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Terry EL, Meng L, Huo Z, Bartley EJ. Examining Reactivity and Recovery Patterns of Pain-Evoked Cortisol and Alpha-Amylase Trajectories: Relations Between Psychological Markers of Risk and Resilience. THE JOURNAL OF PAIN 2024; 25:104464. [PMID: 38246254 PMCID: PMC11128348 DOI: 10.1016/j.jpain.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/12/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024]
Abstract
Chronic low back pain (cLBP) is one of the leading causes of disability globally and represents an enormous burden to aging adults. While numerous factors contribute to cLBP, dysregulation in the hypothalamic-pituitary-adrenal axis and autonomic nervous system functioning have been implicated in its pathogenesis. It is well documented that negative psychological states can modulate biological stress responsivity in chronic pain; however, little is known regarding the influence of positive psychological factors in this relationship. The aim of this study was to examine the association between psychological risk and resilience factors with patterns of physiological stress reactivity and recovery in 60 older adults with cLBP. Participants completed measures of hope, optimism, pain catastrophizing, and perceived stress, and underwent psychophysical pain testing assessing responses to painful pressure, heat, and cold stimuli. Salivary samples were obtained prior to pain induction and at 7 time points spanning 90 minutes after pain testing terminated. To examine reactivity and recovery profiles in hypothalamic-pituitary-adrenal axis and autonomic nervous system function, samples were assayed for cortisol and alpha-amylase, respectively. Results revealed higher levels of hope and optimism were associated with increased cortisol reactivity (p's < .003) and more rapid recovery (p's = .001). Further, pain catastrophizing and perceived stress were associated with cortisol reactivity, with lower levels of these factors predicting larger increases in cortisol from baseline to peak levels (p's < .04). No significant differences in reactivity or recovery patterns emerged for alpha-amylase. Overall, findings highlight the role of psychological risk and resilience factors in modulating physiological stress reactivity. PERSPECTIVE: This article investigated whether psychosocial risk and resilience factors were associated with stress reactivity and recovery in response to laboratory-based pain testing in older adults with chronic low back pain. Results indicate that high resilience factors may be protective by modulating adrenocortical reactivity and recovery profiles.
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Affiliation(s)
- Ellen L. Terry
- University of Florida, Biobehavioral Nursing Science
- University of Florida, Pain Research and Intervention Center of Excellence (PRICE)
| | | | - Zhiguang Huo
- University of Florida, Department of Biostatistics
| | - Emily J. Bartley
- University of Florida, Pain Research and Intervention Center of Excellence (PRICE)
- University of Florida, Community Dentistry and Behavioral Science
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Rösner C, Tüscher O, Petrowski K. Resilience as a predictor of habituation. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01658-y. [PMID: 37526676 DOI: 10.1007/s00406-023-01658-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
Habituation refers to the physiological adaptation to recurrent stressors, which can be measured by cortisol levels, and is considered a central mechanism in reducing allostatic load. Resilience, a potential factor influencing stress reduction, is the focus of this study. Specifically, the study aims to investigate the impact of resilience, as assessed by the Brief Resilience Scale (BRS), on habituation. The Trier Social Stress Test (TSST) was used as the recurrent stressor, and it was administered to each of the 56 subjects at 4 consecutive measurements. To assess habituation, various physiological parameters including the area under the curve with respect to the ground (AUCg) and with respect to the increase (AUCi), cortisol peak, slope from baseline to peak, and recovery were calculated. Mixed linear models were employed to examine the differences in the influence of resilience on habituation across the different time points. The findings indicate that the influence of resilience significantly varies from the first to the fourth measurement time point for AUCg (p = .048), while no significant differences were observed for the other cortisol parameters. The effects plot suggests that individuals with higher levels of resilience exhibit lower AUCg values throughout the measurements. These findings provide initial evidence supporting resilience as a predictor of cortisol habituation. However, future studies should also consider dynamic resilience models, utilizing longitudinally assessed resilience as a predictor for habituation, to explore whether resilience acts as a determinant of habituation or if habituation itself constitutes a resilience mechanism.
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Affiliation(s)
- Christoph Rösner
- Medical Psychology & Medical Sociology, University Medical Center of the Johannes Gutenberg, University Mainz, Duesbergweg 6, 55128, Mainz, Germany.
| | - Oliver Tüscher
- Leibniz Institute for Resilience Research (LIR) gGmbH Mainz, Wallstr. 7, 55122, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg, University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
- Institute of Molecular Biology gGmbH Mainz, Ackermannweg 4, 55128, Mainz, Germany
| | - Katja Petrowski
- Medical Psychology & Medical Sociology, University Medical Center of the Johannes Gutenberg, University Mainz, Duesbergweg 6, 55128, Mainz, Germany
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Wong YP, Yang H. The influence of subjective socioeconomic status on executive functions in middle-aged and older adults. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2023; 30:505-522. [PMID: 35354363 DOI: 10.1080/13825585.2022.2055738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Subjective socioeconomic status (SES) has been shown to influence both psychological and biological outcomes. However, less is known about whether its influence extends to cognitive outcomes. We examined the relation between subjective SES and executive functions (EF)-a set of cognitive control processes-and its underlying mechanisms. By analyzing a nationally representative cohort of middle-aged and older adults (age 40-80) from the MIDUS 2 National Survey and Cognitive Project, we tested a serial mediation model with sense of control and health as sequential mediators. Using structural equation modeling, we found that subjective SES is indirectly related to EF via sense of control and health, above and beyond objective SES and other key covariates. Our study highlights one of the possible biopsychosocial mechanisms that underlies the relation between status-related subjective perceptions of inequalities and executive functioning skills in middle and late adulthood.
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Affiliation(s)
- Yu Ping Wong
- School of Social Sciences, Singapore Management University Singapore Singapore
| | - Hwajin Yang
- School of Social Sciences, Singapore Management University Singapore Singapore
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Delgado-Gallén S, Soler MD, Cabello-Toscano M, Abellaneda-Pérez K, Solana-Sánchez J, España-Irla G, Roca-Ventura A, Bartrés-Faz D, Tormos JM, Pascual-Leone A, Cattaneo G. Brain system segregation and pain catastrophizing in chronic pain progression. Front Neurosci 2023; 17:1148176. [PMID: 37008229 PMCID: PMC10060861 DOI: 10.3389/fnins.2023.1148176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
Pain processing involves emotional and cognitive factors that can modify pain perception. Increasing evidence suggests that pain catastrophizing (PC) is implicated, through pain-related self-thoughts, in the maladaptive plastic changes related to the maintenance of chronic pain (CP). Functional magnetic resonance imaging (fMRI) studies have shown an association between CP and two main networks: default mode (DMN) and dorsoattentional (DAN). Brain system segregation degree (SyS), an fMRI framework used to quantify the extent to which functional networks are segregated from each other, is associated with cognitive abilities in both healthy individuals and neurological patients. We hypothesized that individuals suffering from CP would show worst health-related status compared to healthy individuals and that, within CP individuals, longitudinal changes in pain experience (pain intensity and affective interference), could be predicted by SyS and PC subdomains (rumination, magnification, and helplessness). To assess the longitudinal progression of CP, two pain surveys were taken before and after an in-person assessment (physical evaluation and fMRI). We first compared the sociodemographic, health-related, and SyS data in the whole sample (no pain and pain groups). Secondly, we ran linear regression and a moderation model only in the pain group, to see the predictive and moderator values of PC and SyS in pain progression. From our sample of 347 individuals (mean age = 53.84, 55.2% women), 133 responded to having CP, and 214 denied having CP. When comparing groups, results showed significant differences in health-related questionnaires, but no differences in SyS. Within the pain group, helplessness (β = 0.325; p = 0.003), higher DMN (β = 0.193; p = 0.037), and lower DAN segregation (β = 0.215; p = 0.014) were strongly associated with a worsening in pain experience over time. Moreover, helplessness moderated the association between DMN segregation and pain experience progression (p = 0.003). Our findings indicate that the efficient functioning of these networks and catastrophizing could be used as predictors of pain progression, bringing new light to the influence of the interplay between psychological aspects and brain networks. Consequently, approaches focusing on these factors could minimize the impact on daily life activities.
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Affiliation(s)
- Selma Delgado-Gallén
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina, Universitat Autónoma de Barcelona, Bellaterra, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
- *Correspondence: Selma Delgado-Gallén,
| | - MD Soler
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina, Universitat Autónoma de Barcelona, Bellaterra, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - María Cabello-Toscano
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciéncies de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Kilian Abellaneda-Pérez
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina, Universitat Autónoma de Barcelona, Bellaterra, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Javier Solana-Sánchez
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina, Universitat Autónoma de Barcelona, Bellaterra, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Goretti España-Irla
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina, Universitat Autónoma de Barcelona, Bellaterra, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Alba Roca-Ventura
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciéncies de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - David Bartrés-Faz
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciéncies de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Josep M. Tormos
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Centro de Investigación Traslacional San Alberto Magno, Facultad de Medicina y Ciencias de la Salud, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - Alvaro Pascual-Leone
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew SeniorLife, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Gabriele Cattaneo
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina, Universitat Autónoma de Barcelona, Bellaterra, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
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Mosch B, Hagena V, Herpertz S, Ruttorf M, Diers M. Neural correlates of control over pain in fibromyalgia patients. Neuroimage Clin 2023; 37:103355. [PMID: 36848728 PMCID: PMC9982683 DOI: 10.1016/j.nicl.2023.103355] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/13/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
The perceived lack of control over the experience of pain is arguably-one major cause of agony and impaired life quality in patients with chronic pain disorders as fibromyalgia (FM). The way perceived control affects subjective pain as well as the underlying neural mechanisms have so far not been investigated in chronic pain. We used functional magnetic resonance imaging (fMRI) to examine the neural correlates of self-controlled compared to computer-controlled heat pain in healthy controls (HC, n = 21) and FM patients (n = 23). Contrary to HC, FM failed to activate brain areas usually involved in pain modulation as well as reappraisal processes (right ventrolateral (VLPFC), dorsolateral prefrontal cortex (DLPFC) and dorsal anterior cingulate cortex (dACC)). Computer-controlled (compared to self-controlled) heat revealed significant activations of the orbitofrontal cortex (OFC) in HC, whereas FM activated structures that are typically involved in neural emotion processing (amygdala, parahippocampal gyrus). Additionally, FM displayed disrupted functional connectivity (FC) of the VLPFC, DLPFC and dACC with somatosensory and pain (inhibition)-related areas during self-controlled heat stimulation as well as significantly decreased gray matter (GM) volumes compared to HC in DLPFC and dACC. The described functional and structural changes provide evidence for far-reaching impairments concerning pain-modulatory processes in FM. Our investigation represents a first demonstration of dysfunctional neural pain modulation through experienced control in FM according to the extensive functional and structural changes in relevant sensory, limbic and associative brain areas. These areas may be targeted in clinical pain therapeutic methods involving TMS, neurofeedback or cognitive behavioral trainings.
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Affiliation(s)
- Benjamin Mosch
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum 44791, Germany
| | - Verena Hagena
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum 44791, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum 44791, Germany
| | - Michaela Ruttorf
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Germany; Mannheim Institute for Intelligent Systems in Medicine, Heidelberg University, Mannheim 68167, Germany
| | - Martin Diers
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum 44791, Germany.
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A wearable soft robot that can alleviate the pain and fear of the wearer. Sci Rep 2022; 12:17003. [PMID: 36253420 PMCID: PMC9576738 DOI: 10.1038/s41598-022-21183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/23/2022] [Indexed: 12/29/2022] Open
Abstract
Social soft robotics may provide a new solution for alleviating human pain and fear. Here, we introduce a hand-held soft robot that can be clenched by the wearer. The robot comprises small airbags that can be inflated to provide the wearer with a feeling of being clenched. We then conducted an in-depth study of 66 adults who participated in a pain research protocol using thermal stimulation to investigate the effect of wearing the robot on pain perception and fear of injections. Pain assessment scale scores for perceived pain decreased significantly [Formula: see text] when participants wore the robot compared with the baseline condition in which the robot was not worn. In addition, the saliva test results showed a downward trend in oxytocin level when the robot provided the wearer with haptic feedback via the inflation of the internal airbags in response to the wearer's clench. Furthermore, the negative psychological state of participants, as measured using the positive and negative affect scale, improved significantly when wearing the robot. We also revealed that the salivary cortisol level, an indicator of stress, decreased significantly across all participants at the end of the experiment. In addition, participants' fear of injections was significantly improved after participation in the experiment. These results suggest that the wearable soft robot may alleviate the human perception of pain and fear in during medical treatments, such as vaccinations.
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Aziz F, Khan MF. Association of Academic Stress, Acne Symptoms and Other Physical Symptoms in Medical Students of King Khalid University. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148725. [PMID: 35886577 PMCID: PMC9316820 DOI: 10.3390/ijerph19148725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 02/01/2023]
Abstract
Academic stress has varied effects on medical student life due to multiple factors, like study load, competition, frequent assessment, social pressure, etc. The authors of this paper conducted research to find the academic stress level and its sequel over acne and other physical symptoms on the medical students of King Khalid University (KKU), Saudi Arabia. A total of 168 participant responses were analyzed. Data collection was performed using a self-administered online questionnaire through the university website portal. The study tool was comprised of four sections: demographic characteristics, academic stress, acne symptoms, and other physical symptoms. Statistical analysis was performed using SPSS software. A high proportion of females (88.7%) participated in the study. Upon categorization of overall academic stress, it was found that a majority of the medical students were moderately stressed (58.34%). The response on the academic stress scale revealed that exams are the major cause of stress among students. The Mean ± SD of academic stress, acne symptoms, and physical symptoms differ significantly at <0.01 level of significance. Overall academic stress showed a significant positive association with acne (<0.01) and physical symptoms (<0.01). The strength of this study is the fact that its categorization of stress caused by academics has not been done elsewhere. In addition, the impact of acne and physical symptoms has not been found in recent literature. Keeping the outcome of the present study in mind, it is suggested to arrange timely counselling sessions in medical colleges which can alert medical students to remain conscious about the consequences of stress.
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Affiliation(s)
- Farah Aziz
- Department of Basic Medical Sciences, College of Applied Medical Sciences, King Khalid University, Khamis Mushait 62529, Saudi Arabia
- Correspondence:
| | - Mohammad Fareed Khan
- Department of Laboratory Medicine, Abha International Private Hospital, Abha 61431, Saudi Arabia;
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Tidmarsh LV, Harrison R, Ravindran D, Matthews SL, Finlay KA. The Influence of Adverse Childhood Experiences in Pain Management: Mechanisms, Processes, and Trauma-Informed Care. FRONTIERS IN PAIN RESEARCH 2022; 3:923866. [PMID: 35756908 PMCID: PMC9226323 DOI: 10.3389/fpain.2022.923866] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/20/2022] [Indexed: 12/30/2022] Open
Abstract
Adverse childhood experiences (ACEs) increase the likelihood of reduced physical and psychological health in adulthood. Though understanding and psychological management of traumatic experiences is growing, the empirical exploration of ACEs and physical clinical outcomes remains under-represented and under-explored. This topical review aimed to highlight the role of ACEs in the experience of chronic pain, pain management services and clinical decision making by: (1) providing an overview of the relationship between ACEs and chronic pain; (2) identifying biopsychosocial mechanisms through which ACEs may increase risk of persistent pain; (3) highlighting the impact of ACEs on patient adherence and completion of pain management treatment; and (4) providing practical clinical implications for pain management. Review findings demonstrated that in chronic pain, ACEs are associated with increased pain complications, pain catastrophizing and depression and the combination of these factors further heightens the risk of early treatment attrition. The pervasive detrimental impacts of the COVID-19 pandemic on ACEs and their cyclical effects on pain are discussed in the context of psychological decline during long treatment waitlists. The review highlights how people with pain can be further supported in pain services by maintaining trauma-informed practices and acknowledging the impact of ACEs on chronic pain and detrimental health outcomes. Clinicians who are ACE-informed have the potential to minimize the negative influence of ACEs on treatment outcomes, ultimately optimizing the impact of pain management services.
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Affiliation(s)
- Lydia V. Tidmarsh
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
- *Correspondence: Lydia V. Tidmarsh
| | - Richard Harrison
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | | | - Samantha L. Matthews
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Katherine A. Finlay
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
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Simon E, Zsidó AN, Birkás B, Csathó Á. Pain catastrophizing, pain sensitivity and fear of pain are associated with early life environmental unpredictability: a path model approach. BMC Psychol 2022; 10:97. [PMID: 35399087 PMCID: PMC8996610 DOI: 10.1186/s40359-022-00800-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background Socioeconomic disadvantages in the childhood environment might strongly influence beliefs and behavior characterizing the adult years. When children experience unpredictable and adverse situations, they develop an unpredictability schema with the core belief that situations are unpredictable. Methods In two studies, we examined the association of childhood socioeconomic disadvantages with self-reported pain sensitivity, pain catastrophizing, and pain-related fear. Multidimensional survey measures were used to assess environmental conditions experienced in childhood. In addition, participants completed the Pain Catastrophizing Scale, Pain Sensitivity Questionnaire, Body Awareness Questionnaire, Unpredictability Schema Questionnaire, and Fear of Pain Questionnaire. In Study 1 (N = 252), in separate models, we examined pain sensitivity and pain catastrophizing of a community sample of pain-free young individuals in association with their childhood experiences. In Study 2 (N = 293), in a new sample, but with a wider age range, we examined the association of early life socioeconomic disadvantages with pain-related fear. In both studies, the predictions were tested with Structural Equation Modeling. Our models constituted a path from childhood socioeconomic status and household unpredictability to pain variables via the factors of family resources, unpredictability schemas, and body awareness. Results and conclusions The findings converged on the conclusion that individuals experiencing disadvantageous early life conditions tended to have an elevated level of pain catastrophizing, higher perceived sensitivity to pain, and higher level of pain-related fear. These associations were mediated by an unpredictability schema and body awareness. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00800-0.
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Affiliation(s)
- Eszter Simon
- Department of Behavioral Sciences, Medical School, University of Pécs, Szigeti str. 12, 7624, Pécs, Hungary
| | - András N Zsidó
- Institute of Psychology, University of Pécs, Pécs, Ifjúság str. 6, 7624, Pécs, Hungary
| | - Béla Birkás
- Department of Behavioral Sciences, Medical School, University of Pécs, Szigeti str. 12, 7624, Pécs, Hungary
| | - Árpád Csathó
- Department of Behavioral Sciences, Medical School, University of Pécs, Szigeti str. 12, 7624, Pécs, Hungary.
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Heinzel JC, Dadun LF, Prahm C, Winter N, Bressler M, Lauer H, Ritter J, Daigeler A, Kolbenschlag J. Beyond the Knife-Reviewing the Interplay of Psychosocial Factors and Peripheral Nerve Lesions. J Pers Med 2021; 11:jpm11111200. [PMID: 34834552 PMCID: PMC8624495 DOI: 10.3390/jpm11111200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 01/12/2023] Open
Abstract
Peripheral nerve injuries are a common clinical problem. They not only affect the physical capabilities of the injured person due to loss of motor or sensory function but also have a significant impact on psychosocial aspects of life. The aim of this work is to review the interplay of psychosocial factors and peripheral nerve lesions. By reviewing the published literature, we identified several factors to be heavily influenced by peripheral nerve lesions. In addition to psychological factors like pain, depression, catastrophizing and stress, social factors like employment status and worker's compensation status could be identified to be influenced by peripheral nerve lesions as well as serving as predictors of functional outcome themselves, respectively. This work sheds a light not only on the impact of peripheral nerve lesions on psychosocial aspects of life, but also on the prognostic values of these factors of functional outcome. Interdisciplinary, individualized treatment of patients is required to identify patient at risk for adverse outcomes and provide them with emotional support when adapting to their new life situation.
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Affiliation(s)
- Johannes C. Heinzel
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (L.F.D.); (C.P.); (M.B.); (H.L.); (J.R.); (A.D.); (J.K.)
- Correspondence: ; Tel.: +49-7071-6061038
| | - Lucy F. Dadun
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (L.F.D.); (C.P.); (M.B.); (H.L.); (J.R.); (A.D.); (J.K.)
| | - Cosima Prahm
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (L.F.D.); (C.P.); (M.B.); (H.L.); (J.R.); (A.D.); (J.K.)
| | - Natalie Winter
- Department of Neurology, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany;
| | - Michael Bressler
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (L.F.D.); (C.P.); (M.B.); (H.L.); (J.R.); (A.D.); (J.K.)
| | - Henrik Lauer
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (L.F.D.); (C.P.); (M.B.); (H.L.); (J.R.); (A.D.); (J.K.)
| | - Jana Ritter
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (L.F.D.); (C.P.); (M.B.); (H.L.); (J.R.); (A.D.); (J.K.)
| | - Adrien Daigeler
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (L.F.D.); (C.P.); (M.B.); (H.L.); (J.R.); (A.D.); (J.K.)
| | - Jonas Kolbenschlag
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (L.F.D.); (C.P.); (M.B.); (H.L.); (J.R.); (A.D.); (J.K.)
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11
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Liu Q, Wu J, Zhang L, Sun X, Guan Q, Yao Z. The Relationship Between Perceived Control and Hypothalamic-Pituitary-Adrenal Axis Reactivity to the Trier Social Stress Test in Healthy Young Adults. Front Psychol 2021; 12:683914. [PMID: 34484038 PMCID: PMC8415907 DOI: 10.3389/fpsyg.2021.683914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Psychological factors can modulate the hypothalamic-pituitary-adrenal (HPA) axis activity toward stressors. Animal studies demonstrated that uncontrollability was one critical factor associated with HPA axis stress response, but the results in human studies were inconsistent. The current study adopted a standardized laboratory stress induction procedure, the Trier Social Stress Test (the TSST), as the stressor to regulate the objective controllability level, and young adult participants were asked to rate their subjectively perceived control level toward the stressor and measured their cortisol stress responses (N=54; 19 females and 35 males) to address this concern. Results showed that participants' perceived control on the TSST was related to the cortisol stress response. In other words, under the stress of a certain objective controllability level, the lower the subjectively perceived control level, the greater the HPA axis response. This finding suggested that, in addition to objective controllability, subjectively perceived control is a psychological factor that regulates activation of the HPA axis in young adults.
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Affiliation(s)
- Qian Liu
- Center for Brain Disorder and Cognitive Science, Shenzhen University, Shenzhen, China.,Shenzhen Futian Foreign Languages School, Shenzhen, China
| | - Jianhui Wu
- Center for Brain Disorder and Cognitive Science, Shenzhen University, Shenzhen, China.,Shenzhen Institute of Neuroscience, Shenzhen, China
| | - Liang Zhang
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiaofang Sun
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Qing Guan
- Center for Brain Disorder and Cognitive Science, Shenzhen University, Shenzhen, China
| | - Zhuxi Yao
- Center for Brain Disorder and Cognitive Science, Shenzhen University, Shenzhen, China
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12
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Stressor controllability modulates the stress response in fish. BMC Neurosci 2021; 22:48. [PMID: 34348667 PMCID: PMC8336412 DOI: 10.1186/s12868-021-00653-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In humans the stress response is known to be modulated to a great extent by psychological factors, particularly by the predictability and the perceived control that the subject has of the stressor. This psychological dimension of the stress response has also been demonstrated in animals phylogenetically closer to humans (i.e. mammals). However, its occurrence in fish, which represent a divergent vertebrate evolutionary lineage from that of mammals, has not been established yet, and, if present, would indicate a deep evolutionary origin of these mechanisms across vertebrates. Moreover, the fact that psychological modulation of stress is implemented in mammals by a brain cortical top-down inhibitory control over subcortical stress-responsive structures, and the absence of a brain cortex in fish, has been used as an argument against the possibility of psychological stress in fish, with implications for the assessment of fish sentience and welfare. Here, we have investigated the occurrence of psychological stress in fish by assessing how stressor controllability modulates the stress response in European seabass (Dicentrarchus labrax). RESULTS Fish were exposed to either a controllable or an uncontrollable stressor (i.e. possibility or impossibility to escape a signaled stressor). The effect of loss of control (possibility to escape followed by impossibility to escape) was also assessed. Both behavioral and circulating cortisol data indicates that the perception of control reduces the response to the stressor, when compared to the uncontrollable situation. Losing control had the most detrimental effect. The brain activity of the teleost homologues to the sensory cortex (Dld) and hippocampus (Dlv) parallels the uncontrolled and loss of control stressors, respectively, whereas the activity of the lateral septum (Vv) homologue responds in different ways depending on the gene marker of brain activity used. CONCLUSIONS These results suggest the psychological modulation of the stress response to be evolutionary conserved across vertebrates, despite being implemented by different brain circuits in mammals (pre-frontal cortex) and fish (Dld-Dlv).
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13
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Chronic primary pain in the COVID-19 pandemic: how uncertainty and stress impact on functioning and suffering. Pain 2021; 163:604-609. [PMID: 34382606 DOI: 10.1097/j.pain.0000000000002428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 07/02/2021] [Indexed: 11/27/2022]
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14
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Becker S, Schakib-Ekbatan K, Wroblewski D, Schweiker M. Perception of repeated pain relief with controllable and uncontrollable pain. Eur J Pain 2021; 25:1702-1711. [PMID: 33829599 DOI: 10.1002/ejp.1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The ultimate goal of pain research is to provide effective routes for pain relief. Nevertheless, the perception pain relief as a change in pain intensity and un-/pleasantness has only been rarely investigated. It has been demonstrated that pain relief has rewarding and reinforcing properties, but it remains unknown whether the perception of pain relief changes when pain reductions occur repeatedly. Further, it remains an open question whether the perception of pain relief depends on the controllability of the preceding pain. METHODS In this study, healthy volunteers (N = 38) received five cycles of painful heat stimulation and reduction of this stimulation to a non-painful warm stimulation once in a condition with control of the stimulation and once without control. Participants rated perceived intensity and un-/pleasantness on visual analogue scales during the heat stimulation and immediately after its reduction. RESULTS Results showed that perceived pain relief, estimated by the difference in ratings during ongoing heat stimulation and after its reduction, increased with repetitions. However, this increase levelled off after two to four repetitions. Further, perceived pain relief was larger in the condition without control compared to the condition with control. CONCLUSION The perception of pain relief can be modulated similar to the perception of pain by stimulus characteristics and psychological factors. Mechanistic knowledge about such modulating factors is important, because they can determine, e.g., the amount of requested pain killers in clinical settings and the efficacy of pain relief as a reinforcing stimulus. SIGNIFICANCE When in pain, pain relief can become an all-dominate goal. The perception of such pain relief can vary depending on external and internal characteristics and thus modulate, e.g., requests for pain killers in clinical settings. Here, we show that perceived intensity and pleasantness of pain relief changes with repetitions and whether the preceding pain is perceived as uncontrollable. Such mechanistic knowledge needs to be considered to maximize the effects of pain relief as a rewarding and reinforcing stimulus.
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Affiliation(s)
- Susanne Becker
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Integrative Spinal Research Group, Department of Chiropractic Medicine, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Karin Schakib-Ekbatan
- Heidelberg Academy of Sciences and Humanities, Heidelberg, Germany.,Building Science Group, Karlsruhe Institute of Technology, Karlsruhe, Germany.,Institute for Resource Efficiency and Energy Strategies, Karlsruhe, Germany
| | - Daniel Wroblewski
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marcel Schweiker
- Building Science Group, Karlsruhe Institute of Technology, Karlsruhe, Germany.,Institute for Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
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15
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Munk A, Reme SE, Jacobsen HB. What Does CATS Have to Do With Cancer? The Cognitive Activation Theory of Stress (CATS) Forms the SURGE Model of Chronic Post-surgical Pain in Women With Breast Cancer. Front Psychol 2021; 12:630422. [PMID: 33833718 PMCID: PMC8023326 DOI: 10.3389/fpsyg.2021.630422] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/01/2021] [Indexed: 01/25/2023] Open
Abstract
Chronic post-surgical pain (CPSP) represents a highly prevalent and significant clinical problem. Both major and minor surgeries entail risks of developing CPSP, and cancer-related surgery is no exception. As an example, more than 40% of women undergoing breast cancer surgery struggle with CPSP years after surgery. While we do not fully understand the pathophysiology of CPSP, we know it is multifaceted with biological, social, and psychological factors contributing. The aim of this review is to advocate for the role of response outcome expectancies in the development of CPSP following breast cancer surgery. We propose the Cognitive Activation Theory of Stress (CATS) as an applicable theoretical framework detailing the potential role of cortisol regulation, inflammation, and inflammatory-induced sickness behavior in CPSP. Drawing on learning theory and activation theory, CATS offers psychobiological explanations for the relationship between stress and health, where acquired expectancies are crucial in determining the stress response and health outcomes. Based on existing knowledge about risk factors for CPSP, and in line with the CATS position, we propose the SURGEry outcome expectancy (SURGE) model of CPSP. According to SURGE, expectancies impact stress physiology, inflammation, and fear-based learning influencing the development and persistence of CPSP. SURGE further proposes that generalized response outcome expectancies drive adaptive or maladaptive stress responses in the time around surgery, where coping dampens the stress response, while helplessness and hopelessness sustains it. A sustained stress response may contribute to central sensitization, alterations in functional brain networks and excessive fear-based learning. This sets the stage for a prolonged state of inflammatory-induced sickness behavior - potentially driving and maintaining CPSP. Finally, as psychological factors are modifiable, robust and potent predictors of CPSP, we suggest hypnosis as an effective intervention strategy targeting response outcome expectancies. We here argue that presurgical clinical hypnosis has the potential of preventing CPSP in women with breast cancer.
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Affiliation(s)
- Alice Munk
- The Mind-Body Lab, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Silje Endresen Reme
- The Mind-Body Lab, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Henrik Børsting Jacobsen
- The Mind-Body Lab, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
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16
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Sobas EM, Vázquez A, Videla S, Reinoso R, Fernández I, Garcia-Vazquez C, Maldonado MJ, Pastor JC. Evaluation of Potential Pain Biomarkers in Saliva and Pain Perception After Corneal Advanced Surface Ablation Surgery. Clin Ophthalmol 2020; 14:613-623. [PMID: 32184550 PMCID: PMC7060776 DOI: 10.2147/opth.s225603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/28/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the evolution of a set of proposed pain biomarkers in the saliva of subjects following Advanced Surface Ablation (ASA), in order to determine their validity as objective pain measures. Methods A multicenter, prospective, and descriptive study was carried out to assess the variations between biomarkers and perceived pain. The Inclusion criteria were healthy subjects who underwent a bilateral, alcohol-assisted surface ablation with epithelial removal (ASA). Pain intensity before and after surgery was assessed by Visual Analog Scale (VAS) and the Numeric Pain Rating Scale (NPRS). Cortisol, sAA, sIgA, testosterone, and sTNFαRII were assayed at four-time points (V0, baseline; V1, pre-surgery; V2, 1 hr post-surgery, and V3, 72 hrs post-surgery). Comorbidities and Hospital Anxiety and Depression (HADS) questionnaires were administrated before and at 6 hrs after the surgery. All patients were treated with cold patches, topical steroids, topical cold antibiotics, and benzodiazepines after ASA surgery. A descriptive analysis of biomarkers and pain intensity evolution and the agreement between biomarkers and pain was performed. Results Concentration of sIgA and sTNFαRII post-surgery was significantly higher at each visit compared to baseline (p-value: 0.053, p-value: <0.001, respectively). Relations between VAS scale score and putative biomarker variations were not statistically significant except for the sIgA but only at visit 0 (p-value: 0.024). The HADS questionnaire showed anxiety scores between 0 and 7 in all patients before and at 6 hrs after surgery. Conclusion In this study, sIgA and sTNFαRII are the two potential biomarkers that present correlation with the VAS and these salivary substances showed acceptable levels of reproducibility in healthy subjects.
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Affiliation(s)
- Eva M Sobas
- IOBA Eye Institute, University of Valladolid, Valladolid, Spain.,Nursery Faculty, University of Valladolid, Valladolid, Spain
| | - Amanda Vázquez
- IOBA Eye Institute, University of Valladolid, Valladolid, Spain.,Nursery Faculty, University of Valladolid, Valladolid, Spain
| | - Sebastián Videla
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL)/University of Barcelona, L'Hospitalet de Llobregat, Barcelona
| | - Roberto Reinoso
- IOBA Eye Institute, University of Valladolid, Valladolid, Spain.,Visión I+D, University of Valladolid, Valladolid, Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Itziar Fernández
- IOBA Eye Institute, University of Valladolid, Valladolid, Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | | | - Miguel J Maldonado
- IOBA Eye Institute, University of Valladolid, Valladolid, Spain.,Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Medicine, University of Valladolid, Valladolid, Spain
| | - J Carlos Pastor
- IOBA Eye Institute, University of Valladolid, Valladolid, Spain.,Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Medicine, University of Valladolid, Valladolid, Spain.,Department of Ophthalmology, Hospital Clínico Universitario, Valladolid, Spain
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17
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Controllability affects endocrine response of adolescent male rats to stress as well as impulsivity and behavioral flexibility during adulthood. Sci Rep 2019; 9:3180. [PMID: 30816288 PMCID: PMC6395608 DOI: 10.1038/s41598-019-40061-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 02/01/2019] [Indexed: 11/28/2022] Open
Abstract
Exposure to stress during adolescence exerts a long-term impact on behavior and might contribute to the development of several neuropsychiatric disorders. In adults, control over stress has been found to protect from the negative consequences of stress, but the influence of controllability at early ages has not been extensively studied. Here, we evaluated in a rodent model the effects of repeated exposure in adolescent male rats to controllable versus uncontrollable foot-shock stress (CST or UST, respectively). Rats were assigned to three groups: non-stress (stress-naïve), CST (exposed to 8 sessions of a two-way shuttle active avoidance task over a period of 22 days) and UST (receiving the same amount of shocks as CST, regardless of their actual behavior). During adulthood, different cohorts were tested in several tasks evaluating inhibitory control and cognitive flexibility: 5-choice serial reaction time, delay-discounting, gambling test and probabilistic reversal learning. Results showed that the hypothalamic-pituitary-adrenal response to the first shock session was similar in CST and UST animals, but the response to the 8th session was lower in CST animals. In adulthood, the UST animals presented impaired motor (but not cognitive) impulsivity and more perseverative behavior. The behavioral effects of UST were associated with increased number of D2 dopamine receptors in dorsomedial striatum, but not in other striatal regions. In summary, UST exposure during adolescence induced long-term impairments in impulsivity and compulsivity, whereas CST had only minor effects. These data support a critical role of stress uncontrollability on the long-lasting consequences of stress, as a risk factor for mental illnesses.
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18
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Karsh N, Goldstein O, Eitam B. Evidence for pain attenuation by the motor system-based judgment of agency. Conscious Cogn 2017; 57:134-146. [PMID: 29223073 DOI: 10.1016/j.concog.2017.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 11/30/2017] [Accepted: 11/30/2017] [Indexed: 11/19/2022]
Abstract
Pain is an integral part of our lives. Although the effect of 'control' on sensed pain has been extensively studied and discussed, recent findings seem to be at odds with the substantial evidence for a robust motor-based sensory attenuation effect - an indirect marker for one's sense of agency. The goal of the current study was to re-examine whether there is evidence for such an effect in the context of pain. In three experiments, human participants were aversively stimulated and the sensitivity of self-reported pain to factors previously shown to modulate the sensory attenuation effect was tested (control over parameters of the stimulation; temporal contiguity and predictability, and stimulation intensity). Two of three experiments found some evidence that objective control attenuates pain, but only when the painful stimulation immediately follows the motor response. We discuss the complex relations between having objective control, feeling helpless, predictability and sensed pain.
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Affiliation(s)
- N Karsh
- Department of Psychology, University of Haifa, Mount Carmel, Haifa 31905, Israel; Department of Psychology, Tel-Hai Academic College, Qiryat Shemona, Israel.
| | - O Goldstein
- Department of Psychology, University of Haifa, Mount Carmel, Haifa 31905, Israel
| | - B Eitam
- Department of Psychology, University of Haifa, Mount Carmel, Haifa 31905, Israel
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19
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Different Brain Circuitries Mediating Controllable and Uncontrollable Pain. J Neurosci 2017; 36:5013-25. [PMID: 27147654 DOI: 10.1523/jneurosci.1954-15.2016] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 03/17/2016] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED Uncontrollable, compared with controllable, painful stimulation can lead to increased pain perception and activation in pain-processing brain regions, but it is currently unknown which brain areas mediate this effect. When pain is controllable, the lateral prefrontal cortex (PFC) seems to inhibit pain processing, although it is unclear how this is achieved. Using fMRI in healthy volunteers, we examined brain activation during controllable and uncontrollable stimulation to answer these questions. In the controllable task, participants self-adjusted temperatures applied to their hand of pain or warm intensities to provoke a constant sensation. In the uncontrollable task, the temperature time courses of the controllable task were replayed (yoked control) and participants rated their sensation continuously. During controllable pain trials, participants significantly downregulated the temperature to keep their sensation constant. Despite receiving the identical nociceptive input, intensity ratings increased during the uncontrollable pain trials. This additional sensitization was mirrored in increased activation of pain-processing regions such as insula, anterior cingulate cortex, and thalamus. Further, increased connectivity between the anterior insula and medial PFC (mPFC) in the uncontrollable and increased negative connectivity between dorsolateral PFC (dlPFC) and insula in the controllable task were observed. This suggests a pain-facilitating role of the mPFC during uncontrollable pain and a pain-inhibiting role of the dlPFC during controllable pain, both exerting their respective effects via the anterior insula. These results elucidate neural mechanisms of context-dependent pain modulation and their relation to subjective perception. SIGNIFICANCE STATEMENT Pain control is of uttermost importance and stimulus controllability is an important way to achieve endogenous pain modulation. Here, we show differential effects of controllability and uncontrollability on pain perception and cerebral pain processing. When pain was controllable, the dorsolateral prefrontal cortex downregulated pain-evoked activation in important pain-processing regions. In contrast, sensitization during uncontrollable pain was mediated by increased connectivity of the medial prefrontal cortex with the anterior insula and other pain-processing regions. These novel insights into cerebral pain modulation by stimulus controllability have the potential to improve treatment approaches in pain patients.
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20
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Sobas EM, Reinoso R, Cuadrado-Asensio R, Fernández I, Maldonado MJ, Pastor JC. Reliability of Potential Pain Biomarkers in the Saliva of Healthy Subjects: Inter-Individual Differences and Intersession Variability. PLoS One 2016; 11:e0166976. [PMID: 27907037 PMCID: PMC5132231 DOI: 10.1371/journal.pone.0166976] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/07/2016] [Indexed: 01/17/2023] Open
Abstract
AIM Salivary cortisol, α-amylase (sAA), secretory IgA (sIgA), testosterone, and soluble fraction of receptor II of TNFα (sTNFαRII) could serve as objective pain measures, but the normal variability of these potential biomarkers is unknown. PATIENTS & METHODS Saliva was collected with the passive secretion method from 34, pain-free subjects in two single samples at least 24 hours apart. Biomarker variation and intersession reliability were assessed with the intraclass correlation coefficient (ICC). Also, we calculated the within-subject standard deviation (Sw) and the reproducibility (2.77 × Sw) of intersession measures. RESULTS Salivary cortisol, sAA, sIgA, testosterone, and sTNFαRII yielded the following ICCs: 0.53, 0.003, 0.88, 0.42 and 0.83, respectively. We found no statistically significant systematic differences between sessions in any biomarker except for testosterone, which showed a decrease on the second day (p<0.001). The reproducibility for salivary cortisol, sAA, sIgA, testosterone, and sTNFαRII were 0.46 ng/ml, 12.88 U/ml, 11.7 μg/ml, 14.54 pg/ml and 18.29 pg/ml, respectively. Cortisol, testosterone and TNFαRII measurement variability showed a positive correlation with the magnitude (p<0.002), but no relationship was found for sAA and sIgA. CONCLUSIONS Salivary sIgA and sTNFαRII show a remarkable good reproducibility and, therefore, could be useful as pain biomarkers. When using the passive secretion method, intersession variations in salivary sIgA of more than 11.7 μg/ml may reflect true biomarker change. In the case of sTNFαRII this will depend of the magnitude. The estimates herein provided should help investigators and clinicians differentiate actual biomarker modification from measurement variability.
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Affiliation(s)
- Eva M. Sobas
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Escuela de Enfermería, Universidad de Valladolid, Valladolid, Spain
| | - Roberto Reinoso
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Visión I+D, Valladolid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Rubén Cuadrado-Asensio
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Itziar Fernández
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Miguel J. Maldonado
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - José C. Pastor
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
- Department of Ophthalmology, Hospital Clinico Universitario, Valladolid, Spain
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21
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Duval CZ, Goumon Y, Kemmel V, Kornmeier J, Dufour A, Andlauer O, Vidailhet P, Poisbeau P, Salvat E, Muller A, Mensah-Nyagan AG, Schmidt-Mutter C, Giersch A. Neurophysiological responses to unpleasant stimuli (acute electrical stimulations and emotional pictures) are increased in patients with schizophrenia. Sci Rep 2016; 6:22542. [PMID: 26935652 PMCID: PMC4776095 DOI: 10.1038/srep22542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 02/15/2016] [Indexed: 01/14/2023] Open
Abstract
Patients with schizophrenia have often been described as insensitive to nociceptive signals, but objective evidence is sparse. We address this question by combining subjective behavioral and objective neurochemical and neurophysiological measures. The present study involved 21 stabilized and mildly symptomatic patients with schizophrenia and 21 control subjects. We applied electrical stimulations below the pain threshold and assessed sensations of pain and unpleasantness with rating scales, and Somatosensory Evoked Potentials (SEPs/EEG). We also measured attention, two neurochemical stress indices (ACTH/cortisol), and subjective VEPs/EEG responses to visual emotional stimuli. Our results revealed that, subjectively, patients’ evaluations do not differ from controls. However, the amplitude of EEG evoked potentials was greater in patients than controls as early as 50 ms after electrical stimulations and beyond one second after visual processing of emotional pictures. Such responses could not be linked to the stress induced by the stimulations, since stress hormone levels were stable. Nor was there a difference between patients and controls in respect of attention performance and tactile sensitivity. Taken together, all indices measured in patients in our study were either heightened or equivalent relative to healthy volunteers.
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Affiliation(s)
- Céline Z Duval
- INSERM U-1114, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Département de Psychiatrie, Hôpitaux Universitaires de Strasbourg; 1, place de l'Hôpital, 67000 Strasbourg, France.,Fondation FondaMental, Créteil, France.,Fondation APICIL, 21, place Bellecour, 69002 Lyon, France
| | - Yannick Goumon
- Institut des Neurosciences Cellulaires et Intégratives, CNRS UPR 3212, 5, rue Blaise Pascal, 67084 Strasbourg, France
| | - Véronique Kemmel
- INSERM U-1119 Biopathologie de la Myéline, Neuroprotection et Stratégies Thérapeutiques, Université de Strasbourg, Bâtiment 3 de la Faculté de Médecine, 11 rue Humann, 67000 Strasbourg, France.,Laboratoire de Biochimie et Biologie Moléculaire, Hôpitaux Universitaire de Strasbourg, 67098 Strasbourg, France
| | - Jürgen Kornmeier
- Institute for Frontier Areas of Psychology and Mental Health, 79098 Freiburg, Germany.,University Eye-Hospital, Killianstraße 5, 79106 Freiburg, Germany
| | - André Dufour
- Laboratoire de Neurosciences Cognitives et Adaptatives, UMR 7364, Université de Strasbourg, CNRS, Strasbourg, France
| | - Olivier Andlauer
- EA 481 Laboratoire de Neurosciences, Université de Franche-Comte, 1 place du maréchal Leclerc, 25030 Besançon Cedex, France
| | - Pierre Vidailhet
- INSERM U-1114, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Département de Psychiatrie, Hôpitaux Universitaires de Strasbourg; 1, place de l'Hôpital, 67000 Strasbourg, France
| | - Pierrick Poisbeau
- Institut des Neurosciences Cellulaires et Intégratives, CNRS UPR 3212, 5, rue Blaise Pascal, 67084 Strasbourg, France
| | - Eric Salvat
- Institut des Neurosciences Cellulaires et Intégratives, CNRS UPR 3212, 5, rue Blaise Pascal, 67084 Strasbourg, France.,Centre 'Evaluation et de Traitement de la Douleur (CETD) du CHRU, Hôpital de Hautepierre, 1 av Moliere, 67078 Strasbourg, France
| | - André Muller
- Institut des Neurosciences Cellulaires et Intégratives, CNRS UPR 3212, 5, rue Blaise Pascal, 67084 Strasbourg, France.,Centre 'Evaluation et de Traitement de la Douleur (CETD) du CHRU, Hôpital de Hautepierre, 1 av Moliere, 67078 Strasbourg, France
| | - Ayikoé G Mensah-Nyagan
- INSERM U-1119 Biopathologie de la Myéline, Neuroprotection et Stratégies Thérapeutiques, Université de Strasbourg, Bâtiment 3 de la Faculté de Médecine, 11 rue Humann, 67000 Strasbourg, France
| | | | - Anne Giersch
- INSERM U-1114, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Département de Psychiatrie, Hôpitaux Universitaires de Strasbourg; 1, place de l'Hôpital, 67000 Strasbourg, France
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McParland JL, Knussen C. Catastrophizing Mediates the Relationship Between the Personal Belief in a Just World and Pain Outcomes Among Chronic Pain Support Group Attendees. PSYCHOLOGICAL INJURY & LAW 2016; 9:23-30. [PMID: 27053979 PMCID: PMC4781886 DOI: 10.1007/s12207-015-9246-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 12/23/2015] [Indexed: 12/11/2022]
Abstract
Health-related research suggests the belief in a just world can act as a personal resource that protects against the adverse effects of pain and illness. However, currently, little is known about how this belief, particularly in relation to one's own life, might influence pain. Consistent with the suggestions of previous research, the present study undertook a secondary data analysis to investigate pain catastrophizing as a mediator of the relationship between the personal just world belief and chronic pain outcomes in a sample of chronic pain support group attendees. Partially supporting the hypotheses, catastrophizing was negatively correlated with the personal just world belief and mediated the relationship between this belief and pain and disability, but not distress. Suggestions for future research and intervention development are made.
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Affiliation(s)
- Joanna L McParland
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, George Moore Building, 70 Cowcaddens Road, Glasgow, G4 OBA UK
| | - Christina Knussen
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, George Moore Building, 70 Cowcaddens Road, Glasgow, G4 OBA UK
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Doubling Your Payoff: Winning Pain Relief Engages Endogenous Pain Inhibition. eNeuro 2015; 2:eN-NWR-0029-15. [PMID: 26464995 PMCID: PMC4596013 DOI: 10.1523/eneuro.0029-15.2015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 08/18/2015] [Accepted: 08/19/2015] [Indexed: 01/07/2023] Open
Abstract
When in pain, pain relief is much sought after, particularly for individuals with chronic pain. In analogy to augmentation of the hedonic experience (“liking”) of a reward by the motivation to obtain a reward (“wanting”), the seeking of pain relief in a motivated state might increase the experience of pain relief when obtained. We tested this hypothesis in a psychophysical experiment in healthy human subjects, by assessing potential pain-inhibitory effects of pain relief “won” in a wheel of fortune game compared with pain relief without winning, exploiting the fact that the mere chance of winning induces a motivated state. The results show pain-inhibitory effects of pain relief obtained by winning in behaviorally assessed pain perception and ratings of pain intensity. Further, the higher participants scored on the personality trait novelty seeking, the more pain inhibition was induced. These results provide evidence that pain relief, when obtained in a motivated state, engages endogenous pain-inhibitory systems beyond the pain reduction that underlies the relief in the first place. Consequently, such pain relief might be used to improve behavioral pain therapy, inducing a positive, perhaps self-amplifying feedback loop of reduced pain and improved functionality.
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Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Phys Ther 2014; 94:1816-25. [PMID: 25035267 PMCID: PMC4263906 DOI: 10.2522/ptj.20130597] [Citation(s) in RCA: 336] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pain is a primary symptom driving patients to seek physical therapy, and its attenuation commonly defines a successful outcome. A large body of evidence is dedicated to elucidating the relationship between chronic stress and pain; however, stress is rarely addressed in pain rehabilitation. A physiologic stress response may be evoked by fear or perceived threat to safety, status, or well-being and elicits the secretion of sympathetic catecholamines (epinephrine and norepinepherine) and neuroendocrine hormones (cortisol) to promote survival and motivate success. Cortisol is a potent anti-inflammatory that functions to mobilize glucose reserves for energy and modulate inflammation. Cortisol also may facilitate the consolidation of fear-based memories for future survival and avoidance of danger. Although short-term stress may be adaptive, maladaptive responses (eg, magnification, rumination, helplessness) to pain or non-pain-related stressors may intensify cortisol secretion and condition a sensitized physiologic stress response that is readily recruited. Ultimately, a prolonged or exaggerated stress response may perpetuate cortisol dysfunction, widespread inflammation, and pain. Stress may be unavoidable in life, and challenges are inherent to success; however, humans have the capability to modify what they perceive as stressful and how they respond to it. Exaggerated psychological responses (eg, catastrophizing) following maladaptive cognitive appraisals of potential stressors as threatening may exacerbate cortisol secretion and facilitate the consolidation of fear-based memories of pain or non-pain-related stressors; however, coping, cognitive reappraisal, or confrontation of stressors may minimize cortisol secretion and prevent chronic, recurrent pain. Given the parallel mechanisms underlying the physiologic effects of a maladaptive response to pain and non-pain-related stressors, physical therapists should consider screening for non-pain-related stress to facilitate treatment, prevent chronic disability, and improve quality of life.
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Müller MJ. Depressive attribution style and stressor uncontrollability increase perceived pain intensity after electric skin stimuli in healthy young men. Pain Res Manag 2013; 18:203-206. [PMID: 23717827 PMCID: PMC3812192 DOI: 10.1155/2013/263084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
BACKGROUND Depressive and pain symptoms often occur concurrently in patients with psychiatric disorders or somatic diseases, but the contribution of pre-existing dysfunctional cognitive schemata to pain perception remains unclear. OBJECTIVE To investigate the relationship between depression-related attribution styles and perceived pain intensity (PPI) after controllable versus uncontrollable electrical skin stimulation in healthy male individuals. METHODS Causal attributions for negative events were measured using the attribution style questionnaire (ASQ) on the dimensions internal versus external (INT), global versus specific (GLO) and stable versus unstable (STA) in 50 men (20 to 31 years of age). Additionally, symptoms of anxiety and depression (measured using the depression scale) as well as baseline helplessness were assessed. Participants were randomly assigned to receive self-administered (controllable) or experimenter-administered (uncontrollable) painful skin stimuli. PPI was assessed after stress exposure using a visual analogue scale (0 to 100). Relationships between PPI and depression-related cognitions were calculated using correlation and multiple regression analyses. RESULTS Correlation analyses revealed a moderate correlation between PPI and ASQ-INT scores (r=0.46). Following uncontrollable stress exposure, significantly higher PPI ratings (P=0.001) and a higher correlation between PPI and ASQ-INT (r=0.70) were observed. Multiple regression analysis showed an independent influence of stressor controllability (ß=0.39; P=0.003) and ASQ-INT (ß=0.36; P=0.006) on PPI. DISCUSSION These findings highlight the interaction of specific depression-related cognitions and stress controllability on pain intensity perception. CONCLUSIONS The results of the present study may facilitate understanding of the cognitive aspects of pain intensity perception and improve psychological pain therapies focusing on attributions and controllability.
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Affiliation(s)
- Matthias Johannes Müller
- Vistos Clinics for Psychiatry, Psychosomatic Medicine, and Psychotherapy Giessen and Masbuerg, Germany.
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