Conditioned pain modulation (CPM) reflects endogenous inhibitory capacity and may demonstrate neuroplastic adaptations with repeated activation. However, the association between CPM efficiency changes and pain sensitivity remains unclear. This planned secondary analysis examined whether improvements in CPM efficiency were associated with changes in quantitative sensory testing (QST) measures and psychological factors in healthy adults. Study design, participants, and primary intervention effects have been reported previously in the primary trial publication. Sixty participants (aged 18–75 years) were randomized to high CPM exposure (five sessions), low CPM exposure (two sessions), or no CPM exposure groups. Multiple linear regression examined associations between changes in CPM efficiency and QST measures (thermal and pressure pain thresholds, tolerance, and ratings) and psychological factors (depression, anxiety, fear of pain, affect, and expectations), controlling for group and age. Improvements in CPM efficiency significantly predicted increases in heat pain threshold temperature (β = −1.90, p < 0.001, R2 = 0.43) and heat tolerance temperature (β = −0.56, p = 0.010, R2 = 0.34), indicating that participants required higher temperatures to detect and tolerate pain. However, pain intensity ratings at these thresholds remained unchanged. Age independently predicted smaller threshold improvements (β = −0.11, p < 0.001). No associations emerged between CPM changes and pressure pain measures, aftersensations, or psychological factors. CPM-induced neuroplasticity selectively enhanced thermal nociceptive detection through descending modulation without altering suprathreshold pain intensity encoding or affecting mechanical pain pathways. CPM induced with thermal stimuli functions as a thermal-specific biomarker rather than a global pain sensitivity indicator, with implications for clinical assessment and interventions targeting descending inhibitory pathways.

OBJECTIVE:There is a need for a systematic review on social functioning and peer relationships among adolescents with chronic pain (ACP) given the high prevalence of chronic pain in adolescence and integral role of peer relationships in adolescent development. This review aims to examine the methods used to evaluate social functioning, the types and extent of peer relationship difficulties, and pain characteristics and sociodemographic factors related to social functioning in ACP. METHODS:A systematic literature search of PubMed, PsycINFO, CINAHL, Web of Science, and Cochrane databases was performed. Included studies were written in English, presented original, quantitative, peer-reviewed research, had a primary focus on social functioning or peer relationships in ACP, and included study participants between the ages of 10 and 18 years. The review was registered in PROSPERO (No. CRD42022364870). RESULTS:Twenty-eight articles were included in the review. All studies used self-, parent-, or peer-report questionnaires to evaluate social functioning. Most (89%) of the studies were cross-sectional. Findings suggest that ACP experience social difficulties frequently characterized by loneliness, social anxiety, withdrawal, and peer victimization. Studies examining the associations between social functioning and sociodemographic variables, pain location, and pain-related characteristics yielded mixed findings. Study quality was mixed, with 57.14% rated as "good." CONCLUSIONS:Findings from this review emphasize the increased risk of reduced social connectedness and the complexity of underlying mechanisms associated with poorer social functioning among ACP. Additional research utilizing longitudinal methodologies is needed to understand potential moderators and directionality of associations between chronic pain and social functioning.

Purpose:Measures of pain sensitivity have potential relevance for patient care. We previously identified a subgroup of people at risk for ongoing pain characterized by genetic AND psychological factors. Here, we report planned secondary analyses examining the effect of personalized interventions on pain sensitivity outcomes. Patients and Methods:Two hundred and sixty-one healthy individuals with the COMT SNP rs6269 AA genotype and Pain Catastrophizing Scale scores of 5 or higher received exercise-induced muscle injury, followed by a randomly assigned treatment: (1) general education and placebo; (2) personalized psychological intervention and placebo; (3) general education and propranolol; or (4) personalized psychological intervention and propranolol. Pain sensitivity outcomes (pressure pain thresholds (PPT), suprathreshold heat rating, temporal summation, and conditioned pain modulation efficiency) were compared using a mixed effect model to examine difference among groups, adjusted for age, sex and race. Results:No main effects for group assignment were noted (p > 0.05 for all), when considered as 4 groups or 2 collapsed groups (ie propranolol vs placebo or personalized psychologic vs general education). Interaction terms were then entered into our models in an exploratory fashion. For PPT outcomes interactions were noted for, sex and time, and race and time (p<0.015). For temporal summation outcomes, interactions were noted for sex and group and race and group (p < 0.015). Conclusion:Results indicated no statistically reliable changes in pain sensitivity when considering matched vs unmatched treatment groups. Caution is needed in this interpretation given that the trial was not powered to specifically identify these differences. Exploratory analysis of interactions among ethnic/racial and gender identities by treatment, however, showed the potential for differential effects for specific pain sensitivity measures. Significant interactions across modalities suggest analysis of higher order interactions/intersectionality could be of great interest for testing efficacy of personalized interventions in future trials.

Conditioned pain modulation (CPM) is a behavioral measure of diffuse noxious inhibitory control (DNIC), an endogenous central pain modulatory mechanism in which one pain stimulus suppresses the perception of another. CPM efficiency is reduced in individuals with chronic pain and serves as a potential predictor for the development of chronic pain conditions. Current research indicates that CPM, traditionally viewed as a static metric, may exhibit protocol-dependent variability in its effects on pain sensitivity, potentially through neuroplastic mechanisms and central pain processing pathways. This randomized controlled trial (NCT05783362) investigated whether repeated activation of central pain modulatory systems enhances CPM efficiency. The secondary aim examined associations between repeated CPM exposure and pain-related psychological factors. Sixty healthy participants (52% female; ages 18–75) were randomly allocated to High Exposure (HE), Low Exposure (LE), or No Exposure (NE) CPM intervention groups. Pre- and post-intervention measures included CPM efficiency and pain sensitivity across thermal and pressure pain tests. Two-way ANOVA analyses revealed significant main effects for both time (p < 0.001, η2 = 0.23) and intervention (p = 0.030, η2 = 0.107) on CPM efficiency when comparing HE and LE groups from pre- to post-intervention. One-way ANOVA analysis at the final visit showed that HE demonstrated significantly higher CPM efficiency compared to LE (p = 0.02, Cohen's d = 0.73), while comparisons between HE and NE approached but did not reach statistical significance (p = 0.053–0.060; medium-to-large effect sizes, Cohen's d > 0.70). This was supported by increased heat threshold pain intensity ratings (p < 0.001, η2 = 0.13), suggesting broader adaptations in pain processing that strengthen descending pain control mechanisms. Other QST measures and psychological variables remained unchanged, suggesting the specificity of the modulatory enhancement. Results support the plasticity of endogenous pain modulation and suggest potential therapeutic applications for pain management interventions.Clinical Trial Registrationhttps://clinicaltrials.gov/study/NCT05783362, identifier NCT05783362.

Purpose: We sought to (1) explore the prevalence of pain, and movement and urogenital dysfunction reported following gender confirming vaginoplasty (V) and phalloplasty (P), (2) identify which providers were consulted for pain, and movement and urogenital dysfunction after surgery, and (3) compare these factors between people receiving V and P surgeries. Methods: A custom internet survey, built in REDCap, was distributed through LGBTQIA+ organizations across the US. The survey collected demographic information, types of surgery, postsurgical impairments (pain and urogenital dysfunction), and activity limitations, along with the types of providers seen and interventions provided. Summary statics were calculated and proportions or means and standard deviations based on the data structure. Nonparametric measures were used to test associations between postsurgical care, gender identity, and geographic location. Results: 584 responses remained after data cleaning of which 89 people reported having vaginoplasty (V) and 118 had phalloplasty (P). The average age of respondents was 28.6 ± 5.2 years. 70% of respondents reported pain, 25% difficulty moving, 23% bowel or bladder dysfunction, and 9% dyspareunia. Significantly more respondents who had V reported dyspareunia, while more respondents who had P reported incontinence. 20%, 29%, 15%, and 13% of included respondents received care from a physical therapist for pain, difficulty moving, incontinence, and dyspareunia, respectively. Discussion: These results indicate that both individuals who undergo V or P procedures report musculoskeletal pain, movement problems, and pelvic floor dysfunction following GCS. Notably, these issues are commonly addressed in cisgender patients by physical rehabilitation providers. However, less than half of our sample were referred to a physical therapist.

Background/Objectives: There is a subset of patients with pain who become worse after exercise. To explore this, we examined the responses of people with chronic primary pain to a standardized high intensity exercise protocol used to induce delayed onset muscle soreness (DOMS). Methods: Ten participants with a diagnosis of chronic widespread muscle pain (CWMP) were matched by age and reported gender to ten participants without muscle pain (i.e., no pain (NP)). Participants completed a standardized DOMS protocol. Pain intensity in the arm at rest and with movement was assessed using daily electronic diaries. Peak pain, the timing of peak pain, and the time to recovery were compared between groups. Associations of pain variables with the functional connectivity of the sensorimotor (SMN), cerebellum, frontoparietal control (FPN), and default mode network (DMN) both within network nodes and the rest of the brain was assessed. Results: Significant differences in peak pain, the time to peak pain, and the time to recovery were noted between groups for both pain at rest and pain with movement after controlling for catastrophizing and pain resilience. Connectivity across the SMN, FPN, and DMN was associated with all pain-related variables. Significant group differences were identified between groups. Conclusions: A standardized muscle “injury” protocol resulted in more pain, a longer time to peak pain, and a longer time to resolve pain in the patient group compared to the NP group. These differences were associated with differences in connectivity across brain regions related to sensorimotor integration and appraisal. These findings provide preliminary evidence of the dysregulation of responses to muscle (micro)trauma in people with chronic pain.

Introduction. Individuals with low back pain (LBP) may be classified based on mechanistic descriptors, such as a nociplastic pain presentation (NPP). The purpose of this secondary analysis was to examine the frequency and characteristics of patients with a NPP referred to physical therapy with LBP. Additionally, we characterized patients with LBP meeting the criteria for NPP by demographic, clinical, psychological, and pain sensitivity variables. Finally, we examined short- and long-term clinical outcomes in patients with a NPP compared to those without a NPP. Materials and Methods. Patients referred to physical therapy for LBP completed the Patient Self-report Survey for the Assessment of Fibromyalgia. Participants were categorized as “LBP with NPP” or “LBP without NPP” based on the threshold established in this measure. A rank sum test examined for differences in pain-related psychological factors and pressure-pain threshold between groups. Next, a Friedman test examined if LBP intensity and disability trajectories differed by groups at one and six months after initiation of physical therapy. Results. 22.2% of patients referred to physical therapy for LBP met the criteria for a NPP. Patients with a NPP reported significantly greater disability, pain catastrophizing, depression, anxiety, and somatization compared to individuals without a NPP ( p < 0.05 ). Pressure-pain threshold did not differ between groups ( p > 0.05 ). Individuals with LBP with a NPP demonstrated nonsignificant, small to medium reductions in pain and disability at one and six months. Individuals experiencing LBP without a NPP demonstrated significant reductions in pain and disability in the short- and long term. Conclusion. Patients with LBP with a NPP displayed greater negative pain-related psychological factors but similar pain sensitivity compared to LBP without NPP.

Objectives: In preclinical prognostic studies, the description of expected outcomes during an informed consent process indicates that the extent of pain and disability experienced and recovery time is unknown. In intervention studies, the consent process suggests that pain and disability will definitely occur and a treatment provided. Our objective was to determine whether study design (prognosis or intervention) was associated with the severity of pain intensity and disability reports from a preclinical model. Materials and Methods: We pooled pain and disability outcomes from prognostic and intervention studies using an exercise-induced muscle injury model of pain. Pain intensity, disability, and fear of pain were collected by validated self-report measures. Pain and disability data were z -transformed for pooled analyses and compared across the study design. Results: Data from 310 people were included. The primary findings were that self-reported pain intensity and disability were: (1) higher in prognostic studies than in the intervention studies and (2) associated with fear of pain. A secondary finding was that fear of pain was lower in the intervention compared with the prognostic studies. Discussion: Although there are other possible explanations, we speculate that these results could be related to the uncertainty inherent to providing informed consent for a prognostic study. In light of these findings, we recommend that informed consent language be more carefully considered when pain is induced in a controlled manner. Incorporating informed consent language commonly used in prognostic studies could result in higher pain intensity and disability ratings in studies that use preclinical models to test the efficacy of pain interventions.

Objectives: Telehealth platforms have become a crucial part of healthcare since the onset of the COVID-19 pandemic. The primary aim of this cohort study was to investigate pain outcomes, following telehealth group-based pain management programs (GPMPs) with a focus on comparing subjects who were readier to change (RTC) maladaptive pain behaviors prior to intervention versus those subjects who were less ready to change. Methods: Subjects were divided at baseline into one of 2 cohort groups; the exposed group (more RTC) and unexposed group (less RTC). There were 5 separate telehealth GPMP groups each consisting of subjects from both cohort groups. Each group met once a week via zoom software and ran over a course of 6 weeks in which Chronic Pain (CP) self-management techniques were taught. Pain outcome measures were taken at baseline and at after the final telehealth GPMP. Results: The unexposed group scored greater magnitude in change of scores from pre-to-post intervention in which these changes all signified improvements in scores following the telehealth GPMPs. The primary pain constructs examined being pain self-efficacy, pain catastrophizing and pain kinesiophobia all showed moderate to large effect sizes between the groups; Cohen`s d= 0.55, 0.77 and 0.65 respectively. Conclusions: Within and post the COVID-19 pandemic, telehealth GPMPs have a clinically relevant role to play in the self-management treatment of patients with CP. Understanding individuals` levels of RTC prior to running telehealth GPMPs, seems to be an important factor in predicting improvements in various CP outcomes.

Phenotypes have been proposed as a method of characterizing subgroups based on biopsychosocial factors to identify responders to analgesic treatments. This study aimed to, first, confirm phenotypes in patients with low back pain receiving physical therapy based on an a priori set of factors used to derive subgroups in other pain populations. Second, an exploratory analysis examined if phenotypes differentiated pain and disability outcomes at four weeks of physical therapy. Fifty-five participants completed psychological questionnaires and pressure pain threshold (PPT). Somatization, anxiety, and depression domains of the Symptom-Checklist-90-Revised, and PPT, were entered into a hierarchical agglomerative cluster analysis with Ward's method to identify phenotypes. Repeated measures ANOVAs assessed pain ratings and disability by phenotype at four weeks. Three clusters emerged: 1) high emotional distress and pain sensitivity (n = 10), 2) low emotional distress (n = 34), 3) low pain sensitivity (n = 11). As an exploratory study, clusters did not differentiate pain ratings or disability after four weeks of physical therapy (p's>0.05). However, trends were observed as magnitude of change for pain varied by phenotype. This supports the characterization of homogenous subgroups based on a protocol conducted in the clinical setting with varying effect sizes noted by phenotype for short-term changes in pain. As an exploratory study, future studies should aim to repeat this trial in a larger sample of patients.

Shoulder pain is a highly prevalent musculoskeletal condition that frequently leads to suboptimal clinical outcomes. This study tested the extent to which circulating inflammatory biomarkers are associated with reports of shoulder pain and upper-extremity disability for a high-risk genetic by psychological subgroup (catechol-O-methyltransferase [COMT] variation by pain catastrophizing [PCS]). Pain-free adults meeting high-risk COMT × PCS subgroup criteria completed an exercise-induced muscle injury protocol. Thirteen biomarkers were collected and analyzed from plasma 48 hours after muscle injury. Shoulder pain intensity and disability (Quick-DASH) were reported at 48 and 96 hours to calculate change scores. Using an extreme sampling technique, 88 participants were included in this analysis. After controlling for age, sex, and BMI, there were moderate positive associations between higher c-reactive protein (CRP; βˆ = .62; 95% confidence interval [CI] = -.03, 1.26), interleukin-6 (IL-6; βˆ = 3.13; CI = -.11, 6.38), and interleukin-10 (IL-10; βˆ = 2.51; CI = -.30, 5.32); and greater pain reduction from 48 to 96 hours post exercise muscle injury. Using an exploratory multivariable model to predict pain changes from 48 to 96 hours, we found participants with higher IL-10 were less likely to experience a high increase in pain (βˆ = -10.77; CI = -21.25, -2.69). Study findings suggest CRP, IL-6, and IL-10 are related to shoulder pain change for a preclinical high-risk COMT × PCS subgroup. Future studies will translate to clinical shoulder pain and decipher the complex and seemingly pleiotropic interplay between inflammatory biomarkers and shoulder pain change. PERSPECTIVE: In a preclinical high-risk COMT × PCS subgroup, 3 circulating inflammatory biomarkers (CRP, IL-6, and IL-10) were moderately associated with pain improvement following exercise-induced muscle injury.

Objectives: Telehealth pain management has become instrumental in managing patents with chronic pain (CP) since the onset of the COVID-19 pandemic. Little is known, however, about which patient’s best respond to these telehealth interventions. The primary aim of this study was to investigate patients’ demographic and clinical characteristics that predict the efficacy of telehealth Group-Based Pain Management Programs (GPMPs) based on change in various pain outcome measures from pre-to-post-intervention. Methods: The research included five separate telehealth GPMP groups each consisting of patients from different countries with various musculoskeletal CP conditions. Each group met once a week for 3 hours via zoom software and ran over a course of 6 weeks in which CP self-management techniques were taught. Pain outcome measures were taken at baseline and after the final telehealth GPMP. Regression analyses as well as other statistical procedures were used to determine the predictive nature of the patient’s demographic and clinical variables. Results: Baseline emotional wellbeing demonstrated statistically significant associations (p<0.05) with baseline outcome measures. The primary pain outcome measures including the Pain Self-Efficacy Questionnaire, the Pain Catastrophizing Scale-Total and the Tampa Scale of Kinesiophobia, all showed large effect sizes; d=0.90, d=0.75 and d=0.77 respectively. Changes in the primary pain outcome measures` scores all showed statistically significant relationships (p<0.05) with their individual baseline scores. Conclusion: Telehealth GPMPs have an important clinical role to play in the management of patients with CP. Understanding patients` clinical and demographic characteristics appears to be an important factor in predicting changes in pain manifestations.

Introduction Telehealth pain management has become instrumental in managing patients with chronic pain (CP) since the onset of the COVID-19 pandemic. The primary aim of this study was to investigate whether various covert therapeutic variables aid in the efficacy of telehealth group-based pain management programs (GPMPs). The therapeutic alliance (TA), group dynamics (GDs), attendance and change in pain neuroscience knowledge were evaluated as potential predictor covert variables of change in pain outcome measures and readiness to change (RTC) maladaptive pain behaviors. Methods Telehealth GPMP groups met once a week for 3 hours via zoom software and ran over a course of 6 weeks in which CP self-management techniques were taught. Pain outcome measures were taken at baseline and after the final telehealth GPMP. In addition, the measures around pain neuroscience understanding were examined at baseline and post-intervention. Finally, the TA and GDs were examined at post-treatment using the Therapeutic Group Context Questionnaire (TGCQ). Various statistical procedures were utilized to determine the predictive nature between the specific variables. Results The TA and GDs showed statistically significant ( p < 0.05) predictive relationships with improved changes in maladaptive pain behaviors and pain self-efficacy. There was also a statistically significant ( p < 0.05) predictive relationship between maladaptive pain behavioral changes and improvements in pain self-efficacy, pain catastrophizing and pain kinesiophobia. Discussion This research suggested that covert components in a telehealth GPMP such as changes in readiness to change (RTC) maladaptive pain behaviors, the TA, and GDs are all strong predictors of improvements in pain outcome measures following such an intervention.

Prior cohort studies validated that a subgroup defined by a specific COMT genotype and pain catastrophizing is at increased risk for heightened responses to exercise-induced or surgically induced shoulder pain. In this clinical trial, we used our preclinical model of exercise-induced muscle injury and pain to test the efficacy of interventions matched to characteristics of this high-risk subgroup (ie, personalized medicine approach). Potential participants provided informed consent to be screened for eligibility based on subgroup membership and then, as appropriate, were enrolled into the trial. Participants (n = 261) were randomized to 1 of 4 intervention groups comprised of pharmaceutical (propranolol or placebo) and informational (general education or psychologic intervention) combinations. After muscle injury was induced, participants received randomly assigned treatment and were followed for the primary outcome of shoulder pain intensity recovery over 4 consecutive days. Recovery rates were 56.4% (placebo and psychologic intervention), 55.4% (placebo and general education), 62.9% (propranolol and psychologic intervention), and 56.1% (propranolol and general education). No statistical differences were found between intervention groups in the primary analyses. Additional analyses found no differences between these intervention groups when shoulder pain duration was an outcome, and no differential treatment responses were detected based on sex, race, or level of pain catastrophizing. This trial indicates that these treatments were not efficacious for this high-risk subgroup when shoulder pain was induced by exercise-induced muscle injury. Accordingly, this phenotype should only be used for prognostic purposes until additional trials are completed in clinical populations.

OBJECTIVE:The goal of this scoping review was to determine the types and rates of pain and dysfunction outcomes reported after gender-affirming surgical procedures. In addition, a summary of the involvement of conservative care reported in the literature was produced. METHODS:A research librarian conducted searches through multiple databases from inception to 2021. Abstracts and full texts were reviewed by a team of at least 2 reviewers. Data were extracted from a custom survey and exported for summary. RESULTS:Thirty-one papers discussed masculinizing interventions, and 87 papers discussed feminizing procedures. Most of the studies emphasized surgical outcomes. Of the studies reporting pain or dysfunction, few standardized outcomes were used to collect information from patients. The pain was experienced across body regions after surgery for both feminizing and masculinizing procedures. Vaginal stenosis and incontinence were the most common complications reported. Patients were most often managed by physical therapists for vaginal stenosis or dyspareunia. CONCLUSION:Many published studies do not systematically collect specific or standardized information about pain and dysfunction after gender-affirming surgery. Of those studies that do report these outcomes, few detail the involvement of physical therapists in the recovery after surgery. IMPACT:Pain and urogenital dysfunction, often managed by physical therapists, occur after gender-affirming surgery, suggesting that physical therapists could have a larger role in the recovery of this patient population after surgery. The extent to which interventions used to manage these conditions in cisgender people will be equally effective in transgender people is unknown at this time. Future studies should use recognized measures to characterize patients' experiences with pain and dysfunction after surgery.

Objectives. Lower back pain (LBP) is extremely prevalent in seafood harvesters who often have limited or no access to ergonomic consultation, occupational health support and rehabilitation services. This pilot study aimed to describe a participatory ergonomic approach and determine the feasibility and extent of adoption of self-management strategies in clam farmers with LBP. Methods. A rapid prototype participatory ergonomic approach was used to develop context-specific self-management strategies. Options to adjust lifting and repetitive stress were introduced using video clips, demonstrations and discussions in the workplace. Workers chose and implemented three strategies for 8 weeks with weekly reminders. Survey and qualitative data from focus groups were analyzed. Results. Team strategies were the most popular, but individual options were used more often. Strategies were considered feasible, acceptable and relatively easy to use. Strategies were implemented relatively consistently, and most improved productivity with decreased pain. Challenges for uptake included changing habit, culture and team dynamics. Conclusions. Participatory rapid prototyping provided a feasible and efficient option to introduce strategies for clam farmers with small teams, variable work processes and workloads, and time restrictions. Strategies were considered acceptable and easy to use, and most increased productivity. These methods show potential for future research.

OBJECTIVE:The STarT Back Tool (SBT) predicts risk for persistent low back pain (LBP)-related disability based on psychological distress levels. Other non-psychological factors associated with LBP, such as pain sensitivity and physical performance, may further characterize SBT-risk subgroups. The purpose of this study was to determine whether a low-risk SBT subgroup demonstrated lower pain sensitivity and/or higher physical performance compared with a medium-/high-risk SBT subgroup. METHODS:In this cross-sectional, secondary analysis, adults with LBP (N = 76) completed SBT and demographics (age, sex, race, chronicity) questionnaires. Participants underwent pain sensitivity (local and remote pressure pain thresholds, temporal summation, conditioned pain modulation) and physical performance (Back Performance Scale, walking speed, obstacle negotiation, Timed "Up & Go" [TUG], TUG Cognitive) testing. Independent samples t tests determined low- versus medium-/high-risk SBT subgroup differences. A follow-up discriminant function analysis was also conducted. RESULTS:The medium-/high-risk subgroup demonstrated a lower proportion of participants with acute pain. The low-risk subgroup demonstrated lower pain sensitivity (higher local pressure pain thresholds and higher conditioned pain modulation) and higher physical performance (superior Back Performance Scale scores, faster walking speeds, faster obstacle approach and crossing speeds, and faster TUG completion). Discriminant function analysis results supported the 2-subgroup classification and indicated strong to moderate relationships with obstacle crossing speed, chronicity, and conditioned pain modulation. CONCLUSION:Lower pain sensitivity and higher physical performance characterized the low-risk SBT subgroup and may represent additional LBP prognostic factors associated with persistent disability. Longitudinal studies are needed to confirm whether these factors can enhance SBT prediction accuracy and further direct treatment priorities. IMPACT:Sensory and physical factors contribute to SBT risk classification, suggesting additional, non-psychological factors are indicative of favorable LBP outcomes. Findings highlight the need for assessment of multiple factors to improve LBP clinical prediction. LAY SUMMARY:People at low risk for back pain disability have less sensitivity to pain and better physical performance. By measuring these factors, physical therapists could guide treatment and improve outcomes for people with back pain.

Background: In the US, prescription opioid medication misuse (POMM) necessitates engagement of physical therapists (PTs). We (1) evaluated the attitudes of (PT) related to their management of patients with POMM and (2) examined the association between these attitudes and PTs confidence in POMM–related management abilities and the frequency with which they engaged in POMM–related management practices. Methods: We conducted a national survey of PTs that included a modified Drug and Drug Problems Perception Questionnaire (DDPPQ). Confidence in POMM–related abilities and the frequency of engaging in POMM–related management practices were measured. Logistic regression evaluated the association between the DDPPQ subscales (role adequacy, role legitimacy, role self–esteem, role support, job satisfaction) and confidence and frequency outcomes. Results: The analysis included 402 respondents. Role adequacy and legitimacy subscales were associated with confidence and frequency outcomes ( p<.05), indicating that more favorable role adequacy and legitimacy attitudes are associated with greater odds of having more confidence in POMM–related management abilities and of engaging in more frequent POMM–related management practices. Conclusions: PTs with a greater sense of preparedness to engage in POMM–related management were more likely to report greater confidence in POMM–related management abilities and engage in POMM–related management practices with greater frequency.