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Murray GM, Sessle BJ. Pain-sensorimotor interactions: New perspectives and a new model. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2024; 15:100150. [PMID: 38327725 PMCID: PMC10847382 DOI: 10.1016/j.ynpai.2024.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/25/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
How pain and sensorimotor behavior interact has been the subject of research and debate for many decades. This article reviews theories bearing on pain-sensorimotor interactions and considers their strengths and limitations in the light of findings from experimental and clinical studies of pain-sensorimotor interactions in the spinal and craniofacial sensorimotor systems. A strength of recent theories is that they have incorporated concepts and features missing from earlier theories to account for the role of the sensory-discriminative, motivational-affective, and cognitive-evaluative dimensions of pain in pain-sensorimotor interactions. Findings acquired since the formulation of these recent theories indicate that additional features need to be considered to provide a more comprehensive conceptualization of pain-sensorimotor interactions. These features include biopsychosocial influences that range from biological factors such as genetics and epigenetics to psychological factors and social factors encompassing environmental and cultural influences. Also needing consideration is a mechanistic framework that includes other biological factors reflecting nociceptive processes and glioplastic and neuroplastic changes in sensorimotor and related brain and spinal cord circuits in acute or chronic pain conditions. The literature reviewed and the limitations of previous theories bearing on pain-sensorimotor interactions have led us to provide new perspectives on these interactions, and this has prompted our development of a new concept, the Theory of Pain-Sensorimotor Interactions (TOPSMI) that we suggest gives a more comprehensive framework to consider the interactions and their complexity. This theory states that pain is associated with plastic changes in the central nervous system (CNS) that lead to an activation pattern of motor units that contributes to the individual's adaptive sensorimotor behavior. This activation pattern takes account of the biological, psychological, and social influences on the musculoskeletal tissues involved in sensorimotor behavior and on the plastic changes and the experience of pain in that individual. The pattern is normally optimized in terms of biomechanical advantage and metabolic cost related to the features of the individual's musculoskeletal tissues and aims to minimize pain and any associated sensorimotor changes, and thereby maintain homeostasis. However, adverse biopsychosocial factors and their interactions may result in plastic CNS changes leading to less optimal, even maladaptive, sensorimotor changes producing motor unit activation patterns associated with the development of further pain. This more comprehensive theory points towards customized treatment strategies, in line with the management approaches to pain proposed in the biopsychosocial model of pain.
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Affiliation(s)
- Greg M. Murray
- Discipline of Restorative and Reconstructive Dentistry, Sydney School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Darcy Road, Westmead, NSW 2145, Australia
| | - Barry J. Sessle
- Faculty of Dentistry and Temerty Faculty of Medicine Department of Physiology, and Centre for the Study of Pain, University of Toronto, 124 Edward St, Toronto, ON M5G 1G6, Canada
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Weik E, Neuenschwander R, Edgington B, Jensen K, Tipper CM, Oberlander TF. Conditioning induced placebo-like and nocebo-like effects of thermal discomfort in adults but not in youth. Br J Pain 2023; 17:342-351. [PMID: 37538948 PMCID: PMC10395395 DOI: 10.1177/20494637231153364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Introduction Conditioning can be used to modulate the perception of pain, in the form of placebo and nocebo effects. Previous studies show inconsistent results as to whether adolescents show similar, weaker, or non-significant conditioned placebo and nocebo effects compared to effects found in adults. There are suggestions that such differences (if any) may dependent on the cues used in the thermal conditioning paradigms. Therefore, in this current study, we utilized novel, neutral 3D-shaped visual cues to implicitly induce conditioned placebo-like and nocebo-like effects in adolescents and adults. Methods During the conditioning paradigm, distinct cues (Fribbles) were paired with low and high temperatures in 24 adults and 20 adolescents (mean age = 25.5 years). In the testing phase, these conditioned cues as well as a neutral (unconditioned) cue were presented with moderate temperatures. Results Thermal discomfort of moderate temperatures was lower when presented with the conditioned low heat cue (placebo-like effect) and higher when thermal stimuli were presented with the high heat cue (nocebo-like effect) compared to the neutral cue. The effects were driven by adults, as neither the placebo-like nor the nocebo-like effect was significant in adolescents. The difference between adolescents and adults was not explained by differences in temperature or discomfort levels, as adults and adolescents had comparable calibrated temperatures and levels of discomfort during heat stimuli. Conclusion Our findings suggest that thermal perception in adolescents is less influenced by conditioning to an engaging novel visual cue, compared to adults. Our work may have implications for better understanding the scope and limitations of conditioning as a key mechanism of placebo and nocebo effects in youth.
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Affiliation(s)
- Ella Weik
- Department of Psychiatry, BC Mental Health and Addictions Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Regula Neuenschwander
- Department of Pediatrics, BC Children’s Hospital Research Institute, University of British, Vancouver, BC, Canada
| | - Brinn Edgington
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Karin Jensen
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Christine M Tipper
- Department of Pediatrics, BC Children’s Hospital Research Institute, University of British, Vancouver, BC, Canada
| | - Tim F Oberlander
- Department of Psychiatry, BC Mental Health and Addictions Research Institute, University of British Columbia, Vancouver, BC, Canada
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Boorman DC, Keay KA. Learning pain in context: Response-conditioned placebo analgesia and nocebo hyperalgesia in male rats with chronic neuropathic pain. Physiol Behav 2023; 263:114116. [PMID: 36773736 DOI: 10.1016/j.physbeh.2023.114116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/23/2023] [Accepted: 02/08/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Animal models of placebo analgesia and nocebo hyperalgesia have great potential to assist in the development of novel treatments for chronic pain that exploit or inhibit these phenomena. This study sought to elicit both conditioned placebo analgesia and conditioned nocebo hyperalgesia in rats with chronic neuropathic pain using non-pharmacological, contextual conditioning approaches, similar to those most often used in humans. METHODS Sciatic nerve-injured male Sprague-Dawley rats (n = 80), and sham controls (n = 16), underwent a conditioning procedure in which three different thermal stimulus intensities (4 °C, 20 °C or 30 °C) were paired with contextual cues. Injured hind paw withdrawal behaviours were used to determine pain sensitivity, and either conditioned analgesia or conditioned hyperalgesia was evoked by re-exposing the rats to the same context with either an increased or decreased thermal stimulus, respectively. RESULTS Stronger conditioned analgesia and conditioned hyperalgesia were seen when rats were conditioned in a more complex environment, highlighting the importance of context in these processes. Rats that did not undergo conditioning procedures showed fewer hind paw withdrawals, indicating a learned component to these pain behaviours. CONCLUSIONS Our data call attention to context and learning as two critical factors in the development of placebo and nocebo effects in male rodents with a neuropathic injury. Additionally, the response-conditioning model we present in this study affords better comparisons between human and animal studies, in particular for those seeking to identify commonalities in the neurobiological mechanisms of placebo and nocebo responses.
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Affiliation(s)
- Damien C Boorman
- School of Medical Sciences and the Brain and Mind Centre, The University of Sydney, New South Wales, 2006, Australia.
| | - Kevin A Keay
- School of Medical Sciences and the Brain and Mind Centre, The University of Sydney, New South Wales, 2006, Australia
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Hou Y, Zou G, Wang X, Guo H, Ma X, Cheng X, Xie Z, Zuo X, Xia J, Mao H, Yuan M, Chen Q, Cao P, Yang Y, Zhang L, Xiong W. Coordinated activity of a central pathway drives associative opioid analgesic tolerance. SCIENCE ADVANCES 2023; 9:eabo5627. [PMID: 36753548 PMCID: PMC9908028 DOI: 10.1126/sciadv.abo5627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 12/22/2022] [Indexed: 06/18/2023]
Abstract
Opioid analgesic tolerance, a root cause of opioid overdose and misuse, can develop through an associative learning. Despite intensive research, the locus and central pathway subserving the associative opioid analgesic tolerance (AOAT) remains unclear. Using a combination of chemo/optogenetic manipulation with calcium imaging and slice physiology, here we identify neuronal ensembles in a hierarchically organized pathway essential for AOAT. The association of morphine-induced analgesia with an environmental condition drives glutamatergic signaling from ventral hippocampus (vHPC) to dorsomedial prefrontal cortex (dmPFC) cholecystokininergic (CCKergic) neurons. Excitation of CCKergic neurons, which project and release CCK to basolateral amygdala (BLA) glutamatergic neurons, relays AOAT signal through inhibition of BLA μ-opioid receptor function, thereby leading to further loss of morphine analgesic efficacy. This work provides evidence for a circuit across different brain regions distinct for opioid analgesic tolerance. The components of this pathway are potential targets to treat opioid overdose and abuse.
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Affiliation(s)
- Yiwen Hou
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei 230026, China
| | - Guichang Zou
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei 230026, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei 230088, China
| | - Xianglian Wang
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei 230026, China
| | - Hui Guo
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei 230026, China
| | - Xiao Ma
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei 230026, China
| | - Xingyu Cheng
- National Institute of Biological Sciences, Beijing 102206, China
| | - Zhiyong Xie
- National Institute of Biological Sciences, Beijing 102206, China
| | - Xin Zuo
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei 230026, China
| | - Jing Xia
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei 230026, China
| | - Huanhuan Mao
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei 230026, China
| | - Man Yuan
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei 230026, China
| | - Qi Chen
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei 230026, China
| | - Peng Cao
- National Institute of Biological Sciences, Beijing 102206, China
| | - Yupeng Yang
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei 230026, China
| | - Li Zhang
- Laboratory for Integrative Neuroscience, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892, USA
| | - Wei Xiong
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Hefei National Research Center for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei 230026, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei 230088, China
- Anhui Province Key Laboratory of Biomedical Aging Research, Hefei 230026, China
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Seno FZ, Sgobbi RF, Nobre MJ. Contributions of the GABAergic system of the prelimbic cortex and basolateral amygdala to morphine withdrawal-induced contextual fear. Physiol Behav 2022; 254:113868. [PMID: 35724926 DOI: 10.1016/j.physbeh.2022.113868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/20/2022] [Accepted: 06/08/2022] [Indexed: 11/27/2022]
Abstract
Morphine withdrawal can trigger disruptions in neuronal pathways involved in the modulation and expression of anxiety and fear-related behaviors, particularly those involved in associative learning. When it comes to contextual fear, specific subdivisions of the medial prefrontal cortex (mPFC) regulate the expression of defensive behaviors through projections to specific amygdala (AM) nuclei, such as the prelimbic cortex (PrL). The basolateral nucleus (BLA) of the AM has been shown to be involved in the modulation and expression of associative memories of fear, including those associated with opiate withdrawal-related aversive events. The purpose of this study is to determine the role of GABA mechanisms in the PrL and BLA in startle potentiation and freezing behavior caused by morphine-precipitated withdrawal. Our findings show that morphine withdrawal promotes the emergence of contextual conditioned fear in animals when they are exposed to the same environment where the withdrawal sessions were performed. This suggests that the neural circuits underlying the organism's response to conditioned stressors and the circuits modulating the negative affective states induced by drug withdrawal may overlap. The pharmacological manipulation of GABAergic neurotransmission in the PrL and BLA can reverse contextual fear in morphine-withdrawn rats, an effect that appears to be mediated, at least in part, by GABAA receptors.
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Affiliation(s)
- F Z Seno
- Departamento de Psicologia, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo (USP), 14040-901 Ribeirão Preto, SP, Brasil
| | - R F Sgobbi
- Departamento de Psicologia, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo (USP), 14040-901 Ribeirão Preto, SP, Brasil
| | - M J Nobre
- Departamento de Psicologia, Uni-FACEF, 14401-135, Franca, SP, Brasil; Departamento de Psicologia, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo (USP), 14040-901 Ribeirão Preto, SP, Brasil.
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Psychological pain and opioid receptors: Reward downshift is disrupted when tested in a context signaling morphine. Pharmacol Biochem Behav 2022; 216:173386. [DOI: 10.1016/j.pbb.2022.173386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/29/2022] [Accepted: 04/03/2022] [Indexed: 11/22/2022]
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Pajser A, Foster C, Gaeddert B, Pickens CL. Extended operant training increases infralimbic and prelimbic cortex Fos regardless of fear conditioning experience. Behav Brain Res 2021; 414:113476. [PMID: 34302878 PMCID: PMC8428778 DOI: 10.1016/j.bbr.2021.113476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/11/2021] [Accepted: 07/16/2021] [Indexed: 12/28/2022]
Abstract
Extended fear training can lead to initially low fear expression that grows over time, termed fear incubation. Conversely, a single fear conditioning session typically results in high fear initially that is sustained over time. Fear expression decreases across extended training, suggesting that a fear extinction-like process might be responsible for low fear observed soon after training. Because of the prominent role medial prefrontal cortex (mPFC) plays in fear conditioning and extinction, we decided to examine Fos expression resulting from a cued fear retrieval test to gain insight into possible mechanisms involved in extended training fear incubation. Male Long-Evans rats received 1 or 10 days of tone-shock pairings or tone-only exposure (while lever-pressing for food). Two days after the end of fear training, rats received a cued fear test, with perfusions timed to visualize Fos expression during test. As expected, the limited fear conditioning group exhibited higher fear in the test than any of the other groups (as measured with conditioned suppression of lever-pressing). Interestingly, we found that extended training animals (whether they received tone-shock pairings or tone-only exposure) expressed higher levels of Fos in both prelimbic and infralimbic cortices than limited training animals. There was no association between fear expression and mPFC Fos expression. These results suggest we may have visualized Fos expression related to operant overtraining rather than conditioned fear related processes. Further research is needed to determine the neurobiological basis of extended training fear incubation and to determine processes represented by the pattern of Fos expression we observed.
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Affiliation(s)
- Alisa Pajser
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, 66506, USA
| | - Christian Foster
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, 66506, USA
| | - Brooke Gaeddert
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, 66506, USA
| | - Charles L Pickens
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, 66506, USA.
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8
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Weik E, Neuenschwander R, Jensen K, Oberlander TF, Tipper C. Placebo and nocebo effects in youth: subjective thermal discomfort can be modulated by a conditioning paradigm utilizing mental states of low and high self-efficacy. Br J Pain 2021; 16:60-70. [PMID: 35111315 PMCID: PMC8801682 DOI: 10.1177/20494637211020042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Conditioning is a key mechanism of placebo and nocebo effects in adults, but little is known about these effects in youth. This study investigated whether personalized verbal cues evoking a sense of high or low self-efficacy can induce conditioned placebo and nocebo effects on subjective discomfort of noxious heat in youth. Methods: In a structured interview, 26 adolescents (13–18 years) described personal situations in which they experienced a sense of high, low or neutral self-efficacy. Participants were then asked to recall these memories during a conditioning paradigm, in which a high thermal stimulus applied to the forearm was repeatedly paired with a low self-efficacy cue and a low thermal stimulus with a high self-efficacy cue. In a testing phase, high, low and neutral self-efficacy cues were paired with the same moderate temperature. We hypothesized that conditioned high and low self-efficacy cues would induce conditioned placebo and nocebo responses to moderate temperatures. Results: Moderate temperatures were rated as more uncomfortable when paired with the conditioned low compared with the neutral self-efficacy cue (nocebo effect). While in the whole-group analysis, there was no significant difference between ratings of moderate thermal stimuli paired with high compared with neutral self-efficacy cues (placebo effect), a sub-group of participants with a greater range of emotional valence between high and neutral self-efficacy cues revealed a significant placebo effect. The strength of the nocebo effect was associated with higher anxiety and lower hope. Conclusion: Conditioned associations using internal self-efficacy states can change subjective discomfort of thermal sensations.
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Affiliation(s)
- Ella Weik
- Department of Psychiatry, BC Mental Health and Addictions Research Institute, The University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, BC Children’s Hospital Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Regula Neuenschwander
- Department of Pediatrics, BC Children’s Hospital Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Karin Jensen
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Tim F Oberlander
- Department of Pediatrics, BC Children’s Hospital Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Christine Tipper
- Department of Psychiatry, BC Mental Health and Addictions Research Institute, The University of British Columbia, Vancouver, BC, Canada
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Lomb J, Mauger A, von Keyserlingk MAG, Weary DM. Effects of positive reinforcement training for heifers on responses to a subcutaneous injection. J Dairy Sci 2021; 104:6146-6158. [PMID: 33685711 DOI: 10.3168/jds.2020-19463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022]
Abstract
Cattle are subjected to routine procedures that require restraint and close contact to humans, which are both potentially aversive to the animal. Positive reinforcement training techniques may affect how animals perceive and respond to these procedures. The objectives of the current study were to describe a positive reinforcement regimen used to train cattle to stand still for a sham injection, and to assess the effects of this training on the responses to an actual injection. Eight "agency" heifers were trained, over an average of 85 ± 4.6 sessions, with positive reinforcement (i.e., animals received a grain reinforcer for desired behaviors) to enter a headlock, and they were habituated with counterconditioning and desensitization to a sham injection (i.e., animals were gradually exposed to the sensation of the sham injection, paired with access to grain). The headlock remained open at all times to allow heifers to leave. Eight "habituation" heifers were exposed to the treatment area and headlock for an equal number of sessions and duration as agency heifers, and 7 "naïve" heifers were provided no exposure to the treatment area. Once agency heifers tolerated the sham injection, all animals received a 1-mL subcutaneous injection of 0.9% NaCl while in the head lock (habituation and naïve heifers were locked in but agency heifers were free to withdraw). Immediate responses to the injection, starting with tenting of the skin, were video recorded and summarized as a reactivity score, which included the number of steps, head tosses, and backing-up movements; we also recorded the latency to approach the treatment area and headlock for 3 d after the injection. Of the agency heifers, 5 remained standing for the actual injection, whereas 3 heifers moved out of the headlock for a brief period (1, 3, and 5 s, respectively). Habituation heifers had a higher reactivity score [17.5 (10.5-28); median (IQR)] than agency [6 (2-13.5)] and naïve heifers [6 (5-7)]. Averaged over the 3 d after injection, agency heifers showed lower latencies to come to the treatment area [8.7 (7.2-24.2) s] than did habituation [50.5 (28-60) s] and naïve [53.7 (18-60) s] heifers. Agency heifers voluntarily entered the headlock within 1.3 (1-1.5) s but, with one exception, none of the other heifers did so within the allowed 15 s. These results indicate that dairy heifers can be trained with positive reinforcement and counterconditioning to voluntarily accept a painful procedure, and that training can reduce avoidance behaviors during and after the procedure.
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Affiliation(s)
- J Lomb
- Animal Welfare Program, Faculty of Land and Food Systems, University of British Columbia, 2357 Mall, Vancouver, BC, Canada V6T 1Z4
| | - A Mauger
- Animal Welfare Program, Faculty of Land and Food Systems, University of British Columbia, 2357 Mall, Vancouver, BC, Canada V6T 1Z4
| | - M A G von Keyserlingk
- Animal Welfare Program, Faculty of Land and Food Systems, University of British Columbia, 2357 Mall, Vancouver, BC, Canada V6T 1Z4
| | - D M Weary
- Animal Welfare Program, Faculty of Land and Food Systems, University of British Columbia, 2357 Mall, Vancouver, BC, Canada V6T 1Z4.
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Strickland JA, Dileo AD, Moaddab M, Ray MH, Walker RA, Wright KM, McDannald MA. Foot shock facilitates reward seeking in an experience-dependent manner. Behav Brain Res 2021; 399:112974. [PMID: 33144178 PMCID: PMC7855116 DOI: 10.1016/j.bbr.2020.112974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/01/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
Animals organize reward seeking around aversive events. An abundance of research shows that foot shock, as well as a shock-associated cue, can elicit freezing and suppress reward seeking. Yet, there is evidence that experience can flip the effect of foot shock to facilitate reward seeking. Here we examined cue suppression, foot shock suppression and foot shock facilitation of reward seeking in a single behavioural setting. Male Long Evans rats received fear discrimination consisting of danger, uncertainty, and safety cues. Discrimination took place over a baseline of rewarded nose poking. With limited experience (1-2 sessions), all cues and foot shock suppressed reward seeking. With continued experience (10-16 sessions), suppression became specific to shock-associated cues, foot shock briefly suppressed, then facilitated reward seeking. Our results provide a means of assessing positive properties of foot shock, and may provide insight into maladaptive behaviour around aversive events.
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Affiliation(s)
- J A Strickland
- Boston College, Department of Psychology & Neuroscience, Chestnut Hill, MA, USA.
| | - A D Dileo
- Tufts University School of Medicine, School of Graduate Biomedical Sciences, Boston, MA, USA
| | - M Moaddab
- Boston College, Department of Psychology & Neuroscience, Chestnut Hill, MA, USA
| | - M H Ray
- Boston College, Department of Psychology & Neuroscience, Chestnut Hill, MA, USA
| | - R A Walker
- Boston College, Department of Psychology & Neuroscience, Chestnut Hill, MA, USA
| | - K M Wright
- Boston College, Department of Psychology & Neuroscience, Chestnut Hill, MA, USA
| | - M A McDannald
- Boston College, Department of Psychology & Neuroscience, Chestnut Hill, MA, USA.
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Busserolles J, Lolignier S, Kerckhove N, Bertin C, Authier N, Eschalier A. Replacement of current opioid drugs focusing on MOR-related strategies. Pharmacol Ther 2020; 210:107519. [PMID: 32165137 DOI: 10.1016/j.pharmthera.2020.107519] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
Abstract
The scarcity and limited risk/benefit ratio of painkillers available on the market, in addition to the opioid crisis, warrant reflection on new innovation strategies. The pharmacopoeia of analgesics is based on products that are often old and derived from clinical empiricism, with limited efficacy or spectrum of action, or resulting in an unsatisfactory tolerability profile. Although they are reference analgesics for nociceptive pain, opioids are subject to the same criticism. The use of opium as an analgesic is historical. Morphine was synthesized at the beginning of the 19th century. The efficacy of opioids is limited in certain painful contexts and these drugs can induce potentially serious and fatal adverse effects. The current North American opioid crisis, with an ever-rising number of deaths by opioid overdose, is a tragic illustration of this. It is therefore legitimate to develop research into molecules likely to maintain or increase opioid efficacy while improving their tolerability. Several avenues are being explored including targeting of the mu opioid receptor (MOR) splice variants, developing biased agonists or targeting of other receptors such as heteromers with MOR. Ion channels acting as MOR effectors, are also targeted in order to offer compounds without MOR-dependent adverse effects. Another route is to develop opioid analgesics with peripheral action or limited central nervous system (CNS) access. Finally, endogenous opioids used as drugs or compounds that modify the metabolism of endogenous opioids (Dual ENKephalinase Inhibitors) are being developed. The aim of the present review is to present these various targets/strategies with reference to current indications for opioids, concerns about their widespread use, particularly in chronic non-cancer pains, and ways of limiting the risk of opioid abuse and misuse.
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Affiliation(s)
- Jérôme Busserolles
- Université Clermont Auvergne, INSERM, CHU, NEURO-DOL Pharmacologie Fondamentale et Clinique de la douleur, F-63000 Clermont-Ferrand, France; Institut ANALGESIA, Faculté de Médecine, F-63000 Clermont-Ferrand, France
| | - Stéphane Lolignier
- Université Clermont Auvergne, INSERM, CHU, NEURO-DOL Pharmacologie Fondamentale et Clinique de la douleur, F-63000 Clermont-Ferrand, France; Institut ANALGESIA, Faculté de Médecine, F-63000 Clermont-Ferrand, France
| | - Nicolas Kerckhove
- Université Clermont Auvergne, INSERM, CHU, NEURO-DOL Pharmacologie Fondamentale et Clinique de la douleur, F-63000 Clermont-Ferrand, France; Institut ANALGESIA, Faculté de Médecine, F-63000 Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA), French monitoring centre for analgesic drugs, CHU, F-63000 Clermont-Ferrand, France
| | - Célian Bertin
- Université Clermont Auvergne, INSERM, CHU, NEURO-DOL Pharmacologie Fondamentale et Clinique de la douleur, F-63000 Clermont-Ferrand, France; Institut ANALGESIA, Faculté de Médecine, F-63000 Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA), French monitoring centre for analgesic drugs, CHU, F-63000 Clermont-Ferrand, France
| | - Nicolas Authier
- Université Clermont Auvergne, INSERM, CHU, NEURO-DOL Pharmacologie Fondamentale et Clinique de la douleur, F-63000 Clermont-Ferrand, France; Institut ANALGESIA, Faculté de Médecine, F-63000 Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA), French monitoring centre for analgesic drugs, CHU, F-63000 Clermont-Ferrand, France
| | - Alain Eschalier
- Université Clermont Auvergne, INSERM, CHU, NEURO-DOL Pharmacologie Fondamentale et Clinique de la douleur, F-63000 Clermont-Ferrand, France; Institut ANALGESIA, Faculté de Médecine, F-63000 Clermont-Ferrand, France.
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12
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Vandael K, Meulders M, Vanden Boer C, Meulders A. The relationship between fear generalization and pain modulation: an investigation in healthy participants. Scand J Pain 2019; 20:151-165. [DOI: 10.1515/sjpain-2019-0065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/29/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background and aims
Pain-related fear and its subsequent generalization is key to the development and maintenance of chronic pain disability. Research has shown that pain-related fear acquired through classical conditioning generalizes following a gradient, that is, novel movements that are proprioceptively similar to the original pain-associated movement elicit more fear. Studies suggest that classical conditioning can also modulate pain and conditioned fear seems to mediate this effect. However, it remains uninvestigated whether this is also the case for generalized fear.
Methods
In a voluntary joystick movement paradigm, one movement (conditioned stimulus; CS+) was followed by pain (pain-US), and another was not (CS−). Generalization to five novel movements (generalization stimuli; GSs) with varying levels of similarity to the CSs was tested when paired with an at-pain-threshold intensity stimulus (threshold-USs). We collected self-reported fear and pain, as well as eyeblink startle responses as an additional index of conditioned fear.
Results
Results showed a fear generalization gradient in the ratings, but not in the startle measures. The data did not support the idea that fear generalization mediates spreading of pain.
Conclusions
Despite the lack of effects in the current study, this is a promising novel approach to investigate pain modulation in the context of chronic pain.
Implications
This study replicates the finding that pain-related fear spreads selectively towards movements that are proprioceptively more similar to the original pain-eliciting movement. Although results did not support the idea that such generalized fear mediates spreading of pain, the study provides a promising approach to investigate pain modulation by pain-associated movements.
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Affiliation(s)
- Kristof Vandael
- Experimental Health Psychology, Maastricht University , Maastricht , The Netherlands
| | - Michel Meulders
- Center for Information Management, Modeling and Simulation, KU Leuven , Brussels , Belgium
- Research Group on Quantitative Psychology and Individual Differences, KU Leuven , Leuven , Belgium
| | | | - Ann Meulders
- Experimental Health Psychology, Maastricht University , Maastricht , The Netherlands
- Research Group Health Psychology, KU Leuven , Leuven , Belgium
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13
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Roa JA, Guevara A, Guevara C, Guevara-Aguirre J. Physician's role in prescribing opioids in developing countries. BMJ Case Rep 2019; 12:12/6/e227072. [PMID: 31160299 DOI: 10.1136/bcr-2018-227072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In developed countries, addressing the growing opioid addiction epidemic is focused on preventive measures, developing better overdose-reversal medications and designing newer strategies to treat addiction. Primary prescribers of the therapeutic use of opioids might play a definite role in the aetiology of the epidemics. Developing countries could be affected by similar issues; however, given that no updated statistics are available, it is possible that their populations undergo problems similar to those for which current data is available. Concerns have arisen regarding synthetic opioid tramadol which, given its fast and potent analgesic effects, low cost and easy availability is widely prescribed. A debate remains as to whether tramadol induces addictive effects like those of stronger analogues such as oxycodone or fentanyl. Here we present a case of tramadol dependence in an Ecuadorian patient and find that substance abuse can occur in normal individuals affected by chronic pain, otherwise treatable with standard methods.
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Affiliation(s)
- Jorge A Roa
- Department of Diabetes and Endocrinology, College of Medicine, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
| | - Alexandra Guevara
- Instituto de Endocrinologia y Metabolismo, IEMYR, Quito, Pichincha, Ecuador
| | - Carolina Guevara
- Instituto de Endocrinologia y Metabolismo, IEMYR, Quito, Pichincha, Ecuador
| | - Jaime Guevara-Aguirre
- Department of Diabetes and Endocrinology, College of Medicine, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador.,Instituto de Endocrinologia y Metabolismo, IEMYR, Quito, Pichincha, Ecuador.,Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, Limburg, The Netherlands
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14
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Traxler J, Madden VJ, Moseley GL, Vlaeyen JWS. Modulating pain thresholds through classical conditioning. PeerJ 2019; 7:e6486. [PMID: 30867984 PMCID: PMC6410694 DOI: 10.7717/peerj.6486] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/17/2019] [Indexed: 12/04/2022] Open
Abstract
Background Classical conditioning has frequently been shown to be capable of evoking fear of pain and avoidance behavior in the context of chronic pain. However, whether pain itself can be conditioned has rarely been investigated and remains a matter of debate. Therefore, the present study investigated whether pain threshold ratings can be modified by the presence of conditioned non-nociceptive sensory stimuli in healthy participant. Methods In 51 healthy volunteers, pain threshold to electrocutaneous stimuli was determined prior to participation in a simultaneous conditioning paradigm. Participants underwent an acquisition phase in which one non-painful vibrotactile stimulus (CS+) was repeatedly paired with a painful electrocutaneous stimulus, whereas a second vibrotactile stimulus of the same quality and intensity (CS−) was paired with a non-painful electrocutaneous stimulus. Stimulation was provided on the lower back with close proximity between the conditioned stimulus and the unconditioned stimulus. In the test phase, electrocutaneous stimuli at the individually-set threshold intensity were simultaneously delivered together with either a CS+ or CS−. Pain intensity ratings were obtained after each trial; expectancy ratings were obtained after each block. The primary outcome was the percentage of test stimuli that were rated as painful. Results Test stimuli were more likely to be rated as painful when they were paired with the CS+ than when they were paired with the CS−. This effect was not influenced by contingency awareness, nor by expectancies or mood states. Discussion The findings support the notion that the judgement of an event being painful or non-painful can be influenced by classical conditioning and corroborate the possible role of associative learning in the development and maintenance of chronic pain.
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Affiliation(s)
- Juliane Traxler
- Research Centre for Health Psychology, KU Leuven, Leuven, Belgium.,Experimental Health Psychology, Maastricht University, Maastricht, Netherlands
| | - Victoria J Madden
- Research Centre for Health Psychology, KU Leuven, Leuven, Belgium.,Department of Psychiatry and Mental Health, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - G Lorimer Moseley
- Body in Mind Research Group, University of South Australia, Adelaide, SA, Australia
| | - Johan W S Vlaeyen
- Research Centre for Health Psychology, KU Leuven, Leuven, Belgium.,Experimental Health Psychology, Maastricht University, Maastricht, Netherlands
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15
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Pavlov’s Pain: the Effect of Classical Conditioning on Pain Perception and its Clinical Implications. Curr Pain Headache Rep 2019; 23:19. [DOI: 10.1007/s11916-019-0766-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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16
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Riquino MR, Priddy SE, Howard MO, Garland EL. Emotion dysregulation as a transdiagnostic mechanism of opioid misuse and suicidality among chronic pain patients. Borderline Personal Disord Emot Dysregul 2018; 5:11. [PMID: 29992025 PMCID: PMC5989346 DOI: 10.1186/s40479-018-0088-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/17/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Chronic pain is a prevalent condition that causes functional impairment and emotional suffering. To allay pain-induced suffering, opioids are often prescribed for chronic pain management. Yet, chronic pain patients on opioid therapy are at heightened risk for opioid misuse-behaviors that can lead to addiction and overdose. Relatedly, chronic pain patients are at elevated risk for suicidal ideation and suicidal behaviors. MAIN BODY Opioid misuse and suicidality are maladaptive processes aimed at alleviating the negative emotional hyperreactivity, hedonic hyporeactivity, and emotion dysregulation experienced by chronic pain patients on opioid therapy. In this review, we explore the role of emotion dysregulation in chronic pain. We then describe why emotionally dysregulated chronic pain patients are vulnerable to opioid misuse and suicidality in response to these negative affective states. CONCLUSION Emotion dysregulation is an important and malleable treatment target with the potential to reduce or prevent opioid misuse and suicidality among opioid-treated chronic pain patients.
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Affiliation(s)
- Michael R. Riquino
- University of Utah College of Social Work, 395 South 1500 East, Salt Lake City, UT 84112 USA
- Center on Mindfulness and Integrative Health Intervention Development, 395 South 1500 East, Salt Lake City, UT 84112 USA
| | - Sarah E. Priddy
- University of Utah College of Social Work, 395 South 1500 East, Salt Lake City, UT 84112 USA
- Center on Mindfulness and Integrative Health Intervention Development, 395 South 1500 East, Salt Lake City, UT 84112 USA
| | - Matthew O. Howard
- University of North Carolina at Chapel Hill, Tate Turner Kuralt Building, Chapel Hill, NC 25799 USA
| | - Eric L. Garland
- University of Utah College of Social Work, 395 South 1500 East, Salt Lake City, UT 84112 USA
- Center on Mindfulness and Integrative Health Intervention Development, 395 South 1500 East, Salt Lake City, UT 84112 USA
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17
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Urien L, Xiao Z, Dale J, Bauer EP, Chen Z, Wang J. Rate and Temporal Coding Mechanisms in the Anterior Cingulate Cortex for Pain Anticipation. Sci Rep 2018; 8:8298. [PMID: 29844413 PMCID: PMC5974274 DOI: 10.1038/s41598-018-26518-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/05/2018] [Indexed: 01/11/2023] Open
Abstract
Pain is a complex sensory and affective experience. Through its anticipation, animals can learn to avoid pain. Much is known about passive avoidance during a painful event; however, less is known about active pain avoidance. The anterior cingulate cortex (ACC) is a critical hub for affective pain processing. However, there is currently no mechanism that links ACC activities at the cellular level with behavioral anticipation or avoidance. Here we asked whether distinct populations of neurons in the ACC can encode information for pain anticipation. We used tetrodes to record from ACC neurons during a conditioning assay to train rats to avoid pain. We found that in rats that successfully avoid acute pain episodes, neurons that responded to pain shifted their firing rates to an earlier time, whereas neurons that responded to the anticipation of pain increased their firing rates prior to noxious stimulation. Furthermore, we found a selected group of neurons that shifted their firing from a pain-tuned response to an anticipatory response. Unsupervised learning analysis of ensemble spike activity indicates that temporal spiking patterns of ACC neurons can indeed predict the onset of pain avoidance. These results suggest rate and temporal coding schemes in the ACC for pain avoidance.
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Affiliation(s)
- Louise Urien
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, New York University School of Medicine, New York, New York, 10016, USA
| | - Zhengdong Xiao
- Department of Psychiatry, New York University School of Medicine, New York, New York, 10016, USA.,Department of Instrument Science and Technology, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jahrane Dale
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, New York University School of Medicine, New York, New York, 10016, USA
| | - Elizabeth P Bauer
- Biology Department, Barnard College Columbia University, New York, New York, 10027, USA
| | - Zhe Chen
- Department of Psychiatry, New York University School of Medicine, New York, New York, 10016, USA.,Department of Neuroscience and Physiology, New York University School of Medicine, New York, New York, 10016, USA
| | - Jing Wang
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, New York University School of Medicine, New York, New York, 10016, USA. .,Department of Neuroscience and Physiology, New York University School of Medicine, New York, New York, 10016, USA.
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18
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Manhapra A, Arias AJ, Ballantyne JC. The conundrum of opioid tapering in long-term opioid therapy for chronic pain: A commentary. Subst Abus 2017; 39:152-161. [PMID: 28929914 DOI: 10.1080/08897077.2017.1381663] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND In response to the opioid epidemic and new guidelines, many patients on high-dose long term opioid therapy (LTOT) for chronic pain are getting tapered off opioids. As a result, a unique clinical challenge is emerging: while many on LTOT have poor pain control, functional decline, psychiatric instability, aberrancies and misuse, these issues may often worsen with opioid tapering. Currently, a clear explanation and practical guidance on how to manage this perplexing clinical scenario is lacking. METHODS We offer a commentary with our perspective on possible mechanisms involved in this clinical phenomena and offer practical management guidance, supported by available evidence. RESULTS It is not well recognized that allostatic opponent process involved in development of opioid dependence can cause worsening pain, functional status, sleep and psychiatric symptoms over time, and significant fluctuation of pain and other affective symptoms due to their bidirectional dynamic interaction with opioid dependence ('affective dynamism'). These elements of complex persistent dependence (CPD), the grey area between simple dependence and addiction, can lead to escalating and labile opioid need, often generating aberrant behaviors. Opioid tapering, a seemingly logical intervention in this situation, may lead to worsening of pain, function and psychiatric symptoms due to development of protracted abstinence syndrome. We offer practicing clinicians management principles and practical guidance focused on management of CPD in addition to chronic pain in these difficult clinical scenarios. CONCLUSION Awareness of the science of the neuroplasticity effects of repeated use of opioids is necessary to better manage these patients with complex challenges.
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Affiliation(s)
- Ajay Manhapra
- a VA New England Mental Illness Research and Education Center , West Haven , Connecticut , USA.,b Advanced Pact Pain Clinic, VA Hampton Medical Center , Hampton , Virginia , USA.,c Department of Psychiatry , Yale School of Medicine , New Haven , Connecticut , USA
| | - Albert J Arias
- a VA New England Mental Illness Research and Education Center , West Haven , Connecticut , USA.,c Department of Psychiatry , Yale School of Medicine , New Haven , Connecticut , USA
| | - Jane C Ballantyne
- d Department of Anesthesiology and Pain Medicine , University of Washington School of Medicine , Seattle , Washington , USA
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19
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Raub JN, Vettese TE. Acute Pain Management in Hospitalized Adult Patients with Opioid Dependence: A Narrative Review and Guide for Clinicians. J Hosp Med 2017; 12:375-379. [PMID: 28459910 DOI: 10.12788/jhm.2733] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pain management is a core competency of hospital medicine, and effective acute pain management should be a goal for all hospital medicine providers. The prevalence of opioid use in the United States, both therapeutic and non-medical in origin, has dramatically increased over the past decade. Although nonopioid medications and nondrug treatments are essential components of managing all acute pain, opioids continue to be the mainstay of treatment for severe acute pain in both opioid-naïve and opioid-dependent patients. In this review, we provide an evidence-based approach to appropriate and safe use of opioid analgesics in treating acute pain in hospitalized patients who are opioid-dependent. Journal of Hospital Medicine 2017;12:375-379.
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Affiliation(s)
- Joshua N Raub
- Internal Medicine, Detroit Receiving Hospital/Detroit Medical Center, Wayne State University School of Medicine, and Department of Pharmacy Services, Wayne State University, all in Detroit, MI
| | - Theresa E Vettese
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, GA
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20
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Esch T, Winkler J, Auwärter V, Gnann H, Huber R, Schmidt S. Neurobiological Aspects of Mindfulness in Pain Autoregulation: Unexpected Results from a Randomized-Controlled Trial and Possible Implications for Meditation Research. Front Hum Neurosci 2017; 10:674. [PMID: 28184192 PMCID: PMC5266722 DOI: 10.3389/fnhum.2016.00674] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/19/2016] [Indexed: 01/22/2023] Open
Abstract
Background: Research has demonstrated that short meditation training may yield higher pain tolerance in acute experimental pain. Our study aimed at examining underlying mechanisms of this alleged effect. In addition, placebo research has shown that higher pain tolerance is mediated via endogenous neuromodulators: experimental inhibition of opioid receptors by naloxone antagonized this effect. We performed a trial to discern possible placebo from meditation-specific effects on pain tolerance and attention. Objectives: It was proposed that (i) meditation training will increase pain tolerance; (ii) naloxone will inhibit this effect; (iii) increased pain tolerance will correlate with improved attention performance and mindfulness. Methods: Randomized-controlled, partly blinded trial with 31 healthy meditation-naïve adults. Pain tolerance was assessed by the tourniquet test, attention performance was measured by Attention Network Test (ANT), self-perceived mindfulness by Freiburg Mindfulness Inventory. 16 participants received a 5-day meditation training, focusing on body/breath awareness; the control group (N = 15) received no intervention. Measures were taken before the intervention and on 3 consecutive days after the training, with all participants receiving either no infusion, naloxone infusion, or saline infusion (blinded). Blood samples were taken in order to determine serum morphine and morphine glucuronide levels by applying liquid chromatography-tandem mass spectrometry analysis. Results: The meditation group produced fewer errors in ANT. Paradoxically, increases in pain tolerance occurred in both groups (accentuated in control), and correlated with reported mindfulness. Naloxone showed a trend to decrease pain tolerance in both groups. Plasma analyses revealed sporadic morphine and/or morphine metabolite findings with no discernable pattern. Discussion: Main objectives could not be verified. Since underlying study goals had not been made explicit to participants, on purpose (framing effects toward a hypothesized mindfulness-pain tolerance correlation were thus avoided, trainees had not been instructed how to 'use' mindfulness, regarding pain), the question remains open whether lack of meditation effects on pain tolerance was due to these intended 'non-placebo' conditions, cultural effects, or other confounders, or on an unsuitable paradigm. Conclusion: Higher pain tolerance through meditation could not be confirmed.
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Affiliation(s)
- Tobias Esch
- Division of Integrative Health Promotion, Coburg University of Applied SciencesCoburg, Germany; School of Medicine, Faculty of Health, Witten/Herdecke UniversityWitten, Germany; Institute for General Medicine, University Hospital Essen, University of Duisburg-EssenEssen, Germany
| | - Jeremy Winkler
- Department of Psychosomatic Medicine, Medical Center, Medical Faculty, University of Freiburg Freiburg, Germany
| | - Volker Auwärter
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center, Medical Faculty, University of Freiburg Freiburg, Germany
| | - Heike Gnann
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center, Medical Faculty, University of Freiburg Freiburg, Germany
| | - Roman Huber
- Center for Complementary Medicine, Medical Center, Medical Faculty, University of Freiburg Freiburg, Germany
| | - Stefan Schmidt
- Department of Psychosomatic Medicine, Medical Center, Medical Faculty, University of FreiburgFreiburg, Germany; Institute for Transcultural Health Studies, European University ViadrinaFrankfurt (Oder), Germany
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21
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Inhibition of the cAMP/PKA/CREB Pathway Contributes to the Analgesic Effects of Electroacupuncture in the Anterior Cingulate Cortex in a Rat Pain Memory Model. Neural Plast 2016; 2016:5320641. [PMID: 28090359 PMCID: PMC5206448 DOI: 10.1155/2016/5320641] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/30/2016] [Accepted: 10/24/2016] [Indexed: 12/20/2022] Open
Abstract
Pain memory is considered as endopathic factor underlying stubborn chronic pain. Our previous study demonstrated that electroacupuncture (EA) can alleviate retrieval of pain memory. This study was designed to observe the different effects between EA and indomethacin (a kind of nonsteroid anti-inflammatory drugs, NSAIDs) in a rat pain memory model. To explore the critical role of protein kinase A (PKA) in pain memory, a PKA inhibitor was microinjected into anterior cingulate cortex (ACC) in model rats. We further investigated the roles of the cyclic adenosine monophosphate (cAMP), PKA, cAMP response element-binding protein (CREB), and cAMP/PKA/CREB pathway in pain memory to explore the potential molecular mechanism. The results showed that EA alleviates the retrieval of pain memory while indomethacin failed. Intra-ACC microinjection of a PKA inhibitor blocked the occurrence of pain memory. EA reduced the activation of cAMP, PKA, and CREB and the coexpression levels of cAMP/PKA and PKA/CREB in the ACC of pain memory model rats, but indomethacin failed. The present findings identified a critical role of PKA in ACC in retrieval of pain memory. We propose that the proper mechanism of EA on pain memory is possibly due to the partial inhibition of cAMP/PKA/CREB signaling pathway by EA.
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22
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Madden VJ, Russek LN, Harvie DS, Vlaeyen JW, Moseley GL. Classical Conditioning Fails to Elicit Allodynia in an Experimental Study with Healthy Humans. PAIN MEDICINE 2016; 18:1314-1325. [DOI: 10.1093/pm/pnw221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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23
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Reward deficiency and anti-reward in pain chronification. Neurosci Biobehav Rev 2016; 68:282-297. [DOI: 10.1016/j.neubiorev.2016.05.033] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 12/12/2022]
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Affiliation(s)
- Nora D Volkow
- From the National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD (N.D.V.); and the Treatment Research Institute, Philadelphia (A.T.M.)
| | - A Thomas McLellan
- From the National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD (N.D.V.); and the Treatment Research Institute, Philadelphia (A.T.M.)
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25
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Tapocik JD, Ceniccola K, Mayo CL, Schwandt ML, Solomon M, Wang BD, Luu TV, Olender J, Harrigan T, Maynard TM, Elmer GI, Lee NH. MicroRNAs Are Involved in the Development of Morphine-Induced Analgesic Tolerance and Regulate Functionally Relevant Changes in Serpini1. Front Mol Neurosci 2016; 9:20. [PMID: 27047334 PMCID: PMC4805586 DOI: 10.3389/fnmol.2016.00020] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/29/2016] [Indexed: 12/23/2022] Open
Abstract
Long-term opioid treatment results in reduced therapeutic efficacy and in turn leads to an increase in the dose required to produce equivalent pain relief and alleviate break-through or insurmountable pain. Altered gene expression is a likely means for inducing long-term neuroadaptations responsible for tolerance. Studies conducted by our laboratory (Tapocik et al., 2009) revealed a network of gene expression changes occurring in canonical pathways involved in neuroplasticity, and uncovered miRNA processing as a potential mechanism. In particular, the mRNA coding the protein responsible for processing miRNAs, Dicer1, was positively correlated with the development of analgesic tolerance. The purpose of the present study was to test the hypothesis that miRNAs play a significant role in the development of analgesic tolerance as measured by thermal nociception. Dicer1 knockdown, miRNA profiling, bioinformatics, and confirmation of high value targets were used to test the proposition. Regionally targeted Dicer1 knockdown (via shRNA) had the anticipated consequence of eliminating the development of tolerance in C57BL/6J (B6) mice, thus supporting the involvement of miRNAs in the development of tolerance. MiRNA expression profiling identified a core set of chronic morphine-regulated miRNAs (miR's 27a, 9, 483, 505, 146b, 202). Bioinformatics approaches were implemented to identify and prioritize their predicted target mRNAs. We focused our attention on miR27a and its predicted target serpin peptidase inhibitor clade I (Serpini1) mRNA, a transcript known to be intricately involved in dendritic spine density regulation in a manner consistent with chronic morphine's consequences and previously found to be correlated with the development of analgesic tolerance. In vitro reporter assay confirmed the targeting of the Serpini1 3'-untranslated region by miR27a. Interestingly miR27a was found to positively regulate Serpini1 mRNA and protein levels in multiple neuronal cell lines. Lastly, Serpini1 knockout mice developed analgesic tolerance at a slower rate than wild-type mice thus confirming a role for the protein in analgesic tolerance. Overall, these results provide evidence to support a specific role for miR27a and Serpini1 in the behavioral response to chronic opioid administration (COA) and suggest that miRNA expression and mRNA targeting may underlie the neuroadaptations that mediate tolerance to the analgesic effects of morphine.
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Affiliation(s)
- Jenica D. Tapocik
- National Institute of Alcohol Abuse and Alcoholism, National Institutes of HealthBethesda, MD, USA
| | - Kristin Ceniccola
- Department of Pharmacology and Physiology, The George Washington UniversityWashington, DC, USA
| | - Cheryl L. Mayo
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of MedicineBaltimore, MD, USA
| | - Melanie L. Schwandt
- National Institute of Alcohol Abuse and Alcoholism, National Institutes of HealthBethesda, MD, USA
| | - Matthew Solomon
- National Institute of Alcohol Abuse and Alcoholism, National Institutes of HealthBethesda, MD, USA
| | - Bi-Dar Wang
- Department of Pharmacology and Physiology, The George Washington UniversityWashington, DC, USA
| | - Truong V. Luu
- Department of Pharmacology and Physiology, The George Washington UniversityWashington, DC, USA
| | - Jacqueline Olender
- Department of Pharmacology and Physiology, The George Washington UniversityWashington, DC, USA
| | - Thomas Harrigan
- Department of Pharmacology and Physiology, The George Washington UniversityWashington, DC, USA
| | - Thomas M. Maynard
- Department of Pharmacology and Physiology, The George Washington UniversityWashington, DC, USA
| | - Greg I. Elmer
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of MedicineBaltimore, MD, USA
| | - Norman H. Lee
- Department of Pharmacology and Physiology, The George Washington UniversityWashington, DC, USA
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26
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Rätsep T, Asser T. Placebo effects induced by auditory cues decrease parkinsonian rigidity in patients with subthalamic stimulation. Behav Brain Res 2016; 301:27-32. [DOI: 10.1016/j.bbr.2015.12.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/12/2015] [Accepted: 12/13/2015] [Indexed: 02/03/2023]
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Icenhour A, Kattoor J, Benson S, Boekstegers A, Schlamann M, Merz CJ, Forsting M, Elsenbruch S. Neural circuitry underlying effects of context on human pain-related fear extinction in a renewal paradigm. Hum Brain Mapp 2015; 36:3179-93. [PMID: 26058893 DOI: 10.1002/hbm.22837] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 04/20/2015] [Accepted: 04/27/2015] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The role of context in pain-related extinction learning remains poorly understood. We analyzed the neural mechanisms underlying context-dependent extinction and renewal in a clinically relevant model of conditioned abdominal pain-related fear. EXPERIMENTAL DESIGN In this functional magnetic resonance imaging study, two groups of healthy volunteers underwent differential fear conditioning with painful rectal distensions as unconditioned stimuli (US) and visual conditioned stimuli (CS(+) ; CS(-) ). The extinction context was changed in an experimental group (context group), which was subsequently returned into the original learning context to test for renewal. No context changes occurred in the control group. Group differences in CS-induced differential neural activation were analyzed along with skin conductance responses (SCR), CS valence and CS-US contingency ratings. PRINCIPAL OBSERVATIONS During extinction, group differences in differential neural activation were observed in dorsolateral (dlPFC) and ventromedial (vmPFC) prefrontal cortex and amygdala, mainly driven by enhanced activation in response to the CS(-) in the control group. During renewal, observed group differences in activation of dlPFC and orbitofrontal cortex (OFC) resulted primarily from differential modulation of the CS(-) in the absence of group differences in response to CS(+) or SCR. CONCLUSION The extinction context affects the neural processing of nonpain predictive safety cues, supporting a role of safety learning in pain-related memory processes.
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Affiliation(s)
- Adriane Icenhour
- Institute of Medical Psychology & Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Joswin Kattoor
- Institute of Medical Psychology & Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sven Benson
- Institute of Medical Psychology & Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Armgard Boekstegers
- Institute of Medical Psychology & Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Marc Schlamann
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian J Merz
- Department of Biological and Clinical Psychology, University of Trier, Trier, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sigrid Elsenbruch
- Institute of Medical Psychology & Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Lewis SS, Hutchinson MR, Frick MM, Zhang Y, Maier SF, Sammakia T, Rice KC, Watkins LR. Select steroid hormone glucuronide metabolites can cause toll-like receptor 4 activation and enhanced pain. Brain Behav Immun 2015; 44:128-36. [PMID: 25218902 PMCID: PMC4275344 DOI: 10.1016/j.bbi.2014.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 08/01/2014] [Accepted: 09/02/2014] [Indexed: 12/18/2022] Open
Abstract
We have recently shown that several classes of glucuronide metabolites, including the morphine metabolite morphine-3-glucuronide and the ethanol metabolite ethyl glucuronide, cause toll like receptor 4 (TLR4)-dependent signaling in vitro and enhanced pain in vivo. Steroid hormones, including estrogens and corticosterone, are also metabolized through glucuronidation. Here we demonstrate that in silico docking predicts that corticosterone, corticosterone-21-glucuronide, estradiol, estradiol-3-glucuronide and estradiol-17-glucuronide all dock with the MD-2 component of the TLR4 receptor complex. In addition to each docking with MD-2, the docking of each was altered by pre-docking with (+)-naloxone, a TLR4 signaling inhibitor. As agonist versus antagonist activity cannot be determined from these in silico interactions, an in vitro study was undertaken to clarify which of these compounds can act in an agonist fashion. Studies using a cell line transfected with TLR4, necessary co-signaling molecules, and a reporter gene revealed that only estradiol-3-glucuronide and estradiol-17-glucuronide increased reporter gene product, indicative of TLR4 agonism. Finally, in in vivo studies, each of the 5 drugs was injected intrathecally at equimolar doses. In keeping with the in vitro results, only estradiol-3-glucuronide and estradiol-17-glucuronide caused enhanced pain. For both compounds, pain enhancement was blocked by the TLR4 antagonist lipopolysaccharide from Rhodobacter sphaeroides, evidence for the involvement in TLR4 in the resultant pain enhancement. These findings have implications for several chronic pain conditions, including migraine and temporomandibular joint disorder, in which pain episodes are more likely in cycling females when estradiol is decreasing and estradiol metabolites are at their highest.
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Affiliation(s)
- Susannah S. Lewis
- Department of Psychology & Neuroscience, University of Colorado at Boulder, Boulder, Colorado, USA,Corresponding author: Susannah S. Lewis, Department of Psychology, Campus Box 345, University of Colorado at Boulder, Boulder, Colorado, USA 80309-0345, , Fax: (303) 492-2967, Phone: (303) 492-3288
| | - Mark R. Hutchinson
- Discipline of Physiology, School of Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Morin M. Frick
- Department of Chemistry and Biochemistry, University of Colorado at Boulder, Boulder, Colorado, USA
| | - Yingning Zhang
- Department of Psychology & Neuroscience, University of Colorado at Boulder, Boulder, Colorado, USA
| | - Steven F. Maier
- Department of Psychology & Neuroscience, University of Colorado at Boulder, Boulder, Colorado, USA
| | - Tarek Sammakia
- Department of Chemistry and Biochemistry, University of Colorado at Boulder, Boulder, Colorado, USA
| | - Kenner C. Rice
- Chemical Biology Research Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism National Institutes of Health, Rockville, Maryland, USA
| | - Linda R. Watkins
- Department of Psychology & Neuroscience, University of Colorado at Boulder, Boulder, Colorado, USA
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On the importance of being vocal: saying "ow" improves pain tolerance. THE JOURNAL OF PAIN 2015; 16:326-34. [PMID: 25622894 DOI: 10.1016/j.jpain.2015.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 01/05/2015] [Accepted: 01/13/2015] [Indexed: 01/30/2023]
Abstract
UNLABELLED Vocalizing is a ubiquitous pain behavior. The present study investigated whether it helps alleviate pain and sought to discern potential underlying mechanisms. Participants were asked to immerse one hand in painfully cold water. On separate trials, they said "ow," heard a recording of them saying "ow," heard a recording of another person saying "ow," pressed a button, or sat passively. Compared to sitting passively, saying "ow" increased the duration of hand immersion. Although on average, participants predicted this effect, their expectations were uncorrelated with pain tolerance. Like vocalizing, button pressing increased the duration of hand immersion, and this increase was positively correlated with the vocalizing effect. Hearing one's own or another person's "ow" was not analgesic. Together, these results provide first evidence that vocalizing helps individuals cope with pain. Moreover, they suggest that motor more than other processes contribute to this effect. PERSPECTIVE Participants immersed their hand in painfully cold water longer when saying "ow" than when doing nothing. Whereas button pressing had a similar effect, hearing one's own or another person's "ow" did not. Thus, vocalizing in pain is not only communicative. Like other behaviors, it helps cope with pain.
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