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The effect of a Spanish virtual pain coach for older adults pilot study
S102
Abstracts
The Journal of Pain
(504) Exploring the effectiveness of a comprehensive mind body intervention, the Relaxation Response Resiliency Enhancement Program (R3P) in patients with chronic refractory temporomandibular disorder (TMD)
(506) The association of depression with pain-related treatment utilization in patients with multiple sclerosis
A Vranceanu, A Saadi, M Scult, E Slawsby, J Shaefer, and J Denninger; Massachusetts General Hospital, Boston, MA TMDs are a heterogenous collection of syndromes characterized by orofacial pain, masticatory dysfunction, or both. The annual cost of treating TMD is about 40% of the total cost of treating all chronic pain conditions combined. This high cost is directly related to the unresponsiveness of chronic TMD to traditional medical approaches. We conducted an open pilot study to evaluate the feasibility, acceptability and efficacy of a pain specific version of an established mind-body medicine program, the Relaxation Response Resiliency Program (R3P), in patients with chronic TMD. The R3P combined educational information about pain with relaxation response, cognitive behavioral therapy and resiliency-enhancement skills.Twenty-four subjects (16 females), mean age 38, with at least a six-month history of TMD diagnosed by a dentist using RDC guidelines, who fit study criteria were recruited from the Orofacial Pain Centers of a major hospital. Eligible participants underwent the R3P intervention (8 group sessions). Before and after the group, patients underwent objective measures of impairment— vertical and lateral range of motion (ROM), with and without pain, temporomandibular joint (TMJ) and muscle pain palpation and algometer measures—and completed psychosocial measures—the Symptom Severity Index (SSI), the Perceived Stress Scale (PSS-4) the Symptom Checklist-90-Revised (SCL-90-R), and The Short Form 36 Health Survey (SF-36). The intervention was highly feasible and accepted by patients (92% completion rate). Results revealed improvement on psychosocial measures—pain intensity (p <0.02; ES = .67), pain frequency (p <.002; ES=.93), pain duration (p<.02; ES= .65) and pain tolerability (p<.009; ES=.87)—and objective measures—vertical mandibular ROM without pain (p<.001; ES=.92) and with pain (p<0.004; ES = .87). This study provides preliminary support for the efficacy of the pain specific R3P in patients with chronic refractory TMD. Results should be further tested via a randomized controlled trial.
Persons with multiple sclerosis (MS) often experience pain, leading to the use of multiple pain interventions. Treatment utilization varies as a function of additional variables. For example, in non-MS populations, depression is associated with higher medical utilization, which may in part to be due to patients seeking medical treatment when they might actually need depression treatment. Pain and depression are highly comorbid among persons with MS, which raises concern for the possibility that depressed patients seek excess pain treatment when they need depression management. The present study tested our hypotheses that depression is associated with greater pain treatment utilization among persons with MS and pain and moderates the relationship of pain intensity with pain treatment utilization. A community sample of 117 predominantly Caucasian females with MS and pain completed measures of depression, pain intensity, and pain treatment utilization. Results showed that depression was associated with some, but not all, types of greater pain treatment utilization. Relative to participants scoring below the depression cutoff (PHQ-9 <10), participants scoring above the depression cutoff (PHQ-9 >10) reported that they had tried more pain treatments previously (t=-2.64, p<0.01), but were not currently using more treatments. Those with depression also reported that they made more visits to providers for pain treatment (t=-1.96, p<0.05), and evidenced a trend toward more pain-related ER visits. However, none of the significant associations between depression and treatment utilization remained significant when controlling for pain intensity, and depression did not moderate the association of pain intensity with pain treatment utilization. This suggests that the association of depression with pain treatment utilization is minimal. However, future longitudinal research could further evaluate pathways through which depression impacts utilization, considering whether depression impacts pain intensity, and pain intensity subsequently impacts utilization. Support provided by NIH/NICHD/NCMRR (P01-HD33988) and National Multiple Sclerosis Society (MB-0008).
H05 Pain and Depression
H06 Pain and Illness Behavior
(505) The effect of a Spanish virtual pain coach for older adults pilot study
(507) Elevated pain behavior following experimental manipulation of injustice
D McDonald, S Walsh, T Gifford, C Vergara, and D Weiner; University of Connecticut, Storrs, CT
Z Trost, W Scott, L Manganelli, E Bernier, and M Sullivan; McGill University Montreal, Quebec, Canada
The aim of the randomized controlled pilot was to test the effects of the Hispanic virtual pain coach on pain intensity, pain interference with activity, and depressive symptoms for ambulatory Spanish speaking older adults with moderate or greater osteoarthritis pain. Eighteen Spanish speaking older adults were randomly assigned to the virtual pain coach and pain communication education group or to the pain communication education only group. Pain intensity, pain interference with activities was measured with the Brief Pain Inventory Short Form, and depressive symptoms were measured with the Beck Depression Inventory II at baseline and one month later. Following baseline measures all participants viewed the pain communication videotape. Participants in the virtual pain coach group also practiced talking about their osteoarthritis pain with the Hispanic virtual pain coach. Immediately after the respective intervention participants had their ambulatory medical visit. Older adults in the Hispanic virtual pain coach group reported a clinically significant reduction in depressive symptoms from baseline to one month, M = 24.3 (SD = 14.91) and 17.0 (SD = 12.01), t(7) = 3.11, p = .017, effect size .54. More older adults in the virtual pain coach group reported a change from nonuse to use of opioids at one month, 50% versus 0% of the education only group, p = .023. No between group difference emerged for pain intensity, pain interference with activities, or depressive symptoms one month later. Few reported a multimodal approach to pain management. Interventions are needed to assist Spanish speaking older adults to obtain multimodal osteoarthritis pain treatments to reduce pain intensity and pain interference with activities. Preliminary data indicate that the Spanish virtual pain coach might assist Spanish speaking older adults to begin to talk with their practitioner about their osteoarthritis pain and obtain treatment changes that help reduce depressive symptoms.
Recent research has highlighted that chronic pain patients often perceive themselves as victims of injustice. Higher perceptions of injustice are in turn associated with negative outcomes in terms of rehabilitation, return-to work, and psychiatric symptom severity. To examine potential mechanisms underlying these findings, the current study examined the effect of an experimental manipulation of injustice on the pain experience of healthy individuals undergoing a cold pressor task (CPT). The sample included 92 healthy participants (42 male, 50 female, mean age 21.8 years). All participants were asked to undergo two CPT immersions for a duration of one minute each. Participants assigned to the Control condition were informed that the second immersion was a standard part of the experimental protocol; participants in the Injustice condition were told that they must repeat the immersion due to experimenter negligence during the initial CPT protocol. Participants’ communicative and protective pain behaviors during immersion were recorded and coded using a standardized coding system. Manipulation checks indicated that the experimental manipulation was successful. No differences in pain behavior were apparent between the two conditions prior to delivery of experimental manipulation (i.e., during the first CPT immersion). However, in comparison to participants assigned to the Control condition, participants in the Injustice condition showed significant elevation in protective pain behavior following experimental manipulation of injustice (i.e., during the second CPT immersion). Moreover, no such differences between conditions were apparent in terms of communicative pain behavior. The current findings provide the first experimental support for the effect of injustice perceptions on pain behavior. Theoretical and clinical implications of the findings will be discussed.
K Alschuler, D Ehde, and M Jensen; University of Washington School of Medicine, Seattle, WA
Abstracts
The Journal of Pain
(504) Exploring the effectiveness of a comprehensive mind body intervention, the Relaxation Response Resiliency Enhancement Program (R3P) in patients with chronic refractory temporomandibular disorder (TMD)
(506) The association of depression with pain-related treatment utilization in patients with multiple sclerosis
A Vranceanu, A Saadi, M Scult, E Slawsby, J Shaefer, and J Denninger; Massachusetts General Hospital, Boston, MA TMDs are a heterogenous collection of syndromes characterized by orofacial pain, masticatory dysfunction, or both. The annual cost of treating TMD is about 40% of the total cost of treating all chronic pain conditions combined. This high cost is directly related to the unresponsiveness of chronic TMD to traditional medical approaches. We conducted an open pilot study to evaluate the feasibility, acceptability and efficacy of a pain specific version of an established mind-body medicine program, the Relaxation Response Resiliency Program (R3P), in patients with chronic TMD. The R3P combined educational information about pain with relaxation response, cognitive behavioral therapy and resiliency-enhancement skills.Twenty-four subjects (16 females), mean age 38, with at least a six-month history of TMD diagnosed by a dentist using RDC guidelines, who fit study criteria were recruited from the Orofacial Pain Centers of a major hospital. Eligible participants underwent the R3P intervention (8 group sessions). Before and after the group, patients underwent objective measures of impairment— vertical and lateral range of motion (ROM), with and without pain, temporomandibular joint (TMJ) and muscle pain palpation and algometer measures—and completed psychosocial measures—the Symptom Severity Index (SSI), the Perceived Stress Scale (PSS-4) the Symptom Checklist-90-Revised (SCL-90-R), and The Short Form 36 Health Survey (SF-36). The intervention was highly feasible and accepted by patients (92% completion rate). Results revealed improvement on psychosocial measures—pain intensity (p <0.02; ES = .67), pain frequency (p <.002; ES=.93), pain duration (p<.02; ES= .65) and pain tolerability (p<.009; ES=.87)—and objective measures—vertical mandibular ROM without pain (p<.001; ES=.92) and with pain (p<0.004; ES = .87). This study provides preliminary support for the efficacy of the pain specific R3P in patients with chronic refractory TMD. Results should be further tested via a randomized controlled trial.
Persons with multiple sclerosis (MS) often experience pain, leading to the use of multiple pain interventions. Treatment utilization varies as a function of additional variables. For example, in non-MS populations, depression is associated with higher medical utilization, which may in part to be due to patients seeking medical treatment when they might actually need depression treatment. Pain and depression are highly comorbid among persons with MS, which raises concern for the possibility that depressed patients seek excess pain treatment when they need depression management. The present study tested our hypotheses that depression is associated with greater pain treatment utilization among persons with MS and pain and moderates the relationship of pain intensity with pain treatment utilization. A community sample of 117 predominantly Caucasian females with MS and pain completed measures of depression, pain intensity, and pain treatment utilization. Results showed that depression was associated with some, but not all, types of greater pain treatment utilization. Relative to participants scoring below the depression cutoff (PHQ-9 <10), participants scoring above the depression cutoff (PHQ-9 >10) reported that they had tried more pain treatments previously (t=-2.64, p<0.01), but were not currently using more treatments. Those with depression also reported that they made more visits to providers for pain treatment (t=-1.96, p<0.05), and evidenced a trend toward more pain-related ER visits. However, none of the significant associations between depression and treatment utilization remained significant when controlling for pain intensity, and depression did not moderate the association of pain intensity with pain treatment utilization. This suggests that the association of depression with pain treatment utilization is minimal. However, future longitudinal research could further evaluate pathways through which depression impacts utilization, considering whether depression impacts pain intensity, and pain intensity subsequently impacts utilization. Support provided by NIH/NICHD/NCMRR (P01-HD33988) and National Multiple Sclerosis Society (MB-0008).
H05 Pain and Depression
H06 Pain and Illness Behavior
(505) The effect of a Spanish virtual pain coach for older adults pilot study
(507) Elevated pain behavior following experimental manipulation of injustice
D McDonald, S Walsh, T Gifford, C Vergara, and D Weiner; University of Connecticut, Storrs, CT
Z Trost, W Scott, L Manganelli, E Bernier, and M Sullivan; McGill University Montreal, Quebec, Canada
The aim of the randomized controlled pilot was to test the effects of the Hispanic virtual pain coach on pain intensity, pain interference with activity, and depressive symptoms for ambulatory Spanish speaking older adults with moderate or greater osteoarthritis pain. Eighteen Spanish speaking older adults were randomly assigned to the virtual pain coach and pain communication education group or to the pain communication education only group. Pain intensity, pain interference with activities was measured with the Brief Pain Inventory Short Form, and depressive symptoms were measured with the Beck Depression Inventory II at baseline and one month later. Following baseline measures all participants viewed the pain communication videotape. Participants in the virtual pain coach group also practiced talking about their osteoarthritis pain with the Hispanic virtual pain coach. Immediately after the respective intervention participants had their ambulatory medical visit. Older adults in the Hispanic virtual pain coach group reported a clinically significant reduction in depressive symptoms from baseline to one month, M = 24.3 (SD = 14.91) and 17.0 (SD = 12.01), t(7) = 3.11, p = .017, effect size .54. More older adults in the virtual pain coach group reported a change from nonuse to use of opioids at one month, 50% versus 0% of the education only group, p = .023. No between group difference emerged for pain intensity, pain interference with activities, or depressive symptoms one month later. Few reported a multimodal approach to pain management. Interventions are needed to assist Spanish speaking older adults to obtain multimodal osteoarthritis pain treatments to reduce pain intensity and pain interference with activities. Preliminary data indicate that the Spanish virtual pain coach might assist Spanish speaking older adults to begin to talk with their practitioner about their osteoarthritis pain and obtain treatment changes that help reduce depressive symptoms.
Recent research has highlighted that chronic pain patients often perceive themselves as victims of injustice. Higher perceptions of injustice are in turn associated with negative outcomes in terms of rehabilitation, return-to work, and psychiatric symptom severity. To examine potential mechanisms underlying these findings, the current study examined the effect of an experimental manipulation of injustice on the pain experience of healthy individuals undergoing a cold pressor task (CPT). The sample included 92 healthy participants (42 male, 50 female, mean age 21.8 years). All participants were asked to undergo two CPT immersions for a duration of one minute each. Participants assigned to the Control condition were informed that the second immersion was a standard part of the experimental protocol; participants in the Injustice condition were told that they must repeat the immersion due to experimenter negligence during the initial CPT protocol. Participants’ communicative and protective pain behaviors during immersion were recorded and coded using a standardized coding system. Manipulation checks indicated that the experimental manipulation was successful. No differences in pain behavior were apparent between the two conditions prior to delivery of experimental manipulation (i.e., during the first CPT immersion). However, in comparison to participants assigned to the Control condition, participants in the Injustice condition showed significant elevation in protective pain behavior following experimental manipulation of injustice (i.e., during the second CPT immersion). Moreover, no such differences between conditions were apparent in terms of communicative pain behavior. The current findings provide the first experimental support for the effect of injustice perceptions on pain behavior. Theoretical and clinical implications of the findings will be discussed.
K Alschuler, D Ehde, and M Jensen; University of Washington School of Medicine, Seattle, WA