Institutionalized Adoption of a Protocol for the Management of Median Arcuate Ligament Syndrome Correlates with Improved Surgical Outcomes.

Background: Median arcuate ligament syndrome (MALS) is a rarely diagnosed and treated etiology of abdominal pain with no established diagnostic approach. The effectiveness of our institutional protocol in identifying these patients was investigated by analyzing their surgical outcomes.

Methods: A retrospective review was conducted of patients treated for MALS at our institution from 2001 to 2022.

Recognizing and Treating Major Depression in Fibromyalgia: A Narrative Primer for the Non-Psychiatrist.

Fibromyalgia (FM) affects 2% to 8% of the general population. FM patients often experience self-stigma and feel rejected by healthcare providers and families, resulting in isolation and distressing symptoms of pain, fatigue, and poor cognitive functioning, increasing the risk of depressive symptoms. Major Depressive Disorder (MDD) is the most common comorbidity in FM patients (Any depression: 43%; MDD: 32%).

A retrospective analysis of the prevalence and impact of associated comorbidities on fibromyalgia outcomes in a tertiary care center.

Background: This retrospective study was designed to analyze the prevalence and impact of associated comorbidities on fibromyalgia (FM) outcomes (functionality, pain, depression levels) for patients who participated in an intensive multicomponent clinical program in a tertiary care center.

Methods: Participants included a sample of 411 patients diagnosed with FM at a large tertiary medical center using the 2016 ACR criteria. Patients completed an intensive 2-day cognitive behavioral treatment (CBT) program, filled out the Fibromyalgia Impact Questionnaire Revised (FIQR), the Center for Epidemiologic Studies Depression Scale (CES-D), the Pain Catastrophizing Scale (PCS), and were followed for 6 months after treatment completion.

Sinus Tachycardia: a Multidisciplinary Expert Focused Review.

Sinus tachycardia (ST) is ubiquitous, but its presence outside of normal physiological triggers in otherwise healthy individuals remains a commonly encountered phenomenon in medical practice. In many cases, ST can be readily explained by a current medical condition that precipitates an increase in the sinus rate, but ST at rest without physiological triggers may also represent a spectrum of normal. In other cases, ST may not have an easily explainable cause but may represent serious underlying pathology and can be associated with intolerable symptoms.

Depression: A Modifiable Risk Factor for Poor Outcomes in Fibromyalgia.

Background: About 4 out of 10 fibromyalgia patients suffer from depression. The European Alliance of Associations for Rheumatology (EULAR) guidelines recommend using antidepressants to treat fibromyalgia.

Objective: To determine predictors of improved outcomes following a multicomponent treatment program.

Intensive Multicomponent Fibromyalgia Treatment: A Translational Study to Evaluate Effectiveness in Routine Care Delivery.

Objective: The current study was designed to evaluate the translation of clinical trial outcomes and clinical guidelines for the treatment of fibromyalgia (FM) into an intensive multicomponent clinical program embedded in routine care delivery. The study aimed to assess the adaptation of these recommended strategies into routine clinical care while evaluating their effectiveness and durability in improving functional status and level of distress in a large clinical sample of FM patients.

Methods: Four hundred eighty-nine patients with FM completed a 2-day program that incorporated best practice recommendations for the treatment of FM.

Opioid Use in Fibromyalgia Continues Despite Guidelines That Do Not Support Its Efficacy or Risk.

Background/objective: The aim of this cross-sectional study is to determine the prevalence of opioid use in a large sample of fibromyalgia (FM) patients and examine the factors associated with opioid prescription/use despite multiple clinical guidelines that do not recommend opioid use in this population.

Methods: Data were collected from a convenience sample of 698 patients admitted from August 2017 to May 2019 into an intensive 2-day Fibromyalgia Treatment Program at a tertiary medical center in the United States after FM diagnosis. Patients were administered the Fibromyalgia Impact Questionnaire-Revised, the Center for Epidemiologic Study of Depression Scale, and the Pain Catastrophizing Scale upon admission to the program.

Improving Distress and Behaviors for Parents of Adolescents With Chronic Pain Enrolled in an Intensive Interdisciplinary Pain Program.

Objectives: Intensive interdisciplinary treatment is emerging as an effective treatment of chronic pain in youth. These programs often include a parental component with the belief that targeting parental distress and responses to a child's pain will improve outcomes. However, few studies have evaluated the impact of a parental intervention in the interdisciplinary treatment of pediatric chronic pain.

Development of an Interdisciplinary Pediatric Pain Rehabilitation Program: The First 1000 Consecutive Patients.

Objective: To describe the development of a clinically and financially successful interdisciplinary pediatric pain rehabilitation program at a large tertiary academic medical center and present demographic and clinical information on the first 1000 patients.

Patients And Methods: All patients who were consecutively admitted to this program between October 1, 2008, and March 31, 2015 were included in this review. The patients ranged in age from 9 to 24 years.

Executive Functioning in Pediatric Chronic Pain: Do Deficits Exist?

Objective: Despite ample research documenting deficits in executive functioning for adults with chronic pain, the literature on pediatric patients with chronic pain is limited and provides mixed results. The current study sought to further investigate the nature of executive dysfunction in this population and also examine the relationships between pain intensity, duration, and catastrophizing with sustained attention, working memory, and self- and parent-report of executive functioning.

Settings: Pediatric pain clinic and rehabilitation program.

Getting Back to Living: Further Evidence for the Efficacy of an Interdisciplinary Pediatric Pain Treatment Program.

Objective: This study examined key functional outcomes following a 3-week interdisciplinary pediatric pain rehabilitation program for adolescents with chronic pain. Maintenance of gains was evaluated at 3-month follow-up.

Methods: Participants included 171 adolescents (12 to 18 y of age) with chronic pain who completed a hospital-based outpatient pediatric pain rehabilitation program.

Eating Disorders in Adolescents With Chronic Pain.

Introduction: Given that youth with chronic pain frequently experience disruptions in eating patterns that may place them at risk for disordered eating, the purpose of this study was to examine the clinical characteristics and illness course of adolescents with chronic pain and comorbid eating disorders.

Methods: Using a retrospective chart review, 34 adolescents with chronic pain and concurrent eating disorders were identified. These adolescents were compared with 34 age-, gender-, and eating disorder symptom-matched adolescents who had an eating disorder without chronic pain.

Improvement in Functioning and Psychological Distress in Adolescents With Postural Orthostatic Tachycardia Syndrome Following Interdisciplinary Treatment.

Significant functional impairment and psychological distress have been observed in adolescent patients with postural orthostatic tachycardia syndrome (POTS). Interdisciplinary rehabilitation programs have been shown to be beneficial in the treatment of chronic pain in adults and adolescents. Only preliminary data have examined interdisciplinary rehabilitation efforts in patients with POTS.

Interdisciplinary Treatment of Maladaptive Behaviors Associated with Postural Orthostatic Tachycardia Syndrome (POTS): A Case Report.

The prevalence of postural orthostatic tachycardia syndrome (POTS) in adolescents and young adults has been increasing during the past decade. Despite this increase, documentation regarding treatment of these patients is just beginning to emerge. In addition, despite a call for a multidisciplinary or interdisciplinary approach, no studies have examined the efficacy of such an approach to treatment.

Adolescent fatigue, POTS, and recovery: a guide for clinicians.

Many teenagers who struggle with chronic fatigue have symptoms suggestive of autonomic dysfunction that may include lightheadedness, headaches, palpitations, nausea, and abdominal pain. Inadequate sleep habits and psychological conditions can contribute to fatigue, as can concurrent medical conditions. One type of autonomic dysfunction, postural orthostatic tachycardia syndrome, is increasingly being identified in adolescents with its constellation of fatigue, orthostatic intolerance, and excessive postural tachycardia (more than 40 beats/min).

Pain relief as a primary treatment goal: at what point does functioning and well-being become more important? A case study of an adolescent with debilitating chronic pain.

Background: Pediatric chronic pain is a common problem with significant economic implications and devastating consequences on quality of life. The present report describes a case involving a 15-year-old girl with severe and debilitating chronic pain.

Results: Before her referral to a pain rehabilitation program, the patient saw numerous specialists who treated her with an aggressive medical regimen and two spinal cord stimulators.

Acceptance of pain: associations with depression, catastrophizing, and functional disability among children and adolescents in an interdisciplinary chronic pain rehabilitation program.

Objectives: The aims of this study were: (1) investigate relations between pain acceptance, depressive symptoms, catastrophizing, and functional disability in pediatric patients in an interdisciplinary chronic pain rehabilitation program, (2) examine changes in acceptance from pre- to posttreatment, and (3) test if changes in acceptance predict changes in depressive symptoms, catastrophizing, and functional disability from pre- to posttreatment.

Methods: 112 participants, ages 11-18 years, completed the Chronic Pain Acceptance Questionnaire, Adolescent Version, Center for Epidemiological Studies-Depression-Children's Scale, Pain Catastrophizing Scale for Children, and Functional Disability Inventory on admission to and completion of the program.

Results: Significant and strong relations between acceptance, depression, catastrophizing, and functional disability were demonstrated.

Covert video monitoring in the assessment of medically unexplained symptoms in children.

Objective: Diagnosis of medically unexplained symptoms (MUS) occurs after thorough evaluations have failed to identify a physiological cause for symptoms. However, families and providers may wonder if something has been missed, leading to reduced confidence in behavioral treatment. Confidence may be improved through the use of technology such as covert video monitoring to better assess functioning across settings.

Beliefs and attitudes about prescribing opioids among healthcare providers seeking continuing medical education.

Objective: The purpose of this study was to assess the beliefs and attitudes of healthcare providers about prescribing opioids for chronic pain.

Setting: The setting was a continuing medical education conference that was specifically designed to deliver content about chronic pain and prescription opioids to providers without specialty expertise in pain medicine.

Participants: Conference attendees with prescribing privileges were eligible to participate, including physicians, physician assistants, and advance practice nurses.

Longitudinal treatment outcomes for geriatric patients with chronic non-cancer pain at an interdisciplinary pain rehabilitation program.

Objective: This study examined depression, pain catastrophizing, psychosocial functioning, and physical and emotional health attributes for geriatric patients admitted to an interdisciplinary pain rehabilitation center compared with middle and younger age groups.

Design: Quasi-experimental time series.

Setting: Interdisciplinary pain rehabilitation center at a tertiary referral medical center.

Sex differences in characteristics of smokers with chronic pain undergoing multidisciplinary pain rehabilitation.

Objective: The primary aim of this study was to determine the influence of sex and the interactions between sex and smoking status on the immediate treatment outcomes of patients undergoing multidisciplinary pain treatment.

Design: A retrospective, repeated measures design. Setting.

Chronic pain rehabilitation in chronic headache disorders.

This article reviews the treatment goals and efficacy of comprehensive pain rehabilitation programs for the treatment of chronic headache. Substantial data demonstrate improved outcomes from rehabilitative treatment for chronic noncancer pain. We present a discussion of the most relevant recent publications on pain rehabilitation in chronic headache disorders.

The effects of smoking status on opioid tapering among patients with chronic pain.

Objective: The primary aim of this study was to determine if smoking status affected the ability of patients with chronic pain to reduce opioid consumption during a 3-wk pain rehabilitation program. Secondary aims included determining the associations between smoking status, admission opioid use, and pain severity.

Methods: We used a retrospective, repeated measures design to assess pre- and post-treatment outcomes in a consecutive series of patients admitted to a 3-wk, outpatient pain treatment program from September 2003 through February 2007.