Perceived stress and pain interference in acute rehabilitation following spinal cord injury: Resilience as a moderator.

PURPOSE/OBJECTIVE: Higher levels of resilience is associated with improved pain outcomes in chronic pain and other neurological populations, but the role of resilience in pain following spinal cord injury (SCI) remains unclear. This study examined resilience as a moderator in the relationship between perceived stress and both pain intensity and interference during acute rehabilitation for SCI. RESEARCH METHOD/DESIGN: Individuals admitted to inpatient rehabilitation acutely following SCI (N = 57) completed measures of perceived stress, resilience, pain intensity, and interference. The Johnson-Neyman procedure was used to examine significance of conditional relationships that emerged. RESULTS: Resilience was found to moderate the relationship between perceived stress and pain interference, but not pain intensity, during inpatient rehabilitation. CONCLUSIONS/IMPLICATIONS: When resilience is low, perceived stress has a more profound and adverse impact on pain interference during inpatient rehabilitation, suggesting therapeutic strategies that build components of resilience are needed during acute rehabilitation following SCI. The relationship between stress, resilience, and pain may differ postinpatient rehabilitation for SCI and warrants further investigation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pain interference, pain type, and quality of life among adults with spina bifida.

INTRODUCTION: Individuals with spina bifida (SB) experience nociceptive and neuropathic pain, and women with SB report more pain. However, the relationship between pain type and gender on pain interference and quality of life (QoL) among individuals with SB is less understood. OBJECTIVE: To assess relationships among pain interference, pain quality, participation-related QoL, and gender among adults with SB. DESIGN: Fifty-one adults with SB completed a self-report survey assessing SB characteristics, pain severity, pain type, pain interference, and QoL. SETTING: Hospital outpatient adult SB clinic. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measures of nociceptive pain quality, neuropathic pain quality, participation-related QoL, as well as pain interference with general activities, mood, and sleep were selected a priori as study measures. RESULTS: Fifty-eight percent (N = 30) reported pain and more women than men reported pain (69% vs. 38%, p = .003). Higher general pain interference was associated with lower QoL (r = 0.444, p = .042), but not mood or sleep pain interference (both p's ≥ .451). There was no statistically significant difference in pain interference between genders (p = .138). Nociceptive pain was more common. Levels of nociceptive pain were positively associated with general pain interference, sleep pain interference, and mood pain inference. Neither pain type was associated with QoL (both p's > .082). CONCLUSIONS: The results from this study reveal key differences/similarities among four interrelated factors: pain, pain interference, QoL, and gender. Pertinent information gathered on pain type and QoL, like increased prevalence of nociceptive pain, can be utilized to formulate proactive and effective treatment plans for individuals with SB that may benefit their sleep pain interference and mood pain interference.

The Negative Effect of Social Discrimination on Pain Tolerance and the Moderating Role of Pain Catastrophizing.

This study examined the negative impact of social discrimination on the time to pain tolerance during experimentally induced cold pressor pain among healthy individuals. It was hypothesized that the degree to which one catastrophized about pain would exacerbate the negative impact of a history discriminatory experiences on pain tolerance, and that this interaction would be different between individuals of a racial and ethnic minority and non-Hispanic white individuals (thus testing catastrophizing as a moderated moderator). Higher levels of discrimination were positively related to catastrophic thinking about pain, and there was a significant negative relationship between the level of experienced discrimination and time to pain tolerance. Pain catastrophizing emerged as a significant moderator in that when pain catastrophizing levels were high, there was no association between social discrimination and pain tolerance. A history of social discrimination was significantly associated with reduced pain tolerance at low and moderate levels of pain catastrophizing. Racial minority status did not significantly alter this moderating relationship. Implications for the importance of assessing sociocultural variables, such as experiencing social discrimination in the clinical assessment of the individual with pain are outlined.

The Relationship Between Psychological Resilience and Pain Threshold and Tolerance: Optimism and Grit as Moderators.

This study examined factors that may enhance the relationship between resilience and time to pain threshold and tolerance during experimentally induced pain among 62 healthy adults recruited from a student population. Specifically, dispositional optimism and psychological grit were examined as moderators of the relationship between resilience and pain outcomes. Zero-order correlations revealed that resilience was positively related to grit and optimism, though grit and optimism were not significantly related to each other. Resilience, grit and optimism were all positively related to time to pain threshold and tolerance, but not pain severity. Moderation models showed that dispositional optimism enhanced the effect of resilience on both time to pain threshold and tolerance. Grit, on the other hand, was found to enhance the effect of resilience on time to pain threshold, but not time to pain tolerance. These results suggest that positive psychological factors and their interactions may be important with persevering during adverse experiences such as pain.

Differences in resting cerebellar and prefrontal cortical blood flow in spinal cord injury-related neuropathic pain: A brief report.

Context: Little is understood about differences in resting neural activity among those with spinal cord injury (SCI)-related neuropathic pain. The purpose of this pilot study was to determine resting cerebral blood flow differences in persons with SCI-related neuropathic pain compared to healthy, pain-free able-bodied controls.Methods: Five persons with paraplegia and ten able-bodied participants were included in this study. Resting blood flow, as measured by a continuous arterial spin labeling (ASL) method of fMRI, was analyzed via statistical parametric mapping.Results: Persons with SCI-related neuropathic pain had significantly lower resting blood flow in the cerebellum (Crus I/II), rostral ventromedial medulla and left insular cortex. In contrast, greater resting blood flow occurred in the medial orbitofrontal cortex among those with SCI-related neuropathic pain compared to controls.Conclusion: Differences in resting blood flow were observed among those with SCI-related pain, particularly in regions that may be involved in affective-motivational and cognitive-evaluative aspects of pain. Larger ASL studies in addition to functional connectivity studies using fMRI are needed to clarify unique neural patterns in this complex and often intractable form of pain.

Effects of virtual walking on spinal cord injury-related neuropathic pain: A randomized, controlled trial.

PURPOSE: This study is an examination of the efficacy of a virtual walking protocol to treat spinal cord injury (SCI)-related pain. METHOD: A total of 59 individuals with SCI and neuropathic pain (NP) were randomly assigned to receive 20 min of virtual walking, the treatment condition, or virtual wheeling, the control condition. Although having NP was a requirement to participate in the study, participants also underwent pain classification of up to 3 worst pain sites to also examine the effects of virtual walking on nonneuropathic pain. Pain outcomes included changes in pain severity across all pain types, NP unpleasantness, and severity of various sensory qualities of NP. DESIGN: This was a randomized, controlled, single-blinded trial. RESULTS: There was no significant difference in change in pain between groups, though there was a significant pre- to posttreatment reduction across all pain types in the virtual walking condition, but not the control condition. Specific to NP, there was a significant reduction in pain unpleasantness, but not neuropathic pain intensity. NP experienced as "cold," "deep," and with increased skin sensitivity were significantly reduced following virtual walking compared with the control condition. CONCLUSION: Results from this trial suggest that virtual walking treatment may benefit certain aspects of NP, such as associated unpleasantness, as well as certain sensory qualities of that pain. Efficacy of this treatment modality to reduce overall pain severity remains unclear, and may be modulated by other injury, individual, or personality characteristics. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Evaluating the effectiveness of antidepressant therapy adjuvant to gabapentin and pregabalin for treatment of SCI-related neuropathic pain.

OBJECTIVE: To investigate if a combination of anticonvulsant and antidepressant, two primary therapies for neuropathic pain, is associated with improved pain control compared to individual therapy. DESIGN: Prospective cohort study Setting: The University of Alabama at Birmingham Rehabilitation Center In-patient Program between 2012 and 2015. PARTICIPANTS: Incident SCI cases, 19-65 years of age. OUTCOMES: Bryce-Ragnarsson pain classification scheme and the Numerical Rating Scale Results: Twenty-nine eligible patients completed 6-month follow-up; their average age was 36.4 years, 89% were male, and 65% were white. Baseline characteristics were not different by therapy initiated (combination versus single). At 6 months follow-up, therapy initiated at baseline was not associated with level of pain in the past week (p=0.3145) or past 24 hours (p=0.4107). However, patients who remained on the same therapy reported lower levels of pain 30 minutes after waking (p=0.0235). CONCLUSIONS: The initiation of a combination of anticonvulsant and antidepressant shortly after SCI was not associated with improved pain control at 6 months compared to individual therapy. Adherent patients reported lower levels of pain; further analysis is warranted to elucidate this association.

Changes in pain and quality of life in depressed individuals with spinal cord injury: does type of pain matter?

OBJECTIVE: To examine the association of neuropathic and nociceptive pain severity and interference with quality of life (QoL) in persons with spinal cord injury (SCI) who underwent a randomized controlled 12-week trial of an antidepressant to treat depression. A secondary objective was to assess the effect of changes in pain on mobility and physical independence. DESIGN: Multivariable ANCOVA models controlling for relevant demographic covariates, treatment condition, and baseline pain and QoL were used. SETTING: Six rehabilitation centers. PARTICIPANTS: Of the 133 persons who were randomized into the trial, 108 provided pain severity and interference ratings through follow-up. INTERVENTIONS: Not applicable. OUTCOME MEASURES: The Satisfaction with Life Scale and the physical and mental component summary scores of the 12-Item Short-Form Health Survey (SF-12). Secondary outcome measures included the mobility and physical independence subscales of the Craig Handicap Assessment and Reporting Technique (CHART). RESULTS: Broadly, few associations between pain and QoL were evident. Results revealed relationships between lower baseline nociceptive pain interference and higher satisfaction with life and mental health-related QoL at 12 weeks. Similarly, lower neuropathic pain interference was associated with change in physical independence, but unrelated to mobility. CONCLUSIONS: Pain interference over time may be differentially related to QoL outcomes based on the type of pain following SCI, but overall, there were no extensive relationships between pain and QoL in this sample of depressed persons with SCI.

Evaluating the Psychometric Properties and Responsiveness to Change of 3 Depression Measures in a Sample of Persons With Traumatic Spinal Cord Injury and Major Depressive Disorder.

OBJECTIVES: To compare the measurement properties and responsiveness to change of the Patient Health Questionnaire-9 (PHQ-9), the Hopkins Symptom Checklist-20 (HSCL-20), and the Hamilton Depression Rating Scale (HAM-D) in people with spinal cord injury (SCI) diagnosed with major depressive disorder (MDD). DESIGN: Secondary analysis of depression symptoms measured at 6 occasions over 12 weeks as part of a randomized controlled trial of venlafaxine XR for MDD in persons with SCI. SETTING: Outpatient and community settings. PARTICIPANTS: Individuals (N=133) consented and completed the drug trial. Eligibility criteria were age at least 18 years, traumatic SCI, and diagnosis of MDD. INTERVENTIONS: Venlafaxine XR. MAIN OUTCOME MEASURES: Patients completed the PHQ-9 and the HSCL-20 depression scales; clinical investigators completed the HAM-D and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) Dissociative Disorders, which was used as a diagnostic criterion measure. RESULTS: All 3 instruments were improved with rating scale analysis. The HSCL-20 and the HAM-D contained items that misfit the underlying construct and that correlated weakly with the total scores. Removing these items improved the internal consistency, with floor effects increasing slightly. The HAM-D correlated most strongly with Structured Clinical Interview for DSM-IV Dissociative Disorders diagnoses. Improvement in depression was similar on all outcome measures in both treatment and control groups. CONCLUSIONS: The psychometric properties of the revised depression instruments are more than adequate for routine use in adults with SCI and are responsive to clinical improvement. The PHQ-9 is the simplest instrument with measurement properties as good as or better than those of the other instruments and required the fewest modifications.

Effects of Virtual Walking Treatment on Spinal Cord Injury-Related Neuropathic Pain: Pilot Results and Trends Related to Location of Pain and at-level Neuronal Hypersensitivity.

Previous studies have shown that virtual walking to treat spinal cord injury-related neuropathic pain (SCI-NP) can be beneficial, although the type of SCI-NP that may benefit the most is unclear. This study's aims were to (1) determine the effect of location of SCI-NP on pain outcomes after virtual walking treatment and (2) examine the potential relationship between neuronal hyperexcitability, as measured by quantitative sensory testing, and pain reduction after virtual walking treatment. Participants were recruited from a larger ongoing trial examining the benefits of virtual walking in SCI-NP. Neuropathic pain was classified according to location of pain (at- or below-level). In addition, quantitative sensory testing was performed on a subset of individuals at a nonpainful area corresponding to the level of their injury before virtual walking treatment and was used to characterize treatment response. These pilot results suggest that when considered as a group, SCI-NP was responsive to treatment irrespective of the location of pain (F1, 44 = 4.82, P = 0.03), with a trend for the greatest reduction occurring in at-level SCI-NP (F1, 44 = 3.18, P = 0.08). These pilot results also potentially implicate cold, innocuous cool, and pressure hypersensitivity at the level of injury in attenuating the benefits of virtual walking to below-level pain, suggesting certain SCI-NP sensory profiles may be less responsive to virtual walking.

Novel risk factors associated with current suicidal ideation and lifetime suicide attempts in individuals with spinal cord injury.

OBJECTIVE: To determine unique associations of suicidal ideation (SI) and lifetime suicide attempts (SAs) in individuals with spinal cord injury (SCI). DESIGN: Cross-sectional analysis. SETTING: Outpatient. PARTICIPANTS: Individuals with SCI (N=2533) who were 18 years or older with a history of traumatic SCI. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Any SI in the past 2 weeks (9-item Patient Health Questionnaire) and any lifetime SA. RESULTS: Three hundred twenty-three individuals (13.3%) reported SI in the past 2 weeks and 179 (7.4%) reported lifetime SA. After controlling for other factors, both lifetime SA and current SI were associated with study site and current level of depression. In addition, SA was associated with less education, younger age at injury, having current or past treatment of depression, and having bipolar disorder or schizophrenia. SI was associated with more years since injury and lifetime SA. Several psychological factors were associated with current SI and lifetime SAs, including lower environmental reward and less positive affect. In addition, control of one's community activities and spiritual well-being were associated with current SI. In bivariate comparisons, severity of SCI was also associated with the 47% of the SAs that occurred after injury. CONCLUSIONS: Several unique associations of SI and lifetime SA in individuals with SCI were identified, including level of environmental reward and control, spiritual well-being, and severity of SCI. These factors bear further investigation as prospective risk factors for suicidal behavior after SCI.

Cortical activation during visual illusory walking in persons with spinal cord injury: a pilot study.

OBJECTIVE: To determine the location of cortical activation during a visual illusion walking paradigm, a recently proposed treatment for spinal cord injury (SCI)-related neuropathic pain, in persons with SCI compared with able-bodied controls. DESIGN: Pilot experimental functional magnetic resonance imaging (fMRI) trial. SETTING: Outpatient rehabilitation clinic. PARTICIPANTS: Persons with paraplegia (n=3) and able-bodied participants (n=5) were included in this study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Cortical activation as measured by the blood oxygenation level-dependent method of fMRI. RESULTS: During visually illusory walking there was significant activation in the somatosensory cortex among those with SCI. In contrast, able-bodied participants showed little to no significant activation in this area, but they showed activation in the frontal and premotor areas. CONCLUSIONS: Treatment modalities for SCI-related neuropathic pain that are based on sensory input paradigms (eg, virtual walking, visual illusory walking) may work by targeting the somatosensory cortex, an area that has been previously found to functionally reorganize after SCI.

Effects of nicotine on spinal cord injury pain vary among subtypes of pain and smoking status: results from a randomized, controlled experiment.

UNLABELLED: Smoking has been associated with increased pain severity in general chronic pain populations. Less is known about the effects of smoking and nicotine on the multifaceted and often complex subtypes of pain that frequently occur following spinal cord injury (SCI). The purpose of this study was to examine the effects of nicotine on self-reported pain among individuals with SCI and to determine if the effect of nicotine varied by pain subtype. A randomized, placebo-controlled crossover design was used to determine the effect of nicotine exposure on subtypes of SCI-related pain among smokers and nonsmokers. A complex relationship emerged, such that the degree of reported pain with exposure to 2 mg of nicotine compared to placebo varied according to pain type and smoking status of the subject. Pain sites that had characteristics of both neuropathic and musculoskeletal symptoms (deemed complex neuropathic pain sites) exhibited pain reduction after nicotine exposure in nonsmokers. In sharp contrast, smokers with this form of pain exhibited an increase in pain severity. Data were also examined descriptively to determine potentially unique factors associated with complex neuropathic pain that may explain trends associated with clinically relevant changes following nicotine exposure. In sum, smoking or tobacco use history may determine the analgesic (or enhanced pain perception) effect of nicotine on post-SCI pain. PERSPECTIVE: Pain characterized by both neuropathic and musculoskeletal symptoms decreased in severity after nicotine exposure in nonsmokers with SCI but increased in severity among smokers with SCI. The analgesic (or enhanced nociceptive) effect of nicotine may depend on tobacco use history.

Effects of nicotine on spinal cord injury pain: a randomized, double-blind, placebo controlled crossover trial.

BACKGROUND: One factor affecting spinal cord injury (SCI)-related pain may be nicotine. Case reports have described a worsening of neuropathic pain from smoking and relief from abstinence. Neurobiological correlates also implicate the potential effect of nicotine on SCI-related pain. METHOD: The current study employed a randomized, placebo-controlled crossover design to examine the effect of nicotine exposure on subtypes of SCI-related pain among smokers and nonsmokers. RESULTS: Whereas nonsmokers with SCI showed a reduction in mixed forms of pain following nicotine exposure, smokers with SCI showed a converse increase in pain with regard to both mixed and neuropathic forms of pain. The exacerbation of pain in chronic nicotine or tobacco users may not only elucidate possible pain mechanisms but may also be of use in smoking cessation counseling among those with SCI.

Catastrophizing, acceptance, and interference: laboratory findings, subjective report, and pain willingness as a moderator.

OBJECTIVE: The present study investigated the effects of both catastrophizing and the pain willingness component of acceptance on interference in daily activities and task performance during experimentally induced ischemic pain. In addition, the potential moderating role of pain willingness on the relationship between catastrophizing and degree of pain interference was also examined. DESIGN: Sixty-seven persons with chronic low back pain completed measures of catastrophizing, acceptance, and daily pain interference. Participants underwent an ischemic pain induction procedure during which a Stroop-like task was administered. MAIN OUTCOME MEASURES: Self-reported pain interference and observed performance on a Stroop-like task during induced pain. RESULTS: The pain willingness component of acceptance and catastrophizing both contributed significantly to self-reports of pain interference. However, levels of pain willingness had an effect much stronger than the negative effects associated with catastrophizing with respect to observed pain interference during induced pain. Results also indicated that pain willingness serves as a moderator in the relationship between catastrophizing and task performance during induced pain. CONCLUSION: The pain willingness factor of acceptance and catastrophizing both appear to be strong predictors for self-reported pain interference. During an objective assessment of pain interference, however, pain willingness shows a stronger effect and attenuates the negative impact of catastrophizing on task functioning.

Depressive symptoms and pain evaluations among persons with chronic pain: catastrophizing, but not pain acceptance, shows significant effects.

Cognitive factors such as catastrophic thoughts regarding pain, and conversely, one's acceptance of that pain, may affect emotional functioning among persons with chronic pain conditions. The aims of the present study were to examine the effects of both catastrophizing and acceptance on affective ratings of experimentally induced ischemic pain and also self-reports of depressive symptoms. Sixty-seven individuals with chronic back pain completed self-report measures of catastrophizing, acceptance, and depressive symptoms. In addition, participants underwent an ischemic pain induction procedure and were asked to rate the induced pain. Catastrophizing showed significant effects on sensory and intensity but not affective ratings of the induced pain. Acceptance did not show any significant associations, when catastrophizing was also in the model, with any form of ratings of the induced pain. Catastrophizing, but not acceptance, was also significantly associated with self-reported depressive symptoms when these two variables were both included in a regression model. Overall, results indicate negative thought patterns such as catastrophizing appear to be more closely related to outcomes of perceived pain severity and affect in persons with chronic pain exposed to an experimental laboratory pain stimulus than does more positive patterns as reflected in measures of acceptance.

Contributions of volumetrics of the hippocampus and thalamus to verbal memory in temporal lobe epilepsy patients.

Recent theories have posited that the hippocampus and thalamus serve distinct, yet related, roles in episodic memory. Whereas the hippocampus has been implicated in long-term memory encoding and storage, the thalamus, as a whole, has been implicated in the selection of items for subsequent encoding and the use of retrieval strategies. However, dissociating the memory impairment that occurs following thalamic injury as distinguished from that following hippocampal injury has proven difficult. This study examined relationships between MRI volumetric measures of the hippocampus and thalamus and their contributions to prose and rote verbal memory functioning in 18 patients with intractable temporal lobe epilepsy (TLE). Results revealed that bilateral hippocampal and thalamic volume independently predicted delayed prose verbal memory functioning. However, bilateral hippocampal, but not thalamic, volume predicted delayed rote verbal memory functioning. Follow-up analyses indicated that bilateral thalamic volume independently predicted immediate prose, but not immediate rote, verbal recall, whereas bilateral hippocampal volume was not associated with any of these immediate memory measures. These findings underscore the cognitive significance of thalamic atrophy in chronic TLE, demonstrating that hippocampal and thalamic volume make quantitatively, and perhaps qualitatively, distinct contributions to episodic memory functioning in TLE patients. They are also consistent with theories proposing that the hippocampus supports long-term memory encoding and storage, whereas the thalamus is implicated in the executive aspects of episodic memory.

Structural and functional neuroimaging correlates of depression in temporal lobe epilepsy.

Depression is commonly experienced among persons with temporal lobe epilepsy (TLE). Although evidence exists implicating dysfunction of distributed neural structure and circuitry among depressed persons without epilepsy, little is known regarding the neural correlates of depression in TLE. We examined the relationship between self-reported depression severity and both structural MRI volumetry and [(18)F]fluorodeoxyglucose positron emission tomography (PET)-measured resting metabolism of the amygdala and hippocampus of 18 patients with TLE. Significant positive relationships were noted between right and left amygdala volumes and depression. No other significant relationships were observed between amygdala PET measures, hippocampal volumes, or hippocampal PET measures and degree of depressive symptomatology. These findings indicate that both right and left amygdala volumes are associated with depression severity among persons with TLE. Future studies examining the potential role of extended neural regions may clarify the observed structural relationship between depressive symptoms and the amygdala.

A systematic program to enhance clinician group skills in an inpatient psychiatric hospital.

This article describes the collaborative effort of a team of discipline directors, administrators, and academicians to create a systematic program to enhance the group competencies of a large clinical staff working at a state hospital. The effects of the program were tested by a quasi-experimental field study. Quantitative measures of group process provided limited support for program effectiveness. Stronger support came from qualitative inquiry. The development and effectiveness of the program is examined within a larger context of group programs housed in large health care organizations.