- Email: [email protected]
(331) Impact of Primary Dysmenorrhea on Self-Image in Adolescents and Young Adults
The Journal of Pain .50, p’s <.001 - .005). There were no significant main effects of group (TMJD vs. control), nor were there group by threat or challenge interactions for any outcome (p’s > .05). These results replicate and extend prior research by demonstrating that perceived threat and challenge of a QST procedure can predict pain outcomes in patients with chronic pain. Future research should explore relationships between perceptions of threat and challenge with other QST modalities (i.e., delayed-onset muscle pain, electric pain), and explore how perception of QST parameters may influence pain chronicity. Supported by NIDCRR00DE022368-03.
S57
p=0.032) and greater number of pain sites (r=0.463,p=0.011), but not pain frequency or duration. An older epigenetic age was also significantly associated with greater heat (r=-0.545,p=0.007) and pressure (r=-0.445,p=0.026) pain thresholds, but not vibratory or thermal detection (p’s>0.05). Epigenetic age difference was not generally associated with demographic or psychological function (p’s>0.05). Our findings suggest that chronic pain is associated with greater epigenetic aging in relatively healthy, community-dwelling older individuals and future studies with larger samples are needed to confirm our findings. An aging biomarker such as the epigenetic clock may help identify people with chronic pain at greater risk of functional decline and poorer health outcomes.
Disease Entities (Human) (328) Select Metabolomics Reveal Potential Biomarkers of Fibromyalgia that Correlate with Pain and Fatigue J. Lesnak, E. Merriwether, E. Taylor, D. Dailey, C. Vance, M. Zimmerman, L. Crofford, L. Frey Law, and K. Sluka; University of Iowa Currently, there are no established biomarkers for the diagnosis or symptoms of pain and fatigue in individuals with fibromyalgia (FM). The objective of this study was to identify potential biomarkers in individuals with FM, and to correlate these putative biomarkers with FM-symptoms using a targeted metabolomics approach. The current study was a secondary analysis from baseline data taken in the Fibromyalgia Activity Study with TENS (FAST). We analyzed plasma samples and baseline patient-reported outcomes for resting pain and fatigue from 59 women with FM (mean§SD; age=49.69§11.54, BMI=35.23§10.91) matched with 38 healthy controls (HC) (age=51.0§11.46, BMI=32.33§8.66). Serum/plasma metabolomic extracts were derivatized and analyzed by gas chromatography mass spectrometry for 63 key metabolites representing the tricarboxylic acid cycle, glycolysis, pentose phosphate pathway, amino acid metabolism, neurotransmission, reactive oxygen species defense, and energetics. Differences between FM and HC were assessed for each metabolite using unpaired t-tests (corrected p<0.008) and Pearson’s correlation coefficients were assessed between significant metabolites and baseline pain and fatigue. Ten of the 63 metabolites showed significant between-group differences (P<0.0001). 2-hydroxybutyrate, asparagine, cysteine, fumarate, histidine and tryptophan were negatively correlated with pain and fatigue (P=0.002 to 0.0001, r=-0.315 to -0.894) while 6-phosphogluconate, hypoxanthine, and sphingosine were positively correlated (P=0.004 to 0.0001, r=0.291 to 0.366). The results of this study demonstrate individuals with FM have different resting levels of a variety of metabolites compared to HC, which correlate with their symptoms. These metabolites are generally involved in reduction-oxidation pathways and energy metabolism. Future work will confirm these findings in a new cohort and examine if interventions can alter these metabolites and symptomology. Funded by NIH grant AR06338 and AR06338S1.
(329) Epigenetic Aging is Associated with Clinical and Experimental Pain in Community-Dwelling Older Adults Y. Cruz-Almeida, P. Sinha, A. Rani, P. Lysne, Z. huo, R. Fillingim, and T. Foster; University of Florida Gerontological research reveals considerable interindividual variability in biological aging, which has motivated research efforts to identify ‘aging biomarkers’ that are better predictors of disease risk and residual lifespan when compared to chronological age alone. Emerging evidence using the epigenetic clock as an aging biomarker supports highly reliable individualized predictions about future health and function. The current study focuses on the estimation of “epigenetic age” analyses in blood samples of older adults (60-83 years old) with and without chronic pain to determine whether an epigenetic age biomarker is associated with the presence and burden of chronic pain. A subset of participants (n=29) in the NEPAL study underwent a blood draw, and completed demographic, psychological, and pain assessments, including quantitative sensory testing (n=29). We estimated Horvath’s epigenetic clock and calculated the difference between epigenetic age and chronological age that has been previously reported to predict overall mortality risk. Older individuals without chronic pain (n=9) had significantly “younger” epigenetic age compared to those with chronic pain (n=20,p<0.05). Older epigenetic age was associated with greater self-reported pain during daily activities (r=0.400,
(330) The Role of Tobacco Smoking in the Transition from Acute to Chronic Pain Y. Goh, S. Khoury, A. Velly, L. Diatchenko, and M. Martel; McGill University Tobacco smoking is highly prevalent among patients with chronic pain. The prevalence of smoking has been found to range between 30-60% among patients with chronic pain, and to be approximately 15% in the general population. To date, however, the degree to which tobacco smoking contributes to the development of chronic pain remains unclear. The main objective of this study was to examine the role of tobacco smoking in the transition from acute pain to chronic pain. The sample consisted of adult patients enrolled in the UK Biobank, a large prospective cohort study involving more than 500,000 patients receiving medical care through the UK National Health Service (NHS). Patients were asked to complete self-report questionnaires at three separate time points (i.e., between 2006 and 2014) that assessed a host of demographic, lifestyle, pain, and psychological variables. Across different types of pain diagnoses, analyses indicated that patients smoking tobacco were significantly more likely to develop chronic pain symptoms after an acute pain episode than patients who never smoked (OR = 1.4, p < .05). This effect remained significant even after controlling for relevant demographic and psychological variables. Smoking emerged as a particularly strong determinant of chronic back pain, as patients smoking tobacco were roughly 3 times more likely to transition from acute to chronic back pain than patients who never smoked (OR = 3.1, p < .05). Our findings suggest that smoking plays a role in the etiology of chronic pain. Smoking appears to play a particularly important role in the transition from acute to chronic back pain. Further research will be needed to determine the specific mechanisms through which smoking leads to the development of chronic pain and/or interferes with recovery after an acute pain episode.
(331) Impact of Primary Dysmenorrhea on Self-Image in Adolescents and Young Adults K. Allyn, L. Seidman, S. Evans, A. Rapkin, and L. Payne; David Geffen School of Medicine at UCLA Primary dysmenorrhea (PD), or menstrual pain that is not associated with underlying pathology, is a common condition known to affect 45-95% of menstruating women. Although highly prevalent, a lack of knowledge exists in regards to how girls and young women conceive of their menstrual pain and the ways in which their menstrual pain affects their perceptions and views of themselves and their bodies (self-image). The goal of this qualitative study was to determine impact of menstrual pain on self-image in adolescents and young adults (AYA). Subjects included 39 females ages 16-24 with self-reported menstrual pain ≥ 4/10 on a 0-10 (0= none, 10= worst pain possible) numeric rating scale (M=7.1, SD=1.7). Participants were interviewed using a semi-structured interview guide and the research team then conducted deductive, iterative thematic analysis. Any discrepancies were resolved with group consensus discussion. Three sets of themes emerged: 1. Harmful impact of PD on self-image, including self-frustration, concerns about others’ views, and negative body image; 2. Beneficial impact on self-image, including strength and empowerment and femininity/womanhood; and 3. No impact on self-image. The diverging themes raise questions about the ways in which underlying factors (such as resiliency, PD normalization, and coping mechanisms) may give rise to a spectrum of self-image responses to PD. This study contributes to an understanding of AYA self-image related to menstrual pain, which may aid in the development of future interventions and treatments. Further research should explore how targeting self-image in therapy could impact pain and functioning in AYA with PD.
S58 The Journal of Pain Acknowledgements and Disclosures: This study was supported by National Institutes of Health NICHD grant K23HD077042 (PI: Laura A. Payne) and NCATS University of California Los Angeles Clinical and Translational Science Institute grant KL2TR000122 (PI: Laura A. Payne).
(332) The Association between Mindfulness, Pain Catastrophizing, and Opioid Misuse
Abstracts to-day physical activity and increased FM pain. High catastrophizers were more likely on days they experience more pain to exercise less. Our findings suggest that increases in daily pain are associated with less physical exercise in women with FM pain, particularly among patients reporting higher levels of pain catastrophizing. These results may have clinical implications for the design and testing of interventions targeted at reducing catastrophizing and mechanisms to increase physical activity among women with FM pain.
A. Lazaridou, L. Papianou, K. Dorado, M. Paschali, C. McDonnell, and R. Edwards; Harvard Medical School/Brigham and Women’s Hospital Prescription opioid misuse in the USA has become a serious public health concern and has contributed to an opioid crisis. However, how psychosocial factors are associated to opioid misuse remains unclear. In this study we assessed the association between pain catastrophizing and opioid misuse and examined whether mindfulness mediated this association. In this cross-sectional study, participants (291 chronic low back pain (CLBP) completed self-report measures of mindfulness (MAAS), pain (BPI) and opioid misuse (COMM). Pearson’s correlations examined the associations between study variables in CLBP patients and controls. Bootstrapping mediation analyses assessed the mediating role of mindfulness on the association between pain catastrophizing and opioid misuse. Pain catastrophizing was significantly associated with mindfulness (r = -.02) and opioid misuse (r = .22) in CLBP patients. Results of mediation analyses revealed that pain catastrophizing mediated the relationship between pain catastrophizing and opioid misuse in CLBP patients (ab = .28, 95% CI = .21 - .35). The findings from this study suggest that mindfulness may be the mechanism by which pain catastrophizing can lead to opioid misuse in CLBP patients prescribed opioids.
(333) Screening for Current Opioid Misuse and Associated Risk Factors among Patients with Chronic Pain Prescribed Opioids M. Paschali, A. Lazaridou, K. Dorado, L. Papianou, C. McDonnell, and R. Edwards; Brigham and Women’s Hospital Million patients with chronic pain are treated with opioids and chronic low back pain (CLBP) is the top chronic non-cancer condition for which opioids are prescribed. There are very limited data on the psychosocial factors that can lead to opioid misuse. A multiple linear regression model was used to assess the association of opioid misuse (COMM) with pain severity (BPI), pain catastrophizing (PCS), mindfulness (MAAS) and disability (ODI) at baseline among subjects with low back pain (N = 191) prescribed opioids. Controlling for opioid dose, the overall model was significant for perceived disability (F[4, 187] = 25.33; p < .001). Higher scores of pain catastrophizing (p< .001) and disability (p< .05) but lower scores of mindfulness (p<.001) were associated with higher opioid misuse. Pain intensity was not significantly associated with opioid misuse (p>.05). These results highlight the need to create a clinical profile assessing psychosocial factors (e.g mindfulness, catastrophizing, disability) among chronic pain patients receiving prescribed opioids.
(335) Pupillary Light Responses Differ in Post-Traumatic Headache and Chronic Migraine Compared to Non-Headache Controls L. Millsap, S. Johnson, Zo. Wolcott, C. Sciarretta, A. Rauf, K. Brennan, and M. Cortez; University of Utah Persistent post-traumatic headache (PTH) and chronic migraine (CM) often present with clinically overlapping features including prominent light sensitivity. Dynamic pupillometry is a promising new tool for evaluation of autonomically mediated responses to light in headache disorders, as they may differ between headache phenotypes. While our prior work has evaluated autonomic responses in chronic migraine and mild traumatic brain injury (aka concussion), differences in PTH and chronic migraine have not been explored. The present study sought to identify key sympathetic and parasympathetically mediated variations between pupillary light reflex (PLR) parameters in CM, PTH, and non-headache controls (NH). We hypothesized that while, based on our prior work, CM would exhibit mixed parasympathetic and sympathetic hypo-function resulting in pupillary deficits, PTH would demonstrate a more sympathetically-predominant pattern of dysfunction. We tested PLR’s in 23 PTH, 16 CM, and 26 NH age-matched subjects using a digital infrared binocular pupillometer (Neuroptics DP2000) to quantify direct and consensual pupillary diameter changes in response to a brief light stimulus. Data was exported and analyzed using custom MATLAB code to calculate seven standardized and seven novel parameters of the PLR. We also assessed clinical measures using a REDCAP based questionnaire, including: ICHD-III based headache diagnosis, disease burden and associated symptoms. Groups were compared using the Kruskal-Wallis test, with post-hoc Mann-Whitney test. We found significantly different sympathetically mediated pupillary dilation velocity measures between PTH and NH, and between PTH and CM. In summary, sympathetic pupillometry parameters were significantly different between PTH and CM, as well as between both headache groups and NH, suggesting distinctive pupillary autonomic regulation in PTH and CM and different profiles of dysfunction. Our findings support the hypothesis that PTH and CM are physiologically distinguishable entities, and suggest further investigation into pupillary responses to light as a physiological and clinical biomarker of PTH and CM.
(336) Gender Differences in Cardiovascular Reactivity to Experimental Pain Assessment in Pain-Free Adults C. Valencia, F. Morales, and A. Gurovich; The University of Texas at El Paso
(334) The Association between Daily Physical Activity and Pain among Women with Fibromyalgia: The Moderating Role of Pain Catastrophizing A. Lazaridou, L. Galenkamp, M. Berry, V. Napadow, and R. Edwards; Brigham and Women’s Hospital/Harvard Medical School Fibromyalgia is a condition marked by widespread chronic pain and psychological symptoms. The primary objective of this study was to examine the day-to-day association between physical activity and pain intensity among a sample of women with fibromyalgia (FM) and the potential moderation of this association by pain catastrophizing. In this micro-longitudinal daily diary study, FM patients (N =80) completed questionnaires assessing pain (Brief Pain Inventory) and psychosocial functioning (PROMIS-anxiety, depression) and were then asked to report their levels of pain catastrophizing (e.g negative cognitions on pain), physical activity and pain intensity once per day for a period of seven days using an electronic diary. Multilevel modeling analyses indicated that association between physical activity and pain intensity was moderated by catastrophizing (B = -0.05 SE = 0.023, p< 0.05), with patients scoring higher in catastrophizing showing a relatively stronger link between lower day-
There is a broad literature indicating gender differences in cardiovascular heart diseases. However, gender differences in cardiovascular reactivity to experimental pain have revealed conflicting results. Therefore, we aimed to establish gender differences to experimental pain assessment in cardiovascular reactivity. Cardiovascular reactivity was measured by the change in Central Blood Pressure (CBP), Peripheral Arterial Stiffness (PAS), and Heart Rate Variability (HRV) before and after experimental pain assessment in 28 healthy subjects (12 males, age = 43.7046§6 years; 16 females, age= 49.31§7). CBP and PAS were determined non-invasively by pulse wave analysis (XCEL, SyphgmoCor). High-frequency (HF) and low-frequency (LF) bands were explored as a HRV parameter during each of the phases as an index of vagal cardiac control and sympathetic cardiac activation (MP-150, Biopac). Thermal stimuli were applied to the forearm by a contact thermode to assess thermal pain Tolerance. Repeated measures ANOVA showed a significant interaction term between gender and central diastolic blood pressure [F(1,25)=4.66, p=0.04], where males experienced a significantly steeper increase than females (males DCBP 11.35 mm Hg vs. females DCBP 2.21 mm Hg) . The Central Augmented pressure and the
S57
p=0.032) and greater number of pain sites (r=0.463,p=0.011), but not pain frequency or duration. An older epigenetic age was also significantly associated with greater heat (r=-0.545,p=0.007) and pressure (r=-0.445,p=0.026) pain thresholds, but not vibratory or thermal detection (p’s>0.05). Epigenetic age difference was not generally associated with demographic or psychological function (p’s>0.05). Our findings suggest that chronic pain is associated with greater epigenetic aging in relatively healthy, community-dwelling older individuals and future studies with larger samples are needed to confirm our findings. An aging biomarker such as the epigenetic clock may help identify people with chronic pain at greater risk of functional decline and poorer health outcomes.
Disease Entities (Human) (328) Select Metabolomics Reveal Potential Biomarkers of Fibromyalgia that Correlate with Pain and Fatigue J. Lesnak, E. Merriwether, E. Taylor, D. Dailey, C. Vance, M. Zimmerman, L. Crofford, L. Frey Law, and K. Sluka; University of Iowa Currently, there are no established biomarkers for the diagnosis or symptoms of pain and fatigue in individuals with fibromyalgia (FM). The objective of this study was to identify potential biomarkers in individuals with FM, and to correlate these putative biomarkers with FM-symptoms using a targeted metabolomics approach. The current study was a secondary analysis from baseline data taken in the Fibromyalgia Activity Study with TENS (FAST). We analyzed plasma samples and baseline patient-reported outcomes for resting pain and fatigue from 59 women with FM (mean§SD; age=49.69§11.54, BMI=35.23§10.91) matched with 38 healthy controls (HC) (age=51.0§11.46, BMI=32.33§8.66). Serum/plasma metabolomic extracts were derivatized and analyzed by gas chromatography mass spectrometry for 63 key metabolites representing the tricarboxylic acid cycle, glycolysis, pentose phosphate pathway, amino acid metabolism, neurotransmission, reactive oxygen species defense, and energetics. Differences between FM and HC were assessed for each metabolite using unpaired t-tests (corrected p<0.008) and Pearson’s correlation coefficients were assessed between significant metabolites and baseline pain and fatigue. Ten of the 63 metabolites showed significant between-group differences (P<0.0001). 2-hydroxybutyrate, asparagine, cysteine, fumarate, histidine and tryptophan were negatively correlated with pain and fatigue (P=0.002 to 0.0001, r=-0.315 to -0.894) while 6-phosphogluconate, hypoxanthine, and sphingosine were positively correlated (P=0.004 to 0.0001, r=0.291 to 0.366). The results of this study demonstrate individuals with FM have different resting levels of a variety of metabolites compared to HC, which correlate with their symptoms. These metabolites are generally involved in reduction-oxidation pathways and energy metabolism. Future work will confirm these findings in a new cohort and examine if interventions can alter these metabolites and symptomology. Funded by NIH grant AR06338 and AR06338S1.
(329) Epigenetic Aging is Associated with Clinical and Experimental Pain in Community-Dwelling Older Adults Y. Cruz-Almeida, P. Sinha, A. Rani, P. Lysne, Z. huo, R. Fillingim, and T. Foster; University of Florida Gerontological research reveals considerable interindividual variability in biological aging, which has motivated research efforts to identify ‘aging biomarkers’ that are better predictors of disease risk and residual lifespan when compared to chronological age alone. Emerging evidence using the epigenetic clock as an aging biomarker supports highly reliable individualized predictions about future health and function. The current study focuses on the estimation of “epigenetic age” analyses in blood samples of older adults (60-83 years old) with and without chronic pain to determine whether an epigenetic age biomarker is associated with the presence and burden of chronic pain. A subset of participants (n=29) in the NEPAL study underwent a blood draw, and completed demographic, psychological, and pain assessments, including quantitative sensory testing (n=29). We estimated Horvath’s epigenetic clock and calculated the difference between epigenetic age and chronological age that has been previously reported to predict overall mortality risk. Older individuals without chronic pain (n=9) had significantly “younger” epigenetic age compared to those with chronic pain (n=20,p<0.05). Older epigenetic age was associated with greater self-reported pain during daily activities (r=0.400,
(330) The Role of Tobacco Smoking in the Transition from Acute to Chronic Pain Y. Goh, S. Khoury, A. Velly, L. Diatchenko, and M. Martel; McGill University Tobacco smoking is highly prevalent among patients with chronic pain. The prevalence of smoking has been found to range between 30-60% among patients with chronic pain, and to be approximately 15% in the general population. To date, however, the degree to which tobacco smoking contributes to the development of chronic pain remains unclear. The main objective of this study was to examine the role of tobacco smoking in the transition from acute pain to chronic pain. The sample consisted of adult patients enrolled in the UK Biobank, a large prospective cohort study involving more than 500,000 patients receiving medical care through the UK National Health Service (NHS). Patients were asked to complete self-report questionnaires at three separate time points (i.e., between 2006 and 2014) that assessed a host of demographic, lifestyle, pain, and psychological variables. Across different types of pain diagnoses, analyses indicated that patients smoking tobacco were significantly more likely to develop chronic pain symptoms after an acute pain episode than patients who never smoked (OR = 1.4, p < .05). This effect remained significant even after controlling for relevant demographic and psychological variables. Smoking emerged as a particularly strong determinant of chronic back pain, as patients smoking tobacco were roughly 3 times more likely to transition from acute to chronic back pain than patients who never smoked (OR = 3.1, p < .05). Our findings suggest that smoking plays a role in the etiology of chronic pain. Smoking appears to play a particularly important role in the transition from acute to chronic back pain. Further research will be needed to determine the specific mechanisms through which smoking leads to the development of chronic pain and/or interferes with recovery after an acute pain episode.
(331) Impact of Primary Dysmenorrhea on Self-Image in Adolescents and Young Adults K. Allyn, L. Seidman, S. Evans, A. Rapkin, and L. Payne; David Geffen School of Medicine at UCLA Primary dysmenorrhea (PD), or menstrual pain that is not associated with underlying pathology, is a common condition known to affect 45-95% of menstruating women. Although highly prevalent, a lack of knowledge exists in regards to how girls and young women conceive of their menstrual pain and the ways in which their menstrual pain affects their perceptions and views of themselves and their bodies (self-image). The goal of this qualitative study was to determine impact of menstrual pain on self-image in adolescents and young adults (AYA). Subjects included 39 females ages 16-24 with self-reported menstrual pain ≥ 4/10 on a 0-10 (0= none, 10= worst pain possible) numeric rating scale (M=7.1, SD=1.7). Participants were interviewed using a semi-structured interview guide and the research team then conducted deductive, iterative thematic analysis. Any discrepancies were resolved with group consensus discussion. Three sets of themes emerged: 1. Harmful impact of PD on self-image, including self-frustration, concerns about others’ views, and negative body image; 2. Beneficial impact on self-image, including strength and empowerment and femininity/womanhood; and 3. No impact on self-image. The diverging themes raise questions about the ways in which underlying factors (such as resiliency, PD normalization, and coping mechanisms) may give rise to a spectrum of self-image responses to PD. This study contributes to an understanding of AYA self-image related to menstrual pain, which may aid in the development of future interventions and treatments. Further research should explore how targeting self-image in therapy could impact pain and functioning in AYA with PD.
S58 The Journal of Pain Acknowledgements and Disclosures: This study was supported by National Institutes of Health NICHD grant K23HD077042 (PI: Laura A. Payne) and NCATS University of California Los Angeles Clinical and Translational Science Institute grant KL2TR000122 (PI: Laura A. Payne).
(332) The Association between Mindfulness, Pain Catastrophizing, and Opioid Misuse
Abstracts to-day physical activity and increased FM pain. High catastrophizers were more likely on days they experience more pain to exercise less. Our findings suggest that increases in daily pain are associated with less physical exercise in women with FM pain, particularly among patients reporting higher levels of pain catastrophizing. These results may have clinical implications for the design and testing of interventions targeted at reducing catastrophizing and mechanisms to increase physical activity among women with FM pain.
A. Lazaridou, L. Papianou, K. Dorado, M. Paschali, C. McDonnell, and R. Edwards; Harvard Medical School/Brigham and Women’s Hospital Prescription opioid misuse in the USA has become a serious public health concern and has contributed to an opioid crisis. However, how psychosocial factors are associated to opioid misuse remains unclear. In this study we assessed the association between pain catastrophizing and opioid misuse and examined whether mindfulness mediated this association. In this cross-sectional study, participants (291 chronic low back pain (CLBP) completed self-report measures of mindfulness (MAAS), pain (BPI) and opioid misuse (COMM). Pearson’s correlations examined the associations between study variables in CLBP patients and controls. Bootstrapping mediation analyses assessed the mediating role of mindfulness on the association between pain catastrophizing and opioid misuse. Pain catastrophizing was significantly associated with mindfulness (r = -.02) and opioid misuse (r = .22) in CLBP patients. Results of mediation analyses revealed that pain catastrophizing mediated the relationship between pain catastrophizing and opioid misuse in CLBP patients (ab = .28, 95% CI = .21 - .35). The findings from this study suggest that mindfulness may be the mechanism by which pain catastrophizing can lead to opioid misuse in CLBP patients prescribed opioids.
(333) Screening for Current Opioid Misuse and Associated Risk Factors among Patients with Chronic Pain Prescribed Opioids M. Paschali, A. Lazaridou, K. Dorado, L. Papianou, C. McDonnell, and R. Edwards; Brigham and Women’s Hospital Million patients with chronic pain are treated with opioids and chronic low back pain (CLBP) is the top chronic non-cancer condition for which opioids are prescribed. There are very limited data on the psychosocial factors that can lead to opioid misuse. A multiple linear regression model was used to assess the association of opioid misuse (COMM) with pain severity (BPI), pain catastrophizing (PCS), mindfulness (MAAS) and disability (ODI) at baseline among subjects with low back pain (N = 191) prescribed opioids. Controlling for opioid dose, the overall model was significant for perceived disability (F[4, 187] = 25.33; p < .001). Higher scores of pain catastrophizing (p< .001) and disability (p< .05) but lower scores of mindfulness (p<.001) were associated with higher opioid misuse. Pain intensity was not significantly associated with opioid misuse (p>.05). These results highlight the need to create a clinical profile assessing psychosocial factors (e.g mindfulness, catastrophizing, disability) among chronic pain patients receiving prescribed opioids.
(335) Pupillary Light Responses Differ in Post-Traumatic Headache and Chronic Migraine Compared to Non-Headache Controls L. Millsap, S. Johnson, Zo. Wolcott, C. Sciarretta, A. Rauf, K. Brennan, and M. Cortez; University of Utah Persistent post-traumatic headache (PTH) and chronic migraine (CM) often present with clinically overlapping features including prominent light sensitivity. Dynamic pupillometry is a promising new tool for evaluation of autonomically mediated responses to light in headache disorders, as they may differ between headache phenotypes. While our prior work has evaluated autonomic responses in chronic migraine and mild traumatic brain injury (aka concussion), differences in PTH and chronic migraine have not been explored. The present study sought to identify key sympathetic and parasympathetically mediated variations between pupillary light reflex (PLR) parameters in CM, PTH, and non-headache controls (NH). We hypothesized that while, based on our prior work, CM would exhibit mixed parasympathetic and sympathetic hypo-function resulting in pupillary deficits, PTH would demonstrate a more sympathetically-predominant pattern of dysfunction. We tested PLR’s in 23 PTH, 16 CM, and 26 NH age-matched subjects using a digital infrared binocular pupillometer (Neuroptics DP2000) to quantify direct and consensual pupillary diameter changes in response to a brief light stimulus. Data was exported and analyzed using custom MATLAB code to calculate seven standardized and seven novel parameters of the PLR. We also assessed clinical measures using a REDCAP based questionnaire, including: ICHD-III based headache diagnosis, disease burden and associated symptoms. Groups were compared using the Kruskal-Wallis test, with post-hoc Mann-Whitney test. We found significantly different sympathetically mediated pupillary dilation velocity measures between PTH and NH, and between PTH and CM. In summary, sympathetic pupillometry parameters were significantly different between PTH and CM, as well as between both headache groups and NH, suggesting distinctive pupillary autonomic regulation in PTH and CM and different profiles of dysfunction. Our findings support the hypothesis that PTH and CM are physiologically distinguishable entities, and suggest further investigation into pupillary responses to light as a physiological and clinical biomarker of PTH and CM.
(336) Gender Differences in Cardiovascular Reactivity to Experimental Pain Assessment in Pain-Free Adults C. Valencia, F. Morales, and A. Gurovich; The University of Texas at El Paso
(334) The Association between Daily Physical Activity and Pain among Women with Fibromyalgia: The Moderating Role of Pain Catastrophizing A. Lazaridou, L. Galenkamp, M. Berry, V. Napadow, and R. Edwards; Brigham and Women’s Hospital/Harvard Medical School Fibromyalgia is a condition marked by widespread chronic pain and psychological symptoms. The primary objective of this study was to examine the day-to-day association between physical activity and pain intensity among a sample of women with fibromyalgia (FM) and the potential moderation of this association by pain catastrophizing. In this micro-longitudinal daily diary study, FM patients (N =80) completed questionnaires assessing pain (Brief Pain Inventory) and psychosocial functioning (PROMIS-anxiety, depression) and were then asked to report their levels of pain catastrophizing (e.g negative cognitions on pain), physical activity and pain intensity once per day for a period of seven days using an electronic diary. Multilevel modeling analyses indicated that association between physical activity and pain intensity was moderated by catastrophizing (B = -0.05 SE = 0.023, p< 0.05), with patients scoring higher in catastrophizing showing a relatively stronger link between lower day-
There is a broad literature indicating gender differences in cardiovascular heart diseases. However, gender differences in cardiovascular reactivity to experimental pain have revealed conflicting results. Therefore, we aimed to establish gender differences to experimental pain assessment in cardiovascular reactivity. Cardiovascular reactivity was measured by the change in Central Blood Pressure (CBP), Peripheral Arterial Stiffness (PAS), and Heart Rate Variability (HRV) before and after experimental pain assessment in 28 healthy subjects (12 males, age = 43.7046§6 years; 16 females, age= 49.31§7). CBP and PAS were determined non-invasively by pulse wave analysis (XCEL, SyphgmoCor). High-frequency (HF) and low-frequency (LF) bands were explored as a HRV parameter during each of the phases as an index of vagal cardiac control and sympathetic cardiac activation (MP-150, Biopac). Thermal stimuli were applied to the forearm by a contact thermode to assess thermal pain Tolerance. Repeated measures ANOVA showed a significant interaction term between gender and central diastolic blood pressure [F(1,25)=4.66, p=0.04], where males experienced a significantly steeper increase than females (males DCBP 11.35 mm Hg vs. females DCBP 2.21 mm Hg) . The Central Augmented pressure and the