgery vs. no-surgery) did not differ in the proportion of patients meeting cutoff scores for current disability; however, the no-surgery group was more likely to meet cutoffs for anxiety (χ2 = 11.26, p < .05), stress (χ2 = 14.63, p < .01) and health anxiety (χ2 = 4.63, p < .05). The surgery group reported lower levels of continuous affective pain F(1, 1065) = 10.28, p < .001), anxiety F(1,1026) = 4.96, p < .05) and stress F(1, 978) = 5.67, p < .05) although effect sizes were small (η2s ranging from 0.010 to 0.006, Cohen's D ranging from 0.17 to 0.25). CONCLUSION: CM patients experience high rates of psychological symptomatology regardless of surgical status, suggesting that all CM patients may benefit from evidence-based interventions to address anxiety and depression.