High risk model of threat perception in chronic pain patients: implications for primary care and chronic pain programs

Measuring pain and nociception: Through the glasses of a computational scientist. Transdisciplinary overview of methods

In a healthy state, pain plays an important role in natural biofeedback loops and helps to detect and prevent potentially harmful stimuli and situations. However, pain can become chronic and as such a pathological condition, losing its informative and adaptive function. Efficient pain treatment remains a largely unmet clinical need. One promising route to improve the characterization of pain, and with that the potential for more effective pain therapies, is the integration of different data modalities through cutting edge computational methods. Using these methods, multiscale, complex, and network models of pain signaling can be created and utilized for the benefit of patients. Such models require collaborative work of experts from different research domains such as medicine, biology, physiology, psychology as well as mathematics and data science. Efficient work of collaborative teams requires developing of a common language and common level of understanding as a prerequisite. One of ways to meet this need is to provide easy to comprehend overviews of certain topics within the pain research domain. Here, we propose such an overview on the topic of pain assessment in humans for computational researchers. Quantifications related to pain are necessary for building computational models. However, as defined by the International Association of the Study of Pain (IASP), pain is a sensory and emotional experience and thus, it cannot be measured and quantified objectively. This results in a need for clear distinctions between nociception, pain and correlates of pain. Therefore, here we review methods to assess pain as a percept and nociception as a biological basis for this percept in humans, with the goal of creating a roadmap of modelling options.

[Anonymize or personalize? : Does social desirability influence the response behavior of chronic pain patients?]

BACKGROUND

The subjective state of health with respect to pain and psyche was surveyed utilizing validated pain questionnaires in patients undergoing special pain therapy and represents the basis for targeted treatment measures.

OBJECTIVE

The purpose of this study was to investigate the possible distortion of answers due to social desirability of responses in chronic pain patients.

MATERIAL AND METHODS

During two survey periods assessing patient satisfaction using both anonymized and personalized questionnaires, the effects arising from socially desirable response patterns were analyzed. The sample consisted of chronic pain patients being treated in an inpatient therapy setting.

RESULTS

In both periods of observation no significant impact on the response behavior of chronic pain patients was found in personalized or anonymized questionnaires.

CONCLUSION

The results of the study suggest that the responses of chronic pain patients with respect to their subjective state of health are not influenced by social desirability. Thus, scoring systems such as the German pain questionnaire will not be influenced by social desirability in chronic pain patients and can therefore be used as a part of diagnostics and therapy planning.

[Age-related differences in the effect of social desirability on self-reported emotional state]

INTRODUCTION

It is usually assumed that social desirability increases with ageing, correlates with measures of emotional well-being, and represents a potential threat to research in older adults, and should therefore be systematically controlled. However, this assumption is controversial and lacks a strong empirical basis. The present study aimed to analyze the association between social desirability and measures of emotional well-being, as well as to test for age-related differences in the changes produced in emotional state after experimental anxiety induction.

MATERIAL AND METHODS

We randomly assigned 149 individuals (92 university students and 52 older adults) to one of three groups: a control group and two intervention groups in which anxiety was experimentally induced.

RESULTS

Social desirability scores were significantly higher in older persons (Hedges'g=1.22). No statistically significant correlations were found in any age group between social desirability and measures of emotional well-being. Likewise, in a series of univariate ANOVAs, no differences were found according to the degree of social desirability in changes in emotional state after anxiety induction. Overall, social desirability was not related to the changes produced by experimental anxiety induction.

CONCLUSIONS

The present study confirms the association between social desirability and age. However, social desirability did not seem to correlate with emotional well-being in any age group. Moreover, social desirability was not related to changes in emotional state after experimental anxiety induction. These results do not support the view that social desirability is a threat to the validity of experimental studies in the elderly.

Viral RNA testing in hepatitis C antibody-positive veterans

BACKGROUND

Chronic hepatitis C virus (HCV) infection affects approximately 1.3% of the U.S. population. As up to 30% of HCV-antibody (anti-HCV)-positive patients have negative HCV ribonucleic acid (RNA), indicating resolution of infection, VA (Veterans Affairs) guidelines recommend RNA testing on all anti-HCV-positive patients. As HCV RNA testing is a prequel to treatment, perceived eligibility for treatment may influence the decision to order an RNA test. This study was designed to determine the patient and healthcare facility factors associated with patient receipt of HCV RNA testing.

METHODS

Two logistic regression analyses were conducted in anti-HCV-positive patients, including the entire sample and then on a subsample excluding sites with routine HCV RNA testing policies, using data stored in the VA Southern California Network data warehouse. Significant patient- and site-level predictors of patient receipt of HCV RNA testing were determined.

RESULTS

Of the 13,257 antibody-positive patients, 76% received HCV RNA testing. Excluding sites with routine HCV RNA testing, patients aged >65 years (RR=0.79) and illicit drug users (RR=0.94) were significantly less likely to receive HCV RNA testing. Patients with abnormal transaminases (RR=1.14), presence of non-HCV hepatitis (RR=1.08), or decompensated liver disease (RR=1.22) were significantly more likely to receive HCV RNA testing.

CONCLUSIONS

Without policies for routine RNA testing, patients with hepatitic C who either are aged >65 years or are illicit drug users are less likely to be tested. Also, patient receipt of RNA testing becomes dependent on clinical cues of hepatic decompensation or inflammation. The results support the implementation of routine RNA testing for anti-HCV-positive patients.

Social desirability response bias and self-report of psychological distress in pediatric chronic pain patients

The objective of this study was to investigate associations between social desirability response bias and self-report of pain, disability, and psychological distress (depression, anxiety, and somatic symptoms) in a sample of children presenting to a multidisciplinary pediatric chronic pain clinic. A retrospective review was conducted on 414 consecutive clinic patients, ages 12-17 years, with chronic pain complaints of at least 3 months' duration. As part of a clinical battery, children completed self-report psychological questionnaires including the Children's Depression Inventory, Children's Somatization Inventory, and Revised Children's Manifest Anxiety Scale including the Lie Scale, an indicator of social desirability influence. Children also provided self report of pain intensity, pain duration and functional disability. Clinician ratings of anxiety and depressive symptoms also were collected. Results show that children scoring high on the measure of social desirability reported fewer symptoms of depression and anxiety compared to children scoring low on the social desirability index. No differences arose between these groups on reports of somatic symptoms, pain duration, or pain-related disability. These findings suggest that social desirability response bias may have implications for the self-report of psychological distress among pediatric chronic pain patients. The limits of self-report of symptoms should be considered in the clinical and research contexts.

Empathic features of absorption and incongruence

A study was undertaken to examine whether empathy could be related to absorption and incongruence (repressive coping). The participants were 71 graduate students who completed measures of empathy, absorption, and incongruence (repressive coping). The results confirmed a previous finding that empathy appears positively related to absorption (r = .42, p < .001). The results also suggest that affective components of empathy are inversely related to repressive coping (r = -.29, p < .05) while cognitive components are positively related to the social desirability aspects of incongruence (r = .31, p < .01). The findings are collectively discussed in terms of the Empathic Involvement Hypothesis of Hypnosis (Wickramasekera II, 2001), the Four-factor theory of Repressive Coping (Eysenck, 1997), Incongruence (Rogers, 1957), and the High Risk Model of Threat Perception (I. E. Wickramasekera I, 1998).

Social desirability, psychological symptoms, and perceived health in burn injured patients

Social desirability was previously seen as a nuisance in assessment, but today it is regarded as a personality trait with an influence on health. The aim was to explore relations between social desirability and health in former burn patients. Eighty-four burn patients injured on average 3.8 years ago responded to a questionnaire booklet. Social desirability was assessed with the social desirability subscale of the Swedish universities Scales of Personality, which is standardized in a normative sample. The results showed that a subgroup with high degree of social desirability displayed significantly poorer perceived health on the burn-specific health subscales heat sensitivity, work, and body image than normal responders did. There were no differences regarding age, education, injury-related variables, sick leave, or symptoms of anxiety and depression. In conclusion, participants with high social desirability were characterized by postburn problems in outdoor and work-related situations, and more self-consciousness about appearance.

[Relationship of depression and anxiety with social desirability in chronic pain patients]

OBJECTIVE

This study examines the extent of self-reported pain and psychological distress in chronic pain patients and the influence of social desirability on the data collected.

METHODS

In a cross-sectional multi-center study with 494 chronic pain patients, a pain questionnaire was used similar to the German Federal Health Survey of 1998. Depression and anxiety were measured with the German version of the Hospital Anxiety and Depression Scale (HADS-D) and social desirability with the German Marlowe-Crowne short scale for the measurement of social desirability (KS-SE).

RESULTS

Chronic pain patients reported stronger and more frequent pain, as well as higher psychological distress than the general population of Germany. Of the patients, 36.4% showed depression (HADS-D/D >or =9) and 31.4% anxiety (HADS-D/A > or =11). Depressed/anxious patients stated pain intensities higher than non-depressed/non-anxious patients. In all, 48.4% of the patients achieved social desirability levels in the marked or moderate range. There were positive correlations for social desirability with self-reported pain and the use of therapy, as well as age. A negative correlation was found between anxiety and social desirability, while for depression this interaction appeared only after partial correlation analysis with control of pain and therapy variables.

CONCLUSIONS

Both psychological distress and social desirability are common in chronic pain patients. Patients with high scores for social desirability reveal less depression and anxiety. The psychological distress caused by pain seems to be expressed by somatic complaints and therapy seeking. Since pain research is strongly dependent on the patient's self-report, social desirability should be considered as a factor which may impact measurements and decisions.

Electroencephalographic Cordance Patterns Distinguish Exceptional Clinical Responders with Fibromyalgia to Individualized Homeopathic Medicines

OBJECTIVES

To characterize initial central nervous system responses to olfactory administration of homeopathic remedies as biomarkers for subsequently exceptional, simillimum-like clinical outcomes at a systemic level (i.e., both locally and globally).

DESIGN

Double-blinded, randomized, placebo-controlled clinical trial.

SETTING

A private homeopathic clinic in Phoenix, AZ, and a university laboratory in Tucson, AZ.

PATIENTS

Sixty-two (62) persons with physician-confirmed fibromyalgia (FM) (mean age, 49 years; 94% women) enrolled; 53 completed the 3-month assessment visit. Exceptional responders (n = 6, 23% of active treatment group; none on placebo) were those with improvements in the top one-third for both tender point pain and global health ratings after 3 months.

INTERVENTION

Patients took daily oral doses of treatment solution in LM (1/50,000 dilution) potency (active group received individualized remedy; placebo group received plain solvent). Dependent measures: Baseline and 3-month difference scores for initial prefrontal electroencephalographic alpha frequency cordance (EEG-C, a correlate of functional brain activity) during 16 pairs of randomized, double-blinded bottle sniffs (treatment minus control solutions).

RESULTS

Exceptional responders versus other patients exhibited significantly more negative initial EEG-C difference scores at prefrontal sites. Right prefrontal cordance findings correlated with subsequently reduced pain (r = 0.85, p = 0.03), better global health (r =-0.73, p = 0.10), and trait absorption (genetically determined ability to focus attention selectively and fully) (r = 0.91, p = 0.012).

CONCLUSIONS

These observations suggest prefrontal EEG-C as an early biomarker of individualized homeopathic medicine effects in patients with FM who later exhibit exceptional outcomes. Prefrontal cortex controls executive function, including ability to redirect attention. Interactions between executive function, absorption, and the simillimum remedy could facilitate exceptional responses.