1
|
Paschali M, Thompson GS, Mehta S, Howard PM, Yamin JB, Edwards RR, Donnino MW. Psychophysiologic symptom relief therapy for chronic back pain: hypothesis and trial rationale. FRONTIERS IN PAIN RESEARCH 2024; 5:1328495. [PMID: 39091382 PMCID: PMC11291320 DOI: 10.3389/fpain.2024.1328495] [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] [Received: 10/26/2023] [Accepted: 05/24/2024] [Indexed: 08/04/2024] Open
Abstract
Chronic pain syndromes affect over one-third of the US adult population and often lead to significant disability and a reduced quality of life. Despite their high prevalence, causal links between chronic pain syndromes and anatomic abnormalities are often not apparent. Most current chronic pain treatments provide modest, if any, relief. Thus, there is a pressing need to understand the causal mechanisms implicated in chronic pain as a means to develop more targeted interventions for improvement in clinical outcomes and reduction in morbidity and financial burden. In the present manuscript, we summarize the current literature on treatment for chronic pain, and hypothesize that non-specific chronic back pain (without a clear organic etiology, such as tumors, infections or fractures) is of psychophysiologic origin. Based on this hypothesis, we developed Psychophysiologic Symptom Relief Therapy (PSRT), a novel pain reduction intervention for understanding and treating chronic pain. In this manuscript, we provide the rationale for PSRT, which we have tested in a pilot trial with a subsequent larger randomized trial underway. In the proposed trial, we will evaluate whether non-specific chronic back pain can be treated by addressing the underlying stressors and psychological underpinnings without specific physical interventions.
Collapse
Affiliation(s)
- Myrella Paschali
- Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, Chestnut Hill, MA, United States
| | - Garrett S. Thompson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Shivani Mehta
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Patricia M. Howard
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Jolin B. Yamin
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Robert R. Edwards
- Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, Chestnut Hill, MA, United States
| | - Michael W. Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| |
Collapse
|
2
|
Meeuwis SH, Kłosowska J, Bajcar EA, Wasylewski MT, Badzińska J, Rubanets D, Di Nardo M, Mazzoni G, Bąbel P. Placebo Hypoalgesia and Nocebo Hyperalgesia Induced by Observational Learning May Be Difficult to Disentangle in a Laboratory Setting. THE JOURNAL OF PAIN 2024; 25:805-818. [PMID: 37871681 DOI: 10.1016/j.jpain.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 10/11/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023]
Abstract
Observational learning (OBL) (seeing pain/pain treatment in others) can evoke placebo hypoalgesia and nocebo hyperalgesia. Data that compare these effects and illuminates the role of expectations and empathy are scarce. Healthy participants (n = 105) were randomized to: 1) placebo OBL, 2) nocebo OBL, or 3) no-observation control group. OBL consisted of a model simulating pain relief or increase after a sham ointment was applied to one arm. Pain was evoked with thermal stimuli on both arms (ointment, contralateral) at baseline and postobservation. Expectations, pain ratings, and physiological data (eg, skin conductance level) were collected. A 3 × 2 × 2 (Group × Arm × Phase) mixed analyses of variance revealed a 3-way interaction that confirmed that OBL modulates pain: F(2, 93) = 6.08, P = .003, ηp2 = .12. Significant baseline-to-post-observation pain increases were shown in the nocebo OBL group, with a bigger increase for the arm with ointment (both P ≤ .007). In the placebo OBL group, pain was higher for the contralateral relative to the ointment arm (P < .001). Baseline-to-post-observation pain increase was significant for the contralateral arm (P < .001). Expectation mediated these effects. Skin conductance level decreased over time during ointment trials in the nocebo OBL group, suggesting reduced physiological arousal. The findings illustrate that OBL modulates pain through expectations. In the placebo OBL group, the pain did not decrease for the ointment but increased for the contralateral stimuli, which may reflect nocebo learning. Experimental OBL paradigms typically examine relative differences between ointment and contralateral cues. This can complicate disentangling placebo hypoalgesia and nocebo hyperalgesia in laboratory settings. Implications for existing theories are discussed. PERSPECTIVE: Data that systematically compare placebo hypoalgesia and nocebo hyperalgesia induced by OBL are scarce. The current work illustrates that these effects may be more difficult to disentangle than previously assumed, which could have implications for existing theories on OBL and placebo effects and their translation to clinical practice.
Collapse
Affiliation(s)
- Stefanie H Meeuwis
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Joanna Kłosowska
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Elżbieta A Bajcar
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Mateusz T Wasylewski
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Julia Badzińska
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland; Doctoral School in the Social Sciences, Jagiellonian University, Kraków, Poland
| | - Daryna Rubanets
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland; Doctoral School in the Social Sciences, Jagiellonian University, Kraków, Poland
| | - Marianna Di Nardo
- Department of Dynamic, Clinical Psychology and Health, Sapienza University of Rome, Roma, Italy
| | - Giuliana Mazzoni
- Department of Dynamic, Clinical Psychology and Health, Sapienza University of Rome, Roma, Italy
| | - Przemysław Bąbel
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland
| |
Collapse
|
3
|
Corneille O, Lush P. Sixty Years After Orne's American Psychologist Article: A Conceptual Framework for Subjective Experiences Elicited by Demand Characteristics. PERSONALITY AND SOCIAL PSYCHOLOGY REVIEW 2023; 27:83-101. [PMID: 35801624 DOI: 10.1177/10888683221104368] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Study participants form beliefs based on cues present in a testing situation (demand characteristics). These beliefs can alter study outcomes (demand effects). Neglecting demand effects can threaten the internal and external validity of studies (including their replication). While demand characteristics garnered much attention following Orne's introduction of this notion, consideration of their effects has become sparse in experimental reports. Moreover, the concept remains confusing. Here, we introduce a conceptual framework for subjective experiences elicited by demand characteristics. The model distinguishes between participants' awareness of the hypothesis, their motivation to comply with it, and the strategy they use to meet situational requirements. We stress that demand characteristics can give rise to genuine experiences. To illustrate, we apply the model to Evaluative Conditioning and the Rubber Hand Illusion. In the General Discussion, we discuss risks and opportunities associated with demand characteristics, and we explain that they remain highly relevant to current research.
Collapse
|
4
|
Choi DH, Lee S, Lee IS, Chae Y. The role of visual expectations in acupuncture analgesia: A quantitative electroencephalography study. Mol Pain 2022; 18:17448069221128667. [PMID: 36196847 PMCID: PMC9537492 DOI: 10.1177/17448069221128667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Acupuncture is a complex treatment comprising multisensory stimulation, including visual and tactile sensations and experiences of body ownership. The purpose of this study was to investigate the role of these three components of acupuncture stimulation in acupuncture analgesia. 40 healthy volunteers participated in the study and received acupuncture treatment under three different conditions (real-hand, rubber-hand synchronous, and rubber-hand asynchronous). The tolerance for heat pain stimuli was measured before and after treatment. Brain oscillation changes were also measured using electroencephalography (EEG). The pain tolerance was significantly increased after acupuncture treatment under all three conditions. Noticeable deqi (needle) sensations in response to acupuncture stimulation of the rubber hand were found under both rubber-hand synchronous and rubber-hand asynchronous conditions. Deqi sensations were significantly correlated with acupuncture analgesia only under the rubber-hand synchronous condition. Increased delta and decreased theta, alpha, beta, and gamma waves were observed after acupuncture treatment under all three conditions. Our findings clarified the role of cognitive components of acupuncture treatment in acupuncture analgesia through the rubber-hand illusion. This study is a first step toward separating various components of acupuncture analgesia, i.e. visual, tactile, and body ownership, and utilizing those components to maximize analgesic effects.
Collapse
Affiliation(s)
| | | | - In-Seon Lee
- In-Seon Lee, Department of Science in
Korean Medicine, Graduate School, Kyung Hee University, 1 Hoegi-dong,
Dongdaemun-gu, Seoul 02447, Republic of Korea.
| | - Younbyoung Chae
- Younbyoung Chae, Department of Science in
Korean Medicine, Graduate School, Kyung Hee University, 1 Hoegi-dong,
Dongdaemun-gu, Seoul 02447, Republic of Korea.
| |
Collapse
|
5
|
Ho JT, Krummenacher P, Lenggenhager B. Not my body, not my pain? Pain perception and placebo analgesia in individuals with body integrity dysphoria. Cortex 2022; 153:44-54. [PMID: 35588553 DOI: 10.1016/j.cortex.2022.03.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/14/2022] [Accepted: 03/04/2022] [Indexed: 11/23/2022]
Abstract
Acute and chronic states of physical pain are inherently linked to our bodily perception. Bodily illusion paradigms have demonstrated that an experimentally induced sense of body disownership can modulate both acute and chronic pain. Insight into the relationship between enduring clinical alterations in body perception and pain is much more limited. The current study examined both pain perception and placebo analgesia in Body Integrity Dysphoria (BID), a clinical model of long-term alterations of bodily disownership: in its most commonly studied variant, people feel like a part of their body does not belong to them, leading to a desire for amputation of a physically healthy limb. Heat stimulations were applied before and after a placebo intervention (sham analgesic cream) to the desired and the undesired leg of 19 patients with BID with a unilateral leg amputation desire. Pain perception was assessed using pain thresholds, and ratings for pain intensity and pain unpleasantness. Results show that pain perception and placebo efficacy were lower for the undesired than for the desired leg, demonstrating a potential link between a clinical disorder of body ownership, pain perception, and placebo analgesia.
Collapse
Affiliation(s)
- Jasmine T Ho
- University of Zurich, Department of Psychology, Zurich, Switzerland; Brainability, LLC, Zurich, Switzerland.
| | - Peter Krummenacher
- Brainability, LLC, Zurich, Switzerland; Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, Psychotherapy and Psychosomatics, Zurich, Switzerland.
| | - Bigna Lenggenhager
- University of Zurich, Department of Psychology, Zurich, Switzerland; Department of Psychology, University of Konstanz, Konstanz, Germany.
| |
Collapse
|
6
|
Tanaka T, Hayashida K, Morioka S. Verbal Suggestion Modulates the Sense of Ownership and Heat Pain Threshold During the "Injured" Rubber Hand Illusion. Front Hum Neurosci 2022; 16:837496. [PMID: 35547193 PMCID: PMC9082029 DOI: 10.3389/fnhum.2022.837496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
The appearance of the self-body influences the feeling that one's body belongs to oneself, that is, a sense of ownership (SoO) and pain perception. This can be identified by measuring the SoO and pain thresholds after performing the rubber hand illusion (RHI) with an injured rubber hand. The generation of SoO is thought to be caused by multisensory integration of bottom-up factors (vision, proprioceptive, and touch), and by top-down factors, such as the context effect. The appearance is one of the context effects which may become more effective when used simultaneously with other context effects (e.g., verbal suggestion). However, in the RHI, when appearance and other context effects are used simultaneously, the effect is unclear. In this study, we attempted to identify the influence of verbal suggestion on the SoO and heat pain threshold (HPT). As a preliminary step, in Experiment 1, the "normal" rubber hand and "penetrated nail" as injured rubber hand were used to clarify the context effect with appearance alone during RHI (synchronous/asynchronous), which was conducted within-subjects. In Experiment 2, we only used the "penetrated nail" rubber hand to clarify the context effect with verbal suggestion and appearance during RHI. We randomly classified participants into two suggestion groups ("fear" and "no-fear"). The RHI (synchronous/asynchronous) was conducted for each group. In each experiment, the effect of each condition was assessed by subjective measures of SoO, such as questionnaire, and objective measures of SoO, such as proprioceptive drift and electrodermal activity. Following RHI in each condition, HPT was measured. The main finding was that, in the synchronous condition, the "penetrated nail" appearance with "fear" verbal suggestion modulated questionnaire and HPT, but not electrodermal activity. We conclude that the context-included multisensory integration affected the subjective factors because it contains a higher cognitive process by verbal suggestion.
Collapse
Affiliation(s)
- Tomoya Tanaka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Koryo, Japan
- Department of Rehabilitation, Fukuchiyama City Hospital, Fukuchiyama, Japan
| | - Kazuki Hayashida
- Neurorehabilitation Research Center, Kio University, Koryo, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Koryo, Japan
- Neurorehabilitation Research Center, Kio University, Koryo, Japan
| |
Collapse
|
7
|
Ho JT, Krummenacher P, Lesur MR, Saetta G, Lenggenhager B. Real Bodies Not Required? Placebo Analgesia and Pain Perception in Immersive Virtual and Augmented Reality. THE JOURNAL OF PAIN 2021; 23:625-640. [PMID: 34780993 DOI: 10.1016/j.jpain.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
Pain represents an embodied experience, wherein inferences are not only drawn from external sensory inputs, but also from bodily states. Previous research has demonstrated that a placebo administered to an embodied rubber hand can effectively induce analgesia, providing first evidence that placebos can work even when applied to temporarily embodied, artificial body parts. Using a heat pain paradigm, the present study investigates placebo analgesia and pain perception during virtual embodiment. We examined whether a virtual placebo (a sham heat protective glove) can successfully induce analgesia, even when administered to a virtual body. The analgesic efficacy of the virtual placebo to the real hand (augmented reality setting) or virtual hand (virtual reality setting) was compared to a physical placebo administered to the own, physical body (physical reality setting). Furthermore, pain perception and subjective embodiment were compared between settings. In this mixed design experiment, healthy participants (n=48) were assigned to either an analgesia-expectation or control-expectation group, where subjective and objective pain was measured at pre- and post-intervention time points. Results demonstrated that pre-intervention pain intensity was lower in the virtual reality setting, and that participants in the analgesia-expectation condition, after the intervention, exhibited significantly higher pain thresholds, and lower pain intensity and unpleasantness ratings than control-expectation participants, independent of the setting. Our findings show that a virtual placebo can elicit placebo analgesia comparable to that of a physical placebo, and that administration of a placebo does not necessitate physical bodily interaction to produce analgesic responses.
Collapse
Affiliation(s)
- Jasmine T Ho
- University of Zurich, Department of Psychology, Binzmühlestrasse 14, Box 9, 8050 Zurich, Switzerland
| | - Peter Krummenacher
- University of Zurich, Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, Psychotherapy and Psychosomatics, 8032 Zurich, Switzerland
| | | | | | | |
Collapse
|
8
|
Abstract
OBJECTIVE Chronic pain is a significant health problem that is increasing in prevalence, and advances in treatment are needed. METHODS We briefly review the leading evidence-based psychological therapies for chronic pain-cognitive-behavioral and acceptance/mindfulness-based therapies-and examine several limitations and missing perspectives of these approaches. We review six lesser-known interventions that address these limitations, and we describe our integrative model for psychological assessment and treatment of centralized pain. We present a typical patient and describe how we apply this approach, along with challenges to its implementation and possible solutions to these challenges. RESULTS Greater pain treatment efficacy may be possible if clinicians: (a) distinguish patients with primarily centralized (i.e., somatoform or nociplastic) pain from those with primarily peripheral (nociceptive, inflammatory, or neuropathic) pain; (b) acknowledge the capacity of the brain not only to modulate pain but also generate as well as attenuate or eliminate centralized pain; (c) consider the powerful role that adverse life experiences and psychological conflicts play in centralized pain; and (d) integrate emotional processing and interpersonal changes into treatment. Our integrative treatment involves delivering a progression of interventions, as needed, to achieve pain reduction: tailored pain neuroscience education, cognitive and mindfulness skills to decrease the pain danger alarm mechanism, behavioral engagement in avoided painful and other feared activities, emotional awareness and expression to reverse emotional avoidance and overcome trauma or psychological conflict, and adaptive communication to decrease interpersonal stress. CONCLUSIONS This integrative assessment and treatment model has the potential to substantially reduce and sometimes eliminate centralized pain by changing the cognitive, behavioral, emotional, and interpersonal processes that trigger and maintain centralized pain.
Collapse
Affiliation(s)
- Mark A Lumley
- From the Department of Psychology (Lumley), Wayne State University, Detroit, Michigan; and Department of Internal Medicine (Schubiner), Providence-Providence Park Hospital, Ascension Health, and Michigan State University College of Human Medicine, Southfield, Michigan
| | | |
Collapse
|