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Karacaoglu M, Peerdeman KJ, Numans ME, Stolk MR, Meijer S, Klinger R, Veldhuijzen DS, van Middendorp H, Evers AWM. Nocebo Hyperalgesia in Patients With Fibromyalgia and Healthy Controls: An Experimental Investigation of Conditioning and Extinction Processes at Baseline and 1-Month Follow-up. THE JOURNAL OF PAIN 2023; 24:1696-1711. [PMID: 37196928 DOI: 10.1016/j.jpain.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 04/30/2023] [Accepted: 05/07/2023] [Indexed: 05/19/2023]
Abstract
Nocebo effects are adverse treatment outcomes that are not ascribed to active treatment components. Potentially, their magnitude might be higher in patients with chronic pain compared to healthy controls since patients likely experience treatment failure more frequently. The current study investigated group differences in the induction and extinction of nocebo effects on pressure pain at baseline (N = 69) and 1-month follow-up (N = 56) in female patients with fibromyalgia and matched healthy controls. Nocebo effects were first experimentally induced via classical conditioning combined with instructions on the pain-increasing function of a sham transcutaneous electrical nerve stimulation device, then decreased via extinction. One month later, the same procedures were repeated to explore their stability. Results suggest that nocebo effects were induced in the healthy control group during baseline and follow-up. In the patient group, nocebo effects were only induced during follow-up, without clear group differences. Extinction was only observed during baseline in the healthy control group. Further comparisons of nocebo effects and extinction indicated no significant changes across sessions, possibly suggesting their overall magnitudes were stable over time and across groups. In conclusion, contrary to our expectations, patients with fibromyalgia did not have stronger nocebo hyperalgesia; instead, they might be less responsive to nocebo manipulations than healthy controls. PERSPECTIVE: The current study is the first to investigate group differences in experimentally manipulated nocebo hyperalgesia between chronic pain and healthy populations at baseline and 1-month follow-up. Since nocebo effects are common in clinical settings, their investigation in different populations is essential to explain and minimize their adverse effects during treatment.
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Affiliation(s)
- Merve Karacaoglu
- Health, Medical and Neuropsychology unit, Leiden University, Leiden, The Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands
| | - Kaya J Peerdeman
- Health, Medical and Neuropsychology unit, Leiden University, Leiden, The Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands
| | - Mattijs E Numans
- Public Health and Primary Care Department/LUMC-Campus Den Haag, Leiden University Medical Center, The Hague, The Netherlands
| | - Martha R Stolk
- Health, Medical and Neuropsychology unit, Leiden University, Leiden, The Netherlands
| | - Simone Meijer
- Health, Medical and Neuropsychology unit, Leiden University, Leiden, The Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands
| | - Regine Klinger
- Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dieuwke S Veldhuijzen
- Health, Medical and Neuropsychology unit, Leiden University, Leiden, The Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology unit, Leiden University, Leiden, The Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology unit, Leiden University, Leiden, The Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Medical Delta, Erasmus University Rotterdam, Leiden University & Delft University of Technology, Delft, The Netherlands
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Boorman DC, Keay KA. Learning pain in context: Response-conditioned placebo analgesia and nocebo hyperalgesia in male rats with chronic neuropathic pain. Physiol Behav 2023; 263:114116. [PMID: 36773736 DOI: 10.1016/j.physbeh.2023.114116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/23/2023] [Accepted: 02/08/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Animal models of placebo analgesia and nocebo hyperalgesia have great potential to assist in the development of novel treatments for chronic pain that exploit or inhibit these phenomena. This study sought to elicit both conditioned placebo analgesia and conditioned nocebo hyperalgesia in rats with chronic neuropathic pain using non-pharmacological, contextual conditioning approaches, similar to those most often used in humans. METHODS Sciatic nerve-injured male Sprague-Dawley rats (n = 80), and sham controls (n = 16), underwent a conditioning procedure in which three different thermal stimulus intensities (4 °C, 20 °C or 30 °C) were paired with contextual cues. Injured hind paw withdrawal behaviours were used to determine pain sensitivity, and either conditioned analgesia or conditioned hyperalgesia was evoked by re-exposing the rats to the same context with either an increased or decreased thermal stimulus, respectively. RESULTS Stronger conditioned analgesia and conditioned hyperalgesia were seen when rats were conditioned in a more complex environment, highlighting the importance of context in these processes. Rats that did not undergo conditioning procedures showed fewer hind paw withdrawals, indicating a learned component to these pain behaviours. CONCLUSIONS Our data call attention to context and learning as two critical factors in the development of placebo and nocebo effects in male rodents with a neuropathic injury. Additionally, the response-conditioning model we present in this study affords better comparisons between human and animal studies, in particular for those seeking to identify commonalities in the neurobiological mechanisms of placebo and nocebo responses.
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Affiliation(s)
- Damien C Boorman
- School of Medical Sciences and the Brain and Mind Centre, The University of Sydney, New South Wales, 2006, Australia.
| | - Kevin A Keay
- School of Medical Sciences and the Brain and Mind Centre, The University of Sydney, New South Wales, 2006, Australia
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Timm A, Schmidt-Wilcke T, Blenk S, Studer B. Altered social decision making in patients with chronic pain. Psychol Med 2023; 53:2466-2475. [PMID: 34736548 PMCID: PMC10123842 DOI: 10.1017/s0033291721004359] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 09/10/2021] [Accepted: 10/06/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chronic pain affects up to 20% of the population, impairs quality of life and reduces social participation. Previous research reported that pain-related perceived injustice covaries with these negative consequences. The current study probed whether chronic pain patients responded more strongly to disadvantageous social inequity than healthy individuals. METHODS We administered the Ultimatum Game, a neuroeconomic social exchange game, where a sum of money is split between two players to a large sample of patients with chronic pain disorder with somatic and psychological factors (n = 102) and healthy controls (n = 101). Anonymised, and in truth experimentally controlled, co-players proposed a split, and our participants either accepted or rejected these offers. RESULTS Chronic pain patients were hypersensitive to disadvantageous inequity and punished their co-players for proposed unequal splits more often than healthy controls. Furthermore, this systematic shift in social decision making was independent of patients' performance on tests of executive functions and risk-sensitive (non-social) decision making . CONCLUSIONS Our findings indicate that chronic pain is associated with anomalies in social decision making (compared to healthy controls) and hypersensitivity to social inequity that is likely to negatively impact social partaking and thereby the quality of life.
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Affiliation(s)
- Alicja Timm
- Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Mauritius Hospital Meerbusch, Meerbusch, Germany
| | - Tobias Schmidt-Wilcke
- Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Mauritius Hospital Meerbusch, Meerbusch, Germany
| | - Sandra Blenk
- Centre for Pain Medicine, St.Vinzenz Hospital Düsseldorf, Düsseldorf, Germany
| | - Bettina Studer
- Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Mauritius Hospital Meerbusch, Meerbusch, Germany
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Büchel C. The role of expectations, control and reward in the development of pain persistence based on a unified model. eLife 2023; 12:81795. [PMID: 36972108 PMCID: PMC10042542 DOI: 10.7554/elife.81795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
Chronic, or persistent pain affects more than 10% of adults in the general population. This makes it one of the major physical and mental health care problems. Although pain is an important acute warning signal that allows the organism to take action before tissue damage occurs, it can become persistent and its role as a warning signal thereby inadequate. Although per definition, pain can only be labeled as persistent after 3 months, the trajectory from acute to persistent pain is likely to be determined very early and might even start at the time of injury. The biopsychosocial model has revolutionized our understanding of chronic pain and paved the way for psychological treatments for persistent pain, which routinely outperform other forms of treatment. This suggests that psychological processes could also be important in shaping the very early trajectory from acute to persistent pain and that targeting these processes could prevent the development of persistent pain. In this review, we develop an integrative model and suggest novel interventions during early pain trajectories, based on predictions from this model.
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Affiliation(s)
- Christian Büchel
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
Pain is driven by sensation and emotion, and in turn, it motivates decisions and actions. To fully appreciate the multidimensional nature of pain, we formulate the study of pain within a closed-loop framework of sensory-motor prediction. In this closed-loop cycle, prediction plays an important role, as the interaction between prediction and actual sensory experience shapes pain perception and subsequently, action. In this Perspective, we describe the roles of two prominent computational theories-Bayesian inference and reinforcement learning-in modeling adaptive pain behaviors. We show that prediction serves as a common theme between these two theories, and that each of these theories can explain unique aspects of the pain perception-action cycle. We discuss how these computational theories and models can improve our mechanistic understandings of pain-centered processes such as anticipation, attention, placebo hypoalgesia, and pain chronification.
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Affiliation(s)
- Zhe Sage Chen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY 10016, USA,Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY 10016, USA,Neuroscience Institute, NYU Grossman School of Medicine, New York, NY 10016, USA,Interdisciplinary Pain Research Program, NYU Langone Health, New York, NY 10016, USA,Corresponding author
| | - Jing Wang
- Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY 10016, USA,Neuroscience Institute, NYU Grossman School of Medicine, New York, NY 10016, USA,Interdisciplinary Pain Research Program, NYU Langone Health, New York, NY 10016, USA,Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA,Corresponding author
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Bazanova OM, Kovaleva AV. Stabilometric Biofeedback Training in Cognitive and Affective Function Improvement. Contribution of the Russian Scientific School. Part II. HUMAN PHYSIOLOGY 2022; 48:271-284. [PMID: 35677212 PMCID: PMC9163904 DOI: 10.1134/s0362119722030021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 11/28/2022]
Abstract
This review is the second part of the critical analysis of recent papers of Russian and other authors devoted to the study of the stabilometric parameters in postural control biofeedback training and rehabilitation, associated with psychological functions. The review presents the studies of postural control features in chronic pain syndrome, chronic fatigue syndrome, Parkinson’s disease, multiple sclerosis, and depression. The leading role of Russian researchers in the development and application of stabilometric biofeedback in the training of optimal functioning, rehabilitation, and correction of neurological disorders is noted. The paradigm of stabilometric biofeedback training of the cognitive and affective functions is offered.
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Affiliation(s)
- O. M. Bazanova
- Scientific Research Institute of Neuroscience & Medicine, Novosibirsk, Russia
| | - A. V. Kovaleva
- Anokhin Research Institute of Normal Physiology, Moscow, Russia
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Valdes-Hernandez PA, Montesino-Goicolea S, Hoyos L, Porges EC, Huo Z, Ebner NC, Woods AJ, Cohen R, Riley JL, Fillingim RB, Cruz-Almeida Y. Resting-state functional connectivity patterns are associated with worst pain duration in community-dwelling older adults. Pain Rep 2021; 6:e978. [PMID: 34901680 PMCID: PMC8660002 DOI: 10.1097/pr9.0000000000000978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/25/2021] [Accepted: 10/19/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION An individual's chronic pain history is associated with brain morphometric alterations; but little is known about the association between pain history and brain function. OBJECTIVES This cross-sectional study aimed at determining how worst musculoskeletal pain intensity (WPINT) moderated the association between worst musculoskeletal pain duration (WPDUR) and brain resting-state magnetic resonance imaging functional connectivity (RSFC) in community-dwelling older adults (60-94 years, 75% females, 97% right-handed). METHODS Resting-state magnetic resonance imaging functional connectivity between region of interests was linearly regressed on WPDUR and WPINT. Predictions were compared with a control group's average RSFC (61-85 years, 47% females, 95% right-handed). RESULTS Three significant patterns emerged: (1) the positive association between WPDUR and RSFC between the medial prefrontal cortex, in the anterior salience network (SN), and bilateral lateral Brodmann area 6, in the visuospatial network (VSN), in participants with more severe chronic pain, resulting in abnormally lower RSFC for shorter WPDUR; (2) the negative association between WPDUR and RSFC between right VSN occipitotemporal cortex (lateral BA37 and visual V5) and bilateral VSN lateral Brodmann area 6, independently of WPINT, resulting in abnormally higher and lower RSFC for shorter and longer WPDUR, respectively; and (3) the positive association between WPDUR and the left hemisphere's salience network-default mode network connectivity (between the hippocampus and both dorsal insula and ventral or opercular BA44), independently of WPINT, resulting in abnormally higher RSFC for longer WPDUR. CONCLUSION Musculoskeletal effects on brain functional networks of general healthy individuals could accumulate until being observable at older ages. Results invite to examinations of these effects' impact on function and memory.
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Affiliation(s)
- Pedro A. Valdes-Hernandez
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Soamy Montesino-Goicolea
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Lorraine Hoyos
- University of Central Florida, Department of Clinical Sciences, Orlando, Florida, USA
| | - Eric C. Porges
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Zhiguang Huo
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Natalie C. Ebner
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Psychology, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida, USA
| | - Adam J. Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Ronald Cohen
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Joseph L. Riley
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Roger B. Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Yenisel Cruz-Almeida
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, Florida, USA
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Houde F, Martel M, Coulombe-Lévêque A, Harvey MP, Auclair V, Mathieu D, Whittingstall K, Goffaux P, Léonard G. Perturbing the activity of the superior temporal gyrus during pain encoding prevents the exaggeration of pain memories: A virtual lesion study using single-pulse transcranial magnetic stimulation. Neurobiol Learn Mem 2020; 169:107174. [PMID: 32001336 DOI: 10.1016/j.nlm.2020.107174] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 12/19/2019] [Accepted: 01/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Past studies have shown that pain memories are often inaccurate, a phenomenon known as mnemonic pain bias. Pain memories are thought to play an important role on how future pain is felt. Recent evidence from our laboratory suggests that individuals who exaggerate past pain display increased superior temporal gyrus (STG) activity during the encoding of experimental painful stimulations, suggesting that this brain structure plays an important role in pain memories. OBJECTIVE /hypothesis. To determine whether a virtual lesion paradigm, targeting the STG during pain encoding, can affect long-lasting pain memories. We hypothesized that interfering with the activity of the STG would attenuate mnemonic bias. METHODS Randomized double-blind study with two parallel groups. Participants received either sham (n = 21) or real (n = 21) transcranial magnetic stimulation (TMS - virtual lesion paradigm) over the STG during pain encoding (milliseconds after the administration of a painful stimuli). Pain intensity and unpleasantness were evaluated using a visual analog scale (VAS; 0 to 10) immediately after the painful event, and at recall, 2 months later. The mnemonic pain bias (calculated by subtracting the pain scores obtained at recall from the pain score obtained during encoding) was compared between the two groups for both pain intensity and unpleasantness. RESULTS Participants in both groups did not differ in terms of age and gender (real TMS = 27 years ± 9, 43% female; sham TMS = 25 years ± 4, 49% female; p > 0.64). The mnemonic bias related to pain intensity was similar in both groups (p = 0.83). However, the mnemonic bias related to pain unpleasantness was lower in the real TMS group (p = 0.04). CONCLUSIONS Our results provide the first evidence that the STG, is causally involved in the formation of biased memories of pain unpleasantness.
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Affiliation(s)
- Francis Houde
- Centre de recherche sur le vieillissement, CIUSSS de l'Estrie - CHUS, 1036, rue Belvédère Sud, Sherbrooke, Qc J1H 4C4, Canada; Centre de recherche du CHUS, CIUSSS de l'Estrie - CHUS, 3001, 12e Avenue Nord, Sherbrooke, Qc J1H 5N4, Canada; Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001, 12e avenue Nord, Qc J1H 5N4, Canada.
| | - Marylie Martel
- Centre de recherche sur le vieillissement, CIUSSS de l'Estrie - CHUS, 1036, rue Belvédère Sud, Sherbrooke, Qc J1H 4C4, Canada; Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001, 12e avenue Nord, Qc J1H 5N4, Canada.
| | - Alexia Coulombe-Lévêque
- Centre de recherche sur le vieillissement, CIUSSS de l'Estrie - CHUS, 1036, rue Belvédère Sud, Sherbrooke, Qc J1H 4C4, Canada; Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001, 12e avenue Nord, Qc J1H 5N4, Canada.
| | - Marie-Philippe Harvey
- Centre de recherche sur le vieillissement, CIUSSS de l'Estrie - CHUS, 1036, rue Belvédère Sud, Sherbrooke, Qc J1H 4C4, Canada; Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001, 12e avenue Nord, Qc J1H 5N4, Canada.
| | - Vincent Auclair
- Centre de recherche du CHUS, CIUSSS de l'Estrie - CHUS, 3001, 12e Avenue Nord, Sherbrooke, Qc J1H 5N4, Canada; Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001, 12e avenue Nord, Qc J1H 5N4, Canada.
| | - David Mathieu
- Neurosurgery, Neuro-oncology and Radiobiology departments, Université de Sherbrooke, 3001, 12e Avenue Nord, Qc J1H 5N4, Canada; Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001, 12e avenue Nord, Qc J1H 5N4, Canada.
| | - Kevin Whittingstall
- Centre de recherche du CHUS, CIUSSS de l'Estrie - CHUS, 3001, 12e Avenue Nord, Sherbrooke, Qc J1H 5N4, Canada; Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001, 12e avenue Nord, Qc J1H 5N4, Canada.
| | - Philippe Goffaux
- Centre de recherche du CHUS, CIUSSS de l'Estrie - CHUS, 3001, 12e Avenue Nord, Sherbrooke, Qc J1H 5N4, Canada; Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001, 12e avenue Nord, Qc J1H 5N4, Canada.
| | - Guillaume Léonard
- Centre de recherche sur le vieillissement, CIUSSS de l'Estrie - CHUS, 1036, rue Belvédère Sud, Sherbrooke, Qc J1H 4C4, Canada; Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001, 12e avenue Nord, Qc J1H 5N4, Canada.
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Reddan MC, Wager TD. Brain systems at the intersection of chronic pain and self-regulation. Neurosci Lett 2018; 702:24-33. [PMID: 30503923 DOI: 10.1016/j.neulet.2018.11.047] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic pain is a multidimensional experience with cognitive, affective, and somatosensory components that can be modified by expectations and learning. Individual differences in cognitive and affective processing, as well as contextual aspects of the pain experience, render chronic pain an inherently personal experience. Such individual differences are supported by the heterogeneity of brain representations within and across chronic pain pathologies. In this review, we discuss the complexity of brain representations of pain, and, with respect to this complexity, identify common elements of network-level disruptions in chronic pain. Specifically, we identify prefrontal-limbic circuitry and the default mode network as key elements of functional disruption. We then discuss how these disrupted circuits can be targeted through self-regulation and related cognitive strategies to alleviate chronic pain. We conclude with a proposal for how to develop personalized multivariate models of pain representation in the brain and target them with real-time neurofeedback, so that patients can explore and practice self-regulatory techniques with maximal efficiency.
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Affiliation(s)
| | - Tor D Wager
- University of Colorado, Boulder, United States.
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10
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A Concurrent Cognitive Task Does Not Perturb Quiet Standing in Fibromyalgia and Chronic Fatigue Syndrome. Pain Res Manag 2018; 2018:9014232. [PMID: 30159106 PMCID: PMC6109464 DOI: 10.1155/2018/9014232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/20/2018] [Accepted: 07/17/2018] [Indexed: 11/25/2022]
Abstract
Background and Objectives Cognitive complaints are common in fibromyalgia (FM) and chronic fatigue syndrome (CFS). Fatigue as well as pain may require greater effort to perform cognitive tasks, thereby increasing the load on processing in the central nervous system and interfering with motor control. Methods The effect of a concurrent arithmetic cognitive task on postural control during quiet standing was investigated in 75 women (aged 19–49 years) and compared between FM, CFS, and matched controls (n=25/group). Quiet standing on a force plate was performed for 60 s/condition, with and without a concurrent cognitive task. The center of pressure data was decomposed into a slow component and a fast component representing postural sway and adjusting ankle torque. Results Compared to controls, CFS and FM displayed lower frequency in the slow component (p < 0.001), and CFS displayed greater amplitude in the slow (p=0.038 and p=0.018) and fast (p=0.045) components. There were no interactions indicating different responses to the added cognitive task between any of the three groups. Conclusion Patients displayed insufficient postural control across both conditions, while the concurrent cognitive task did not perturb quiet standing. Fatigue but not pain correlated with postural control variables.
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Placebo analgesia persists during sleep: An experimental study. Prog Neuropsychopharmacol Biol Psychiatry 2018; 85:33-38. [PMID: 29631002 DOI: 10.1016/j.pnpbp.2018.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/29/2018] [Accepted: 03/30/2018] [Indexed: 11/23/2022]
Abstract
Although placebo analgesia is a well-recognized phenomenon with important clinical implications, the possibility that placebo effects occur during sleep has received little attention. This experimental study examined whether responsiveness to acute heat pain stimuli applied during sleep could be reduced following a placebo conditioning procedure administered before sleep. Healthy individuals (n = 9) underwent polysomnographic recordings for one habituation night followed by one placebo analgesia night and one control night in counterbalanced order. Conditioning induced robust analgesia expectations before the placebo night. In the morning after the placebo night, participants reported less nocturnal pain, anxiety, and associated sleep disturbance (all p's < 0.05) compared to the control night. Furthermore, placebo induction produced a 10% reduction in brain arousals evoked by noxious stimuli during rapid-eye-movement (REM) sleep (p = 0.03), consistent with our previous findings suggesting that analgesia expectations are reprocessed during REM sleep. In contrast, arousals increased by 14% during slow wave sleep (SWS) (p = 0.02). In the morning after the last recording night, placebo testing administered as a manipulation check confirmed that typical placebo analgesic responses were produced during waking (p's < 0.05). These results suggest that analgesia expectations developed before sleep reduced nocturnal pain perception and subjective sleep disturbances and activated brain processes that modulate incoming nociceptive signals differentially according to sleep stage. These results need to be replicated in future studies exploring how analgesia expectations may be reactivated during different sleep stages to modulate nociceptive responses.
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Lower regulatory frequency for postural control in patients with fibromyalgia and chronic fatigue syndrome. PLoS One 2018; 13:e0195111. [PMID: 29617424 PMCID: PMC5884530 DOI: 10.1371/journal.pone.0195111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 03/16/2018] [Indexed: 11/20/2022] Open
Abstract
As many similar symptoms are reported in fibromyalgia (FM) and chronic fatigue syndrome (CFS), underlying defcits may potentially also be similar. Postural disequilibrium reported in both conditions may thus be explained by similar deviations in postural control strategies. 75 females (25/group FM, CFS and control, age 19-49 years) performed 60 s of quiet standing on a force platform in each of three conditions: 1) firm surface with vision, 2) firm surface without vision and, 3) compliant surface with vision. Migration of center of pressure was decomposed into a slow and a fast component denoting postural sway and lateral forces controlling postural sway, analyzed in the time and frequency domains. Main effects of group for the antero-posterior (AP) and medio-lateral (ML) directions showed that patients displayed larger amplitudes (AP, p = 0.002; ML, p = 0.021) and lower frequencies (AP, p < 0.001; ML, p < 0.001) for the slow component, as well as for the fast component (amplitudes: AP, p = 0.010; ML, p = 0.001 and frequencies: AP, p = 0.001; ML, p = 0.029) compared to controls. Post hoc analyses showed no significant differences between patient groups. In conclusion, both the CFS- and the FM-group differed from the control group. Larger postural sway and insufficient control was found in patients compared to controls, with no significant differences between the two patient groups.
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Cognitive Behavioral Therapy (CBT) for Subacute Low Back Pain: a Systematic Review. Curr Pain Headache Rep 2018; 22:15. [DOI: 10.1007/s11916-018-0669-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
From the point of view of healthcare policies, improvement in pain care has been required for years; however, there is a great discrepancy between the current need for pain care and the actual provision by healthcare services. This article seeks to demonstrate that while healthcare policies are one of the critical factors involved, a variety of conceptual, diagnostic and therapeutic causes should also be taken into account. Firstly, considering that pain care is primarily concerned with the suffering of pain by patients, the focus lies with their conscious experience in order to define the patients' understanding of pain. Additionally, in this article current biomedical and psychosocial comprehension concerning chronic pain will be illustrated and why it is necessary to broaden our horizons in order to do justice to patients with chronic pain.
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