Emotional Intelligence and Acute Pain: The Mediating Effect of Negative Affect

The Relationship Between Emotional Intelligence and Fear of Pain in Patients Undergoing Elective Surgery

PURPOSE

This study aimed to investigate the effect of emotional intelligence levels on the fear of pain for patients undergoing surgical intervention.

DESIGN

This descriptive and cross-sectional study consisted of 254 patients.

METHODS

Data were collected using the Personal Characteristics Information Form, Modified Schutte Emotional Intelligence Scale, Fear of Pain Questionnaire-III, and Numerical Pain Form. A correlational analysis was performed.

FINDINGS

The mean age of patients was 47.33 ± 17.70 years, and 57.9% (n = 147) were female. More than half of the patients (n = 174) were experiencing a certain degree of preoperative pain. A positive and statistically significant correlation was observed between the mean scores of the Fear of Pain Questionnaire-III and the Emotional Intelligence Scale. Female patients had significantly more fear of pain and higher scores in the Fear of Pain Questionnaire-III (optimism/mood regulation, utilization of emotions) and the Emotional Intelligence Scale.

CONCLUSIONS

The patients who manage "optimism/mood regulation" and have increasing levels of Emotional Intelligence could have a relatively higher fear of experiencing severe pain in the preoperative period. Despite the fear of experiencing severe pain, the patients tried to turn this negative situation into a positive one, as the dimensions of their emotional intelligence that provide and manage optimism/mood regulation were at a high level. The increasing level of Emotional Intelligence and "appraisal of emotions" might result in a decrease in the levels of fear of "minor pain" and "medical pain".

Preoperative Versus Perioperative Risk Factors for Delayed Pain and Opioid Cessation After Total Joint Arthroplasty: A Prospective Cohort Study

INTRODUCTION

The evolution of pre- versus postoperative risk factors remains unknown in the development of persistent postoperative pain and opioid use. We identified preoperative versus comprehensive perioperative models of delayed pain and opioid cessation after total joint arthroplasty including time-varying postoperative changes in emotional distress. We hypothesized that time-varying longitudinal measures of postoperative psychological distress, as well as pre- and postoperative use of opioids would be the most significant risk factors for both outcomes.

METHODS

A prospective cohort of 188 patients undergoing total hip or knee arthroplasty at Stanford Hospital completed baseline pain, opioid use, and emotional distress assessments. After surgery, a modified Brief Pain Inventory was assessed daily for 3 months, weekly thereafter up to 6 months, and monthly thereafter up to 1 year. Emotional distress and pain catastrophizing were assessed weekly to 6 months, then monthly thereafter. Stepwise multivariate time-varying Cox regression modeled preoperative variables alone, followed by all perioperative variables (before and after surgery) with time to postoperative opioid and pain cessation.

RESULTS

The median time to opioid and pain cessation was 54 and 152 days, respectively. Preoperative total daily oral morphine equivalent use (hazard ratio-HR 0.97; 95% confidence interval-CI 0.96-0.98) was significantly associated with delayed postoperative opioid cessation in the perioperative model. In contrast, time-varying postoperative factors: elevated PROMIS (Patient-Reported Outcomes Measurement Information System) depression scores (HR 0.92; 95% CI 0.87-0.98), and higher Pain Catastrophizing Scale scores (HR 0.85; 95% CI 0.75-0.97) were independently associated with delayed postoperative pain resolution in the perioperative model.

CONCLUSIONS

These findings highlight preoperative opioid use as a key determinant of delayed postoperative opioid cessation, while postoperative elevations in depressive symptoms and pain catastrophizing are associated with persistent pain after total joint arthroplasty providing the rationale for continued risk stratification before and after surgery to identify patients at highest risk for these distinct outcomes. Interventions targeting these perioperative risk factors may prevent prolonged postoperative pain and opioid use.

The Role of Pain Catastrophizing, Emotional Intelligence, and Pain Intensity in the Quality of Life of Cancer Patients with Chronic Pain

Pain catastrophizing (PC) is a negative cognitive distortion to actual or anticipated pain. This study aims to investigate the relationship between pain catastrophizing, emotional intelligence, pain intensity, and quality of life (QoL) in cancer patients with chronic pain. Eighty-nine outpatients with chronic pain attending pain clinics and palliative care units were recruited. Participants were men (42.7%) and women (57.3%) with an average age of 56.44 years (SD = 14.82). Self-report psychological measures were completed, including a measure of emotional intelligence, a standard measure of PC, a scale assessing pain intensity, and a scale measuring QoL. The PC scale was found to assess three correlated yet different dimensions of pain catastrophizing (helplessness, magnification, and rumination). Moreover, as expected, patients with PC scale scores ≥ 30 had lower scores in functional QoL dimensions and higher scores in the fatigue, pain, and insomnia symptom dimensions. Regression analyses demonstrated that PC (B = − 0.391, p = 0.004), pain intensity (B = − 1.133, p < 0.001), and education (B = 2.915, p = 0.017) remained the only significant variables related to QoL, when controlling for demographic and clinical confounders. Regarding mediating effects, PC and pain intensity were jointly found to be significant mediators in the relationship between emotional intelligence and QoL. Results are discussed in the context of the clinical implications regarding interventions designed to improve cancer patients’ quality of life and offer new insight, understanding, and evaluation targets in the field of pain management.

Vulnerable Dispositional Traits and Chronic Pain: Predisposing but not Predetermining

Dispositional traits can be protective or contribute to increased vulnerability in individuals with chronic pain. This study aims to evaluate the association between two dispositional trait measures, affect balance style and multi-domain trait groups, with psychosocial measures, clinical pain, functional pain, and experimental pain at two years in individuals with chronic knee pain. The study is a prospective analysis of 168 community dwelling individuals aged 45 to 85 years old with knee pain with or at risk for knee osteoarthritis. At baseline, affect balance style and multi-domain trait groups were associated with psychosocial measures, clinical pain, and functional status. At the two-year time point, the multi-domain trait groups were associated with the clinical pain measures. Interestingly, individuals with previously demonstrated vulnerable traits showed more variability in dispositional trait status at the two-year time point compared to those with dispositional traits previously demonstrated as more protective. Findings reiterate that dispositional traits are predisposing but are not predetermining regarding pain-related experiences. PERSPECTIVE: Vulnerable and protective dispositional traits are positively and negatively associated with clinical pain and functional limitations respectively. Although considered relatively stable, a 30-50% shift in dispositional traits was indicated over a two-year period. Findings highlight that dispositional trait are modifiable and thus, predisposing but not predetermining for persisting chronic pain.

Understanding the relationship between parenting style and chronic pain in adolescents: a structural equation modelling approach

BACKGROUND

Although the context of parenting has been incorporated into psychosocial pain research, very little attention has been paid to how parenting styles influence chronic pain in adolescents. The present study aimed to investigate the mediating role of self-esteem, emotional intelligence, and psychological distress in the association between parenting styles and chronic pain.

METHOD

Seven hundred and thirty nine adolescents and their parents participated in this study. To identify adolescents with chronic pain, screening questions based on the 11th revision of the International Classification of Diseases were used. Baumrind parenting style questionnaire was used to assess the parenting style (permissive, authoritarian, and authoritative parenting styles). The structural equation modelling (SEM) was carried out in M-Plus version 6 to evaluate the direct, indirect, and total effects of different parenting styles on chronic pain.

RESULTS

The results in the SEM models revealed that only the indirect paths from authoritative and authoritarian parenting styles to pain through emotional intelligence (βauthoritative = - 0.003, 95% CI = - 0.008 to - 0.003; βauthoritarian = 0.001, 95% CI = 0.001 to 0.003) and psychological distress (βauthoritative = - 0.010, 95% CI = - 0.021 to - 0.004; βauthoritarian = 0.008, 95% CI = 0.004 to 0.016) were significant. Indirect paths from permissive style to pain and the mediating role of self-esteem were not significant.

DISCUSSION

Emotional intelligence and psychological distress significantly mediated the effects of authoritative and authoritarian parenting styles on chronic pain. The current results support the notion that interventions targeting effective parent-adolescent communication may be an important part of chronic pain management in adolescents. Moreover, the results provide rationale for targeting emotional intelligence and psychological distress in adolescents by explicitly teaching effective communication skills, expressing opinions and minds, and emotion regulation strategies.

Depression and work-family conflict mediating the effects of job stress on chronic pain: A structural equation modelling approach

PURPOSE

The majority of research studying the relationship between job stress and chronic pain has relied on physiological responses. This study aims to determine psycho-social mechanisms by which job stress can influence chronic pain in workers.

METHODS

This cross-sectional study was carried out among 793 workers in gas and oil platforms or petroleum refinery plants in southern Iran. Structural equation modelling was applied to evaluate the direct, indirect, and total effects of job stress on chronic pain in the presence of mediating variables (work-family conflict and depression).

RESULTS

According to the results, job stress (B=0.024, β=0.477), 95% CI [0.016, 0.032], work-family conflict (B=0.031, β=0.446), 95% CI [0.023, 0.038], depression (B=0.046, β=0.224), 95% CI [0.028, 0.064], and work experience (B=0.083, β=0.380), 95% CI [0.065, 0.101] had significant direct effects on chronic pain. The indirect paths from job stress to chronic pain via depression (B=0.002, β=0.042), 95%CI [0.001, 0.003] and work-family conflict (B=0.004, β=0.085), 95%CI [0.003, 0.006] were significant.

CONCLUSIONS

Given that depression and work-family conflict mediate the effects of job stress on pain, stress management programs for workers might include various strategies to reduce negative thoughts as well as cognitive biases and minimize role conflicts between work and private life.

Efficacy of motivational-interviewing and guided opioid tapering support for patients undergoing orthopedic surgery (MI-Opioid Taper): A prospective, assessor-blind, randomized controlled pilot trial

BACKGROUND

Postoperative opioid use can lead to chronic use and misuse. Few studies have examined effective approaches to taper postoperative opioid use while maintaining adequate analgesia.

METHODS

This randomized, assessor-blinded, pilot trial of postoperative motivational interviewing and guided opioid tapering support (MI-Opioid Taper) added to usual care (UC) enrolled patients undergoing total hip or knee arthroplasty at a single U.S. academic medical center. MI-Opioid Taper involved weekly (to seven weeks) and monthly (to one year) phone calls until patient-reported opioid cessation. Opioid tapering involved 25% weekly dose reductions. The primary feasibility outcome was study completion in the group to which participants were randomized. The primary efficacy outcome, time to baseline opioid use, was the first of five consecutive days of return to baseline preoperative dose. Intention-to-treat analysis with Cox proportional hazards regression was adjusted for operation. ClinicalTrials.gov registration: NCT02070003.

FINDINGS

From November 26, 2014, to April 27, 2018, 209 patients were screened, and 104 patients were assigned to receive MI-Opioid Taper (49 patients) or UC only (55 patients). Study completion after randomization was similar between groups (96.4%, 53 patients receiving UC, 91.8%, 45 patients receiving MI-Opioid Taper). Patients receiving MI-Opioid Taper had a 62% increase in the rate of return to baseline opioid use after surgery (HR 1.62; 95%CI 1.06-2.46; p = 0•03). No trial-related adverse events occurred.

INTERPRETATION

In patients undergoing total joint arthroplasty, MI-Opioid Taper is feasible and future research is needed to establish the efficacy of MI-Opioid Taper to promote postoperative opioid cessation.

FUNDING

National Institute on Drug Abuse.

Emotional intelligence impairments in women with fibromyalgia: Associations with widespread pain

This study aimed at testing the differences in emotional intelligence ability between women with fibromyalgia (cases) and their age-matched counterparts not with fibromyalgia from the general population (controls) and analysing the association between emotional intelligence ability and widespread pain in women with fibromyalgia. A total of 133 cases and 77 controls participated in this cross-sectional study. Controls performed better than cases on emotion understanding. Higher emotion perception and management were significantly associated with lower widespread pain. Therefore, women with fibromyalgia may experience difficulties in understanding emotional information. In fibromyalgia, higher emotion perception and management abilities are independently related to lower widespread pain.

Global Versus Momentary Osteoarthritis Pain and Emotional Distress: Emotional Intelligence as Moderator

Background

Pain and emotional well-being are complexly associated both globally and in the moment. Emotional regulation strategies may contribute to that complexity by shaping the pain-well-being association.

Purpose

Using emotional intelligence (EI) as an integrative conceptual framework, this study probed the role of emotional regulation in the associations of osteoarthritis pain with emotional well-being in varying time frames. Perceived attention to, clarity, and regulation of emotions were examined as predictors of well-being, and as moderators of the well-being-pain association, at global and momentary (within-day) levels.

Methods

In a microlongitudinal study, 218 older adults with physician-diagnosed knee osteoarthritis self-reported global pain, depressive symptoms, and EI (mood attention, clarity, and repair). Momentary pain and positive and negative affect were then assessed four times daily for 7 days. EI subscales were examined as moderators of the pain-well-being association at global and momentary levels, controlling demographics and general health.

Results

Global and momentary pain were positively associated with mood clarity and negatively with attention, but not with repair. Clarity and repair negatively predicted depression, and buffered effects of pain on depression. Momentary negative affect was negatively predicted by mood clarity and repair; again, clarity and mood repair buffered effects of momentary pain on negative affect. Only mood repair predicted positive affect, with no interactions emerging.

Conclusions

Attention to mood states exacerbates the experience of pain in both short and long terms. In contrast, both mood clarity and ability to repair moods appear important to both momentary and longer-term emotional well-being.

Intervention in emotional abilities for adolescents with type 1 diabetes mellitus in a hospital setting: a study protocol for a randomised controlled trial

INTRODUCTION

Type 1 diabetes mellitus (T1DM) is one of the most frequent chronic endocrine diseases in the paediatric population. As a result, this disease has a strong impact on psychological well-being. In line with this, emotional factors play an important role in adaptation. The aim of the present study protocol is to design an emotional abilities programme to improve metabolic control assessed by haemoglobin A1c (HbA1c) samples. Specifically, this intervention will be focused on adaptive coping strategies to deal with unpleasant emotions associated with T1DM. The primary aim of this project is to assess whether the employment of this new psychological intervention improves the emotional abilities of adolescents with T1DM.

METHODS AND ANALYSIS

Two focus groups will be carried out for the design and evaluation of the programme following the APEASE criteria (affordability, practicability, effectiveness, acceptability, side effects/safety and equity). Behavioural change will be based on the Behaviour Change Wheel. Sixty-two participants from 12 to 18 years of age will be recruited at a public hospital and randomised to either an intervention or a control group. The intervention group will receive an emotional abilities training programme. The control group will receive usual educational intervention. The primary outcomes are metabolic control and emotional abilities. The secondary outcomes include emotional distress control, positive and negative affect, healthy habits, and quality of life. Data will be collected at baseline, immediately postintervention, and at follow-up visits at 6 and 12 months. A feasibility analysis will be conducted.

ETHICS AND DISSEMINATION

The study has been approved by the Ethics Committee of Universidad Loyola Andalucía. Results will be submitted for publication in peer-reviewed journals and disseminated across the scientific community.

TRIAL REGISTRATION NUMBER

NCT03734367.

A meta-analysis of the possible behavioural and biological variables linking trait emotional intelligence to health

Trait Emotional Intelligence (trait EI) is a constellation of correlated emotion-related traits that capture an individual's typical way of processing emotion-related information and reacting in emotional situations. Numerous studies have shown that trait EI is a significant predictor of both subjective and objective health. This correlational meta-analysis (k = 106, N = 45,262) aims to explore the behavioural and biological variables that could account for these effects. It also aims to provide a roadmap for future research by identifying what should be studied (pinpointing dead-end roads and promising paths) and how (methodological improvements needed to draw stronger conclusions). The results revealed large associations of trait EI with social support, sleep quality, and hypothalamic-pituitary-adrenal axis activity in challenging situations as well as medium associations with dietary habits, physical activity, and substance use. Other candidate pathways have given rise to much less research. Based on both theoretical predictions and preliminary findings, the paper categorises these pathways as promising or not promising. Future research would benefit from using more diverse samples, measuring behavioural variables more objectively, controlling for personality, and systematically examining to what extent changes in EI (e.g., following training) lead to changes in behaviours and/or biological parameters.

Does Emotional Intelligence Buffer the Effects of Acute Stress? A Systematic Review

People with higher levels of emotional intelligence (EI: adaptive emotional traits, skills, and abilities) typically achieve more positive life outcomes, such as psychological wellbeing, educational attainment, and job-related success. Although the underpinning mechanisms linking EI with those outcomes are largely unknown, it has been suggested that EI may work as a "stress buffer." Theoretically, when faced with a stressful situation, emotionally intelligent individuals should show a more adaptive response than those with low EI, such as reduced reactivity (less mood deterioration, less physiological arousal), and faster recovery once the threat has passed. A growing number of studies have begun to investigate that hypothesis in respect to EI measured as both an ability (AEI) and trait (TEI), but results are unclear. To test the "stress-buffering" function of EI, we systematically reviewed experimental studies that explored the relationship between both types of EI and acute stress reactivity or recovery. By searching four databases, we identified 45 eligible studies. Results indicated that EI was only adaptive in certain contexts, and that findings differed according to stressor type, and how EI was measured. In terms of stress reactivity, TEI related to less mood deterioration during sports-based stressors (e.g., competitions), physical discomfort (e.g., dental procedure), and cognitive stressors (e.g., memory tasks), but did not appear as helpful in other contexts (e.g., public speaking). Furthermore, effects of TEI on physiological stress responses, such as heart rate, were inconsistent. Effects of AEI on subjective and objective stress reactivity were often non-significant, with high levels detrimental in some cases. However, data suggest that both higher AEI and TEI relate to faster recovery from acute stress. In conclusion, results provide mixed support for the stress-buffering effect of EI. Limitations and quality of studies are also discussed. Findings could have implications for EI training programmes.

Increases in Emotional Intelligence After an Online Training Program Are Associated With Better Decision-Making on the Iowa Gambling Task

Higher levels of emotional intelligence have been associated with better inter and intrapersonal functioning. In the present study, 59 healthy men and women were randomized into either a three-week online training program targeted to improve emotional intelligence (n = 29), or a placebo control training program targeted to improve awareness of nonemotional aspects of the environment (n = 30). Compared to placebo, participants in the emotional intelligence training group showed increased performance on the total emotional intelligence score of the Mayer-Salovey-Caruso Emotional Intelligence Test, a performance measure of emotional intelligence, as well as subscales of perceiving emotions and facilitating thought. Moreover, after emotional intelligence training, but not after placebo training, individuals displayed the ability to arrive at optimal performance faster (i.e., they showed a faster learning rate) during an emotion-guided decision-making task (i.e., the Iowa Gambling Task). More specifically, although both groups showed similar performance at the start of the Iowa Gambling Task from pre- to posttraining, the participants in the emotional intelligence training group learned to choose more advantageous than disadvantageous decks than those in the placebo training group by the time they reached the "hunch" period of the task (i.e., the point in the task when implicit task learning is thought to have occurred). Greater total improvements in performance on the Iowa Gambling Task from pre- to posttraining in the emotional intelligence training group were also positively correlated with pre- to posttraining changes in Mayer-Salovey-Caruso Emotional Intelligence Test scores, in particular with changes in the ability to perceive emotions. The present study provides preliminary evidence that emotional intelligence can be trained with the help of an online training program targeted at adults; it also suggests that changes in emotional intelligence, as a result of such a program, can lead to improved emotion-guided decision-making.

Effects of experimental pain induction on alcohol urge, intention to consume alcohol, and alcohol demand

Research suggests one determinant of alcohol consumption may be physical pain, but there is no empirical evidence that pain has a causal effect on drinking. Therefore, the primary aim of this study was to test experimental pain as a determinant of several alcohol consumption proxies: self-reported urge to drink, intention to consume alcohol, and alcohol demand. This study also was designed to test negative affect as a mediator of the effects of pain on alcohol use proxies. We hypothesized that participants randomized to experimental pain induction (vs. no pain) would report greater urge, intention, and alcohol demand, and that these effects would be mediated by increased negative affect. Participants were healthy undergraduates who were moderate-heavy drinkers (N = 61). Experimental pain was induced using a novel capsaicin-heat model intended to approximate key features of clinical pain. Results indicated that participants in the pain condition subsequently endorsed greater urge and intention to drink. Furthermore, these effects were mediated by pain-induced negative affect. We observed no effect of pain on alcohol demand. This is the first study to demonstrate a causal effect of acute pain on urge and intention to drink. Given the close association between alcohol consumption, urge and intention to drink, these findings suggest that pain may influence alcohol consumption, which can have implications for individuals with co-occurring pain and alcohol use disorder (AUD). Specifically, individuals with co-occurring pain and AUD may drink to alleviate pain-related negative affect. Therefore, improving pain-coping skills may enhance pain-management abilities, subsequently reducing coping-motivated drinking. (PsycINFO Database Record

Behavioral, cognitive, and emotional coping strategies of women with endometriosis: a critical narrative review

Endometriosis is a disabling and long-term medical condition affecting quality of life and mental health. Behavioral, cognitive, and emotional coping strategies, emotional intelligence, and metacognition could in part explain the link between the disease and impaired psychological and life functioning. This critical narrative review aimed at examining the state of the art of the relationships between endometriosis and these factors. According to PRISMA principles, we performed a systematic search for quantitative and qualitative studies on multiple electronic databases as regards coping strategies, emotional intelligence, and metacognition in women with endometriosis. Studies were subjected to interpretative and critical narrative synthesis. A total of 9 papers were included in the review. Three main categories were identified in thematic analysis and resumed in the manuscript. Findings suggested that (a) pain is considered the major stressor; (b) they usually use both adaptive and maladaptive coping strategies; (c) women with endometriosis and related chronic pain seem to repress emotions more likely than healthy ones; (d) suppressing own emotions, pain catastrophizing, and having a passive coping style are related to higher self-reported pain; and (e) emotional and avoidance coping styles are associated to poor mental status, while positive coping strategies focusing on the problem or on emotions, detached and rational styles are associated to better mental health. Few studies with mixed results and some methodological flaws have focused on coping strategies in women with endometriosis. No studies focusing on metacognition or emotional intelligence were found. Methodological biases, suggestions for future research, and implications for clinical practice were discussed.

Measuring Emotional Intelligence Enhances the Psychological Evaluation of Chronic Pain

The assessment of emotional factors, in addition to other psychosocial factors, has been recommended as a means of identifying individuals with chronic pain who may not respond to certain pain treatments. Systematic reviews of the evidence regarding the prediction of responsiveness to a treatment called the spinal cord stimulator (SCS) have yielded inconclusive results. Emotional intelligence is a term which refers to the ability to identify and manage emotions in oneself and others and has been shown to be inversely associated with emotional distress and acute pain. This study aims to investigate the relationship between emotional intelligence, chronic pain, and the more established psychosocial factors usually used for SCS evaluations by clinical psychologists in medical settings. A sample of 112 patients with chronic pain on an acute hospital waiting list for SCS procedures in a pain medicine service were recruited. Psychological measures were completed including: a novel measure of emotional intelligence; usual measures of emotional distress and catastrophizing; and a numerical rating scale designed to assess pain intensity, pain-related distress, and interference. As predicted, findings revealed significant associations between most of the measures analyzed and current pain intensity. When entered into a simultaneous regression analysis, emotional intelligence scores remained the only significant predictor of current pain intensity. There are potential clinical, ethical, and organizational implications of emotional intelligence processes partially predicting pain in patients on a waiting list for a medical procedure. These results may offer new insight, understanding, and evaluation targets for clinical psychologists in the field of pain management.

Relationships between components of emotional intelligence and physical pain in alcohol-dependent patients

PURPOSE

Chronic pain is a significant comorbidity in individuals with alcohol dependence (AD). Emotional processing deficits are a substantial component of both AD and chronic pain. The aim of this study was to analyze the interrelations between components of emotional intelligence and self-reported pain severity in AD patients.

PATIENTS AND METHODS

A sample of 103 participants was recruited from an alcohol treatment center in Warsaw, Poland. Information concerning pain level in the last 4 weeks, demographics, severity of current anxiety and depressive symptoms, as well as neuroticism was obtained. The study sample was divided into "mild or no pain" and "moderate or greater pain" groups.

RESULTS

In the logistic regression model, across a set of sociodemographic, psychological, and clinical factors, higher emotion regulation and higher education predicted lower severity, whereas increased levels of anxiety predicted higher severity of self-reported pain during the previous 4 weeks. When the mediation models looking at the association between current severity of anxiety and depressive symptoms and pain severity with the mediating role of emotion regulation were tested, emotion regulation appeared to fully mediate the relationship between depression severity and pain, and partially the relationship between anxiety severity and pain.

CONCLUSION

The current findings extend previous results indicating that emotion regulation deficits are related to self-reported pain in AD subjects. Comprehensive strategies focusing on the improvement of mood regulation skills might be effective in the treatment of AD patients with comorbid pain symptoms.

The Role of Esophageal Hypersensitivity in Functional Esophageal Disorders

The Rome IV diagnostic criteria delineates 5 functional esophageal disorders which include functional chest pain, functional heartburn, reflux hypersensitivity, globus, and functional dysphagia. These are a heterogenous group of disorders which, despite having characteristic symptom profiles attributable to esophageal pathology, fail to demonstrate any structural, motility or inflammatory abnormalities on standard clinical testing. These disorders are associated with a marked reduction in patient quality of life, not least considerable healthcare resources. Furthermore, the pathophysiology of these disorders is incompletely understood. In this narrative review we provide the reader with an introductory primer to the structure and function of esophageal perception, including nociception that forms the basis of the putative mechanisms that may give rise to symptoms in functional esophageal disorders. We also discuss the provocative techniques and outcome measures by which esophageal hypersensitivity can be established.

The Effects of an Online Mind-Body Training Program on Stress, Coping Strategies, Emotional Intelligence, Resilience and Psychological State

The goal of this study was to evaluate the effects of an online mind-body training (MBT) program on participants’ stress, anger, coping strategies, emotional intelligence, resilience, and positive and negative affect. Forty-two healthy women participated in an online MBT program for approximately 8–10 minutes a day for 8 weeks; a control group of 45 healthy women did not participate in the program. Self-report psychological questionnaires were administered before the beginning of the program and at 4 and 8 weeks following its onset. Data from the MBT group and the control group were compared using repeated measures ANOVA and Student’s t-tests. Significant time x group interaction effects were found with respect to stress, coping strategies, anger, emotional intelligence, negative affect and resilience. These results demonstrate beneficial effects of the online MBT program and significant improvements in the psychological capabilities of participants compared with the control group. The effects of online MBT program were similar with those of the previous offline MBT in psychological aspects, suggesting further studies for neuroscientific evidence related stress and emotion of online MBT effects.

Aerobic Exercise As a Potential Way to Improve Self-Control after Ego-Depletion in Healthy Female College Students

Purpose: To test whether aerobic exercise can help build self-control stamina in healthy female young adults. Stamina in this context is defined as the capability to endure ego depletion, which can be measured with a self-control task following another activity also requiring self-control.

Methods: Forty-five healthy undergraduate women were randomized to either an experimental group or control group. Participants in the experimental group were required to run in their campus running field for 30 min for a period of 5 weeks. Individuals in the control group were required to do diary entries regarding self-control in their daily lives, also for a period of 5 weeks. Before and after the 5-week intervention, participants completed a pain threshold test, a color word Stroop task and the following Cold Pressor Task (CPT) (with and without a distraction component).

Results: There was significant decrease of pain tolerance in session 2 relative to session 1 in the control group, but no such decline was found in the experimental group (though the improvement of pain tolerance was not significant), possibly suggesting successful self-control against this kind of decline.

Conclusions: Five weeks of aerobic exercise increased self-control after ego depletion in terms of pain tolerance. These findings suggest that aerobic exercise may serve as a potential effective intervention for enhancing self-control in a college female population.

A Discordant Monozygotic-Twin Approach to Potential Risk Factors for Chronic Widespread Pain in Females

Chronic widespread pain (CWP) is a common disorder affecting up to 15% of the general population. The objective of the present study was to explore the role of previously reported psychosocial and interpersonal risk factors on variation in CWP by investigating CWP discordant monozygotic (MZ) twins. This approach allows separation of cause and effect relationships, albeit imperfectly, as well the control for critical confounding variables such as common environment or genetics. In a total sample of N = 3,266 female twins aged 18–89 years, MZ (113 full pairs) and DZ twins (180 full pairs) discordant for CWP were selected. Items from the London fibromyalgia symptom screening questionnaire were used to discriminate cases from controls. To assess potential risk factors, including body mass index, anxiety sensitivity (AS), emotional intelligence, personality, obsessive-compulsive behavior, and coping, validated questionnaires were used. A set of univariate and multivariate logistic regression analyses were conducted. Of the variables showing significant links with CWP in the univariate individual-level analyses, including age, AS, and emotional intelligence, only emotional intelligence turned out to an independent predictor to the pathogenesis of CWP in both the individual level and discordant MZ analyses. These data indicate that in women having identical genetic risk, emotional intelligence seems to play a key role, although of small effect, in the development and/or maintenance of CWP. It further seems that many of the previously reported risk factors for CWP suffer from genetic confounding.

Understanding the relationship between smoking and pain

This review provides an overview of evidence regarding several key mechanisms pertinent to understanding the co-occurrence of smoking dependence and pain, both potentially costly conditions, and highlights treatment implications and future research directions. We describe each of pain and smoking dependence and introduce a revised integrative reciprocal model that explains their co-occurrence. We then provide a selective review of evidence pertinent to direct and indirect pathways between variables postulated in the model. We also provide general recommendations for improving assessment and treatment of smokers with clinically significant pain. We conclude with a targeted agenda for future investigation of the co-occurrence of smoking and pain. Empirical efforts directed at testing postulates of the proposed integrative model may yield a better understanding of the nature of the relationship between these prevalent and costly health conditions as well as evidence-based preventive and treatment strategies for people who experience nicotine dependence and pain-related disability.

Psychological modulation in patients surgically intervened for gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) has been related with certain psychological dimensions. The influence of mood, emotional intelligence, and perceived quality of life on clinical symptoms and outcome of antireflux surgery was evaluated in GERD patients with and without hiatal hernia. The study included 61 patients who were diagnosed with GERD between 2003 and 2008: 16 of them without hiatal hernia (group A) and 45 of them with hiatal hernia (group B). All of these patients had undergone laparoscopic antireflux surgery. Patients were clinically examined and evaluated with the following instruments: Short Form (SF)-36 Health Survey, Gastrointestinal Quality of Life Index, Hospital Anxiety and Depression (HAD) Scale, and Trait Meta-Mood Scale (TMMS)-24. Proportions were compared by using the chi-squared test; averages were compared by using the Student's t-test (with Bonferroni's correction). In general, our patients intervened for GERD showed results lower than normal or close to the lower limit of normal in the administered tests. Patients in the group without hernia were younger (P < 0.001) and with lower American Society of Anaesthesiologists risk. They showed higher scores in the SF-36 dimensions: Physical Functioning, Physical Role and Emotional Role, and lower scores in the Social Role (P < 0.001). They showed lower scores in the Emotional dimension of Gastrointestinal Quality of Life Index (P = 0.0068) and worse results in the Hospital Anxiety and Depression subscales of Anxiety (P < 0.001) and Depression (not significant). Men in the group without hernia showed higher scores than men in the group with hernia in the TMMS subscales corresponding to Emotional Clarity and Emotional Repair (P < 0.001). Women in the group with hernia showed higher scores than women in the group without hernia regarding Emotional Clarity (P = 0.0012). GERD patients showed poor results in all the tests, and patients without hiatal hernia compared with patients with hernia showed higher levels of anxiety, which interfered with their social life. Moreover, they showed lower tolerance to stress and higher frustration, fear, and worry. On the basis of such unfavorable phychoemotional results observed with GERD patients (especially those without hernia) in the different tests, we propose that improving our knowledge of the psychological profile of GERD patients - particularly those without hiatal hernia - could help in designing individualized medical and psychological therapies and increase success rates.

Computer-delivered social norm message increases pain tolerance

BACKGROUND

Few experimental studies have been conducted on social determinants of pain tolerance.

PURPOSE

This study tests a brief, computer-delivered social norm message for increasing pain tolerance.

METHODS

Healthy young adults (N = 260; 44 % Caucasian; 27 % Hispanic) were randomly assigned into a 2 (social norm) × 2 (challenge) cold pressor study, stratified by gender. They received standard instructions or standard instructions plus a message that contained artificially elevated information about typical performance of others.

RESULTS

Those receiving a social norm message displayed significantly higher pain tolerance, F(1, 255) = 26.95, p < .001, η p (2)  = .10 and pain threshold F(1, 244) = 9.81, p = .002, η p (2)  = .04, but comparable pain intensity, p > .05. There were no interactions between condition and gender on any outcome variables, p > .05.

CONCLUSIONS

Social norms can significantly increase pain tolerance, even with a brief verbal message delivered by a video.

Five-factor personality traits and pain sensitivity: a twin study

Factors underlying individual differences in pain responding are incompletely understood, but are likely to include genetic influences on basal pain sensitivity in addition to demographic characteristics such as age, sex, and ethnicity, and psychological factors including personality. This study sought to explore the relationship between personality traits and experimental pain sensitivity, and to determine to what extent the covariances between these phenotypes are mediated by common genetic and environmental factors. A sample composed of 188 twins, aged 23 to 35years, was included in the study. Heat pain intensity (HPI) and cold-pressor pain intensity (CPI) ratings were obtained using standardized pain testing procedures, and personality traits were assessed with the NEO Personality Inventory, Revised. Associations between personality and the pain sensitivity indices were examined using zero-order correlations and generalized estimating equations. Bivariate Cholesky models were used in the biometric analyses. The most robust finding was a significant phenotypic association between CPI and the personality facets Impulsiveness (a facet of Neuroticism) and Excitement-Seeking (a facet of Extraversion), and estimates of the genetic correlation were .37 (P<.05) and .43 (P<.05), respectively. In contrast, associations between HPI and personality seemed weak and unstable, but a significant effect of Angry Hostility (a facet of Neuroticism) emerged in generalized estimating equations analysis. Although the genetic correlation between these phenotypes was essentially zero, a weak but significant individual-specific environmental correlation emerged (re=.21, P<.05). Taken together, these findings suggest that CPI is more consistently related to personality dispositions than HPI, both phenotypically and genetically.

Acute pain speeds skin barrier recovery in healthy men and women

OBJECTIVE

Psychological stress is known to impair skin barrier recovery, but little is known about the impact of pain on skin healing processes. Our primary goals were to examine the degree to which acute pain affects recovery from skin barrier disruption, and the potential mediating impact of cortisol and catecholamines.

METHODS

Healthy non-smokers aged 18-43 (N = 53, 65% women) underwent a 3-minute cold pressor pain stimulus to their foot. Tape-stripping of forearm skin occurred at two separate locations: before (site 1) and after (site 2) the pain stimulus. Transepidural water loss (TEWL) was assessed at baseline (pre-stripping), immediately post-stripping, and at 75 min to determine skin barrier recovery. Cortisol and catecholamine responses were obtained from multiple saliva and plasma samples, respectively.

RESULTS

Contrary to expectations, greater pain was associated with faster skin barrier recovery, even after controlling for demographics, mood, anxiety, and other factors. Those who reported higher pain showed faster recovery at site 2 compared to a) individuals who experienced lower pain; and b) their own recovery at site 1. Greater increase in norepinephrine (but not in cortisol) was also associated with faster recovery at site 2, and mediated the impact of pain on recovery.

DISCUSSION

Results bolster evidence that acute pain can affect immune-related processes. It is possible that acute pain may speed recovery from dermal abrasions, although pain is likely to impair recovery from more severe wounds. As pain is an important potential target for clinical intervention, further investigation of pain, stress, and healing processes is warranted.