CONTEXT: Recent studies have considered the role of inflammation in the development of both cardiovascular disease (CVD) and musculoskeletal conditions, such as rheumatoid arthritis. Studies suggest that inflammation plays a significant role in the development of cardiovascular disease. In conditions of chronic pain, as with rheumatoid arthritis, inflammation has also been noted through elevated levels of inflammatory markers. There are currently no studies that examine the possible connection between inflammatory markers related to increased risk of cardiovascular disease and nonspecific chronic musculoskeletal pain (NCMP). OBJECTIVE: The purpose of this study was to determine whether urinary levels of microalbumin (MA) and F2-isoprostanes (F2-isoPs), inflammatory biomarkers associated with increased CVD risk, are elevated in persons with NCMP compared to nonpain case controls. NCMP refers to pain present for more than 3 days per week and for more than 12 weeks. This type of pain is not due to injury but is associated with interference of normal function. DESIGN: Nonrandomized observational study. METHODS: A cross-sectional study with 120 participants (60 pain subjects, 60 nonpain case-controls). A single first-morning void urine sample was collected from each subject. Urine specific gravity and total volume were measured and then a sample was sent to a lab for analysis of MA and F2-isoPs. Inflammatory biomarker levels in the pain and nonpain groups were compared. RESULTS: There were no significant differences in F2-isoPs levels between the chronic pain group (0.65ng/mg ± 0.05) and the nonpain group (0.80ng/mg ± 0.07) (95% CI (-0.32, 0.03)). However, MA levels were significantly higher in the chronic pain group (2.41mg/g ± 0.24) compared to the nonpain group (1.88mg/g ± 0.14) (95% CI (0.34, 1.68)). MACR levels were also significantly higher in the chronic pain group (2.07mg/g ± 0.31) compared to the nonpain group (1.14mg/g ± 0.14) (95% CI (0.32, 1.64)). CONCLUSION: These findings suggest a possible link between at least one inflammatory marker (microalbumin) and NCMP. This in turn allows for a limited but reasonable inference that NCMP may be a risk factor for cardiovascular disease, mediated through the MA inflammatory biomarker. Further research is needed to more fully understand the possible connection between NCMP and CVD.

A central component of many psychological interventions is breathing training. Breathing training protocols based on a mindfulness or a cognitive behavioral therapy (CBT) have demonstrated value in the management of psychological and medical ailments. Yet, despite the wealth of literature examining each approach, little direct comparison exists. An additional concern is the proliferation of smart phone health (mHealth) applications (apps) providing breathing training with little empirical evidence to support their clinical use. A possible explanation for the interest in breathing and mHealth apps is the growing body of literature indicating breathing training provides wide ranging health benefits through improved stasis of the autonomic nervous system (ANS). As ANS dysregulation underlies many chronic health conditions such as persistent temporomandibular disorders (TMDs), there is a need for empirical research to identify the most effective modality of breathing training and validate the clinical efficacy of breathing based mHealth apps. Study One compared the effectiveness of a mindfulness breathing meditation (MB) and a CBT based protocol teaching diaphragmatic breathing (DB) to improve biomarkers of ANS stasis. An attention control approach based on the Nolen-Hoeksema task (C) was included as a comparison group. Ninety participants were randomly assigned to either the MB, DB, or C condition. Within each condition, 30 participants were provided skills training with practice time and completed a behavioral self-regulation task. Participants in the DB condition approach had significantly lower breathing rates than those in the MB and C conditions (p < .001). DB condition participants experienced improvements on high-frequency heart rate variability (p < .05) and the standard deviation in NN intervals (p < .001), which served as indicators for ANS stasis. No differences were found between conditions on the behavioral self-regulation task (p’s > .05). Given these results, the DB training protocol was converted into a mHealth app to facilitate a clinical trial with patients suffering persistent TMDs. Study Two examined the additive benefits of including the mHealth app with standard dental care (SDC+) versus standard dental care alone (SDC). Nineteen patients seeking care for persistent TMDs were recruited. All participants were asked to track daily ratings of pain (VAS), relaxation (RR), and complete weekly assessments on several comorbid psycho-social factors. Within the SDC+ condition participants were asked to track the proximate effects of each breathing practice on VAS and RR ratings. Given a high drop-out rate (nine participants) and low overall sample size (N = 10), results are exploratory at best. Within the SDC+ condition, results indicated reliable improvements in average VAS and RR ratings from before and after SDC+ participants used the mHealth app (p’s < .05). Within a one session training paradigm, results supported the use of a DB based intervention above the use of a MB or C intervention. Future research should consider the effects of having multiple training sessions. Study Two results were complicated by a limited sample size and failed to provide a clear picture of whether the conjunctive treatment in the SDC+ condition provided additional symptom relief above traditional dental care alone. Although exploratory results indicated the mHealth app provided temporary improvements in pain and feelings of relaxation, a well powered trial is needed to clarify whether the finding represents an enduring treatment effect.

Chronic pain is a common and costly health condition for children. Previous studies have documented racial and gender disparities in pain care for adults, with women and racial minorities receiving poorer pain assessment and treatment. Providers contribute to these disparities when their pain-related decision-making systematically varies across patient demographic groups. Little is known about racial and gender disparities in children with chronic pain, or the extent to which providers contribute to these disparities. In a sample of 129 medical students (henceforth referred to as ‘providers’), Virtual Human (VH) methodology and a pain-related version of the Implicit Association Test (IAT) were used to assess the effects of patient race/gender and provider implicit racial/gender attitudes on providers’ pain assessment and treatment decisions for children with chronic pain. Findings indicated that, in the context of abdominal pain, providers rated Black patients as more distressed (mean difference [MD]=2.33, p<.01, SE=.71, 95% CI=.92, 3.73) and as experiencing more pain-related interference in daily activities (MD=3.14, p<.01, SE=.76, 95% CI=1.63, 4.64) compared to White patients. Providers were also more likely to recommended opioids for Black patients’ pain compared to White patients (MD=2.41, p<.01, SE=.58, 95% CI=1.05, 3.76). Female patients were also perceived to be more distressed by their pain (MD=2.14, p<.01, SE=.79, 95% CI=.58, 3.70), however they there were no differences in treatment recommendations based on patient gender (all ps>.05). The sample reported implicit attitudes that men and Black Americans were more pain-tolerant than their demographic counterparts; however, pain assessment and treatment decisions were not related to these implicit attitudes. This study represents a critical step in research on pain-related disparities in pediatric pain. Future studies are needed to further elucidate specific paths through which the pain experience and consequent treatment differ across racial and gender groups.<br>

Background: Juvenile idiopathic arthritis (JIA) refers to a group of auto-immune conditions involving joint inflammation that first appears before the age of 16. In the United States, about 294,000 children are affected. Although JIA can be widely attributed to genetic factors, the consensus is that environmental factors also play a role. Attempts to assess the role of environmental factors, though scarce, have focused on the role of infections, smoking exposure, and breastfeeding. Hygiene hypothesis, which suggests that adaptive immunological response improves with higher frequencies of pathogen exposure in early childhood, has been used to try to explain the risk of JIA. Common markers of microbe exposure in early life include sibling number, pet number, and maternal parity. Some prior studies conducted outside the U.S. suggests that increasing sibling number is protective against the risk of JIA. This study aimed to evaluate prior findings, using data from the U.S. Methods: The study used data from the 2017 Centers for Disease Control and Prevention National Survey for Child Health. The survey used a sample size of 21599 children to estimate the number of children in the U.S. Descriptive statistics was carried out, and logistic regression was used to determine the association between family number and the odds of developing JIA, while adjusting for sociodemographic variables. Family number was used as a proxy for sibling number. SAS v 9.4 was used for analysis. Results: Complete data on all the variables of interest were available for 17618 children, of which 67 had JIA. Although there was a marginal association between sibling number and JIA in the unadjusted model (OR [95% CI] 0.983-1.602) (P=0.068), in the adjusted model, there was no significant association between JIA and sibling number ([OR 95% CI] 0.8985-1.447) (P=0.29). There was a significant association between JIA and age, low birth weight, highest education level in the family, while sex had a marginal association. Conclusion: There was no association between family size and the development of JIA in this study. While some prior results have supported the observed significant effect of low birth weight, the disparity in results between this study and the Australian study could be due to the use of family number instead of sibling number. Further studies should assess the association of sibling number and developing JIA in the U.S.

Opioid therapy is widely used to treat veterans with chronic noncancer pain (CNCP) despite evidence indicating patient safety concerns with the treatment. Although there is a place for opioid therapy in chronic pain management, opioids are not recommended as the first line of treatment for CNCP because of the risk for accidental overdose and death. The purpose of this project was to examine alternative practices for managing CNCP through a systematic review of the literature guided by the conceptual model of the Joanna Briggs Institute method for systematic reviews (JBIM-SR). A critical appraisal of the literature was conducted, and data were extracted and analyzed to identify evidence-based alternatives to opioids for managing CNCP in veterans. Using Cochrane, CINAHL, Joanna Briggs, and PubMed databases for the search, 116 articles were initially identified and through exclusion of duplicates and those not consistent with the study purpose, the review was narrowed to 16 articles. A 2nd reviewer completed an identical search using the exclusion criteria and databases confirming the search results of the primary reviewer. The 16 peer-reviewed research studies published between 2006 and 2016 selected for the analysis were graded using the JBIM-SR grading chart. Educational programs were seen as positive for improving providers' use of alternative therapies for CNCP. Complementary and alternative therapies such as yoga, peer support, injection therapy, cognitive behavioral therapy and acceptance commitment therapy provided improvement in pain perceptions, and coping abilities. Results of this project can promote positive social change as the findings are shared with providers in the practice site and as Veterans receive safe alternatives to opioid therapy.

The prevalence of adults 65 years of age and older with significant pain is 25% to 50%, with many experiencing pain on a daily basis. The financial toll due to chronic pain is staggering; American's spend nearly $635 billion annually on health care. The purpose of this mixed methods study was to better understand the relationship between resilience, general health, and chronic pain in older adults. The quantitative question pertained to the relationship between resilience and both levels of chronic pain and general health in elderly chronic pain patients, and the qualitative question addressed participants' lived experiences of chronic pain. Resilience theory, which suggests that individual strengths enable people to rise above adversity, grounded the study. Participants were between ages 65 and 75 and were recruited from 3 pain centers and through the Survey Monkey participant pool; they included 55 older adults with chronic pain who responded to surveys (including Resilience scale, the Pain Impact Questionnaire-Revised (PIQ-R) Pain scale, and the Short Form 12 item (version 2) (SF-12v2) Health Survey, and 10 of them also participated in interviews. Regression analyses found no statistical relationships between resilience and either chronic pain or general health. Interview participants noted that to cope with pain they used personal strength, a positive outlook, religion, spirituality, pain management, physical activity, rest/sleep, managing their life, and religion and spirituality. Resilient behavior was inherent across various pain diagnoses, and participants appeared to place a great value in the social networks formed throughout life. These findings may help medical practitioners have a better understanding of the relationship between chronic pain and resilience in an aging, at-risk population.

Fibromyalgia (FM) is a musculoskeletal and neurological disorder that causes constant pain, cognitive problems with short term memory, and sleep disorders. There are more females diagnosed with FM than males, and research has therefore primarily been conducted with females. Because little is known about African American males with FM, biopsychosocial theory was used in this phenomenological study to examine how African American males with FM are affected biologically, psychologically, and socially. Eight African American males diagnosed with FM were recruited from Houston, Texas and were interviewed about their lived experiences with FM, including experiences with the healthcare system, and how they used the internet to seek information about FM. Individual interview transcripts, conduct open coding, and thematic analysis led to identification of the following themes: (a) lengthy multiple medical evaluations to receive a diagnosis and various symptoms; (b) physical challenges, physical limitations, emotional issues, and cognitive issues experienced with FM; (c) limited physical and emotional support from family and friends; (d) hopeful about work and plans; (e) trust and confidence in healthcare providers and medical information obtained by asking questions; (f) limited internet search and not involved in online FM forums. The study showed that African American males with FM may experience debilitating symptoms and may use faith-based beliefs as one way to cope with FM. These results may bring positive social changes by providing caretakers with a better understanding of how FM affects the quality of life of African American males with FM, and provide new data to assist healthcare providers in diagnosing, treating, and serving this population.

Typescript (photocopy) Includes bibliographical references (leaves: 260-304)

"December, 2003" / Bibliography: leaves 283-311. / xiv, 311 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, School of Medicine, Dept. of Psychology, 2005

<p><strong>Sammanfattning</strong></p><p>Fibromyalgi har betraktats ända framtill våra dagar som en ren psykosomatisk sjukdom som uppkom utan känd orsak. Sjukdomen innebar en ständig smärta och en oändlig trötthet/ utmattning. Det fanns ingen behandling för sjukdomen bara lindra symtomen. Syftet med denna litteraturstudie var att beskriva hur kvinnor med fibromyalgi upplevde sin livssituation. Metoden som användes var en litteraturstudie med beskrivande design. Artiklarna kvalitetsbedömdes, innehållet sammanställdes och resulterade i fyra kategorier. Resultatet som rörde dem fysiska aspekterna av livssituation visade att smärta, trötthet/utmattning och sömnlöshet var vanligt förekommande symtom i kvinnornas vardag som påverkade deras livskvalitet. Symtomen hindrade dem från att leva ett aktivt liv samt delta i sociala aktiviteter. De psykiska aspekterna inom livssituationen visade att kvinnorna med fibromyalgi gav uttryck för en längtan efter det liv de levt innan sjukdomen och den förlorade identiteten. De sociala aspekterna visade att kvinnorna med fibromyalgi hade en önska att få spendera mer tid tillsammans med familjen. Sjukdomen hade också en negativ inverkan på förhållande och separationer var inte ovanligt. Arbetet prioriterades högt och arbetslivet uppskattades som stimulerande. Bristen på synliga symtom vid sjukdomen  gjorde att kvinnorna blev ifrågasatta av personer i omgivningen och sjukvårdspersonal. Under de existentiella aspekterna föll de positiva sidorna med sjukdomen in. Kvinnorna började reflektera över alla måsten och plikter i livet samt lärde sig att prioritera på ett bättre sätt.</p><p> </p> / <p><strong>Abstract</strong></p><p><strong></strong><strong></strong>Fibromyalgia has considered until to day as a psychosomatic disease that emerged without any known cause.The main symptoms are constant pain and an abnormal feeling of fatigue or exhaustion. There are no treatment for the illness it just alleviated the symptoms. The aim of this study was the describe how women with fibromyalgi experienced their life-situation.The method used was a literature study with a descriptive design. The articles were quality-tested, the content put together/compiled and resulting in four categories as follows.The result involving the physical aspects of life-situation showed that pain, tiredness and sleeplessness was commonly occurring symptoms in women´s daily life which affected their quality of life.The symptoms prevented women from living an active life and actively taking part in social activites. The psychological aspects of life-situation showed that women with fibromyalgia expressed a longing for the life they lived before the illness and the lost identity. The social aspects showed that the women wished to spend more time with their families. The disease had negative effects on their relationships and separation was not unusual. Work was highly prioritised and estimated as stimulating. The deficiency on visible symptoms of the disease made that the women became questioned by persons in their environment and by health-personal. The positive sides of the disease was found in the existential aspects. The women started to reflect about their duties in life and learned how to prioritise on a better way.</p>