Human Studies

Mindfulness training ameliorates clinical and self-report measures of depression and chronic pain, but its use as an emotion regulation strategy – in individuals who do not meditate – remains understudied. As such, whether it (a) down-regulates early affective brain processes and (b) depends on cognitive control systems remains unclear. We exposed meditation-naïve participants to two kinds of stimuli: negative vs. neutral images and painful vs. warm temperatures. On alternating blocks, we asked participants to either react naturally or exercise mindful-acceptance. Emotion regulation using mindful-acceptance was associated with reductions in reported pain and negative affect, reduced amygdala responses to negative images, and reduced heat-evoked responses in medial and lateral pain systems. Critically, mindful-acceptance significantly reduced activity in a distributed, a-priori neurologic signature that is sensitive and specific to experimentally-induced pain. In addition, these changes occurred in the absence of detectable increases in prefrontal control systems. The findings support the idea that momentary mindful-acceptance regulates emotional intensity by changing initial appraisals of the affective significance of stimuli, which has consequences for clinical treatment of pain and emotion.

There is growing evidence to support Acceptance and Commitment Therapy (ACT) in the management of chronic pain. However, there is a need for further research evaluating ACT combined with physical exercise, and few studies have assessed the long-term impact of this type of intervention. This case series reports on the acceptability and impact of an ACT-based multidisciplinary pain management programme on a range of health outcomes in both the short and long-term.

Race disparities in pain care are well-documented. Given that the majority of Black patients are treated by White providers, patient-provider racial discordance is one hypothesized contributor to these disparities. Research and theory suggest that providers' trait-level intergroup anxiety impacts their state-level comfort while treating patients, which, in turn, impacts their pain treatment decisions. To test these hypothesized relationships, we conducted a planned secondary analysis of data from a randomized controlled trial of a perspective-taking intervention to reduce pain treatment disparities. Mediation analyses were conducted on treatment decision data from White providers for Black virtual patients with chronic pain. Results indicated that White providers with higher trait-level intergroup anxiety reported lower state-level comfort treating Black patients and were thereby more likely to recommend opioid (indirect effect=0.76, 95% confidence interval [CI]: 0.21,1.51) and pain specialty (indirect effect=0.91, 95% CI: 0.26,1.78) treatments and less likely to recommend non-opioid analgesics (indirect effect=-0.45, 95% CI: -0.94,-0.12). Neither trait-level intergroup anxiety nor state-level comfort significantly influenced provider decisions for physical therapy. This study provides important new information about intra- and inter-personal contributors to race disparities in chronic pain care. These findings suggest that intergroup anxiety and the resulting situational discomfort encroach on the clinical decision-making process by influencing White providers' decisions about which pain treatments to recommend to Black patients. Should these findings be replicated in future studies, they would support interventions to help providers become more aware of their trait-level intergroup anxiety and manage their state-level reactions to patients who are racially/ethnically different from themselves.

Shoulder surgery is a primary intervention for shoulder pain, yet many individuals experience persistent post-operative pain. Previously, we found individuals categorized as having a high-risk phenotype (comprised of COMT variation and pain catastrophizing) had approximately double the chance of not reaching a 12-month pain recovery criterion. As a means to better understand the development of persistent post-operative shoulder pain, this study advanced our previous work by examining temporal ordering of post-operative shoulder recovery based on potential mediating factors, and expansion of outcomes to include movement-evoked pain and shoulder active range of motion. Before surgery, individuals were categorized as either high-risk (high pain catastrophizing, COMT-genotype linked to low enzyme activity (n=41)) or low-risk (low pain catastrophizing, COMT-genotype linked to normal enzyme activity (n=107)). We then compared potential mediating variables at 3, 6, and 12 months post-operatively: 1) endogenous pain modulation defined by a conditioned pain modulation paradigm (CPM); and 2) and emotion factors such as anxiety, fear of movement, and depressive symptoms. At 3 months, the high-risk subgroup had higher fear and movement-evoked pain, and causal mediation analysis confirmed the direct effect of risk subgroup on 12-month movement evoked pain. However, 12-month depressive symptoms were found to mediate 53% of the total effect of risk subgroup on 12-month movement-evoked pain. This study introduces potential temporal components and relationships to the development of persistent post-operative shoulder pain, which future studies will confirm and assess for potential therapeutic targets. Perspective: This study expands upon post-operative shoulder recovery measures to include movement-evoked pain and depressive symptoms, and provides preliminary indication of temporal ordering to post-operative shoulder recovery for a pre-identified high-risk subgroup. Future studies will distinguish temporal components of shoulder surgery that may optimize treatment targets of post-operative recovery.