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Chronic pain is a pervasive health care issue affecting over 50 million Americans and costing more than $100 billion dollars annually in lost productivity and health care costs. As a financially and emotionally taxing condition, the families and friends of people with chronic pain, as well as society at large, are affected. Current theory supports the role of biological, psychological, and environmental factors in the etiology, exacerbation, and maintenance of chronic pain. Recently, the specific role of pain-related fear in pain experience has received increasing attention. This article summarizes current understanding of the role of pain-related fear in the onset of acute pain incidents, the transition of acute pain to chronic, and the pain severity and disability of patients with ongoing chronic pain conditions. Treatments demonstrated to reduce pain-related fear are presented, evidence demonstrating their efficacy at reducing disability and pain severity are summarized, and recent criticisms of the fear-avoidance model and future directions are considered.

Objective People with fibromyalgia (FM) report a number of physical, cognitive, and psychological symptoms. The purpose of the current study was to determine whether people with FM differed based on the type and severity of symptoms, and if so, whether sub-groups differ with respect to health care utilization, functional ability, and work status. Methods Symptom, health care utilization, work and physical data were available for 2,182 female responders to an internet survey. Factor analysis was conducted on the (1) physical and (2) cognitive/psychological symptoms, and resulting factor scores were utilized in a cluster analysis to identify sub-groups based on symptoms. Cluster groups were compared on a set of variables (e.g., healthcare utilization, coping). Results FAs resulted in 3 symptom factor scores: musculoskeletal (MS), non-musculoskeletal (NMS), and cognitive/psychological (CP) symptoms. The optimal cluster solution to the cluster analysis revealed 4 clusters. Group 1 was high on all 3 symptom domains, group 2 was moderate on the 2 physical symptom domains, high on the CP, group 3 was moderate on the 2 physical symptom domains, low on the CP, whereas group 4 was low on all symptom domains. The more symptomatic groups reported the greatest amount of healthcare utilization and difficulty in coping with symptoms. Conclusion FM population is heterogeneous with regards to symptom reporting. Additional research is needed to better understand differential symptom experience among people with FM. Clarification of these differences may increase understanding of the mechanisms involved in FM and provide guidance for treatment decisions.

Purpose Little is known of the potential long term gait alterations that occur after an anterior cruciate ligament (ACL) reconstruction. In particular, variables such as impact loading which have been previously associated with joint deterioration have not been studied in walking and running after an ACL reconstruction. The purpose of this study was to define the alterations in impact forces, loading rates, and the accompanying sagittal plane kinematic and kinetic mechanics at the time of impact between the ACL reconstructed group and a healthy control group. Methods 40 females (20 ACL reconstruction, 20 controls) participated in the study. An instrumented gait analysis was performed on all subjects. Between group and limb comparisons were made for initial vertical impact force, loading rate, sagittal plane knee and hip angles as well as moments. Results During walking and running the ACL cohort had significantly greater initial vertical impact force (p=0.002 and p= 0.001), and loading rates (p=0.03 and p= 0.01), as well as a smaller knee extensor moment and hip angle during walking (p=0.000 and p=0.01). There was a trend towards a smaller knee moment and hip angle during running (p=0.08 and p=0.06) as well as a larger hip extensor moment during walking (p=0.06) in the ACL group. No differences were found for hip extensor moment during running, knee angles between groups during walking or running. Lastly, no between limb differences were found for any variable. Conclusion Gait deviations such as elevated impact loading and loading rates do not resolve long term after the individual has resumed previous activity levels and may contribute to the greater risk of early joint degeneration in this population.

IMMPACT meeting and were not employed by industry or government at the time of the meeting received travel stipends, hotel accommodations, and meals during the meeting provided by ACTTION. ACTTION has received research contracts, grants, or other revenue from the FDA, multiple pharmaceutical and device companies, philanthropy, and other sources. Preparation of background literature reviews and the article was supported by ACTTION. No funding from any other source was received for the meeting, nor for the literature reviews and article preparation. No official endorsement by the FDA, US National Institutes of Health, or the pharmaceutical and device companies that have provided unrestricted grants to support the activities of ACTTION should be inferred. SMS has received in the past 36 months a research grant from the Richard W. and Mae Stone Goode Foundation. RHD has received in the past 5 years research grants and contracts from the US Food and Drug Administration and the US National Institutes of Health, and compensation for serving on advisory boards or consulting on clinical trial methods from

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Conditioned pain modulation (CPM) is a phenomenon that may be tested with a dynamic quantitative sensory test that assesses the inhibitory aspect of this pain modulatory network. Although CPM has been adopted as a clinical assessment tool in recent years, the stability of the measure has not been determined over long time intervals. The question of stability over time is crucial to our understanding of pain processing, and critical for the use of this tool as a clinical test. The primary objective of this study was to evaluate the stability of a CPM paradigm over time in healthy women. The secondary objective was to determine the potential influence of menstrual cycle phase on CPM. CPM was assessed 8 times in 22 healthy women during the follicular and luteal phases of 4 different cycles. The CPM effect was evidenced by a reduction in the pain rating of a test stimulus (6.3 ± 0.2) with the introduction of a conditioning stimulus (5.0 ± 0.3; P < 0.001). The intraclass correlation coefficient for the CPM effect was modest (0.39; CI = 0.23-0.59), suggesting that there is significant variation in CPM over long time intervals. CPM did not vary across phases in the menstrual cycle. Prior to the adoption of CPM as a clinical tool to predict individual risk and aid diagnosis, additional research is needed to establish the measurement properties of CPM paradigms and evaluate factors that influence CPM effects.

IntroductionWe evaluated the psychometric properties of the St George’s Respiratory Questionnaire (SGRQ) in patients with idiopathic pulmonary fibrosis (IPF) using data from the two INPULSIS trials.MethodsData from 1061 patients treated with nintedanib or placebo were pooled. Internal consistency, test–retest reliability, construct validity, known-groups validity, responsiveness and responder thresholds were examined.ResultsCronbach’s α was 0.93 for SGRQ total score and >0.75 for domain scores. In patients with stable disease based on change in forced vital capacity (FVC) ≤5% predicted or ‘no change’ on Patient’s Global Impression of Change, intraclass correlation coefficients for the SGRQ total score were 0.72 or 0.76, respectively. Moderate to strong correlations were observed between SGRQ total and domain scores and the Cough and Sputum Assessment Questionnaire cough domains (−0.34 to −0.65), University of California San Diego Shortness of Breath Questionnaire (0.56 to 0.83) and EuroQol 5-Dimensional Quality of Life Questionnaire Visual Analogue Scale (−0.41 to −0.55); correlations with FVC % predicted were weak (−0.24 to −0.30). Longitudinal correlations between changes in SGRQ total score and these patient-reported outcomes over 52 weeks were moderate. Changes in SGRQ total, impact and activity scores were sensitive to detecting improvement or deterioration in FVC >10% predicted at week 52. Collectively, distribution-based and anchor-based approaches suggested using a change of 4–5 points in SGRQ total score as a starting point for responder analyses.ConclusionsThe psychometric properties of the SGRQ support its use as a measure of health-related quality of life in patients with IPF.