Cognitive-behavioral therapy for chronic pain (CBT-CP) is an important evidence-based non-pharmacologic treatment for chronic back and neck pain that is frequently recommended as a component of multidisciplinary treatment. However, the success of CBP-CP’s implementation in clinical settings is affected by a variety of poorly understood obstacles to patient engagement with CBT-CP. Expanding upon the limited prior research conducted in heterogeneous practice settings, this study examines patterns of treatment initiation for CBT-CP at an interdisciplinary, hospital-based chronic pain practice and conducts exploratory comparisons between groups of patients who did and did not engage in CBT-CP after receiving a referral. Patients’ descriptive data, including pain severity, work status, prior therapy, and behavioral health questionnaire scores at intake visit, were obtained through a retrospective chart review of electronic medical records. Data were then analyzed using inter-group comparisons and logistic regression modeling to determine factors that predicted treatment initiation for CBT-CP. On multivariate analysis, we found that patient’s depression level as measured by their Patient Health Questionnaire 9 (PHQ-9) score was solely predictive of treatment initiation, as chronic pain patients with a higher level of depression were found to be more likely to attend their recommended appointments of CBT-CP. Anxiety score as measured by GAD-7, work status, pain scores, and prior therapy engagement were not independently predictive. No single “profile” of patient-level factors was found to delineate patients who did and did not initiate CBT-CP, demonstrating the limitations of clinical variables as predictors of uptake.

BACKGROUND: Multiple myeloma (MM) and plasmacytoma metastases to the spine are extremely rare, with 9 cases reported in the literature. Only 2 describe cases of solitary plasmacytoma (SP) specifically in the cervical spine, both in patients without known histories of MM. Therefore, the natural history of MM recurrence as SP in the cervical spine remains unknown. OBSERVATIONS: The authors describe the case of a 67-year-old woman with a history of MM after stem cell transplant and chemotherapy in remission for a year who presented with progressive cervical myelopathy found to have an intradural extramedullary solitary lesion at C2–3 on MRI of the whole spine. The patient underwent C1–3 laminectomies for decompression and intradural biopsy of the lesion, with pathology consistent with plasmacytoma. The patient’s motor examination improved significantly postoperatively. LESSONS: SP should be included in the differential diagnosis for intradural extramedullary lesions found in the spine, particularly in patients with a history of MM and tumor resistance to radiotherapy. Despite plasmacytoma’s classically radiosensitive nature, it is possible to have residual tumor after radiation therapy. In these cases, patients may benefit greatly from surgical biopsy and decompression followed by adjuvant radiotherapy. https://thejns.org/doi/10.3171/CASE24731