Lakeya S. McGill

Background: Individuals living with HIV often experience chronic pain, which contributes to diminished physical and mental health. Skills TO Manage Pain (STOMP), a pain self-management intervention tailored for individuals with HIV, has demonstrated immediate and sustained efficacy at reducing pain and strengthening pain self-efficacy. Evaluating STOMP’s effectiveness in real-world settings remains a critical next step in advancing its implementation. Methods: This article describes how we used implementation mapping to develop strategies aimed at strengthening the delivery and long-term sustainability of STOMP in HIV care settings. Results: Through semi-structured interviews with 17 key informants, we identified several barriers to and facilitators of STOMP implementation. Examples included patients potentially feeling their pain is being invalidated because they are being offered a behavioral rather than biomedical intervention; however, STOMP was also an adaptable, evidence-based CBT intervention that people may perceive as a better option than opioids for pain management. We also held a community engagement studio in which key informants provided insights on how to promote equitable implementation of STOMP in HIV clinics. Conclusion: Using a rigorous theory-based approach, we selected ten strategies to reduce barriers and strengthen facilitators for STOMP implementation in HIV care settings. This process involved qualitative interviews and a focus group with key informants, including people with lived experience. Implementation mapping appears to be a promising approach to bolster uptake of evidence-based interventions like STOMP. In our future research, we will evaluate both our implementation strategies and the effectiveness of STOMP for improving health in people with HIV and chronic pain.

Studies have shown that disease- and race-based discrimination in healthcare exacerbate pain, yet little is known about the role of psychological processes and symptoms, such as internalized stigma and depressive symptoms, in the relationship between discrimination (i.e., enacted stigma) and pain. In a sample of 284 Black adults living with sickle cell disease (SCD) (54% women, M_age = 35.37), we examined internalized stigma and depressive symptoms as mediators between disease- and race-based discrimination in healthcare and pain severity and interference. Disease-based but not race-based discrimination in healthcare was associated with internalized stigma, depressive symptoms, and pain severity and interference. Furthermore, internalized stigma and depressive symptoms partially mediated the association between disease-based discrimination in healthcare and pain severity and interference. Results suggest that individuals with SCD who experience discrimination, including based on their SCD status, may internalize these discriminatory messages from others, leading to negative thoughts and feelings about having SCD. These negative internalized beliefs may then contribute to depressive symptoms and subsequent worse pain. Internalized stigma and depressive symptoms may be potential treatment targets in behavioral and psychological interventions. More research is needed to understand the impact of intersecting experiences of discrimination and stigma on health outcomes in adults living with SCD.

Background: People with HIV (PWH) frequently experience chronic pain, which negatively affects their health and functioning. To improve health outcomes, we need effective interventions for HIV-related chronic pain. Skills TO Manage Pain (STOMP), a novel pain self-management intervention tailored for PWH and chronic pain, has demonstrated efficacy in reducing pain impact (measured by the Brief Pain Inventory) and improving pain self-efficacy immediately after a 12-week intervention and 3 months later. Setting: We conducted this study at 2 Center for AIDS Research Network of Integrated Clinical Systems clinics. Methods: We evaluated the efficacy of STOMP across 12 months by comparing trajectories of pain impact and pain self-efficacy among 244 adults (49% female, M _age = 53.62) randomized equally to the STOMP intervention or an Enhanced Usual Care (EUC) control condition. We also examined whether pain self-efficacy is a mechanism of change that helps explain how STOMP affects pain impact. Results: For 12 months, individuals who participated in STOMP reported lower pain impact and higher pain self-efficacy than those in EUC. Over time, the difference in pain impact attenuated slightly between the 2 groups but remained statistically significant. Pain self-efficacy remained significantly higher for the STOMP group. Individuals in STOMP showed greater improvements in their confidence to manage pain than those in EUC, resulting in less severe pain and reduced interference in daily life. Conclusions: STOMP is an efficacious chronic pain intervention for PWH, improving pain outcomes 1 year later. Future research should evaluate mechanisms of change and best practices for implementing STOMP.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Chronic pain is prevalent among adults with sickle cell disease (SCD) and can be worsened by psychosocial factors such as depression and inadequate social support. Effective behavioral interventions (i.e., cognitive behavioral therapy, CBT) exist for chronic pain in various populations; however, few have been developed to address chronic pain in SCD. Several barriers have restricted the development and dissemination of CBT pain interventions in SCD, such as limited accessibility and time constraints. Digital interventions provide accessible and cost-effective pain management tools, offering self-management strategies, real-time monitoring, and personalized treatment options. Yet, there is limited data regarding patients’ experiences with such intervention within the sickle cell population. The Comparing the Effectiveness of Education Versus Digital Cognitive Behavioral Therapy for Adults with Sickle Cell Disease (CaRISMA, clinicaltrials.gov NCT04419168) trial evaluated the effectiveness of a digital CBT intervention compared to a digital educational intervention for pain management in SCD. Objective: This study aimed to gain a deeper understanding of the lived experiences of participants in the CaRISMA trial and to determine how to better adapt this intervention to SCD population. The study examined individuals’ overall experience with the trial and their perspectives of the trial components, including a health coach, a chatbot-delivered digital CBT program, and an electronic pain diary. Methods: Respondents were randomly selected to participate in semi-structured interviews at 1) baseline, 2) at the end of the intervention period at 3 months, and 3) post-intervention timepoint, 6 months or beyond. Interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. Results: A total of 48 participants (68.8% F, n=33) completed baseline interviews. Among them, 21 participants took part in mid-trial interviews, and 17 completed post-intervention interviews. Participants generally had a positive experience, highlighting the safe space the study provided to speak openly about SCD. Many found value in learning about the connection between pain and mental health, considering it an important aspect of their well-being. Feedback indicated that the health coach played a key role in offering personalized support and guidance. While the chatbot reinforced pain management strategies, its usefulness and engagement varied based on participants’ prior knowledge of SCD. The pain diary helped increase self-awareness of pain patterns, but was perceived as tedious and irrelevant by those without current pain episodes. Conclusions: The CaRISMA trial showed that participants valued the personalized support of the health coach, education about the connection between stress and pain, and the self-reflection fostered by the pain diary. These findings highlight the potential of digital, patient-centered approaches to address the multifaceted needs of SCD care. For digital interventions, the inclusion of personalized support with ongoing communication appears to be critical component that can influence treatment adherence and effectiveness. Clinical Trial: clinicaltrials.gov NCT04419168

BACKGROUND Chronic pain is prevalent among adults with sickle cell disease (SCD) and can be worsened by psychosocial factors such as depression and inadequate social support. Effective behavioral interventions (eg, cognitive behavioral therapy [CBT]) exist for chronic pain in various populations; however, few have been developed to address chronic pain in SCD. Several barriers have restricted the development and dissemination of CBT pain interventions in SCD, such as limited accessibility and time constraints. Digital interventions provide accessible and cost-effective pain management tools, offering self-management strategies, real-time monitoring, and personalized treatment options. Yet, there are limited data regarding patients’ experiences with such interventions within the SCD population. The Cognitive Behavioral Therapy and Real-Time Pain Management Intervention for Sickle Cell Via Mobile Applications (CaRISMA) trial evaluated the effectiveness of a digital CBT intervention compared with a digital educational intervention for pain management in SCD. Evaluating participants’ experiences can guide refinement of digital pain interventions in SCD. OBJECTIVE This study aimed to gain a deeper understanding of the lived experiences of participants in the CaRISMA trial and to determine how to better adapt this intervention to the SCD population. The study examined individuals’ overall experience with the trial and their perspectives of the trial components: a health coach, a chatbot-delivered digital CBT program, and an electronic pain diary. METHODS Respondents were randomly selected to participate in semistructured interviews at (1) baseline, (2) the end of the intervention period at 3 months, and (3) the postintervention time point at 6 months or beyond. Interviews were audiotaped, transcribed verbatim, and analyzed using conventional content analysis. RESULTS A total of 48 participants (women: 33/48, 69%) completed the interviews, with 24 and 19 completing midpoint and postintervention interviews, respectively. Participants generally had a positive experience in the trial. Many found value in learning about the connection between pain and mental health, considering it an important aspect of their well-being. The health coach played a key role in offering personalized support and guidance. Although the chatbot reinforced pain management strategies, its usefulness and engagement varied based on participants’ prior knowledge of SCD. The pain diary helped increase self-awareness of pain patterns but was perceived as tedious and irrelevant by those without current pain episodes. CONCLUSIONS This qualitative substudy of the CaRISMA trial showed that participants valued the personalized support of the health coach, education about the connection between stress and pain, and the self-reflection fostered by the pain diary. These findings highlight the potential of digital, patient-centered approaches to address the multifaceted needs of SCD care. For digital interventions, the inclusion of personalized support with ongoing communication appears to be a critical component that can influence treatment adherence and effectiveness. CLINICALTRIAL ClinicalTrials.gov NCT04419168; https://clinicaltrials.gov/study/NCT04419168 INTERNATIONAL REGISTERED REPORT RR2-10.2196/29014

Individuals with historically oppressed identities, such as disabled or racialized minorities, face inequities across all societal institutions, including education, criminal justice, and healthcare. Systems of oppression (e.g., ableism, racism) lead to inequities that have ultimately contributed to disproportionate rates of COVID-19 morbidity and mortality in the United States. In the midst of the COVID-19 pandemic, increased public attention regarding police brutality toward Black people and the reinvigoration of the national Black Lives Matter (BLM) movement further highlighted the detrimental effects of oppressive systems and the urgent need to promote equity in the United States. The disproportionate number of COVID-19-related deaths and police brutality are inextricably connected, as both are products of oppression toward minoritized communities. The co-occurrence of the pandemic and BLM movement protests also creates an opportunity for critical discourse on the intersection of ableism and anti-Black racism specifically within the field of rehabilitation psychology. The overarching goals of this review are to apply the Intersectional Ecological Model with the addition of the chronosystem to illustrate how systems of oppression lead to health disparity in COVID-19 survivorship and to provide recommendations to promote health equity. Conclusions/Implication: As the COVID-19 pandemic shifts to an endemic and efforts to eliminate oppressive systems continue, rehabilitation psychologists have an ongoing, evolving, and shared responsibility to employ socially-responsive solutions to promote optimal functioning for patients, families, and communities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Chronic illness experiences often interfere with daily functioning (a concept known as illness intrusiveness) and health-related quality of life (HRQoL). However, less is known about the role of specific symptoms in predicting illness intrusiveness in sickle cell disease (SCD). This exploratory study examined associations between common SCD-related symptoms (i.e., pain, fatigue, depression, and anxiety), illness intrusiveness, and HRQoL among adults with SCD (n = 60). Illness intrusiveness significantly correlated with fatigue severity (r = .39, p = .002), depression severity (r = .45, p < .001), anxiety severity (r = .41, p = .001), physical HRQoL (r = − .53, p < .001), and mental HRQoL (r = − .44, p < .001). Multiple regression revealed a significant overall model, (R² = .28, F(4, 55) = 5.21, p = .001), with fatigue, but not pain, depression, or anxiety, significantly predicting illness intrusiveness (β = .29, p = .036). Results suggest that fatigue may be a primary factor contributing to illness intrusiveness—a determinant of HRQoL—in individuals with SCD. Given the limited sample size, larger confirmatory studies are warranted.

Experiences of racism occur across a continuum from denial of services to more subtle forms of discrimination and exact a significant toll. These multilevel systems of oppression accumulate as chronic stressors that cause psychological injury conceptualized as racism-based traumatic stress (RBTS). RBTS has overlapping symptoms with posttraumatic stress disorder (PTSD) with the added burden that threats are constantly present. Chronic pain is a public health crisis that is exacerbated by the intersection of racism and health inequities. However, the relationship between RBTS and pain has not yet been explored. To highlight how these phenomena are interlinked, we present Racism ExpoSure and Trauma AccumulatiOn PeRpetuate PAin InequiTIes-AdVocating for ChangE (RESTORATIVE); a novel conceptual model that integrates the models of racism and pain and demonstrates how the shared contribution of trauma symptoms (e.g., RBTS and PTSD) maintains and perpetuates chronic pain for racialized groups in the United States. Visualizing racism and pain as "two halves of the same coin," in which the accumulative effects of numerous events may moderate the severity of RBTS and pain, we emphasize the importance of within-group distinctiveness and intersectionality (overlapping identities). We call on psychologists to lead efforts in applying the RESTORATIVE model, acting as facilitators and advocates for the patient's lived experience with RBTS in clinical pain care teams. To assist with this goal, we offer suggestions for provider and researcher antiracism education, assessment of RBTS in pain populations, and discuss how cultural humility is a central component in implementing the RESTORATIVE model. (PsycInfo Database Record (c) 2023 APA, all rights reserved).