Jenna L. Adamowicz

Objective: To examine the prevalence of co-occurring chronic overlapping pain conditions (COPCs) and utilization of recommended treatments for the management of fibromyalgia among veterans served by the US Department of Veterans Affairs (VA) healthcare system. Methods: Data from the Veterans Health Administration Corporate Data Warehouse were derived from a cohort diagnosed with fibromyalgia. Sociodemographic and clinical characteristics and the presence of 9 COPCs were examined. Commonly recommended treatments for the management of fibromyalgia were assessed across 2 domains: nonpharmacological and pharmacological. Multimodal treatment engagement was also examined. A series of logistic regressions was used to assess the impact of sex on treatment engagement, in both unadjusted models and models adjusted for sociodemographic and clinical characteristics. Results: The 30 462 veterans were majority female (58.9%), White (68.3%) and 45 to 64 years old (55.0%). Women were more likely than men to be diagnosed with a co-occurring COPC (adjusted odds ratio [aOR]: 1.17, 95% confidence interval [CI]: 1.11–1.23). Women were more likely to engage in physical therapy, psychotherapy, or any complementary approaches (aOR range: 1.28–1.52). Women were also more likely than men to be prescribed cyclobenzaprine (aOR: 1.36, 95% CI: 1.28–1.45) and less likely than men to be prescribed pregabalin (aOR: 0.80, 95% CI: 0.75–0.85). Although women were more likely to engage in multimodal treatment (aOR: 1.29, 95% CI: 1.19–1.40), overall rates for both women and men were between 9% and 12%. Conclusions: Although women veterans with fibromyalgia were more likely than men to receive nonpharmacological treatments, overall receipt rates for these approaches were low in both women and men. Future work in this area is needed to examine potential barriers to access and engagement.

Importance: Mindfulness meditation is an evidence-based therapy for chronic pain for which some have explored possible mechanisms of action. However, these mechanisms can vary widely depending on the mindfulness-based intervention (MBI). Objective: To study possible mechanisms of action of 2 similar MBIs for pain. Design: We used data from our learning to apply mindfulness to pain (LAMP) pragmatic randomized controlled trial comparing usual care with virtual group or self-paced MBIs. The LAMP MBIs included education on adaptive pain behaviors and mindfulness and used shorter, less formal mindfulness practice than standard MBIs. We examined whether mindfulness, pain self-efficacy, pain catastrophizing, and stress mediated the treatment effects on 2 pain and 7 pain-related biopsychosocial outcomes at 10 weeks and 6 months using mediation models. Results: The MBIs improved pain catastrophizing, pain self-efficacy, and mindfulness but did not affect perceived stress. Pain catastrophizing and pain self-efficacy had large mediating effects between the MBIs and pain interference, pain intensity, physical functioning, social functioning, anxiety, fatigue, sleep disturbance, depression, and post-traumatic stress disorder. mindfulness also mediated the above relationships with smaller effects between MBIs and all outcomes except for pain interference, pain intensity, physical functioning, and social functioning. Conclusions: Reduced pain catastrophizing and increased pain self-efficacy were apparent mechanisms of action improving pain interference, pain intensity, and other biopsychosocial outcomes in our MBIs, whereas increased mindfulness was the apparent mechanism of action improving psychological and sleep-related outcomes. This study improves our understanding of mechanisms by which MBIs can affect pain and important pain-related outcomes. Study registration and analytic plan registration: clinicaltrials.gov. Identifier: NCT04526158.

Although myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) symptoms (dysautonomia, dizziness, balance impairments) may theoretically contribute to an association with concussion, the nature of this association has not been determined. This study explored the association between ME/CFS and concussion, as well as risk factors for concussion, history of recent falls, and feelings of being dizzy or off balance. 2023 National Health Interview Survey data were utilized. United States adults (unweighted N = 29,373) responded to items regarding sociodemographic factors, ME/CFS status, and history of concussion, falls, and feeling off balance or dizzy. Logistic regression analyses assessed the association between ME/CFS and concussion, falls, and feeling dizziness or balance problems within the past year, adjusting for sociodemographic factors. Individuals with ME/CFS had 4.89 times greater odds of reporting concussion in the past year compared to individuals without ME/CFS. Individuals with ME/CFS also had 2.86 times greater odds of having fallen within the past year and 5.88 times greater odds of reporting feeling dizzy or off balance in the past year. ME/CFS status may be associated with concussion status. Healthcare practitioners should improve concussion screening and referrals for reducing concussion risk among individuals with ME/CFS.

Background: Chronic overlapping pain conditions (COPCs) are a constellation of disorders posited to share an underlying pain mechanism (nociplastic pain). Unfortunately, individuals with COPCs are under‐represented in clinical research. The current study aimed to determine COPC prevalence among participants enrolled in a pragmatic clinical trial and compare those with COPCs to those with non‐COPCs across several domains. Methods: Learning to Apply Mindfulness to Pain (LAMP) study baseline data of veterans with chronic pain ( N = 811) were utilised. COPC diagnoses were determined using ICD‐10 codes within electronic health records. Group differences across pain and functioning‐related domains were compared with and without adjustment for age and gender. Results: Among participants with COPCs (54%), most were diagnosed with only one COPC (74%). Chronic lower back pain (71%) and migraine (28%) were the most common. Participants with COPCs were younger and more likely to be female relative to those with non‐COPCs. The COPC subset was also more likely to be diagnosed with PTSD, depressive disorders and sleep disorders ( p < 0.05). Those with COPCs also reported greater pain severity and interference, more impaired health‐related quality of life, greater pain catastrophising and lower pain self‐efficacy than participants without COPCs ( p < 0.05). Conclusions: COPCs were common among a sample of veterans in a pragmatic clinical trial. Several baseline differences emerged indicating veterans with COPCs experience greater mental health concerns and endorse distinct pain characteristics and pain mediators. Future research is needed to further characterise this recently defined and under‐represented group. Significance Statement: Individuals with COPCs are medically complex, yet are understudied and underrepresented within pain trials research. COPCs, which predominantly impact women, are also understudied within U.S. veterans. Our findings highlight how veterans with COPCs are participating in clinical research even when interventions are not tailored to their unique characteristics. Our work also contributes to a nuanced understanding of this disease burden and is among the first to describe differences among veterans with COPCs and veterans with chronic pain but without COPCs.

Cognitive impairments, including memory and concentration difficulties, are common in individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID. These conditions frequently co-occur, but it remains unclear how cognitive difficulties differ between individuals with ME/CFS, long COVID, both, or neither. The purpose of this study was to examine cognitive impairment presence and type for individuals with and without these conditions. Data from the 2022 and 2023 National Health Interview Survey were analyzed. Participants included 27,512 and 29,404 U.S. adults in 2022 and 2023, respectively. Survey weights and variance estimation variables were utilized and multivariate logistic regression models assessed the likelihood of cognitive difficulty, accounting for sociodemographics and shared variance. Participants from both cohorts were primarily female, white, and non-Hispanic/Latine, with an average age of 48.1 years in both cohorts. ME/CFS (aOR 6.18; 95% CI 4.82–7.93; aOR 5.33; 95% CI 4.04–7.05) and long COVID (aOR 2.01; 95% CI 1.67–2.44; aOR 2.16; 95% CI 1.82–2.56) were significantly associated with reported cognitive difficulties, after controlling for the other condition and sociodemographic factors. Individuals with ME/CFS, particularly those with comorbid long COVID, are especially prone to memory and concentration difficulties.