Publications by authors named "Keefe F"

Background: The rate of VTE in trauma patients varies significantly in the reported literature. We aimed to determine the incidence of VTE in trauma patients in a trauma-receiving hospital over a 7-year period. We sought to evaluate the timing and nature of VTE events and explore the patterns of co-occurrence between PE and DVT, while factoring in clinical care and death outcome.

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Importance: Chronic pain is common among individuals with dialysis-dependent kidney failure.

Objective: To evaluate the effectiveness of pain coping skills training (PCST), a cognitive behavioral intervention, on pain interference.

Design, Setting, And Participants: This multicenter randomized clinical trial of PCST vs usual care was conducted across 16 academic centers and 103 outpatient dialysis facilities in the US.

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Chronic pain affects ~20% of the adult population and is associated with smoking. Smoking and pain worsen each other in the long term, but short-term temporal associations between smoking and pain throughout the day are unclear. Understanding these relationships may inform strategies for managing comorbid smoking and pain.

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Objective: Studies have found that cancer patients with dependent children exhibit high symptoms of anxiety, depression, and worry. Patients' parenting concerns can negatively impact their own and their family's adjustment to the cancer experience. However, relatively little is known about parenting concerns of partners of cancer patients, or associations between parenting concerns and couples' relationship adjustment.

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Background: Aromatase inhibitors (AIs) are a cornerstone of adjuvant systemic therapy for postmenopausal patients with hormone-receptor positive (HR+) breast cancer. Although AIs decrease cancer recurrence rates and improve survival rates, approximately 50 % of patients experience arthralgia-persistent pain related to worse patient outcomes and poor AI adherence. Current medical interventions for AI-associated arthralgia have limited efficacy and side effects that restrict their use among older patients.

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Purpose: AIM-Back is an embedded pragmatic clinical trial (ePCT) with cluster randomization designed to increase access and compare the effectiveness of two different non-pharmacological care pathways for low back pain (LBP) delivered within the Veteran Administration Health Care System (VAHCS). This manuscript describes baseline characteristics of AIM-Back participants as well as the representativeness of those referred to the AIM-Back program by sex, age, race, and ethnicity, relative to Veterans with low back pain at participating clinics.

Participants: To be eligible for AIM-Back, Veterans were referred to the randomized pathway at their clinic by trained primary care providers (Referral cohort).

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Pain Coping Skills Training (PCST) is a first-line cognitive-behavioral, non-pharmacological treatment for chronic pain and comorbid symptoms. PCST has been shown to be effective in racially and ethnically diverse cohorts across several chronic medical conditions. However, PCST has not been evaluated in those with end stage kidney disease (ESKD) receiving in-center maintenance hemodialysis.

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  • * Critical issues in research include poor governance, lack of diversity, inadequate stakeholder engagement, and issues with data transparency and reporting, which can lead to misguided clinical practices and low value care.
  • * The article proposes the ENTRUST-PE framework to enhance the reliability of pain research, aiming to build trust among stakeholders and calling for collective action to improve the quality and outcomes of pain science.
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  • Cancer impacts both patients and their caregivers, and avoidant communication styles are linked to poorer psychological and relationship adjustments for both parties involved.* ! -
  • The study involved 286 patient-caregiver pairs responding to smartphone prompts over 14 days, focusing on their communication and relationship dynamics.* ! -
  • Results indicated that intimacy plays a critical role in relationship satisfaction and psychological distress, suggesting that improving communication could help foster closer relationships and better coping in cancer care.* !
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  • Cognitive therapy (CT), mindfulness-based stress reduction (MBSR), and behavior therapy (BT) for chronic pain show improvements linked to changes in treatment mechanisms, but these connections weaken over time.
  • A study with 521 participants revealed that the relationship between treatment mechanisms and outcomes was significant early in treatment but became nonsignificant as therapy progressed.
  • This suggests that participants may learn that negative pain-related thoughts and pain spikes don’t necessarily affect their overall experience, highlighting a shift in understanding as therapy continues.
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  • One-fifth of US adults suffer from chronic pain, which is linked to higher consumption of tobacco and cannabis, but the connections between these substances and pain are not well studied.
  • The study analyzed data from nearly 32,000 adults over several years to understand how substance use impacts pain levels and vice versa, finding that those who used cannabis, tobacco, or both had a higher likelihood of experiencing significant pain.
  • Additionally, individuals with moderate to severe pain were more likely to use cannabis, tobacco, or both later on, suggesting a mutual influence between pain intensity and substance use patterns.
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  • The research identified that Black and Asian older adults are less likely to report chronic pain compared to White older adults, and those with higher household incomes also report lower instances of chronic pain.
  • Additionally, older adults who are not working due to disability are significantly more likely to experience chronic pain, highlighting the need for further exploration of disparities among this group.
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Background: Young adult (YA) cancer survivors are a growing, yet underserved population who often face significant and long-lasting cancer-related physical (e.g., pain, fatigue) and emotional (e.

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Background: Chronic musculoskeletal pain (CMP) is the most common, disabling, and costly of all pain conditions. While evidence exists for the efficacy of both duloxetine and web-based cognitive behavioral therapy (CBT) as monotherapy, there is a clear need to consider study of treatment components that may complement each other. In addition, given the reported association between patient's adherence and treatment outcomes, strategies are needed to enhance participant's motivation to adopt and maintain continued use of newly learned pain coping skills from CBT.

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Background: Chronic musculoskeletal pain (CMP) is the most common, disabling, and costly of all pain conditions. While evidence exists for the efficacy of both duloxetine and web-based cognitive behavioral therapy (CBT) as monotherapy, there is a clear need to consider study of treatment components that may complement each other. In addition, given the reported association between patient's adherence and treatment outcomes, strategies are needed to enhance participant's motivation to adopt and maintain continued use of newly learned pain coping skills from CBT.

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Article Synopsis
  • People with chronic pain often rely on analgesic medications to cope with both physical pain and emotional distress, but regular use can have side effects.
  • A study involving 105 participants with chronic low back pain showed that higher levels of pain and negative feelings increased the likelihood of taking pain medication, while using medication resulted in temporary relief from pain and distress.
  • The research also highlighted that these associations were stronger in women, supporting the idea that the cycle of pain and medication use is driven by negative reinforcement.
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Background: 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.

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  • Psychosocial interventions for chronic pain can improve outcomes, but the effects are generally modest and vary widely among individuals.
  • A study with 521 participants compared cognitive therapy, mindfulness-based stress reduction, behavior therapy, and standard treatment, examining factors that may influence treatment effectiveness using the Limit, Activate, and Enhance model.
  • Key findings revealed that low cognitive/behavioral function and positive treatment expectations predicted better outcomes, with women showing more benefit than men; high cognitive/behavioral function linked to better results only in the standard treatment group.
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  • The HOPE Trial is a multicenter randomized trial aimed at reducing chronic pain and opioid use in patients on maintenance hemodialysis for end-stage kidney disease.
  • Phase 1 involves randomly assigning participants to either Pain Coping Skills Training (PCST) or Usual Care, while Phase 2 offers buprenorphine to those on high doses of opioid medications.
  • The trial tracks outcomes like pain interference, hospitalizations, and mortality over 36 weeks, ultimately seeking to improve management strategies for chronic pain in this patient population.
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  • A randomized clinical trial investigated whether a cognitive behavioral intervention, called PEERC, could improve patient expectations for physical therapy (PT) and influence their decisions about surgery for rotator cuff related shoulder pain (RCRSP).
  • The trial involved 54 participants, with one group receiving only PT while the other received PT plus the PEERC intervention, and outcomes were assessed at various points over six months.
  • Results showed no significant differences between the two groups regarding the number of participants reporting surgery or scheduled for surgery, nor in satisfaction, pain levels, or functional outcomes after treatment.
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For some time, the gold standard treatment for anxiety disorders has been exposure therapy, defined as the repeated approach of anxiety-inducing situations, memories, or physiological sensations. Existing treatments to target fear and avoidance of pain can be augmented by innovations from exposure research in the anxiety disorders, including greater emphasis on safety learning, the utilization of imaginal exposure to catastrophic fears, and exposure to contrasting emotions. Given that treatments to target core, maintaining mechanisms of anxiety, including imaginal exposures, can be administered as self-directed treatments without therapist involvement, they represent important avenues for ensuring the millions of people with chronic musculosketal pain can gain access to psychosocial treatment and reduce the interference of pain in their lives.

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