Headache impairs attentional performance

A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar

Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.

Persistent post-COVID headache is associated with suppression of scale-free functional brain dynamics in non-hospitalized individuals

INTRODUCTION

Post-acute coronavirus disease 2019 (COVID-19) syndrome (PACS) is a growing concern, with headache being a particularly debilitating symptom with high prevalence. The long-term effects of COVID-19 and post-COVID headache on brain function remain poorly understood, particularly among non-hospitalized individuals. This study focused on the power-law scaling behavior of functional brain dynamics, indexed by the Hurst exponent (H). This measure is suppressed during physiological and psychological distress and was thus hypothesized to be reduced in individuals with post-COVID syndrome, with greatest reductions among those with persistent headache.

METHODS

Resting-state blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging data were collected for 57 individuals who had COVID-19 (32 with no headache, 14 with ongoing headache, 11 recovered) and 17 controls who had cold and flu-like symptoms but  tested negative for COVID-19. Individuals were assessed an average of 4-5 months after COVID testing, in a cross-sectional, observational study design.

RESULTS

No significant differences in H values were found between non-headache COVID-19 and control groups., while those with ongoing headache had significantly reduced H values, and those who had recovered from headache had elevated H values, relative to non-headache groups. Effects were greatest in temporal, sensorimotor, and insular brain regions. Reduced H in these regions was also associated with decreased BOLD activity and local functional connectivity.

CONCLUSIONS

These findings provide new insights into the neurophysiological mechanisms that underlie persistent post-COVID headache, with reduced BOLD scaling as a potential biomarker that is specific to this debilitating condition.

Developing a simple risk metric for the effect of sport-related concussion and physical pain on mental health

Risk factors associated with depression in athletes include biological sex, physical pain, and history of sport-related concussion (SRC). Due to the well-documented benefits of sport and physical activity on mental health, athletes and non-athletes were recruited to assess any differences. Beyond this, athletes were also grouped by sport-type (contact/non-contact sports) due to the increased prevalence of pain and SRC in contact sports. To our knowledge, there has been no research on how these factors influence the likelihood of depression. In the current study, 144 participants completed a short survey on the above factors and the Center for Epidemiological Studies Depression Scale. Sixty-two of these reported a history of concussion. Logistic regression revealed all the above predictors to be significantly associated with the depression scale. Individuals that had previously sustained SRC, were experiencing greater physical pain and females were more likely to display poor mental health. However, we provide further evidence for the benefits of engaging in sport and physical activity as those that took part in sport were less likely to report depression. Therefore, this study provides a simple risk metric whereby sportspeople can make a better informed choice of their sporting participation, making their own cost/reward judgement.

Personal protective equipment-associated headaches in health care workers during COVID-19: A systematic review and meta-analysis

Introduction

Health Care Workers (HCWs) use Personal Protective Equipment (PPE) during the COVID-19 pandemic to protect themselves and prevent the transmission of the disease. The use of PPE, especially respiratory masks, has adverse consequences, including headaches, which have been secondary and unusual. The aim of the present systematic review and meta-analysis study was to investigate the prevalence of PPE-associated headaches in HCWs during COVID-19 pandemic.

Methods

The present review study was performed based on the PRISMA guideline. The protocol of the present study was registered in PROSPERO with the code CRD42022304437. Valid data resources such as Scopus, PubMed, Web of Science, Science Direct, Google Scholar, Embase were used to identify and extract relevant studies. The searches were conducted between the beginning of 2020 and the end of January 2022. A random effects model was used for meta-analysis and I ² index was used to investigate between-study heterogeneity. Data were analyzed using STATA ver. 14.

Results

A total of 539 articles were first identified through initial search and finally 26 final studies were selected to undergo the meta-analysis phase. According to the results of meta-analysis, the prevalence of headache after and before the use of PPE was 48.27% (95% CI: 40.20-56.34, I ² = 99.3%, p = 0 < 001) and 30.47% (95% CI: 20.47-40.47, I ² = 97.3%, p = 0 < 001), respectively.

Conclusion

The results of the present study showed that the prevalence of PPE-associated headache in HCWs was relatively high, so, the use of PPE during COVID-19 pandemic can be considered as one of the causes of headache. Therefore, management strategies such as regular screening of HCWs for headaches and regular rest periods without the use of PPE can be effective in reducing the prevalence of headaches.

Greater interruption of visual processing and memory encoding by visceral than somatic pain in healthy volunteers - An fMRI study

Visceral pain is regarded as more salient than somatic pain. It has greater affective and emotional components, i.e., it elicits higher levels of pain-related fear and is perceived as more unpleasant than somatic pain. In this fMRI study, we examined the neural effects of painful visceral as compared to painful somatic stimulation on visual processing and memory encoding in a visual categorization and surprise recognition task in healthy volunteers. During the categorization task, participants received either rectal distensions or heat stimuli applied to the forearm, with stimuli being individually matched for unpleasantness. Behaviorally, visceral pain reduced memory encoding as compared to somatic pain (Kleine-Borgmann et al., 2021). Imaging analyses now revealed that visceral pain was associated with reduced activity (i.e., greater pain-related interruption) in neural areas typically involved in visual processing and memory encoding. These include the parahippocampal gyrus, fusiform gyrus, striatum, occipital cortex, insula, and the amygdala. Moreover, reduced engagement of the lateral occipital complex during visual categorization under visceral pain was associated with higher visceral pain-related fear. These findings obtained in healthy volunteers shed light on the neural circuitry underlying the interruptive effect of visceral pain and pave the way for future studies in patient samples.

Does pain modality play a role in the interruptive function of acute visceral compared with somatic pain?

ABSTRACT

Acute pain captures attentional resources and interferes with ongoing cognitive processes, including memory encoding. Despite broad clinical implications of this interruptive function of pain for the pathophysiology and treatment of chronic pain conditions, existing knowledge exclusively relies on studies using somatic pain models. Visceral pain is highly prevalent and seems to be more salient and threatening, suggesting that the interruptive function of pain may be higher in acute visceral compared with somatic pain. Implementing rectal distensions as a clinically relevant experimental model of visceral pain along with thermal cutaneous pain for the somatic modality, we herein examined the impact of pain modality on visual processing and memory performance in a visual encoding and recognition task and explored the modulatory role of pain-related fear and expectation in 30 healthy participants. Despite careful and dynamically adjusted matching of stimulus intensities to perceived pain unpleasantness over the course of trials, we observed greater impairment of cognition performance for the visceral modality with a medium effect size. Task performance was not modulated by expectations or by pain-related fear. Hence, even at matched unpleasantness levels, acute visceral pain is capable of interfering with memory encoding, and this impact seems to be relatively independent of pain-related cognitions or emotions, at least in healthy individuals. These results likely underestimate the detrimental effect of chronic pain on cognitive performance, which may be particularly pronounced in acute and chronic visceral pain.

Positive affect and distraction enhance while negative affect impairs pain modulation in recurrent low back pain patients and matched controls

ABSTRACT

Pathophysiological causes of low back pain (LBP) remain generally unclear, so focus has shifted to psychosocial features and central pain processing. Effects of attentional and affective manipulation on conditioned pain modulation (CPM) and tonic pain perception were examined in thirty recurrent LBP patients in two sessions, one with and one without clinical pain, and compared to healthy participants. Phasic cuff pressure on one leg, scored on a numerical rating scale (NRS), was used for test-stimuli (TS) and contralateral tonic cuff pain rated on an electronic visual analogue scale (eVAS) was the conditioning-stimulus (CS). TS were assessed before and during: 1) control with no manipulation/CS, 2) three attentional manipulations (Flanker with/without CS or CS-Only), and 3) three affective manipulations (positive, neutral, negative pictures) with CS. Greater inhibition of TS-NRS scores was observed in CS-only (P=0.028), combined CS&attention (P=0.026), and CS&Positive (P=0.006) than Control paradigms, and greater in CS&Positive (P=0.019) than CS&Negative paradigms. eVAS scores of CS pain increased throughout all paradigms with CS (P<0.05), except the CS&Positive paradigm, and greater facilitation was observed in the CS-Only paradigm than all others (P<0.02) and lower facilitation was additionally observed in the CS&Positive paradigm compared to CS&Attention and CS&Negative paradigms (P<0.01). Flanker effects and interruptive effects of CS pain on attention were observed consistent with prior findings, and affective manipulation produced less shift in valence among people with RLBP than controls (P<0.05). Attention and positive affect with CS pain evoked CPM, and all attentional/affective tasks, especially positive affect, reduced facilitation of CS pain.

When driving hurts: characterizing the experience and impact of driving with back pain

OBJECTIVES

Driving is one of the most widespread aspects of daily living to people in the United States and is an active process that requires various cognitive functions, such as attention. Chronic low back pain (CLBP) is one of the more prevalent and costly health conditions in the world, with individuals who report CLBP also reporting significant impairment across different domains of daily life both physically and cognitively. However, despite the prevalence of these two constructs, research detailing the experience of driving in pain remains largely underrepresented. This cross-sectional study sought to characterize the driving experience of people who experience CLBP, focusing on the psychological constructs related to chronic pain like pain catastrophizing, affective responses (irritability, anxiety, fear), and self-reported driving behaviors and outcomes.

METHODS

This study distributed an online questionnaire measuring pain, disability, and other psychological constructs commonly associated with CLBP like pain catastrophizing through M-turk to 307 U.S. participants with recurring CLBP and regular driving activity. Participants also answered questions regarding driving in pain, affective responses to driving in pain (i.e., irritability, anxiety, and fear), driving behaviors and violations, driving avoidance habits as a result of pain, opioid use, using pain medication while driving, and recent vehicle collisions within the past three years. Bivariate correlations were used to compare study variables, and one-way ANOVA's were used to compare means between participants with and without a collision history within the past three years.

RESULTS

Findings demonstrated significant positive associations not only between the psychological factors commonly associated with chronic pain, such as pain intensity, pain disability, pain catastrophizing, and the cognitive intrusion by pain, but also statistically significant relationships between these measures and pain intensity while driving, affective responses to driving in pain, driving violations, and driving avoidance habits. Additionally, in comparison to participants with no collision history within the past three years, participants who had been driving during a vehicle collision reported greater pain catastrophizing and cognitive intrusion by pain scores.

CONCLUSIONS

To our knowledge, the current study is the first to characterize driving experience specifically among individuals with CLBP, with attention to the relationship among key sensory, affective, and cognitive psychological metrics as well as self-reported driving history and behavior. The current findings reinforce multiple associations between pain and cognitive-affective variables that have been observed in literature outside the driving context, including pain intensity, anger, inattention, and behavioral disruption. Given that driving is a pervasive, potentially risky behavior that requires some form of cognitive focus and control, the current findings point to a continued need to examine these associations within this specific life context. We believe we have laid a groundwork for research considering the role of psychological pain variables in a driving performance. However, the nature of our analyses prevents any sort of causality from being inferred, and that future experimental research is warranted to better understand and explain these mechanisms underlying driving in pain while accounting for participant bias and subject interpretation.

Attentional Biases Towards Body Expressions of Pain in Men and Women

This study investigated whether there are gender differences in attention to bodily expressions of pain and core emotions. Three experiments are reported using the attentional dot probe task. Images of men and women displaying bodily expressions, including pain, were presented. The task was used to determine whether participants' attention was drawn towards or away from target expressions. Inconsistent evidence was found for an attentional bias towards body expressions, including pain. While biases were affected by gender, patterns varied across the Experiments. Experiment 1, which had a presentation duration of 500 ms, found a relative bias towards the location of male body expressions compared to female expressions. Experiments 2 and 3 varied stimulus exposure times by including both shorter and longer duration conditions (e.g., 100 vs. 500 vs. 1250 ms). In these experiments, a bias towards pain was confirmed. Gender differences were also found, especially in the longer presentation conditions. Expressive body postures captured the attention of women for longer compared to men. These results are discussed in light of their implications for why there are gender differences in attention to pain, and what impact this has on pain behaviour. PERSPECTIVE: We show that men and women might differ in how they direct their attention towards bodily expressions, including pain. These results have relevance to understanding how carers might attend to the pain of others, as well as highlighting the wider role that social-contextual factors have in pain.

Visible Signs of Concussion and Cognitive Screening in Community Sports

Video surveillance and detection of players with visible signs of concussion by experienced medical staff facilitates rapid on-field screening of suspected concussion in professional sports. This method, however has not been validated in community sports where video footage is unavailable. This study aimed to explore the utility of visible signs of concussion to identify players with decrements in performance on concussion screening measures. In this observational prospective cohort study, personnel with basic training observed live matches across a season (60 matches) of community male and female Australian football for signs of concussion outlined in the community-based Head Injury Assessment form (HIAf). Players identified to have positive signs of concussion (CoSign+) following an impact were compared with players without signs (CoSign-). Outcome measures, the Sport Concussion Assessment Tool (SCAT3) and Cogstate, were administered at baseline and post-match. CoSign+ (n = 22) and CoSign- (n = 61) groups were similar with respect to age, sex, education, baseline mood, and medical history. CoSign+ players exhibited worse orientation, concentration, and recall, and slower reaction time in attention and working memory tasks. Comparing individual change from baseline to post-match assessment revealed 100% (95% confidence interval [CI]: 84-100%) of CoSign+ players demonstrated clinically significant deficits on SCAT3 or Cogstate tasks, compared with 59% (95% CI: 46-71%) of CoSign- players. All CoSign+ players observed to have a blank/vacant look demonstrated clinically significant decline on the Standardized Assessment of Concussion (SAC). Detection of visible signs of concussion represents a rapid, real-time method for screening players suspected of concussion in community sports where video technology and medical personnel are rarely present. Consistent with community guidelines, it is recommended that all CoSign+ players be immediately removed from play for further concussion screening.

21st century headache: mapping new territory

Background

With headache experienced by up to 75% of adults worldwide in the last year, primary headache disorders constitute a major public health problem, yet they remain under-diagnosed and under-treated.

Headache prevalence and burden is changing as society evolves, with headache now occurring earlier in life. Contributing factors, mostly associated with changing life style, such as stress, bad posture, physical inactivity, sleep disturbance, poor diet and excess use of digital technology may be associated with the phenomenon that could be labelled as ‘21st century headache’. This is especially notable in workplace and learning environments where headache impacts mental clarity and therefore cognitive performance. The headache-related impact on productivity and absenteeism negatively influences an individual’s behaviour and quality of life, and is also associated with a high economic cost. Since the majority of sufferers opt to self-treat rather than seek medical advice, substantial knowledge on headache prevalence, causation and burden is unknown globally. Mapping the entire population of headache sufferers can close this knowledge gap, leading to better headache management. The broad use of digital technology to gather real world data on headache triggers, burden and management strategies, in self-treated population will allow these sufferers to access appropriate support and medication, and therefore improve quality of life.

Conclusion

These data can yield important insights into a substantial global healthcare issue and form the basis for improved patient awareness, professional education, clinical study design and drug development.

Cognitive performance in patients with chronic tension-type headache and its relation to neuroendocrine hormones

Background

Tension-type headache is the most common headache to be seen in clinical practice. Depression is highly prevalent in chronic tension-type headache (CTTH) patients attending the clinical settings. Cognitive impairment and neuroendocrine dysregulation had been reported in patients with depression and patients with CTTH.

Objective

To assess the cognitive performance and investigate its possible relations to neuroendocrine levels in patients with CTTH.

Subjects and methods

Patients with CTTH, depression, and control subjects were recruited. CTTH was diagnosed according to the International Classification of Headache Disorders. Cognitive performance, depression severity, and pain intensity were assessed by the Montreal Cognitive Assessment Arabic version, Beck’s Depression Inventory, and McGill Pain Questionnaire respectively. Blood samples were collected in the morning within 60 min after waking up from 8:00 to 9:00 a.m. to measure serum levels of basal plasma CRH, ACTH, Cortisol, TSH, FT3, and FT4.

Results

Both patients with CTTH and depression had impaired cognitive performance. Patients with CTTH and patients with depression had altered the hypothalamus-pituitary-adrenal axis, and pituitary-thyroid axis. The hormonal levels significantly correlated with cognitive function in patient groups, especially patients with CTTH.

Conclusion

Patients with CTTH had cognitive dysfunction which could be related to neuroendocrine hormonal dysregulation.

The Effects of Alcohol Hangover on Executive Functions

Recent research has suggested that processes reliant on executive functions are impaired by an alcohol hangover, yet few studies have investigated the effect of hangovers on core executive function processes. Therefore, the current study investigated the effect of hangovers on the three core components of the unity/diversity model of executive functions: the ability to switch attention, update information in working memory, and maintain goals. Thirty-five 18-to-30-year-old non-smoking individuals who reported experiencing a hangover at least once in the previous month participated in this study. They completed tasks measuring switching (number-switching task), updating (n-back task), and goal maintenance (AX Continuous Performance Test, AX-CPT) whilst experiencing a hangover and without a hangover in a 'naturalistic' within-subjects crossover design. Participants made more errors in the switching task (p = 0.019), more errors in both the 1- (p < 0.001) and 2-back (p < 0.001) versions of the n-back, and more errors in the AX-CPT (p = 0.007) tasks when experiencing a hangover, compared to the no-hangover condition. These results suggest that an alcohol hangover impairs core executive function processes that are important for everyday behaviours, such as decision-making, planning, and mental flexibility.

Dorsal Root Ganglion Stimulation Modulates Cortical Gamma Activity in the Cognitive Dimension of Chronic Pain

A cognitive task, the n-back task, was used to interrogate the cognitive dimension of pain in patients with implanted dorsal root ganglion stimulators (DRGS). Magnetoencephalography (MEG) signals from thirteen patients with implanted DRGS were recorded at rest and while performing the n-back task at three increasing working memory loads with DRGS-OFF and the task repeated with DRGS-ON. MEG recordings were pre-processed, then power spectral analysis and source localization were conducted. DRGS resulted in a significant reduction in reported pain scores (mean 23%, p = 0.001) and gamma oscillatory activity (p = 0.036) during task performance. DRGS-induced pain relief also resulted in a significantly reduced reaction time during high working memory load (p = 0.011). A significant increase in average gamma power was observed during task performance compared to the resting state. However, patients who reported exacerbations of pain demonstrated a significantly elevated gamma power (F(3,80) = 65.011612, p < 0.001, adjusted p-value = 0.01), compared to those who reported pain relief during the task. Our findings demonstrate that gamma oscillatory activity is differentially modulated by cognitive load in the presence of pain, and this activity is predominantly localized to the prefrontal and anterior cingulate cortices in a chronic pain cohort.

Executive Functions and Pain

Abstract. A growing body of literature suggests that chronic-pain patients suffer from problems in various neuropsychological domains, including executive functioning. In order to better understand which components of executive functioning (inhibition, shifting and/or updating) might be especially affected by pain and which mechanisms might underlie this association, we conducted a systematic review, including both chronic-pain studies as well as experimental-pain studies. The chronic-pain studies (N = 57) show that pain is associated with poorer executive functioning. The findings of experimental-pain studies (N = 28) suggest that this might be a bidirectional relationship: Pain can disrupt executive functioning, but poorer executive functioning might also be a risk factor for higher vulnerability to pain.

Pain could negatively affect school grades - Swedish middle school students with low school grades most affected

Recurrent headache, abdominal and musculoskeletal pain are common in adolescents and it is therefore important to understand their impact on the transitional period from childhood to adulthood. However, studies of the prevalence over time and implications on educational outcomes are still limited, especially regarding multiple pain symptoms. The present study material consists of questionnaire surveys, completed in 2000 and 2008, including two study populations of 9th grade adolescents aged 15 living in West Sweden (n = 20 877). Pain symptoms and demographic variables were based on self-reports from the questionnaires, and school grades were obtained from Statistics Sweden after the student had finished their 9th grade. Between 2000 and 2008, the prevalence of abdominal pain increased among Swedish adolescents (largest increase in girls); the prevalence of headache increased only in girls; the prevalence of pain in upper body decreased only in boys. School grades were significantly lower among those with headache or abdominal pain. Among students with low school grades (10th percentile) the estimated difference between those having any of the symptoms or none were -27 school grade units (95% confidence interval for girls (-27.8; -26.0), for boys (-27.6; -25.5). Both symptoms being present pronounced the association. Low parental education increased the negative effect of symptoms on school grades, most pronounced in the group with the lowest grades. In conclusion, identification of pain symptoms may improve academic achievements, especially in students with multiple symptoms and with parents having low education. Further intervention studies are need.

Post-concussion Symptom Factors and Neuropsychological Outcomes in Collegiate Athletes

OBJECTIVES

Research indicates that symptoms following a concussion are related to cognitive dysfunction; however, less is known about how different types of symptoms may be related to cognitive outcomes or how specific domains of cognition are affected. The present study explored the relationship between specific types of symptoms and these various cognitive outcomes following a concussion.

METHODS

One-hundred twenty-two student-athletes with sports-related concussion were tested with a battery that included a symptom report measure and various cognitive tests. Symptoms factors were: Physical, Sleep, Cognitive, Affective and Headache. Participants were grouped into "symptom" and "no symptom" groups for each factor. Cognitive outcomes included both overall performance as well as impairment scores in which individuals were grouped into impaired and not impaired based on a cutoff of 2 or more tests at the impaired level (<80 in standard scores). These cognitive outcomes were examined for all the tests combined and then specifically for the memory tests and attention/processing speed tests. A Bonferroni correction was used, and the results were considered significant at a level of p<.008.

RESULTS

Headache symptoms were significantly (p<.008) associated with overall cognitive impairment as well as memory and attention/processing speed impairment. Sleep symptoms were related to memory impairments.

CONCLUSIONS

The symptom specific relationships to cognitive outcomes demonstrated by our study can help guide treatment and accommodations for athletes following concussion. (JINS, 2018, 24, 684-692).

Filling the glass: Effects of a positive psychology intervention on executive task performance in chronic pain patients

BACKGROUND

Chronic pain is associated with emotional problems as well as difficulties in cognitive functioning. Prior experimental studies have shown that optimism, the tendency to expect that good things happen in the future, and positive emotions can counteract pain-induced task performance deficits in healthy participants. More specifically, induced optimism was found to buffer against the negative effects of experimental pain on executive functioning. This clinical experiment examined whether this beneficial effect can be extended to a chronic pain population.

METHODS

Patients (N = 122) were randomized to a positive psychology Internet-based intervention (PPI; n = 74) or a waiting list control condition (WLC; n = 48). The PPI consisted of positive psychology exercises that particularly target optimism, positive emotions and self-compassion.

RESULTS

Results demonstrated that patients in the PPI condition scored higher on happiness, optimism, positive future expectancies, positive affect, self-compassion and ability to live a desired life despite pain, and scored lower on pain catastrophizing, depression and anxiety compared to patients in the WLC condition. However, executive task performance did not improve following completion of the PPI, compared to the WLC condition.

CONCLUSIONS

Despite the lack of evidence that positive emotions and optimism can improve executive task performance in chronic pain patients, this study did convincingly demonstrate that it is possible to increase positive emotions and optimism in chronic pain patients with an online positive psychology intervention. It is imperative to further explore amendable psychological factors that may reduce the negative impact of pain on executive functioning.

SIGNIFICANCE

We demonstrated that an Internet-based positive psychology intervention strengthens optimism and positive emotions in chronic pain patients. These emotional improvements are not associated with improved executive task performance. As pain itself often cannot be relieved, it is imperative to have techniques to reduce the burden of living with chronic pain.

A Review of Chronic Pain and Cognitive, Mood, and Motor Dysfunction Following Mild Traumatic Brain Injury: Complex, Comorbid, and/or Overlapping Conditions?

Mild traumatic brain injury (mTBI) is commonly encountered in clinical practice. While the cognitive ramifications of mTBI are frequently described in the literature, the impact of mTBI on emotional, sensory, and motor function is not as commonly discussed. Chronic pain is a phenomenon more prevalent among patients with mTBI compared to those with moderate or severe traumatic brain injury. Chronic pain can become a primary disorder of the central nervous system (CNS) expressed as widespread pain, and cognitive, mood, and movement dysfunction. Shared mechanisms across chronic pain conditions can account for how pain is generated and maintained in the CNS, irrespective of the underlying structural pathology. Herein, we review the impact of mTBI on cognitive, emotional, sensory, and motor domains, and the role of pain as an important confounding variable in patient recovery and dysfunction following mTBI.

Long working hours directly and indirectly (via short sleep duration) induce headache even in healthy white-collar men: cross-sectional and 1-year follow-up analyses

OBJECTIVE

Headache in employees may be linked with both overwork and sleep restriction induced by long working hours. Inter-relationships among working hours, sleep duration and headache were investigated.

METHODS

Cross-sectional analyses for prevalent headache (n = 35,908) and 1-year follow-up analyses for incident headache (n = 19,788) were conducted in apparently healthy white-collar men aged 25-59 years. Headache (yes/no), working hours and sleep duration were based on self-administered questionnaire. After determination of relationships between working hours and sleep duration, logistic regression analysis estimated odds ratio (OR) and 95% confidence interval for prevalent and incident headache according to working hours (35-44, 45-49, 50-59 and ≥60 h/week) and sleep duration (≥7, 6-6.9, 5-5.9 and <5 h/day), and tested linear trends in OR. Additionally, interactive effects of working hours and sleep duration on OR were checked. Covariates in the analyses were age, body mass index, drinking, smoking and exercise.

RESULTS

Prevalent and incident headache was found in 1979 (5.5%) men and 707 (3.6%) men, respectively. Working hours were inversely associated with sleep duration. OR for prevalent and incident headache rose with increasing working hours and with reducing sleep duration, regardless of influences of the covariates. Working hours and sleep duration had no interactive effects on OR for prevalent or incident headache.

CONCLUSIONS

The results indicate that long working hours directly and indirectly (via short sleep duration) induce headache even in apparently healthy white-collar men. Headache in employees may be useful for early detection of adverse health effects by long working hours.

The disruptive effects of pain on multitasking in a virtual errands task

Background and aims

Pain is known to have a disruptive effect on cognitive performance, but prior studies have used highly constrained laboratory tasks that lack ecological validity. In everyday life people are required to complete more complex sets of tasks, prioritising task completion and recalling lists of tasks which need to be completed, and these tasks continue to be attempted during episodes or states of pain. The present study therefore examined the impact of thermal induced pain on a simulated errand task.

Methods

Fifty-five healthy adults (36 female) performed the Edinburgh Virtual Errands Task (EVET) either during a painful thermal sensation or with no concurrent pain. Participants also completed the Experience of Cognitive Intrusion of Pain (ECIP) questionnaire to measure their self-reported cognitive impact of pain in general life.

Results

Participants who completed the EVET task in pain and who self-reported high intrusion of pain made significantly more errors than those who reported lower intrusion on the ECIP.

Conclusions

Findings here support the growing literature that suggests that pain has a significant impact on cognitive performance. Furthermore, these findings support the developing literature suggesting that this relationship is complex when considering real world cognition, and that self-report on the ECIP relates well to performance on a task designed to reflect the complexities of everyday living.

Implications

If extrapolated to chronic pain populations, these data suggest that pain during complex multitasking performance may have a significant impact on the number of errors made. For people highly vulnerable to cognitive intrusion by pain, this may result in errors such as selecting the wrong location or item to perform tasks, or forgetting to perform these tasks at the correct time. If these findings are shown to extend to chronic pain populations then occupational support to manage complex task performance, using for example diaries/electronic reminders, may help to improve everyday abilities.

The effect of postsurgical pain on attentional processing in horses

OBJECTIVE

To investigate the effect of postsurgical pain on the performance of horses in a novel object and auditory startle task.

STUDY DESIGN

Prospective clinical study.

ANIMALS

Twenty horses undergoing different types of surgery and 16 control horses that did not undergo surgery.

METHODS

The interaction of 36 horses with novel objects and a response to an auditory stimulus were measured at two time points; the day before surgery (T1) and the day after surgery (T2) for surgical horses (G1), and at a similar time interval for control horses (G2). Pain and sedation were measured using simple descriptive scales at the time the tests were carried out. Total time or score attributed to each of the behavioural categories was compared between groups (G1 and G2) for each test and between tests (T1 and T2) for each group.

RESULTS

The median (range) time spent interacting with novel objects was reduced in G1 from 58 (6-367) seconds in T1 to 12 (0-495) seconds in T2 (p=0.0005). In G2 the change in interaction time between T1 and T2 was not statistically significant. Median (range) total auditory score was 7 (3-12) and 10 (1-12) in G1 and G2, respectively, at T1, decreasing to 6 (0-10) in G1 after surgery and 9.5 (1-12) in G2 (p=0.0003 and p=0.94, respectively). There was a difference in total auditory score between G1 and G2 at T2 (p=0.0169), with the score being lower in G1 than G2.

CONCLUSIONS AND CLINICAL RELEVANCE

Postsurgical pain negatively impacts attention towards novel objects and causes a decreased responsiveness to an auditory startle test. In horses, tasks demanding attention may be useful as a biomarker of pain.

Attention and Working Memory in Female Adolescents With Chronic Pain and Pain-free Female Adolescents: A Preliminary Pilot Study

OBJECTIVES

Adolescents with chronic pain often report inattention and poor memory. There has been little research on cognitive function in this population. The goal of this preliminary pilot study was to examine differences in cognitive function between adolescents with chronic pain to pain-free adolescents.

MATERIALS AND METHODS

All participants completed baseline assessments of pain, school absences, depression, anxiety, and sleep habits. Standardized neurocognitive tests were used to examine cognitive function with a focus on working memory and attention.

RESULTS

Recruitment from the chronic pain clinic resulted in a female sample of 13 individuals (largely reflective of the clinical population). Pain-free age-matched and sex-matched individuals (n=12) were therefore also recruited as controls. Individuals with chronic pain had significantly lower working memory scores than controls. Differences were found between groups on the most difficult selective attention task and not on tests of sustained attention, divided attention, or attentional switching. In a stepwise regression with baseline characteristics entered in the first step, pain accounted for approximately 15% of the variance in working memory and medication score counted for 49% of the variance.

DISCUSSION

This pilot study is the first study to examine differences in working memory and attention between participants with chronic pain and pain-free adolescents. Our findings suggest that chronic pain may negatively affect adolescents' working memory function and highlights the risk for cognitive difficulties and problems with educational progression in addition to negative health and social effects associated with chronic pain. The study provides a starting point for more research and has the potential to direct better identification and treatment of these cognitive deficits.

Neurocognitive performance and physical function do not change with physical-cognitive-mindfulness training in female laboratory technicians with chronic musculoskeletal pain: Randomized controlled trial

BACKGROUND

Cognitive and physical performance can be negatively affected by chronic pain. This study evaluates the effect of combined physical-, cognitive-, and mindfulness training (PCMT) on cognitive and physical performance.

METHODS

From a large pharmaceutical company in Denmark we randomly allocated 112 female laboratory technicians with chronic upper limb pain to group-based PCMT at the worksite or a reference group for 10 weeks. Neurocognitive performance was measured by the computerized central nervous system vital signs neurocognitive assessment battery. Physical function was assessed in terms of shoulder external rotation strength and rate of force development in a custom-made dynamometer setup.

RESULTS

No between-group differences (least square means [95% confidence interval]) from baseline to follow-up could be detected in any of the neurocognitive domains as measured by the central nervous system vital signs neurocognitive assessment battery, for example, Psychomotoer Speed 1.9 (-1.0 to 4.7), Reaction Time -4.0 (-19.5 to 11.6), Complex Attention -0.3 (-1.9 to 1.4), and Executive Function -0.2 (-3.5 to 3.0). Similarly, we found no change in maximal voluntary isometric strength -0.63 (-4.8 to 3.6), or rate of force development 14.8 (-12.6 to 42.2) of the shoulder external rotators. Finally, test-retest reliability of maximal voluntary contraction and rate of force development shoulder external rotation showed high reliability at 0 to 30 ms, 0 to 50 ms, 0 to 100 ms, and 0 to 200 ms with ICCs at 0.95, 0.92, 0.93, 0.92, and 0.91, respectively.

CONCLUSION

Ten weeks of PCMT did not improve neurocognitive or physical performance.

The Experience of Cognitive Intrusion of Pain: scale development and validation

Patients with chronic pain often report their cognition to be impaired by pain, and this observation has been supported by numerous studies measuring the effects of pain on cognitive task performance. Furthermore, cognitive intrusion by pain has been identified as one of 3 components of pain anxiety, alongside general distress and fear of pain. Although cognitive intrusion is a critical characteristic of pain, no specific measure designed to capture its effects exists. In 3 studies, we describe the initial development and validation of a new measure of pain interruption: the Experience of Cognitive Intrusion of Pain (ECIP) scale. In study 1, the ECIP scale was administered to a general population sample to assess its structure and construct validity. In study 2, the factor structure of the ECIP scale was confirmed in a large general population sample experiencing no pain, acute pain, or chronic pain. In study 3, we examined the predictive value of the ECIP scale in pain-related disability in fibromyalgia patients. The ECIP scale scores followed a normal distribution with good variance in a general population sample. The scale had high internal reliability and a clear 1-component structure. It differentiated between chronic pain and control groups, and it was a significant predictor of pain-related disability over and above pain intensity. Repairing attentional interruption from pain may become a novel target for pain management interventions, both pharmacologic and nonpharmacologic.

The disruptive effects of pain on n-back task performance in a large general population sample

Pain captures attention, displaces current concerns, and prioritises escape and repair. This attentional capture can be measured by its effects on general cognition. Studies on induced pain, naturally occurring acute pain, and chronic pain all demonstrate a detrimental effect on specific tasks of attention, especially those that involve working memory. However, studies to date have relied on relatively small samples and/or one type of pain, thus restricting our ability to generalise to wider populations. We investigated the effect of pain on an n-back task in a large heterogeneous sample of 1318 adults. Participants were recruited from the general population and tested through the internet. Despite the heterogeneity of pain conditions, participant characteristics, and testing environments, we found a performance decrement on the n-back task for those with pain, compared with those without pain; there were significantly more false alarms on nontarget trials. Furthermore, we also found an effect of pain intensity; performance was poorer in participants with higher intensity compared with that in those with lower intensity pain. We suggest that the effects of pain on attention found in the laboratory occur in more naturalistic settings. Pain is common in the general population, and such interruption may have important, as yet uninvestigated, consequences for tasks of everyday cognition that involve working memory, such as concentration, reasoning, motor planning, and prospective memory.

Clinical Utility of the Mig-SCog

BACKGROUND

Mig-SCog is a 9-item questionnaire developed to quantify attack-related cognitive complaints in migraine (M). The items relate to executive function and language, and the total Mig-SCog score is the sum of those scales.

OBJECTIVE

To evaluate the Mig-SCog scores regarding cognitive symptoms during a variety of conditions.

METHODS

We conducted a prospective comparative study of the Mig-SCog scores (1) between migraine and tension-type headache (TTH) patients during a headache; (2) in migraine patients between migraine attacks, non-headache pain and pain-free status; (3) in migraine patients during and outside a migraine attack.

RESULTS

One hundred forty-nine patients (98 M and 51 TTHA). Total Mig-SCog score was higher in migraine patients than TTH (8.0 ± 4.1 vs 3.4 ± 3.2, P < .0001). Sixty-three patients took part in the next part of the study. Migraine patients rated the Mig-SCog higher for migraine (7.9 ± 4.6) than for non-headache pain (2.3 ± 2.9, P < .0006) or pain-free (1.6 ± 2.4, P < .0006). In the final phase of the study, 38 patients Mig-SCog scores were not significantly different whether obtained during or outside an M attack (P = .26).

CONCLUSIONS

Attack-related subjective cognitive symptoms, assessed by Mig-SCog scores, differed between migraine and TTH patients. The Mig-SCog scores from migraine patients were found to be higher during migraine than during non-headache pain or pain-free conditions. Patient scoring from memory for usual attacks was not significantly different to scoring within attacks, We believe this demonstrates negligible recall bias.

Acute Tension-Type Headaches Are Associated with Impaired Cognitive Function and More Negative Mood

BACKGROUND/AIMS

Research has shown that migraine is often associated with memory problems. There have, however, been few studies of tension-type headache (TTH) and cognition. People who report frequent headaches often report high levels of negative affect. However, less is known about the acute effects of TTH on mood. To address these gaps in our knowledge, two studies examined the effects of acute TTH on -cognitive performance and mood.

METHODS

Both studies involved one group of participants completing a battery of tasks when they had a TTH and when they had no headache. Another group (the control) was headache free on both occasions. Duration of the headache was >30 min and <4 h. In the "no headache" condition, the participants were headache free for at least 24 h. In the first study, 12 participants (6 with TTH and 6 controls) completed a computerized battery measuring mood and aspects of cognition. In the second study, 22 participants (7 TTH, 5 after TTH, and 10 controls) completed paper and pencil mood and cognitive tasks.

RESULTS

In the first study, having a headache was associated with an increase in negative affect both before and after the tasks. Three performance tasks showed impairments when the participants had headaches: logical reasoning was slower and less accurate; retrieval from semantic memory was slower; and reaction times in the categorical search task were slower. Results from the second study confirmed the global increase in negative affect when the person has a TTH. The results confirmed the impairments in the logical reasoning and semantic processing tasks, and also showed that those with a TTH had greater psychomotor slowing and were more easily distracted. Effects did not continue after the headache had gone.

CONCLUSION

Two small-scale studies have shown that TTH is associated with negative affect and impaired cognitive function. It is now of interest to determine whether OTC treatment can remove these effects.

Does mutual compensation of the cognitive effects induced by pain and opioids exist? An experimental study

RATIONALE

Studies have demonstrated that both pain and opioids have actions on the central nervous system that may interfere with cognitive function, but their effects have mainly been analysed separately and not as an integrated process.

OBJECTIVE

The objective of this study is to test two hypotheses: (1) the analgesic effect of opioids improves cognitive function by decreasing pain, and (2) pain antagonizes cognitive effects of opioids.

METHODS

Randomized, placebo-controlled, crossover study. Three experiments were conducted with 22 healthy males. Sustained attention, memory and motor function/attention/mental flexibility were evaluated by continuous reaction time (CRT), verbal fluency test (VFT) and trail making test-B (TMT-B), respectively. In the 1st experiment, the cognitive effects of experimental tonic pain of mild and moderate intensities produced by a computer-controlled pneumatic tourniquet cuff were assessed; in the 2nd, the effects of saline solution and remifentanil were assessed in the absence of pain; and in the 3rd experiment, the cognitive effects of moderate pain intensity relieved by remifentanil infusion were assessed followed by increasing pain to moderate intensity during a constant remifentanil infusion.

RESULTS

The first two experiments demonstrated that pain and remifentanil impaired CRT. In the 3rd experiment, remifentanil infusion relieving pain significantly impaired CRT and further deterioration was noted following increasing pain intensity.

CONCLUSION

Pain and remifentanil seemed to have additive deleterious cognitive effects. This study represents an initial step to enhance our basic understanding of some of the cognitive effects following a painful stimulus and an opioid infusion separately and combined in a sequence comparable to clinical settings.

Use of a fixed combination of acetylsalicylic acid, acetaminophen and caffeine compared with acetaminophen alone in episodic tension-type headache: meta-analysis of four randomized, double-blind, placebo-controlled, crossover studies

Background

Most patients with episodic tension-type headache treat headache episodes with over-the-counter medication. Combination analgesics containing caffeine may be more effective and as well tolerated as monotherapy. The aim of this study was to evaluate the efficacy of the combination of acetylsalicylic acid, acetaminophen (paracetamol) and caffeine in episodic tension-type headache using recently recommended endpoints.

Methods

Four randomized, controlled trials of identical design in 1,900 patients with episodic tension-type headache comparing acetylsalicylic acid, acetaminophen and caffeine vs. acetaminophen or placebo were pooled. Analysis populations were ‘all headache episodes’ and those with ‘severe pain at baseline’. Post-hoc defined primary endpoint: headache episodes pain-free at 2 h. Secondary endpoints: headache episodes pain-free at 1 h, headache response at 2 h (mild or no pain), degree of interference with daily activities.

Results

6,861 headache episodes were treated, including 2,215 severe headache episodes. The proportion of headache episodes pain-free at 2 h was significantly higher with the triple combination (28.5%) vs. acetaminophen (21.0%) and placebo (18.0%) (p < 0.0001), and similarly for those severe at baseline (20.2% vs. 12.1% and 10.8%; p ≤ 0.0003). A similar pattern of superiority was observed for secondary endpoints. The triple combination was generally well tolerated.

Conclusions

The combination of acetylsalicylic acid, acetaminophen and caffeine is effective and well tolerated in episodic tension-type headache, and significantly superior to acetaminophen with regard to being pain-free at 2 h, headache response at 2 h and ability to return to daily activities, even in those with pain rated severe at baseline.

Is performance in goal oriented head movements altered in patients with tension type headache?

Background

Head repositioning tasks have been used in different experimental and clinical contexts to quantitatively measure motor control performance. Effects of pain on sensorimotor control have often been described in various musculoskeletal conditions and may provide relevant information with regard to potential mechanisms underlying tension-type headaches. The purpose of the current study was to compare the performance of patients with tension-type headache and healthy participants in a cervical aiming task using the Fitts’ task paradigm.

Methods

Patients with tension-type headache and healthy controls were compared in a cervical aiming task. Participants were asked to move their head as quickly, and precisely as possible to a target under various experimental conditions. Dependent variables included movement time, variable error, constant error and absolute error.

Results

As predicted by Fitts’ law, decreasing target size and increasing head rotation amplitudes yielded longer movement times in both groups. Participants with tension-type headache, when compared to healthy participants showed a significant increase in both constant and absolute errors for each of the four conditions.

Conclusion

Decreased motor performance was observed in participants with tension-type headache, likely due to altered motor control of the neck musculature. Future research is warranted to investigate the clinical aspect related to decrease in motor performance.