Although pain-related outcome expectancies are hypothesized to contribute to elevated rates of cannabis use among individuals with pain, research has been hindered by the absence of a psychometrically validated measure of expectancies regarding the effects of cannabis on pain. The goals of this study were to develop a Cannabis Pain Expectancies Scale (CPES; Study 1) and assess its psychometric properties (Study 2). An initial pool of 58 items was drafted; 32 items were retained after evaluation by a panel of subject-matter experts. Study 1: Items were administered to 277 cannabis users with chronic pain via online survey. Item properties were examined, and exploratory factor analysis (EFA) was used to evaluate factor structure. Study 2: The CPES developed in Study 1 was administered to a separate sample of 314 cannabis users with chronic pain to confirm the factor structure and evaluate reliability and validity. Study 1: EFA of proposed CPES items indicated a two-factor structure comprising 14 items. Study 2: Confirmatory factor analysis indicated that a parsimonious one-factor model provided comparable fit and was retained for the final scale. The CPES demonstrated excellent internal consistency, reliability, and evidence of convergent validity via positive covariation with measures of cannabis use and chronic pain. This study provides initial support for the factor structure, reliability, and validity of a new measure of expectancies regarding the effects of cannabis on pain. Future research is needed to corroborate these findings and evaluate the predictive utility of CPES scores in relation to pain and cannabis use trajectories. Perspective The article presents the psychometric properties of a novel measure of cannabis-related pain expectancies, the Cannabis Pain Expectancies Scale (CPES). The CPES may inform prevention and treatment efforts by identifying pain-related expectancies associated with continued or escalating cannabis use.

BACKGROUND:Pain from musculoskeletal pain conditions is often persistent, bothersome, and negatively impacts physical function. Individuals with musculoskeletal pain report difficulty with walking and regular activities. For some, this may be related to overly negative pain cognitions, such as pain catastrophizing and kinesiophobia. In a geographically and racially diverse sample, we examined relationships between pain catastrophizing, kinesiophobia, and multimodal physical function (i.e., self-report, performance-based, objective). METHODS:Participants were sedentary adults with ≥3 months of chronic musculoskeletal pain. Participants completed self-report measures of pain catastrophizing (Pain Catastrophizing Scale), kinesiophobia (Tampa Scale of Kinesiophobia), and physical function (World Health Organization Disability Assessment Scale 2.0). Performance-based physical function was assessed in-clinic with the Six-Minute Walk Test (6MWT). Physical function was objectively measured with ≥4 days of ActiGraph wear outside the clinic. We conducted descriptive, correlation, and linear regression statistics in SPSS. RESULTS:Higher levels of pain catastrophizing (β = 0.42) and kinesiophobia (β = 0.25) were significantly associated with worse self-reported physical function. Neither pain catastrophizing nor kinesiophobia were related to performance-based or objectively measured physical function. The direction and significance of relationships between pain catastrophizing, kinesiophobia, and physical function measures were consistent in unadjusted and adjusted regression models. CONCLUSIONS:Pain catastrophizing and kinesiophobia are associated with an individual's perceived physical functioning. Behavioral interventions designed to enhance physical function may benefit from including cognitive restructuring to challenge catastrophic thoughts about pain, as well as thoughts about injuring oneself or worsening pain with movement. More work is needed to understand why neither pain catastrophizing nor kinesiophobia were significantly associated with performance-based or objective assessment of physical function. It is possible that other pain-related cognitions, for example self-efficacy for pain control, or variables (e.g., in vivo pain catastrophizing, mood, stress, sleep) assessed closer in time to performance-based or objective measures of physical function are more relevant.

Neurofibromatoses (NF; NF1, NF2-related schwannomatosis, and other forms) are incurable genetic disorders linked to poor quality of life (QoL). Limited research exists on social support as a protective factor for QoL in NF. This secondary analysis examined whether baseline social support moderates QoL outcomes in individuals with NF. Participants (N = 228, Mage=41.5, 75 https://clinicaltrials.gov/study/NCT03406208

Importance:Increasing physical function for individuals in chronic pain is challenging. Despite the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials guidelines, no pain trial has comprehensively assessed multimodal physical function (ie, self-reported, performance-based, and objective or step count-based measures), and most of these trials have limited racial and ethnic diversity. Objective:To test the feasibility of a mind-body walking program and a health education program among geographically, racially, and ethnically diverse sedentary adults with chronic pain. Design, Setting, and Participants:This single-blind, 2-arm, feasibility randomized clinical trial was conducted at Massachusetts General Hospital in the Northeast, Duke University in the Southeast, and Rush University in the Midwest, capturing a racially, ethnically, and geographically diverse US population. Recruitment occurred between April 2023 and January 2024. Participants were sedentary adults with chronic musculoskeletal pain. After baseline assessment, participants were randomized to either the mind-body walking program or the health education program. Given the pilot nature of this trial, all analyses were conducted on the observed data rather than following intent-to-treat principles. Interventions:Both interventions consisted of 10 weekly hour-long, in-person group sessions. Main Outcomes and Measures:Primary outcomes were feasibility benchmarks, including feasibility of recruitment, treatment arms, assessments, participant retention, racial and ethnic diversity attainment, treatment expectancy, treatment credibility, participant satisfaction, and treatment fidelity. Results:Ninety-two participants were randomized to the mind-body walking program (n = 47) or the health education program (n = 45). Participants had a mean (SD) age of 57 (14.3) years; were predominantly females (69 [75.0%]); and included Asian (2.2%), Black or African American (44.6%), Hispanic (5.4%), non-Hispanic (83.7%), and White (40.2%) individuals. Both mind-body walking and health education interventions met the benchmarks for feasibility of treatment arms (95.7% [44 of 46 patients] and 82.2% [37 of 45 patients]), treatment credibility (100% (41 of 41 patients] and 87.2% [34 of 39 patients]), treatment fidelity (9.93 and 9.95 scores), assessment (93.0% accuracy), and participant retention (93.6% [44 of 47 patients] and 86.7% [39 of 45 patients]). Benchmarks for treatment expectancy (85.7% [36 of 42 patients] vs 66.7% [26 of 39 patients]) and participant satisfaction (97.6% [41 of 42 patients] vs 75.0% [30 of 40 patients]) were met in the mind-body walking program but not in the health education program. The racial and ethnic diversity benchmark was met (54.3% [50 of 92] vs ≥38.0% planned). The recruitment benchmark was not met (69.7% [92 of 132] of eligible participants recruited vs ≥80.0% planned). Conclusions and Relevance:In this trial, both a mind-body walking program and a health education program were feasible at 3 geographically, racially, and ethnically diverse academic medical centers. The findings support and inform a fully powered, multisite, future efficacy trial of these interventions. Trial Registration:ClinicalTrials.gov Identifier: NCT05700383.

Importance Increasing physical function for individuals in chronic pain is challenging. Despite the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials guidelines, no pain trial has comprehensively assessed multimodal physical function (ie, self-reported, performance-based, and objective or step count-based measures), and most of these trials have limited racial and ethnic diversity. Objective To test the feasibility of a mind-body walking program and a health education program among geographically, racially, and ethnically diverse sedentary adults with chronic pain. Design, Setting, and Participants This single-blind, 2-arm, feasibility randomized clinical trial was conducted at Massachusetts General Hospital in the Northeast, Duke University in the Southeast, and Rush University in the Midwest, capturing a racially, ethnically, and geographically diverse US population. Recruitment occurred between April 2023 and January 2024. Participants were sedentary adults with chronic musculoskeletal pain. After baseline assessment, participants were randomized to either the mind-body walking program or the health education program. Given the pilot nature of this trial, all analyses were conducted on the observed data rather than following intent-to-treat principles. Interventions Both interventions consisted of 10 weekly hour-long, in-person group sessions. Main Outcomes and Measures Primary outcomes were feasibility benchmarks, including feasibility of recruitment, treatment arms, assessments, participant retention, racial and ethnic diversity attainment, treatment expectancy, treatment credibility, participant satisfaction, and treatment fidelity. Results Ninety-two participants were randomized to the mind-body walking program (n = 47) or the health education program (n = 45). Participants had a mean (SD) age of 57 (14.3) years; were predominantly females (69 [75.0%]); and included Asian (2.2%), Black or African American (44.6%), Hispanic (5.4%), non-Hispanic (83.7%), and White (40.2%) individuals. Both mind-body walking and health education interventions met the benchmarks for feasibility of treatment arms (95.7% [44 of 46 patients] and 82.2% [37 of 45 patients]), treatment credibility (100% (41 of 41 patients] and 87.2% [34 of 39 patients]), treatment fidelity (9.93 and 9.95 scores), assessment (93.0% accuracy), and participant retention (93.6% [44 of 47 patients] and 86.7% [39 of 45 patients]). Benchmarks for treatment expectancy (85.7% [36 of 42 patients] vs 66.7% [26 of 39 patients]) and participant satisfaction (97.6% [41 of 42 patients] vs 75.0% [30 of 40 patients]) were met in the mind-body walking program but not in the health education program. The racial and ethnic diversity benchmark was met (54.3% [50 of 92] vs >= 38.0% planned). The recruitment benchmark was not met (69.7% [92 of 132] of eligible participants recruited vs >= 80.0% planned). Conclusions and Relevance In this trial, both a mind-body walking program and a health education program were feasible at 3 geographically, racially, and ethnically diverse academic medical centers. The findings support and inform a fully powered, multisite, future efficacy trial of these interventions.

Chronic pain is associated with lower physical activity (PA) levels in older adults. However, pain characteristics change over time, and the impacts of changes in pain levels on daily PA quantities and patterns remain unknown. The PRIME pilot study recruited 30 older adults (mean age=74.1±6.0y) with multisite pain (≥2 pain sites in shoulder, elbow, hand/wrist, back, hip, knee, or ankle/foot) in Pittsburgh and surrounding areas in Pennsylvania. Pain characteristics (e.g., severity, laterality, interference) were measured using questionnaires during the 2-hour clinic visit. After the clinic visit, ecological pain was assessed using Qualtrics surveys four times a day, along with Actigraph accelerometer assessment on the non-dominant wrist for 14 days. Linear regression models showed that participants with back pain had significantly lower activity counts (β=-493,271, p = 0.020), higher activity fragmentation (β = 5.0%, p = 0.005), and fewer active minutes (β=-88.4, p = 0.017). Number of pain sites and severity of hand/wrist pain decreased over a day (β=-0.08, p = 0.019; β=-0.09, p = 0.042, respectively) but tended to be stable across 14 days. Linear mixed models showed that every one-unit higher in overall pain severity at one time point was associated with 28,480 fewer activity counts at the subsequent time point (p = 0.012), and these associations were weaker at later time points over a day (p = 0.011). The severity and distribution of pain vary throughout the day, and the impact of pain severity on daily activity weakens as the day progresses. Individualized pain management programs should be provided to older adults with varying pain characteristics, particularly early in the day.

Interventions aimed at preventing chronic pain after acute traumatic injury have significant potential to reduce healthcare expenditures and improve quality of life for millions of individuals. Given recent development of such interventions, limited research has examined mechanisms of change using repeated measures (e.g., session-by-session assessments). This study examines within-person relationships between pain catastrophizing and intensity during and after a four-session mind-body intervention for individuals with acute traumatic orthopedic injury (N = 76, T = 445). Random intercept cross-lagged panel models were used to examine within-person autoregressive, contemporaneous, and cross-lagged effects between pain catastrophizing and pain intensity, after accounting for stable between-person differences. Our primary hypothesis that improvements in catastrophizing would be associated with subsequent reductions in pain intensity was partially supported by a significant within-person cross-lagged effect between catastrophizing at post-test and pain with activity reported at three-month follow-up (β = 0.421, SE = 0.099, p < .001). Improvement in catastrophizing was also associated with same-session improvement in pain intensity midway through the intervention. Importantly, bidirectional within-person analyses allowed us to rule out the possibility that improvements in pain were responsible for subsequent improvements in catastrophizing, but not vice versa. Together, these findings suggest improvements in catastrophizing during psychosocial intervention may prevent transition from acute to chronic pain after injury. Future research with larger between-person sample sizes, more frequent within-person assessment, and comparable control group data is necessary to facilitate greater understanding of psychosocial mechanisms for preventing chronic pain after injury. PERSPECTIVE: This study examines within-person relationships between pain catastrophizing and intensity during and after a four-session mind-body intervention to prevent persistent pain after acute traumatic orthopedic injury. Improved catastrophizing at post-test was associated with reduced pain with activity at three-month follow-up. Within-person analyses enhance understanding of psychosocial mechanisms for preventing chronic pain after injury.

Objective: Chronic musculoskeletal pain (CMP) is prevalent, burdensome, and associated with an increased risk for opioid use disorder. Evidence suggests that perceived racial/ethnic discrimination is associated with problematic substance use among Black individuals, but studies have not focused on problematic opioid use among Black individuals with CMP specifically or explored the contribution of perceived discrimination, pain intensity, and pain-relevant psychological factors to this association. Method: We recruited 401 Black individuals (M-age = 35.98, 51.9% female) with self-reported CMP and prescription opioid use. We tested whether perceived discrimination (a) was associated with self-reported problematic opioid use and (b) explained unique variance in this outcome after accounting for pain intensity, demographic factors, and psychological factors previously implicated in problematic opioid/substance use (distress tolerance and pain avoidance). Results: Hierarchical linear regression analysis revealed that our model as a whole explained significant variance in problematic opioid use, R-2 = .30, F(6, 394) = 28.66, p < .001. Perceived discrimination specifically was associated with more problematic opioid use (beta = .39, SE = .05, p < .001) and explained unique variance in this outcome even after accounting for pain intensity (beta = .06, SE = .04, p = .20), distress tolerance (beta = -.10, SE = .05, p = .04), pain avoidance (beta = .12, SE = .05, p = .02), age (beta = -.10, SE = .05, p < .05), and employment status (beta = .13, SE = .11, p < .01). Conclusions: Systemic efforts to combat racism along with individualized therapeutic approaches to process and cope with perceived racial discrimination may be particularly important to prevent and reduce problematic opioid use among Black individuals with CMP.

Chronic musculoskeletal pain (CMP) is highly prevalent, frequently associated with negative health outcomes, and disproportionately impacts Black Americans. Perceived racial and ethnic discrimination has emerged as a factor that may influence the experience of chronic pain in this population. Identifying modifiable psychosocial factors that influence the link between perceived discrimination and pain and that can be directly targeted in treatment is vital to reducing the disproportionate burden of CMP among Black individuals. The present study examines the moderating role of five risk factors (i.e., pain avoidance, pain fusion, experiential avoidance, pain catastrophizing, and pain anxiety) on the relationship between perceived discrimination and pain outcomes (i.e., pain intensity and interference) in a sample of 401 Black adults with CMP. We recruited 401 Black individuals (Mage = 35.98, 51.9

Background Pain is prevalent among adults with neurofibromatoses (NF) and hinders quality of life. Pain management for NF is predominantly pharmacological and often ineffective. Psychosocial treatments improve pain outcomes in other chronic illness populations but have not been developed and tested in fully powered efficacy trials among adults with NF. Using data from a fully powered randomized clinical trial of an 8-week mind-body program (Relaxation Response Resiliency Program for NF [3RP-NF]) versus a health education control (HEP-NF), we examined (1) improvements in pain intensity and pain interference, and (2) mechanisms underlying improvements. Methods Participants (N = 210, M-age = 42.6, 73.4% female) were randomized to 3RP-NF versus HEP-NF. They completed measures of pain intensity, pain interference, and putative mechanisms (eg, mindfulness, coping, and social support) at baseline, post-intervention, 6-month, and 12-month follow-ups. Results There was a statistically significant change in pain interference over time F(3, 537.06) = 7.21, P < .001, but not pain intensity. Neither group (3RP-NF vs. HEP-NF) nor the group-by-time interaction predicted change in pain interference. While the group-by-time interaction was not statistically significant across all time points, planned post-hoc analyses probing the interaction at specific time points revealed a statistically significant decrease in pain interference from baseline to post-intervention (P < .001), which was sustained (ie, no subsequent change) from post-intervention through 6-month (P = 1.00) and 12-month follow-ups (P = 1.00) in the 3RP-NF group. The HEP-NF group had no significant changes in pain intensity or interference over time. The association between group (3RP-NF) and decreased pain interference from baseline to post-intervention was fully mediated by change in coping over the same period. Conclusions Participation in the 3RP-NF is associated with sustained improvement in pain interference. Improvement occurred through increased coping.

Chronic pain is associated with substantial impairment in physical function, which has been identified as a top concern among persons with pain. GetActive-Fitbit, a mind-body activity program, is feasible, acceptable, and associated with improvement in physical function among primarily White, sedentary individuals with pain. In preparation for a multisite efficacy trial, we must examine feasibility across multiple sites with diverse patient populations. Here we describe the protocol of a multisite, feasibility RCT comparing GetActive-Fitbit with a time- and attention-matched educational comparison (Healthy Living for Pain). We aim to 1) test multisite fidelity of clinician training; 2) evaluate multisite feasibility benchmarks, including recruitment of chronic pain patients taking <5,000 steps/day and racial and ethnic minorities; and 3) optimize fidelity and study protocol in preparation for a future multisite efficacy trial. Clinician training fidelity was assessed via roleplays and mock group sessions. Feasibility (i.e., recruitment, acceptability, credibility, adherence, satisfaction), multimodal physical function (e.g., self-report, 6-Minute Walk Test, step-count), and other psychosocial outcomes are assessed at baseline, posttest, and 6 months. Protocol optimization will be assessed using exit interviews and cross-site meetings. The trial is ongoing. Clinician training is complete. 87 participants have been recruited. 54 completed baseline assessments and randomization, 44 are mid-intervention, and 9 have completed the intervention and posttest. This study addresses the critical need for feasible, acceptable mind-body-activity interventions for chronic pain that follow evidence-based guidelines and improve all aspects of physical function across diverse populations. Results will inform a future fully-powered multisite efficacy trial. Funding: NIH/NCCIH 1RO1AT012069-01.

Objectives:Traumatic orthopedic injuries are a top cause of hospital visits in the U.S. The Toolkit for Optimal Recovery (TOR) is a brief mind-body intervention that targets catastrophic thinking and pain anxiety following orthopedic injury. This study examines the baseline presentation of adults with traumatic orthopedic injuries who were enrolled in our recent multisite feasibility RCT of TOR versus usual care at four geographically distinct Level 1 trauma centers. We also examine whether patient presentation varies by site. Methods:We recruited 181 adults (Mage=44.16, SD=16.5) from four Level I trauma centers located in the northeast (Site A; N=63), southwest (Site B; N=44), southeast (Site C; N=44), and southeast (Site D; N=30). At baseline, participants provided information about sociodemographic factors, pain and physical function, and physicians completed the Abbreviated Injury Scale (AIS). Descriptive statistics were used to characterize the sample, and one-way analysis of variance (ANOVA) and Chi-square tests were used to compare variables between sites. Results:The majority of the sample (88.4%) sustained a fracture, and the mean AIS score was 2.31 (SD=0.55). Age, race, sex, gender, occupation, or marital status did not differ across sites (ps>.05). Over half (63%) of the sample was treated surgically, and 28.7% endorsed taking narcotic pain medications. More participants at Sites B (75%) and D (96.7%) received surgery than participants at Sites A (41%) and C (61.4%). More participants at Sites D and B reported narcotic usage than participants at Sites C and A. Participants at Site D demonstrated greater functional impairment than participants at the other sites. Conclusion:Although sites were largely comparable, we did find key differences in surgical management, narcotic use, and functional disability which may have important implications for treatment response. This information will be used to iterate and refine TOR for a future multisite efficacy trial.

BackgroundChronic musculoskeletal pain is prevalent and disabling among older adults in underserved communities. Psychosocial pain management is more effective than pharmacological treatment in older adults. However, underserved community clinics often lack psychosocial treatments, in part because of a lack of trained providers. Shared medical appointments, in which patients undergo brief medical evaluation, monitoring, counseling, and group support, are an efficacious and cost-effective method for chronic disease management in underserved clinics, reducing the need for specialized providers. However, shared medical visits are often ineffective for chronic pain, possibly owing to lack of inclusion of skills most relevant for older adults (eg, pacing to increase engagement in daily activities). ObjectiveWe have described the protocol for the development and initial pilot effectiveness testing of the GetActive+ mind-body activity intervention for older adults with chronic pain. GetActive+ was adapted from GetActive, an evidence-based intervention that improved pain outcomes among mostly affluent White adults. We aim to establish the initial feasibility, acceptability, fidelity, and effectiveness of GetActive+ when delivered as part of shared medical appointments in a community clinic. MethodsWe conducted qualitative focus groups and individual interviews with providers (n=25) and English-speaking older adults (aged ≥55 y; n=18) with chronic pain to understand the pain experience in this population, perceptions about intervention content, and barriers to and facilitators of intervention participation and implementation in this setting. Qualitative interviews with Spanish-speaking older adults are in progress and will inform a future open pilot of the intervention in Spanish. We are currently conducting an open pilot study with exit interviews in English (n=30 individuals in total). Primary outcomes are feasibility (≥75% of patients who are approached agree to participate), acceptability (≥75% of patients who enrolled complete 8 out of 10 sessions; qualitative), and fidelity (≥75% of session components are delivered as intended). Secondary outcomes include physical function—self-reported, performance based (6-minute walk test), and objective (step count)—and emotional function (depression and anxiety). Other assessments include putative mechanisms (eg, mindfulness and pain catastrophizing). ResultsWe began enrolling participants for the qualitative phase in November 2022 and the open pilot phase in May 2023. We completed the qualitative phase with providers and English-speaking patients, and the results are being analyzed using a hybrid, inductive-deductive approach. We conducted rapid analysis of these data to develop GetActive+ before the open pilot in English, including increasing readability and clarity of language, reducing the number of skills taught to increase time for individual check-ins and group participation, and increasing experiential exercises for skill uptake. ConclusionsWe provide a blueprint for the refinement of a mind-body activity intervention for older adults with chronic pain in underserved community clinics and for incorporation within shared medical visits. It will inform a future, fully powered, effectiveness-implementation trial of GetActive+ to help address the chronic pain epidemic among older adults. Trial RegistrationClinicalTrials.gov NCT05782231; https://clinicaltrials.gov/study/NCT05782231 International Registered Report Identifier (IRRID)DERR1-10.2196/52117

BackgroundChronic pain and early cognitive decline, which are costly to treat and highly prevalent among older adults, commonly co-occur, exacerbate one another over time, and can accelerate the development and progression of Alzheimer disease and related dementias. We developed the first mind-body activity program (Active Brains [AB]) tailored to the needs of older adults with chronic pain and early cognitive decline. Results from our previous study strongly supported the feasibility of conducting AB remotely and provided evidence for improvements in outcomes. ObjectiveWe are conducting a single-blinded, National Institutes of Health stage-2, randomized clinical trial to establish the efficacy of AB versus a time-matched and dose-matched education control (Health Enhancement Program [HEP]) in improving self-reported and objective outcomes of physical, cognitive, and emotional functions in 260 participants. The methodology described in this paper was informed by the lessons learned from the first year of the trial. MethodsParticipants are identified and recruited through multidisciplinary clinician–referred individuals (eg, pain psychologists and geriatricians), the Rally Research platform, social media, and community partnerships. Interested participants complete eligibility screening and electronic informed consent. Baseline assessments include self-report, performance-based measures (eg, 6-min walk test) and objective measures (eg, Repeatable Battery for the Assessment of Neuropsychological Status). Participants are mailed a wrist-worn ActiGraph device (ActiGraph LLC) to passively monitor objective function (eg, steps) during the week between the baseline assessment and the beginning of the programs, which they continue to wear throughout the programs. After baseline assessments, participants are randomized to either AB or HEP and complete 8 weekly, remote, group sessions with a Massachusetts General Hospital psychologist. The AB group receives a Fitbit (Fitbit Inc) to help reinforce increased activity. Assessments are repeated after the intervention and at the 6-month follow-up. Coprimary outcomes include multimodal physical function (self-report, performance based, and objective). Secondary outcomes are cognitive function (self-report and objective), emotional function, and pain. ResultsWe began recruitment in July 2022 and recruited 37 participants across 4 cohorts. Of them, all (n=37, 100%) have completed the baseline assessment, 26 (70%) have completed the posttest assessment, and 9 (24%) are actively enrolled in the intervention (total dropout: n=2, 5%). In the three cohorts (26/37, 70%) that have completed the AB or HEP, 26 (100%) participants completed all 8 group sessions (including minimal makeups), and watch adherence (1937/2072, 93.48%, average across ActiGraph and Fitbit devices) has been excellent. The fourth cohort is ongoing (9/37, 24%), and we plan to complete enrollment by March 2026. ConclusionsWe aim to establish the efficacy of the AB program over a time-matched and dose-matched control in a live video-based trial and test the mechanisms through theoretically driven mediators and moderators. Findings will inform the development of a future multisite effectiveness-implementation trial. Trial RegistrationClinicalTrials.gov NCT05373745; https://classic.clinicaltrials.gov/ct2/show/NCT05373745 International Registered Report Identifier (IRRID)DERR1-10.2196/47319

OBJECTIVE:Clinical trials of cannabinoids for chronic pain have mixed and often inconclusive results. In contrast, many prospective observational studies show the analgesic effects of cannabinoids. This survey study aimed to examine the experiences/attitudes of individuals with chronic pain who are currently taking, have previously taken, or never taken cannabinoids for chronic pain to inform future research. METHODS:This study is based on a cross-sectional, web-based survey of individuals with self-reported chronic pain. Participants were invited to participate through an email that was distributed to the listservs of patient advocacy groups and foundations that engage individuals with chronic pain. RESULTS:Of the 969 respondents, 444 (46%) respondents reported currently taking, 213 (22%) previously taken, and 312 (32%) never taken cannabinoids for pain. Participants reported using cannabinoids to treat a wide variety of chronic pain conditions. Those currently taking cannabinoids (vs previously) more frequently reported: (1) large improvements from cannabinoids in all pain types, including particularly difficult-to-treat chronic overlapping pain conditions (eg, pelvic pain), (2) improvements in comorbid symptoms (eg, sleep), and (3) lower interference from side effects. Those currently taking cannabinoids reported more frequent and satisfactory communication with clinicians regarding cannabinoid use. Those never taken cannabinoids reported a lack of suggestion/approval of a clinician (40%), illegality (25%), and lack of FDA regulation (19%) as reasons for never trying cannabinoids. CONCLUSION:These findings underscore the importance of conducting high-quality clinical trials that include diverse pain populations and clinically relevant outcomes that if successful, could support FDA approval of cannabinoid products. Clinicians could then prescribe and monitor these treatments similarly to other chronic pain medications.

Benzodiazepines (BZDs), a class of sedative-hypnotic medications, generated concern as their popularity grew, with particular alarm regarding elevated rates of BZD use among chronic pain populations. Consistent with negative reinforcement/motivational models of substance use, desire for pain alleviation may motivate BZD use. Yet, little is known about relations between pain and addiction-relevant BZD use processes. This cross-sectional survey study aimed to: a) test associations between pain intensity and clinically relevant BZD use patterns, and b) examine the role of pain cata-strophizing in hypothesized pain-BZD relations. Participants included 306 adults with chronic muscu-loskeletal pain and a current BZD prescription who completed an online survey study (Mage = 38.7, 38.9% female). Results indicated that pain intensity was positively associated with past-month BZD use frequency, BZD dependence severity, and likelihood of endorsing BZD misuse behaviors (ps < .05). Pain catastrophizing was positively associated with BZD dependence/likelihood of BZD misuse, covarying for pain intensity (P < .05). These findings build upon an emerging literature by highlight-ing positive covariation of pain intensity and pain catastrophizing with addiction-relevant BZD use behaviors. Results underscore the need to further investigate high-risk BZD use among individuals with chronic pain, with and without concurrent opioid use, to inform prevention/intervention efforts. Perspective: This article presents findings on cross-sectional associations of pain intensity and pain catastrophizing with clinically relevant benzodiazepine (BZD) use outcomes, including depen-dence and misuse, among individuals with chronic pain. Findings help elucidate the higher burden of BZD misuse/dependence in chronic pain populations and suggest that pain relief may be a common, yet under recognized, self-reported motivation for taking BZDs.(c) 2022 by United States Association for the Study of Pain, Inc.

Co-use of alcohol and prescription opioid medication increases risk for harmful and potentially fatal health effects (e.g., overdose). Behavioral intentions (i.e., the immediate antecedent of corresponding behavior according to the Theory of Planned Behavior) are important in prediction of substance use, and a valid measure assessing intentions to co-use alcohol and opioids is needed to identify individuals at-risk for harmful substance use. The goal of the current study was to develop and conduct the psychometric validation of a six-item Intentions to Co-Use Alcohol and Opioids (ICAO) scale. Participants included 261 (M-age = 38; 64% male) past-month drinkers with a current opioid prescription and chronic musculoskeletal pain who completed a targeted online survey. Confirmatory factor analysis indicated that a single-factor structure provided good model fit (Bollen-Stine bootstrap p = .121). Moreover, the ICAO demonstrated high internal consistency (alpha = .96) and was correlated with measures of alcohol and opioid use/co-use. These findings provide support for the single-factor structure, reliability, and concurrent/convergent validity of the ICAO among individuals who endorse alcohol use, opioid use, and chronic musculoskeletal pain. The ICAO may offer clinical utility as a tool to identify individuals at greater risk of potentially fatal co-use of alcohol and opioid medications.

Objective: Clinical trials of cannabinoids for chronic pain have mixed and often inconclusive results. In contrast, many prospective observational studies show the analgesic effects of cannabinoids. This survey study aimed to examine the experiences/attitudes of individuals with chronic pain who are currently taking, have previously taken, or never taken cannabinoids for chronic pain to inform future research. Methods: This study is based on a cross-sectional, web-based survey of individuals with self-reported chronic pain. Participants were invited to participate through an email that was distributed to the listservs of patient advocacy groups and foundations that engage individuals with chronic pain. Results: Of the 969 respondents, 444 (46%) respondents reported currently taking, 213 (22%) previously taken, and 312 (32%) never taken cannabinoids for pain. Participants reported using cannabinoids to treat a wide variety of chronic pain conditions. Those currently taking cannabinoids (vs previously) more frequently reported: (1) large improvements from cannabinoids in all pain types, including particularly difficult-to-treat chronic overlapping pain conditions (eg, pelvic pain), (2) improvements in comorbid symptoms (eg, sleep), and (3) lower interference from side effects. Those currently taking cannabinoids reported more frequent and satisfactory communication with clinicians regarding cannabinoid use. Those never taken cannabinoids reported a lack of suggestion/approval of a clinician (40%), illegality (25%), and lack of FDA regulation (19%) as reasons for never trying cannabinoids. Conclusion: These findings underscore the importance of conducting high-quality clinical trials that include diverse pain populations and clinically relevant outcomes that if successful, could support FDA approval of cannabinoid products. Clinicians could then prescribe and monitor these treatments similarly to other chronic pain medications.

To test the effects of the Relaxation Response Resiliency Program - Neurofibromatosis (3RP-NF), a mind-body resilience program for people with NF, on resilience factors from baseline to post-treatment and 6- and 12-month follow-up. This is a secondary analysis of a fully powered randomized clinical trial (RCT) of 3RP-NF and health education control (HEP-NF). We recruited adults with NF1, NF2, or schwannomatosis who reported stress or difficulty coping with NF symptoms. Both conditions received 8 weekly 90-minute group sessions; 3RP-NF focused on building resilience skills. We measured resilience factors via the Measure of Current Status-A (adaptive coping), Cognitive and Affective Mindfulness Scale-Revised (mindfulness), Gratitude Questionnaire-6 (gratitude), Life Orientation Test Optimism Scale (optimism), and Medical Outcomes Study Social Support Survey (perceived social support) at baseline, post-intervention, and 6- and 12-month follow-up. We used linear mixed models with completely unstructured covariance across up to four repeated measurements (baseline, post-treatment, and 6- and 12-month follow-up) to investigate treatment effects on resilience factors. We enrolled 228 individuals (Mage=42.7, SD = 14.6; 74.5