kelley bevers | University of Texas at Arlington (original) (raw)
Papers by kelley bevers
Healthcare, May 17, 2018
Traditionally, there has been a widely accepted notion that the transition from acute to chronic ... more Traditionally, there has been a widely accepted notion that the transition from acute to chronic pain follows a linear trajectory, where an injury leads to acute episodes, subacute stages, and progresses to a chronic pain condition. However, it appears that pain progression is much more complicated and individualized than this original unsupported assumption. It is now becoming apparent that, while this linear progression may occur, it is not the only path that pain, specifically low-back pain, follows. It is clear there is a definite need to evaluate how low-back pain trajectories are classified and, subsequently, how we can more effectively intervene during these progression stages. In order to better understand and manage pain conditions, we must examine the different pain trajectories, and develop a standard by which to use these classifications, so that clinicians can better identify and predict patient-needs and customize treatments for maximum efficacy. The present article examines the most recent trajectory research, and highlights the importance of developing a broader model for patient evaluation.
The Spine Journal, Dec 1, 2017
BACKGROUND CONTEXT: The Central Sensitization Inventory (CSI) is a valid and reliable patient-rep... more BACKGROUND CONTEXT: The Central Sensitization Inventory (CSI) is a valid and reliable patient-reported instrument designed to identify patients whose presenting symptoms may be related to Central Sensitization (CS). Part A of the CSI measures a full array of 25 somatic and emotional symptoms associated with CS, and Part B asks if patients have previously been quantitatively-directed and medically-supervised exercise process, as well as a multimodal psychosocial disability management component. RESULTS: The CSI severity groups were strongly associated with Major Depressive Disorder and previous abuse history (p < .01), which are known risk factors for CS-related symptoms and diagnoses. CSI scores were also strongly associated with patient-reported CSS diagnoses on CSI Part B. The percentage of patients who reported a comorbid CSS diagnosis increased in each higher CSI-severity group, from 11% in the Subclinical group, to 56% in the Extreme group. The CSI severity groups were significantly related to other CS-related patient-reported symptoms, including pain intensity, pain-related anxiety, depressive symptoms, somatization symptoms, perceived disability, and sleep disturbance (ps < .001). CSI scores, along with all other psychosocial measures, decreased at treatment discharge. CONCLUSIONS: In the present study, admission CSI scores were highly associated with previous CSS diagnoses, CS-related symptoms, and clinically relevant patient-reported psychosocial variables. All psychosocial variables, as well as scores on the CSI, were significantly improved at FRP discharge. The CSI may be have important clinical utility, as a screener and as a treatment outcome measure, for CSPD patients participating in an interdisciplinary FRP.
Handbooks in health, work, and disability, 2018
Effectively managing pain in older adults often requires an interdisciplinary approach that utili... more Effectively managing pain in older adults often requires an interdisciplinary approach that utilizes less traditional methods such as massage therapy, myofascial release therapy, yoga, electrical muscle stimulation, acupuncture, chiropractic adjustment, hypnosis, holistic approaches, surgical interventions, plasma injections, and prolotherapy. These methods are often used in complement to one another and may also coincide with traditional physical and pharmacological interventions. In addition to developing a customized management program, older adults face unique challenges that must be considered by healthcare providers exceeding the physical experience of pain and incorporating the social and psychological aspects of the pain experience. Older adults often face additional complications with traditional physical and pharmacological therapeutic approaches as stand-alone treatments due to comorbid conditions, the number of medications taken daily, lack of social support, and financial concerns. This chapter will focus on these therapeutic options for pain management in older adults as well as emphasizing the importance and effectiveness of customizable, interdisciplinary strategies.
I want to express my sincerest gratitude that I am writing this statement in itself, it is truly ... more I want to express my sincerest gratitude that I am writing this statement in itself, it is truly an honor to be extended this opportunity to pursue my passion. Firstly, I would like to thank Dr. Robert Gatchel for his mentorship, his guidance and support has been invaluable. I am deeply grateful for the opportunities and knowledge he has afforded me the past several years. Thank you to Dr. Angela Liegey-Dougall for serving on my committee, being an amazing student advocate and teacher, and for her support, encouragement, and guidance. Thank you to Dr. Shannon Layman for serving on my committee, giving me an excellent example of how to be a great educator, and for being a vital secondary mentor to me over the past several years. The support and guidance from my committee has had a lasting impact on my life. Massive thanks to my lab mates Ryan Hulla and Eric Salas for their friendship and hard work. To my mother, Debbie, for her unwavering support, I am incredibly grateful, I know no one greater or kinder. To the people who have provided invaluable insight, instruction, friendship, and support:
Handbook of Experimental Pharmacology, 2018
Effectively managing pain in older adults often requires an interdisciplinary approach that utili... more Effectively managing pain in older adults often requires an interdisciplinary approach that utilizes less traditional methods such as massage therapy, myofascial release therapy, yoga, electrical muscle stimulation, acupuncture, chiropractic adjustment, hypnosis, holistic approaches, surgical interventions, plasma injections, and prolotherapy. These methods are often used in complement to one another and may also coincide with traditional physical and pharmacological interventions. In addition to developing a customized management program, older adults face unique challenges that must be considered by healthcare providers exceeding the physical experience of pain and incorporating the social and psychological aspects of the pain experience. Older adults often face additional complications with traditional physical and pharmacological therapeutic approaches as stand-alone treatments due to comorbid conditions, the number of medications taken daily, lack of social support, and financial concerns. This chapter will focus on these therapeutic options for pain management in older adults as well as emphasizing the importance and effectiveness of customizable, interdisciplinary strategies.
Journal of Pain & Relief, 2017
Chronic low back pain is a debilitating condition affecting millions of Americans annually. Older... more Chronic low back pain is a debilitating condition affecting millions of Americans annually. Older-adult populations suffer a high prevalence of this continually painful state, and further face a unique set of challenges to manage short-and long-term biopsychosocial functioning. As the population ages, and the proportion of older adults grow, it is essential to explore and develop the most effective interdisciplinary strategies to care for older adults who are chronic pain sufferers. In this Commentary, we highlight some of the special challenges that the older-adult population encounters, and their influence on pain management strategies.
Expert Review of Clinical Pharmacology, 2017
Introduction: A recent literature review concluded that the comorbidity of chronic pain and depre... more Introduction: A recent literature review concluded that the comorbidity of chronic pain and depression in adults is approximately 50%-65%. Physical and cognitive declines, concurrent multiple health conditions, and complex medication regimens add to the unique and complex challenges of effectively treating pain in particularly geriatric populations. Interdisciplinary medical intervention and monitoring for psychiatric sequelae, such as depression, cognitive change, and synergistic physical side effects are necessary. Areas Covered: This review covers an extensive multi-database wide search of the pharmacotherapy of pain and depression in older adults, including biopsychosocial approaches. One of these, on which this review focuses, is Functional Restoration, an interdisciplinary application of quantified physical rehabilitation, case management, and cognitive behavioral and educational therapies to achieve improved well-being and better physical functioning. The biopsychosocial model incorporates an overview of the overlapping and interactive dimensions of a patient's life and addresses them within a comprehensive plan of treatment. Expert Commentary: A multifactorial, rather than a single factor approach to the treatment of complicated health care problems such as chronic pain in an elderly patient is emphasized as an important change in perspective for the health care provider.
The spine journal : official journal of the North American Spine Society, Dec 12, 2017
The Central Sensitization Inventory (CSI) is a valid and reliable patient-reported instrument des... more The Central Sensitization Inventory (CSI) is a valid and reliable patient-reported instrument designed to identify patients whose presenting symptoms may be related to Central Sensitization (CS). Part A of the CSI measures a full array of 25 somatic and emotional symptoms associated with CS, and Part B asks if patients have previously been diagnosed with one or more specific Central Sensitivity Syndromes (CSSs) and related disorders. The CSI has previously been validated in a group of chronic pain patients who were screened by a trained psychiatrist for specific CSS diagnoses. It is currently unknown if the CSI can be a useful treatment-outcome assessment tool for chronic spinal pain disorder (CSPD) patients who are not screened for comorbid CSSs. It is known, however, that previous studies have identified CS-related symptoms, and comorbid CSSs, in subsets of patients with CSPDs. Studies have also shown that CS-related symptoms can be influenced by cognitive and psychosocial factors...
US Neurology, 2016
The biopsychosocial model has been demonstrated to be the most heuristic approach to chronic pain... more The biopsychosocial model has been demonstrated to be the most heuristic approach to chronic pain assessment, prevention, and treatment. Currently, this model also provides the best foundation for tailoring the most comprehensive pain management program for each specific patient. Chronic pain patients have an increased risk for developing deficits in physical functioning, emotional reactivity, and cognition. Interdisciplinary treatment, based on the biopsychosocial model, is vital to address these multifaceted issues facing chronic pain sufferers. These interdisciplinary pain management strategies have progressed with advancements in science and technology in an attempt to provide the best possible outcomes for pain patients. However, while research has made enormous advances, there are still some clinical research gaps to be addressed. This article will begin with a historical overview of pain management in order to demonstrate the evolution in theory from ancient practices to the ...
Healthcare, 2018
Traditionally, there has been a widely accepted notion that the transition from acute to chronic ... more Traditionally, there has been a widely accepted notion that the transition from acute to chronic pain follows a linear trajectory, where an injury leads to acute episodes, subacute stages, and progresses to a chronic pain condition. However, it appears that pain progression is much more complicated and individualized than this original unsupported assumption. It is now becoming apparent that, while this linear progression may occur, it is not the only path that pain, specifically low-back pain, follows. It is clear there is a definite need to evaluate how low-back pain trajectories are classified and, subsequently, how we can more effectively intervene during these progression stages. In order to better understand and manage pain conditions, we must examine the different pain trajectories, and develop a standard by which to use these classifications, so that clinicians can better identify and predict patient-needs and customize treatments for maximum efficacy. The present article examines the most recent trajectory research, and highlights the importance of developing a broader model for patient evaluation.
Journal of Translational Medicine
Background: Identifying how pain transitions from acute to chronic is critical in designing effec... more Background: Identifying how pain transitions from acute to chronic is critical in designing effective prevention and management techniques for patients' well-being, physically, psychosocially, and financially. There is an increasingly pressing need for a quantitative and predictive method to evaluate how low back pain trajectories are classified and, subsequently, how we can more effectively intervene during these progression stages. Methods: In order to better understand pain mechanisms, we investigated, using computational modeling, how best to describe pain trajectories by developing a platform by which we studied the transition of acute chronic pain. Results: The present study uses a computational neuroscience-based method to conduct such trajectory research, motivated by the use of hypothalamic-pituitary-adrenal (HPA) axis activity-history over a time-period as a way to mimic pain trajectories. A numerical simulation study is presented as a "proof of concept" for this modeling approach. Conclusions: This model and its simulation results have highlighted the feasibility and the potential of developing such a broader model for patient evaluations.
Healthcare, May 17, 2018
Traditionally, there has been a widely accepted notion that the transition from acute to chronic ... more Traditionally, there has been a widely accepted notion that the transition from acute to chronic pain follows a linear trajectory, where an injury leads to acute episodes, subacute stages, and progresses to a chronic pain condition. However, it appears that pain progression is much more complicated and individualized than this original unsupported assumption. It is now becoming apparent that, while this linear progression may occur, it is not the only path that pain, specifically low-back pain, follows. It is clear there is a definite need to evaluate how low-back pain trajectories are classified and, subsequently, how we can more effectively intervene during these progression stages. In order to better understand and manage pain conditions, we must examine the different pain trajectories, and develop a standard by which to use these classifications, so that clinicians can better identify and predict patient-needs and customize treatments for maximum efficacy. The present article examines the most recent trajectory research, and highlights the importance of developing a broader model for patient evaluation.
The Spine Journal, Dec 1, 2017
BACKGROUND CONTEXT: The Central Sensitization Inventory (CSI) is a valid and reliable patient-rep... more BACKGROUND CONTEXT: The Central Sensitization Inventory (CSI) is a valid and reliable patient-reported instrument designed to identify patients whose presenting symptoms may be related to Central Sensitization (CS). Part A of the CSI measures a full array of 25 somatic and emotional symptoms associated with CS, and Part B asks if patients have previously been quantitatively-directed and medically-supervised exercise process, as well as a multimodal psychosocial disability management component. RESULTS: The CSI severity groups were strongly associated with Major Depressive Disorder and previous abuse history (p < .01), which are known risk factors for CS-related symptoms and diagnoses. CSI scores were also strongly associated with patient-reported CSS diagnoses on CSI Part B. The percentage of patients who reported a comorbid CSS diagnosis increased in each higher CSI-severity group, from 11% in the Subclinical group, to 56% in the Extreme group. The CSI severity groups were significantly related to other CS-related patient-reported symptoms, including pain intensity, pain-related anxiety, depressive symptoms, somatization symptoms, perceived disability, and sleep disturbance (ps < .001). CSI scores, along with all other psychosocial measures, decreased at treatment discharge. CONCLUSIONS: In the present study, admission CSI scores were highly associated with previous CSS diagnoses, CS-related symptoms, and clinically relevant patient-reported psychosocial variables. All psychosocial variables, as well as scores on the CSI, were significantly improved at FRP discharge. The CSI may be have important clinical utility, as a screener and as a treatment outcome measure, for CSPD patients participating in an interdisciplinary FRP.
Handbooks in health, work, and disability, 2018
Effectively managing pain in older adults often requires an interdisciplinary approach that utili... more Effectively managing pain in older adults often requires an interdisciplinary approach that utilizes less traditional methods such as massage therapy, myofascial release therapy, yoga, electrical muscle stimulation, acupuncture, chiropractic adjustment, hypnosis, holistic approaches, surgical interventions, plasma injections, and prolotherapy. These methods are often used in complement to one another and may also coincide with traditional physical and pharmacological interventions. In addition to developing a customized management program, older adults face unique challenges that must be considered by healthcare providers exceeding the physical experience of pain and incorporating the social and psychological aspects of the pain experience. Older adults often face additional complications with traditional physical and pharmacological therapeutic approaches as stand-alone treatments due to comorbid conditions, the number of medications taken daily, lack of social support, and financial concerns. This chapter will focus on these therapeutic options for pain management in older adults as well as emphasizing the importance and effectiveness of customizable, interdisciplinary strategies.
I want to express my sincerest gratitude that I am writing this statement in itself, it is truly ... more I want to express my sincerest gratitude that I am writing this statement in itself, it is truly an honor to be extended this opportunity to pursue my passion. Firstly, I would like to thank Dr. Robert Gatchel for his mentorship, his guidance and support has been invaluable. I am deeply grateful for the opportunities and knowledge he has afforded me the past several years. Thank you to Dr. Angela Liegey-Dougall for serving on my committee, being an amazing student advocate and teacher, and for her support, encouragement, and guidance. Thank you to Dr. Shannon Layman for serving on my committee, giving me an excellent example of how to be a great educator, and for being a vital secondary mentor to me over the past several years. The support and guidance from my committee has had a lasting impact on my life. Massive thanks to my lab mates Ryan Hulla and Eric Salas for their friendship and hard work. To my mother, Debbie, for her unwavering support, I am incredibly grateful, I know no one greater or kinder. To the people who have provided invaluable insight, instruction, friendship, and support:
Handbook of Experimental Pharmacology, 2018
Effectively managing pain in older adults often requires an interdisciplinary approach that utili... more Effectively managing pain in older adults often requires an interdisciplinary approach that utilizes less traditional methods such as massage therapy, myofascial release therapy, yoga, electrical muscle stimulation, acupuncture, chiropractic adjustment, hypnosis, holistic approaches, surgical interventions, plasma injections, and prolotherapy. These methods are often used in complement to one another and may also coincide with traditional physical and pharmacological interventions. In addition to developing a customized management program, older adults face unique challenges that must be considered by healthcare providers exceeding the physical experience of pain and incorporating the social and psychological aspects of the pain experience. Older adults often face additional complications with traditional physical and pharmacological therapeutic approaches as stand-alone treatments due to comorbid conditions, the number of medications taken daily, lack of social support, and financial concerns. This chapter will focus on these therapeutic options for pain management in older adults as well as emphasizing the importance and effectiveness of customizable, interdisciplinary strategies.
Journal of Pain & Relief, 2017
Chronic low back pain is a debilitating condition affecting millions of Americans annually. Older... more Chronic low back pain is a debilitating condition affecting millions of Americans annually. Older-adult populations suffer a high prevalence of this continually painful state, and further face a unique set of challenges to manage short-and long-term biopsychosocial functioning. As the population ages, and the proportion of older adults grow, it is essential to explore and develop the most effective interdisciplinary strategies to care for older adults who are chronic pain sufferers. In this Commentary, we highlight some of the special challenges that the older-adult population encounters, and their influence on pain management strategies.
Expert Review of Clinical Pharmacology, 2017
Introduction: A recent literature review concluded that the comorbidity of chronic pain and depre... more Introduction: A recent literature review concluded that the comorbidity of chronic pain and depression in adults is approximately 50%-65%. Physical and cognitive declines, concurrent multiple health conditions, and complex medication regimens add to the unique and complex challenges of effectively treating pain in particularly geriatric populations. Interdisciplinary medical intervention and monitoring for psychiatric sequelae, such as depression, cognitive change, and synergistic physical side effects are necessary. Areas Covered: This review covers an extensive multi-database wide search of the pharmacotherapy of pain and depression in older adults, including biopsychosocial approaches. One of these, on which this review focuses, is Functional Restoration, an interdisciplinary application of quantified physical rehabilitation, case management, and cognitive behavioral and educational therapies to achieve improved well-being and better physical functioning. The biopsychosocial model incorporates an overview of the overlapping and interactive dimensions of a patient's life and addresses them within a comprehensive plan of treatment. Expert Commentary: A multifactorial, rather than a single factor approach to the treatment of complicated health care problems such as chronic pain in an elderly patient is emphasized as an important change in perspective for the health care provider.
The spine journal : official journal of the North American Spine Society, Dec 12, 2017
The Central Sensitization Inventory (CSI) is a valid and reliable patient-reported instrument des... more The Central Sensitization Inventory (CSI) is a valid and reliable patient-reported instrument designed to identify patients whose presenting symptoms may be related to Central Sensitization (CS). Part A of the CSI measures a full array of 25 somatic and emotional symptoms associated with CS, and Part B asks if patients have previously been diagnosed with one or more specific Central Sensitivity Syndromes (CSSs) and related disorders. The CSI has previously been validated in a group of chronic pain patients who were screened by a trained psychiatrist for specific CSS diagnoses. It is currently unknown if the CSI can be a useful treatment-outcome assessment tool for chronic spinal pain disorder (CSPD) patients who are not screened for comorbid CSSs. It is known, however, that previous studies have identified CS-related symptoms, and comorbid CSSs, in subsets of patients with CSPDs. Studies have also shown that CS-related symptoms can be influenced by cognitive and psychosocial factors...
US Neurology, 2016
The biopsychosocial model has been demonstrated to be the most heuristic approach to chronic pain... more The biopsychosocial model has been demonstrated to be the most heuristic approach to chronic pain assessment, prevention, and treatment. Currently, this model also provides the best foundation for tailoring the most comprehensive pain management program for each specific patient. Chronic pain patients have an increased risk for developing deficits in physical functioning, emotional reactivity, and cognition. Interdisciplinary treatment, based on the biopsychosocial model, is vital to address these multifaceted issues facing chronic pain sufferers. These interdisciplinary pain management strategies have progressed with advancements in science and technology in an attempt to provide the best possible outcomes for pain patients. However, while research has made enormous advances, there are still some clinical research gaps to be addressed. This article will begin with a historical overview of pain management in order to demonstrate the evolution in theory from ancient practices to the ...
Healthcare, 2018
Traditionally, there has been a widely accepted notion that the transition from acute to chronic ... more Traditionally, there has been a widely accepted notion that the transition from acute to chronic pain follows a linear trajectory, where an injury leads to acute episodes, subacute stages, and progresses to a chronic pain condition. However, it appears that pain progression is much more complicated and individualized than this original unsupported assumption. It is now becoming apparent that, while this linear progression may occur, it is not the only path that pain, specifically low-back pain, follows. It is clear there is a definite need to evaluate how low-back pain trajectories are classified and, subsequently, how we can more effectively intervene during these progression stages. In order to better understand and manage pain conditions, we must examine the different pain trajectories, and develop a standard by which to use these classifications, so that clinicians can better identify and predict patient-needs and customize treatments for maximum efficacy. The present article examines the most recent trajectory research, and highlights the importance of developing a broader model for patient evaluation.
Journal of Translational Medicine
Background: Identifying how pain transitions from acute to chronic is critical in designing effec... more Background: Identifying how pain transitions from acute to chronic is critical in designing effective prevention and management techniques for patients' well-being, physically, psychosocially, and financially. There is an increasingly pressing need for a quantitative and predictive method to evaluate how low back pain trajectories are classified and, subsequently, how we can more effectively intervene during these progression stages. Methods: In order to better understand pain mechanisms, we investigated, using computational modeling, how best to describe pain trajectories by developing a platform by which we studied the transition of acute chronic pain. Results: The present study uses a computational neuroscience-based method to conduct such trajectory research, motivated by the use of hypothalamic-pituitary-adrenal (HPA) axis activity-history over a time-period as a way to mimic pain trajectories. A numerical simulation study is presented as a "proof of concept" for this modeling approach. Conclusions: This model and its simulation results have highlighted the feasibility and the potential of developing such a broader model for patient evaluations.