Effects of cognitive pain coping strategies and locus of control on perception of cold pressor pain in healthy individuals: Experimental study

Neuronal activation patterns during self-referential pain imagination

In clinical assessments and pain therapy, patients are asked to imagine themselves in pain. However, the underlying neuronal processes remain poorly understood. Prior research has focused on empathy for pain or reported small sample sizes. Thus, the present study aimed to promote the neurobiological understanding of self-referential pain imagination. We hypothesised to find activation contrasts (pain vs. no pain) across pain-related areas and expected two of the most prominent predictors of chronic pain, pain sensitivity (PS) and locus of control (LoC), to be moderators. In an fMRI study, N = 82 participants completed a pain imagination task, in which they were asked to imagine themselves in painful and non-painful situations presented in the form of pictures and texts. After each trial, they were instructed to give painfulness ratings. As a laboratory measure of PS, electrical pain thresholds were assessed. A questionnaire was completed to measure LoC. Across presentation modes we found activity contrasts in previously pain-related regions, such as the prefrontal, supplementary motor, primary motor, somatosensory and posterior parietal cortices, and the cerebellum. We found positive associations of PS and external LoC with painfulness ratings, and a negative correlation between PS and internal LoC. Despite our hypotheses, neither PS nor internal LoC were significant predictors of the BOLD-signal contrasts. Though future studies are needed to draw further conclusions, our results provide preliminary evidence of a potential neuronal imagination-perception overlap in pain.

Effectiveness of spontaneous pain coping strategies for acute pain management: A laboratory study

The aim of the present study has been to analyze the relationship between the use of not previously trained, diverse acute pain coping strategies and levels of pain intensity and pain tolerance in a group of healthy participants. Previous research has analyzed the usefulness of the training of these strategies after several training sessions, but adequate patient training requires a great deal of time. Two hundred and forty healthy people participated in the study. Pain coping strategies was evaluated with a version of CSQ-S. Subsequently, the participants completed a cold pressor test and tolerance test. After that, subjects filled in the adaptation of the CSQ-S about the strategies which they had employed throughout the test. Correlation analyses showed a positive relationship between pain intensity and catastrophizing, distractor behaviors, hoping and ignoring the pain. Pain tolerance correlated with self-instructions, ignoring the pain, reinterpreting the pain, catastrophizing and faith and praying. Regression analyses showed that catastrophizing was found to be the strategy that most predicts the variance of pain intensity, and catastrophizing (negative) and ignoring the pain (positive) and praying (negative) were the most predictive ones for pain tolerance. This is the first laboratory study that identifies the more useful pain coping strategies which can be used by patients without previous training in an acute pain context. The results of this study could be useful in the development of protocols for nurses and other health professionals, especially for situations where potentially painful techniques are to be applied to patients.

Emotion regulation and peripheral psychophysiological correlates in the management of induced pain: A systematic review

Cognitive reappraisal and acceptance strategies have been shown to be effective in reducing pain experience and increasing pain tolerance. However, no systematic reviews have focused on the relationship between the use of these two strategies and peripheral physiological correlates when pain is experimentally induced. This systematic review aims to summarize the existing literature that explores the relationship between emotion regulation strategies (i.e., cognitive reappraisal and acceptance) and peripheral correlates of the autonomic nervous system and facial electromyography, such as affect-modulated responses and corrugator activity, on laboratory tasks where pain is induced. The systematic review identifies nine experimental studies that meet our inclusion criteria, none of which compare these strategies. Although cognitive reappraisal and acceptance strategies appear to be associated with decreased psychological responses, mixed results were found for the effects of the use of both strategies on all the physiological correlates. These inconsistencies between the studies might be explained by the high methodological heterogeneity in the task designs, as well as a lack of consistency between the instructions used in the different studies for cognitive reappraisal, acceptance, and the control conditions.

The dynamics of pain reappraisal: the joint contribution of cognitive change and mental load

This study was designed to investigate the neural mechanism of cognitive modulation of pain via a reappraisal strategy with high temporal resolution. The EEG signal was recorded from 29 participants who were instructed to down-regulate, up-regulate, or maintain their pain experience. The L2 minimum norm source reconstruction method was used to localize areas in which a significant effect of the instruction was present. Down-regulating pain by reappraisal exerted a robust effect on pain processing from as early as ~100 ms that diminished the activity of limbic brain regions: the anterior cingulate cortex, right orbitofrontal cortex, left anterior temporal region, and left insula. However, compared with the no-regulation condition, the neural activity was similarly attenuated in the up- and down-regulation conditions. We suggest that this effect could be ascribed to the cognitive load that was associated with the execution of a cognitively demanding reappraisal task that could have produced a general attenuation of pain-related areas regardless of the aim of the reappraisal task (i.e., up- or down-regulation attempts). These findings indicate that reappraisal effects reflect the joint influence of both reappraisal-specific (cognitive change) and unspecific (cognitive demand) factors, thus pointing to the importance of cautiously selected control conditions that allow the modulating impact of both processes to be distinguished.

Anxiety sensitivity and anxiety as correlates of expected, experienced and recalled labor pain

There has been a good deal of research on the role of anxiety sensitivity in pain perception, but only recently have investigators begun to assess its role in labor pain. The aim of this study was to investigate the nature of this relationship as well as the relationship of state and trait anxiety with labor pain. Assessments of maximum and average labor pain were completed in three different time periods (before, during and immediately after labor, and 1 month postpartum). Anxiety and anxiety sensitivity measures were completed during the late stage of pregnancy. A total of 46 primiparous healthy pregnant women, carrying a single child, participated in the study. State anxiety correlated significantly with maximum (r?=?0.352, p?<?0.01) and average (r?=?0.325, p?<?0.05) labor pain expectancies, whereas trait anxiety correlated significantly with maximum labor pain expectancies (r?=?0.306, p?<?0.05). During labor, only the physical concerns dimension of anxiety sensitivity shared a significant relationship with sensory pain (r?=?0.292, p?<?0.05). In conclusion, anxiety shares a significant relationship with labor pain expectancies only, whereas the physical concerns dimension of anxiety sensitivity correlates significantly with sensory pain during labor. These data clarify the role of anxiety and anxiety sensitivity in the experience of labor pain. Clinical implications are discussed.

How a clock can change your pain? The illusion of duration and pain perception

The intensity of experimental pain is known to be dependent on stimulation duration. However, it remains unknown whether this effect arises largely from the actual stimulus duration or is substantially influenced by the subject's perception of the stimulus duration. In the present study, we questioned this issue by misleading the perception of the duration of pain in a population of 36 healthy volunteers stimulated with a thermode. To this aim, time was signified by a clock with rotating hands in which imperceptible differences in speed rotation had been introduced. Subjects were therefore immersed in 2 comparative conditions in which time was manipulated to provide the illusion of either long or short duration of the painful stimulus. In a first condition ("full-length" clock), participants were instructed that pain would last for a complete revolution of the clock's hands, whereas in the second condition ("shortened" clock), revolution was reduced by 25%. Although the intensity and the real duration of stimulation were identical in both conditions, the intensity of pain was significantly reduced when the perception of time was misleadingly shortened by the manipulated clock. This study suggests that the perceived duration of a noxious stimulation may influence the perceived intensity of pain. The perceived duration of the length of a noxious stimulation influences (decreases) the intensity of perceived pain.