Chronic pain is common among individuals with opioid use disorder (OUD) who are maintained on medications for OUD (MOUD; eg, buprenorphine or methadone). Chronic pain is associated with worse ...retention and higher levels of substance use. Treatment of individuals with chronic pain receiving MOUD can be challenging due to their increased clinical complexity. Given the acute and growing nature of the opioid crisis, MOUD is increasingly offered in a wide range of settings, where high-quality, clinician-delivered, empirically validated behavioral treatment for chronic pain may not be available. Therefore, digital treatments that support patient self-management of chronic pain and OUD have the potential for wider implementation to fill this gap.
This study aims to evaluate the efficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT), an interactive digital treatment program with asynchronous coach feedback, compared to treatment as usual (TAU) in individuals with chronic pain and OUD receiving MOUD.
Adult participants (n=160) receiving MOUD and reporting bothersome or high-impact chronic pain will be recruited from outpatient opioid treatment programs in Connecticut (United States) and randomized 1:1 to either IMPACT+TAU or TAU only. Participants randomized to IMPACT+TAU will complete an interactive digital treatment that includes 9 modules promoting training in pain and addiction coping skills and a progressive walking program. The program is augmented with a weekly personalized voice message from a trained coach based on daily participant-reported pain intensity and interference, craving to use opioids, sleep quality, daily steps, pain self-efficacy, MOUD adherence, and engagement with IMPACT collected through digital surveys. Outcomes will be assessed at 3, 6, and 9 months post randomization. The primary outcome is MOUD retention at 3 months post randomization (ie, post treatment). Secondary outcomes include pain interference, physical functioning, MOUD adherence, substance use, craving, pain intensity, sleep disturbance, pain catastrophizing, and pain self-efficacy. Semistructured qualitative interviews with study participants (n=34) randomized to IMPACT (completers and noncompleters) will be conducted to evaluate the usability and quality of the program and its outcomes.
The study has received institutional review board approval and began recruitment at 1 site in July 2022. Recruitment at a second site started in January 2023, with a third and final site anticipated to begin recruitment in January 2024. Data collection is expected to continue through June 2025.
Establishing efficacy for a digital treatment for addiction and chronic pain that can be integrated into MOUD clinics will provide options for individuals with OUD, which reduce barriers to behavioral treatment. Participant feedback on the intervention will inform updates or modifications to improve engagement and efficacy.
ClinicalTrials.gov NCT05204576; https://clinicaltrials.gov/ct2/show/NCT05204576.
DERR1-10.2196/54342.
Abstract
Background
The fear-avoidance model of chronic pain holds that individuals who catastrophize in response to injury are at risk for pain-related fear and avoidance behavior, and ultimately ...prolonged pain and disability.
Purpose
Based on the hypothesis that the predictive power of the fear-avoidance model would be enhanced by consideration of positive psychological constructs, the present study examined inclusion of pain resilience and self-efficacy in the model.
Methods
Men and women (N = 343) who experienced a recent episode of back pain were recruited in a longitudinal online survey study. Over a 3-month interval, participants repeated the Pain Resilience Scale, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia, Pain Self-Efficacy Questionnaire, the McGill Pain Questionnaire, and NIH-recommended measures of pain, depressive symptoms, and physical dysfunction. Structural equation modeling assessed the combined contribution of pain resilience and pain catastrophizing to 3-month outcomes through the simultaneous combination of kinesiophobia and self-efficacy.
Results
An expanded fear-avoidance model that incorporated pain resilience and self-efficacy provided a good fit to the data, Χ2 (df = 14, N = 343) = 42.09, p = .0001, RMSEA = 0.076 (90% CI: 0.05, 0.10), CFI = 0.97, SRMR = 0.03, with higher levels of pain resilience associated with improved 3-month outcomes on measures of pain intensity, physical dysfunction, and depression symptoms.
Conclusions
This study supports the notion that the predictive power of the fear-avoidance model of pain is enhanced when individual differences in both pain-related vulnerability (e.g., catastrophizing) and pain-related protective resources (e.g., resilience) are considered.
Pain resilience protects against development of fear following acute back injury and is longitudinally associated with less pain, distress, and disability after three months.
Over the past decade, the role of positive psychology in pain experience has gained increasing attention. One such positive factor, identified as resilience, has been defined as the ability to ...maintain positive emotional and physical functioning despite physical or psychological adversity. Although cross-situational measures of resilience have been shown to be related to pain, it was hypothesized that a pain-specific resilience measure would serve as a stronger predictor of acute pain experience. To test this hypothesis, we conducted a series of studies to develop and validate the Pain Resilience Scale. Study 1 described exploratory and confirmatory factor analyses that support a scale with 2 distinct factors, Cognitive/Affective Positivity and Behavioral Perseverance. Study 2 showed test-retest reliability and construct validity of this new scale, including moderate positive relationships with measures of positive psychological functioning and small to moderate negative relationships with vulnerability measures such as pain catastrophizing. Finally, consistent with our initial hypothesis, study 3 showed that the Pain Resilience Scale is more strongly related to ischemic pain responses than existing measures of general resilience. Together, these studies support the predictive utility of this new pain-specific measure of resilience in the context of acute experimental pain.
The Pain Resilience Scale represents a novel measure of Cognitive/Affective Positivity and Behavioral Perseverance during exposure to noxious stimuli. Construct validity is supported by expected relationships with existing pain-coping measures, and predictive validity is shown by individual differences in response to acute experimental pain.
Psychosocial factors that protect against negative outcomes for individuals with chronic pain have received increased attention in recent years. Pain resilience, or the ability to maintain behavioral ...engagement and regulate emotions as well as cognitions despite prolonged or intense pain, is one such factor. A measure of pain-specific resilience, the Pain Resilience Scale, was previously identified as a better predictor of acute pain tolerance than general resilience. The present study sought to validate this measure in a chronic pain sample, while also furthering understanding of the role of pain resilience compared with other protective factors. Participants with chronic pain completed online questionnaires to assess factors related to positive pain outcomes, pain vulnerability, pain intensity, and quality of life. A confirmatory factor analysis confirmed the 2-factor structure of the Pain Resilience Scale previously observed among respondents without chronic pain, although one item from each subscale was dropped in the final version. For this chronic pain sample, structural equation modeling showed that pain resilience contributes unique variance to a model including pain acceptance and pain self-efficacy in predicting quality of life and pain intensity. Further, pain resilience was a better fit in this model than general resilience, strengthening the argument for assessing pain resilience over general resilience.
A modified version of the Pain Resilience Scale retained the original factor structure when tested in a chronic pain sample. Construct validity was supported by expected relationships with pain-related protective and vulnerability measures. Further, a model including positive pain constructs showed that pain resilience accounts for unique variability when predicting quality of life and pain intensity.
Pain resilience, one's ability to maintain behavioral engagement and adaptively regulate cognitions and emotions despite intense or prolonged pain, has been shown to protect against negative ...pain-related outcomes in experimental settings. A weakness of this research, and much of experimental pain research in general, has been the lack of rationale behind the selection of noxious stimuli which can activate different nociceptive fibers. The present study sought to determine if the relationship between pain resilience and pain ratings differed across stimuli based on the stimulated nociceptors.
Healthy undergraduate students (N = 100; mean age =19.4 SD = 1.2 years; 60% female) completed the Pain Resilience Scale and provided continuous pain ratings during exposure to three different tasks, each selected based on their ability to stimulate specific combinations of nociceptive fibers: pinprick (Aδ fibers), cold water immersion (Aδ and C fibers), and ischemic tourniquet (C fibers).
Participants with high pain resilience reported lower pain ratings over time during cold water immersion than those with low pain resilience, F(1, 39) = 8.526, p = 0.006; however, there was no relationship between pain resilience and pain ratings during either of the pinprick or ischemic tourniquet stimuli.
This study provides further support for the use of multiple pain stimuli for pain assessment given their unique characteristics and concludes that outcome variables aside from pain ratings may provide additional insight into the role of resilience on pain adaptation.
Purpose of Review
The purpose of this review is to evaluate and summarize recent empirical research investigating motivational factors for management of chronic pain and headache disorders.
Recent ...Findings
Research on motivation for non-pharmacological treatment of chronic pain and headache disorders has identified factors that influence initiation of and adherence to treatment. To address common factors that inhibit initiation of treatment (i.e., cost, time commitment), several electronic treatments have been developed. Self-efficacy is the most commonly studied psychosocial influence on treatment adherence, with evidence that it is positively correlated with adherence. Other studies have sought to improve adherence to treatment using motivational interviewing interventions.
Summary
There is currently limited research on how to enhance motivation for initial adherence to non-pharmacological treatment for chronic pain and headache disorders. Instead of enhancing motivation, researchers have looked to reduce barriers to treatment with electronic health treatments; however, many of these studies have focused on intervention feasibility, rather than efficacy or effectiveness. Numerous studies have identified a relationship between self-efficacy and treatment adherence. Although motivational interviewing interventions have been shown to improve adherence to treatment, there is little evidence that they improve treatment outcomes. Recommendations for further investigation include improving interventions to enhance accessibility and adherence to treatment with the goal of improving outcomes, as well as identifying ways to improve treatment initiation and adherence in patients who are currently engaged in long-term opioid therapy.
OBJECTIVES:Perceived injustice is a maladaptive cognitive appraisal of pain or injury, characterized by attributions of blame, unfairness, severity of loss, and irreparability of loss. Research ...suggests that perceived injustice may negatively affect pain outcomes by inhibiting the development of pain-related acceptance. The current study aimed to extend cross-sectional research by testing whether pain acceptance mediates the effects of perceived injustice on pain-related outcomes longitudinally.
MATERIALS AND METHODS:Data was analyzed from a prospective study to examine the potential mediating role of pain acceptance on recovery 3 months after an episode of low back pain. Using Mechanical Turk, we recruited participants who experienced an episode of back pain within the preceding 2 weeks, 343 of whom completed measures of perceived injustice, pain acceptance, pain ratings, and quality of life at each of 3 timepoints (recruitment, 1 mo later, and 3 mo later). Path analyses were conducted to examine pain acceptance at 1 month as a potential mediator of the relationship between perceived injustice at recruitment and pain intensity, disability, and depressive symptoms at 3 months.
RESULTS:Results indicated that perceived injustice at recruitment was directly related to pain intensity, disability, and depressive symptoms 3 months later, and that pain acceptance partially mediated these relationships.
DISCUSSION:Although these findings provide further support for pain acceptance as a buffer for the deleterious effects of perceived injustice, they also highlight that adjunctive mechanisms should be investigated to provide more comprehensive clinical insight.
Psychological research on pain has primarily focused on factors that confer vulnerability to pain-related outcomes; however, the past fifteen years have seen an increase in studies investigating ...factors that confer resilience to pain outcomes. One such factor is pain resilience, one’s ability to maintain behavioral engagement and regulate emotions as well as cognitions despite intense or prolonged pain. A weakness in not only the pain resilience literature, but pain research in general, has been the lack of rationale behind the selection of experimental pain stimuli. These pain stimuli can activate different nociceptive fibers, meaning that stimuli are not interchangeable. The present study examined the relationship between pain resilience and reported pain during three pain stimuli that stimulate different combinations of nociceptors: pinprick (primarily Aδ fibers), cold water immersion (Aδ and C fibers), and ischemic tourniquet (primarily C fibers). Results indicated that individuals with high pain resilience reported lower cold water immersion pain ratings over time than those with low pain resilience; however, here was no relationship between pain resilience and either pinprick or ischemic tourniquet pain ratings. Pain resilience was also more closely related to pain ratings than a generic resilience measure. This study provides further support for the use of multiple pain stimuli for pain assessment given their unique characteristics, further support for the use of a pain-specific measure of resilience, and concludes that outcome variables aside from pain ratings may provide additional insight into the role of resilience on pain adaptation.
Background
This study aimed to promote competence, autonomy, and relatedness among first‐time whole blood donors to enhance intrinsic motivation and increase retention.
Study design and methods
Using ...a full factorial design, first‐time donors (N = 2002) were randomly assigned to a no‐treatment control condition or to one of seven intervention conditions designed to promote donation competence, autonomy, relatedness, a combination of two (e.g., competence and autonomy), or all three constructs. Participants completed donor motivation measures before the intervention and 6 weeks later, and subsequent donation attempts were assessed for 1 year.
Results
There was no significant group difference in the frequency of donation attempts or in the number of days to return. Significant effects of group were observed for 10 of the 12 motivation measures, although follow‐up analyses revealed significant differences from the control group were restricted to interventions that included an autonomy component. Path analyses confirmed direct associations between interventions involving autonomy and donor motivation, and indirect mediation of donation attempts via stronger donation intentions and lower donation anxiety.
Conclusion
Among young, first‐time, whole blood donors, brief interventions that include support for donor autonomy were associated with direct effects on donor motivation and indirect, but small, effects on subsequent donation behavior.
