Psychology

Patients with adolescent idiopathic scoliosis (AIS) often report chronic back pain; however, there is inadequate research on psychological factors associated with pain in this patient population. Pain catastrophizing, a psychological factor that describes a pattern of negative thoughts and feelings about pain, has been associated with poorer responses to medical treatment for pain. The purpose of this study was to report the prevalence of pain catastrophizing in the AIS population and assess its relationship with preoperative and postoperative self-reported outcomes.

The United States (US) Department of Veterans Affairs (VA) is the largest integrated health care system in the US and provides dental care to approximately one half million Veterans annually. In response to the opioid crisis, the VA released several opioid risk mitigation strategies. While opioid prescribing by VA dentists have decreased on the whole, the implementation experiences at the level of dentists remains unclear. Our objective was to explore the barriers and facilitators that impact opioid decision-making for management of acute dental pain among VA dentists.Dentists practicing in the VA facilities with the highest and lowest volume of opioid prescriptions were recruited. Standardized qualitative interviews by telephone followed a semi-structured guide designed around the COM-B model. Audio-recordings were transcribed and independently double-coded using NVivo to identify potential targets for future guideline-based opioid interventions. Of 395 eligible general and specialty dentists, 90 (24.8%) completed an interview representing 33 VA facilities. Opportunities for prescribing opioids included: 1) completion of dental procedures associated with acute dental pain, 2) caring for patients who presented with existing dental pain, and 3) responding to patient opioid requests. Capabilities included using resources (e.g. electronic medical records), clinical judgement (e.g. evaluation of medical history including medication use), communication skills, and ability to screen for opioid misuse. Motivation themes focused on alleviating patients' acute dental pain. Barriers and facilitators of opioid prescribing varied across facilities. Results can offer intervention targets for continued opioid risk mitigation efforts.

Invited Clinical Commentary BACKGROUND: Arthritis is one of the most frequently reported causes of disability in the United States and the prevalence is expected to increase in the coming decades. While many rheumatic diseases involve hand impairments, most are systemic and involve more than the musculoskeletal system. Functional and work disability are high and people would benefit from the services of occupational and physical therapists.

Leprosy-related multiple mononeuropathy offers a pattern of impairment where neuropathy with and without neuropathic pain (NeP) are present in the same individual, thus allowing to investigate peripheral sensory and innervation in both conditions. This cross-sectional study collected data on clinical and neurological examination, pain-assessment questionnaires, quantitative sensory test, and intraepidermal nerve fiber density (IENFD) of patients with leprosy and divided the cohort into two groups: with (P+) and without NeP (P-). Further, we assessed mirror body areas in the same NeP individuals with bilateral neuropathy also presenting unilateral NeP. Pain-free patients having unilateral neuropathy were controls. A total of 37 P+ patients and 22 P- patients were evaluated. Limb areas with NeP had signs of C-fiber dysfunction and hyperesthesia on QST compared with limb areas having neuropathy without NeP. Skin denervation was found in all leprosy patients. Comparisons of limbs with and without neuropathy, and with and without NeP revealed that higher heat pain thresholds (HPT) were associated with neuropathic pain areas, whereas less altered HPT was correlated with higher fiber density. Furthermore, a relationship was found between time of leprosy treatment termination and more intense neuropathy, expressed by HPT increasing 0.03 °C each month. As expected, interindividual comparisons failed to show differences in IENFD and subepidermal plexus areas between patients P+ and P- (p=0.2980, p = 0.9044; respectively). Higher HPT and lower mechanical detection threshold were related to NeP. The present study pointed out the relevance of intra-individual comparisons including mirror areas when assessing local changes in peripheral NeP.