Tailoring Individualized Evaluation of Pediatric Abdominal Pain Using Ecological Momentary Assessment (EMA): A Pilot Study Testing Feasibility and Acceptability Objective: The current study aimed to determine if it was feasible and acceptable to use ecological momentary assessment (EMA) to assess individual associations between biopsychosocial contributors to chronic abdominal pain with two objective sensors and a mobile application. Specifically, we aimed to determine if it was possible to identify individualized associations between idiopathic pain associations. The goal is to determine if idiographic profiles have clinical value while the field works torward consensus about nomothetic trends. Methods: Participants included 30 pediatric chronic abdominal pain patients, aged 8-17, who wore a physiological monitor and accelerometer that measured sleep and physical activity and answered four surveys per day on an app over the course of a 14-day study period. Results: Results indicated that participants were 96.2% and 95.5% compliant to the wrist-worn accelerometer measuring sleep and physical activity, respectively. Participants completed 76.3% of expected surveys and were least adherent to the physiological monitor (37.9%). Additionally, it was possible to generate 24 (80%) personalized reports describing unique associations with pain for participants in the study. Discussion: Findings provide initial support for the use of EMA over a two-week period to inform and create personalized profiles for improved clinical care in this population. This work was supported by a grant from the Katherine B. Richardson Foundation. There are no conflicts of interest. Reprints: Christopher C. Cushing, PhD, Clinical Child Psychology Program, University of Kansas, 2015 Dole Human Development Center, Lawrence, KS, 66045 (e-mail: christopher.cushing@ku.edu). Received February 28, 2019 Received in revised form July 5, 2019 Accepted July 23, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

A Distorted Body Schema and Susceptibility to Experience Anomalous Somatosensory Sensations in Fibromyalgia Syndrome Objectives: Evidence suggests there to be an association between chronic pain and disruption of the body schema. We tested the hypothesis in fibromyalgia syndrome. Methods: We investigated distinct perceptual aspects of the body schema both in a sample of patients with FMS and in healthy controls. Performances on the left/right judgment task were measured; tactile acuity was assessed by using the two-point discrimination test. Furthermore, we evaluated sensations evoked by tactile stimulation with Von Frey filaments to body parts which were experiencing pain. Anomalous sensations elicited by sensory-motor conflict also were investigated. Results: Subjects with FMS showed inferior performance on the right/ left judgment task, both in terms of correct matches (75.38% vs. 89.67%, respectively; P<0.05) and response time (2.58 s vs. 1.89 s, respectively; P<0.05). Effect sizes were large and very large, respectively. Two-point discrimination thresholds were significantly higher (P<0.05) in participants from the FMS sample (mean of 49.71▒mm, SD 12.09▒mm) relative to healthy controls (mean of 37.36▒mm , SD 7.81▒mm). Nine out of fourteen participants with FMS, but no control subjects, reported referred sensations upon tactile stimulation, including tingling, pins and needles, weight, and cramps. Referral sites included regions both adjacent and remote to stimulated sites. Subjects with FMS scored higher across all items within the administered questionnaire addressing anomalous sensations on the mirror set-up (Cohen’s d 1.04-2.42 across all items) and FMS subjects perceived pain during the sensory-motor conflict (the required statistical power for it to be statistically significant was 96% and for it to be recognized as a difference of means in pain item). Conclusion: Our present findings suggest a disrupted body schema and propensity to experiencing anomalous somatosensory sensations during sensory-motor conflict in people suffering from FMS. Original article: Clinical investigation Funding: This work was supported by the Basque Government (Euskal unibertsitate-sistemako ikerketa-taldeen jarduerak bultzatzeko diru-laguntzak, GIC15/25) and the University of the Basque Country UPV/EHU (PPG17/06). AUTHOR CONTRIBUTIONS: All authors contributed equally to this paper and all authors discussed the results and commented on the manuscript. Funding supported by the Basque Government (Euskal unibertsitate-sistemako ikerketa-taldeen jarduerak bultzatzeko diru-laguntzak, GIC15/25) and the University of the Basque Country UPV/EHU (PPG17/06). Disclosure statement: All authors declared no conflicts of interest. Reprints: Itsaso Buesa, PhD (e-mail: itsaso.buesa@ehu.eus). Received March 29, 2019 Received in revised form June 29, 2019 Accepted July 27, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Relation Between Level of Catastrophizing and Mental Health Comorbidity in Individuals with Whiplash Injuries Objectives: Pain catastrophizing has been shown to be correlated with measures of mental health problems such as depression and PTSD. However, the clinical implications of findings reported to date remain unclear. To date, no study has been conducted to determine meaningful cut-scores on measures of catastrophizing indicative of heightened risk of mental health comorbidity. One objective of the present study was to identify the cut-score on the Pain Catastrophizing Scale (PCS) indicative of heightened risk of the comorbidity of depression and PTSD. A second objective was to determine whether mental health comorbidity mediated the relation between catastrophizing and occupational disability. Methods: The sample consisted of 143 individuals with whiplash injuries. Pain severity, pain catastrophizing, depression, and post-traumatic stress symptoms were assessed following admission to a rehabilitation program. Mental health comorbidity was operationally defined as obtaining a score above clinical threshold on measures of depressive and/or post-traumatic stress symptom severity. Results: A ROC curve analysis revealed that a PCS score of 22 best distinguished between participants with and without mental health comorbidity. Results also revealed that mental health comorbidity mediated the relation between catastrophizing and occupational disability. Discussion: The findings suggest that a score of 22 or greater on the PCS should alert clinicians to the possibility that patients might also be experiencing clinically significant symptoms of depression or PTSD. Greater attention to the detection and treatment of mental health conditions associated with whiplash injury might contribute to more positive recovery outcomes. Sources of financial support: This research was supported by funds from the Canadian Institutes for Health Research (CIHR), and the Canada Research Chairs program. The authors have no financial interest in the results of this research. Name of institutional review board: This study was approved by the ethics review board of McGill University. Acknowledgments: The authors thank Elena Bernier for her assistance in data collection and data entry. The authors declare no conflict of interest. Reprints: Michael J.L. Sullivan, PhD, Department of Psychology, McGill University, 2001 McGill College, Montreal, Quebec, H3A 1G1 (e-mail: Michael.Sullivan@McGill.ca). Received April 2, 2019 Received in revised form July 20, 2019 Accepted July 27, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Couple Interventions for Chronic Pain: A Systematic Review Objective: Couple interventions for chronic pain have been shown to more effectively reduce pain intensity for individuals with chronic pain (ICPs) than individual behavioral interventions or usual care. This systematic review identifies randomized controlled trials (RCTs) of couple interventions to highlight strategies that could be incorporated into psychotherapy with ICPs and their romantic partners. Methods: We identified articles reporting RCTs of couple interventions for chronic pain. Three databases were searched (i.e., PubMed, Embase, and PsycInfo), resulting in 18 studies and 22 articles. Results: Couple interventions resulted in statistically significant improvements in pain intensity compared to other conditions in 8-40% of the studies, as well as in statistically significant improvements on a pain-related outcome compared to other conditions in 31-50% of the studies. Educating couples about pain was the most common strategy (83%). Jointly administered relaxation or meditation skills were included in nearly half of the interventions (48%). Many interventions taught cognitive behavioral skills jointly to couples (39%) or to the ICP with partner encouragement (30%). Teaching couples how to request and provide assistance (30%), as well as encouraging partners to avoid reinforcing pain behaviors (39%), occurred frequently. ICPs and their partners were often asked to set goals (30%). Discussion: This review outlines strategies included in couple interventions for chronic pain which are derived from the cognitive behavioral therapy, acceptance and commitment therapy, and operant-behavioral traditions, but delivered relationally. Therapists working with ICPs and their partners may integrate these strategies into their practice to help couples who are managing chronic pain. Conflict of interest: The authors do not have conflicts of interest related to the content of this review. Reprints: Shannon M. Smith, PhD, University of Rochester Medical Center, 601 Elmwood Ave, Box 604, Rochester, NY 14642 (e-mail: shannon1_smith@urmc.rochester.edu). Received February 28, 2019 Received in revised form June 12, 2019 Accepted July 27, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Interdisciplinary Pain Neuroscience Continuing Education in the Veteran’s Affairs: Live Training and Live-Stream with 1-year Follow-up Objective: Because of the pain and opioid epidemic in the United States, there is a need to update clinician’s knowledge, attitudes, and beliefs regarding persistent pain across healthcare disciplines. The aim of this study was to determine if healthcare professionals can positively change their knowledge, attitudes, and beliefs regarding chronic pain, following a pain neuroscience education (PNE) lecture and one year follow-up. Methods: 270 healthcare providers at the Minneapolis Veteran’s Affairs (VA) received a 3.5-hour PNE lecture in person or via live-stream. Primary outcomes were the Neurophysiology of Pain Questionnaire (NPQ) and Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) measured before, immediately after, and 1-year after the PNE lecture. At 1 year participants were also asked how the PNE lecture affected their practice. Results: Pain knowledge (NPQ) (P<0.01) and attitudes and beliefs regarding persistent pain (HC-PAIRS) (P<0.01) improved for all providers, with specific improvements across several disciplines. Positive gains in outcomes were equal for in-person attendance, and live-streaming of the lecture. One year later, NPQ and HC-PAIRS gains diminished, yet clinicians reported a large positive impact on daily clinical practice. Discussion: PNE resulted in a positive clinical impact for healthcare providers treating patients with persistent pain. The mechanism of this effect may be about healthier attitudes and beliefs regarding persistent pain rather than increased knowledge about pain. Sources of support : None. Conflicts of interest : None. Reprints: Adriaan Louw, PT, PhD, International Spine and Pain Institute, PO Box 232, Story City, IA 50248 (e-mail: adriaan@ispinstitute.com). Received May 14, 2019 Received in revised form August 2, 2019 Accepted August 6, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Cognitive and Personality Factors Implicated in Pain Experience in Women with Endometriosis: A Mixed Method Study Objective: The impact of pain on quality of life and mental health of women with endometriosis is well-known. However, the role that personality traits and coping strategies might have in influencing pain experience is still poorly understood and was the chief purpose of this study. Methods: We conducted a mixed-method sequential explanatory study, composed by a quantitative survey followed by qualitative interviews. The first quantitative phase included 162 women with endometriosis which completed a battery of validated questionnaires. After statistical analysis, a semi-structured qualitative interview has been developed and conducted with six of them in order to help explain findings obtained in the first phase. Then, both analyses were combined in a meta-matrix. Results: From meta-matrix emerged that acute pain experience, fear of its occurrence, its unpredictability, and control difficulties are the main concerns of women with endometriosis. Worry trait characteristics (i.e. the need for control, anticipatory anxiety, intrusive worry thoughts) and maladaptive thoughts as coping strategies (i.e. self-blame, rumination, catastrophizing) were common in this sample and seem to indirectly affect pain experience. Indeed, the unsuccessful struggle in controlling pain reinforces negative thoughts/beliefs and feelings of powerlessness, leading, in turn, to psychological distress and higher pain experience. Discussion: From the study emerged a model of onset and maintenance of acute pain in women with endometriosis. Findings have clinical implications for the medical team and psychologists. Conflicts of Interest and Source of Funding: None. Reprints: Cristina Zarbo, MA, University of Bergamo, Bergamo, Lombardia ITALY (e-mail: cristina.zarbo@unibg.it). Received February 20, 2019 Received in revised form July 24, 2019 Accepted August 6, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Sensory Function and Pain Experience in Arthritis, Complex Regional Pain Syndrome, Fibromyalgia Syndrome and Healthy Volunteers: A Cross-sectional Study Objectives: This study aimed to identify relationships between sensory function and pain in common pain conditions (Arthritis, Complex Regional Pain Syndrome (CRPS) and Fibromyalgia Syndrome (FMS)) and healthy participants. Sensory abnormalities are known to be concomitant with some types of chronic pain but comparison across pain conditions using existing research is difficult due to methodological differences. Pragmatic Quantitative Sensory Testing (QST) methods were used. Methods: Hot and cold sensitivity, light touch threshold (LTT), two-point discrimination (TPD) and pressure pain threshold (PPT) were assessed in 143 participants (n=37 Healthy, n=34 Arthritis, n=36 CRPS, n=36 FMS). Outcomes were assessed in the index (“affected” or right) and contralateral arm. Participants also completed the Brief Pain Inventory and McGill Pain Questionnaire. Results: There were statistically significant differences between groups for all QST outcomes except TPD. Relative to healthy participants, FMS displayed heat hyperesthesia in both arms and cold hyperesthesia in the contralateral arm. CRPS demonstrated no changes in thermal sensitivity. Both CRPS and FMS exhibited bilateral pressure hyperalgesia. LTT hypoesthesia was observed bilaterally for CRPS but only in the contralateral arm for FMS. CRPS and FMS had pressure hyperalgesia in the index arm relative to Arthritis patients. There were no differences between Arthritis and Healthy participants for any QST outcome. In CRPS there were significant correlations between LTT and pain outcomes bilaterally. Discussion: People with FMS and CRPS demonstrate extensive sensory dysfunction. Arthritis patients had sensory profiles closer to healthy participants. LTT may provide a clinically relevant and accessible assessment for CRPS. Address for reprints: as above. Sources of support: C McCabe was funded by a National Institute for Health Research Career Development Fellowship (CDF/2009/02). This paper presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Acknowledgements: The research team would like to thank Lindsay Davies for her administrative support for the project. The authors declare no conflict of interest. Reprints: Shea Palmer, PhD, University of the West of England, Glenside Campus, Blackberry Hill, Bristol BS16 1DD (e-mail: Shea.Palmer@uwe.ac.uk). Received March 12, 2019 Received in revised form July 5, 2019 Accepted July 27, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

A Subgroup of Chronic Low Back Pain Patients with Central Sensitization Background: Our knowledge of central sensitization (CS) in chronic low back pain (CLBP) is limited. 2011 fibromyalgia criteria and severity scales (2011 FM survey) has been used to determine FM positive as a surrogate of CS. The major features of CS including widespread hyperalgesia and dysfunction of the descending inhibitory pathways can be identified by pressure pain threshold (PPT) and conditioned pain modulation (CPM) tests. The purpose of the study was to examine neurophysiological characteristics and psychosocial symptoms in a subgroup of FM positive CLBP compared to FM negative CLBP patients. Methods: 46 participants with CLBP and 22 healthy controls completed outcome measures of the 2011 FM survey, PPT and CPM tests, and psychosocial questionnaires. Differences between FM positive and FM negative CLBP participants on these measures and correlations were analyzed. Results: The 2011 FM survey identified 22 (48%) participants with CLBP as FM positive. FM positive CLBP participants showed lower PPT values of the thumbnail (P=0.011) and lower back (P=0.003), lower CPM values of the thumbnail (P=0.002), and more severe pain catastrophizing, anxiety and depression symptoms (P<0.05) than FM negative CLBP participants. The 2011 FM scores were significantly correlated with the PPT and CPM values of the thumbnail and with psychosocial symptoms (P<0.001). Discussion: Our findings suggest a subgroup of CLBP patients exhibiting with signs and symptoms of CS. Associations between subjective and objective CS measures indicate that the 2011 FM survey can be utilized to identify the presence of CS in CLBP in clinical practice. Author contributions: Study concept, design, and protocol development: KA, DC and NS. Data collection and statistical analyses: KA. Interpretation of the data and drafting of the manuscript: KA, JH and NS. Discussion of the results, revising the drafts and final approval of the manuscript: All authors. Conflict of interest disclosure and source of funding: The authors have no conflict of interest to declare. This work was partially supported by the T32 Program (T32HD057850; PI: Randolph Nudo) to Andrew D and J Vaughan and by the Department of Physical Therapy and Rehabilitation Science to NK Sharma. A Nicol has received research funding from National Institute of General Medical Sciences of the National Institutes of Health (NIH #K23GM123320) and served as a consultant for Heron Therapeutics and on an advisory board of Sandoz International. Reprints: Neena Sharma, PT, PhD, 3901 Rainbow Blvd, Kansas City, KS 66160 (e-mail: nsharma@kumc.edu). Received March 13, 2019 Received in revised form June 13, 2019 Accepted July 27, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Letter to the Editor in Response to “The Impact of Female Chronic Pelvic Pain Questionnaire (IF-CPPQ)”: A Validation Study No abstract available

Comparison of Effectiveness of Etoricoxib and Diclofenac On Pain and Perioperative Sequelae After Surgical Avulsion of Mandibular Third Molars: A Randomized, Controlled, Clinical Trial Objectives: The objective of this analysis was to compare the efficacy of etoricoxib and diclofenac in the management of perioperative sequelae following impacted mandibular third molar surgery. Materials and Methods: Ninety-seven patients who needed surgical avulsion of an impacted mandibular third molar were chosen for the study. All patients were randomly allocated to receive one of the following treatments, twice a day for 5 days after surgery: placebo (n=33), diclofenac (n=32), or etoricoxib (n=32). The primary outcome evaluated was postoperative pain, recorded by each patient and evaluated using the visual analogue scale (VAS) score. The secondary outcomes chosen were, compared to preoperative ones, changes in postoperative swelling and maximum mouth opening. Results: Compared to placebo, treatment with etoricoxib and diclofenac determined an enhancement in the primary outcome. Furthermore, when compared to the other groups, patients which undergone etoricoxib presented a significant median reduction in postoperative pain at 2 hours (P<0.001), 12 hours (P=0.025), and at 48 hours (P=0.018) after surgery. Moreover, the linear regression analysis showed that diclofenac and etoricoxib determined a significant influence on VAS at 2,6,12,24,48 hours and at 10 days after surgery. There were no differences in swelling and maximum mouth opening values between groups. Discussion: This study demonstrated that both treatment were effective. However, treatment with etoricoxib determine a better decrease in the incidence and severity of postoperative pain following third molar surgery compared to diclofenac and placebo. Sources of support: This work was carried out with funding from the Department Department of General Surgery and Surgical-Medical Specialties of the University of Catania. Funding: This work was carried out with funding from the Department of Biomedical, Odontostomatological Sciences and of Morphological and Functional Images of the University of Messina. Ethical approval: This study followed the Declaration of Helsinki on medical protocol. The Institutional Review Board of the University of Messina approved the study protocol (#35-17). Patient consent: Written informed consent was obtained from the patient for publication. Author Contributions: G.I. and G.M. conceived the idea of the work, and planned and performed the experimental procedures. AA performed the statistical analysis. G.I., M.M., D.D., E.P. and E.R. analysed and summarized the experimental results. G.I. wrote the paper. Competing interests: The authors declare that they have no conflict of interest or other benefits in the manuscript. Reprints: Gaetano Isola, DDS, PhD, Pg. Oral Surg., Department of General Surgery and Surgical-Medical Specialties, University of Catania. Via Plebiscito 628, 15a Building, Catania, 95124 Italy (e-mail: gaetano.isola@unict.it). Received January 24, 2019 Received in revised form June 25, 2019 Accepted July 14, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.