S100 The Journal of Pain Abstracts

(496) Successful treatment of post-stroke pain in a chronic painrehabilitation program

K Hadlandsmyth, D Conklin, and J Scheman; Cleveland Clinic, Cleveland, OH

Persistent pain following stroke ismost commonly associatedwith central post-stroke pain, post-stroke headache, or pain that persists in the affected sites inthe periphery. Little has beenwritten regarding treatment of patients with anypost-stroke pain in a comprehensive pain rehabilitation program. This multiplecase study examined the outcomes of 10 patients with post-stroke pain whoparticipated in the Cleveland Clinic Chronic Pain Rehabilitation Programfrom 1999-2011. Sixty percent were female, and their mean age was 52 years;the range of duration of pain was 3-37 years. Fifty percent had only post-stokepain, while others hadmultiple pain diagnoses with themost common co-mor-bidities being cervical pain and neuropathies. Eight of the 10 patients com-pleted the program and outcomes analysis was on completers only. TheChronic Pain Rehabilitation Program is a comprehensive, interdisciplinarypain rehabilitation program that consists of 3-4 weeks of physiotherapy, occu-pational therapy, relaxation training, psychophysiological pain and stress man-agement, as well as group and individual psychotherapy, and medicationmanagement including weaning from all addictive substances. Outcome vari-ables examined in the present study included pain (as measured on a Visual An-alogue Scale 0-10), impairment in function, as measured by the Pain DisabilityIndex (7 item scale with each item being its own domain of function, on a 0-10scale, with total scores ranging from 0-70), and depression as measured by theBeck Depression Inventory or the Depression, Anxiety, Stress Scales. Followingtreatment, patient’s pain was significantly reduced (p < .05), as was disabilitydue to pain (p < .05) and depression (p < .05). Although the sample size isvery small, this case study appears to demonstrate the efficacy of pain rehabil-itation with this population.

(497) Pediatric chronic pain: active versus passive religiouscoping

B Barber and J Gold; Children’s Hospital Los Angeles, Los Angeles, CA

Several studies have explored adult’s use of religion in copingwith chronic painor illness, focusing on active religious coping techniques (social support, prayer,partnering with god or looking to God for support) and religion’s enhance-ment of one’s well-being with the subsequent reduction of physical and emo-tional pain. However, research has shown that when compared to an activestyle, passive religious coping (avoidance, denial, or deferring to or passivelywaiting for God to take control of the situation) is associated with negativemental health outcomes.We describe the clinical presentation of three adoles-cent girls (M age = 14.3) who came from low SES, ethnicminority intact familieswith fathers whowere Christian pastors. They presentedwith chronic pain thatwas described by their rheumatologists as being excessive given their medicaldiagnosis (diagnosis; juvenile idiopathic arthritis, fibromyalgia, pain disorderNOS). The patients attended weekly individual therapy with their mothers,noting disapproval by their fathers who refused to participate. The patientsall reported active religious coping for their pain management, using prayerin addition to outside support to help manage their chronic pain. However,they emphasized their fathers’ preference towards passive religious copingmethods for pain management, denying the presence of their pain and theaid of psychiatric, therapeutic, and/or medical treatment. As a result, highlevels of anxiety, depression, guilt, self-blame, andnegative religious appraisalswere observed in the adolescents, with all three prematurely ending therapywithin the year. Religion plays a strong role in many patients’ lives, requiringmedical staff to be attuned to coping methods used by not only the patientsbut their families as well. Future research should examine the role of religionin pain coping amongst the patient, family, and medical professionals. (Schu-maker, Religion & Mental Health, 1992; Pargament, Koenig, & Perez, J ClinicalPsychology, 2000.)

(498) Psychosocial influence on pediatric pain: contextual anddevelopmental factors in coping

B Russell; University of Connecticut, Storrs, CT

Normative developmental trajectories for neurocognitive and socioemotionalchange in pediatric samples have considerable implications for the reliablemeasurement of pain and the development of effective analgesic therapy. Dur-ing the first 3-6 years of life, as language and theory of mind skills develop, un-derstanding cultural display rules for discomfort improves; over time, their painschemas grow to include socially desirable affect and the rewards (attention/sensitive care) and costs for violating them (neglect, or minimizing/patronizingresponses). Patients sensitive to social influencemay report pain through a lensof stoicism or of catastrophizing, depending on past patterns of care in thefamily or in therapeutic settings. Patient reported pain can, therefore, endup biased at either end of this spectrum, reflecting the social mediation of in-dividuals’ cognitive pain schemas. Hence, clinicians/researchers concernedwithpain and analgesiamust be concernedwith patients’ contextual circumstances.Of particular interest in this area is the process of individuation that can be ob-served in samples as young as toddlerhood: in these youngest patients, adap-tive social development trends include parents’ sensitive attention to alldistress, over time this attention becomes more selective. This decrease in at-tention coincides with a new source of social influence for children as they en-ter primary school – peer influence, which during the course of the followingdecade, will become an even more powerful source of social influence govern-ing affect. These relationship dynamics are vital considerations in developingtreatment plans that rely on coping strategies - particularly for out-patienttherapies that take place in the child’s everyday social contexts.Many of the be-haviors social influence impacts strongly in adolescence are those that carry thegreatest rewards/risks (i.e., cultural demand for masculine behavior to be stoic,daring, and demonstrate high endurance). This presentation discusses how cli-nicians/researchers can adapt coping plans accordingly.

H03 Hypnosis/Distraction

(499) Pain catastrophizing as an underlying mechanism exam-ining the hypoalgesic effects of clinical hypnosis

T Kronfli, B Goodin, and L McGuire; University of Maryland, Baltimore County(UMBC), Baltimore, MD

Our group has previously demonstrated the efficacy of a trial of hypnosis forreducing healthy individuals’ ratings of pain using a noxious cold water bathin a laboratory setting. This finding is consistent with other clinical studiesthat have also revealed significant pain attenuating effects of hypnosis in sam-ples with acute and chronic clinical pain conditions. Despite the growing evi-dence base attesting to the hypoalgesic effects of hypnosis, potentialpsychosocial mechanisms explaining how hypnosis exerts its effects have re-ceived little attention. Pain catastrophizing may be one such mechanism be-cause a trial of hypnosis may prevent individuals from fully orienting to thepainful stimulus and thereby evaluate it less negatively. The current study rep-resents secondary data analysis of a randomized, controlled trial that was orig-inally developed to examine the impact of hypnosis on pain-relatedneuroendocrine and immune changes. A total of 24 healthy individuals com-pleted the study (12 hypnosis, 12 no intervention). Study participants each com-pleted twopain induction sessionswith a cold pressor task (CPT). They providedratings of pain intensity (PI) and pain unpleasantness (PU), and completed twosituation-specific versions of the Pain Catastrophizing Scale (PCS) followingCPTexposure. Approximately two weeks separated pain testing sessions; duringthis time the treatment group participated in therapist-facilitated hypnosiswhile the control group was not instructed to do anything. Pain catastrophiz-ing did not significantly mediate pre-treatment ratings of PI (p > .05) or PU(p > .05). Controlling for basal pain catastrophizing and pain ratings, 95%bootstrapped confidence intervals revealed that post-treatment pain cata-strophizing significantly mediated post-treatment ratings of PI (95% BC CI:-36.10 to -3.48 with 5000 resamples) and PU (95% BC CI: -38.89 to -4.14 with5000 resamples). Specifically, hypnosis was associatedwith less pain catastroph-izing following treatment, which in turn was associated with less severe painratings.