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(503) Whither the twain shall meet: insomnia and distraction analgesia
Abstracts
(500) The role of perceived injustice in chronic pain in a clinical pediatric sample M Miller, E Scott, M Franz, Z Trost, and A Hirsh; Indiana University- Purdue University Indianapolis, Indianapolis, IN Upwards of 35% of children and adolescents experience chronic pain. Expectations and beliefs about the self and the environment may play a critical role in the pain experience. The idea that the world is a just and fair place is a commonly held belief among the general population; when that belief is violated, feelings of injustice can emerge. In adults with chronic pain, recent research found that perceived injustice augmented the relationship between pain intensity and depressive symptoms and, thus, may be a possible focus for intervention efforts. To our knowledge, perceptions of injustice have not been examined in the pediatric pain population. The purpose of the current study was to examine perceived injustice and its relationship to pain and emotional functioning among children and adolescents with chronic pain. This was a retrospective analysis of clinical data from 109 pediatric chronic pain patients (mean age = 15.03 years, 68% female) presenting to an outpatient university-based pain clinic. Patients completed measures assessing their current pain intensity (NRS), perceptions of injustice (IEQ), and emotional functioning (Emotional Functioning Scale-PedsQL). Results indicated significant associations between perceived injustice and emotional functioning (r = -0.64, p < .05), perceived injustice and pain intensity (r = .25, p < .05), and pain intensity and emotional functioning (r = -.23, p < .05). However, perceived injustice did not moderate the relationship between pain intensity and emotional functioning (p = 0.59). These findings suggest that perceived injustice is an important cognitive-emotional factor in the pain experience of children and adolescents, however, its role may differ from that which it plays for adults with chronic pain.
(501) Pain-related fear is associated with pain and functional outcomes in a level-I trauma sample
The Journal of Pain
S101
(502) Feasibility of an internet-enabled tablet-based guided imagery for stress and pain reduction intervention in adults with sickle cell disease M Ezenwa, Y Yao, R Molokie, C Engeland, Z Wang, M Suarez, Z Zhao, J Carrasco, R Angulo, and D Wilkie; University of Illinois at Chicago, Chicago, IL Pain of sickle cell disease (SCD) has both physiological and psychological components. Current treatment of SCD pain focuses on alleviating pain using opioids, but guided imagery is rarely used. This 2-phase, attention control pre-post randomized clinical trial was conducted to test the feasibility of a protocol focused on guided imagery (GI) for stress and pain reduction intervention in adults with SCD. Patients (N=21, mean age 3068 years [ranged from 21-47 years], 95% African-American, 67% female) completed stress and pain measures daily for 2 weeks via an Android tablet and the experimental group watched any of six video clips (2-min, 5-min, 8-min, 10-min, 15-min, and 20min lengths) regardless of whether they are stressed or not to obtain a minimal intervention dose, at stress onset and as often as they desired via the tablet. We analyzed data using multi-level regression analysis. 100% of consented patients participated and 90% completed the study. Overall, patients used the tablet on 79% of study days; 100% reported that they liked the study; and 99% of questionnaire items were completed. At two weeks, there was a trend for effects of GI on stress and pain, wherein average stress intensity and composite pain index were lower for the GI group than the control group, but the difference was not statistically significant. The study protocol was feasible and we were able to determine the effect size for the GI intervention and calculate the sample size needed to conduct an efficacy trial of GI intervention using this protocol in adults with SCD. Patients kept the scheduled study appointments and completed a simple and cost-effective trial of GI intervention on the mobile tablet device; the GI intervention shows promise for reducing the impact of stress on SCD pain and warrants a larger randomized clinical trial to determine its efficacy.
(503) Whither the twain shall meet: insomnia and distraction analgesia
A Guck, S Agtarap, M Reynolds, K Roden-Foreman, M Foreman, A Warren, and Z Trost; University of North Texas, Denton, TX
C Odonkor, M Pejsa, M Hand, S Wegener, D Tompkins, M and C Campbell; Johns Hopkins University, Baltimore, MD
Smith,
Pain-related fear – the belief that one’s pain is indicative of harm or (re)injury and should therefore be avoided – is associated with negative pain and disability outcomes among individuals with acute and chronic pain. To date, research on the predictive power of this construct has focused on individuals with chronic pain from benign musculoskeletal conditions. However, research suggests that patients with traumatic injuries may endorse beliefs closely associated with pain-related fear. The current study examined the relationships between pain-related fear, pain catastrophizing (a highly negative orientation toward pain closely associated with pain-related fear), and relevant measures of function in a sample of individuals admitted to a Level-I trauma center. Causes of injury spanned motor vehicle collisions, falls, and violent crime (e.g., stabbing, gunshot wounds), and included orthopedic trauma, organ injury, and abrasion/laceration. Phone surveys were administered to 137 trauma patients 12 months following initial hospitalization. The Tampa Scale of Kinesiophobia and Pain Catastrophizing Scale served as measures of painrelated fear and catastrophizing, respectively. Bivariate analyses indicated that both measures were associated with higher disability/poorer quality of life, greater depression, and increased healthcare utilization following discharge (r =.16 -.58; all p’s<.05). For those patients employed prior to injury, pain-related fear was associated with lower return to work following injury. In separate hierarchical regression analyses, both measures accounted for variance in outcomes above and beyond demographic and medical variables, including etiology and severity of injury and pain intensity. Findings support the role of pain-related fear in physical and psychological outcomes following traumatic injury and, more broadly, the potential significance of pain-related psychological factors in long-term disability following trauma. Implications for further research of pain-related fear in clinical trauma outcomes is discussed. Support for the study was provided by the Stanley Seeger Surgical Endowment Funds of the Baylor Health Care System.
Recent reports indicate that poor sleep is associated with hyperalgesia and worsens clinical pain. However, the impact of insomnia on pain modulation via cognitive distraction remains unknown. The present study investigated the relationship between insomnia (assessed by the Insomnia Severity Index, ISI) and distraction analgesia. A 10% capsaicin cream was applied to the nondominant hand in forty healthy, participants (mean age 26.5 6 6.1 yrs), during two sessions, where pain was rated every five minutes for 90 minutes. Distraction analgesia was computed as the difference between the normalized visual analog scale (VAS)-pain ratings under pain alone vs. pain plus cognitive distraction (video games). Correlation analysis showed an association between insomnia and distraction analgesia (r=-0.15, P< 0.001). Mixed model and repeated measures ANOVA showed an adjusted main effect of insomnia with distraction analgesia (F (1,35)=11.09 at P=0.0021). Three patterns of distraction analgesia were observed: non-responders (no benefit of distraction over 60 mins), intermediate responders (late peak effect at 50mins), and clinical responders (with a peak effect observed between 35-40 mins). This response pattern overlapped with insomnia analyzed as a categorical variable (clinical insomnia, ISI >15, sub-threshold insomnia and no insomnia). Clinical insomnia was associated with non-response to distraction (47% predicted probability), subthreshold insomnia with intermediate distraction-analgesia (54% predicted probability) and no insomnia with 57% predicted probability of response to distraction analgesia, p<0.05. Maximum and mean analgesic effect for each group was as follows: No insomnia (31.4 and 19), Sub-threshold insomnia (14.4 and 4) and Clinical insomnia (-0.5 and -8.0). These findings suggest that poor sleep may be associated with pain modulation by cognitive distraction. The results support prior studies suggesting poor sleep impairs endogenous opioid activity. The observed association between sleep and distraction analgesia has implications for clinicians with regards to stratifying who would potentially benefit clinically from distraction analgesia.
(500) The role of perceived injustice in chronic pain in a clinical pediatric sample M Miller, E Scott, M Franz, Z Trost, and A Hirsh; Indiana University- Purdue University Indianapolis, Indianapolis, IN Upwards of 35% of children and adolescents experience chronic pain. Expectations and beliefs about the self and the environment may play a critical role in the pain experience. The idea that the world is a just and fair place is a commonly held belief among the general population; when that belief is violated, feelings of injustice can emerge. In adults with chronic pain, recent research found that perceived injustice augmented the relationship between pain intensity and depressive symptoms and, thus, may be a possible focus for intervention efforts. To our knowledge, perceptions of injustice have not been examined in the pediatric pain population. The purpose of the current study was to examine perceived injustice and its relationship to pain and emotional functioning among children and adolescents with chronic pain. This was a retrospective analysis of clinical data from 109 pediatric chronic pain patients (mean age = 15.03 years, 68% female) presenting to an outpatient university-based pain clinic. Patients completed measures assessing their current pain intensity (NRS), perceptions of injustice (IEQ), and emotional functioning (Emotional Functioning Scale-PedsQL). Results indicated significant associations between perceived injustice and emotional functioning (r = -0.64, p < .05), perceived injustice and pain intensity (r = .25, p < .05), and pain intensity and emotional functioning (r = -.23, p < .05). However, perceived injustice did not moderate the relationship between pain intensity and emotional functioning (p = 0.59). These findings suggest that perceived injustice is an important cognitive-emotional factor in the pain experience of children and adolescents, however, its role may differ from that which it plays for adults with chronic pain.
(501) Pain-related fear is associated with pain and functional outcomes in a level-I trauma sample
The Journal of Pain
S101
(502) Feasibility of an internet-enabled tablet-based guided imagery for stress and pain reduction intervention in adults with sickle cell disease M Ezenwa, Y Yao, R Molokie, C Engeland, Z Wang, M Suarez, Z Zhao, J Carrasco, R Angulo, and D Wilkie; University of Illinois at Chicago, Chicago, IL Pain of sickle cell disease (SCD) has both physiological and psychological components. Current treatment of SCD pain focuses on alleviating pain using opioids, but guided imagery is rarely used. This 2-phase, attention control pre-post randomized clinical trial was conducted to test the feasibility of a protocol focused on guided imagery (GI) for stress and pain reduction intervention in adults with SCD. Patients (N=21, mean age 3068 years [ranged from 21-47 years], 95% African-American, 67% female) completed stress and pain measures daily for 2 weeks via an Android tablet and the experimental group watched any of six video clips (2-min, 5-min, 8-min, 10-min, 15-min, and 20min lengths) regardless of whether they are stressed or not to obtain a minimal intervention dose, at stress onset and as often as they desired via the tablet. We analyzed data using multi-level regression analysis. 100% of consented patients participated and 90% completed the study. Overall, patients used the tablet on 79% of study days; 100% reported that they liked the study; and 99% of questionnaire items were completed. At two weeks, there was a trend for effects of GI on stress and pain, wherein average stress intensity and composite pain index were lower for the GI group than the control group, but the difference was not statistically significant. The study protocol was feasible and we were able to determine the effect size for the GI intervention and calculate the sample size needed to conduct an efficacy trial of GI intervention using this protocol in adults with SCD. Patients kept the scheduled study appointments and completed a simple and cost-effective trial of GI intervention on the mobile tablet device; the GI intervention shows promise for reducing the impact of stress on SCD pain and warrants a larger randomized clinical trial to determine its efficacy.
(503) Whither the twain shall meet: insomnia and distraction analgesia
A Guck, S Agtarap, M Reynolds, K Roden-Foreman, M Foreman, A Warren, and Z Trost; University of North Texas, Denton, TX
C Odonkor, M Pejsa, M Hand, S Wegener, D Tompkins, M and C Campbell; Johns Hopkins University, Baltimore, MD
Smith,
Pain-related fear – the belief that one’s pain is indicative of harm or (re)injury and should therefore be avoided – is associated with negative pain and disability outcomes among individuals with acute and chronic pain. To date, research on the predictive power of this construct has focused on individuals with chronic pain from benign musculoskeletal conditions. However, research suggests that patients with traumatic injuries may endorse beliefs closely associated with pain-related fear. The current study examined the relationships between pain-related fear, pain catastrophizing (a highly negative orientation toward pain closely associated with pain-related fear), and relevant measures of function in a sample of individuals admitted to a Level-I trauma center. Causes of injury spanned motor vehicle collisions, falls, and violent crime (e.g., stabbing, gunshot wounds), and included orthopedic trauma, organ injury, and abrasion/laceration. Phone surveys were administered to 137 trauma patients 12 months following initial hospitalization. The Tampa Scale of Kinesiophobia and Pain Catastrophizing Scale served as measures of painrelated fear and catastrophizing, respectively. Bivariate analyses indicated that both measures were associated with higher disability/poorer quality of life, greater depression, and increased healthcare utilization following discharge (r =.16 -.58; all p’s<.05). For those patients employed prior to injury, pain-related fear was associated with lower return to work following injury. In separate hierarchical regression analyses, both measures accounted for variance in outcomes above and beyond demographic and medical variables, including etiology and severity of injury and pain intensity. Findings support the role of pain-related fear in physical and psychological outcomes following traumatic injury and, more broadly, the potential significance of pain-related psychological factors in long-term disability following trauma. Implications for further research of pain-related fear in clinical trauma outcomes is discussed. Support for the study was provided by the Stanley Seeger Surgical Endowment Funds of the Baylor Health Care System.
Recent reports indicate that poor sleep is associated with hyperalgesia and worsens clinical pain. However, the impact of insomnia on pain modulation via cognitive distraction remains unknown. The present study investigated the relationship between insomnia (assessed by the Insomnia Severity Index, ISI) and distraction analgesia. A 10% capsaicin cream was applied to the nondominant hand in forty healthy, participants (mean age 26.5 6 6.1 yrs), during two sessions, where pain was rated every five minutes for 90 minutes. Distraction analgesia was computed as the difference between the normalized visual analog scale (VAS)-pain ratings under pain alone vs. pain plus cognitive distraction (video games). Correlation analysis showed an association between insomnia and distraction analgesia (r=-0.15, P< 0.001). Mixed model and repeated measures ANOVA showed an adjusted main effect of insomnia with distraction analgesia (F (1,35)=11.09 at P=0.0021). Three patterns of distraction analgesia were observed: non-responders (no benefit of distraction over 60 mins), intermediate responders (late peak effect at 50mins), and clinical responders (with a peak effect observed between 35-40 mins). This response pattern overlapped with insomnia analyzed as a categorical variable (clinical insomnia, ISI >15, sub-threshold insomnia and no insomnia). Clinical insomnia was associated with non-response to distraction (47% predicted probability), subthreshold insomnia with intermediate distraction-analgesia (54% predicted probability) and no insomnia with 57% predicted probability of response to distraction analgesia, p<0.05. Maximum and mean analgesic effect for each group was as follows: No insomnia (31.4 and 19), Sub-threshold insomnia (14.4 and 4) and Clinical insomnia (-0.5 and -8.0). These findings suggest that poor sleep may be associated with pain modulation by cognitive distraction. The results support prior studies suggesting poor sleep impairs endogenous opioid activity. The observed association between sleep and distraction analgesia has implications for clinicians with regards to stratifying who would potentially benefit clinically from distraction analgesia.