Facing the experience of pain: A neuropsychological perspective

A Multilevel Approach to Explore the Wandering Mind and Its Connections with Mindfulness and Personality

We propose an innovative approach to study Mind Wandering (MW), and we present an application of this methodology to study the effects of a Mindfulness-Oriented Meditation (MOM) training. We assessed individuals' MW through a free association task and an attentional task with thought-probes combined with a questionnaire for the phenomenological characteristic of each MW episode. We used the Temperament and Character Inventory to assess participants' personality traits and their associations with measures of MW. Our study was limited by the course of the Covid-19 pandemic and only nine healthy young individuals completed the testing sessions, which were carried out before and after the MOM training. After MOM, participants showed fewer repetitive and self-relevant thoughts and indices of better performance in the attentional task; the linguistic analysis of participants' free associations showed lower verbal productivity and a decrease in utterances that expressed anxiety/stress. Overall, we foresee that future studies could replicate our preliminary findings with larger samples and in a period without a global health emergency. This multilevel approach to the study of MW may allow researchers to gain a broader view of the phenomenon, considering its occurrence, qualitative characteristics, impact on cognitive tasks, malleability via mindfulness or other psychological interventions, and relations with personality traits.

Some Prospective Alternatives for Treating Pain: The Endocannabinoid System and Its Putative Receptors GPR18 and GPR55

Background: Marijuana extracts (cannabinoids) have been used for several millennia for pain treatment. Regarding the site of action, cannabinoids are highly promiscuous molecules, but only two cannabinoid receptors (CB₁ and CB₂) have been deeply studied and classified. Thus, therapeutic actions, side effects and pharmacological targets for cannabinoids have been explained based on the pharmacology of cannabinoid CB₁/CB₂ receptors. However, the accumulation of confusing and sometimes contradictory results suggests the existence of other cannabinoid receptors. Different orphan proteins (e.g., GPR18, GPR55, GPR119, etc.) have been proposed as putative cannabinoid receptors. According to their expression, GPR18 and GPR55 could be involved in sensory transmission and pain integration.

Methods: This article reviews select relevant information about the potential role of GPR18 and GPR55 in the pathophysiology of pain.

Results: This work summarized novel data supporting that, besides cannabinoid CB₁ and CB₂ receptors, GPR18 and GPR55 may be useful for pain treatment.

Conclusion: There is evidence to support an antinociceptive role for GPR18 and GPR55.

Contributions of Neuropsychology to the Study of Ancient Literature

The present work introduces the neuropsychological paradigm as a new approach to studying ancient literature. In the first part of the article, an epistemological framework for the proper use of neuropsychology in relation to ancient literature is presented. The article then discusses neuropsychological methods of studying different human experiences and dimensions already addressed by ancient literatures. The experiences of human encounters with gods among ancient cultures are first considered, through the contributions of Julian Jaynes and Eric R. Dodds. The concepts of right and left in the Bible, and that of soul are then discussed. Ecstatic experience in Paul of Tarsus is also presented, with a particular focus on glossolalia. Neuroscientific differences between mindful and unitive meditative practices are then described referring to ancient Buddhist literature, and finally a brief description of dreams in ancient Greek literature is proposed. Neuropsychology variously enables a more profound understanding of themes characterizing human experiences that ancient literature has already explored; these investigations prove that the collaboration of neuroscience and humanistic studies can return fruitful and interesting results.

Stress and Alterations in the Pain Matrix: A Biopsychosocial Perspective on Back Pain and Its Prevention and Treatment

The genesis of chronic pain is explained by a biopsychosocial model. It hypothesizes an interdependency between environmental and genetic factors provoking aberrant long-term changes in biological and psychological regulatory systems. Physiological effects of psychological and physical stressors may play a crucial role in these maladaptive processes. Specifically, long-term demands on the stress response system may moderate central pain processing and influence descending serotonergic and noradrenergic signals from the brainstem, regulating nociceptive processing at the spinal level. However, the underlying mechanisms of this pathophysiological interplay still remain unclear. This paper aims to shed light on possible pathways between physical (exercise) and psychological stress and the potential neurobiological consequences in the genesis and treatment of chronic pain, highlighting evolving concepts and promising research directions in the treatment of chronic pain. Two treatment forms (exercise and mindfulness-based stress reduction as exemplary therapies), their interaction, and the dose-response will be discussed in more detail, which might pave the way to a better understanding of alterations in the pain matrix and help to develop future prevention and therapeutic concepts.

Evolutionary aspects of self- and world consciousness in vertebrates

Although most aspects of world and self-consciousness are inherently subjective, neuroscience studies in humans and non-human animals provide correlational and causative indices of specific links between brain activity and representation of the self and the world. In this article we review neuroanatomic, neurophysiological and neuropsychological data supporting the hypothesis that different levels of self and world representation in vertebrates rely upon (i) a “basal” subcortical system that includes brainstem, hypothalamus and central thalamic nuclei and that may underpin the primary (or anoetic) consciousness likely present in all vertebrates; and (ii) a forebrain system that include the medial and lateral structures of the cerebral hemispheres and may sustain the most sophisticated forms of consciousness [e.g., noetic (knowledge based) and autonoetic, reflective knowledge]. We posit a mutual, bidirectional functional influence between these two major brain circuits. We conclude that basic aspects of consciousness like primary self and core self (based on anoetic and noetic consciousness) are present in many species of vertebrates and that, even self-consciousness (autonoetic consciousness) does not seem to be a prerogative of humans and of some non-human primates but may, to a certain extent, be present in some other mammals and birds

Pain during medical abortion, the impact of the regimen: a neglected issue? A review

OBJECTIVES

To evaluate pain and other early adverse events associated with different regimens of medical abortion up to nine weeks of amenorrhoea.

METHODS

The literature was searched for comparative studies of medical abortion using mifepristone followed by the prostaglandin analogue misoprostol. Publications, which included pain assessment were further analysed.

RESULTS

Of the 1459 publications on medical abortion identified, only 23 comparative, prospective trials corresponded to the inclusion criteria. Patients in these studies received different dosages of mifepristone in combination with different dosages of misoprostol administered via diverse routes or at various intervals. Information on pain level was reported in 12/23 papers (52%), information regarding systematic administration of analgesics in 12/23 articles (52%) and information concerning analgesia used was available for only 10/23 studies (43%).

CONCLUSIONS

Neither pain nor its treatment are systematically reported in clinical trials of medical abortion; this shortcoming reflects a neglect of the individual pain perception. When data are mentioned, they are too inconsistent to allow for any comparison between different treatment protocols. Standardised evaluation of pain is needed and the correlation between the dosage of misoprostol and the intensity of pain must be assessed in future studies.