An evaluation of sex differences in psychological and physiological responses to experimentally-induced pain: a path analytic description

Examining Reactivity and Recovery Patterns of Pain-Evoked Cortisol and Alpha-Amylase Trajectories: Relations Between Psychological Markers of Risk and Resilience

Chronic low back pain (cLBP) is one of the leading causes of disability globally and represents an enormous burden to aging adults. While numerous factors contribute to cLBP, dysregulation in the hypothalamic-pituitary-adrenal axis and autonomic nervous system functioning have been implicated in its pathogenesis. It is well documented that negative psychological states can modulate biological stress responsivity in chronic pain; however, little is known regarding the influence of positive psychological factors in this relationship. The aim of this study was to examine the association between psychological risk and resilience factors with patterns of physiological stress reactivity and recovery in 60 older adults with cLBP. Participants completed measures of hope, optimism, pain catastrophizing, and perceived stress, and underwent psychophysical pain testing assessing responses to painful pressure, heat, and cold stimuli. Salivary samples were obtained prior to pain induction and at 7 time points spanning 90 minutes after pain testing terminated. To examine reactivity and recovery profiles in hypothalamic-pituitary-adrenal axis and autonomic nervous system function, samples were assayed for cortisol and alpha-amylase, respectively. Results revealed higher levels of hope and optimism were associated with increased cortisol reactivity (p's < .003) and more rapid recovery (p's = .001). Further, pain catastrophizing and perceived stress were associated with cortisol reactivity, with lower levels of these factors predicting larger increases in cortisol from baseline to peak levels (p's < .04). No significant differences in reactivity or recovery patterns emerged for alpha-amylase. Overall, findings highlight the role of psychological risk and resilience factors in modulating physiological stress reactivity. PERSPECTIVE: This article investigated whether psychosocial risk and resilience factors were associated with stress reactivity and recovery in response to laboratory-based pain testing in older adults with chronic low back pain. Results indicate that high resilience factors may be protective by modulating adrenocortical reactivity and recovery profiles.

A two-component model of hair cortisol concentration in fibromyalgia: Independent effects of pain chronicity and severity

BACKGROUND

Fibromyalgia (FM) is a chronic pain disorder of unknown aetiopathogenesis, in which the role of activity of the hypothalamic-pituitary-adrenal (HPA) axis is not clearly established.

METHODS

This study analysed the modulatory effects of disease chronicity and severity on cortisol levels. Hair cortisol concentrations (HCC) and clinical evaluation data (pain severity, impact of FM on daily activities, depression, anxiety, fatigue and insomnia) were collected from 47 female patients with FM and 36 healthy women (HW).

RESULTS

The results showed that disease chronicity, with a negative effect, and symptom severity, with a positive effect, were independent predictors of HCC. Patients with a shorter disease duration had higher HCC than patients with a longer disease duration and healthy participants. Furthermore, patients with greater symptom severity had higher HCC than those patients with lower clinical severity and healthy participants. While disease chronicity in FM was associated with a decrease in HCC, clinical severity increased HCC.

CONCLUSIONS

These results support the existence of a dysfunction in the regulation of the HPA axis in FM and its possible contribution to chronic pain development.

SIGNIFICANCE

This is the first study to assess hair cortisol concentrations in a specific sample of patients with fibromyalgia (FM). This method is especially useful for the assessment of long-term regular cortisol excretion. Results showed a two-component model for explaining cortisol levels: disease chronicity, with a negative effect, and symptom severity, with a positive effect. This suggests that severe pain/stress evokes higher cortisol levels at earlier stages of FM, while in the longer term a decrease in cortisol levels was observed.

Establishing the Reliability, Validity, and Prognostic Utility of the Momentary Pain Catastrophizing Scale for Use in Ecological Momentary Assessment Research

Despite the marked increase in ecological momentary assessment research, few reliable and valid measures of momentary experiences have been established. The goal of this preregistered study was to establish the reliability, validity, and prognostic utility of the momentary Pain Catastrophizing Scale (mPCS), a 3-item measure developed to assess situational pain catastrophizing. Participants in 2 studies of postsurgical pain outcomes completed the mPCS 3 to 5 times per day prior to surgery (N = 494, T = 20,271 total assessments). The mPCS showed good psychometric properties, including multilevel reliability and factor invariance across time. Participant-level average mPCS was strongly positively correlated with dispositional pain catastrophizing as assessed by the Pain Catastrophizing Scale (r = .55 and .69 in study 1 and study 2, respectively). To establish prognostic utility, we then examined whether the mPCS improved prediction of postsurgical pain outcomes above and beyond one-time assessment of dispositional pain catastrophizing. Indeed, greater variability in momentary pain catastrophizing prior to surgery was uniquely associated with increased pain immediately after surgery (b = .58, P = .005), after controlling for preoperative pain levels and dispositional pain catastrophizing. Greater average mPCS score prior to surgery was also uniquely associated with lesser day-to-day improvement in postsurgical pain (b = .01, P = .003), whereas dispositional pain catastrophizing was not (b = -.007, P = .099). These results show that the mPCS is a reliable and valid tool for ecological momentary assessment research and highlight its potential utility over and above retrospective measures of pain catastrophizing. PERSPECTIVE: This article presents the psychometric properties and prognostic utility of a new measure to assess momentary pain catastrophizing. This brief, 3-item measure will allow researchers and clinicians to assess fluctuations in pain catastrophizing during individuals' daily lives, as well as dynamic relationships between catastrophizing, pain, and related factors.

Exploration of the trait-activation model of pain catastrophizing in Native Americans: results from the Oklahoma Study of Native American pain risk (OK-SNAP)

OBJECTIVES

Native Americans (NAs) have the highest prevalence of chronic pain of any racial/ethnic group. This issue has received little attention from the scientific community. One factor that may contribute to racial pain disparities is pain catastrophizing. Pain catastrophizing is a construct related to negative pain outcomes in persons with/without chronic pain. It has been suggested that the relationship between trait catastrophizing and pain is mediated by situation-specific (state) catastrophizing. The present study has 2 aims: (1) to investigate whether state pain catastrophizing mediates the relationship between trait catastrophizing and experimental pain (e.g., cold, ischemic, heat and electric tolerance), and (2) to investigate whether this relationship is stronger for NAs.

METHODS

145 non-Hispanic Whites (NHWs) and 137 NAs completed the study. Bootstrapped indirect effects were calculated for 4 unmoderated and 8 moderated mediation models (4 models with path a moderated and 4 with path b).

RESULTS

Consistent with trait-activation theory, significant indirect effects indicated a tendency for trait catastrophizing to be associated with greater state catastrophizing which in turn is associated with reduced pain tolerance during tonic cold (a × b=-0.158) and ischemia stimuli (a × b=-0.126), but not during phasic electric and heat stimuli. Moderation was only noted for the prediction of cold tolerance (path a). Contrary to expectations, the indirect path was stronger for NHWs (a × b for NHW=-.142).

CONCLUSIONS

Together, these findings suggest that state catastrophizing mediates the relationship between trait catastrophizing and some measures of pain tolerance but this indirect effect was non-significant for NAs.

The Effect of Induced Optimism on Situational Pain Catastrophizing

Background

There is broad evidence that optimism is associated with less pain, while pain catastrophizing leads to increased pain. The aim of this study was to examine whether experimentally induced optimism can reduce situational pain catastrophizing and whether this relation is moderated by dispositional optimism and/or dispositional pain catastrophizing.

Methods

Situational pain catastrophizing during two thermal stimulations was measured in 40 healthy participants with the Situational Catastrophizing Questionnaire (SCQ). Between the two stimulations, the Best Possible Self (BPS) imagery and writing task was performed to induce situational optimism in the experimental group while the control group wrote about their typical day. Questionnaires were administered to assess dispositional optimism [Life Orientation Test-Revised (LOT-R)] and dispositional pain catastrophizing [Pain Catastrophizing Scale (PCS)].

Results

There was a significant interaction between the optimism induction and trait pain catastrophizing: the association of trait pain catastrophizing with state pain catastrophizing was weakened after the optimism induction. No overall effect of induced optimism on situational pain catastrophizing and no significant moderating influence of trait optimism were found.

Conclusion

The state optimism induction apparently counteracted the manifestation of dispositional pain catastrophizing as situational pain catastrophizing. This implies that high trait pain catastrophizers may have especially benefitted from the optimism induction, which is in line with resilience models stressing the buffering role of optimism.

Sciatic nerve injury rebalances the hypothalamic-pituitary-adrenal axis in rats with persistent changes to their social behaviours

Increased glucocorticoids characterise acute pain responses, but not the chronic pain state, suggesting specific modifications to the hypothalamic-pituitary-adrenal (HPA)-axis preventing the persistent nature of chronic pain from elevating basal glucocorticoid levels. Individuals with chronic pain mount normal HPA-axis responses to acute stressors, indicating a rebalancing of the circuits underpinning these responses. Preclinical models of chronic neuropathic pain generally recapitulate these clinical observations, but few studies have considered that the underlying neuroendocrine circuitry may be altered. Additionally, individual differences in the behavioural outcomes of these pain models, which are strikingly similar to the range of behavioural subpopulations that manifest in response to stress, threat and motivational cues, may also be reflected in divergent patterns of HPA-axis activity, which characterises these other behavioural subpopulations. We investigated the effects of sciatic nerve chronic constriction injury (CCI) on adrenocortical and hypothalamic markers of HPA-axis activity in the subpopulation of rats showing persistent changes in social interactions after CCI (Persistent Effect) and compared them with rats that do not show these changes (No Effect). Basal plasma corticosterone did not change after CCI and did not differ between groups. However, adrenocortical sensitivity to adrenocorticotropic hormone (ACTH) diverged between these groups. No Effect rats showed large increases in basal plasma ACTH with no change in adrenocortical melanocortin 2 receptor (MC₂ R) expression, whereas Persistent Effect rats showed modest decreases in plasma ACTH and large increases in MC₂ R expression. In the paraventricular nucleus of the hypothalamus of Persistent Effect rats, single labelling revealed significantly increased numbers of corticotropin releasing factor (CRF) +ve and glucocorticoid receptor (GR) +ve neurons. Double-labelling revealed fewer GR +ve CRF +ve neurons, suggesting a decreased hypothalamic sensitivity of CRF neurons to circulating corticosterone in Persistent Effect rats. We suggest that in addition to rebalancing the HPA-axis, the increased CRF expression in Persistent Effect rats contributes to changes in complex behaviours, and in particular social interactions.

The Association Between Adverse Life Events, Psychological Stress, and Pain-Promoting Affect and Cognitions in Native Americans: Results from the Oklahoma Study of Native American Pain Risk

Native Americans (NAs) experience higher rates of chronic pain. To examine the mechanisms for this pain inequity, we have previously shown that NAs report higher levels of pain-related anxiety and pain catastrophizing, which are in turn related to pronociceptive (pain-promoting) processes. But, it is currently unclear why NAs would report greater pain-related anxiety and catastrophizing. Given that NAs are also more likely to experience adverse life events (ALEs) and associated psychological distress, it was hypothesized that higher anxiety/catastrophizing in NAs would be partially explained by higher rates of ALEs and psychological distress. Structural equation modeling was used to analyze these pathways (NA ethnicity ➔ ALEs ➔ psychological distress ➔ pain anxiety/catastrophizing) in 305 healthy, pain-free adults (N = 155 NAs, N = 150 non-Hispanic Whites [NHWs]). Pain-related anxiety and situational pain catastrophizing were assessed in response to a variety of painful tasks. The Life Events Checklist was used to assess cumulative exposure to ALEs that directly happened to each participant. A latent psychological distress variable was modeled from self-reported perceived stress and psychological symptoms. Results found that NAs experienced more ALEs and greater psychological distress which was associated with higher rates of pain-related anxiety and pain catastrophizing. Notably, NAs did not report greater psychological distress when controlling for ALE exposure. This suggests that a higher risk of chronic pain in NAs may be due, in part, to psychological distress, pain-related anxiety, and pain catastrophizing that are promoted by exposure to ALEs. These results highlight several targets for intervention to decrease NA pain risk.

The Moderating Role of Attention Control in the Relationship Between Pain Catastrophizing and Negatively-Biased Pain Memories in Youth With Chronic Pain

The present study examined the role of attention control in understanding the development of negatively-biased pain memories as well as its moderating role in the relationship between pain catastrophizing and negatively-biased pain memories. Youth with chronic pain (N = 105) performed a cold pressor task (CPT) and completed self-report measures of state/trait pain catastrophizing and attention control, with the latter comprising both attention focusing and attention shifting. Two weeks after the CPT, youth's pain-related memories were elicited via telephone allowing to compute pain and anxiety memory bias indices (ie, recalling pain intensity or pain-related anxiety, respectively, as higher than initially reported). Results indicated no main effects of attention control and pain catastrophizing on pain memories. However, both components of attention control (ie, attention focusing and attention shifting) moderated the impact of pain catastrophizing on youth's memory bias, with opposite interaction effects. Specifically, whereas high levels of attention shifting buffered the influence of high pain catastrophizing on the development of pain memory bias, high levels of attention focusing strengthened the influence of high pain catastrophizing on the development of anxiety memory bias. Interaction effects were confined to trait catastrophizing (ie, not state catastrophizing). Theoretical and clinical implications are discussed. PERSPECTIVE: This article investigates the role of attention control in the development of negatively-biased pain memories in children with chronic pain. Findings underscore the importance of targeting differential components of attention control and can inform intervention efforts to minimize the development of negatively biased pain memories in youth with chronic pain.

"Big girls don't cry": the effect of the experimenter's sex and pain catastrophising on pain

OBJECTIVES

The expression of pain in males and females involves complex socio-psychological mechanisms. Males may report lower pain to a female experimenter to appear strong, whereas females may report higher pain to a male experimenter to appear weak and to seek protection. However, evidence to support these stereotypes is inconclusive. Individuals who catastrophise about pain rate higher pain than those who do not. How pain catastrophising interacts with the effect of the experimenter's sex on pain reports is yet to be explored. Thus, the aim of this study was to determine whether pain catastrophising moderated the effect of the experimenter's sex on pain reports in healthy males and females.

METHODS

Participants (n=60, 30 males) were assigned to one of four experimental conditions: males tested by male experimenters, males tested by female experimenters, females tested by male experimenters, and females tested by female experimenters. Participants completed the Pain Catastrophising Scale, and then sensitivity to heat and to blunt (pressure-pain threshold) and sharp stimuli was assessed on both forearms, and to high frequency electrical stimulation (HFS) administered to one forearm.

RESULTS

Females reported lower pressure-pain thresholds than males irrespective of the experimenters' sex. Females reported lower sharpness ratings to male than female experimenters only when the test stimuli were moderately or intensely sharp. Higher pain catastrophising scores were associated with higher sharpness ratings in females but not males. Additionally, higher pain catastrophising scores were associated with greater temporal summation of pain to HFS, and with lower pressure-pain thresholds in females who were tested by male experimenters.

CONCLUSIONS

These findings indicate that the experimenters' sex and the participant's pain catastrophising score influence pain reports, particularly in females. Awareness of these psychosocial factors is important in order to interpret pain responses in a meaningful way, especially when females are tested by male experimenters. A greater awareness of sex/gender role biases and their potential interaction with pain catastrophising may help researchers and clinicians to interpret pain reports in meaningful ways. In turn, this may help to improve delivery of treatments for patients with chronic pain.

Systematic Review of Autonomic Nervous System Functioning in Pediatric Chronic Pain

OBJECTIVES

Chronic pain is a common and debilitating health problem that impacts up to one third of children and adolescents. The pathophysiological mechanisms of chronic pain are complex, but considerable research links dysfunction of the autonomic nervous system (ANS) and chronic pain in adults. No review of ANS functioning has been conducted in pediatric chronic pain. We systematically reviewed studies examining ANS activity among youth with primary chronic pain conditions.

METHODS

A systematic search of PsycINFO, PubMed, and CINAHL was conducted using specific search terms. Articles were included if studies measured heart rate, blood pressure, heart rate variability, galvanic skin responses, or pupillometry among children or adolescents with a chronic pain condition. Studies examining these factors in the context of a specific disease-related pain condition were excluded.

RESULTS

Of the 1304 articles screened, 15 studies met the criteria for inclusion in this review. All included studies were cross-sectional and primarily included youth with abdominal pain. Results revealed preliminary evidence of reduced parasympathetic activity among youth with pain as measured by heart rate variability. However, results were mixed across ANS indices. Measurement and procedural differences, in addition to a lack of control groups in some studies, limit the interpretability of the reviewed findings.

DISCUSSION

Additional studies with larger and more diverse samples of youth with various chronic primary pain conditions are needed to delineate possible relationships among ANS functioning and the development and maintenance of chronic pain in children and adolescents. Clinical implications and avenues for future research are discussed.

An exploratory investigation into the effects of mental defeat on pain threshold, pain rating, pain anticipation, and mood

In chronic pain, mental defeat is considered as a disabling type of self-evaluation triggered by repeated episodes of debilitating pain. This exploratory study experimentally tested the effect of an activated sense of defeat, as well as its interaction with pain catastrophizing, on pain and mood. Participants (N = 71) were allocated to either high or low pain catastrophizing groups and then randomly assigned to receive either defeat or neutral manipulations. A cold pressor task administered before and after the thought manipulation measured pain threshold, alongside visual analogue scales for mental defeat, attention, pain intensity, pain anticipation as well as mood. Thought manipulation checks supported successful defeat activation. Defeat activation was associated with increased negative mood and attentional disengagement from the nociceptive stimuli, irrespective of pain catastrophizing tendency. There were no changes in pain threshold, pain or pain anticipation ratings. The results suggest that mental defeat can be experimentally activated using an autobiographical memory task and that an activated sense of defeat appears to operate independently from pain catastrophizing in influencing mood and attentional disengagement from the nociceptive stimuli. Future research can utilize our experimental approach to evaluate the effect of an activated sense of mental defeat in people with chronic pain, for whom the magnitude of pain, mood and attentional responses may be stronger and broader.

The Resurrection of Interdisciplinary Pain Rehabilitation: Outcomes Across a Veterans Affairs Collaborative

OBJECTIVE

Despite empirical support for interdisciplinary pain rehabilitation programs improving functioning and quality of life, access to this treatment approach has decreased dramatically over the last 20 years within the United States but has grown significantly in the Department of Veterans Affairs (VA). Between 2009 and 2019, VA pain rehabilitation programs accredited by the Commission on Accreditation of Rehabilitation Facilities increased 10-fold in the VA, expanding from two to 20. The aim of this collaborative observational evaluation was to examine patient outcomes across a subset of six programs at five sites.

METHODS

Outcomes were assessed using agreed-upon measures of patient-reported pain intensity, pain interference across various domains, pain catastrophizing, and sleep.

RESULTS

A total of 931 patients enrolled in the selected VA interdisciplinary pain programs, with 84.1% of participants completing the full course of treatment. Overall, all programs showed significant improvements from pretreatment to posttreatment in nearly all patient-reported outcomes. The effect sizes ranged from medium to large. Notably, the results demonstrate that positive outcomes were typical despite differences in structure and resources across programs.

CONCLUSIONS

The adverse impacts of opioid use have highlighted the importance of chronic pain treatment approaches that emphasize team-based care focused on functional improvements. This study represents the first and largest analysis of outcomes across chronic pain rehabilitation programs and demonstrates the need for increased access to similar comprehensive approaches to pain management across the health care system. Further, it suggests that a variety of structures may be effective, encouraging flexibility in adopting this interdisciplinary approach.

A Preliminary Investigation of the Underlying Mechanism Associating Daily Sleep Continuity Disturbance and Prescription Opioid Use Among Individuals With Sickle Cell Disease

BACKGROUND

There are emerging data indicating that sleep disturbance may be linked with an increase in opioid use. The majority of sickle cell disease (SCD) patients experience sleep disturbances, which can elevate pain severity and pain catastrophizing, both of which are important predictors of opioid consumption.

PURPOSE

We conducted a preliminary investigation on the association between previous night sleep disturbance and short-acting opioid use, as well as the potential mediating roles of pain severity and pain catastrophizing. Because sex is associated with sleep disturbance, pain-related experiences, and opioid use, we also explored the potential moderating role of sex.

METHODS

Participants were 45 SCD patients who were prescribed opioids. For 3 months, sleep diaries were collected immediately upon participants' awakening. Daily pain severity, pain catastrophizing, and prescription opioid use measures were collected before bedtime.

RESULTS

Multilevel structural equation modeling revealed that wake time after sleep onset (WASO) during the previous night (Time 1) predicted greater short-acting opioid use during the next day (Time 2). Pain severity and pain catastrophizing measured during the next day (Time 2) also mediated the association between the two. Sex moderation analysis showed that the positive association between WASO and pain severity was largely driven by women.

CONCLUSION

These findings provide some preliminary evidence as to the mechanism linking sleep continuity disturbance and opioid requirement in SCD patients. Future studies should replicate and extend these findings with clearer temporal information and employing more refined measures of sleep continuity and prescription opioid use in a larger sample.

The gender context of pain

Pain is a major source of global suffering, with women bearing the greatest burden. Alongside biology, psychological and social factors, including gender, help explain these differences. However, there has been no direct attempt to develop a unified social psychological model of men and women's pain. By drawing on approaches to both gender and pain, a gender context model of pain is presented. It proposes that pain is partly influenced by the gender context in which it occurs, which operates at both individual and interpersonal levels. The model is used to structure an appraisal of the existing evidence around gender and pain, and explore whether the model helps explain why such variation occurs. It is argued that despite evidence for an association between gender and pain, there are empirical gaps that need to be addressed. Implications and directions for future investigations into sex, gender and pain are considered.

The Effect of Pain Catastrophizing on Endogenous Inhibition of Pain and Spinal Nociception in Native Americans: Results From the Oklahoma Study of Native American Pain Risk

BACKGROUND

Conditioned pain modulation (CPM) is a task that involves measuring pain in response to a test stimulus before and during a painful conditioning stimulus (CS). The CS pain typically inhibits pain elicited by the test stimulus; thus, this task is used to assess endogenous pain inhibition. Moreover, less efficient CPM-related inhibition is associated with chronic pain risk. Pain catastrophizing is a cognitive-emotional process associated with negative pain sequelae, and some studies have found that catastrophizing reduces CPM efficiency.

PURPOSE

The current study examined the relationship between catastrophizing (dispositional and situation specific) and CPM-related inhibition of pain and the nociceptive flexion reflex (NFR; a marker of spinal nociception) to determine whether the catastrophizing-CPM relationship might contribute to the higher risk of chronic pain in Native Americans (NAs).

METHODS

CPM of pain and NFR was assessed in 124 NAs and 129 non-Hispanic Whites. Dispositional catastrophizing was assessed at the beginning of the test day, whereas situation-specific catastrophizing was assessed in response to the CS, as well as painful electric stimuli.

RESULTS

Situation-specific, but not dispositional, catastrophizing led to less NFR inhibition but more pain inhibition. These effects were not moderated by race, but mediation analyses found that: (a) the NA race was associated with greater situation-specific catastrophizing, which led to less NFR inhibition and more pain inhibition, and (b) situation-specific catastrophizing was associated with greater CS pain, which led to more pain inhibition.

CONCLUSIONS

Catastrophizing may contribute to NA pain risk by disrupting descending inhibition.

Datasets for Cognitive Load Inference Using Wearable Sensors and Psychological Traits

This study introduces two datasets for multimodal research on cognitive load inference and personality traits. Different to other datasets in Affective Computing, which disregard participants’ personality traits or focus only on emotions, stress, or cognitive load from one specific task, the participants in our experiments performed seven different tasks in total. In the first dataset, 23 participants played a varying difficulty (easy, medium, and hard) game on a smartphone. In the second dataset, 23 participants performed six psychological tasks on a PC, again with varying difficulty. In both experiments, the participants filled personality trait questionnaires and marked their perceived cognitive load using NASA-TLX after each task. Additionally, the participants’ physiological response was recorded using a wrist device measuring heart rate, beat-to-beat intervals, galvanic skin response, skin temperature, and three-axis acceleration. The datasets allow multimodal study of physiological responses of individuals in relation to their personality and cognitive load. Various analyses of relationships between personality traits, subjective cognitive load (i.e., NASA-TLX), and objective cognitive load (i.e., task difficulty) are presented. Additionally, baseline machine learning models for recognizing task difficulty are presented, including a multitask learning (MTL) neural network that outperforms single-task neural network by simultaneously learning from the two datasets. The datasets are publicly available to advance the field of cognitive load inference using commercially available devices.

Pain and Distraction According to Sensory Modalities: Current Findings and Future Directions

BACKGROUND

This review discusses the findings in the literature on pain and distraction tasks according to their sensory modality. Distraction tasks have been shown to reduce (experimentally induced) acute pain and chronic pain. This can be influenced by nature and by the sensory modalities used in the distraction tasks. Yet the effect on reducing pain according to the sensory modality of the distraction task has received little attention.

METHODS

A bibliographic search was performed in different databases. The studies will be systematized according to the sensory modality in which the distraction task was applied.

RESULTS

The analyzed studies with auditory distractors showed a reduction of acute pain in adults. However, these are not effective at healthy children and in adults with chronic pain. Visual distractors showed promising results in acute pain in adults and children. Similarly, tactile and mixed distractors decreased acute pain in adults.

CONCLUSION

Distraction tasks by diverse sensory modalities have a positive effect on decreasing the perception of acute pain in adults. Future studies are necessary given the paucity of research on this topic, particularly with tactile distractors (there is only one study). Finally, the most rigorous methodology and the use of ecological contexts are encouraged in future research.

The relationships between worry, happiness and pain catastrophizing in the experience of acute pain

BACKGROUND

The current study aimed to (a) evaluate the effects of an experimental manipulation of worry and happiness on pain perception and measures of worry about pain and pain catastrophizing and (b) determine if changes in situation-specific worry about pain and pain catastrophizing would be related to changes in acute pain.

METHODS

The study included 120 healthy, pain-free volunteers. Participants were exposed to four levels of noxious stimulation and asked to report on the pain intensity, worry about pain and pain catastrophizing they experienced during the stimulation procedures. They were then randomly assigned to either a Happy or a Worry condition, where they were exposed to emotion induction procedures. The noxious exposure procedures and measures of pain, pain-related worry and pain catastrophizing were then repeated.

RESULTS

Participants in the Worry condition reported significant increases in pain intensity, and those in the Happy condition reported significant decreases in pain intensity. Further, the Worry condition participants reported significant increases in both pain-related worry and pain catastrophizing, while the Happy condition showed the opposite effects. Finally, changes in worry about pain and pain catastrophizing were found to mediate the impact of the affect induction procedure on pain intensity.

CONCLUSIONS

The findings demonstrate that pain intensity, worry about pain and pain catastrophizing are all sensitive to changes in mood. The results have potential clinical implications.

SIGNIFICANCE

The current study shows that manipulation-induced changes in pain-related worry, pain catastrophizing, and affect have direct effects on the experience of acute pain. More broadly, the overlap of these three variables provides with anxiety and mood disorders offers the promise of new vistas for research and treatment of pain conditions by assessing and targeting the cognitions and behaviors that are common to worry and catastrophizing.

Neuroticism and pain catastrophizing aggravate response to pain in healthy adults: an experimental study

Background

The aim of this study was to investigate the association between neuroticism, pain catastrophizing, and experimentally induced pain threshold and pain tolerance in a healthy adult sample from two regions of the country of Croatia: the island of Korcula and city of Split.

Methods

A total of 1,322 participants were enrolled from the Island of Korcula (n = 824) and the city of Split (n = 498). Participants completed a self-reported personality measure Eysenck Personality Questionnaire (EPQ) and pain catastrophizing questionnaire Pain Catastrophizing Scale (PCS), followed by a mechanical pain pressure threshold and tolerance test. We have explored the mediating role of catastrophizing in the relationship between neuroticism and pain intensity.

Results

The results showed that pain catastrophizing partially mediated the relationship between neuroticism and pain intensity, suggesting the importance of pain catastrophizing in increasing vulnerability to pain. The results also indicated gender-related differences, marked by the higher pain threshold and tolerance in men.

Conclusions

This study adds to the understanding of the complex interplay between personality and pain, by providing a better understanding of such mechanisms in healthy adults.

Sex-Specific Effects of Gender Identification on Pain Study Recruitment

Epidemiological, clinical, and laboratory studies show sex differences in pain responses, with women more sensitive to nociceptive stimulation and more vulnerable to long-term pain conditions than men. Because of evidence that men are culturally reinforced for the ability to endure (or under-report) pain, some of these findings might be explained by sociocultural beliefs about gender-appropriate behavior. One potential manifestation of these effects might be differential participation in pain studies, with men adhering to stereotypical masculine roles viewing participation as a way to demonstrate their masculinity. To test this possibility, we assessed gender identification in 137 healthy participants. At the end of the assessment, they were asked if they would like to participate in other research studies. Interested participants were then asked to participate in a study involving administration of pain-evoking stimulation. We compared individuals who agreed to participate in the pain study with those who declined. We observed a significant Sex × Participation interaction in masculine gender identification, such that men (but not women) who agreed to participate identified significantly more with masculine gender. Among masculine gender traits examined, we found that high levels of aggression and competitiveness were the strongest predictors of pain study participation. Our results suggest that men in pain studies might have higher levels of masculine gender identification than the wider male population. Taken together with previous findings of lower levels of pain sensitivity (or reporting) in masculine-identifying male participants, these results suggest an explanation for some of the sex-related differences observed in pain responses.

PERSPECTIVE

To examine whether sex and gender affect willingness to participate in pain studies, we assessed gender identification in men and women, then attempted to recruit them to participate in a pain study. Men who agree to participate in pain studies are significantly higher in masculine gender identification than men who decline to participate or women who agree to participate. Men who agreed to participate were rated particularly high in aggressiveness and competitiveness.

Psychosocial Influences on Exercise-Induced Hypoalgesia

Objective

The purpose of this study was to examine psychosocial influences on exercise-induced hypoalgesia (EIH).

Design

Randomized controlled trial.

Setting

Clinical research unit in a hospital.

Subjects

Fifty-eight healthy men and women (mean age = 21 ± 3 years) participated in this study.

Methods

Participants were first asked to complete a series of baseline demographic and psychological questionnaires including the Pain Catastrophizing Scale, the Fear of Pain Questionnaire, and the Family Environment Scale. Following this, they were familiarized with both temporal summation of heat pain and pressure pain testing protocols. During their next session, participants completed the Profile of Mood States, rated the intensity of heat pulses, and indicated their pressure pain thresholds and ratings before and after three minutes of submaximal, isometric exercise. Situational catastrophizing was assessed at the end of the experimental session.

Results

Results indicated that experimental pain sensitivity was significantly reduced after exercise ( P  < 0.05). Men and women did not differ on any of the measured psychosocial variables ( P  > 0.05). Positive family environments predicted attenuated pain sensitivity and greater EIH, whereas negative and chronic pain-present family environments predicted worse pain and EIH outcomes. Situational catastrophizing and negative mood state also predicted worse pain and EIH outcomes and were additionally associated with increased ratings of perceived exertion and muscle pain during exercise.

Conclusions

This study provides preliminary evidence that psychosocial variables, such as the family environment and mood states, can affect both pain sensitivity and the ability to modulate pain through exercise-induced hypoalgesia.

Influence of Catastrophizing and Personality Traits on Recalled Ratings of Acute Pain Experience in Healthy Young Adults

Objective

To investigate whether pain catastrophizing and personality traits bias recalled ratings of acute pain in an experimental tonic pain model.

Subjects and Setting

Fifty-six undergraduates (14 males) recruited from the University of Peradeniya (mean age 21.7 ± 0.8 SD years).

Design and Methods

Participants completed the Pain Catastrophizing Scale and the Eysenck Personality Questionnaire. They were subjected to two cold pressor tests (dominant and non-dominant hands) and pain threshold, maximum pain intensity, and pain tolerance were recorded. One-week later, the maximum pain intensities of both hands were recalled and percentage distortions in recalling were calculated. Based on a 180 s cutoff, two participants were considered pain-insensitive during the test and were excluded from the analysis.

Results

The maximum pain intensity was recalled with a moderate accuracy (Intraclass Correlation Coefficients = 0.68 for dominant and 0.59 for non-dominant hands). Hierarchical multiple regression analyses revealed that maximum pain intensity ( P  < 0.001) and pain catastrophizing ( P  < 0.001) contributed significantly to recalled pain intensity, and only pain catastrophizing contributed significantly ( P  < 0.001) to percentage distortion in recalling with positive β-coefficients. Participants who consistently overrated pain for both hands in recalling scored significantly higher on catastrophizing ( P  < 0.001).

Conclusion

This study demonstrated that memory for painful events in healthy subjects was reasonably accurate over a period of 1 week. Pain catastrophizing biased pain recall, whereas among personality traits only neuroticism exhibited a weak positive association with the recalled ratings.

Effect of Age, Sex and Gender on Pain Sensitivity: A Narrative Review

Introduction:

An increasing body of literature on sex and gender differences in pain sensitivity has been accumulated in recent years. There is also evidence from epidemiological research that painful conditions are more prevalent in older people. The aim of this narrative review is to critically appraise the relevant literature investigating the presence of age and sex differences in clinical and experimental pain conditions.

Methods:

A scoping search of the literature identifying relevant peer reviewed articles was conducted on May 2016. Information and evidence from the key articles were narratively described and data was quantitatively synthesised to identify gaps of knowledge in the research literature concerning age and sex differences in pain responses.

Results:

This critical appraisal of the literature suggests that the results of the experimental and clinical studies regarding age and sex differences in pain contain some contradictions as far as age differences in pain are concerned. While data from the clinical studies are more consistent and seem to point towards the fact that chronic pain prevalence increases in the elderly findings from the experimental studies on the other hand were inconsistent, with pain threshold increasing with age in some studies and decreasing with age in others.

Conclusion:

There is a need for further research using the latest advanced quantitative sensory testing protocols to measure the function of small nerve fibres that are involved in nociception and pain sensitivity across the human life span.

Implications:

Findings from these studies should feed into and inform evidence emerging from other types of studies (e.g. brain imaging technique and psychometrics) suggesting that pain in the older humans may have unique characteristics that affect how old patients respond to intervention.

Pain Catastrophizing, rather than Vital Signs, Associated with Pain Intensity in Patients Presenting to the Emergency Department for Pain

This study examined the relationships of self-reported pain intensity with vital signs, pain catastrophizing, and state anxiety in patients presenting to the emergency department (ED) for acute pain, exacerbations of chronic pain, or acute pain with concurrent chronic (combined) pain, comparing the pattern of relationships among these three pain groups. One hundred fifty-eight patients presenting to the ED for pain were recruited. Vital signs and self-reported pain intensity were obtained at triage, then participants completed self-report measures of pain catastrophizing, state anxiety, and demographic information. No significant associations were found between vital signs and pain intensity at triage in any of the pain groups. Pain catastrophizing was significantly associated with self-reported pain intensity in the acute pain group (r = .34, p < .05) and combined pain group (r = .30, p < .05), and state anxiety was significantly associated with self-reported pain intensity in with the acute pain group (r = .27, p < .05). When pain catastrophizing and state anxiety were used in a stepwise multiple regression analysis to predict self-reported pain intensity in the acute pain group, only pain catastrophizing emerged as a unique predictor (β = .405, p < .01). Consistent with previous research, vital signs were not associated with self-reported pain intensity in patients presenting to the ED for pain, including those with chronic pain. Given the significant association of pain catastrophizing and pain intensity among patients presenting to the ED for acute pain, brief measurement of pain catastrophizing may inform pain treatment in the ED.

The Role of Stress Regulation on Neural Plasticity in Pain Chronification

Pain, especially chronic pain, is one of the most common clinical symptoms and has been considered as a worldwide healthcare problem. The transition from acute to chronic pain is accompanied by a chain of alterations in physiology, pathology, and psychology. Increasing clinical studies and complementary animal models have elucidated effects of stress regulation on the pain chronification via investigating activations of the hypothalamic-pituitary-adrenal (HPA) axis and changes in some crucial brain regions, including the amygdala, prefrontal cortex, and hippocampus. Although individuals suffer from acute pain benefit from such physiological alterations, chronic pain is commonly associated with maladaptive responses, like the HPA dysfunction and abnormal brain plasticity. However, the causal relationship among pain chronification, stress regulation, and brain alterations is rarely discussed. To call for more attention on this issue, we review recent findings obtained from clinical populations and animal models, propose an integrated stress model of pain chronification based on the existing models in perspectives of environmental influences and genetic predispositions, and discuss the significance of investigating the role of stress regulation on brain alteration in pain chronification for various clinical applications.

Pain-Related Rumination, But Not Magnification or Helplessness, Mediates Race and Sex Differences in Experimental Pain

Compared with white individuals and men, black individuals and women show a lower tolerance for experimental pain stimuli. Previous studies suggest that pain catastrophizing is important in this context, but little is known about which components of catastrophizing contribute to these race and sex differences. The purpose of the current study was to examine the individual components of catastrophizing (rumination, magnification, and helplessness) as candidate mediators of race and sex differences in experimental pain tolerance. Healthy undergraduates (N = 172, 74% female, 43.2% black) participated in a cold pressor task and completed a situation-specific version of the Pain Catastrophizing Scale. Black and female participants showed a lower pain tolerance than white (P < .01, d = .70) and male (P < .01, d = .55) participants, respectively. Multiple mediation analyses indicated that these race and sex differences were mediated by the rumination component of catastrophizing (indirect effect = -7.13, 95% confidence interval (CI), -16.20 to -1.96, and 5.75, 95% CI, .81-15.57, respectively) but not by the magnification (95% CI, -2.91 to 3.65 and -1.54 to 1.85, respectively) or helplessness (95% CI, -5.53 to 3.31 and -.72 to 5.38, respectively) components. This study provides new information about race and sex differences in pain and suggests that treatments targeting the rumination component of catastrophizing may help mitigate pain-related disparities.

PERSPECTIVE

This study suggests that differences in pain-related rumination, but not magnification or helplessness, are important contributors to race and sex differences in the pain experience. Interventions that target this maladaptive cognitive style may help reduce disparities in pain.

How do I cope with pain? Let me count the ways: awareness of pain coping behaviors and relationships with depression and anxiety

Patients with chronic pain are often undertreated with medications alone and need alternative ways of coping. Identifying pain coping skills patients use may be beneficial; however, no research has investigated whether patients are aware of their coping skills. The purpose of this study was to determine whether patients are aware of their pain coping skills, whether certain patient characteristics were related to using coping strategies, and whether coping strategies were related to psychiatric symptoms. Chart reviews were conducted on seventy-eight chronic pain patients who completed a semi-structured psychological interview. Patients endorsed using more coping strategies on the measure compared to the verbal self-report. Identifying with certain patient demographics was related to higher use of some coping strategies. Symptoms of anxiety and depression were also related to the use of some coping strategies. Anxiety was negatively related to ignoring the pain and using self-talk coping statements and positively related to catastrophizing. Depression was negatively related to the use of distraction, ignoring the pain, and using self-talk coping statements. Depression and pain severity were both positively related to catastrophizing and prayer. Results suggest that clinicians may need to help patients become aware of adaptive coping strategies they already use and that the use of certain coping strategies is related to lower levels of depression and anxiety.

Does atraumatic restorative treatment reduce dental anxiety in children? A systematic review and meta-analysis

Dental anxiety is one of the major problems affecting children, which impairs the rendering of dental care, leading to impaired quality of life. It often leads to occupational stress in dental personnel and conflict between parents/caregivers. The objective of this study was to conduct a systematic review and meta-analysis of randomized controlled trials done in children, to synthesize evidence of the effectiveness of atraumatic restorative treatment (ART) in reducing dental anxiety in children compared to conventional restorative treatments. The databases searched included PubMed, Google Scholar and The Cochrane Oral Health Group's Trials Register. Eligible studies reporting dental anxiety by a variety of psychometric scales were tabulated. The review was conducted and reported in accordance with the guidelines provided by the Cochrane Collaboration. Among 416 studies retrieved through literature search, six studies matched the inclusion criteria. Due to lack of data, only three studies were included for meta-analysis using RevMan software (Review Manager, Version 5.3;The Cochrane Collaboration, Copenhagen, 2014). The pooled meta-analysis data, (standardized mean difference − 2.12 [95% confidence interval: −4.52, 0.27]) failed to show any difference between ART group and the conventional treatment group. In conclusion, ART was not more beneficial in reducing dental anxiety among pediatric dental patients. The findings are relevant in the field of clinical practice in dentistry in the management of the anxious pediatric dental patient.

Actions and interactions of estradiol and glucocorticoids in cognition and the brain: Implications for aging women

Menopause involves dramatic declines in estradiol production and levels. Importantly, estradiol and the class of stress hormones known as glucocorticoids exert countervailing effects throughout the body, with estradiol exerting positive effects on the brain and cognition, glucocorticoids exerting negative effects on the brain and cognition, and estradiol able to mitigate negative effects of glucocorticoids. Although the effects of these hormones in isolation have been extensively studied, the effects of estradiol on the stress response and the neuroprotection offered against glucocorticoid exposure in humans are less well known. Here we review evidence suggesting that estradiol-related protection against glucocorticoids mitigates stress-induced interference with cognitive processes. Animal and human research indicates that estradiol-related mitigation of glucocorticoid damage and interference is one benefit of estradiol supplementation during peri-menopause or soon after menopause. The evidence for estradiol-related protection against glucocorticoids suggests that maintaining estradiol levels in post-menopausal women could protect them from stress-induced declines in neural and cognitive integrity.

Pain related catastrophizing on physical limitation in rheumatoid arthritis patients. Is acceptance important?

The experience of Rheumatoid Arthritis (RA) includes significant suffering and life disruption. This cross-sectional study examined the associations between pain, catastrophizing, acceptance and physical limitation in 55 individuals (11 males and 44 female; Mean age = 54.37; SD = 18.346), from the Portuguese population with (RA) 2 years after the diagnosis; also explored the role of acceptance as a mediator process between pain, catastrophizing and physical limitation. Results showed positive correlation between pain and catastrophizing (r = .544; p ≤ .001), and also between pain and 2-years' physical limitation (r = .531; p ≤ .001) Results also showed that acceptance was negatively correlated with physical limitation 2 years after the diagnosis (r = -.476; p ≤ .001). Path-analysis was performed to explore the direct effect of pain (ß = -.393; SD = .044; Z = 3.180; p ≤ .001) and catastrophizing (n.sig.) on physical limitation and also to explore the buffer effect of acceptance in this relationship (indirect effect ß = -.080). Results showed that physical limitation is not necessarily a direct product of pain and catastrophizing but acceptance was also involved. Pain and catastrophizing are associated but the influence of catastrophizing on physical limitation is promoted by low levels of acceptance. Results emphasize the relevance of acceptance as the emotional regulation process by which pain and catastrophizing influence physical functioning and establish the basic mechanism by which pain and catastrophizing operate in a contextual-based perspective. Also the study results offer a novel approach that may help behavioral health and medical providers prevent and treat these conditions.

In Vivo praying and catastrophizing mediate the race differences in experimental pain sensitivity

Black individuals have a lower tolerance for experimental pain than white individuals. Black and white individuals also differ in their use of pain coping strategies, which may explain the race differences in pain sensitivity. We examined the extent to which situation-specific pain coping mediated black-white differences in pain sensitivity. We hypothesized that 1) black participants would demonstrate lower pain tolerance than white participants, 2) black participants would use different pain coping strategies than white participants, and 3) the differential use of these strategies would mediate the relationship between race and pain tolerance. Healthy college undergraduates (N = 190) participated in a cold pressor task and then completed the Coping Strategies Questionnaire-Revised to assess their situation-specific pain coping. Compared with white participants, black participants demonstrated lower pain tolerance, engaged in more situation-specific catastrophizing and praying, and ignored pain less frequently. Catastrophizing and praying were inversely related to pain tolerance and were significant mediators of the relationship between race and pain tolerance. The indirect effect of praying was stronger than that of catastrophizing. Race differences in pain sensitivity may be due, in part, to differences in the use of catastrophizing and praying as coping strategies. These results may help guide treatments addressing maladaptive pain coping.

PERSPECTIVE

This study suggests that race differences in pain sensitivity may be due, in part, to the differential use of catastrophizing and praying strategies. Psychosocial treatments for pain should encourage patients to take an active role in their pain management.

Individual and gender differences in subjective and objective indices of pain: gender, fear of pain, pain catastrophizing and cardiovascular reactivity

According to fear-avoidance models of pain perception, heightened fear of pain may increase disruptive effects of pain; however, the extent to which this affects self-reported pain severity versus physiological indices of pain is not well delineated. The current study examined self-report measures and physiological indices of pain during a cold pressor (CP) task. Individual differences in fear of pain and pain catastrophizing were also assessed via questionnaire. The primary aim of the current study was to examine the extent to which individual differences associated with fear and catastrophizing in response to pain influences subjective and physiological measures of pain. A secondary aim was to examine gender differences associated with response to pain. Average subjective pain ratings were higher for females than males. In contrast, males exhibited higher systolic and diastolic reactivity in response to the CP task relative to females, as well as failure to fully recover to baseline levels. Follow-up correlational analyses revealed that subjective pain ratings were positively associated with fear of pain in both sexes, but were not associated with cardiovascular indices. These results suggest that fear of pain and pain catastrophizing do not influence cardiovascular responses to induced pain. Further research is necessary in order to determine whether these gender differences in blood pressure and heart rate response profiles are due to biological or psychosocial influences. Results support the notion that fear of pain increases subjective pain ratings, but does not influence cardiovascular responses during CP pain-induction.

Differential effects of two virtual reality interventions: distraction versus pain control

There is evidence that virtual reality (VR) pain distraction is effective at improving pain-related outcomes. However, more research is needed to investigate VR environments with other pain-related goals. The main aim of this study was to compare the differential effects of two VR environments on a set of pain-related and cognitive variables during a cold pressor experiment. One of these environments aimed to distract attention away from pain (VRD), whereas the other was designed to enhance pain control (VRC). Participants were 77 psychology students, who were randomly assigned to one of the following three conditions during the cold pressor experiment: (a) VRD, (b) VRC, or (c) Non-VR (control condition). Data were collected regarding both pain-related variables (intensity, tolerance, threshold, time perception, and pain sensitivity range) and cognitive variables (self-efficacy and catastrophizing). Results showed that in comparison with the control condition, the VRC intervention significantly increased pain tolerance, the pain sensitivity range, and the degree of time underestimation. It also increased self-efficacy in tolerating pain and led to a reduction in reported helplessness. The VRD intervention significantly increased the pain threshold and pain tolerance in comparison with the control condition, but it did not affect any of the cognitive variables. Overall, the intervention designed to enhance control seems to have a greater effect on the cognitive variables assessed. Although these results need to be replicated in further studies, the findings suggest that the VRC intervention has considerable potential in terms of increasing self-efficacy and modifying the negative thoughts that commonly accompany pain problems.

Acute psychological and physical stress transiently enhances brachial artery flow-mediated dilation stimulated by exercise-induced increases in shear stress

Exercise elevates conduit artery shear stress and stimulates flow-mediated dilation (FMD). However, little is known regarding the impact of acute psychological and physical stress on this response. The purpose of this study was to examine the impact of the Trier Social Stress Test (TSST (speech and arithmetic tasks)) and a cold pressor test (CPT) with and without social evaluation (SE) on exercise-induced brachial artery FMD (EX-FMD). A total of 59 healthy male subjects were randomly assigned to 1 of 3 conditions: TSST, CPT, or CPT with SE. During 6 min of handgrip exercise, brachial artery EX-FMD was assessed before and 15 and 35 min poststress with echo and Doppler ultrasound. Shear stress was estimated as shear rate, calculated as brachial artery mean blood velocity/brachial artery diameter. Results are means ± SD. All conditions elicited significant physiological stress responses. Salivary cortisol increased from 4.6 ± 2.4 nmol/L to 10.0 ± 5.0 nmol/L (p < 0.001; condition effect: p = 0.292). Mean arterial pressure increased from 98.6 ± 12.1 mm Hg to 131.9 ± 18.7 mm Hg (p < 0.001; condition effect: p = 0.664). Exercise shear rate did not differ between conditions (p = 0.592), although it was modestly lower poststress (prestress: 72.3 ± 4.5 s−1; 15 min poststress: 70.8 ± 5.4 s−1; 35 min poststress: 70.6 ± 6.1 s−1; trial effect: p = 0.011). EX-FMD increased from prestress to 15 min poststress in all conditions (prestress: 6.2% ± 2.8%; 15 min poststress: 7.9% ± 3.2%; 35 min poststress: 6.6% ± 2.9%; trial effect: p < 0.001; condition effect: p = 0.611). In conclusion, all conditions elicited similar stress responses that transiently enhanced EX-FMD. This response may help to support muscle perfusion during stress.

Mediating effects of depression and anxiety on the relationship between bullying involvement and pain problems among adolescents in Taiwan

BACKGROUND

This study aimed to examine the mediating effects of depression and anxiety on the relationships of bullying victimization and perpetration with pain among adolescents in Taiwan.

METHOD

A total of 4976 students of junior and senior high schools completed the questionnaires. Bullying victimization and perpetration, pain problems, depression, and anxiety were assessed. The mediating effects of depression and anxiety on the relationship between bullying involvement and pain problems and the moderating effects of sex on the medicating roles of depression and anxiety were examined by structural equation model.

RESULTS

Both depression and anxiety were significant mediators of the relationship between bullying victimization and pain problems among adolescents. Depression was also a significant mediator of the relationship between bullying perpetration and pain problems among adolescents. Sex had no moderating effect on the mediating role of depression/anxiety on the association between bullying involvement and pain problems.

CONCLUSIONS

Medical and educational professionals should survey and intervene in depression and anxiety when managing pain problems among adolescents involved in bullying.

Amygdala functional connectivity is reduced after the cold pressor task

The amygdala forms a crucial link between central pain and stress systems. Previous research indicates that psychological stress affects amygdala activity, but it is less clear how painful stressors influence subsequent amygdala functional connectivity. In the present study, we used pulsed arterial spin labeling (PASL) to investigate differences in healthy male adults' resting-state amygdala functional connectivity following a cold pressor versus a control task, with the stressor and control conditions being conducted on different days. During the period of peak cortisol response to acute stress (approximately 15-30 min after stressor onset), participants were asked to rest for 6 min with their eyes closed during a PASL scanning sequence. The cold pressor task led to reduced resting-state functional connectivity between the amygdalae and orbitofrontal cortex (OFC) and ventromedial prefrontal cortex, and this occurred irrespective of cortisol release. The stressor also induced greater inverse connectivity between the left amygdala and dorsal anterior cingulate cortex (ACC), a brain region implicated in the down-regulation of amygdala responsivity. Furthermore, the degree of poststressor left amygdala decoupling with the lateral OFC varied according to self-reported pain intensity during the cold pressor task. These findings indicate that the cold pressor task alters amygdala interactions with prefrontal and ACC regions 15-30 min after the stressor, and that these altered functional connectivity patterns are related to pain perception rather than cortisol feedback.

Pressure pain threshold of the cervico-facial muscles in healthy elderly people: the role of gender, age and dominance

OBJECTIVE

The aim of this study was to assess the impact of age on pressure pain threshold (PPT) of cervico-facial muscles in healthy geriatric subjects and to investigate the role of gender and dominance on nociception.

BACKGROUND

Musculo-skeletal pain is common in the elderly, but being subjective, it risks to be underdiagnosed and undertreated. A useful method for assessment of local pain is determining PPT through pressure algometry. Ageing process seems to increase PPTs, but reference values for the assessment of pain in geriatric subjects are lacking.

METHODS

In this study, PPTs in temporal muscle, masseter, sternocleidomastoid, occipital and splenius capitis of 97 healthy elderly subjects were measured using Fischer algometer. Participants were divided by age in four classes (years 65-69; 70-74; 75-79; ≥80).

RESULTS

Women had lower PPTs in all muscles compared with men. Comparing PPTs obtained from the right and the left side, no significant differences were recorded neither in men nor in women. When dividing subjects by age class and education, in both genders no significant differences were observed in PPTs among the groups, neither in the right nor in the left sides.

CONCLUSION

In conclusion, the present study reports reference PPT values for the cervico-facial muscles that can be applied to a population of healthy elderly subjects. After 65 years of age, further ageing does not influence PPTs in cervico-facial muscles whereas female gender has lower PPTs.

Pain rating schema: three distinct subgroups of individuals emerge when rating mild, moderate, and severe pain

Background

While the validity of pain assessment has been well documented, the underlying schema (ie, organized, preconceived ideas) of how individuals interpret numerical pain ratings is not well understood. This study’s objectives were to examine numerical pain intensity ratings, from (0 to 10 cm on the visual analog scale [VAS]) across multiple severities of commonly experienced acute pain conditions to determine whether the ratings differed between these pain conditions and/or between individuals.

Methods

A community sample (N=365, 66% female) rated their anticipated pain intensity (VAS) for threshold, mild, moderate, severe, and tolerance level, using several common pain conditions: headache, toothache, joint injury, delayed-onset muscle soreness, burns, and “general pain.”

Results

Cluster analysis revealed three subgroups of individuals, suggesting three types of underlying pain rating schema: 1) Low Rating subgroup (low VAS pain intensity ratings across all the pain severity categories); 2) Low/High Rating subgroup (low VAS pain intensity rating for mild, but high VAS pain intensity rating for severe pain); and 3) High Rating subgroup (high VAS pain intensity ratings across all the pain severity categories). Overall, differences between pain conditions were small: muscle soreness pain intensity was consistently rated lower than the other pain types across severities. The highest pain ratings varied between joint injury and general pain, depending on severity level. No effects of sex or current experience of pain were noted.

Conclusion

The results indicate that: 1) three distinct pain schemas were present in this community-based sample, indicating significant variation in how pain scales are utilized and/or interpreted between clusters of individuals; 2) pain ratings vary by condition, but these differences are minor; and 3) pain rating schemas are not significantly different between males and females or between individuals with and without current pain.

Music can effectively reduce pain perception in women rather than men

Objective: Nowadays music is used to decrease pain and increase relaxation in clinical settings. It is hypothesized that music can affect women more easily than men. We assessed the effect of two types of music (Iranian folkloric and preferred music) on pain tolerance and pain rating in cold pressor test.

Methodology: A consecutive sample of 50 healthy Iranian medical students was enrolled. They reported pain tolerance and pain rating in cold pressor test in three different musical conditions served as the outcome measures. The results were analyzed with repeated measurement analysis of variance.

Result: Mean tolerance time was significantly higher in preferred music compared to Iranian folkloric music (F (1,48) =25.44, p=0.0001) and no music (F(1,48)=3.51, p=0.0001) conditions. There was a significant interaction when tolerance time in no music condition was compared to preferred music condition, regarding sex; Tolerance time increased more in females (F(1,48)=5.53, p=0.023). The results also indicated that pain ratings, regardless of sex, were different in three musical conditions (F(1.7,81.34)=15.37, p=0.0001).

Conclusion: Music distracted attention from pain and Women can be impressed and distracted more easily by music.

Examining the developmental interface of cortisol and depression symptoms in young adolescent girls

Despite the substantial amount of data supporting a link between HPA-axis functioning and depression, the ontogeny of this association is not known. The aim of the present study was to contribute data on the developmental interface of HPA-axis functioning and depression in girls by testing associations between repeated measures of depression symptoms and cortisol levels in childhood and early adolescence. Girls (N=232) and their mothers, who were participating in a longitudinal study, were interviewed about depression symptoms annually from ages 9 to 12 years. Cortisol was assayed from saliva at ages 10 and 12 years upon arrival to the lab and following administration of the cold pressor task (CPT). Time of day of collection of saliva and level of pubertal development were included as covariates in model testing. Although most girls did not show an increase in cortisol in response to the CPT, lower levels of output during the CPT were associated with higher levels of depression symptoms. These findings were observed only for cortisol levels assessed at age 12 years. Girls with low levels of cortisol output at age 12, and decreases in output from ages 10 to 12, had stable or slightly increasing depression symptoms from ages 9 to 12 years. We conclude that associations between HPA-axis functioning and depression emerge as early as age 12. However, individual differences in cortisol levels at age 12 also were associated with depression symptoms at earlier ages. The data suggest two possibilities: (1) that childhood depression is associated with HPA-axis dysregulation, but that age related changes in the sensitivity or plasticity of the HPA-axis may result in a delay in the emergence of such an association, or (2) that dysregulation of the functioning of the HPA-axis develops following repeated experience of depression symptoms.

Association of trauma, posttraumatic stress disorder, and experimental pain response in healthy young women

BACKGROUND

Evidence of pain alterations in trauma-exposed individuals has been found. The presence of posttraumatic stress disorder (PTSD) may be explaining these alterations, as some of the psychological characteristics of PTSD are hypothesized to increase pain response.

OBJECTIVES

To examine differences in pain response and in certain psychological variables between trauma-exposed women (TEW) with PTSD, TEW without PTSD, and non-trauma-exposed women (NTEW) and to explore the role of these psychological variables in the differences in pain response between the groups.

METHODS

A total of 122 female students completed a cold pressor task (42 TEW with PTSD, 40 TEW without PTSD, and 40 NTEW). Anxiety sensitivity, experiential avoidance, trait and state dissociation, depressive symptoms, state anxiety, catastrophizing, and arousal were assessed.

RESULTS

TEW with PTSD reported significantly higher pain unpleasantness than NTEW, but not more than that of TEW without PTSD. They also presented higher trait dissociation, state anxiety, depressive symptoms, and skin conductance than the other 2 groups and higher anxiety sensitivity than TEW without PTSD. TEW without PTSD reported more pain unpleasantness than NTEW, but they recovered faster from pain. However, these differences were not explained by any psychological variable.

CONCLUSIONS

The results suggest that although trauma-exposed individuals are not more sensitive to painful stimulation, they evaluate pain in a more negative way. Exposure to trauma itself, but not to PTSD, may explain the differences found in pain unpleasantness.