Anxiety sensitivity and pain-related anxiety in the prediction of fear responding to bodily sensations: A laboratory test

Anxiety sensitivity and Pain Experience: a prospective investigation among World Trade Center Responders

Chronic pain is a significant public health problem and is exacerbated by stress. The World Trade Center (WTC) Disaster represents a unique stressor, and responders to the WTC disaster are at increased risk for pain and other health complaints. Therefore, there is a significant need to identify vulnerability factors for exacerbated pain experience among this high-risk population. Anxiety sensitivity (AS), defined as fear of anxiety-related sensations, is one such vulnerability factor associated with pain intensity and disability. Yet, no work has tested the predictive effects of AS on pain, limiting conclusions regarding the predictive utility and direction of associations. Therefore, the current study examined the prospective associations of AS, pain intensity, and pain interference among 452 (M_age = 55.22, SD = 8.73, 89.4% male) responders to the WTC disaster completing a 2-week daily diary study. Using multi-level modeling, AS total score was positively associated with both pain intensity and pain interference, and that AS cognitive concerns, but not social or physical concerns, were associated with increased pain. These results highlight the importance of AS as a predictor of pain complaints among WTC responders and provide initial empirical evidence to support AS as a clinical target for treating pain complaints among WTC responders.

Negative interpretation of ambiguous bodily symptoms among illness-anxious individuals: Exploring the role of developmental and maintenance constructs

BACKGROUND

Cognitive factors play an essential role in the development and maintenance of anxiety problems. Among individuals with illness anxiety problems, their interpretation of bodily symptoms is a crucial factor in the determination of their ability to regulate their emotions. The catastrophic interpretation of ambiguous bodily symptoms and changes, known as interpretation bias, in line with the failure to reappraise the symptoms in safer ways, is supposed to increase the levels of anxiety in illness-anxious individuals.

METHODS

This study aimed to address the statistical limitations of the direct (self-report) measure of interpretation bias, using an indirect (online interpretation bias task) measure for assessing biased interpretations of bodily symptoms. In addition, we examined the contribution of self-report anxiety sensitivity (AS), intolerance of uncertainty (IU), interpretation bias, and reappraisal to illness anxiety problems in a subclinical population and compared it with controls with low levels of illness anxiety.

FINDINGS

Illness-anxious individuals made more negative interpretations of ambiguous, potentially health-threatening information. They used less reappraisal to regulate their emotion. Among the measures, the physical subscale of AS and the reaction time to the safe resolution of ambiguous information were the best factors that could contribute to the differentiation between the illness-anxious individuals and non-anxious individuals.

CONCLUSION

Our findings provided further support for the biased processing of information related to physical symptoms among individuals with illness anxiety. AS-physical and safe resolutions for ambiguous situations could differentiate the illness-anxious and the control groups better than other factors. These findings suggest that a change of interpretation of ambiguous bodily symptoms among individuals suffering from chronic conditions can be a possible intervention to target anxiety and improve patients' lives.

Patient periprocedural stress in cardiovascular medicine: friend or foe?

Stress, a disruption of homeostasis, is an unavoidable part of everyday life. In medical procedures, stress profoundly affects both operators and patients. Although the stress reaction has evolved to aid survival of physical trauma, it may also be harmful, by aggravating the baseline medical condition and/or creating new stress-related medical problems. Stress responses comprise several protective mechanisms that are particularly relevant in the clinical setting (e.g., a procoagulatory state and blood loss counteraction, preservation of blood perfusion pressure, prevention of hypoglycemia, enhanced immune response). Beneficial psychological effects prevent recurrence of traumatic memories, and promote patient compliance and positive lifestyle changes. In contrast, overt acute stress responses may lead to severe pathological conditions such as cytokine storm, post-traumatic stress disorder, takotsubo syndrome, deep venous thrombosis and pulmonary embolism, myocardial infarction, life-threatening arrhythmias and sudden cardiac death. There is also evidence that stress exposure may promote atherosclerosis and reduce long-term benefits from the intervention (increase in major adverse clinical events, in-stent restenosis, etc.). Insights into the role of stress on the operator’s performance have recently led to the introduction of counteractive measures such as simulation training. Conversely, very little is known about the effect of the patient’s periprocedural stress on the outcomes of cardiovascular procedures. Recent data show that the patient periprocedural stress affects the well-being of whole families. This review, focused on topics particularly relevant to cardiovascular interventions, provides a mechanistic insight into beneficial and harmful effects of periprocedural patient stress, including the array of available stress-relieving measures.

A specially designed medical screen for children suffering from burns: A randomized trial of a distraction-type therapy

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The current study is the first to explore the medical screen as a treatment to control the pain and its related psychological symptoms on children suffering from burns;.

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Compared with conventional dressing methods, the medical screen can be used as a novel way to decrease the negative experience of burn patients -ages 1–3 who require dressing changes.

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The medical screen is likely a feasible, acceptable and potentially efficacious treatment option for burns medical workers.

Objective

To evaluate the impact of the specially designed medical dressing screen during wound dressing changes of children who suffered burns to their hand or foot.

Design

Randomized controlled trial.

Setting

Burns and Plastic Reconstruction Unit.

Participants

Children (NN = 120) with burns on up to 1%-–5% of the total body surface area.

Interventions

The patients were selected and randomly allocated to 3 equal-sized groups as follows:control group (N control group (N = 40): the children received only regular dressing changes; computer group (NN = 40): a touch-screen computer was used for children during dressing changes; medical screen group (NN = 40): a medical screen combined with the touch-screen computer were used for children during dressing changes. All patients underwent a dressing change once per day for four days. Data were distributed four times: immediately after the initial dressing change (T1); and immediately after each times at next three consecutive days (T2-T4).Main Outcome M–T4).

Main outcome measures

The Pain level of the children evaluated by medical staffs was the primary outcome, the Pain level of the children evaluated by children's parents and the satisfaction of wound therapist were used as second outcomes.

Results

The mean scores related to pain level at the medical screen group displayed significantly better results than those of control group and those of the computer group. Additionally, the results of the pain evaluated by parents and satisfaction score of the wound therapist at the medical screen group was also better than other groups.

Conclusions

This study demonstrated “that the” application of the medical screen for burns can relieve the pain of 1-–3 years old children suffering from a burns during dressing changes. Additionally, the application of the medical screen also increased the satisfaction of the parents and the wound therapist performing the dressing changes.

Identifying pain perceptual biases related to fear of pain and threat in a pain-free sample

BACKGROUND

The association between fear of pain (FOP) and pain intensity has remained unclear. This study aimed to examine whether highly pain-fearful participants showed pain perceptual biases to general painful stimulus or to specific threatening painful stimulus.

METHODS

Fifty-nine undergraduates were recruited into low (n = 30) and high (n = 29) FOP groups and completed a threatening pain perception task with two tasks. Task 1 assessed pain perceptual biases by calculating the percentage of near-threshold pain stimulus judged as painful and assessing the average pain intensity ratings to those painful stimuli. Task 2 assessed pain perceptual biases by measuring pain ratings to each single threshold (low intensity) and twice-threshold (high intensity) pain stimulus.

RESULTS

Results from task 1 indicated that higher FOP levels were associated with higher pain sensitivity when pain was appraised as a threat, reflected as high FOP group reporting higher pain intensity to those stimuli judged as painful in high threat condition than in low threat condition. Consistently, results from task 2 observed that when noxious stimulus intensity increased to threshold pain and twice threshold pain levels, high FOP group also generally reported higher pain intensity in high threat condition than in low threat condition. However, for both tasks, no such threat level differences were observed in low FOP group.

CONCLUSIONS

The current research emphasized that participants with higher FOP level showed pain perceptual biases to specific threatening painful stimulus. Threat appraisal of pain played a key role in the positive association between pain-related fear and pain perceptual biases.

SIGNIFICANCE

The findings highlight the modulatory influence of threat appraisal of pain in the positive association between pain-related fear and pain perceptual biases.

Impact of orally administered tramadol combined with self-selected music on adult outpatients with burns undergoing dressing change: A randomized controlled trial

OBJECTIVE

To investigate the effects of music and/or tramadol on pain and anxiety in burn outpatients undergoing dressing changes.

DESIGN

Randomized controlled trial.

SETTING

Burns and Plastic Reconstruction Unit.

PARTICIPANTS

Patients (N=180) with burns on up to 10%-30% of the total body surface area (TBSA).

INTERVENTIONS

The patients were randomly allocated to 4 equal-sized groups as follows: (1) tramadol group (TG), patients received 100mg of tramadol orally 20min before the dressing change; (2) music group (MG), patients listened to self-selected music during the dressing change; (3) music-plus-tramadol group (MTG), patients received tramadol and listened to self-selected music; and (4) control group (CG), patients received a routine dressing change only. All patients underwent the interventions once per day for 2days.

MAIN OUTCOME MEASURES

McGill Pain Questionnaire Short Form (MPQ-SF) (primary outcome), McGill Pain Persian version of Burn Specific Pain Anxiety Scale (BSPAS) (primary outcome), and heart rate (HR) and overall patient satisfaction (secondary outcomes).

RESULTS

The results showed that music-plus-tramadol group (MTG) had better outcomes with respect to pain and anxiety management during dressing changes.

CONCLUSIONS

In comparison with music or tramadol alone, the integration of music and tramadol offers a secure and favorable treatment choice to relieve pain and anxiety, ultimately improving the satisfaction levels of burn outpatients during dressing changes.

Emotion dysregulation as an explanatory factor in the relation between negative affectivity and non-medical use of opioid in a diverse young adult sample

The non-medical use of prescription opioids is an area of increasing public health concern, particularly among young college-age adults (ages 18-25) who demonstrate an increased risk of opioid-related problems. Negative mood states are consistently associated with more severe non-medical use of opioid. Emotion dysregulation defined an impaired ability to understand, evaluate, and differentiate one's emotions, and access strategies to regulate them could play an explanatory role in this association. The present study examined the potential explanatory role of emotion dysregulation in the relationship between negative affectivity and non-medical use of prescription opioid among a racially/ethnically diverse young adult sample (N = 2080, 78.7% female, Mage = 21.9, SD = 4.9) attending a large southwestern state university, and across the two sub-samples of individuals with and without pain. Results indicated that emotion dysregulation explained, in part, the association between negative affectivity and non-medical use of opioid-related variables, including self-reported addiction to opioids, denial of opioid prescription by a healthcare provider, and family concerns about participant's opioid use. These indirect effects were comparable across individuals with and without pain. Findings suggest that targeting emotion dysregulation may be one therapeutic strategy to reduce non-medical use of opioid in the context of negative affectivity among college students.

Visual reminders of death enhance nociceptive-related cortical responses and event-related alpha desynchronisation

Previous research suggests that prompting individuals to think on their own mortality affects their perception of painful somatic stimuli and related brain activity. Grounded on the assumption that reminders of mortality may recruit threat-defence mechanisms similar to the ones activated by painful nociceptive stimuli, we hypothesize that the effects exerted by linguistic reminders of death on pain perception and brain activity would be elicited by passive observation of death-related pictures vs. more generic threat-related pictures. Results showed an increase of the laser evoked P2 amplitude and oscillatory theta activity when participants observed death-related images. However, no change in pain ratings was found. Moreover, observation of death-related content was linked to increased oscillatory alpha desynchronisation but not to variations of visual evoked potentials amplitude. Our findings indicate that pairing potentially noxious stimuli with death-related images exerts a preferential modulation of nociceptive and visual cortical representations.

Polish Adaptation and Psychometric Validation of the Anxiety Sensitivity Index-III

The present study sought to adapt and validate the psychometric properties of the Anxiety Sensitivity Index-III in Poland. The ASI-III consists of three subscales, each representing one of the three domains of fears of the negative consequences of anxiety-related physical, cognitive, or social sensations. The study included a total of 116 panic disorder patients and 411 controls who did not show the presence of mental disorders. The results indicated that the Polish-language version of the ASI-III is characterized by high content validity, internal consistency, and stability over a period of 28 days. Moreover, its factor structure was largely equivalent to that found on the original ASI-III.

Anxiety and anxiety sensitivity as predictors of fear of childbirth: different patterns for nulliparous and parous women

OBJECTIVE

The demographic characteristics, maternal parity and personal traits of pregnant women have been frequently studied predictors of fear of childbirth (FOC). The aim of this study was to examine the role of demographic variables, expected pain level, trait anxiety and anxiety sensitivity in FOC among nulliparous and multiparous women in the last trimester of pregnancy.

METHOD

Two-hundred pregnant women completed a booklet with questionnaires including the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), Anxiety Sensitivity Index (ASI), The State - Trait Anxiety Inventory (STAI) and questions on expected labor pain and demographics.

RESULTS

Results showed that FOC was higher amongst nulliparous women, but FOC level was not associated with other demographic variables. Different predictors were established in nulliparous and multiparous women. While higher intensity of expected labor pain and anxiety sensitivity (dimension physical concern) were significant predictors in both groups, trait anxiety was significant for the first-time mothers only.

CONCLUSION

Amongst all women, anxiety sensitivity (physical concerns dimension) was identified as an important vulnerability factor for FOC. As such, the level of anxiety sensitivity, and any resulting fear or expectations of pain, should be assessed in expectant mothers by clinicians in prenatal settings. Furthermore, anxiety sensitivity should be an important target for psychological interventions aimed at managing FOC.

Disposition and adjustment to chronic pain

Several empirical studies have shown that personal characteristics act as differential variables, which determine how pain is experienced and how the chronic pain patient adjusts to pain. The main aim of the present research is to review the relationships between some dispositional characteristics and pain adjustment. Taking into account the empirical literature, 6 personality traits that are relevant to the pain experience have been selected: neuroticism, anxiety sensitivity, and experiential avoidance as risk factors that increase the probability of patients experiencing a disability; and extraversion, optimism, and resilience as personal resources that increase their capacity to manage pain effectively. The results suggest that it would be useful to include an assessment of normal personality structure during the multi-dimensional evaluation of a person with chronic pain. Understanding these individual personality characteristics will aid in designing pain intervention programs and help predict possible treatment outcomes.

Panic attack history and anxiety sensitivity in relation to cognitive-based smoking processes among treatment-seeking daily smokers

INTRODUCTION

Empirical research has found that panic attacks are related to increased risk of more severe nicotine withdrawal and poor cessation outcome. Anxiety sensitivity (AS; fear of anxiety and related sensations) has similarly been found to be related to an increased risk of acute nicotine withdrawal and poorer cessation outcome. However, research has yet to examine the relative contributions of panic attacks and AS in terms of cognitive-based smoking processes (e.g., negative reinforcement smoking expectancies, addictive and negative affect-based reduction smoking motives, barriers to cessation, problem symptoms experienced while quitting).

METHOD

Participants (n = 242; 57.4% male; M (age) = 38.1) were daily smokers recruited as a part of a larger randomized control trial for smoking cessation. It was hypothesized that both panic attacks and AS would uniquely and independently predict the studied cognitive-based smoking processes.

RESULTS

As hypothesized, AS was uniquely and positively associated with all smoking processes after controlling for average number of cigarettes smoked per day, current Axis I diagnosis, and participant sex. However, panic attack history was only significantly related to problem symptoms experienced while quitting smoking.

CONCLUSIONS

Although past research has demonstrated significant associations between panic attacks and certain aspects of cigarette smoking (e.g., severity of nicotine withdrawal; lower abstinence rates, and negative affect reduction motives), the present findings suggest that AS may be more relevant to understanding beliefs about and motives for smoking behavior as well as perceptions of cessation-related difficulties.