Outpatient Engagement Lowers Predicted Risk of Suicide Attempts in Fibromyalgia
Fibromyalgia (FM) patients are 10x more likely to die by suicide than the general population. The purpose of this study was to externally validate published models predicting suicidal ideation and attempts in FM and identify interpretable risk and protective factors for suicidality unique to FM. This is the first study to successfully apply machine learning to reliably detect suicidality in FM, identifying novel risk factors for suicidality and highlighting outpatient engagement as a protective factor against suicide.
Personality and Affect When the Central Nervous System is Sensitized: An Analysis of Central Sensitization Syndromes in a Substance Use Disorder Population
Functional somatic syndromes, or more recently termed central sensitivity syndromes (CSS), comprise a significant portion of the chronic pain population. Although it is evident that personality is intricately related to the pain experience, it has not been widely studied. This article examines the impact of CSS on the clinical presentation of individuals presenting to treatment for a substance use disorder (SUD), with an emphasis on personality and emotional functioning.
Integrative Medicine Strategies for Changing Health Behaviors
Until system reforms allow adequate time and reimbursement for primary care providers to focus on lifestyle change to prevent and mitigate chronic disease, primary care providers need a manageable, defined role to support lifestyle change.
An integrative trauma-based approach toward chronic pain: Specific applications to IC/BPS
The impact of chronic illness on an individual’s life is profound, affecting physical, social, and vocational functioning. Incurring and living with illness can dramatically alter an individual’s life trajectory, challenging identity and ideas of the future. The illness itself can be physically and psychologically traumatic. Vulnerability to trauma increases when individuals have poor preexisting coping mechanisms and with illness severity. In this paper, we discuss interstitial cystitis/bladder pain syndrome (IC/BPS), a disabling chronic pain condition with no known cure.
Posttraumatic Stress Symptoms Mediate the Effects of Trauma Exposure on Clinical Indicators of Central Sensitization in Patients with Chronic Pain
Evidence supports high rates of co-occurrence of posttraumatic stress disorder (PTSD) and chronic pain disorders involving central sensitization (CS). The nature of this relationship, however, remains relatively unexplored. In this study, we aimed to (1) assess how both trauma exposure and current PTSD symptoms are related to clinical manifestations of CS, and (2) test whether PTSD symptoms explain the relationship between trauma exposure and CS. Because experiential avoidance has been shown to impact the relationship between trauma and health outcomes, we (3) explored experiential avoidance as a possible mediator or moderator of the trauma-CS relationship.
Protecting Life while Preserving Liberty: Ethical Recommendations for Suicide Prevention with Artificial Intelligence
In the United States, suicide increased by 24% in the past 20 years, and suicide risk identification at point-of-care remains a cornerstone of the effort to curb this epidemic (1). As risk identification is difficult because of symptom under-reporting, timing, or lack of screening, healthcare systems rely increasingly on risk scoring and now artificial intelligence (AI) to assess risk. AI remains the science of solving problems and accomplishing tasks, through automated or computational means, that normally require human intelligence. This science is decades-old and includes traditional predictive statistics and machine learning. Only in the last few years has it been applied rigorously in suicide risk prediction and prevention. Applying AI in this context raises significant ethical concern, particularly in balancing beneficence and respecting personal autonomy. To navigate the ethical issues raised by suicide risk prediction, we provide recommendations in three areas—communication, consent, and controls—for both providers and researchers.
Posttraumatic Stress Disorder in Interstitial Cystitis/Bladder Pain Syndrome: Relationship to Patient Phenotype and Clinical Practice Implications
The relationship between exposure to abuse and interstitial cystitis/bladder pain syndrome (IC/BPS) is well-documented. However, studies have yet to examine posttraumatic stress disorder (PTSD), which develops following exposure to trauma and worsens health outcomes in chronic pain. We aimed to assess the prevalence and impact of PTSD in patients with IC/BPS, including their relation to genitourinary symptom presentation and widespread pain phenotype.
Preoperative and postoperative psychologically-informed physical therapy: A systematic review of randomized trials among patients with degenerative spine, hip, and knee conditions
This project summarizes evidence on preoperative and postoperative psychologically informed physical therapy (PIPT) for improving outcomes after degenerative spine, hip, or knee surgery.