A MAPP Network Case-Control Study of Urologic Chronic Pelvic Pain Compared with Non-Urologic Pain Conditions Objectives: Limited research suggests commonalities between urologic chronic pelvic pain syndromes (UCPPS) and other non-urologic chronic overlapping pain conditions (COPCs) including fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome. The goal of this case-control study was to examine similarities and differences between UCPPS and these other COPCs. Methods: As part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network, we examined 1,039 individuals with UCPPS (n=424), non-urologic COPCs (n=200), and healthy controls (n=415). Validated standardized measures were used to assess urological symptoms, non-urological pain symptoms, and psychosocial symptoms and traits. Results: Participants with UCPPS had more urologic symptoms than non-urologic COPCs or healthy controls (P<0.001); non-urological COPC group also had significantly worse urological symptoms than healthy controls (P<0.001). Participants with non-urological COPCs reported more widespread pain than those with UCPPS (P<0.001), yet both groups had similarly increased symptoms of anxiety, depression, negative affect, perceived stress, neuroticism, and lower levels of extraversion than healthy controls (P<0.001). Participants with UCPPS with and without COPCs reported more catastrophizing than those with non-urological COPCs (P<0.001). Discussion: Findings are consistent with the hypothesis of common underlying biopsychosocial mechanisms and can guide the comprehensive assessment and treatment of these conditions regardless of the primary site of pain or diagnosis. Heightened catastrophizing in UCPPS should be examined to inform psychosocial interventions and improve patient care. Acronyms: CFS, chronic fatigue syndrome; CMSI, Complex Multi-Symptom Inventory; COPCs, chronic overlapping pain conditions; CP/CPPS, chronic prostatitis/chronic pelvic pain syndrome; FM, fibromyalgia; HC, healthy control; IBS, irritable bowel syndrome; IC/BPS, interstitial cystitis/bladder pain syndrome; MAPP, Multidisciplinary Approach to Chronic Pelvic Pain; NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases; UCPPS, urological chronic pelvic pain syndrome Conflicts of Interest and Source of Funding: None of the authors have any conflicts of interest to declare. All authors have approved the final article. This research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Multidisciplinary Approach to Chronic Pelvic Pain (MAPP) Research Network grants DK82370, DK82342, DK82315, DK82344, DK82325, DK82345, DK82333, and DK82316. Reprints: Niloofar Afari, PhD, 9500 Gilman Drive, 0737, La Jolla, CA 92093 (e-mail: nafari@ucsd.edu). Received March 31, 2019 Received in revised form September 8, 2019 Accepted September 11, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Increasing Parental Access to Pediatric Pain-Related Knowledge: A Systematic Review of Knowledge Translation Research Among Parents Objectives: Parents can play an integral role in managing their child’s pain, yet many parents remain unaware of evidence-based strategies to support their child during painful experiences. Recent advances in Knowledge Translation (KT) research, which include dissemination and implementation studies, have resulted in programs geared towards parents to offset this knowledge gap. The nature of these programs and degree to which parents find them useful remains unclear. Our goal was to systematically review programs aimed as disseminating and implementing evidence-based pain-related knowledge to parents. Methods: Systematic searches of PubMed, Web of Science, CINAHL, and PsycInfo were completed. Articles in which information was disseminated to parents with the goal of assessing dissemination and implementation outcomes were retained. Information was extracted to identify study characteristics, primary outcomes, and quality of evidence. Results: A total of 24,291 abstracts were screened and 12 articles describing programs were retained. Programs were positively rated by parents in terms of the appropriateness of formats selected, presentation of information, and helpfulness of content. The majority of research has been focused in the area of procedural pain among infants. Although several implementation domains are reported by researchers, certain areas have been overlooked to date, including cost and sustainability of programs. The majority of reports presented with methodological limitations and bias. Discussion: Knowledge translation research in pediatric pain is in its infancy. Development of theories and guidelines to increase the utility and quality of evidence are needed. Conflict of Interest and Sources of Funding: No conflicts of interest are declared. No sources of funding were provided for this project. Reprints: Michelle M. Gagnon, PhD, Department of Psychology, University of Saskatchewan, 9 Campus Drive, Room 164, Saskatoon, SK, Canada (e-mail: michelle.gagnon@usask.ca). Received September 26, 2018 Received in revised form September 5, 2019 Accepted September 11, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Pre-treatment Exercise-induced Hypoalgesia is Associated with Change in Pain and Function after Standardized Exercise Therapy in Painful Knee Osteoarthritis Objectives: Exercise-induced hypoalgesia (EIH), a measure of descending pain inhibitory control, has been found hyperalgesic in subgroups of painful knee osteoarthritis (KOA) patients. The effect of standardized exercise therapy (ET) on clinical pain intensity in KOA has been demonstrated. However, the prognostic value of EIH in KOA patients completing an ET program has not been investigated. This study investigated the prognostic value of EIH on pain relief following ET in KOA patients. Methods: In 24 painful KOA patients (numeric rating scale [NRS, 0-10] ≥3), EIH was assessed as change in pressure pain threshold (PPT) after 2-minute “lateral raises” (2MLR) before and after ET in this observational study. In addition, temporal summation of pain (TSP), clinical pain scores (NRS, Knee injury and Osteoarthritis Outcome Score [KOOS] and PainDETECT [PDQ]) were assessed before and after ET. The KOOS-4 is defined by the KOOS subscale scores for Pain, Symptoms, Activities of daily living, and Quality-of-life and was used as primary outcome. Results: Following ET, all clinical pain scores improved (P<0.01) but no changes in PPT, TSP or EIH were found (P>0.05). Linear regression models identified pre-treatment EIH (beta=0.59, P<0.005) and PDQ (beta=0.57, P<0.005) as independent factors for relative change in KOOS-4 after ET (adjusted R2=46.8%). Discussion: These preliminary and exploratory results suggest that patients with a high EIH response prior to a standardized ET program may be associated with large improvement in pain after treatment. This measure may potentially help clinicians as a prognostic tool for outcome prediction following ET in KOA patients. Conflicts of Interest and Source of Funding: Kristian Kjær Petersen is supported by The Aalborg University Talent Management Program (j.no. 771126). Center for Neuroplasticity and Pain (CNAP) is supported by the Danish National Research Foundation (DNRF121). None of the authors have conflicts of interest to declare. Reprints: Kristian Kjær Petersen, PhD, MSc, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Frederik Bajers Vej 7 D3, DK-9220 Aalborg, Denmark (e-mail: KKP@HST.AAU.DK). Received May 22, 2019 Received in revised form September 10, 2019 Accepted September 17, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Superior Hypogastric Plexus Blocks for Postoperative Pain Management in Abdominal Hysterectomies Objective: To evaluate the efficacy of intraoperative superior hypogastric plexus (SHP) blocks on postoperative pain management in abdominal hysterectomies. Methods: A total of 78 female ASA I-II patients who underwent elective total abdominal hysterectomy for benign reasons were assessed for eligibility. After exclusion of patients who did not fulfil the inclusion criteria, 60 patients were evaluated in 2 groups: patients who had intraoperative SHP block (SHP; n=30), and patients who did not have intraoperative SHP block (No-SHP; n=30). Results: There was no statistically significant difference between the 2 groups in demographic attributes, surgical duration, and length of hospital stay. Opioid requirements in both the post-anaesthesia care unit and gynaecology ward, and non-steroidal anti-inflammatory drug requirements in the ward were statistically significantly higher in the No-SHP group (P<0.05). Rescue analgesic times were found to be significantly longer in the SHP group (627±352.9▒min) (P<0.05). All VAS score assessments were found to be statistically significantly low in the SHP group (P<0.05). No complications related to the SHP blocks were observed. Conclusions: Intraoperative superior hypogastric plexus blocks in abdominal hysterectomies are promising methods for acute postoperative pain management as part of a multimodal analgesia regimen. Although single superior hypogastric plexus blocks provide adequate pain relief and reduce analgesic consumption, these blocks would have better results when used together with somatic nerve blocks, including abdominal wall blocks or wound site infiltrations. Clinical trial registration: NCT03428152. Ahmet Kale and Gulfem Basol: New affiliation: Department of Gynaecology and Obstetrics; University of Health Sciences, Kartal Training and Research Hospital, Istanbul, Turkey. Conflicts of interest: None declared. Funding: None declared. Authors’ contributions and authorship: H.G.A., A.K., G.B., and C.B.: Study design and data analysis; H.G.A., A.K., B.S., and G.B.: Patient recruitment, and data collection; H.G.A., C.B., and T.C. writing up of the first draft of the paper. Conflict of interest: The authors have no conflict of interest. Reprints: Hande Gurbuz Aytuluk, MD, Department of Anaesthesiology and Reanimation; Derince Training and Research Hospital, 41900, Kocaeli, Turkey (e-mail: handegrbz@gmail.com). Received May 8, 2019 Received in revised form August 22, 2019 Accepted September 8, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Less Severe Preoperative Synovitis is Associated with Higher Self-reported Pain Intensity 12 Months After Total Knee Arthroplasty – An Exploratory Prospective Observational Study Objectives: Synovitis is one of the possible pain generators in osteoarthritis (OA) and associated with upregulation of pro-inflammatory cytokines, which can lead to worsening of the postoperative pain. This explorative study aimed to investigate the association between perioperative synovitis and self-reported pain 12-months after total knee arthroplasty (TKA) in patients with OA. Methods: Twenty-six knee OA patients were included in this analysis. Perioperative volume of synovitis in predefined locations was assessed by contrast enhanced magnetic resonance imaging (CE-MRI) and dynamic CE-MRI (DCE-MRI). Perioperative synovitis was assessed histologically from biopsies of the synovium. Highest pain intensity within the last 24-hours (visual analog scale, VAS, 0-100) was assessed before and 12-months after TKA. Patients were divided into a low-pain intensity (VAS≤30) and a high-pain intensity (VAS>30) group based on 12-months postoperative VAS. Results: The high-pain intensity group had significantly lower perioperative CE-synovitis (P=0.025), DCE-synovitis (P<0.04) and a trend towards lower histologically assessed synovitis (P=0.077) compared to the low-pain intensity group. Perioperative synovitis scores were inversely correlated with pain intensity 12-months after TKA (P<0.05), indicating that more severe perioperative synovitis is associated with less severe pain intensity at 12-months. Discussion: Higher degrees of perioperative synovitis scores are found to be associated with less postoperative pain 12-months after TKA. Further, correlation analysis revealed that less severe perioperative CE-MRI and DCE-MRI synovitis was associated with higher pain intensity 12-months after TKA, suggesting that CE and DCE-MRI synovitis grades could be used as imaging markers for prediction of chronic postoperative pain after TKA. Original Paper for: Clinical Journal of Pain. Article Type: Clinical/Basic science research report. The authors declare no conflict of interest. Reprints: Kristian Kjær Petersen, PhD, MSc, Center for Neuroplasticity and Pain (CNAP), Center for Sensory Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7 D3, DK-9220 Aalborg, Denmark (e-mail: KKP@HST.AAU.DK). Received March 12, 2019 Received in revised form August 8, 2019 Accepted September 8, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Impact of Emotional Regulation Strategies On Pain Catastrophizing in the Context of Interpersonal Relationships Objectives: The Communal Coping Model suggests that pain catastrophizing may serve to elicit support from others. What is not known is how emotional regulation, namely emotional inhibition, impacts pain catastrophizing within the context of an interpersonal relationship. Individuals who have a greater tendency to emotionally inhibit may have a greater likelihood to use catastrophizing as a means for seeking support, particularly in relationships characterized by satisfaction and emotional validation. Methods: Data were collected from 50 undergraduate couples at the University of Michigan-Dearborn. Participants were videotaped during completion of an acute pain cold pressor task and completed measures involving pain catastrophizing, emotional inhibition, and relationship dynamics (i.e. AEQ, WBSI, DAS). In addition, the videotaped interactions were coded for both invalidation/validation and overt expressions of pain catastrophizing. Results: Emotional inhibition, and both validation and invalidation, were associated with pain catastrophizing. Observed validation and invalidation were not, however, directly associated with relationship satisfaction. Hierarchical linear regression showed a significant interaction between thought suppression and relationship satisfaction to predict pain catastrophizing. Discussion: Results show relationship satisfaction moderates the association between pain catastrophizing and thought suppression in a manner in which couples with high levels of relationship satisfaction who also engage in thought suppression are more likely to use pain catastrophizing as a cognitive strategy to elicit support. This study offers direction into treatment, and suggests that couples based cognitive-behavioral treatments that aim to utilize adaptive cognitive and behavioral coping strategies as well as emotional exploration and validation may be beneficial. The authors declare no conflict of interest. Reprints: Michelle Leonard, PhD, Department of Behavioral Sciences, University of Michigan-Dearborn, 4901 Evergreen Road, Dearborn, MI 48128 (e-mail: mtleon@umich.edu). Received December 5, 2018 Received in revised form July 25, 2019 Accepted August 30, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Acute Pain Assessment in Prematurely Born Infants Less Than 29 Weeks: A Long Way to Go Objectives: Neonates born extremely prematurely are at high risk of acute and prolonged pain. Effective treatment requires reliable pain assessment, which is currently missing. Our study explores if existing pain assessment tools and physiological indicators measure pain and comfort accurately in this population. Methods: We prospectively collected data in 16 neonates born less than 29 weeks gestational age during three conditions: skin-to-skin care, rest and heelstick procedure for capillary blood sampling in the incubator. The neonates were video recorded in these situations and recordings were coded using five observational pain assessment tools and numeric rating scales for pain and distress. We simultaneously collected heart rate, respiratory rate, arterial oxygen saturation, regional cerebral oxygenation and number of skin conductance peaks. All measures across the three conditions were compared using general linear modeling. Results: The median gestational age was 27.1 weeks (range 24.1 to 28.7). Forty measurement periods across the three conditions were analyzed. Heart rate was significantly higher during heelstick procedures compared to during rest with a mean difference of 10.7 beats/minute (95% CI 2.7 to 18.6). Oxygen saturation was significantly higher during skin-to-skin care compared to during heelstick procedures with a mean difference of 5.5% (95% CI 0.2 to 10.8). The Premature Infant Pain Profile-revised (PIPP-R) score was significantly higher during heelstick procedures compared to skin-to-skin care with a mean difference of 3.2 points (95% CI 1.6 to 5.0). Discussion: Pain measurement in clinical practice in prematurely born infants <29 weeks remains challenging. The included behavioral and physiological indicators did not adequately distinguish between a painful situation, rest and skin-to-skin care in premature neonates. Acknowledgements: Ko Hagoort is thanked for editorial assistance. Conflicts of Interest and Source of Funding: None declared. Reprints: Naomi Meesters, RN, MSc, Erasmus MC-Sophia Children’s Hospital, Department of Pediatrics, Division of Neonatology Wytemaweg 80, 3015 CN Rotterdam, the Netherlands (e-mail: n.meesters@erasmusmc.nl). Received January 14, 2019 Received in revised form July 23, 2019 Accepted August 27, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Under Pressure to Perform: Impact of Academic Goal Orientation, School Motivational Climate, and School Engagement on Pain and Somatic Symptoms in Adolescents Objectives: Various academic factors are known to influence pain and somatic symptoms in adolescents, but the role of academic goal orientation, school motivational climate, and school engagement are unknown. This study examined how these understudied academic factors are associated with adolescent pain and somatic symptoms and whether gender moderates the relations. Methods: High school students (n=90) from a high-achieving community completed questionnaires assessing academic variables, various pain characteristics, and somatic symptoms. Results: The majority of adolescents (67%) experienced pain and somatic symptoms in the past month, with 56% reporting multisite pain and 58% reporting at least one severe somatic symptom. Headache and abdominal pain were the most frequently reported “most bothersome” pains, and pain was rated, on average, as moderately severe, typically occurring several times per month, and was primarily chronic in nature (duration ≥3▒mo). Higher levels of ego goal orientation and perceived performance motivational climate were associated with more somatic symptoms, and ego goal orientation was also associated with more intense and frequent pain. Alternatively, greater school engagement was associated with fewer somatic symptoms. Task goal orientation and mastery motivational climate were unassociated with all pain and somatic symptom outcomes. Discussion: This study demonstrates that adolescents from a high-achieving community report more somatic symptoms and pain when they are less engaged in school and when their academic focus is on grades and outperforming peers. Results suggest that de-emphasizing competition and performance outcomes may support physical well-being in adolescents. Disclosures: There are no conflicts of interests to disclose for any of the above listed authors. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Reprints: Edin T. Randall, PhD, 9 Hope Ave, Waltham, MA 02453 (e-mail: edin.randall@childrens.harvard.edu). Received February 28, 2019 Received in revised form July 11, 2019 Accepted August 27, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Co-occurrence of Pediatric Chronic Pain and Anxiety: A Theoretical Review of a Developmentally Informed Shared Vulnerability Model The development and maintenance of pediatric chronic pain and anxiety are complex, underscoring the need to better understand the interactive forces contributing to their co-occurrence. The Shared Vulnerability Model (SVM) was developed to explain the co-occurrence of chronic pain and posttraumatic stress disorder in adults. Though many core tenets have been well supported by pediatric research, the SVM has yet to be extended to pediatric pain populations. We propose a developmentally informed pediatric SVM for advancing our understanding of the co-occurrence of pediatric chronic pain and anxiety disorders. The proposed SVM postulates that youth at increased risk for the development of chronic pain and/or anxiety share predisposing vulnerabilities, including anxiety sensitivity, and that these shared vulnerabilities give rise to negative emotional responses (child and parent) in the context of stressful events. Consequences of fear and anxiety, including avoidance behavior, further contribute to the development of chronic pain, anxiety, and their co-occurrence. The parental, school, and peer contexts in which these problems develop and are maintained in youth are pertinent to integrate into a SVM, as pediatric chronic pain and anxiety disorders share several social-contextual risk and maintenance factors. We also highlight new areas of inquiry. This work was conducted at the University of Cincinnati, Cincinnati OH. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The author reports no conflicts of interest. Reprints: Kristen E. Jastrowski Mano, PhD, Department of Psychology, University of Cincinnati, 5130D Edwards One, ML 0376, Cincinnati, Ohio 45221-0376 (e-mail: manokn@ucmail.uc.edu). Received March 13, 2019 Received in revised form August 10, 2019 Accepted August 27, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Relation between Patients’ Beliefs about Pain Medication, Medication Adherence and Treatment Outcome in Chronic Pain Patients: A Prospective Study Objectives: Non-adherence to prescribed pain medication is common in chronic non-malignant pain patients. Beliefs about pain medication have been reported to be associated with non-adherence behaviour in cross-sectional studies. The aim of this study was to prospectively investigate the relation between patients’ beliefs about pain medication and their medication adherence and treatment outcome. Methods: Chronic non-malignant pain patients completed a baseline questionnaire including the 47-item Pain Medication Attitudes Questionnaire (PMAQ), consisting of seven subscales regarding beliefs on prescribed medication. After 11 weeks, medication underuse and overuse were assessed by self-report. In addition, patient satisfaction regarding the effect of prescribed pain medication and satisfaction regarding prescribed medication and care, and the burden of side effects were assessed. Results: One hundred thirty three participants completed the baseline questionnaire, and 99 patients completed the follow-up questionnaire. Concerns over side effects at baseline were positively associated with underuse and the presence of side effects after 11 weeks. Perceived need was positively associated with overuse, whereas concerns over addiction were negatively associated with overuse. Concerns over tolerance were negatively associated with patient satisfaction with medication effects after 11 weeks. Concerns over tolerance and mistrust in the prescribing doctor were negatively associated with satisfaction about medication and care. Conclusion: Attitudes and concerns towards pain medication are associated with adherence patterns and outcome parameters. In order to improve medication adherence and therapy outcome, patient beliefs about pain medication should be taken into account by providing tailored education, adequate follow-up or alternate therapy. Declaration of funding: none. Conflicts of interest: none. Reprints: Leon Timmerman, PhD, St Antonius Hospital, Department of Anesthesiology, Intensive Care and Pain Medicine, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands (e-mail: l.timmerman@antoniusziekenhuis.nl). Received February 12, 2019 Received in revised form August 2, 2019 Accepted August 29, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.