Social exclusion and pain sensitivity: why exclusion sometimes hurts and sometimes numbs

Social Determinants and Consequences of Pain: Toward Multilevel, Intersectional, and Life Course Perspectives

Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain remain rarely addressed in the context of pain prevention and management. In this review, we aim to 1) examine the broad scope of social determinants and consequences of pain and their interactions across multiple levels of organization, and 2) provide a framework synthesizing existing concepts and potential areas for future work on social aspects of pain, drawing upon socioecological, intersectional, and life course approaches. Integrating interdisciplinary theory and evidence, we outline pathways through which multilevel social factors and pain may affect each other over time. We also provide a brief summary of intrapersonal aspects of pain, which are thought to operate at the interface between individuals and the social context. Progressing from micro- to macrolevel factors, we illustrate how social determinants of pain can directly or indirectly contribute to pain experiences, expression, risk, prognosis, and impact across populations. We consider 1) at the interpersonal level, the roles of social comparison, social relatedness, social support, social exclusion, empathy, and interpersonal conflict; 2) at the group or community level, the roles of intimacy groups, task groups, social categories, and loose associations; and 3) at the societal level, the roles of political, economic, and cultural systems, as well as their policies and practices. We present examples of multilevel consequences of pain across these levels and discuss opportunities to reduce the burden and inequities of pain by expanding multilevel social approaches in pain research and practice. PERSPECTIVE: Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain are often unclearly defined, hindering their use in pain prevention, management, and research. We summarize the scope of social aspects of pain and provide a framework synthesizing existing concepts and potential areas for future work.

Effects of two different social exclusion paradigms on ambiguous facial emotion recognition

Social exclusion is an emotionally painful experience that leads to various alterations in socio-emotional processing. The perceptual and emotional consequences that may arise from experiencing social exclusion can vary depending on the paradigm used to manipulate it. Exclusion paradigms can vary in terms of the severity and duration of the leading exclusion experience, thereby classifying it as either a short-term or long-term experience. The present study aimed to study the impact of exclusion on socio-emotional processing using different paradigms that caused experiencing short-term and imagining long-term exclusion. Ambiguous facial emotions were used as socio-emotional cues. In study 1, the Ostracism Online paradigm was used to manipulate short-term exclusion. In study 2, a new sample of participants imagined long-term exclusion through the future life alone paradigm. Participants of both studies then completed a facial emotion recognition task consisting of morphed ambiguous facial emotions. By means of Point of Subjective Equivalence analyses, our results indicate that the experience of short-term exclusion hinders recognising happy facial expressions. In contrast, imagining long-term exclusion causes difficulties in recognising sad facial expressions. These findings extend the current literature, suggesting that not all social exclusion paradigms affect socio-emotional processing similarly.

Denver pain authenticity stimulus set (D-PASS)

We introduce the Denver Pain Authenticity Stimulus Set (D-PASS), a free resource containing 315 videos of 105 unique individuals expressing authentic and posed pain. All expressers were recorded displaying one authentic (105; pain was elicited via a pressure algometer) and two posed (210) expressions of pain (one posed expression recorded before [posed-unrehearsed] and one recorded after [posed-rehearsed] the authentic pain expression). In addition to authentic and posed pain videos, the database includes an accompanying codebook including metrics assessed at the expresser and video levels (e.g., Facial Action Coding System metrics for each video controlling for neutral images of the expresser), expressers' pain threshold and pain tolerance values, averaged pain detection performance by naïve perceivers who viewed the videos (e.g., accuracy, response bias), neutral images of each expresser, and face characteristic rating data for neutral images of each expresser (e.g., attractiveness, trustworthiness). The stimuli and accompanying codebook can be accessed for academic research purposes from https://digitalcommons.du.edu/lsdl_dpass/1/ . The relatively large number of stimuli allow for consideration of expresser-level variability in analyses and enable more advanced statistical approaches (e.g., signal detection analyses). Furthermore, the large number of Black (n = 41) and White (n = 56) expressers permits investigations into the role of race in pain expression, perception, and authenticity detection. Finally, the accompanying codebook may provide pilot data for novel investigations in the intergroup or pain sciences.

Does subjective social status affect pain thresholds? - an experimental examination

Past research regarding the relationship between different constructs of social status and different aspects of pain has yielded divergent results. So far, there are few experimental studies to investigate the causal relationship between social status and pain. Therefore, the present study aimed to examine the effect of perceived social status on pain thresholds by experimentally manipulating participants' subjective social status (SSS). 51 female undergraduates were randomly assigned to a low- or high-status condition. Participants' perceived social standing was temporarily elevated (high SSS condition) or reduced (low SSS condition). Before and after experimental manipulation participants' pressure pain thresholds were assessed. The manipulation check confirmed that participants in the low-status condition reported significantly lower SSS than participants in the high-status condition. A linear mixed model revealed a significant group x time interaction for pain thresholds: Whereas participants' pain thresholds in the low SSS condition increased post manipulation, pain thresholds of participants in the high SSS condition decreased post manipulation (β = 0.22; 95% CI, 0.002 to 0.432; p < .05). Findings suggest that SSS may have a causal effect on pain thresholds. This effect could either be due to a change in pain perception or a change in pain expression. Future research is needed to determine the mediating factors.

Preexposure to one social threat alters responses to another social threat: Behavioral and electrophysiological evidence

A recent Cyberball study has indicated that the experience of loss of control can affect how people process subsequent social exclusion. This "preexposure effect" supports the idea of a common cognitive system involved in the processing of different types of social threats. To test the validity of this assumption in the current study, we reversed the sequence of the preexposure setup. We measured the effects of social exclusion on the subsequent processing of loss of control utilizing event-related brain potentials (ERPs) and self-reports. In the control group (CG, n = 26), the transition to loss of control elicited significant increases in both the P3 amplitude and the self-reported negative mood. Replicating the results of the previous preexposure study, these effects were significantly reduced by the preexposure to an independent social threat (here: social exclusion). In contrast to previous findings, these effects were not modulated by the discontinuation (EG1disc, n = 25) or continuation (EG2cont, n = 24) of the preexposure threat. Given that the P3 effect is related to the violation of subjective expectations, these results support the notion that preexposure to a specific social threat has widespread effects on the individuals' expectancy of upcoming social participation and control.

The impact of gender-exclusive language on women's anticipated ostracism: A preregistered replication of Stout and Dasgupta (2011)

In a 2011 study, Stout and Dasgupta exposed men and women to what they termed gender-inclusive language, which used both male and female referents, or to what they termed gender-exclusive language, which used male referents only. They found that, in comparison to gender-inclusive language, a job description that used gender-exclusive language negatively impacted women; they reported higher anticipated job-based ostracism and perceived sexism and lower job-based motivation and identification. This work reports a high-powered, preregistered study with women that fully replicated Stout and Dasgupta's findings. Moreover, in an exploratory analysis, we found that, for women, gender-exclusive language is perceived as sexist, which in turn predicted feelings of greater anticipated ostracism, which in turn predicted lower job-based motivation and identification. Therefore, our findings support past research that subtle linguistic cues can be interpreted as exclusionary, that this interpretation can trigger negative outcomes, and that people can experience group-level ostracism based on their social identity.

Excluded and myopic: Social exclusion increases temporal discounting

Social exclusion is a painful yet ubiquitous experience that modulates affect, behavior, and cognition. Decision-making is an essential cognitive ability that some forms of it are altered following social exclusion. However, how intertemporal decision-making is influenced by social exclusion is scarcely studied. Here, using Future Life Alone paradigm we demonstrated that experiencing social exclusion increases temporal discounting. We further tested whether the increased temporal discounting is mediated by either time perception or risk-taking. Our results revealed that although time perception is influenced by social exclusion, neither time perception nor risk-taking mediated the changes in temporal discounting. Our results are providing further evidence corroborating that social exclusion evokes cognitive deconstruction and therefore alters temporal discounting.

Acute Ostracism-Related Pain Sensitization in the Context of Accumulated Lifetime Experiences of Ostracism

Ostracism (ie, being ignored/excluded) is a form of social adversity that powerfully impacts health and well-being. While laboratory research indicates that experimentally manipulated experiences of ostracism impact pain, findings have been mixed. Prior investigations have not considered moderating or main effects of individual histories of ostracism, and have been limited in the scope of their pain testing. In this study, participants without current pain reported lifetime experiences of ostracism prior to a laboratory visit where they were randomized to experience either a single episode of ostracism (ie, acute ostracism) or control condition that was immediately followed by quantitative sensory testing. Results indicate that the experimental effect of a single episode of ostracism on pain ratings, after-sensations, and temporal summation of pain is moderated by lifetime ostracism; no main effects were found. For individuals with histories of more lifetime ostracism, encountering a single episode of ostracism led to greater pain sensitization relative to the control condition, whereas no experimental effect was observed for individuals with little lifetime exposure to ostracism. These findings indicate that acute experiences of ostracism may be accompanied by periods of hyperalgesia for people who are chronically ostracized, implicating ostracism as a potential social moderator of pain sensitization. People who are stigmatized may therefore experience enhanced pain burden with repeated and accumulating experiences of ostracism. PERSPECTIVE: Results suggest that in the context of accumulated lifetime experiences of ostracism, single experiences of ostracism evoke central sensitization. In this way, ostracism may function to trigger central sensitization and shape socially- and societally-determined patterns of pain burden and disparity.

Sensitivity to ostracism is blunted in suicide attempters only when they report suicidal ideation

BACKGROUND

Modified pain perception is at the core of many theories on suicide; however, studies on the relationship between pain perception and suicidal behavior (attempt) have produced contradictory results. In this experimental study, we investigated whether physical pain and social pain are concomitantly influenced by suicidal ideation (SI) and past suicidal behavior.

METHODS

155 inpatients with depression (90 with and 65 without past history of suicide attempt) were included. They underwent thermal stimulation of the skin to assess physical pain tolerance and played the Cyberball game to assess their sensitivity to ostracism (social pain). Participants self-assessed current SI through the specific item in the Beck Depression Inventory.

RESULTS

Pain tolerance was not associated with history of suicide attempt, current SI, and their interaction. Social pain was associated with the interaction between history of suicide attempt and current SI. Social pain was decreased in suicide attempters, compared with non-attempters, only when they reported current SI.

LIMITATIONS

Cyberball game may not be representative of everyday stress and ecological social context.

CONCLUSIONS

Unlike what suggested by many theories, pain tolerance does not seem to be necessary to attempt suicide. Suicide attempters with current SI displayed blunted sensitivity to ostracism and could be less willing to restore social affiliation compared with non-attempters.

Cognitive exertion affects the appraisal of one's own and other people's pain

Correctly evaluating others' pain is a crucial prosocial ability. In both clinical and private settings, caregivers assess their other people's pain, sometimes under the effect of poor sleep and high workload and fatigue. However, the effect played by such cognitive strain in the appraisal of others' pain remains unclear. Fifty participants underwent one of two demanding tasks, involving either working memory (Experiment 1: N-Back task) or cognitive interference (Experiment 2: Stroop task). After each task, participants were exposed to painful laser stimulations at three intensity levels (low, medium, high), or video-clips of patients experiencing three intensity levels of pain (low, medium, high). Participants rated the intensity of each pain event on a visual analogue scale. We found that the two tasks influenced rating of both one's own and others' pain, by decreasing the sensitivity to medium and high events. This was observed either when comparing the demanding condition to a control (Stroop), or when modelling linearly the difficulty/performance of each depleting task (N-Back). We provide converging evidence that cognitive exertion affects the subsequent appraisal of one's own and likewise others' pain.

Does Level of Social Support During Rejection Affect Pain Sensitivity and Distress?

This study investigated whether level of social support would decrease emotional distress and physical pain sensitivity following rejection. Healthy undergraduate students received varying levels of social support from a close companion during the Partial Future Life Alone rejection paradigm. Participants also completed baseline and post-stressor measures of physical pain sensitivity as well as post-stressor measures of emotional distress. Results indicated that all levels of social support benefited rejected participants by either buffering and/or improving fundamental needs, mood, and pain to levels comparable to non-rejected participants; however, passive support resulted in the fewest beneficial outcomes. The current study provides preliminary evidence that even minimal levels of support during rejection benefits or at least neutralizes associated pain and distress outcomes.

Far from the eyes, far from the heart: COVID-19 confinement dampened sensitivity to painful facial features

In the last 2 years, governments of many countries imposed heavy social restrictions to contain the spread of the COVID-19 virus, with consequent increase of bad mood, distress, or depression for the people involved. Few studies investigated the impact of these restrictive measures on individual social proficiency, and specifically the processing of emotional facial information, leading to mixed results. The present research aimed at investigating systematically whether, and to which extent, social isolation influences the processing of facial expressions. To this end, we manipulated the social exclusion experimentally through the well-known Cyberball game (within-subject factor), and we exploited the occurrence of the lockdown for the Swiss COVID-19 first wave by recruiting participants before and after being restricted at home (grouping factor). We then tested whether either form of social segregation influenced the processing of pain, disgust, or neutral expressions, across multiple tasks probing access to different components of affective facial responses (state-specific, shared across states). We found that the lockdown (but not game-induced exclusion) affected negatively the processing of pain-specific information, without influencing other components of the affective facial response related to disgust or broad unpleasantness. In addition, participants recruited after the confinement reported lower scores in empathy questionnaires. These results suggest that social isolation affected negatively individual sensitivity to other people's affect and, with specific reference to the processing of facial expressions, the processing of pain-diagnostic information.

Forgiving lark, resentful owl: Self-control mediates the relationship between chronotype and forgiveness

Considerable evidence shows that nocturnal chronotypes have increased odds of mental health problems, poor academic performance, and impairment in executive functions. Although the cognitive and health costs of evening-oriented preference are well-documented in the literature, little is known about its interpersonal costs. In this article, we propose that people with a preference for an evening chronotype show a lower tendency to forgive following an interpersonal offense because of their lower self-control ability. Three studies using independent samples and complementary measures reveal that morning-evening preference plays a role in the emergence of forgiveness, which provides support for our theoretical perspective. In Study 1, we found that evening-type students were less forgiving when responding to a transgression than morning-type students. Employing a longer measure of forgiveness and a more representative population, Study 2 replicated our initial findings and supported our hypothesis regarding the mediating role of self-control. To circumvent methodological issues associated with self-report data, Study 3 used a behavioral measure of forgiveness and revealed that chronotype can also predict actual forgiving behavior in a laboratory setting. Together, these findings suggest that diurnal preference towards eveningness not only imposes threats on people's health, but can also incur interpersonal costs.

It will (never) stop hurting: Do repeated or chronic experiences of exclusion lead to hyper- or hyposensitive psychological responses?

Unlike one-time lab manipulations of exclusion, in real life, many people experience exclusion, from others and from groups, over extended periods, raising the question of whether individuals could, over time, develop hypo- or hypersensitive responses to chronic exclusion. In Study 1, we subjected participants to repeated experiences of inclusion or exclusion (three Cyberball games, time lag of three days, N = 194; 659 observations). We find that repeatedly excluded individuals become hypersensitive to inclusion, but not to exclusion. Study 2 ( N = 183) tested whether individuals with chronic experiences of real-world exclusion show hypo- or hypersensitive responses to a novel episode of exclusion. In line with Study 1, exclusion hurt to the same extent regardless of baseline levels of chronic exclusion in daily life. However, chronically excluded individuals show more psychological distress in general. We discuss theoretical and practical implications for dealing with chronically excluded individuals and groups.

Direct and displaced aggression after exclusion: role of gender differences

The present studies consider the influence of exclusion on aggressive behavior depending on the target of the aggression and the gender of the aggressor. Previous studies have shown that after exclusion, aggressive behavior occurs toward the excluder as well as toward innocent bystanders. However, there is also evidence that men have a greater tendency toward direct aggression and women have a greater tendency toward displaced aggression. In Studies 1 (N = 89) and 2 (N = 120), participants were ostracized, in Studies 3 (N = 88) and 4 (N = 133), participants were rejected. Then, aggressive behavior toward the excluder or bystander was measured. The results confirmed the gender differences hypothesis, but only in the case of ostracism. After ostracism, more retaliatory aggression was observed in men, and more displaced aggression was noted in women. Rejection resulted in generalized aggressive behavior directed toward the excluder and the bystander in men and women. The results are discussed in light of Sexual Selection Theory.

Lifetime ostracism experiences and mechanisms of pain

One social mechanism by which marginalization is enacted is via ostracism. Recent research has demonstrated ostracism's impact on physical health, but little is known about the relationship between accumulated lifetime experiences of ostracism and pain. Despite recent calls for added attention to social modulation of pain and social indicators of pain disparities, the impact of specific social factors on pain-including those of ostracism-are not well understood. Results of laboratory studies on the effects of acute ostracism experiences on pain sensitivity have been mixed. However, these studies have not considered lived and repeated experiences of ostracism, and primarily included single static measures of pain sensitivity. Additionally, inclusion and representation of the relationship between ostracism experiences and pain among people with minoritized identities are lacking in the current literature. In this study, we explored accumulated lifetime experiences of ostracism as a potential contributing factor to enhanced pain and one social mechanism by which societal inequity may create and maintain inequity in pain. We extracted measures of lifetime experiences of ostracism from six studies focused on social factors and (non-chronic) pain conducted between 2016 and 2020 (n = 505 adults). To retain and examine diversity within the sample, we used moderation and within-group analyses. Results indicate that greater experiences of lifetime ostracism are associated with lower cold pain tolerance, but not other pain measures, in the whole sample. Moderation and within-group analyses reveal opposing patterns of results between populations included in the extant literature (White participants, convenience samples) and those under-represented in the scientific literature (racialized groups, community samples). This study provides an example of a diversity science approach to examining social indicators of pain, illustrates the limited generalizability of previous studies on ostracism and pain, and highlights the need for increased representation and inclusion to understand mechanisms of pain and inequity.

Deeply lonely in the borderland between childhood and adulthood - Experiences of existential loneliness as narrated by adolescents

BACKGROUND

Adolescence is associated with different feelings and experiences that can negatively affect adolescents' health and well-being. In the transition between childhood and adulthood, experiences of loneliness are common. A deep form of loneliness is described as existential loneliness. Studies among adults have shown that existential loneliness often arises in connection with transitions and is related to suffering, but may lead to positive experiences when acknowledged and addressed. Therefore, the aim of this study was to explore adolescents' experiences of existential loneliness.

METHODS

This was an exploratory-descriptive qualitative study based on narrative interviews with 16 adolescents (median age 17.5). The data were analysed inductively using qualitative content analysis.

FINDINGS

Existential loneliness among adolescents was related to experiences of social exclusion and "in-betweenness". To alleviate their suffering, the adolescents tried to avoid burdensome feelings and thoughts, and they chose between sharing or not sharing their inner lives with someone else.

CONCLUSIONS

It is important to support adolescents' sense of belonging, and they may need assistance in dealing with existential loneliness, as well as with finding constructive and healthy ways of recuperating from the suffering. Professionals need knowledge of existential loneliness to promote adolescents' existential health and well-being.

Social pain by non-social agents: Exclusion hurts and provokes punishment even if the excluding source is a computer

Prior research has shown that being excluded by computer-agents in experimental exclusion paradigms threatens individuals' basic needs to a similar extent as being excluded by humans. It is less clear, however, why this similarity between computer and human exclusion occurs, and whether it applies only to reactions immediately after the exclusion event (reflexive stage), or also to reactions that occur further downstream (e.g., reflective stage). Four studies (N = 1048) with three different exclusion paradigms provide several key insights: First, the similarity between computer and human exclusion is robust and pervasive, as Bayesian analyses provide consistent support that the source of exclusion (human vs. computer) does not affect reflexive need satisfaction. Second, this similarity also extends to reflective reactions and punishing behavior. Finally, the present studies extend our knowledge about the processes underlying this similarity by uncovering the role of anthropomorphism. Implications and directions for future research are discussed.

The analgesic effect of nostalgia elicited by idiographic and nomothetic approaches on thermal stimulus

Nostalgia is shown to relieve an individual's perception of pain evoked by cold water, pressure, and thermal stimuli. However, there is no direct evidence to show the analgesic effects of different nostalgia-inducing methods on various stimulus intensities. We conducted two studies to examine the analgesic effect, at different pain intensities, after inducing nostalgia either idiographically or nomothetically. Study 1 (N = 118) induced nostalgia through an idiographic approach (i.e., event reflection task) and found that nostalgia relieved both high and low thermal pain. Study 2 (N = 66) induced nostalgia through a nomothetic approach (i.e., viewing nostalgic pictures) and found that nostalgia relieved low but not high thermal pain. The findings verify the analgesic effect of nostalgia on thermal pain and suggest the potential moderating role of the nostalgia induction approach and pain intensity. Practically, these findings have implications for using nostalgia as a nonpharmacological treatment for pain.

From pity to numbness: Social exclusion moderates the relationship between trait empathy and bystanders' aggressive tendencies in cyberbullying

Studies on cyberbullying have revealed an inconsistent relationship between trait empathy and bystanders' aggressive tendencies towards victims. We believe that these studies have overlooked the role of social exclusion. We infer that high-severity social exclusion suppresses the negative relationship between trait empathy and bystanders' aggressive tendencies. In Study 1, 226 participants read a news report concerning a singer's humiliation by netizens due to lack of talent. The results revealed that trait empathy predicted lower aggressive tendencies towards the singer for participants with fewer experiences of social exclusion. However, trait empathy was unrelated to aggressive tendencies for participants with more experiences of social exclusion. In Study 2, 146 participants were randomly assigned to a low-severity or a high-severity social exclusion condition and were required to recall their experiences of low- or high-severity social exclusion, respectively. The results demonstrated that in the low-severity condition, trait empathy was negatively associated with participants' aggressive tendencies towards the singer and this relationship was mediated by state empathy. However, there was no evidence that the process was at work in the high-severity condition. This study further presents implications and directions for future research.

The induction of social pessimism reduces pain responsiveness

OBJECTIVES

Past work has found that optimism reduces a person's responsiveness to pain, but the effects of pessimism are not clear. Therefore, we gave pessimistic forecasts of participants' future social life and measured changes in their pain responsiveness. In particular, some participants were told that they would end up alone in life.

METHODS

Seventy-five subjects were investigated in three conditions (negative forecast, positive forecast, no forecast) for changes in pain threshold and pain tolerance threshold. Pressure pain induction was accomplished by either human- or machine-driven algometers. A randomly assigned bogus forecast promising either a lonely or a socially satisfying future was ostensibly based on a personality questionnaire and an emotional dot-probe task. As potential covariates, questionnaires assessing dispositional optimism (LOT-R), pain catastrophizing (PCS), and self-esteem (SISE) were given.

RESULTS

Pain thresholds suggested a change toward unresponsiveness only in the negative forecast condition, with only small differences between the modes of pain induction (i.e., human or machine). The results for pain tolerance thresholds were less clear also because of limiting stimulation intensity for safety reasons. The covariates were not associated with these changes.

CONCLUSIONS

Thus, people expecting a lonely future became moderately less responsive to pain. This numbing effect was not modulated by personality measures, neither in a protective fashion via dispositional optimism and self-esteem nor in a risk-enhancing fashion via trait pain catastrophizing. Alternative mechanisms of action should be explored in future studies.

Mental Imagery and Social Pain in Adolescents-Analysis of Imagery Characteristics and Perspective-A Pilot Study

BACKGROUND

Mental imagery (MI) may play a key role in the development of various mental disorders in adolescents. Adolescence is known to be a fragile life period, in which acceptance by one's favored peer group is extremely important, and social rejection is particularly painful. This is the first pilot study investigating MI and its relationship to social pain (SP).

METHOD

A sample of 80 adolescents (14-20 years; 75.3% female) completed a web-based quasi-experimental design about the contents and characteristics of their spontaneous positive and negative MI and associated emotions, and were asked to complete the Social Pain Questionnaire, the Becks Depression Inventory and the Social Phobia Inventory.

RESULTS

A higher score of SP was significantly associated with increased fear, sadness, and feelings of guilt, and less control over negative MI. Characteristics of negative MI were more precisely predicted by SP scores than depression- and social anxiety scores. Adolescents with higher SP-scores more often reported negative images including social situations and were more likely to perceive negative images in a combination of field-and observer perspectives than adolescents with lower SP scores.

CONCLUSION

SP-sensitivity seems to be linked to unique characteristics of negative MI, which reveals the strong emotional impact of social exclusion in youths. The results do not allow causal conclusions to be drawn, but raise questions about previous studies comparing each imagery perspective individually.

Gender discrimination facilitates fMRI responses and connectivity to thermal pain

Gender discrimination is a serious social issue that has been shown to increase negative consequences, especially in females when accompanied by acute or chronic pain. Experiencing social pain through discrimination can increase an individual's evaluation of evoked physical pain. However, few studies have explored the mechanism underlying how gender discrimination modulates brain responses when individuals experience physical pain evoked by noxious stimuli. In this study, we addressed this issue using a gender discrimination fMRI paradigm with thermal pain stimulation. We found that discrimination indeed affected participants' own behavioral self-evaluation of noxious stimuli. Discrimination-encoded brain activations were identified in the temporopolar cortex, while brain activations to thermal stimuli after viewing pictures of discrimination were found in the dorsal anterior cingulate cortex (dACC). Brain activations in the temporopolar cortex and the dACC were correlated. Furthermore, pain perception-specific functional connectivity of the dACC-SII in the cue stage and the dACC-frontal in the pain stage were identified, suggesting a facilitative effect of gender discrimination on females' experience of physical pain. Our results indicate that the dACC may play a central role in mediating the affective aspect of physical pain after experiencing discrimination. These findings provide novel insights into the underlying mechanism of how gender discrimination facilitates females' experience of physical pain.

Pelvic Pain Alters Functional Connectivity Between Anterior Cingulate Cortex and Hippocampus in Both Humans and a Rat Model

The anterior cingulate cortex (ACC) and hippocampus (HIPP) are two key brain regions associated with pain and pain-related affective processing. However, whether and how pelvic pain alters the neural activity and connectivity of the ACC and HIPP under baseline and during social pain, and the underlying cellular and molecular mechanisms, remain unclear. Using functional magnetic resonance imaging (fMRI) combined with electrophysiology and biochemistry, we show that pelvic pain, particularly, primary dysmenorrhea (PDM), causes an increase in the functional connectivity between ACC and HIPP in resting-state fMRI, and a smaller reduction in connectivity during social exclusion in PDM females with periovulatory phase. Similarly, model rats demonstrate significantly increased ACC-HIPP synchronization in the gamma band, associating with reduced modulation by ACC-theta on HIPP-gamma and increased levels of receptor proteins and excitation. This study brings together human fMRI and animal research and enables improved therapeutic strategies for ameliorating pain and pain-related affective processing.

Emotional working memory updating in individuals with borderline personality features

BACKGROUND AND OBJECTIVES

Individuals with features of borderline personality disorder (BPD) are highly sensitive to social rejection. Working memory (WM) may play a critical role in processing emotional interpersonal information in BPD. Yet, little is known about how emotional WM operations are related to sensitivity to rejection cues and BPD features. Therefore, this study examined relationships among emotional WM operations, rejection sensitivity, and BPD features.

METHODS

Participants with BPD features (n = 39 with non-suicidal self-injury history; n = 47 without non-suicidal self-injury history) and healthy participants (n = 46) completed an emotional two-back task before and after a social exclusion induction (the Cyberball game).

RESULTS

Results showed that participants with BPD features were slower at discarding faces expressing anger and pain from WM compared to healthy individuals before the social exclusion induction. Participants with BPD features and a history of self-injury were also slower at entering happy faces into WM compared to the other participants. Moreover, across participants, slower WM discarding of angry and pain faces was associated with higher levels of rejection sensitivity. Finally, no group differences emerged with respect to WM entering and discarding operations for emotional faces in response to social exclusion.

LIMITATIONS

This study was conducted in a sample of undergraduate students and did not consider comorbidity with other forms of psychopathology.

CONCLUSIONS

These findings cast light on how emotional WM difficulties may be involved in how individuals with BPD process emotional interpersonal information.

Different semantic and affective meaning of the words associated to physical and social pain in cancer patients on early palliative/supportive care and in healthy, pain-free individuals

Early palliative/supportive care (ePSC) is a medical intervention focused on patient's needs, that integrates standard oncological treatment, shortly after a diagnosis of advanced/metastatic cancer. ePSC improves the appropriate management of cancer pain. Understanding the semantic and emotional impact of the words used by patients to describe their pain may further improve its assessment in the ePSC setting. Psycholinguistics assumes that the semantic and affective properties of words affect the ease by which they are processed and comprehended. Therefore, in this cross-sectional survey study we collected normative data about the semantic and affective properties of words associated to physical and social pain, in order to investigate how patients with cancer pain on ePSC process them compared to healthy, pain-free individuals. One hundred ninety patients and 124 matched controls rated the Familiarity, Valence, Arousal, Pain-relatedness, Intensity, and Unpleasantness of 94 words expressing physical and social pain. Descriptive and inferential statistics were performed on ratings in order to unveil patients' semantic and affective representation of pain and compare it with those from controls. Possible effects of variables associated to the illness experience were also tested. Both groups perceived the words conveying social pain as more negative and pain-related than those expressing physical pain, confirming previous evidence of social pain described as worse than physical pain. Patients rated pain words as less negative, less pain-related, and conveying a lower intense and unpleasant pain than controls, suggesting either an adaptation to the pain experience or the role played by ePSC in improving patients' ability to cope with it. This exploratory study suggests that a chronic pain experience as the one experienced by cancer patients on ePSC affects the semantic and affective representation of pain words.

Sexism-Related Stigma Affects Pain Perception

People with stigmatized characteristics tend to be devalued by others in a given society. The negative experiences related to stigma cause individuals to struggle as they would if they were in physical pain and bring various negative outcomes in the way that physical pain does. However, it is unclear whether stigma related to one's identity would affect their perception of physical pain. To address this issue, using sexism-related paradigms, we found that females had reduced pain threshold/tolerance in the Cold Pressor Test (Experiment 1) and an increased rating for nociceptive laser stimuli with fixed intensity (Experiment 2). Additionally, we observed that there was a larger laser-evoked N1, an early laser-evoked P2, and a larger magnitude of low-frequency component in laser-evoked potentials (LEPs) in the stigma condition than in the control condition (Experiment 3). Our study provides behavioral and electrophysiological evidence that sexism-related stigma affects the pain perception of females.

Social Exclusion Down-Regulates Pain Empathy at the Late Stage of Empathic Responses: Electrophysiological Evidence

Social exclusion has a significant impact on cognition, emotion, and behavior. Some behavioral studies investigated how social exclusion affects pain empathy. Conclusions were inconsistent, and there is a lack of clarity in identifying which component of pain empathy is more likely to be affected. To investigate these issues, we used a Cyberball task to manipulate feelings of social exclusion. Two groups (social exclusion and social inclusion) participated in the same pain empathy task while we recorded event-related potentials (ERP) when participants viewed static images of body parts in painful and neutral situations. The results showed early N2 differentiation between painful and neutral pictures in the central regions in both groups. The pattern at the late controlled processing stage was different. Parietal P3 amplitudes for painful pictures were significantly smaller than those for neutral pictures in the social exclusion group; they did not differ in the social inclusion group. We observed a parietal late positive potential (LPP) differentiation between painful and neutral pictures in both groups. LPP amplitudes were significantly smaller in the social exclusion group than those in the social inclusion group for painful stimuli. Our results indicate that social exclusion does not affect empathic responses during the early emotional sharing stage. However, it down-regulates empathic responses at the late cognitive controlled stage, and this modulation is attenuated gradually. The current study provides neuroscientific evidence of how social exclusion dynamically influences pain empathy.

Noradrenergic activation induced by yohimbine decreases interoceptive accuracy in healthy individuals with childhood adversity

Acute stress affects interoception, but it remains unclear if this is due to activation of the sympatho-adreno-medullary (SAM) or hypothalamic-pituitary-adrenocortical axis. This study aimed to investigate the effect of SAM axis activation on interoceptive accuracy (IAcc). Central alpha2-adrenergic receptors represent a negative feedback mechanism of the SAM axis. Major depressive disorder and adverse childhood experiences (ACE) are associated with alterations in the biological stress systems, including central alpha2-adrenergic receptors. Here, healthy individuals with and without ACE as well as depressive patients with and without ACE (n = 114; all without antidepressant medication) were tested after yohimbine (alpha2-adrenergic antagonist) and placebo. We assessed IAcc and sensibility in a heartbeat counting task. Increases in systolic and diastolic blood pressure after yohimbine confirmed successful SAM axis activation. IAcc decreased after yohimbine only in the healthy group with ACE, but remained unchanged in all other groups (Group × Drug interaction). This effect may be due to selective upregulation of alpha2-adrenergic receptors after childhood trauma, which reduces capacity for attention focus on heartbeats. The sympathetic neural pathway including alpha2-adrenergic circuitries may be essential for mediating interoceptive signal transmission. Suppressed processing of physical sensations in stressful situations may represent an adaptive response in healthy individuals who experienced ACE.

Prognostic Factors in Complex Regional Pain Syndrome Type 1 Occurring in the Korean Army

OBJECTIVES

In Korea, patients diagnosed with complex regional pain syndrome (CRPS) in the army are typically discharged from the army; however, the course of the disease after discharge is not known. The purpose of this study was to investigate the course of CRPS that occurred in the army and to identify the influences of various clinical and psychosocial factors immediately before discharge on the disease course.

METHODS

Clinical profiles and psychosocial status were collected from the medical records of 16 patients with CRPS type 1 who were discharged during the period between March 2017 and April 2018. The degree of improvement after discharge was assessed by follow-up evaluation through telephone contact. Cox proportional hazards regression was performed to identify clinical and psychosocial predictors for the rate of recovery.

RESULTS

The median time to recovery after discharge was 39 weeks (95% confidence interval [CI] = 8.8-69.2 weeks). The sole predictor for time to recovery after discharge was the time period from the onset of pain to discharge. Each one-week increase in the duration of pain experienced in the military was associated with a 18.2% (95% CI = 5.3%-29.5%) reduction in the rate of recovery after discharge (P = 0.007).

CONCLUSIONS

Patients who experienced a short period of pain in the military demonstrated a relatively good prognosis after discharge. This may show how prolonged pain in the army could affect the experience of pain from a social point of view, in that it shows the disease course after a change in the social environment.

Interaction between social pain and physical pain

People often experience two types of pain: social pain and physical pain. The former is related to psychological distance from other people or social groups, whereas the latter is associated with actual or potential tissue damage. Social pain caused by interpersonal interactions causes negative feelings in individuals and has negative consequences to the same degree as physical pain. Various studies have shown an interaction between social pain and physical pain, not only in behavioral performance but also in activities within shared neural regions. Accordingly, the present paper reviews: (1) the interaction between social pain and physical pain in individuals’ behavioral performances; and (2) the overlap in neural circuitry as regards the processing of social pain and physical pain. Understanding the relationship between social pain and physical pain might provide new insights into the nature of these two types of pain, and thus may further contribute to the treatment of illnesses associated with both types of painful experience.

The Effects of Brief Social Exclusion on Pain Perception and Pain Memory in Adolescents

PURPOSE

Peer relationship problems are associated with pain complaints; however, experimental data linking the two are lacking. The purpose of this study was to determine whether brief social exclusion influences pain processing in healthy adolescents.

METHODS

A total of 40 adolescents were randomly assigned to a social exclusion or social inclusion/control condition; they then completed a cold pressor task and provided pain ratings. Two weeks later, participants provided ratings for their memory for pain during the cold pressor (n_analyzed = 33).

RESULTS

Social exclusion had no immediate effect on pain ratings; however, adolescents assigned to the exclusion condition recalled the pain as being less intense compared with adolescents in the inclusion/control condition.

CONCLUSIONS

In healthy adolescents, brief social exclusion may represent an emotionally salient event that inhibits subsequent rumination or focus on physical pain. Findings should be replicated, and future studies should include youth with chronic pain and/or personal histories of peer victimization.

Future Directions in Peer Relations Research

Peer relationships among youth have been examined as predictors of mental health outcomes for at least fifty years, revealing dozens of discrete peer constructs that each are associated with adjustment in childhood, adolescence, and later in adulthood. Future research may benefit by examining a range of new outcomes and psychological processes that have been discussed recently in related literatures. This paper reviews recent research on interpersonal determinants of physical health outcomes, and opportunities for greater examination of 1) peer influence processes toward health risk behaviors; 2) neural correlates of peer adversity; 3) adverse peer experiences that may affect physiological markers of stress response; and 4) immune system markers of peer adversity. Additional future directions include the study of differences in the forms and functions of peer interactions within the digital age.

Effects of rejection intensity and rejection sensitivity on social approach behavior in women

Objective

Perceived rejection plays an important role for mental health and social integration. This study investigated the impact of rejection intensity and rejection sensitivity on social approach behavior.

Method

121 female participants were randomly assigned to one of three conditions differing in the degree of induced rejection (inclusion, medium rejection, severe rejection). Thereafter they were asked to interact with an unknown person during a touch-based cooperative task.

Results

Participants high in rejection sensitivity sought significantly less physical contact than participants low in rejection sensitivity. Individuals in the medium rejection condition touched their partners more often than those in the included condition, while no difference between included and severely rejected participants could be observed.

Conclusions

The results suggest that the intensity of rejection matters with regard to coping. While participants in the medium intensity rejection condition aimed to ‘repair’ their social self by seeking increased contact with others, severely rejected participants did not adapt their behavior compared to included participants. Implications for therapy are discussed.

Shared Sensitivity to Physical Pain and Social Evaluation

Many studies have demonstrated a link between experiences of physical pain and those of social rejection, both of which can trigger cognitive processes involved in detecting, orienting toward, or reacting to potentially threatening events. This study tested the hypothesis that healthy individuals who are more sensitive to physical pain are also more sensitive to social rejection. We recruited participants with high or low pain-sensitivity (HPS and LPS), as assessed by scores on a pain-sensitivity questionnaire and confirmed by experimental pain-sensitivity assessment. A modified social-judgment task was adopted in which participants first provided expectations about being liked/disliked by "peers", and then received "peers" feedback indicating acceptance or rejection. While both groups rated rejection as more unpleasant than acceptance, this difference was greater in the HPS group. Electroencephalographic results showed that only participants in the HPS group exhibited greater early delta/theta-oscillations (δ/θ-oscillations) in response to rejection than to acceptance, regardless of whether the feedback was expected or unexpected. However, both groups consistently exhibited greater late δ/θ-oscillations in response to rejection when the feedback was unexpected. These results suggest that participants in the HPS group were more sensitive to social cues signaling acceptance or rejection at early stages of information processing. Furthermore, neither early nor late δ/θ-oscillations following nonsocial feedback (correct or incorrect time-estimation) differed between groups. Altogether, these results supported the idea of shared sensitivity in detecting potentially physical and social threats in the environment. PERSPECTIVES: This study showed the greater emotional reactions and early-latency δ/θ-oscillations in response to social evaluation among healthy individuals with high pain sensitivity. It supports the idea of shared sensitivity to physical pain and social evaluation, which could be governed by a common system for detecting and monitoring potentially environmental threats.

Processing of Painful Pictures in Individuals With High and Low Rejection Sensitivity: Evidence From Event-Related Potentials

An increasing number of studies have investigated the relation between the processing of painful stimuli and rejection. Little was known, however, about the impact of the rejection sensitivity (RS) on the processing of painful pictures. This study addressed this issue using high temporal resolution event-related potential techniques. Thirty high RS (20 women and 10 men who scored in the top 20th percentile of the Rejection Sensitivity Questionnaire scores) and 30 low RS (20 women and 10 men who scored in the bottom 20th percentile) volunteers participated in the experiment. All volunteers performed a discrimination task of painful pictures in which they were asked to judge whether target pictures were painful or not. Behaviorally, participants exhibited shorter reaction times for painful than nonpainful pictures. For the P100 component, low RS participants showed stronger brain activities for painful than nonpainful pictures, suggesting vigilance toward painful pictures. High RS participants, however, exhibited no P100 amplitude differences between painful and nonpainful pictures, indicating an analgesia phenomenon. Furthermore, we found that there were larger amplitudes in the late late positive complex component for painful compared with nonpainful pictures, regardless of participants' RS. This suggested a person's further assessment for painful pictures. In short, our findings demonstrated that the level of RS influenced the pain processing at a very early stage of processing.

Feeling Hurt: Revisiting the Relationship Between Social and Physical Pain

Pain overlap theory has generated decades of controversy and still receives considerable research attention. A major advance has been the revelation that social and physical pain activate similar neural regions, providing suggestive evidence of a “piggybacked” alarm system that coevolved to detect social exclusion. Recent developments, however, have brought neural evidence for pain overlap into question. We analyze these developments from a social psychological perspective and identify the need for a reformulated approach. To meet this need, we provide a framework that a priori predicts generalized overlap and specific divergence across a range of biopsychosocial domains. The framework points to a functional pattern for similarities and differences, which can be utilized to generate testable hypotheses so that the field can move forward. To demonstrate the utility and promise of the framework, we identify key hypotheses relating to attention, motivation, and responses to pain, and review research relevant to these hypotheses.

A preliminary analysis of the association between perceived stigma and HIV-related pain in South Africans living with HIV

Background

Stigma related to the human immunodeficiency virus (HIV) remains common and has been associated with severity of HIV-related symptoms. Associations between HIV stigma and HIV-related pain, one of the most common symptoms in HIV, have however not been investigated. Data from low back pain populations suggest that stigma is associated with worse pain intensity and so we hypothesised that the same would be the case in HIV.

Aim

The goal of this study was to assess the association between HIV stigma and pain intensity in people living with HIV (PLWH) with chronic pain whilst controlling for depression, a well-established correlate of pain.

Setting

The study took place at an HIV clinic in Johannesburg, South Africa.

Methods

Mediation analysis was used to assess the effect of depression on the relationship between stigma and pain intensity in a cross-sectional cohort of 50 PLWH and chronic pain (pain most days of the week for > 3 months). All participants were assessed using the HIV/AIDS Stigma Instrument – PLWA, an 11-point numerical pain rating scale and the Beck Depression Inventory II.

Results

In all, 88% (44/50) of participants reported experiencing some form of HIV stigma (HIV stigma scale score ≥ 1). Worst pain intensity and depressive symptoms individually correlated with total stigma score (Spearman’s r = 0.33, p = 0.02 for both). The mediation analysis highlighted that mediation of the relationship by depression was equivocal (b = -0.002, bootstrapped confidence interval -0.02 to 0.00).

Conclusion

Whilst these preliminary data are marginal, they do suggest that associations between HIV stigma and HIV-related pain warrant further investigation. Future study should also include potential mechanisms, which may include mediation through depression.

Childhood Trauma Affects Stress-Related Interoceptive Accuracy

Early life adversity (ELA) may cause permanent disturbances in brain-body signaling. These disturbances are thought to contribute to physical symptoms and emotional dysregulation in adulthood. The current study investigated the effects of childhood trauma on young adults' interoceptive accuracy as an indicator of brain-body communication that may be dysregulated by ELA. Sixty-six participants completed an online questionnaire followed by a laboratory session including the socially evaluated cold pressor stress test during which ECG, salivary cortisol, and interoceptive accuracy were assessed. Childhood trauma was negatively related to interoceptive accuracy (IAc) after the stressor. This stress effect could not be observed for heart rate and cortisol, which were unrelated to IAc. Participants reporting higher baseline unpleasantness exhibited lower IAc after the stressor, while increases in unpleasantness due to the stressor were associated with higher IAc. Unpleasantness at baseline mediated the effect of childhood trauma on IAc after the stressor.

The impact of social-emotional context in chronic cancer pain: patient-caregiver reverberations : Social-emotional context in chronic cancer pain

PURPOSE

Pain is a multifactorial and subjective experience. Psychological and social factors can modulate it. This study analyzed whether and how prolonged cancer pain is related to the social-relational environment's characteristics. Specifically, we investigated whether the caregiver's emotional support, his/her compassion ability or, on the contrary, his/her personal distress, associates with the patient's pain level.

METHODS

The sample consisted of 38 cancer patients suffering from pain and 38 family caregivers. The patients completed the McGill Pain Questionnaire (MPQ), the Balanced Emotional Empathy Scale (BEES) referred to caregiver, and an interview concerning the patient's perception of the caregiver's compassion level. Caregivers completed the distress thermometer (DT), the BEES, and an interview assessment of their compassion level.

RESULTS

Caregiver's distress level correlated with patient's pain intensity (r = .389; p = .028). Exploratory linear regression confirmed this association (R² = .151; F (1, 30) = 5.33; p = .028; β = 0.389). The number of problems reported by caregivers correlated with the patients' pain level (r = .375; p = .020), which was verified in a regression analysis (R² = .140; F (1, 36) = 5.88; p = .020; β = 0.375). In particular, the caregiver's amount of emotional problems was related to patient's pain level (r = .427; p = .007); this result was reaffirmed in a regression (R² = .182; F (1, 36) = 8.03; p = .007; β = 0.427).

CONCLUSIONS

Our results show an association between social suffering, as indicated by the caregiver's emotional distress and the patient's physical pain. The results also highlight high distress levels and emotional problems among caregivers. The work emphasizes the need of a bio-psychosocial approach in managing cancer pain, along with the necessity to find effective interventions to fight emotional distress in family caregivers. The recovery of the caregivers' emotional resources could have beneficial implications on the patients' pain.

Social support, social undermining, and acute clinical pain in women: Mediational pathways of negative cognitive appraisal and emotion

Women may be disproportionately vulnerable to acute pain, potentially due to their social landscape. We examined whether positive and negative social processes (social support and social undermining) are associated with acute pain and if the processes are linked to pain via negative cognitive appraisal and emotion (pain catastrophizing, hyperarousal, anger). Psychosocial variables were assessed in inner-city women (N = 375) presenting to an Emergency Department with acute pain. The latent cognitive-emotion variable fully mediated social undermining and support effects on pain, with undermining showing greater impact. Pain may be alleviated by limiting negative social interactions, mitigating risks of alternative pharmacological interventions.

Beyond unpleasantness. Social exclusion affects the experience of pain, but not of equally-unpleasant disgust

Seminal theories posit that social and physical suffering underlie partly-common representational code. It is unclear, however, if this shared information reflects a modality-specific component of pain, or alternatively a supramodal code for properties common to many aversive experiences (unpleasantness, salience, etc.). To address this issue, we engaged participants in a gaming experience in which they were excluded or included by virtual players. After each game session, participants were subjected to comparably-unpleasant painful or disgusting stimuli. Subjective reports and cardiac responses revealed a reduced sensitivity to pain following exclusion relative to inclusion, an effect which was more pronounced in those participants who declared to feel more affected by the gaming manipulation. Such modulation was not observed for disgust. These findings indicate that the relationship between social and physical suffering does not generalize to disgust, thus suggesting a shared representational code at the level of modality-specific components of pain.

Disrupted physical pain sensation by social exclusion in women with dysmenorrhea

Purpose

Dysmenorrhea (DM), which involves both acute and chronic pain, is associated with abnormalities in pain modulation. Previous studies have shown that social pain relies on some of the same neural regions that process physical pain, highlighting a possible physical–social pain overlap. However, evidence suggesting that social pain modulates the sensitivity to physical pain remains controversial. The present study aimed to assess the effects of social pain manipulation on sensitivity to physical pain in DM sufferers and healthy female controls (HC).

Materials and methods

Fifty-nine otherwise healthy patients with DM and 55 HC matched for age, education, calendar age, and gynecological age were randomly assigned to inclusion or exclusion conditions of Cyberball, a virtual ball tossing game used to induce social pain (social exclusion). Pain threshold and pain tolerance in response to nociceptive pressure and cold stimuli were assessed before and after the study condition.

Results

In response to cold stimulation, pain threshold and tolerance significantly reduced in DM compared to HC participants in the inclusion condition, indicating increased pain sensitivity in DM group. However, exclusion increased the pain threshold and tolerance compared to inclusion in DM but decreased pain threshold and tolerance in HC. Neither inclusion nor exclusion altered pressure pain sensitivity in DM, but, after social exclusion, DM participants were more fearful of being evaluated unfavorably. No significant differences were observed in self-esteem scores between DM and HC after both inclusion and exclusion.

Conclusion

We observed altered pain sensation in DM participants in response to social pain manipulation, suggesting that DM not only impacts menstruation but also modulates the perception of pain more generally, especially its affective processes. The present study suggests that the effect of social pain on pain sensation and certain psychometric properties depends on previous pain experience, implicating a reciprocal influence of social and physical pain processes.

Ostracized but why? Effects of attributions and empathy on connecting with the socially excluded

The present research examined people's responses towards others' exclusion experience. The authors predicted that both causal attributions and empathy would mediate whether people affiliate with a victim of an ambiguous exclusion experience. Perceivers observing another's exclusion (relative to inclusion) without clearly announced reasons chose to affiliate with the target and this was mediated by increased external attributions for the exclusion (Studies 1a, 1b, 2). When the attributions people made for the exclusion of a target was experimentally manipulated, internal attributions decreased desire for affiliation relative to external or ambiguous attributions, and this was mediated by differences in empathy for the target (Study 3). Further, external attributions arisen from perceiving a causally unclear exclusion leads to an empathetic response which results in an increased desire to affiliate with the target (Study 4). Future directions on perceptions of those who have been excluded are discussed.