***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Osteoarthritis ( OA ) is the most common cause of disability in older adults , which , in turn , leads to poor quality of life ( QOL ) . Disability is caused primarily by the joint degeneration and pain associated with OA . A r and omized pilot study was conducted to test the effectiveness of guided imagery with relaxation ( GIR ) to improve health-related QOL ( HRQOL ) in women with OA . A two-group ( intervention versus control ) longitudinal design was used to determine whether GIR leads to better HRQOL in these individuals and whether improvement in HRQOL could be attributed to intervention-associated improvements in pain and mobility .  Twenty-eight women were r and omized to either the GIR intervention or the control intervention group . Using GIR for 12 weeks significantly increased women 's HRQOL in comparison to the women who used the control intervention , even after statistically adjusting for changes in pain and mobility . These findings suggest that the effects of GIR on HRQOL are not limited to improvements in pain and mobility .  GIR may be an easy-to-use self-management intervention to improve the QOL of older adults with OA Abstract The objective of the study was to analyze the relationships between Pain Readiness to Change , weekly measures of positive and negative affect and pain over eight subsequent weeks in patients with rheumatoid arthritis ( RA ) . Factor analysis based on data from three different sample s of patients with rheumatic diseases and other chronic pain conditions suggested a three factor solution for the Norwegian version of the Pain Stages of Change question naire ( PSOCQ ) representing Precontemplation , Contemplation , and Action/Maintenance ( ACT ) stages from the original Transtheoretical Model . Multilevel analyses on the weekly assessed data from a sub sample of 40 patients with RA revealed that higher levels of Pain Readiness to Change represented by high ACT scores were associated with more positive affect from week to week while no association was found between Readiness to Change and weekly pain . However , there was an interaction effect between Pain Readiness to Change and weekly positive affect on weekly pain , indicating that those persons having a higher level of Readiness to Change reported less pain in weeks when they also experienced increased positive affect . This may imply that a combination of cognitive factors and positive affect is most effective in relation to pain reduction . Results encourage continued investigation of apparent interactions between chronic pain , affect , and pain self‐management Background Chronic pain with comorbid depression is characterized by poor mood regulation and stress-related pain . Purpose This study aims to compare depressed and non-depressed pain patients in  mood and pain stress reactivity and recovery , and test whether a post-stress positive mood induction moderates pain recovery . Methods Women with fibromyalgia and /or osteoarthritis ( N = 110 ) underwent interpersonal stress  and were then r and omly assigned by pain condition and depression status , assessed via the Center for Epidemiological Studies -Depression scale , to positive versus neutral mood induction . Results Depression did not predict stress-related reactivity in despondency , joviality , or clinical pain . However , depression × mood condition predicted recovery in joviality and clinical pain ; depressed women recovered only in the positive mood condition , whereas non-depressed women recovered in both mood conditions . Conclusions Depression does not alter pain and mood stress reactivity , but does impair recovery . Boosting post-stress jovial mood ameliorates pain recovery deficits in depressed patients , a finding relevant to chronic pain interventions Abstract Cognitive behavioral therapy ( CBT ) is believed to improve chronic pain problems by decreasing patient catastrophizing and increasing patient self-efficacy for managing pain . Mindfulness-based stress reduction ( MBSR ) is believed to benefit patients with chronic pain by increasing mindfulness and pain acceptance . However , little is known about how these therapeutic mechanism variables relate to each other or whether they are differentially impacted by MBSR vs CBT . In a r and omized controlled trial comparing MBSR , CBT , and usual care ( UC ) for adults aged 20 to 70 years with chronic low back pain ( N = 342 ) , we examined ( 1 ) baseline relationships among measures of catastrophizing , self-efficacy , acceptance , and mindfulness and ( 2 ) changes on these measures in the 3 treatment groups . At baseline , catastrophizing was associated negatively with self-efficacy , acceptance , and 3 aspects of mindfulness ( nonreactivity , nonjudging , and acting with awareness ; all P values < 0.01 ) . Acceptance was associated positively with self-efficacy ( P < 0.01 ) and mindfulness ( P values < 0.05 ) measures . Catastrophizing decreased slightly more posttreatment with MBSR than with CBT or UC ( omnibus P = 0.002 ) . Both treatments were effective compared with UC in decreasing catastrophizing at 52 weeks ( omnibus P = 0.001 ) . In both the entire r and omized sample and the sub sample of participants who attended ≥6 of the 8 MBSR or CBT sessions , differences between MBSR and CBT at up to 52 weeks were few , small in size , and of question able clinical meaningfulness . The results indicate overlap across measures of catastrophizing , self-efficacy , acceptance , and mindfulness and similar effects of MBSR and CBT on these measures among individuals with chronic low back pain Objectives : To examine preliminarily the effectiveness of a short message service ( SMS ) text message – based social support intervention for reducing daily pain and pain interference levels , improving affect and perceptions of social support in patients with chronic noncancer pain , and exploring the feasibility of a novel mobile application to track perceptions of pain and pain interference . Material s and Methods : Participants ( 17 men , 51 women ) from 2 pain clinics in New York City downloaded a pain tracking application ( App ) on their Smartphone and used it to record twice-daily pain , pain interference , and affect scores over the 4-week study period . Participants were r and omly assigned to receive st and ard care ( control ) or st and ard care along with receipt of twice-daily supportive SMS text messages delivered during the second and third week of the study ( intervention ) . Demographic and clinical data were obtained at baseline , and social support measures were administered at baseline and at 4 weeks . Statistical analysis was carried out using general linear mixed models , taking into account variances associated with time of assessment s and with patients . Results : The social support intervention  reduced perceptions of pain and pain interference and improved positive affect for  chronic noncancer pain patients assigned to the intervention condition in comparison with controls . Participants completed approximately 80 % of the daily measurements requested . Discussion : These findings establish the feasibility of collecting daily pain data using a mobile tracking App and provide significant implication s and insight into a nuanced approach to reducing the daily experience of pain through mobile technology , especially because of its accessibility Background : Chronic pain involves hypervigilance for pain-related stimuli . Selective attention to pain-related stimuli , known as pain attentional bias ( AB ) , can exacerbate chronic pain , prolong suffering , and undermine quality of life . The aim of this study was to determine if a multimodal mindfulness-oriented intervention could significantly reduce pain AB among chronic pain patients receiving opioid analgesics . Methods : A total of 67 chronic pain patients were r and omized to an 8-week Mindfulness-Oriented Recovery Enhancement ( MORE ) intervention or a social support group intervention and began treatment . A dot probe task was used to measure pain AB . Primary outcomes were pain AB scores for cues presented for 2,000 and 200 ms . Results : Prior to intervention , participants exhibited a significant bias towards pain-related cues presented for 2,000 ms , but no bias for cues presented for 200 ms . A statistically significant time × intervention condition interaction was observed for 2,000 ms pain AB , such that participants in MORE evidence d significantly reduced posttreatment pain AB relative to pretreatment levels , whereas no significant pre-post treatment changes in pain AB were observed for support group participants . Decreases in pain AB were associated with increased perceived control over pain and attenuated reactivity to distressing thoughts and emotions . Conclusion : Study findings provide the first indication that a mindfulness-oriented intervention may reduce pain AB among adults suffering from chronic pain . Given the magnitude of chronic pain in postindustrial societies , coupled with the dramatic escalation in prescription opioid misuse , future studies should evaluate MORE as a nonpharmacological means of addressing factors linked with chronic pain Purpose : Loving-kindness meditation has been used for centuries in the Buddhist tradition to develop love and transform anger into compassion . This pilot study tested an 8-week loving-kindness program for chronic low back pain patients . Method : Patients ( N = 43 ) were r and omly assigned to the intervention or st and ard care .  St and ardized measures assessed patients ’ pain , anger , and psychological distress . Findings : Post and follow-up analyses showed significant improvements in pain and psychological distress in the loving-kindness group , but no changes in the usual care group . Multilevel analyses of daily data showed that more loving-kindness practice on a given day was related to lower pain that day and lower anger the next day . Conclusions : Preliminary results suggest that the loving-kindness program can be beneficial in reducing pain , anger , and psychological distress in patients with persistent low back pain . Implication s : Clinicians may find loving-kindness meditation helpful in the treatment of patients with persistent pain UNLABELLED Inducing temporary positive states reduces pain and increases pain tolerance in laboratory studies . We tested whether completing positive activities in one 's daily life produces long-term reductions in self-reported bodily pain in a r and omized controlled trial of an online positive activities intervention .  Participants recruited via the Web were r and omly assigned to complete 0 , 2 , 4 , or 6 positive activities administered online over a 6-week period . Follow-up assessment s were collected at the end of 6 weeks and at 1 , 3 , and 6 months postintervention . We used linear mixed effects models to examine whether the intervention reduced pain over time among those who had a score < 67 on the bodily pain subscale of the Short Form-36 at baseline ( N = 417 ; pain scores range from 0 to 100 ; higher scores indicate less pain ) . Mean pain scores improved from baseline to 6 months in the 2-activity ( 55.7 to 67.4 ) , 4-activity ( 54.2 to 71.0 ) , and 6-activity ( 50.9 to 67.9 ) groups . Improvements were significantly greater ( P < .05 ) in the 4-activity and 6-activity groups than in the 0-activity control group ( 54.1 to 62.2 ) in unadjusted and adjusted models . This study suggests that positive activities administered online can reduce bodily pain in adults with at least mild to moderate baseline pain . PERSPECTIVE This study demonstrates that teaching people simple positive activities can decrease reported levels of bodily pain ; moreover , these activities can be administered over the internet , a potential avenue for broadly disseminating health interventions at relatively low costs and with high sustainability Cognitive behavioral treatment has been incorporated into st and ard medical treatment procedures in German pain centers . Acceptance of the treatment by patients and outcome in terms of pain , coping , and disability was investigated . Components of the psychological treatment are education , relaxation and imagery , modifying thoughts and feelings , enhancement of pleasant activities , and training of good postural habits . The program was conducted in a group setting in accordance with a treatment manual and consists of 12 weekly 2.5-h sessions . A two-factor experiment with repeated measures on one factor was applied . Ninety-four consecutive patients with low-back pain were r and omly assigned to an experimental group having a combined medical and cognitive-behavioral treatment , or to a control group with medical treatment only . Assessment s were taken pre-treatment , post-treatment , and --in the treated group only -- at a 6-months follow-up . At each assessment , patients kept a pain diary over a period of 4 weeks , and filled in self-report question naires . The sample consisted of 36 experimental and 40 control subjects at post-treatment . Experimental subjects reported less pain , better control over pain , more pleasurable activities and feelings , less avoidance and less catastrophizing . In addition , disability was reduced in terms of social roles , physical functions and mental performance . The results were maintained at follow-up . Patients who only received medical treatment showed little improvement . Data indicate that the program meets the needs of the patients and should be continued This research examined whether cognitive behavioral therapy and mindfulness interventions that target responses to chronic stress , pain , and depression reduce pain and improve the quality of everyday life for adults with rheumatoid arthritis ( RA ) . The 144 RA participants were clustered into groups of 6 - 10 participants and r and omly assigned to 1 of 3 treatments : cognitive behavioral therapy for pain ( P ) ; mindfulness meditation and emotion regulation therapy ( M ) ; or education-only group ( E ) , which served as an attention placebo control . The authors took a multi method approach , employing daily diaries and laboratory assessment of pain and mitogen-stimulated levels of interleukin-6 ( IL-6 ) , a proinflammatory cytokine . Participants receiving P showed the greatest Pre to Post improvement in self-reported pain control and reductions in the IL-6 ; both P and M groups showed more improvement in coping efficacy than did the E group . The relative value of the treatments varied as a function of depression history . RA patients with recurrent depression benefited most from M across several measures , including negative and positive affect and physicians ' ratings of joint tenderness , indicating that the emotion regulation aspects of that treatment were most beneficial to those with chronic depressive features OBJECTIVE Opioid pharmacotherapy is now the leading treatment for chronic pain , a problem that affects nearly one third of the U.S. population . Given the dramatic rise in prescription opioid misuse and opioid 
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Subgroup analyses showed a significant effect for gender and marginally significant effects for age in studies that adjusted for NA .
On average , effect sizes for observational studies were larger in studies with a higher proportion of female respondents and in studies that did not adjust for NA .
Finally , larger effect sizes were found in intervention studies with older compared with younger sample