IMPORTANCE Chronic low back pain (CLBP), the most prevalent chronic pain condition, imparts substantial disability and discomfort. Cognitive behavioral therapy (CBT) reduces the effect of CLBP, but access is limited.OBJECTIVE To determine whether a single class in evidence-based pain management skills (empowered relief) is noninferior to 8-session CBT and superior to health education at 3 months after treatment for improving pain catastrophizing, pain intensity, pain interference, and other secondary outcomes. DESIGN, SETTING, AND PARTICIPANTS This 3-arm randomized clinical trial collected data fromMay 24, 2017, to March 3, 2020. Participants included individuals in the community with selfreported CLBP for 6 months or more and an average pain intensity of at least 4 (range, 0-10, with 10 indicating worst pain imaginable). Data were analyzed using intention-to-treat and per-protocol approaches.Author affiliations and article information are listed at the end of this article.

Introduction: Critical for the diagnosis and treatment of chronic pain is the anatomical distribution of pain. Several body maps allow patients to indicate pain areas on paper; however, each has its limitations. Objectives: To provide a comprehensive body map that can be universally applied across pain conditions, we developed the electronic Collaborative Health Outcomes Information Registry (CHOIR) self-report body map by performing an environmental scan and assessing existing body maps. Methods: After initial validation using a Delphi technique, we compared (1) pain location questionnaire responses of 530 participants with chronic pain with (2) their pain endorsements on the CHOIR body map (CBM) graphic. A subset of participants (n 5 278) repeated the survey 1 week later to assess test-retest reliability. Finally, we interviewed a patient cohort from a tertiary pain management clinic (n 5 28) to identify reasons for endorsement discordances. Results: The intraclass correlation coefficient between the total number of body areas endorsed on the survey and those from the body map was 0.86 and improved to 0.93 at follow-up. The intraclass correlation coefficient of the 2 body map graphics separated by 1 week was 0.93. Further examination demonstrated high consistency between the questionnaire and CBM graphic (,10% discordance) in most body areas except for the back and shoulders (15-19% discordance). Participants attributed inconsistencies to misinterpretation of body regions and laterality, the latter of which was addressed by modifying the instructions. Conclusions: Our data suggest that the CBM is a valid and reliable instrument for assessing the distribution of pain.

Study findings reveal continued opioid reduction and enduring pain stability for a substantial fraction of patients, 2 to 3 years after a patient-centered voluntary opioid tapering program.

Background: Independent of pain intensity, pain-specific distress is highly predictive of pain treatment needs, including the need for prescription opioids. Given the inherently distressing nature of chronic pain, there is a need to equip individuals with pain education and self-regulatory skills that are shown to improve adaptation and improve their response to medical treatments. Brief, targeted behavioral medicine interventions may efficiently address the key individual factors, improve self-regulation in the context of pain, and reduce the need for opioid therapy. This highlights the critical need for targeted, cost-effective interventions that efficiently address the key psychological factors that can amplify the need for opioids and increased risk for misuse. In this trial, the primary goal is to test the comparative efficacy of a single-session skills-based pain management class to a health education active control group among patients with chronic pain who are taking opioids. Methods/design: Our study is a randomized, double-blind clinical trial testing the superiority of our 2-h, singlesession skills-based pain management class against a 2-h health education class. We will enroll 136 adult patients with mixed-etiology chronic pain who are taking opioid prescription medication and randomize 1:1 to one of the two treatment arms. We hypothesize superiority for the skills-based pain class for pain control, self-regulation of pain-specific distress, and reduced opioid use measured by daily morphine equivalent. Team researchers masked to treatment assignment will assess outcomes up to 12 months post treatment.

Ampullae of Lorenzini are sensory organs capable of detecting microvolt gradients in seawater. Electroreception involves interplay between voltage-dependent calcium channels CaV1.3 and big conductance calcium-activated potassium (BK) channels in apical membranes of receptor cells. Expression of BK (kcnma1) and CaV1.3 (cacna1d) channels in skate (Leucoraja erinacea) ampullary electroreceptors was studied by in situ confocal microscopy. BK and CaV1.3 channels colocalize in plasma membranes, ribbon synapses and kinocilia. BK channels additionally colocalize with chromatin and nuclear lamins in electroreceptor cells. Bioinformatic sequence analysis identified an alternatively spliced bipartite nuclear localization sequence (NLS) in kcnma1 (at site of mammalian STREX exon). Skate kcnma1 wild type cDNA transfected into HEK293 cells localized to the endoplasmic reticulum and nucleus. Mutations in the NLS (KRàAA or SVLSàAVLA) independently attenuated nuclear translocation from endoplasmic reticulum. BK channel localization may be controlled by splicing or phosphorylation to tune electroreception and modulate gene expression.