Emily P. Rabinowitz

Women with Chiari malformation (CM), a congenital physical disability associated with significant chronic pain, frequently experience functional difficulties and depression. This study examined whether chronic pain acceptance, defined as the ability to acknowledge unpleasant sensations without attempting to alter or avoid them, mediates the association between functional difficulties and depression symptoms. This study included a baseline and 1-month follow-up assessment of 100 women with CM. At baseline, participants completed the interference subscale of the Brief Pain Inventory, the Instrumental Activities of Daily Living scale, and the Chronic Pain Acceptance Questionnaire; at 1-month follow-up, participants completed the depression subscale of the 21-item version of the Depression, Anxiety, and Stress Scale. Mediation analyses were conducted using maximum likelihood estimation with missing values. Chronic pain acceptance fully mediated the relationship between Instrumental Activities of Daily Living scores and depression symptoms, accounting for 76% of the total effect (b = 0.87, SE = 0.28, p = .002). Chronic pain acceptance partially mediated the relationship between pain interference and depression symptoms, accounting for 29% of the total effect (b = 0.71, SE = 0.30, p = .02). Chronic pain acceptance may be one possible modifiable mechanism linking functional difficulties and pain interference to depression symptoms among women with CM, suggesting that interventions targeting chronic pain acceptance may reduce depression risk in this population. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Chiari malformation Type I (CMI) is a chronic pain syndrome associated with an increase in disability. However, little is known about the relationship between pain and disability among CMI patients. Using a web-based study of 372 adults diagnosed with CMI, we examined pain catastrophizing along with self-reported pain, head and neck disability, loneliness, depression, anxiety, and stress. Our primary analytic method was statistical mediation. Pain catastrophizing was positively correlated with self-reported pain, depression, anxiety, and disability. Finally, pain catastrophizing (rumination and helplessness subscales) mediated the relationship between Pain scores and Disability scores in this sample of CMI patients. Our findings are that pain catastrophizing mediates the effect of pain on disability—but depression does not. The importance of pain catastrophizing in explaining the relationship between pain and disability may provide new insight into more effect treatments for chronic pain and disability in CMI.

Episodic memory is contextual memory linking temporal, spatial, emotional, and self-referential contexts. In this review, we placed particular emphasis on the emotional context because of its nexus with chronic pain effects. Psychological (e.g., depression, anxiety, stress, & loneliness) and medical (neurological, cardiovascular, chronic pain) conditions can adversely affect episodic memory. Furthermore, individual differences in emotional/affective experience as represented by trait personality variables (e.g., conscientiousness, openness to experience, introversion, extraversion, and neuroticism) can either facilitate or harm episodic memory performance. This paper aims to review episodic memory, its associated attention and executive function co-processes, the modulation of memory function as a result of affective experiences as represented by trait personality, and how coping mechanisms can serve as a buffer to maintain episodic memory function using Chiari malformation Type I (a chronic pain syndrome) as a model. Finally, allostatic load and pharmacological effects of pain medications on episodic memory are discussed.

Adult Chiari malformation Type 1 is a neurological condition characterized by high levels of chronic pain, disability, and psychological distress, yet self-harming behaviors have not previously been studied in this patient group. The purpose of this study was to determine the prevalence of elevated suicide risk scores among adults with Chiari malformation Type I using the Columbia Suicide Severity Rating Scale – Screen and examine the association between risk scores and pain, disability, and psychological distress. A web-based, anonymous survey was administered comprised of validated scales and demographic questions. Suicide risk (Columbia Screen score) was dichotomized as Low or High-Risk and both crude and adjusted odds ratios were calculated to determine statistical associations with pain, disability, and psychological measures. Overall, 44% of 372 respondents scored in the High-Risk group. Logistic regression showed that depression at the moderate level or above (Adjusted Odd Ratio (AOR) = 4.27, 95% CI = 2.58–7.05, p < .0001), age younger than 30 years (AOR = 3.10, 95% CI = 1.67–5.78, p = .0003), and severe or complete neck related disability (AOR = 2.02, 95% CI = 1.22–3.33, p = .0056) were significant predictors of High-Risk scoring. This study is the first to examine suicidal ideation and risk in the adult CMI population. Clinicians should be aware that suicidal ideation is a serious morbidity in this patient population.

To examine the levels of patient self-advocacy in a sample of participants with Chiari Malformation (CM) and to explore how they relate to clinical outcomes. As part of a larger clinical trial addressing chronic pain in patients with CM, 111 participants completed the Patient Self Advocacy Scale (PSAS), the Depression, Anxiety, and Stress Scale (DASS-21), and the Brief Pain Inventory (BPI). PSAS scores indicated a moderately high level of patient self-advocacy (Mean = 3.86 SD = 0.50). The PSAS was not related to depression, anxiety, stress, pain intensity, or pain interference. There were no differences in PSAS according to surgical status ( t (61.25) = 0.44, p = 0.66) or use of pain medication ( t (109) = 1.05, p = .29). Participants in a clinical trial for CM have high levels of pre-existing patient self-advocacy. Research is needed to understand how patient self-advocacy contributes to the management of CM and how it could impact research of individuals with understudied conditions. Clinical Trials Registration: NCT05581472

Approximately 30% of patients who undergo spinal surgery for chronic back pain continue to experience significant pain and disability up to 2 months following surgery. Prior studies have identified mental health variables including depression and anxiety as predictors of poorer postsurgical outcomes using screening instruments, but no studies have examined long-term outcomes using the Minnesota Multiphasic Personality Inventory-3 (MMPI-3), a commonly used tool used in presurgical psychological evaluations (PPE). Using group-based trajectory modeling and a sample of 404 spine surgery evaluees, the present study examined the trajectories of changes in disability scores from presurgery through 3, 12, and 24 months postsurgery. We then compared scores on MMPI-3 scales between trajectory groups. We identified three trajectory groups of change in disability over time: a rapid-remitting group (8%), characterized by moderate presurgical disability that rapidly and substantially remitted by 12 and 24 months; a steady-recovering group (68%), characterized by moderate presurgical disability, slower change over time, and mild levels of disability at the 2-year time point; and a persisting disability group (24%), characterized by severe presurgical disability that continued into long-term follow-ups. Participants in the persisting pain group produced higher presurgical scores on somatic/cognitive and internalizing MMPI-3 scales than participants in the rapid-remitting and steady-recovering groups. Our results support the clinical utility of the MMPI-3 in PPEs and highlight the importance of evaluating somatic/cognitive concerns and internalizing dysfunction to identify patients who are likely to have poorer postsurgical outcomes.

Posttraumatic stress disorder (PTSD) is frequently comorbid with substance use disorder (SUD) in individuals seeking treatment for substance use. Further, SUD and PTSD are individually associated with cognitive impairment (CI) and poor treatment outcomes. Despite the frequent use of the Montreal Cognitive Assessment (MoCA) as a screening tool for CI, the validity of the MoCA has not been established in individuals with comorbid SUD-PTSD. We assessed the criterion validity of the MoCA in 128 participants seeking inpatient medically-assisted detoxification using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) as a reference for CI. The correlation between the RBANS and MoCA was weaker in those with SUD-PTSD (r = .32) relative to SUD alone (r = .56). Receiver operating characteristic (ROC) curves demonstrated that the MoCA had moderate-to-high ability to discriminate CI in individuals with SUD alone, with an area under the ROC curve of .82 (95% CI .69-.92) and optimal cutoff score of ≤23. However, in individuals with comorbid SUD-PTSD, the ROC analysis was not significant. Results suggest that PTSD, when comorbid with SUD, reduces the criterion-related validity of the MoCA. We recommend exercising caution when classifying CI in individuals with SUD-PTSD using the MoCA and suggest reducing the cutoff score to ≤23 in order to limit the rate of false-positive CI diagnoses in SUD-PTSD populations.