Master of Science, The Ohio State University, 2022, Dentistry

Chronic oral and maxillofacial pain conditions represent a diverse group of disorders. Broadly, they can be broken down into temporomandibular disorders (TMDs) and/or orofacial pain disorders. These classifications further detail a series of conditions ranging from joint pains, muscles pains, headaches, to various neuralgias of the head, neck, and face. The presence of depression often complicates these conditions. In addition, chronic noxious stimuli can lead to central sensitization, amplifying and protracting pain. Ketamine, a commonly used general anesthetic agent, has been studied in pre-clinical animal and human clinical trials and has shown great promise for treating chronic pain and depression. It has also been proposed that intravenous ketamine administration plays a role in reversing central sensitization. Albeit simplified, the hypothesized mechanism of action behind ketamine's ability to perform these actions primarily lies within the drug's ability to inhibit N-methyl-D-aspartate receptors (NMDAR) in the central nervous system. However, it is thought that other factors are at play behind ketamine's clinically valuable attributes. Unfortunately, most research in this field has been studied without regard to the head, neck, and face. The following is a systematized review of ketamine therapy to treat such disorders. Regrettably, the results demonstrated the dental profession's lack of pursuit in ketamine therapy when treating chronic oral and maxillofacial pain patients. Nevertheless, there was a meaningful amount of data covering the utility of ketamine therapy. Although most clinical trials present with large degrees of design heterogenicity, the overwhelming conclusion of these publications suggests great promise for the use of intravenous ketamine infusions to treat a multitude of chronic pain conditions. Given these results, the dental profession, with its recent addition of two new specialties (i.e., dental anesthesiology and orofacial pain), alo (open full item for complete abstract)

BS, Kent State University, 2011, College of Nursing

Pain is a multidimensional phenomenon that affects each patient in a unique way. It is essential for nurses in the post anesthesia care unit to be knowledgeable about this multidimensional phenomenon, including the various aspects of pain management, in order to safely care for those patients who are in pain. If nurses lack the necessary knowledge and skills to provide exceptional pain management, then nursing care will be suboptimal. Although there is much literature on this topic, a lack of adequate knowledge on the part of nursing professionals persists. In fact, pain is typically undertreated. The primary purpose of this paper was to explore pain management in the post anesthesia phase of nursing care. This has been accomplished through a comprehensive and systematic review of the available literature. A large amount of information was synthesized from sixty-five peer reviewed, scholarly sources. This paper includes discussion regarding patient preferences and consequences of uncontrolled pain, as well as factors related to assessment, documentation, and pain control methods. Various pain management methods were reviewed, including pharmacologic and non-pharmacologic techniques. This systematic review yielded findings that demonstrated the need for various changes that should be implemented related to pain management in the post operative phase of nursing care. Furthermore, it is important that nursing care evolves as an evidence-based practice profession and that nurses incorporate these recommendations into their day-to-day nursing care of patients.

Doctor of Philosophy, The Ohio State University, 2021, Psychology

Pain is widely prevalent across the world, and individuals with excess weight are disproportionally affected by it relative to those with normal weight. Research suggests that obesity is associated with biological indicators of systemic inflammation (e.g., C-reactive protein), which may contribute to pain. Individuals with excess weight, especially women, also are at greater risk of experiencing the emotional pain of weight stigma, which may in turn exacerbate physical pain. Recent studies have shown that brain areas involved in the processing of physical pain (dorsal anterior cingulate cortex, anterior insula) are the same areas associated with emotional pain, and that analgesics (e.g., acetaminophen) used for reducing physical pain may also dampen extremity of emotional responses. However, analgesic effects have not been tested in the context of individuals with excess weight experiencing weight stigmatization. The current study was designed to 1) evaluate the influence of a weight stigma induction and acute dose of acetaminophen on pain, distress, and affect among women with overweight or obesity; and 2) evaluate the relationship between body mass index (BMI) and pain, the degree to which this relationship is mediated by weight stigma, and the degree to which acetaminophen moderate the weight stigma-pain relationship. One hundred sixty women with overweight or obesity (78% Caucasian; average age 41.7±17.4 years; average BMI 32.4±6.4) were recruited from the Columbus and surrounding communities. Prospective participants were screened for eligibility including BMI 25 or greater, female sex, and age 18 years or greater. The sample of eligible participants was stratified by age (18-40 years vs. over 40 years) and BMI (overweight vs. obese) for randomization into one of four study conditions: acetaminophen and weight stigma induction; placebo and weight stigma induction; acetaminophen and control condition; and placebo and control condition. Participants att (open full item for complete abstract)

Doctor of Psychology (Psy.D.), Xavier University, 2020, Psychology

The biopsychosocial model argues multiple biological, psychological, and social factors influence the experience, development, and management of chronic pain. The relations between pain intensity, pain interference, substance use, personality, depression, pain attitudes, pain catastrophizing, coping and social support were explored in a sample of 86 new pain treatment patients. An Exploratory Factor Analysis (EFA) revealed four underlying factors that explained 55.55% of the variance: psychological factors (25.34% variance), daily functioning (15.82% variance), control (7.63% variance), and substance use/support (6.57% variance). Logistic regression analyses were conducted to identify the predictive value of the identified factors for current and future chronic pain treatment (0 = noninvasive vs. 1 = invasive). Results indicated no factor was related to current pain treatment; however, control was predictive of future pain treatment (B = -.04, Exp(B) = .97). Formal prediction models were built to identify unique associations to current and future pain treatment. General pain attitudes—including beliefs one should be cared for, negative emotions increase pain, pain can be cured, pain can be controlled, pain causes harm, pain makes one disabled, and medications are the best treatment— was predictive of current pain treatment (B = .80, Exp(B) = 2.22). Pain catastrophizing (B = -.04, Exp(B)= .96) and general pain attitudes (B = 1.01, Exp(B) = 2.75) were predictive of future chronic pain treatment. Our findings suggest that cognitive factors play an important role in chronic pain treatment selection. Future research should use a larger, more diverse sample size to make findings more generalizable.

MS, University of Cincinnati, 2017, Medicine: Genetic Counseling

Objective Tumor growths, bone deformities, migraine headaches and other health-related complications reported in patients with neurofibromatosis type 1 (NF1) are often associated with substantial pain. However, due to the lack of systematic studies investigating the features of the pain experience, information in the literature regarding pain interference, intensity, chronicity, frequency, and pain characteristics in the NF1 population is limited. Thus, the current study sought to describe and quantify the pain experience in children and adults with NF1. Methods A cross-sectional study was conducted via validated and supplemental surveys, administered to children and adults between the ages of 8 and 40, at the following locations: Neurofibromatosis (NF) clinic at Cincinnati Children's Hospital Medical Center (CCHMC), CCHMC general genetics clinics, the adult NF clinic at University Hospital, and the annual NF Symposium held at CCHMC. Validated questionnaires include the Numeric Rating Scale 11 (NRS11) to assess pain intensity and the Patient Reported Outcomes Measurement Information System (PROMIS) to assess pain interference. Additionally, we created a supplemental survey to measure pain frequency, chronicity, quality, and location. Results A total of 49 participants (28 children and 21 adults) with NF1 participated in the study. Pain was present in 55% of participants (46% of children and 67% of adults), and can begin at an early age (i.e. as young as 8 years old). Further, 35% of individuals describe their pain to be chronic in nature (25% of children and 48% of adults) with 41% of participants reporting the need to take over-the-counter and/or prescription medication to manage their pain symptoms. The most commonly identified sources of pain included migraine headaches (31%) and NF-related tumors (27%). Pain was often described as neuropathic (burning, tingling, numbness, or itching), which was localized to the head, back, and extremities. Patients wer (open full item for complete abstract)

Master of Science (MS), Ohio University, 2011, Journalism (Communication)

This study compared depictions of chronic pain in newspapers and magazines with blogs by people with chronic pain. Using critical discourse analysis, the study identified and compared frames, definitions of people with chronic pain, symbols and metaphors, and depictions of otherness/unhomelikeness. Marked differences were found among blogs and mainstream print media, with lesser differences between newspapers and magazines. By defining people with chronic pain by their illnesses, downplaying the impact of persistent pain on everyday life, and relating chronic pain to character or mental fortitude, magazines and newspapers contributed to the stigmatization and otherization bloggers described. Mainstream print media authors also portrayed chronic pain as less impactful, less agonizing, and less real than bloggers' descriptions. As such, newspapers and magazines made chronic pain more palatable to readers, but deprived them of the knowledge people with chronic pain glean through the lived experience of illness.

MA, University of Cincinnati, 2024, Arts and Sciences: Psychology

Chronic pain can disrupt adolescents' attention. Such interruptions, in turn, may negatively impact one's overall functioning, causing frustration and distress when trying to engage in important tasks (e.g., schoolwork). This experience has been referred to as cognitive intrusion of pain (Attridge et al., 2015). To date, only one adult self-report measure of cognitive intrusion of pain exists: the Experience of Cognitive Intrusion of Pain Scale (ECIP). This is a critical gap in the literature, as there is currently no known measure of experienced cognitive intrusion of pain for pediatric chronic pain patients. The current study examined the psychometric properties of an adapted version of the ECIP (ECIP-A) among children and adolescents (ages 11-18) with pediatric chronic pain. Data were collected from pediatric chronic pain patients (N = 194) presenting for treatment at a tertiary pain clinic at a large Midwestern children's hospital. Exploratory analyses were conducted for deeper understanding of the current sample, as this is the first study to assess the ECIP-A in pediatric patients with chronic pain. The current sample consisted of 81.9% self-identified as Non-Hispanic White and 77.5% female chronic pain patients. There were no significant differences in ECIP-A scores between males and females, across patient age, or across primary pain condition. ECIP-A scores and Pain Frequency-Severity-Duration composite scores were significantly correlated, indicating that as pain symptoms increase, so does cognitive intrusion of pain (r = 0.23, p = 0.002). Confirmatory factor analysis (CFA) results supported a one-factor model for the ECIP-A, with excellent model fit (?2 = 30.24, df = 23, p = 0.14; CFI = 0.99, TLI = 0.99, RMSEA = .042 (90% CI 0.00 - 0.078), and SRMR = 0.021). Results suggest excellent internal consistency of ECIP-A scores (Cronbach's alpha = 0.94). Pearson correlations indicated good convergent and discriminant validity, as the ECIP-A was moderately and p (open full item for complete abstract)

Master of Science (MS), Bowling Green State University, 2022, Biological Sciences

Chronic pain is a poorly understood biological response to acute nerve damage. Chronic pain encompasses both central and peripheral nervous system sensitization, sometimes referred to as long term potentiation. The research community has traditionally focused its studies of these states on mammals, but recent work has shown that Drosophila experience central nervous system modulation which results in chronic pain. Flies also show conserved nociceptive TRP ion channels, which supports the hypothesis that pain is a highly conserved state. As the pain modulatory system must evolve after simple nociceptive systems, a deeper conservation may exist than has previously been thought. Thus we have reason to investigate if the modulation of pain with injury is conserved as well. The present work validates a novel paradigm to measure conditioned place avoidance in Drosophila as a function of stimulus intensity. With the focus on conditioned place avoidance, the present study makes assays on pain avoidance possible. Pain avoidance is a much more complex phenomenon than simple pain reflex, but one which is definitionally included in the pain phenomenon by the International Association for the Study of Pain. Further, pain modulation is widely known to affect pain avoidance behavior, establishing a definitional and biological connection between pain and pain avoidance. The present study inquires if injury can modulate pain avoidance behavior in Drosophila. The present study demonstrates that leg amputation induces quicker aversion to aversive stimuli. Drosophila offers the research community a high-throughput chronic pain model which can provide quantitative characterizations of chronic pain and analgesia in a model that is genetically accessible, with widely understood neuronal circuitry.

Bachelor of Science, Walsh University, 2021, Honors

This research study compared the effectiveness of music therapy in reducing pain levels in the pediatric, adult, and older adult populations. In addition, this study compared different types of music therapy and their effectiveness in reducing pain levels in comparison to pediatric, adult, and older adult populations. The research design is a content analysis to study the relationships between the effectiveness of music therapy in reducing pain levels in various populations with different types of music therapy. This study included peer-reviewed scholarly journals that included human participants that researched the effect of music therapy implemented by a licensed music therapist on pain levels using valid and reliable pain measurement tools in the pediatric, adult, and elderly populations. Music therapy is a growing field and is effective in providing non-pharmacological pain relief in individuals of all ages. The results of this research study can assist in guiding future research by identifying the varying effectiveness of music therapy in different populations.

Master of Science, The Ohio State University, 2019, Dentistry

Introduction: The aim of this study was to examine the effectiveness of bite wafers, teethers, chilled teethers, and vibrating oral motor tools on self-reported pain and anxiety that commonly accompanies initial archwire activation. Methods: 150 orthodontic patients aged 9-18 years were randomly assigned to one of five groups and matched for sex and age. One group served as the control while the other four groups received either a bite wafer, teether, chilled teether, or vibrating oral motor tool. The subjects completed baseline questionnaires to assess their levels of anxiety (Six-Item State Anxiety Scale) and pain (a 100-mm visual analogue scale) before initial archwire placement. After initial archwire placement, the subjects were given their respective devices and instructed to use them for at least 20 minutes each day for one week while continuing to answer the anxiety and pain surveys each day. Results: Preadolescent males (9-13) of the Teether Group (p ≤ 0.012) displayed less anxiety than the Control Group. The preadolescent males reported less pain in the Bite Wafer Group (p ≤ 0.001), Chilled Teether Group (p ≤ 0.024), and Vibration Group (p ≤ 0.002) compared with the Control Group. The female groups consistently showed heightened pain levels compared to their controls. Conclusions: Sex and age do affect nonpharmacological interventions for pain and state anxiety. The nonpharmacologic interventions in this study did affect the age and sex groups differently. However, this may have been the result of small group size and should be confirmed in other studies.

MS, University of Cincinnati, 2018, Medicine: Genetic Counseling

OBJECTIVE: Individuals with Neurofibromatosis Type 1 (NF1) and Costello syndrome (CS) present with pain from various sources. This pain can be associated with concurrent clinical pain conditions (e.g., migraine headaches, postoperative pain from corrective surgeries) in addition to pain associated with features of the disorder (e.g., plexiform neurofibromas). A limited number of studies have investigated these population's pain experience, resulting in an incomplete description of their pain experience. The purpose of this study is to elucidate the pain experience by examining the following variables of pain: perceived burden of pain, source, location, intensity, chronicity, frequency, and qualitative description. METHODS: The Numeric Rating Scale 11 (NRS11), Patient Reported Outcomes Measurement Information system (PROMIS) survey, and a supplemental survey created for this study were administered to individuals between the ages of 8-60 years. Participants and controls, usually unaffected relatives, were recruited from Neurofibromatosis (NF) Clinic at Cincinnati Children's Hospital Medical Center (CCHMC), CCHMC general genetics clinics, the 10th International Costello Syndrome Family Forum, and the annual Cincinnati NF walk. Chi2, Fisher's Exact, and Wilcoxon ranked sum tests were used to analyze our variables. RESULTS: One-hundred-forty-nine participants (41 with NF1, 19 with CS, and 89 controls) partook in the survey between May 2017 and January 2018. Chronic pain, pain lasting 3 months or longer, was present in adults with NF1 (72%), children with NF1 (30%), adults with CS (30%) and children with CS (56%). Adults with NF1 (p=0.009) and children with CS (p=0.02) experienced more chronic pain than controls. Adults (p=0.003) and children (p=0.003) with NF1 experienced a higher intensity of pain. Pain interference (PROMIS score) was higher in NF1 adults compared to controls (p=0.01). Compared to controls, children with CS (p=0.01) had higher pain intensity a (open full item for complete abstract)

PhD, University of Cincinnati, 2018, Pharmacy: Pharmaceutical Sciences/Biopharmaceutics

Background: Cancer pain, either tumor-related or treatment-related, is common among cancer survivors. The objectives of this study were to 1) report recent trends in the pharmaceutical treatment of pain and HRQoL among cancer survivors; 2) to understand better the reasons for and the effects of pharmaceutical treatment of pain and 3) to assess relationship between pain medication use and workers' productivity. Methods: This was a retrospective observational study using a nationally representative survey database. Cancer survivors, excluding survivors of non-melanoma skin cancer, were identified using survey questions and clinical classification codes. Utilization, cost and payer cost shares were obtained for following class of drugs such as non-opioids, opioids, narcotic analgesic combinations and adjuvants annually from 2008 to 2013. The demographic, geographical, clinical and economic predictor variables were regressed to assess their association with the total number of pain/opioid prescriptions. Productivity measures obtained from SF-12 and CSAQ were assessed for their association with pain/opioid medications use. Descriptive statistics were computed employing appropriate statistical procedures for the MEPS with its unique sampling design. Estimates were reported using zero-inflated Poisson regression. Results: Out of 23.4 million cancer survivors in 2008, 40.8% took pain medications; in 2013, 43.9% of 24.8 million survivors took pain medications; these percentages exceed those for patients without a history of cancer. The total number of prescriptions for pain medications increased from 60.3 million in 2008 to 74.3 million in 2013. The utilization of opioids and adjuvant analgesics was significantly (p<0.05) higher among the cancer survivors compared to individuals without cancer history. The cost (not adjusted for inflation) of pain medications increased from $3.5 billion in 2008 to $5.6 billion in 2013. Overall, the patient cost share decreased from 23 (open full item for complete abstract)

Doctor of Psychology (Psy.D.), Xavier University, 2018, Psychology

The present study examined the predictive role of body-related components (i.e., Body Compassion and BMI) and components of the ACT model (i.e., Mindfulness and Experiential Avoidance), in two dimensions of pain (i.e., pain severity [PS] and pain interference [PI]) and quality of life (QOL) in endometrial cancer (EC) survivors. Data were utilized from 82 participants who are members of a national online support group for EC and had completed treatment. Results indicated that the ACT components and body-related components, as a set, predicted PI and QOL but not PS. Experiential avoidance was determined to be an independent predictor of QOL. Negative affect, used as a covariate, independently predicted unique variance in PS, PI, and QOL while age as a covariate was an independent predictor of PI and QOL. Post hoc analyses found statistical differences between obese and non-obese groups within the sample, such that obese EC survivors endorsed higher experiential avoidance, lower mindfulness, and lower body compassion compared to non-obese EC survivors. Results suggest that body-related and ACT components, taken together, may be predictive of PI and QOL while experiential avoidance may contribute uniquely to QOL, rendering it a key target of future intervention for EC survivors post-treatment.

Psy. D., Antioch University, 2016, Antioch Seattle: Clinical Psychology

Negative stereotypes about people with chronic pain pose a barrier in the delivery of care; contribute to worsening symptoms of physical and psychological distress; and play a role in policy decisions that adversely affect patients and providers. Pain-care seekers may be accused of malingering, laziness, mental aberration, attention seeking, and drug seeking. The propagation of stigmatizing attitudes was explored in this Critical Discourse Analysis of online-reader-comments responding to a series of pain-care policy articles published by a large metropolitan newspaper. Results suggest that framing pain patients as legitimate and deserving can inadvertently reproduce the inequities advocates seek to redress. Ascriptions of deservingness were associated with the locus of choice and agency. Assignments of blameworthiness were used to distinguish the legitimate pain patient from the illegitimate care seeker. Motivation for seeking pain care, as much as the effects of opioids, provided crucial determinants in evaluating legitimacy claims and blame ascriptions. Evaluations of deservingness were predicated on the valence of social regard. Compassion, empathy, respect and believability were rewards of positive social regard. The subjects of addiction and drug abuse were maligned to the detriment of people with pain and people with opioid addiction alike. The disease-entity model of chronic pain was associated with psychiatric discourses of mental illness through a narratives inaccurate reality perception. Loss of independence, rationality, and respectability were semantically linked to negative stereotypes of pain patients, drug addicts, and mentally ill groups. Medical discourses drawing on empirical materialist traditions assert taken-for-granted population categories (e.g. chronic noncancer pain patient) with little acknowledgment of confounding variables, lack of evidence, or their social impact. For the benefit of people seeking care, there is a critical need for moral (open full item for complete abstract)

Doctor of Engineering, Cleveland State University, 2015, Washkewicz College of Engineering

Chronic neuropathic pain is a debilitating disorder of the central or peripheral nervous system and estimated to affect 100 million Americans. Pain is not just physiological, but a social issue because it leads to severe disability and affects quality of life. According to pain “neuromatrix” theory, pain has significant affective and cognitive components that enhances pain experience and hence disability. The current project aims to characterize this affect component using magnetoencephalography (MEG) in patients with post-stroke thalamic pain (PSTP). For this purpose, specific experimental paradigms to evoke pain anticipation were designed along with MEG data analysis methodology. In Experiment-1, normal healthy subjects were studied to establish a standard against which patient population could be studied. Pain was conditioned using visual countdown cues. In Experiment-2, conditioning cues from visual, tactile and auditory modalities were employed to study the effect of multi-modal conditioning on pain affect in normal healthy population. In Experiment-3, PSTP patients who had stroke induced lesion in the thalamic nuclei and consequently unrelenting chronic pain on the side of the body contralateral to the lesion, were studied. Pain affect was characterized at baseline and after deep brain stimulation (DBS) treatment. Departing from conventional approach, in this project DBS of the ventral capsule was employed to modulate the affective (or anticipatory) component of pain and thereby reduce pain related disability in PSTP patients. MEG correlates of pain anticipation at both sensor and source level from each experiment is consolidated and summarized. Findings support MEG's role as a functional biomarker to characterize neural oscillatory activity related to pain affect and anticipation.

Master of Science, The Ohio State University, 2009, Dentistry

Objective The purpose of this study was to examine parental management of acute dental pain in children. Methods: This IRB approved study consisted of a survey of parents bringing children to Nationwide Children's Hospital's emergency walk-in dental clinic. Results: Data from 300 children-parent dyads were included in this analysis. The mean age of children was 8 years 8 months, and mean duration of pain was 17.7 days. Seventy-Six percent of children were treated with at least one dose of over-the-counter pain medication. Acetaminophen was the most commonly used (40%), followed by ibuprofen (37%). Age was the most significant response variable with over 40% of the categories being clinically significant. Younger children were less likely to have received OTC analgesia for dental pain (p=.048) Conclusion: Acute dental pain in children is being mismanaged with children waiting more than 17 days for treatment. Age is the most significant response variable.

Specialist in Education (Ed.S.), University of Dayton, 2012, School Psychology

Chronic pain is a widespread and complex concern, which affects students academically, emotionally, and socially. Teachers' knowledge about meeting the academic, emotional, and social needs of children with chronic pain needs is essential. Previous findings indicate that attention and relief from responsibility may reinforce and maintain functional disability; however, teachers may not be properly educated about ways to help students manage chronic pain. This study assessed regular education teachers' understanding of chronic pain. One hundred and five teachers from a midwestern school district completed a survey rating their understanding of chronic pain. The majority of teachers reported no knowledge about chronic pain and had not received any formal training. Most of the teachers, however, indicated that they have previously had a student with chronic pain whose academic, emotional, and social functioning was somewhat affected. Teachers did not vary significantly in their perceptions of impact of pain on functioning based on their school type. Future research should focus on specific chronic pain conditions and the effectiveness of interventions to improve teacher knowledge of working with students with chronic pain. School systems should ensure that teachers understand medical conditions associated with chronic pain in order to provide effective interventions.

Doctor of Philosophy, Case Western Reserve University, 2013, Epidemiology and Biostatistics

This dissertation uses an existing data source from the Cleveland Clinic's Chronic Pain Rehabilitation Program (CPRP) to describe factors predicting attrition and failure in interdisciplinary pain care, as well as to use the evidence basis from interdisciplinary pain care to translate to concrete policy strategies for use in primary care. The dissertation has three aims: build a model describing factors that patient attrition in an interdisciplinary pain rehabilitation program using the patient data registry at the CPRP, build a nomogram to predict program failure in a comprehensive chronic pain rehabilitation program, using the CPRP patient data registry and examine the evidence basis for interdisciplinary pain care interventions to suggest focused near-term strategies for implementation of the primary care recommendations in the Institute of Medicine's report Relieving Pain in America. Four factors predictive of program attrition in the CPRP were identified: marital status, IQ, chemical dependence and clinician assessed depression. After imputation, variable selection using Harrrell's `model approximation' method and bootstrap validation of the model were used to develop a nomogram to predict program failure. The final nomogram contained ten variables: marital status, IQ, hours rest/day, smoking, chemical dependence, University of Alabama Pain Behavior Scale, anxiety diagnosis, Pain Disability Index, pain duration (years), and the depression subscale of the Depression, Anxiety, and Stress Scale. The model validation results showed the pooled C-statistic=.794 (.722-.803), r2=.226, and shrinkage factor=.97. Interdisciplinary pain care strategies can provide the evidence base for primary care providers to respond to the recommendations from the IOM. Primary care providers and health systems can use evidence based practice to implement these recommendations in the near-term by: changing screening and evaluation of chronic pain, partnering with community stakeholde (open full item for complete abstract)

Doctor of Psychology (Psy.D.), Xavier University, 2025, Psychology

Chronic pain is a potentially debilitating health condition in which pain lasts beyond normal healing time or for a duration longer than three months. Several psychiatric disorders are comorbid with chronic pain, including mood disorders, anxiety disorders, substance use disorders, suicidal ideation, and post-traumatic stress disorder (PTSD). Chronic pain affects more than one in 10 young adults worldwide. Understanding how chronic pain affects the mental health of individuals in the early stages of adulthood may help clinicians better tailor psychotherapeutic interventions to their needs. Datasets were obtained from 146 participants ages 20-83 (M = 48.67 years) who completed self-report measures related to their psychological functioning. Pearson correlation and a parallel multiple regression mediation analysis were conducted to investigate the relationships between Acceptance and Commitment Therapy (ACT) processes, age, and depressive symptoms. A significant inverse correlation was found between age and depressive symptoms. Younger participants reported significantly lower levels of mindfulness, a weaker sense of "self-as-context," more values discrepancy, and higher levels of cognitive fusion as compared to older participants. Among the ACT processes tested, cognitive fusion was the only one which mediated the relationship between age and depressive symptoms. Psychological inflexibility, chronic pain values discrepancy, and cognitive fusion had a significant direct effect on self-reported symptoms of depression. Younger adults with chronic pain exhibited more depressive symptoms and lower psychological functioning as seen through the lens of the core ACT processes. Understanding the unique psychological challenges of early adulthood may help clinicians to customize psychotherapeutic interventions to help improve psychological functioning in younger adults with chronic pain.

Master of Science (MS), Wright State University, 2024, Computer Science

Sickle Cell Disease (SCD) is one of the most prevalent genetic blood disorders affecting millions of people worldwide. It is often accompanied by acute and/or chronic pain leading to increased healthcare costs and adverse outcomes. Effective management of SCD requires an understanding of the diverse physiological profiles. This study employs unsupervised machine learning, specifically K-means clustering to categorize the patients suffering with SCD into different clusters based on their vital signs. The main aim is to identify the groups that reflect similarities in physiological and pain profiles, allowing an in-depth analysis to reveal distinctive features distinguishing patient clusters. The project pipeline involved data collection, preprocessing, clustering, cluster validation and statistical analysis of clusters. Following this we found the choice of four clusters to be the best fit for the patient cohort using cluster validity measures with the following physiological behavior: (i) a combination of low blood pressure, high respiration, and elevated heart rates; (ii) low blood pressure and slightly high oxygen saturation; (iii) high blood pressure; and (iv) elevated heart rates. Statistical methods ANOVA (Analysis of Variance) and effect size calculations were performed to validate the obtained clusters and assess the importance and amplitude of feature differences across the clusters. The findings demonstrate the effectiveness of unsupervised learning in revealing patient heterogeneity within SCD population. The study concludes that clustering can play a vital role in enabling healthcare providers with a better understanding of patient-specific needs.