Background Recent work has established the validity of assessing drinking topography using a virtual reality (VR) bar environment compared to a more traditional simulated bar environment. Here, we test the sensitivity of the VR paradigm in detecting the impact of a previously validated experimental manipulation on drinking topography compared with an identical simulated bar environment. Methods We assessed the drinking topography (DT) of participants (N = 21) exceeding moderate drinking guidelines across four counterbalanced testing sessions: two used the simulated bar and two used the virtual bar. In this secondary analysis, we compared participant responses to an experimental manipulation that provided disincentives for excessive drinking in both bar environments. Results Participants reported increased sip interval during their disincentive manipulation sessions (t = 3.024, p = .003, β=27.323), such that participants drank more slowly (~27 additional seconds per sip). However, as expected, the bar environment did not significantly moderate this effect (t = -1.353, p = .176, β=-8.110). Results also found a significant main effect of manipulation on sip volume: participants reported decreased sip volume during their disincentive manipulation sessions (t = -3.055, p = .002, β=-4.051), such that participants had smaller sips (~4 fewer grams per sip). Again, no significant interactive effects (t = .538, p = .591, β=.473) were found. Conclusions This study found the effect of a disincentive-based experimental manipulation on drinking topography does not differ significantly between a simulated physical bar and a VR bar. Combined with evidence that drinking topography measures are highly consistent between environments, results suggest that VR bar environments are well-suited to study biospsychosocial influences on self-paced drinking behavior.

BACKGROUND:Self-medicating pain with alcohol is common. Chronic heavy alcohol use is associated with increased risk for chronic pain and alcohol-related consequences. The anterior (AIC) and posterior (PIC) insula play key, but distinct, roles in pain processing. Because insula dysregulation is implicated in both chronic pain and alcohol use disorder, we hypothesized alcohol intake would reduce pain-related insula activation and modulate pain-related functional connectivity, with subdivision-specific effects. METHODS:N = 97 moderate drinkers (Mage = 26.1 years) completed double-blind laboratory sessions where they received alcohol (0.08 g/dL target BAC) or placebo. Then, T2∗-weighted BOLD fMRI was collected using a 3T MRI Scanner during heat pain stimulation. Repeated measures ANOVA characterized alcohol effects on AIC and PIC functional activation. Alcohol effects on pain-related FC were assessed using whole-brain generalized psychophysiological interaction (gPPI) analysis (pFDR<0.05). RESULTS:Alcohol significantly decreased pain-related AIC activation, but increased PIC activation. Alcohol increased pain-related FC of AIC with bilateral postcentral gyrus, left precentral gyrus, and lateral occipital cortex. In contrast, alcohol increased FC of PIC with bilateral supramarginal gyrus, right frontal pole, right orbitofrontal cortex, right angular gyrus, and right middle frontal gyrus. Increased PIC FC with angular gyrus predicted greater subjective pain relief. FC with orbitofrontal gyrus was associated with reduced pain intensity. CONCLUSION:Alcohol had subregion-specific effects on functional activation and FC during painful heat. Alcohol-induced changes in FC during heat pain were associated with pain relief and pain intensity. Our findings suggest an important contribution of the IC to alcohol's analgesic and pain-relieving effects.

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.

BACKGROUND:The insular cortex (IC), which includes anterior (AIC) and posterior (PIC) subdivisions, plays a role in numerous functions and behaviors, including chronic alcohol consumption. This study investigated acute alcohol effects on functional connectivity (FC) of the IC in healthy social drinkers. We hypothesized that acute alcohol consumption would significantly disrupt IC resting-state FC (rsFC) with the whole brain and would differentially modulate the rsFC of the AIC and PIC. This study also examined the association of alcohol-induced changes in IC rsFC with subjective intoxication and whether sex and family history of alcohol problems moderate the effect of acute alcohol intake on IC rsFC. METHODS:One hundred and seven healthy social drinkers (25-45 years) completed two counterbalanced laboratory sessions where they consumed either a placebo or alcohol-containing beverage (target breath alcohol concentration 0.08 g/dL), followed by a 9-min resting-state functional magnetic resonance imaging scan. Subjective intoxication was assessed using a visual analog scale from "not at all intoxicated" to "most intoxicated imaginable." Effects of alcohol on IC connectivity were assessed using the CONN toolbox with IC regions of interest (ROIs) defined using the atlas of intrinsic connectivity of homotopic areas (AICHA). RESULTS:Alcohol intake resulted in widespread changes in rsFC of the IC with other brain regions, including increased rsFC with nodes of the salience network. Alcohol also attenuated differences in rsFC between the AIC and PIC compared with placebo. Sex and family history of alcohol problems did not significantly moderate these effects. CONCLUSIONS:Acute alcohol intake altered the rsFC of the IC and its connections to numerous structures. Consistent with prior evidence that alcohol disrupts the brain's functional organization, alcohol intake tended to attenuate differences in the connectivity profiles of AIC and PIC. Additional research is needed to determine how these effects may underlie alcohol's broader neurobehavioral consequences.

Alcohol intake disrupts cognitive and sensory processing. However, its effects on the role of individual structures within cortical networks, or on the larger network structure, remain unclear. This acute alcohol administration study addressed this gap using graph theory analysis. Healthy individuals (n=107, 21-45yrs, 61 women) consumed alcohol (0.08g/dL target BrAC) or a placebo drink in 2 double-blinded sessions and self-reported their perceived intoxication using a visual analog scale. Resting state fMRI was acquired with a Siemens Prisma 3T scanner 30min after consumption. The effect of alcohol on graph theory outcomes in a network of 106 cerebral ROIs was identified using the CONN toolbox. We also determined the association between graph theory metrics and subjective intoxication. Results revealed alcohol 1) significantly decreased global efficiency in several occipital nodes and increased global efficiency for nodes within the frontal and temporal cortex; 2) increased local efficiency at a network level as well as in specific nodes in the temporal and frontal cortices; 3) increased degree in frontal and temporal regions; 4) decreased closeness centrality and increased mean path length in parietal and occipital regions as well at the network level compared with placebo conditions. Additionally, decreases in global efficiency and increases in local efficiency and clustering coefficient in the alcohol vs. placebo condition significantly predicted subjective intoxication. Taken together, results provide new evidence that alcohol intake produces changes in the overall topography of the cerebral network that at least partially underlie individual differences in subjective alcohol response.

Background: Previous research has demonstrated that placebo induction manipulations can reduce an individual's pain through nonspecific mechanisms, such as expectancy manipulations. However, despite robust research characterizing these effects, individual differences in predicting placebo analgesic responses are not well understood. Methods: Fifty-four healthy pain-free adults over 18 (M=22.8, SD=7.82) were recruited (66.7% women). Participants completed a baseline followed by a placebo session involving the application of an inactive cream in the context of an expectancy-enhancing instruction set while undergoing a functional magnetic resonance imaging scan (fMRI). Painful heat stimuli were applied to the thenar eminence of the right palm. Stimulus intensity was individually calibrated to produce pain ratings of approximately 40 on a 100-point visual analog scale. Generalized psychophysiological interaction (gPPI) was used to assess the group differences in functional connectivity during painful stimulation compared to warmth stimulation. Results: About 68.5% showed a reduction in pain in the placebo condition with an average decrease of 30.3%. Non-responders showed an increase in pain in the placebo condition, with an average increase of 18.6%. Repeated measures ANOVA demonstrated a significant within-subjects interaction between expectancy and responder type (F(1,49)=4.27, p=0.04, eta p2=0.08). Expected pain was significantly associated with pain in the placebo session for the responders (b=0.37, R2=0.29, p<0.001), but not for the non-responders (b=0.11, R2=0.04, p=0.42). gPPI analysis revealed three clusters exhibiting greater increases in FC in areas related to attention and sensory integration in placebo responders compared to non-responders. One cluster was identified where greater increases in functional connectivity were associated with non-responders compared to responders in regions associated with attention and motor processing. Conclusion: Our results provide evidence that responders and non-responders have differential behavioral and functional responses to acute pain during a placebo analgesic task.

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.

AbstractObjectiveTreatment of obesity has been transformed by the recent approval of incretin‐based therapies for weight loss (e.g., glucagon‐like peptide 1 agonist semaglutide), but little is known about patient perspectives on these medications.MethodsBetween December 2023 and March 2024, healthcare patients from an academic medical center in the Southeast United States with Body Mass Index ≥30 kg/m2 completed a cross‐sectional online survey on attitudes toward incretin‐based medications.ResultsCompared to patients with a bachelor's degree, those without a degree were less likely to be aware of incretin‐based pharmacotherapies (96% vs. 78%) and to have discussed pharmacotherapies with a doctor (43% vs. 27%) but had greater interest in using these pharmacotherapies (4.3 vs. 4.7). These pharmacotherapy‐related variables did not differ significantly according to gender, race, or financial security. Concerns about side effects, long‐term health risks, and potential for weight regain were highly endorsed and were associated with lower interest in using incretin‐based therapies and with some demographic factors. Patients reported high interest in lifestyle programs designed for individuals taking anti‐obesity medications.ConclusionDemographic considerations, notably education level, should be factored into the strategy to promote equitable utilization of incretin‐based therapies, particularly as their accessibility expands.

BACKGROUND:Task-based functional connectivity (FC) of pain-related regions resulting from expectancy-based placebo induction has yet to be examined, limiting our understanding of regions and networks associated with placebo analgesia.METHODS:Fifty-five healthy pain-free adults over 18 (M = 22.8 years, SD = 7.75) were recruited (65.5% women; 63.6% non-Hispanic/Latino/a/x; 58.2% White). Participants completed a baseline followed by a placebo session involving the topical application of an inactive cream in the context of an expectancy-enhancing instruction set. Noxious heat stimuli were applied to the thenar eminence of the right palm using an fMRI-safe thermode. Stimulus intensity was individually calibrated to produce pain ratings of approximately 40 on a 100-point visual analogue scale.RESULTS:A total of 67.3% of the participants showed a reduction in pain intensity in the placebo condition with an average reduction in pain across the whole sample of 12.7%. Expected pain intensity was associated with reported pain intensity in the placebo session (b = 0.32, p = 0.004, R2  = 0.15). Voxel-wise analyses indicated seven clusters with significant activation during noxious heat stimulation at baseline (pFDR  < 0.05). Generalized psychophysiological interaction analysis suggested that placebo-related FC changes between middle frontal gyrus-superior parietal lobule during noxious stimulation were significantly associated with the magnitude of pain reduction (pFDR  < 0.05).CONCLUSIONS:Results suggest that stronger expectancy-based placebo responses might be underpinned by greater FC among attentional and somatosensory regions.SIGNIFICANCE:This article provides support and insight for task-dependent functional connectivity differences related to the magnitude of placebo analgesia. Our findings provide key support that the magnitude of expectation-based placebo response depends on the coupling of regions associated with somatosensory and attentional processing.

Objectives Chronic pain results in significant impairment in older adults, yet some individuals maintain adaptive functioning. Limited research has considered the role of positive resources in promoting resilience among older adults. Likewise, these factors have largely been examined independently. We aimed to identify resilience domains based on biopsychosocial factors and explore whether resilience phenotypes vary across sleep disturbance, fatigue, and cognitive function. Methods Sixty adults (ages >= 60 years) with chronic low back pain completed measures of psychological, health, and social functioning. On the basis of previously published analyses, principal-components analysis was conducted to create composite domains for these measures, followed by cluster analysis to identify phenotypes. Results Four profiles emerged: Cluster 1, with high levels of psychosocial and health-related functioning; Cluster 2, with high health-related functioning and low psychosocial functioning; Cluster 3, with high psychosocial functioning and poorer health; and Cluster 4, with low levels of functioning across all domains. Significant differences across cluster membership emerged for sleep disturbance (eta(2)(p) = 0.29), fatigue (eta(2)(p) = 0.29), and cognitive abilities (eta(2)(p) = 0.47). Individuals with the highest levels of resilience demonstrated more optimal outcomes in sleep and fatigue (P values <= 0.001) than did individuals with a less resilient phenotype. Furthermore, the High-Resilience group (Cluster 1) and the High Psychosocial / Low Health group (Cluster 3) had lower cognitive impairment than did the High Health / Low Psychosocial group (Cluster 2) and the Low-Resilience group (Cluster 4) (P values <= 0.009). Conclusions A higher array of protective resources could buffer against the negative sequelae associated with chronic low back pain. These exploratory findings support the multidimensional nature of resilience and suggest that targeting resilience from a multisystem perspective might help to optimize interventions for older adults with chronic pain.

Objective:Widespread musculoskeletal pain disorders like fibromyalgia are often accompanied by varying levels of cognitive dysfunction. Fibromyalgia research suggests that around the time of diagnosis, typically 30-50 years of age, many patients are already showing cognitive difficulties on various neuropsychological assessments. It is unknown, however, how older adults with fibromyalgia perform on rapid cognitive screeners in clinical settings. The present study compared older adults with and without fibromyalgia on a digitized version of a classic neuropsychological screener, the clock drawing test.Participants and Methods:Participants aged 65+ were recruited as part of a larger IRB-approved and federally funded investigation within the preoperative surgical center at the University of Florida (UF) and UF Health. Participant data were obtained with Health Insurance Portability and Accountability Act (HIPAA) waiver and honest broker medical extraction from January 2018 to December 2019 (N=14,807). Based on medical record diagnostic code, participants were categorized into fibromyalgia or non-fibromyalgia groups, then propensity score matched based on age, ethnicity, race, sex, and years of education. The final sample contained 718 older adults (mean age= 71.3±4.89, education years= 13.7±2.62, female= 98.1%, white= 87.9%) (n=359 in each group). All participants completed the command and copy condition of the digital Clock Drawing Test (dCDT). Variables of interest for both conditions included: total completion time (TCT), pre-first hand latency (PFHL), clock face area (CFA), and digit misplacement. These variables were chosen to represent two latency and two graphomotor variables. A natural log transformation was applied to all dCDT variables to achieve normality of the distribution.Results:We confirmed that there was no significant group difference in age, ethnicity, race, sex, and years of education following the propensity match. Fibromyalgia patients had higher comorbidity scores on American Society of Anesthesiologists Classification (ASA) (p= 0.003). Analysis of variance (ANOVA) showed a significant group difference in TCT for both command [F(1,637)= 5.13, p= 0.024, d=0.178] and copy conditions [F(1,466)= 4.03, p= 0.045, d=0.179j. Controlling for ASA, a repeated measures analysis of covariance (ANCOVA) showed that groups still differed in TCT in the command condition [F(1,630)= 4.21, p= 0.041, n2= 0.007; Fibromyalgia > Non-Fibromyalgia], but not in the copy condition.Conclusions:In our sample, older adults with fibromyalgia showed slower TCT to command by approximately three seconds compared to non-fibromyalgia peers. Since TCT to command taps into multiple domains of cognitive functioning, our results are consistent with previous work demonstrating poorer performance across many cognitive domains in fibromyalgia. Future research should continue investigating digital cognitive assessments to identify older adults with fibromyalgia who may be at higher risk for cognitive change. Data acquired through NIH R01 AG055337.

Promises to perform supererogatory actions present an interesting puzzle. On the one hand, this seems like a promise that one should be able to keep simply by performing some good deed or other. On the other hand, the only way to keep it is to do something that exceeds one’s duties. But any good deed that one performs, which might otherwise have been supererogatory, will not go above and beyond what one is morally required to do in such a case because one has an obligation that one does not normally have—namely, an obligation to do something supererogatory. Thus, some scholars have argued that promises of this sort cannot possibly be kept and so are wrong to make. I show that, far from being impossible, keeping promises to supererogate is easy, and so there is nothing wrong with making promises of this sort.

Although laboratory studies indicate alcohol reduces pain intensity and increases pain threshold, these effects likely do not completely explain perceived pain relief from alcohol intake. In this study, we tested expectancy of alcohol analgesia (EAA) as a moderator of subjective pain relief following oral alcohol challenge in individuals with and without chronic orofacial pain. Social drinkers (N = 48; 19 chronic pain; 29 pain-free controls) completed two testing sessions: alcohol administration (BrAC: 0.08 g/dL) and placebo. Alcohol expectancy (AE) was assessed using the EAA questionnaire and two 100-mm Visual Analogue Scales (VASs) regarding strength of belief that alcohol provides pain relief (AE VAS 1) or reduces pain sensitivity (AE VAS 2). Participants completed quantitative sensory testing (QST) involving application of pressure to the masseter insertion. Pain threshold (lbf; three repetitions) and pain intensity (4, 5, and 6 lbf; three repetitions each; 100-mm VAS) were collected. After each stimulus, participants rated perceived pain relief due to consumption of the study beverage (0-100 VAS). Higher EAA and AE VAS 1 ratings were associated with stronger perceived relief in the alcohol, but not placebo, condition. However, expectancy specifically related to reduction in pain sensitivity (AE VAS 2) was not associated with relief. Additionally, changes in pain threshold and intensity were not significantly correlated with perceived relief. Taken together, results suggest expectancy that alcohol provides pain relief is an important determinant of its negative reinforcing effects. Future studies should investigate challenging these expectancies as a means of reducing alcohol-related risk in people with pain. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Recent work indicates that increasing the drinking rate of a virtual bar-goer (VB) increases the rate of drinking for participants in a virtual reality (VR) bar environment. Here, we test the hypothesis that biopsychosocial factors including typical drinking pattern and expectancy that alcohol enhances social interactions would moderate this effect. Methods: We assessed the drinking topography (DT) of participants (N=20) in a VR environment with a programmable VB during two testing sessions: one with a fast-drinking VB (30-60 s sip interval) and one in which the VB drank slowly (60-120 s sip interval). In this secondary analysis, linear mixed models were used to characterize potential interactions of typical daily alcohol intake (quantity-frequency index [QFI]), maximal alcohol consumed in one bout over the past six months (maxQ), Alcohol Use Disorder Identification Test (AUDIT) score, and expectancy that alcohol enhances social and physical pleasures (SPP) with time in simulation and condition on sip interval and volume. Results: Individuals with higher MaxQ showed a reduced effect of time on sip volume such that more intense recent binge episodes were associated with consistent drinking. Greater AUDIT scores were associated with lower sip intervals. In addition, greater SPP expectancy was associated with higher sip volumes, but only in the fastdrinking VB condition. Conclusions: Greater drinking behavior and social expectancies were associated with more rapid drinking topography. In addition, findings suggest challenging alcohol outcome expectancies related to social enhancement could reduce alcohol-related risks by slowing the rate of alcohol intake in social situations.

Introduction Simply inspecting one’s own body can reduce clinical pain and magnification of body parts can increase analgesia. Thus, body perceptions seem to play an important role for analgesia. Conversely, pain may also affect bodily perceptions. Therefore, we evaluated the effects of clinical and/or experimental pain on perceived hand size in fibromyalgia patients (FM) and healthy controls (HC). Methods To investigate the effects of chronic and/or acute pain on size perception we compared hand size estimates of 35 HC and 32 FM patients at baseline and during tonic mechanical pain stimuli applied to one ear lobe. Mechanical stimuli were adjusted for each individual pain sensitivity to achieve a rating of 4 ± 1 VAS (0–10) units. Photographs of each subject’s hands were digitally manipulated to produce a monotonic series of 5 images larger and 6 smaller than actual size which were then presented to the participants in ascending and descending order (total number of images: 12). Results FM and HC participants’ clinical pain ratings at baseline were 3.3 (3.1) and .3 (.8) VAS units, respectively. At baseline, FM participants selected significantly smaller hand images than HC as representative of their actual size (p < .02). During application of tonic experimental pain, the image size chosen to represent their actual hand size decreased significantly in FM participants and HC (p < .001) but this decrease was not different between groups (p > .05). Hand size estimates of FM participants correlated negatively with their clinical pain ratings (p < .04). Conclusion The decreased hand size perception of FM patients and HC was associated with their clinical and/or experimental pain, supporting the hypothesis that pain can result in visual body distortions.

Research suggests situational pain may motivate alcohol consumption, suggesting that pain may be an antecedent for problematic drinking behavior. In this pilot project, we assessed the effect of a painful thermal stimulus on drinking topography in a virtual reality bar environment using real alcohol-containing beverages. We also examined psychosocial factors that may account for individual differences in pain as an antecedent for alcohol use. Participants (N = 20, Mage = 25.65 years, 55% female, 15% Hispanic/Latino/a/x) completed a psychosocial screening battery before completing two counterbalanced alcohol self-administration sessions. In each, participants experienced either painful heat (44 °C) or nonnoxious warmth (38 °C). Sip interval (s) and sip volume (g) were measured. Effects of pain on drinking topography were assessed using multilevel models. Multilevel models assessed associations of pain-related changes in topography with hypothesized vulnerability factors. Analyses indicated a significant interaction of pain condition and sex on sip interval (b = -.16.96, p = .015, 95% CI [-30.75, -2.97]), such that painful heat significantly decreased sip interval in men (b = 16.38) but not women (b = -.45). No effect of pain on sip volume was detected (p > .49). Exploratory analyses indicated significant interactions such that the effect of the painful heat condition was stronger in individuals with higher levels of greater negative urgency but the opposite effect for pain catastrophizing. Results suggest acute pain has sex-contingent effects on drinking topography, such that men drank more rapidly while experiencing painful heat. Furthermore, analyses indicated that individuals with greater negative urgency, regardless of sex, may be at elevated risk for hazardous alcohol use when experiencing pain. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Insomnia is an adverse cancer outcome impacting mood, pain, quality of life, and mortality in cancer patients. Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for diverse psychophysiological disorders, including pain and insomnia. Primarily studied in breast cancer, there is limited research on CBT within gynecology oncology. This study examined CBT effects on subjective and behavioral sleep outcomes: Sleep Efficiency (SE), Sleep Quality (SQ), Total Wake Time (TWT), Sleep Onset Latency (SOL), and Wake After Sleep Onset (WASO). Thirty-five women with insomnia status/post-surgery for gynecologic cancer were randomized to CBT for insomnia and pain (CBTi.p., N = 18) or Psychoeducation (N = 17). Sleep was assessed via sleep diaries and wrist-worn actigraphy at baseline (T1), post-intervention (T2), and two-month follow-up (T3). Intent-to-treat analyses utilizing mixed linear modeling examined longitudinal group differences on sleep controlling for age and advanced cancer. All participants demonstrated improved (1) subjective SE (0.5, p < .01), SOL (-1.2, p < .01), TWT (-1.2, p < .01), and (2) behavioral SE (0.1, p = .02), TWT (-1.2, p = .03), WASO (-0.8, p < .01) across time. Group-level time trends were indicative of higher subjective SE (6.8, p = .02), lower TWT (-40.3, p = .01), and lower SOL (-13.0, p = .05) in CBTi.p. compared to Psychoeducation. Supplemental analyses examining clinical significance and acute treatment effects demonstrated clinical improvements in SE (T1), TWT (T2, T3), and SOL (T3). Remaining effects were not significant. Despite lacking power to detect interaction effects, CBTi.p. clinically improved sleep in women with gynecologic cancers and insomnia during the active treatment phase. Future research will focus on developing larger trials within underserved populations.

BACKGROUND Although recent literature provides promising support for the analgesic properties of alcohol, potential differences in alcohol analgesia as a function of chronic pain status are not well understood. Thus, this study examined chronic pain status as a potential moderator of alcohol analgesia and distinguished between multiple aspects of pain experience and sensitivity: pain threshold, pain intensity, pain unpleasantness, and perceived relief. METHODS Social drinkers with (N = 19) and without (N = 29) chronic jaw pain completed two testing sessions in a counterbalanced order: alcohol (target BrAC = 0.08 g/dl) and placebo. In each, pressure algometry was performed at the insertion of the masseter. Alcohol analgesia was assessed by examining the main and interactive effects of beverage condition, pressure level (4, 5, or 6 pound-feet [lbf]), and chronic jaw pain status (chronic pain vs. pain-free control) on quantitative sensory testing measures and pain relief ratings following noxious stimuli. RESULTS Analyses indicated significant increases in pain threshold and pain relief and reductions in pain unpleasantness and pain intensity, under the alcohol condition. Chronic pain participants demonstrated lower pain thresholds and greater pain intensity and pain unpleasantness ratings than controls. There were no interactive effects of alcohol and pain conditions on any pain measure. CONCLUSIONS Findings provide experimental evidence of alcohol's analgesic and pain-relieving effects and suggest that these effects do not significantly differ by chronic pain status. Individuals, who self-medicate pain via alcohol consumption, irrespective of pain status, may be at increased risk to engage in hazardous drinking patterns and thus experience adverse alcohol-related consequences.

Background:Minority and older adult patients remain underrepresented in cancer clinical trials (CCTs). The current study sought to examine sociodemographic inequities in CCT interest, eligibility, enrollment, decline motivation, and attrition across two psychosocial CCTs for gynecologic, gastrointestinal, and thoracic cancers. Methods:Patients were approached for recruitment to one of two interventions: (1) a randomized control trial (RCT) examining effects of a cognitive-behavioral intervention targeting sleep, pain, mood, cytokines, and cortisol following surgery, or (2) a yoga intervention to determine its feasibility, acceptability, and effects on mitigating distress. Prospective RCT participants were queried about interest and screened for eligibility. All eligible patients across trials were offered enrollment. Patients who declined yoga intervention enrollment provided reasons for decline. Sociodemographic predictors of enrollment decisions and attrition were explored. Results:No sociodemographic differences in RCT interest were observed, and older patients were more likely to be ineligible. Eligible Hispanic patients across trials were significantly more likely to enroll than non-Hispanic patients. Sociodemographic factors predicted differences in decline motivation. In one trial, individuals originating from more urban areas were more likely to prematurely discontinue participation. Discussion:These results corroborate evidence of no significant differences in CCT interest across minority groups, with older adults less likely to fulfill eligibility criteria. While absolute Hispanic enrollment was modest, Hispanic patients were more likely to enroll relative to non-Hispanic patients. Additional sociodemographic trends were noted in decline motivation and geographical prediction of attrition. Further investigation is necessary to better understand inequities, barriers, and best recruitment practices for representative CCTs.