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Varangot-Reille C, Pezzulo G, Thacker M. The fear-avoidance model as an embodied prediction of threat. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2024:10.3758/s13415-024-01199-4. [PMID: 38890209 DOI: 10.3758/s13415-024-01199-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/24/2024] [Indexed: 06/20/2024]
Abstract
The fear-avoidance model is a well-established framework in the understanding of persistent pain. It proposes a dichotomous path: either the context is interpreted as safe; there is no fear reaction and, therefore, the individual engages in active (positive) coping; or the context is interpreted as threatening, leading to a self-reinforcing vicious circle of fear and (negative) avoidance. We propose an embodied interpretation of this phenomenon employing the joint framework of predictive coding and active inference. The key idea is that multisensory integration of exteroceptive, proprioceptive, and interoceptive sensory inputs can lead to dysfunctional experiences of threat in nonthreatening situations. Threat inference can promote fear responses, maladaptive strategies (i.e., avoidance) and self-provides evidence for threat in associated or future contexts, or both. Under this treatment, the prediction of nonrealized threat becomes self-evidencing and context-invariant, and hence self-perpetuating. Safety cues are unable to attenuate the interpretation of the negative context as the dominant inference of the context is threatful and gains more precision and becomes resistant over time. Our model provides an explanation for the emergence of a dysfunctional fear response in the clinical setting despite apparent safety based on modern concepts from theoretical (computational) neuroscience.
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Affiliation(s)
- Clovis Varangot-Reille
- MSc Statistics and Computer Science for Data Science, University Lumière Lyon 2, Bron, France.
| | - Giovanni Pezzulo
- Institute of Cognitive Sciences and Technologies, National Research Council, Rome, Italy
| | - Mick Thacker
- Department of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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2
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Forgács‐Kristóf K, Ádám S, Vargay A, Major J. Novel motivational interviewing-based intervention improves engagement in physical activity and readiness to change among adolescents with chronic pain. Health Expect 2024; 27:e14031. [PMID: 38556853 PMCID: PMC10982597 DOI: 10.1111/hex.14031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/22/2024] [Accepted: 03/17/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Engaging adolescents with chronic pain in physical activities is challenging. Motivational interviewing (MI) combined with activity promotion may encourage teens to make behavioural changes. This research aimed to assess the feasibility and acceptability of our MI-based physical activity promotion programme, the M3 training. METHODS In our exploratory study with 35 adolescent-parent dyads, we evaluated the feasibility by enrolment, drop-out and retention rates. Acceptability of the M3 training was examined by adherence rates and participation experiences through open-ended questions. We also assessed changes in pain self-efficacy and readiness to change after the M3 training intervention. RESULTS The M3 training was feasible with an adequate enrolment (77.8%) and retention (85.7%) rate. Both teens and parents found the M3 training acceptable and considered exercise and physical activity the most helpful elements of the programme (36% and 37%, respectively). While self-efficacy remained unchanged, we identified a significant increase in the readiness to change for adolescents and parents. CONCLUSION M3 training improved physical activity engagement while prioritising adolescents' autonomy. Furthermore, it appears to be a clinically relevant approach and could result in a positive shift in readiness to change within a shorter timeframe. PATIENT OR PUBLIC CONTRIBUTION The preliminary version of the M3 training was reviewed and commented upon by the public (adolescents and adults). Adolescents who participated in this study were designing their own movement programme, considering their lived experiences. Participants' feedback was used to create the online version of the M3 training (which will be published elsewhere).
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Affiliation(s)
| | - Szilvia Ádám
- Health Services Management Training Centre, Faculty of Health and Public ServicesSemmelweis UniversityBudapestHungary
| | - Adrienn Vargay
- Institute of PsychologyELTE Eötvös Loránd UniversityBudapestHungary
- HRC Bethesda Children's HospitalPaediatric Pain CentreBudapestHungary
| | - János Major
- HRC Bethesda Children's HospitalPaediatric Pain CentreBudapestHungary
- Institute of Behavioural SciencesSemmelweis UniversityBudapestHungary
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3
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Ecija C, Gutierrez L, Catala P, Peñacoba C. Preference for Hedonic Goals in Fibromyalgia; Is It Always an Avoidance Mechanism? Looking the Relationship with Pain Acceptance from a Positive Psychology Perspective. Pain Manag Nurs 2024; 25:80-87. [PMID: 38129209 DOI: 10.1016/j.pmn.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 12/23/2023]
Abstract
The aim of this study was to analyze the effect of openness to experience on pain acceptance through positive affect (PA) considering the moderating role of preference for mood management goals in women with fibromyalgia (FM). A cross-sectional study (n = 231) was carried out. A simple mediation model and a moderate mediation model were conducted by SPSS macro-PROCESS. Results showed that PA mediated positively the effect of openness to experience on acceptance (B = 0.46, SE = 0.80, t = 5,59; 95% CI = [0.3016, 0.6298], p < .001) and that the contribution of openness to experience to PA varied at different values of mood management goals (medium: - .04; ß = .40, p < .001; high: .95; ß = .61, p<.001). Findings may serve as a foundation for tailored interventions to promote activity through acceptance focusing on PA and mood management goals among women with medium to high level of hedonic goals.
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Affiliation(s)
- Carmen Ecija
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Lorena Gutierrez
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Patricia Catala
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Cecilia Peñacoba
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain.
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4
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Cheng AL, Carbonell KV, Prather H, Hong BA, Downs DL, Metzler JP, Hunt DM. Unique characteristics of patients who choose an intensive lifestyle medicine program to address chronic musculoskeletal pain. PM R 2023; 15:761-771. [PMID: 35567523 PMCID: PMC9659670 DOI: 10.1002/pmrj.12847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/20/2022] [Accepted: 05/01/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Factors that motivate musculoskeletal patients to pursue an intensive, lifestyle medicine-based approach to care are poorly understood. OBJECTIVE To determine whether, compared to patients seeking musculoskeletal care through traditional pathways, patients who choose an intensive lifestyle medicine program for musculoskeletal pain endorse greater physical dysfunction, worse psychological health, and/or more biopsychosocial comorbidities. DESIGN Cross-sectional analysis of existing medical records from 2018 to 2021. SETTING Orthopedic department of one academic medical center. PATIENTS Fifty consecutive patients who enrolled in an intensive lifestyle medicine program to address a musculoskeletal condition. Comparison groups were the following: (1) 100 patients who presented for standard nonoperative musculoskeletal care, and (2) 100 patients who presented for operative evaluation by an orthopedic surgeon and qualified for joint arthroplasty. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Primary outcomes were age-adjusted, between-group differences in Patient-Reported Outcomes Measurement Information System (PROMIS) physical and psychological health measures. Secondary outcomes were between-group differences in sociodemographic and medical history characteristics. RESULTS Patients who enrolled in the intensive lifestyle medicine program were more racially diverse (non-White race: lifestyle cohort 34% vs. comparison cohorts 16%-18%, p ≤ .029) and had a higher prevalence of obesity and diabetes than both comparison groups (mean body mass index: lifestyle cohort 37.6 kg/m2 vs. comparison cohorts 29.3-32.0, p < .001; diabetes prevalence: lifestyle cohort 32% vs. comparison cohorts 12%-16%, p ≤ .024). Compared to standard nonoperative patients, there were no clear between-group differences in PROMIS physical or psychological health scores. Compared to standard operative evaluation patients, patients in the lifestyle program reported worse anxiety but less pain interference (PROMIS Anxiety: B = 3.8 points [95% confidence interval, 0.1 to 7.4], p = .041; Pain interference: B = -3.6 [-6.0 to -1.2], p = .004). CONCLUSIONS Compared to musculoskeletal patients who sought care through traditional pathways, patients who chose an intensive lifestyle medicine pathway had a higher prevalence of metabolic comorbidities, but there was substantial overlap in patients' physical, psychological, and sociodemographic characteristics.
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Affiliation(s)
- Abby L Cheng
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | | | - Heidi Prather
- Department of Physiatry, Hospital for Special Surgery, Weill Cornell Medical College, New York City, New York, USA
| | - Barry A Hong
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Dana L Downs
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - John P Metzler
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Devyani M Hunt
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Guerra-Armas J, Flores-Cortes M, Pineda-Galan C, Luque-Suarez A, La Touche R. Role of Immersive Virtual Reality in Motor Behaviour Decision-Making in Chronic Pain Patients. Brain Sci 2023; 13:brainsci13040617. [PMID: 37190582 DOI: 10.3390/brainsci13040617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
Primary chronic pain is a major contributor to disability worldwide, with an estimated prevalence of 20-33% of the world's population. The high socio-economic impact of musculoskeletal pain justifies seeking an appropriate therapeutic strategy. Immersive virtual reality (VR) has been proposed as a first-line intervention for chronic musculoskeletal pain. However, the growing literature has not been accompanied by substantial progress in understanding how VR exerts its impact on the pain experience and what neurophysiological mechanisms might be involved in the clinical effectiveness of virtual reality interventions in chronic pain patients. The aim of this review is: (i) to establish the state of the art on the effects of VR on patients with chronic pain; (ii) to identify neuroplastic changes associated with chronic pain that may be targeted by VR intervention; and (iii) to propose a hypothesis on how immersive virtual reality could modify motor behavioral decision-making through an interactive experience in patients with chronic pain.
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Affiliation(s)
- Javier Guerra-Armas
- Faculty of Health Sciences, Universidad Las Palmas de Gran Canaria (ULPGC), 35016 Las Palmas, Spain
| | - Mar Flores-Cortes
- Faculty of Health Sciences, Universidad de Malaga, 29071 Malaga, Spain
| | | | - Alejandro Luque-Suarez
- Faculty of Health Sciences, Universidad de Malaga, 29071 Malaga, Spain
- Instituto de la Investigacion Biomedica de Malaga (IBIMA), 29071 Malaga, Spain
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), 28008 Madrid, Spain
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The Role of Self-Efficacy and Activity Patterns in the Physical Activity Levels of Women with Fibromyalgia. BIOLOGY 2023; 12:biology12010085. [PMID: 36671777 PMCID: PMC9855924 DOI: 10.3390/biology12010085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
Keeping high levels of physical activity is a challenge among chronic patients. In this regard, self-efficacy has been identified as a crucial variable to reduce sedentarism and physical inactivity in women with fibromyalgia. The current study aimed to evaluate the associations among objective physical activity levels, self-efficacy, activity patterns, and the impact of the disease, as well as to compare those variables between women with fibromyalgia with different self-efficacy levels. For this purpose, in this cross-sectional study, the physical activity levels of 123 women with fibromyalgia were assessed by accelerometers, together with self-efficacy, the impact of the disease, and activity patterns. Results revealed that self-efficacy for light or moderate physical activity was directly related to light (p < 0.01), moderate (p < 0.01), and vigorous physical activity (p < 0.05), as well as inversely related to sedentary time (p < 0.01). Moreover, the main differences were observed between those with low self-efficacy levels and the rest of the sample, while there were no differences between the high and the medium self-efficacy groups (p > 0.05). Thus, self-efficacy for walking and light physical activity seems to be more relevant than self-efficacy for moderate and vigorous physical activity to achieve higher levels of physical activity.
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Okhrimenko IМ, Tomenko OA, Leonenko AV, Cherednichenko SV, Krasilov AD, Liakhova N, Baldetskiy AA. CADETS' MOTIVATION FOR MOTOR ACTIVITY AS AN IMPORTANT FACTOR IN IMPROVING THEIR HEALTH. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2023; 51:260-267. [PMID: 37589113 DOI: 10.36740/merkur202303113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
OBJECTIVE Aim: To investigate cadets' motivational priorities for physical exercises and sports in the process of their training and the dynamics of their health indicators. PATIENTS AND METHODS Materials and methods: The research was conducted at the National Academy of Internal Affairs in 2018-2022. The research of motivational priorities involved 372 male cadets from the 1st to the 4th instructional years aged 17 to 22. Two groups were formed to investigate the state of cadets' health: group A (n = 39) included motivated cadets who were additionally engaged in sports, group B (n = 66) was represented by insufficiently motivated cadets who undertook training according to the traditional physical education program and did not additionally engage in physical exercises and sports. RESULTS Results: It was found that the motivational priorities of cadets for physical exercises and sports vary depending on the instructional year. Group A cadets showed a significantly better level of health than those from group B, by 2.98 points (p ≤ 0.001) during the 4th instructional year. CONCLUSION Conclusions: A high level of cadets' health formed in the process of physical exercises and sports during training will contribute to the mastering of the educational program and, in the future, will ensure the effectiveness of their service activities. Therefore, the formation of cadets' conscious motivation for motor activities during training in order to improve their health is an important task of higher educational institutions.
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Affiliation(s)
| | - Oleksandr A Tomenko
- SUMY STATE PEDAGOGICAL UNIVERSITY NAMED AFTER A. S. MAKARENKO, SUMY, UKRAINE
| | - Andriy V Leonenko
- SUMY STATE PEDAGOGICAL UNIVERSITY NAMED AFTER A. S. MAKARENKO, SUMY, UKRAINE
| | | | - Andriy D Krasilov
- SUMY STATE PEDAGOGICAL UNIVERSITY NAMED AFTER A. S. MAKARENKO, SUMY, UKRAINE
| | | | - Andriy A Baldetskiy
- MILITARY INSTITUTE OF TARAS SHEVCHENKO NATIONAL UNIVERSITY OF KYIV, KYIV, UKRAINE
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The Relationship Between Pain-Related Psychological Factors and Maximal Physical Performance in Low Back Pain: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2022; 23:2036-2051. [PMID: 36057387 DOI: 10.1016/j.jpain.2022.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/06/2022] [Accepted: 08/09/2022] [Indexed: 01/04/2023]
Abstract
Theoretical frameworks explain how pain-related psychological factors may influence the physical performance. In this systematic review and meta-analysis, we evaluated the evidence regarding the relationship between the pain-related psychological factors and the maximal physical performance in patients with low back pain (LBP). Pubmed, Embase, CINAHL and Web of Science databases were searched from inception to May 2022. Cross-sectional or longitudinal studies reporting cross-sectional measures of association between at least one pain-related psychological factor and a quantitatively measured outcome of maximal physical performance in patients with LBP were eligible for inclusion. Thirty-eight studies (n = 2,490; 27 cross-sectional studies, n = 1,647 (66%); 11 longitudinal studies, n = 843 (34%)) were included, with 92% of participants (n = 2,284) having chronic LBP. Results showed that pain-related fear, pain catastrophizing, and anticipated pain were consistently and negatively associated with the maximal physical performance in chronic LBP, whereas pain-self efficacy showed positive correlations. Overall, magnitudes of absolute pooled r-values were small (r ≤ 0.25), except for anticipated pain, which was moderately associated with maximal physical performance (r = -0.34 to -0.37). Subanalyses and sensitivity analyses yielded similar pooled correlation coefficients. Certainty of evidence using the GRADE recommendations was very low to moderate for pain-related fear, and very low to low for the other pain-related psychological factors. Prospero registration: CRD42021227486. PERSPECTIVE: Overall, small pooled correlation coefficients were shown between pain-related psychological factors and maximal physical performance in chronic LBP. Certainty of evidence was very low to low for all pain-related psychological factors other than pain-related fear. Future studies taking into account limitations of the current literature may therefore change these conclusions.
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Matthews D, Cancino EE, Falla D, Khatibi A. Exploring pain interference with motor skill learning in humans: A systematic review. PLoS One 2022; 17:e0274403. [PMID: 36099284 PMCID: PMC9470002 DOI: 10.1371/journal.pone.0274403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/26/2022] [Indexed: 11/20/2022] Open
Abstract
Motor learning underpins successful motor skill acquisition. Although it is well known that pain changes the way we move, it’s impact on motor learning is less clear. The aim of this systematic review was to synthesize evidence on the impact of experimental and clinical pain on task performance and activity-dependent plasticity measures across learning and explore these findings in relation to different pain and motor learning paradigms. Five databases were searched: Web of Science, Scopus, MEDLINE, Embase and CINAHL. Two reviewers independently screened the studies, extracted data, and assessed risk of bias using the Cochrane ROB2 and ROBIN-I. The overall strength of evidence was rated using the GRADE guidelines. Due to the heterogeneity of study methodologies a narrative synthesis was employed. Twenty studies were included in the review: fifteen experimental pain and five clinical pain studies, covering multiple motor paradigms. GRADE scores for all outcome measures suggested limited confidence in the reported effect for experimental pain and clinical pain, on motor learning. There was no impact of pain on any of the task performance measures following acquisition except for ‘accuracy’ during a tongue protrusion visuomotor task and ‘timing of errors’ during a motor adaptation locomotion task. Task performance measures at retention, and activity dependent measures at both acquisition and retention showed conflicting results. This review delivers a detailed synthesis of research studies exploring the impact of pain on motor learning. This is despite the challenges provided by the heterogeneity of motor learning paradigms, outcome measures and pain paradigms employed in these studies. The results highlight important questions for further research with the goal of strengthening the confidence of findings in this area.
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Affiliation(s)
- David Matthews
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Edith Elgueta Cancino
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ali Khatibi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
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Esteves JE, Cerritelli F, Kim J, Friston KJ. Osteopathic Care as (En)active Inference: A Theoretical Framework for Developing an Integrative Hypothesis in Osteopathy. Front Psychol 2022; 13:812926. [PMID: 35250743 PMCID: PMC8894811 DOI: 10.3389/fpsyg.2022.812926] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/11/2022] [Indexed: 12/11/2022] Open
Abstract
Osteopathy is a person-centred healthcare discipline that emphasizes the body’s structure-function interrelationship—and its self-regulatory mechanisms—to inform a whole-person approach to health and wellbeing. This paper aims to provide a theoretical framework for developing an integrative hypothesis in osteopathy, which is based on the enactivist and active inference accounts. We propose that osteopathic care can be reconceptualised under (En)active inference as a unifying framework. Active inference suggests that action-perception cycles operate to minimize uncertainty and optimize an individual’s internal model of the lived world and, crucially, the consequences of their behaviour. We argue that (En)active inference offers an integrative framework for osteopathy, which can evince the mechanisms underlying dyadic and triadic (e.g., in paediatric care) exchanges and osteopathic care outcomes. We propose that this theoretical framework can underpin osteopathic care across the lifespan, from preterm infants to the elderly and those with persistent pain and other physical symptoms. In situations of chronicity, as an ecological niche, the patient-practitioner dyad provides the osteopath and the patient with a set of affordances, i.e., possibilities for action provided by the environment, that through shared intentionally, can promote adaptations and restoration of productive agency. Through a dyadic therapeutic relationship, as they engage with their ecological niche’s affordances—a structured set of affordances shared by agents—osteopath and patient actively construct a shared sense-making narrative and realise a shared generative model of their relation to the niche. In general, touch plays a critical role in developing a robust therapeutic alliance, mental state alignment, and biobehavioural synchrony between patient and practitioner. However, its role is particularly crucial in the fields of neonatology and paediatrics, where it becomes central in regulating allostasis and restoring homeostasis. We argue that from an active inference standpoint, the dyadic shared ecological niche underwrites a robust therapeutic alliance, which is crucial to the effectiveness of osteopathic care. Considerations and implications of this model—to clinical practice and research, both within- and outside osteopathy—are critically discussed.
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Affiliation(s)
- Jorge E. Esteves
- Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
- Malta ICOM Educational, Gżira, Malta
- Research Department, University College of Osteopathy, London, United Kingdom
- *Correspondence: Jorge E. Esteves,
| | - Francesco Cerritelli
- Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
| | - Joohan Kim
- Department of Communication, Yonsei University, Seoul, South Korea
| | - Karl J. Friston
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, London, United Kingdom
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11
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Pain-Related Worrying and Goal Preferences Determine Walking Persistence in Women with Fibromyalgia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031513. [PMID: 35162534 PMCID: PMC8835050 DOI: 10.3390/ijerph19031513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 11/17/2022]
Abstract
Physical activity and exercise are relevant behaviors for fibromyalgia health outcomes; however, patients have difficulties undertaking and maintaining an active lifestyle. With a cross-sectional design, this study explored the role of pain-related worrying and goal preferences in the walking persistence of women with fibromyalgia. The sample included 111 women who attended a tertiary health setting. We adapted the Six-Minute Walk Test where participants decided either to stop or continue walking in five voluntary 6 min bouts. Women who were categorized higher in pain-related worrying reported higher preference for pain avoidance goals (t = -2.44, p = 0.02) and performed worse in the walking task (LongRank = 4.21; p = 0.04). Pain avoidance goal preference increased the likelihood of stopping after the first (OR = 1.443), second (OR = 1.493), and third (OR = 1.540) 6 min walking bout, and the risk of ending the walking activity during the 30 min task (HR = 1.02, [1.0-1.03]). Influence of pain-related worrying on total walking distance was mediated by goal preferences (ab = -3.25). In interventions targeting adherence in physical activity and exercise, special attention is needed for women who are particularly worried about pain to help decrease their preference for short-term pain avoidance goals relative to long-term goals such as being active through walking.
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12
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Pastor-Mira MÁ, López-Roig S, Martínez-Zaragoza F, Toribio E, Nardi-Rodríguez A, Peñacoba C. Motivational Determinants of Objective Physical Activity in Women with Fibromyalgia Who Attended Rehabilitation Settings. J Clin Med 2021; 10:jcm10235547. [PMID: 34884246 PMCID: PMC8658437 DOI: 10.3390/jcm10235547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 12/12/2022] Open
Abstract
Being physically active has positive effects on fibromyalgia functioning. However, promoting an active lifestyle in these patients continues to be a relevant clinical challenge. Our aim was to test a motivational model to explain light (LPA) and moderate-vigorous physical activity (MVPA). A cross-sectional prospective study was conducted at a tertiary level of care. Participants completed sociodemographic, clinical, motivational (physical activity self-efficacy and goal preferences) and behavioral measures (activity avoidance). LPA and MVPA were measured with triaxial accelerometers, starting the same day of the aforementioned assessment. Out of 211 women, 183 completed this measure. Structural models were performed. Our results show that the best fit indices (CFI = 0.97, SRMR = 0.04) showed a model with direct influence of PA self-efficacy on MVPA (p < 0.01) and indirect influence on LPA (p < 0.001). LPA received the influence of PA self-efficacy mainly through activity avoidance (p < 0.01). Clinical variables did not have any effect on PA intensities. Thus, the motivational variables showed different paths to explain two PA intensities. Targeting PA self-efficacy in rehabilitation settings is needed to enhance both daily LPA and MVPA intensities.
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Affiliation(s)
- María-Ángeles Pastor-Mira
- Department of Behavioral Sciences and Health, Miguel Hernández University, 03550 Alicante, Spain; (M.-Á.P.-M.); (F.M.-Z.); (A.N.-R.)
| | - Sofía López-Roig
- Department of Behavioral Sciences and Health, Miguel Hernández University, 03550 Alicante, Spain; (M.-Á.P.-M.); (F.M.-Z.); (A.N.-R.)
- Correspondence:
| | - Fermín Martínez-Zaragoza
- Department of Behavioral Sciences and Health, Miguel Hernández University, 03550 Alicante, Spain; (M.-Á.P.-M.); (F.M.-Z.); (A.N.-R.)
| | - Eva Toribio
- Fibromyalgia Unit, Hospital of San Vicente del Raspeig, 03690 Alicante, Spain;
| | - Ainara Nardi-Rodríguez
- Department of Behavioral Sciences and Health, Miguel Hernández University, 03550 Alicante, Spain; (M.-Á.P.-M.); (F.M.-Z.); (A.N.-R.)
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, 28922 Madrid, Spain;
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Neural and behavioral correlates of human pain avoidance in participants with and without episodic migraine. Pain 2021; 163:1023-1034. [PMID: 34510134 DOI: 10.1097/j.pain.0000000000002472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
ABSTRACT The innate motivation to avoid pain can be disrupted when individuals experience uncontrollable stress, such as pain. This can lead to maladaptive behaviors, including passivity, and negative affect. Despite its importance, motivational aspects of pain avoidance are understudied in humans and their neural mechanisms vastly unknown. Rodent models suggest an important role of the periaqueductal gray, but it is unknown whether it subserves a similar role in humans. Furthermore, it is unclear whether pain avoidance is associated with individual differences in pain coping. Using functional magnetic resonance imaging, networks underlying pain avoidance behavior were examined in 32 participants with and without episodic migraine. Pain avoidance behavior was assessed using an adaptation of the incentive delay task. In each trial of the task, participants tried to avoid a painful stimulus and receive a nonpainful one instead while the difficulty to succeed varied across trials (3 difficulty levels: safe, easy, and difficult). After unsuccessful pain avoidance on the preceding trial, participants showed reduced pain avoidance behavior, especially in the difficult condition. This reduction in behavior was associated with higher helplessness scores only in participants with migraine. Higher helplessness in participants with migraine was further correlated with a stronger decrease in activation of cortical areas associated with motor behavior, attention, and memory after unsuccessful pain avoidance. Of these areas, specifically posterior parietal cortex activation predicted individual's pain avoidance behavior on the next trial. The results link individual pain coping capacity to patterns of neural activation associated with altered pain avoidance in patients with migraine.
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Matthews D, Elgueta Cancino E, Falla D, Khatibi A. Exploring pain interference with motor skill learning in humans: a protocol for a systematic review. BMJ Open 2021; 11:e045841. [PMID: 34272217 PMCID: PMC8287617 DOI: 10.1136/bmjopen-2020-045841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Motor skill learning is intrinsic to living. Pain demands attention and may disrupt non-pain-related goals such as learning new motor skills. Although rehabilitation approaches have used motor skill learning for individuals in pain, there is uncertainty on the impact of pain on learning motor skills. METHODS AND ANALYSIS The protocol of this systematic review has been designed and is reported in accordance with criteria set out by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Web of Science, Scopus, MEDLINE, Embase and CINAHL databases; key journals; and grey literature will be searched up until March 2021, using subject-specific searches. Two independent assessors will oversee searching, screening and extracting of data and assessment of risk of bias. Both behavioural and activity-dependent plasticity outcome measures of motor learning will be synthesised and presented. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION No patient data will be collected, and therefore, ethical approval was not required for this review. The results of this review will provide further understanding into the complex effects of pain and may guide clinicians in their use of motor learning strategies for the rehabilitation of individuals in pain. The results of this review will be published in a peer-reviewed journal and presented at scientific conferences. PROSPERO REGISTRATION NUMBER CRD42020213240.
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Affiliation(s)
- David Matthews
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Edith Elgueta Cancino
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Ali Khatibi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
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Examining attentional biases, interpretation biases, and attentional control in people with and without chronic pain. Pain 2021; 162:2110-2119. [PMID: 33769370 DOI: 10.1097/j.pain.0000000000002212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/21/2021] [Indexed: 12/19/2022]
Abstract
ABSTRACT Psychological models of chronic pain (CP) highlight cognitive-processing biases (ie, attentional biases, interpretation biases, and attentional control) as pivotal processes that uniquely and synergistically impact the development and maintenance of CP. Very few studies explore multiple cognitive biases, and no studies have examined these 3 processes together in a CP sample. Furthermore, there is a lack of research investigating the relationship between these cognitive processes and pain-relevant variables (eg, pain intensity and pain catastrophising). The current study aimed to (1) compare attentional biases, interpretation biases, and attentional control in people with and without CP, (2) explore their interrelationships, and (3) explore their association with pain-related variables. Seventy-four participants with CP and 66 without pain volunteered. Participants completed a visual scanning task with eye tracking, a recognition task, and a flanker task. Traditional and Bayesian analysis indicated no effect of pain status on cognitive-processing biases. All participants, regardless of pain status, demonstrated attentional biases towards pain on some indices of early and late attention, but not interpretation bias or attentional control. There was weak evidence of associations between attentional biases, interpretation biases, and attentional control. Pain intensity was significantly correlated with interpretation biases, and follow-up analyses revealed people with high pain intensity demonstrated an interpretation bias towards pain significantly more than those with low pain intensity. Findings suggest that attentional biases towards pain are ubiquitous, but for people with moderate-to-severe pain, interpretation biases may have a role worthy of further research.
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Kent M, Mardian AS, Regalado-Hustead ML, Gress-Smith JL, Ciciolla L, Kim JL, Scott BA. Adaptive Homeostatic Strategies of Resilient Intrinsic Self-Regulation in Extremes (RISE): A Randomized Controlled Trial of a Novel Behavioral Treatment for Chronic Pain. Front Psychol 2021; 12:613341. [PMID: 33912102 PMCID: PMC8074861 DOI: 10.3389/fpsyg.2021.613341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/12/2021] [Indexed: 11/29/2022] Open
Abstract
Current treatments for chronic pain have limited benefit. We describe a resilience intervention for individuals with chronic pain which is based on a model of viewing chronic pain as dysregulated homeostasis and which seeks to restore homeostatic self-regulation using strategies exemplified by survivors of extreme environments. The intervention is expected to have broad effects on well-being and positive emotional health, to improve cognitive functions, and to reduce pain symptoms thus helping to transform the suffering of pain into self-growth. A total of 88 Veterans completed the pre-assessment and were randomly assigned to either the treatment intervention (n = 38) or control (n = 37). Fifty-eight Veterans completed pre- and post-testing (intervention n = 31, control = 27). The intervention covered resilience strengths organized into four modules: (1) engagement, (2) social relatedness, (3) transformation of pain and (4) building a good life. A broad set of standardized, well validated measures were used to assess three domains of functioning: health and well-being, symptoms, and cognitive functions. Two-way Analysis of Variance was used to detect group and time differences. Broadly, results indicated significant intervention and time effects across multiple domains: (1) Pain decreased in present severity [F(1, 56) = 5.02, p < 0.05, η2p = 0.08], total pain over six domains [F(1, 56) = 14.52, p < 0.01, η2p = 0.21], and pain interference [F(1, 56) = 6.82, p < 0.05, η2p = 0.11]; (2) Affect improved in pain-related negative affect [F(1, 56) = 7.44, p < 0.01, η2p = 0.12], fear [F(1, 56) = 7.70, p < 0.01, η2p = 0.12], and distress [F(1, 56) = 10.87, p < 0.01, η2p = 0.16]; (3) Well-being increased in pain mobility [F(1, 56) = 5.45, p < 0.05, η2p = 0.09], vitality [F(1, 56) = 4.54, p < 0.05, η2p = 0.07], and emotional well-being [F(1, 56) = 5.53, p < 0.05, η2p = 0.09] Mental health symptoms and the cognitive functioning domain did not reveal significant effects. This resilience intervention based on homeostatic self-regulation and survival strategies of survivors of extreme external environments may provide additional sociopsychobiological tools for treating individuals with chronic pain that may extend beyond treating pain symptoms to improving emotional well-being and self-growth. Clinical Trial Registration: Registered with ClinicalTrials.gov (NCT04693728).
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Affiliation(s)
- Martha Kent
- Research Department, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, United States.,Department of Psychology, Arizona State University, Tempe, AZ, United States
| | - Aram S Mardian
- Department of Family, Community, and Preventive Medicine, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, United States.,Chronic Pain Wellness Center, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, United States
| | - Morgan Lee Regalado-Hustead
- Chronic Pain Wellness Center, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, United States.,Department of Educational Psychology, Northern Arizona University, Flagstaff, AZ, United States
| | - Jenna L Gress-Smith
- Department of Psychology, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, United States
| | - Lucia Ciciolla
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Jinah L Kim
- Department of Psychology, University of California, San Diego, San Diego, CA, United States
| | - Brandon A Scott
- Department of Psychology, Midwestern University, Glendale, AZ, United States
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Popkirov S, Enax-Krumova EK, Mainka T, Hoheisel M, Hausteiner-Wiehle C. Functional pain disorders - more than nociplastic pain. NeuroRehabilitation 2021; 47:343-353. [PMID: 32986624 DOI: 10.3233/nre-208007] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Nociplastic pain has been recently introduced as a third mechanistic descriptor of pain arising primarily from alterations of neural processing, in contrast to pain due to tissue damage leading to nociceptor activation (nociceptive) or due to lesion or disease of the somatosensory nervous system (neuropathic). It is characterized by hyperalgesia and allodynia, inconsistency and reversibility, as well as dynamic cross-system interactions with biological and psychobehavioral factors. Along with this renewed understanding, functional pain disorders, also classified as chronic primary pain, are being reframed as biopsychosocial conditions that benefit from multimodal treatment. OBJECTIVE To summarize the current understanding of nociplastic pain and functional pain disorders, with a focus on conditions that are common in neurology practice. METHODS This was a narrative literature review. RESULTS Chronic back pain, fibromyalgia syndrome and complex regional pain syndrome are best understood within a biopsychosocial framework of pain perception that considers structural factors (predispositions and sequelae) and psychobehavioral mechanisms. Although pain is often the primary complaint, it should not be the only focus of treatment, as accompanying symptoms such as sleep or mood problems can significantly impact quality of life and offer useful leverage points for multimodal treatment. Analgesic pharmacotherapy is rarely helpful on its own, and should always be imbedded in a multidisciplinary setting.
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Affiliation(s)
- Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Elena K Enax-Krumova
- Department of Neurology, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany
| | - Tina Mainka
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | | | - Constanze Hausteiner-Wiehle
- Neurocenter, BG Trauma Center Murnau, Murnau, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
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Chan FH, Suen H, Jackson T, Vlaeyen JW, Barry TJ. Pain-related attentional processes: A systematic review of eye-tracking research. Clin Psychol Rev 2020; 80:101884. [DOI: 10.1016/j.cpr.2020.101884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 05/03/2020] [Accepted: 06/11/2020] [Indexed: 02/01/2023]
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Embodied Pain: There is a Need to Reflect Interactions Between Cognitions, Behavior, and Neuromuscular Activity in Chronic Pain. Clin J Pain 2019; 36:178-180. [PMID: 31850934 DOI: 10.1097/ajp.0000000000000789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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