Publications by authors named "Sean C Mackey"

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  • A 30-day alcohol abstinence challenge was introduced to help heavy drinkers, both with and without chronic pain, focusing on its feasibility, safety, and perceived benefits.
  • The study involved 34 participants from a pain clinic and a university, with 72.3% completing the challenge successfully, without serious negative effects.
  • The challenge led to significant improvements in withdrawal symptoms, sleep, and self-efficacy regarding alcohol abstinence, while identifying various coping strategies and benefits; further research is needed to assess long-term effects.
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  • Chronic pain is linked to a higher risk of opioid misuse, prompting the need for non-drug interventions; the MOBILE Relief study aims to compare a skill-based digital intervention ('Empowered Relief') tailored for those at risk of opioid misuse with a general health education program ('Living Better').
  • The study is a randomized controlled trial involving adults with chronic pain, who will participate through online screenings, treatment assignments, and follow-up surveys to assess the effectiveness of the interventions.
  • Key outcomes will focus on pain perception, opioid cravings, and misuse rates at 1 and 3 months post-treatment, with a hypothesis that the 'Empowered Relief' group will show better results than the control group.
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Background And Objectives: The learning healthcare system (LHS) has been developed to integrate patients' clinical data into clinical decisions and improve treatment outcomes. Having little guidance on this integration process, we aim to explain (a) an applicable analytic tool for clinicians to evaluate the clinical outcomes at a group and an individual level and (b) our quality improvement (QI) project, analyzing the outcomes of a new outpatient pain rehabilitation program ("Back-in-Action": BIA) and applying the analysis results to modify our clinical practice.

Methods: Through our LHS (CHOIR; https://choir.

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  • The study investigates the relationship between chronic pain, specifically pain localized to the left side of the body, and depressive symptoms in adults seeking treatment for mixed-etiology chronic pain.
  • Results indicated that having any left-sided pain was linked to slightly worse depression, but left-only pain did not significantly impact depressive symptoms.
  • Overall, the findings emphasize that more widespread pain across the body correlates with higher levels of depression, challenging the idea that left-lateralized pain is a specific risk factor for worsening depression.
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Introduction: We previously conducted a 3-arm randomized trial (263 adults with chronic low back pain) which compared group-based (1) single-session pain relief skills intervention (Empowered Relief; ER); (2) 8-session cognitive behavioral therapy (CBT) for chronic back pain; and (3) single-session health and back pain education class (HE). Results suggested non-inferiority of ER vs. CBT at 3 months post-treatment on an array of outcomes.

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  • A new 4-item scale called "BriefPCS" was created to minimize the burden of the longer 13-item Pain Catastrophizing Scale (PCS) for patients.
  • The study aimed to link BriefPCS scores to PCS scores, examine their validity, and assess BriefPCS in a randomized clinical trial (RCT).
  • Findings showed that BriefPCS scores reliably reflect levels of pain catastrophizing and are sensitive to treatment changes, providing a valid and less burdensome alternative to the PCS.
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Urological chronic pelvic pain syndrome (UCPPS) is a debilitating painful condition with unclear etiology. Prior researchers have indicated that compared to healthy controls, patients with UCPPS demonstrated altered brain activity. Researchers have also shown that in UCPPS, several blood inflammatory markers relate to clinical variables of pain, fatigue, and pain widespreadness.

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Introduction: The evolution of pre- versus postoperative risk factors remains unknown in the development of persistent postoperative pain and opioid use. We identified preoperative versus comprehensive perioperative models of delayed pain and opioid cessation after total joint arthroplasty including time-varying postoperative changes in emotional distress. We hypothesized that time-varying longitudinal measures of postoperative psychological distress, as well as pre- and postoperative use of opioids would be the most significant risk factors for both outcomes.

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Large randomized clinical trials or aggregates of clinical trials represent the highest levels of clinical evidence because they minimize different sources of confounding and bias. The current review provides an in-depth discussion of the challenges faced and methods we can use to overcome these obstacles to tailor novel designs of pragmatic effectiveness trials to pain medicine. The authors describe their experiences with an open-source learning health system to collect high-quality evidence and conduct pragmatic clinical trials within a busy academic pain center.

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Weaning opioids in patients with noncancerous chronic pain often poses a challenge when psychosocial factors complicate the patient's chronic pain syndrome and opioid use. A blinded pain cocktail protocol used to wean opioid therapy has been described since the 1970s. At the Stanford Comprehensive Interdisciplinary Pain Program, a blinded pain cocktail remains a reliably effective medication-behavioral intervention.

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  • The study explored how the COVID-19 pandemic affected stressors and health outcomes for patients at a pain clinic over two years (May 2020 to June 2022).
  • It involved 1270 adult patients, mainly white, female, married, and with college education, using linear mixed effect modeling to track changes in stress and health indicators.
  • Results showed that while patients reported more exposure to COVID-19, overall pandemic-related stress decreased, and their health outcomes improved, with particular vulnerabilities noted in younger adults, Hispanics, and those on disability.
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Background: Inclusion of self-reported and capacity-based measures may help to further elucidate the interactive link between how people think and move.

Objective: To characterize the relationship between self-reported factors of physical function and pain with objective physical capacity measures.

Design: Cross-sectional study of 328 adults with chronic low back pain (CLBP).

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Objectives: Awareness (being present), acceptance, and engagement (committed action) are three dimensions of psychological flexibility. Understanding these in the context of chronic pain may identify treatment targets to help refine individual treatment. Our objective was to test the predictive capacity of three dimensions within the psychological flexibility model on the longitudinal trajectory of pain interference.

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Background: Opioids have been commonly used to treat chronic pain, but they are associated with significant morbidity and mortality. Cannabis has been advocated as an alternative; however, a growing number of patients are now using a combination of opioid and cannabis and the impact of this combination is not well-studied.

Aim: We characterized use of opioid and/or cannabis in patients with chronic pain; and compared utilization of healthcare resources.

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The ability of clinical trials to inform the care of chronic pain may be limited if only an unrepresentative subset of patients are allowed to enroll. We summarize and report new insights on published studies that report on how trial exclusions affect the generalizability of their results. We conducted a PubMed search on the following terms: (("eligibility criteria" AND generalizability) OR ("exclusion criteria" AND generalizability) OR "exclusion criteria"[ti] OR "eligibility criteria"[ti]) AND pain.

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Pain catastrophizing is understood as a negative cognitive and emotional response to pain. Researchers, advocates and patients have reported stigmatizing effects of the term in clinical settings and the media. We conducted an international study to investigate patient perspectives on the term pain catastrophizing.

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Brain corticostriatal circuits are important for understanding chronic pain and highly relevant to motivation and cognitive processes. It has been demonstrated that in patients with chronic back pain, altered nucleus accumbens (NAcc)-medial prefrontal cortex (MPFC) circuit fMRI-based activity is predictive of patient outcome. We evaluated the NAcc-MPFC circuit in patients with another chronic pain condition, fibromyalgia, to extend these important findings.

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Introduction: Abdominal pain frequently co-occurs with pain in other body sites. Chronic overlapping pain conditions (COPCs) represent a group of widespread pain diagnoses. Our study characterized how patterns of somatic pain distribution are associated with COPCs and aimed to characterize predictors of widespread pain among patients with chronic abdominal pain.

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Article Synopsis
  • High Impact Chronic Pain (HICP) is a new concept for categorizing chronic pain patients based on the extent to which their pain affects daily activities, defined as having substantial restrictions for at least six months.
  • The study explored the perceived impact of HICP on adults younger than 65 and older adults 65 and over, using surveys and established scales to measure pain interference in daily life.
  • Results indicated that younger adults primarily felt pain's impact on work and social activities, while older adults reported difficulties with basic physical activities and daily living tasks, highlighting differences in how chronic pain affects these two age groups.
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