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Diallo S, Marchand S, Dumais A, Potvin S. The impact of an immersive digital therapeutic tool on experimental pain: a pilot randomized within-subject experiment with an active control condition. FRONTIERS IN PAIN RESEARCH 2024; 5:1366892. [PMID: 38903416 PMCID: PMC11187308 DOI: 10.3389/fpain.2024.1366892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
Background Pain is a complex and multifaced sensory and emotional experience. Virtual reality (VR) has shown promise in reducing experimental pain and chronic pain. This study examines an immersive VR environment initially designed for endometriosis patients, which demonstrated short-term analgesic effects. The research aims to determine the impact of the VR environment on experimental pain intensity and unpleasantness both during and after VR exposure (3D with binaural beats), while using an active control condition (2D with no binaural beats). Additionally, a secondary objective of the study was to identify the psychological and psychophysical factors that predict the analgesic effects of the immersive digital therapeutic tool. Methods The study involved twenty-one healthy individuals and used a within-subject design, comparing a VR treatment with an active control condition. Continuous heat stimulation was applied to the left forearm with a Peltier thermode. Pain ratings were collected for immediate and short-term effects. Results In both the VR and Control conditions, there were no significant differences in pain intensity before, during, and after exposure. However, during VR exposure, there was a significant decrease in pain unpleasantness as compared to before exposure (p < 0.001), with a 27.2% pain reduction. In the Control condition, there were no significant differences in pain unpleasantness during and after exposure. Furthermore, no psychological and psychophysical factors predicted the analgesic effects. Discussion The study investigated how a VR environment affected experimentally induced pain in healthy volunteers. It showed that VR reduced pain unpleasantness during exposure but had no lasting impact. The VR environment mainly influenced the emotional aspect of pain, possibly due to its inclusion of binaural beats and natural stimuli. The study suggests that the VR environment should be tested in chronic pain population with high distress levels. Registration number clinicaltrialsgov NCT06130267.
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Affiliation(s)
- Sanoussy Diallo
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Serge Marchand
- Department of Surgery, Faculty of Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Alexandre Dumais
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, QC, Canada
| | - Stéphane Potvin
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
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2
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Mazaheri A, Seminowicz DA, Furman AJ. Peak alpha frequency as a candidate biomarker of pain sensitivity: the importance of distinguishing slow from slowing. Neuroimage 2022; 262:119560. [PMID: 35973563 DOI: 10.1016/j.neuroimage.2022.119560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/27/2022] [Accepted: 08/11/2022] [Indexed: 10/31/2022] Open
Abstract
The study by Valentini et al. (2022) observed that the peak alpha frequency (PAF) of participants became slower after they were exposed to painful, as well as non-painful but unpleasant stimuli. The authors interpreted this as a challenge to our previous studies which propose that the speed of resting PAF, independently of pain-induced changes to PAF, can be a reliable biomarker marker for gaging individual pain sensitivity. While investigations into the role that PAF plays in pain perception are timely, we have some concerns about the assumptions and methodology employed by Valentini et al. Moreover, we believe the authors here have also misrepresented some of our previous work. In the current commentary, we detail the critical differences between our respective studies, with the ultimate aim of guiding future investigations.
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Affiliation(s)
- Ali Mazaheri
- School of Psychology, University of Birmingham, Birmingham, UK; Centre for Human Brain Health (CHBH), University of Birmingham, Birmingham, UK.
| | - David A Seminowicz
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Andrew J Furman
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD 21201, USA
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3
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Nagasaka K, Otsuru N, Sato R, Watanabe H, Sakurai N, Ohno K, Kodama N, Onishi H. Cortical signature related to psychometric properties of pain vigilance in healthy individuals: A voxel-based morphometric study. Neurosci Lett 2022; 772:136445. [PMID: 35007688 DOI: 10.1016/j.neulet.2022.136445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/21/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
The Pain Vigilance and Awareness Questionnaire (PVAQ) is a questionnaire for non-clinical and clinical cases of patients, such as those suffering from chronic pain. Moreover, it is used for evaluation of two aspects of habitual attention to pain: attention to pain and attention to changes in pain. As the PVAQ assesses two different aspects of attention function, different neural basis may present. However, it remains unclear which brain regions are involved. Here, we performed voxel-based morphometry (VBM) in 30 healthy participants to determine the regional morphology associated with the two attention states. Multiple regression analysis was conducted between each score and the regional grey matter (GM) volume, which revealed that a decreased GM volume in the left anterior insular cortex (AIC) was associated with a higher attention to pain score. In contrast, no brain region was correlated with the attention to changes in pain score. Our VBM results demonstrate that attention to pain scores assessed by PVAQ are associated with morphological features of the left AIC. Moreover, they may contribute to the elucidation of the complex psychological and neurophysiological characteristics of patients with chronic pain.
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Affiliation(s)
- Kazuaki Nagasaka
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata-City, Niigata 950-3198, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan.
| | - Naofumi Otsuru
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata-City, Niigata 950-3198, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan.
| | - Rui Sato
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan
| | - Hiraku Watanabe
- Graduate School, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata-City, Niigata 950-3198, Japan; Division of Physical Therapy and Rehabilitation Medicine, University of Fukui Hospital, 23-3, Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, Japan.
| | - Noriko Sakurai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata-City, Niigata 950-3198, Japan; Department of Radiological Technology, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan.
| | - Ken Ohno
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata-City, Niigata 950-3198, Japan; Department of Radiological Technology, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan.
| | - Naoki Kodama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata-City, Niigata 950-3198, Japan; Department of Radiological Technology, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan.
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata-City, Niigata 950-3198, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan.
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4
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Alghareeb Z, Alhaji K, Alhaddad B, Gaffar B. Assessment of Dental Anxiety and Hemodynamic Changes during Different Dental Procedures: A Report from Eastern Saudi Arabia. Eur J Dent 2022; 16:833-840. [PMID: 34991162 DOI: 10.1055/s-0041-1740222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES This study aimed to investigate hemodynamic changes in healthy adult patients during different dental procedures and evaluate whether these changes were associated with patients' dental anxiety. MATERIALS AND METHODS A convenience sample of 119 patients of both genders undergoing routine dental care participated in the study. Participants responded to the Arabic version of the modified dental anxiety scale (MDAS) and a self-structured questionnaire. Each patient had their blood pressure, heart rate, and oxygen saturation measured at three points: before, during, and after the dental procedure using an electronic sphygmomanometer. MDAS scores were categorized into no anxiety, mild, moderate or severe anxiety, while readings of heart rate and blood pressure were categorized into no change, increased or decreased and either "no change" or "increased" for oxygen saturation. Chi-square test was used to investigate the association between the study variables and a p value of < 0.05 was considered statistically significant. SPSS version 20 was used in the analysis. RESULTS Mean ( ± standard deviation [SD]) of MDAS was 11.12 ( ± 3.9) an indicative of moderate dental anxiety. No changes in blood pressure, heart rate, or in oxygen saturation were observed on 39.5%, 54.6% and 97.5% among the study participants, respectively. Half of the participants avoided dental care, with dental anxiety being the main reason for that (26.1%). Pattern of dental visits was significantly associated with MDAS scores (p = 0.042). There were significant changes in blood pressure (p = 0.0003), heart rate (p = 0.01) but not in oxygen saturation (p = 0.33). Changes in blood pressure, heart rate, and oxygen saturation were not associated with dental anxiety p = 0.15, 0.10, and 0.99, respectively. CONCLUSION The results of this study indicate that the type of dental procedure may cause dental anxiety and cause hemodynamic changes. Therefore, close monitoring of patients with dental anxiety during the treatment is advised.
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Affiliation(s)
- Zainab Alghareeb
- Intership Program, College of Dentistry, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Kawther Alhaji
- Intership Program, College of Dentistry, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Bayan Alhaddad
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Balgis Gaffar
- Preventive Dental Sciences Department, College of Dentistry, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
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5
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Short NA, Tungate AS, Bollen KA, Sullivan J, D'Anza T, Lechner M, Bell K, Black J, Buchanan J, Reese R, Ho JD, Reed GD, Platt MA, Riviello RJ, Rossi CH, Martin SL, Liberzon I, Rauch SAM, Kessler RC, Nugent N, McLean SA. Pain is common after sexual assault and posttraumatic arousal/reactivity symptoms mediate the development of new or worsening persistent pain. Pain 2022; 163:e121-e128. [PMID: 34224498 DOI: 10.1097/j.pain.0000000000002329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 04/22/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Clinically significant new or worsening pain (CSNWP) is a common, yet often overlooked, sequelae of sexual assault. Little is known regarding factors influencing the development of CSNWP in sexual assault survivors. The current study used data from a recently completed prospective study to evaluate whether posttraumatic alterations in arousal and reactivity in the early aftermath of sexual assault influence the transition from acute to clinically significant new or worsening persistent pain. Women ≥ 18 years of age (n = 706) presenting for emergency care after sexual assault to 13 emergency care sites were enrolled in the study. Women completed assessments at the time of presentation as well as at 1 week (n = 706, 100%) and 6 weeks (n = 630, 91%). Nearly 70% of women reported CSNWP at the time of emergency care (n = 475, 69%), which persisted to 6 weeks in approximately 2 in 5 survivors (n = 248, 41%). A structural equation model adjusted for age, race, past trauma exposure, and preassault pain levels suggested that posttraumatic alterations in arousal/reactivity symptoms 1 week after assault partially mediated the transition from acute to persistent CSNWP. A significant portion (41%) of women sexual assault survivors develop CSNWP 6 weeks postassault. Posttraumatic arousal/reactivity symptoms in the early aftermath of assault contribute to CSNWP development; such symptoms are potential targets for secondary preventive interventions to reduce chronic postassault pain.
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Affiliation(s)
- Nicole A Short
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
| | - Andrew S Tungate
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
| | - Kenneth A Bollen
- Psychology and Neuroscience, and Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jenyth Sullivan
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
| | - Teresa D'Anza
- Albuquerque SANE Collaborative, Albuquerque, NM, United States
| | - Megan Lechner
- Emergency Deprtment, UC Health Memorial Hospital, Colorado Springs, CO, United States
| | - Kathy Bell
- Tulsa Forensic Nursing Services, Tulsa, OK, United States
| | | | - Jennie Buchanan
- Department of Emergency Medicine, Denver Health, Denver, CO, United States
| | - Rhiannon Reese
- Crisis Center of Birmingham, Birmingham, AL, United States
| | - Jeffrey D Ho
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Gordon D Reed
- Department of Emergency Medicine, Christiana Care, Newark, DE, United States
| | - Melissa A Platt
- Department of Emergency Medicine, University of Louisville, Louisville, KY, United States
| | - Ralph J Riviello
- Department of Emergency Medicine, University of Texas Health San Antonio, TX, United States
| | | | - Sandra L Martin
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Israel Liberzon
- Department of Psychiatry, Texas A&M University, Bryan, TX, United States
| | - Sheila A M Rauch
- Department of Psychiatry, Emory University, Atlanta, GA, VA Atlanta Healthcare System, Atlanta, GA, United States
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Nicole Nugent
- Departments of Psychiatry and Human Behavior, Pediatrics, and Emergency Medicine, Brown University, Providence, RI, United States
| | - Samuel A McLean
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
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6
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Otsuru N, Ogawa M, Yokota H, Miyaguchi S, Kojima S, Saito K, Inukai Y, Onishi H. Auditory change-related cortical response is associated with hypervigilance to pain in healthy volunteers. Eur J Pain 2021; 26:349-355. [PMID: 34528347 PMCID: PMC9292983 DOI: 10.1002/ejp.1863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 09/06/2021] [Accepted: 09/11/2021] [Indexed: 11/24/2022]
Abstract
Background Patients with chronic pain exhibit hypervigilance (heightened responsiveness to stimuli) to innocuous auditory stimuli as well as noxious stimuli. “Generalized hypervigilance” suggests that individuals who show heightened responsiveness to one sensory system also show hypervigilance to other modalities. However, research exploring the existence of generalized hypervigilance in healthy subjects is limited. Methods We investigated whether hypervigilance to pain is associated with auditory stimuli in healthy subjects using the pain vigilance and awareness questionnaire (PVAQ) and auditory change‐related cortical responses (ACRs). ACRs are thought to reflect a change detection system, based on preceding sensory memory. We recorded ACRs under conditions that varied in terms of the accumulation of sensory memory as follows: short‐ACR, with short preceding continuous stimuli and long‐ACR, with long preceding continuous stimuli. In addition, the attention to pain (PVAQ‐AP) and attention to changes in pain (PVAQ‐ACP) subscales were evaluated. Results Amplitudes of long‐ACR showed significant positive correlations with PVAQ‐ACP, whereas those of short‐ACR did not show any significant correlations. Conclusions Generalized hypervigilance may be observed even in healthy subjects. ACR may be a useful index to evaluate the hypervigilance state in the human brain.
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Affiliation(s)
- Naofumi Otsuru
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Mayu Ogawa
- Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Shota Miyaguchi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Sho Kojima
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Kei Saito
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Yasuto Inukai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
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7
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Beaudoin FL, Kessler RC, Hwang I, Lee S, Sampson NA, An X, Ressler KJ, Koenen KC, McLean SA. Pain after a motor vehicle crash: The role of socio-demographics, crash characteristics and peri-traumatic stress symptoms. Eur J Pain 2021; 25:1119-1136. [PMID: 33458880 PMCID: PMC10913946 DOI: 10.1002/ejp.1733] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 01/13/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND The vast majority of individuals who come to the emergency department (ED) for care after a motor vehicle collision (MVC) are diagnosed with musculoskeletal strain only and are discharged to home. A significant subset of this population will still develop persistent pain and posttraumatic psychological sequelae may play an important role in pain persistence. METHODS We conducted a multisite longitudinal cohort study of adverse post-traumatic neuropsychiatric sequelae among patients seeking ED treatment in the aftermath of a traumatic life experience. We report on a sub-group of patients (n = 666) presenting after an MVC, the most common type of trauma and we examine associations of socio-demographic and MVC characteristics, and persistent pain 8 weeks after MVC. We also examine the degree to which these associations are related to peritraumatic psychological symptoms and 2-week acute stress reactions using an applied approach. RESULTS Eight-week prevalence of persistent moderate or severe pain was high (67.4%) and positively associated with patient sex (female), older age, low socioeconomic status (education and income) and pain severity in the ED. Peritraumatic stress symptoms (distress and dissociation) appear to exert some influence on both acute pain and the transition from acute to persistent pain. DISCUSSION AND CONCLUSIONS The early aftermath of an MVC may be an important time period for intervening to prevent and reduce persistent pain. Substantial variation in mediating pathways across predictors also suggests potential diverse and complex underlying biological and psychological pathogenic processes are at work in the early weeks following trauma. SIGNIFICANCE The first several days after trauma may dictate recovery trajectories. Persistent pain, pain lasting beyond the expected time of recovery, is associated with pain early in the recovery period, but also mediated through other pathways. Future work is needed to understand the complex neurobiological processes in involved in the development of persistent and acute post-traumatic pain.
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Affiliation(s)
- Francesca L. Beaudoin
- Department of Emergency Medicine & Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - I. Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - S. Lee
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - N. A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - X. An
- Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K. J. Ressler
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA
| | - K. C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - S. A. McLean
- Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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8
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Geisler M, Rizzoni E, Makris N, Pasternak O, Rathi Y, Bouix S, Herbsleb M, Bär KJ, Weiss T, Kikinis Z. Microstructural alterations in medial forebrain bundle are associated with interindividual pain sensitivity. Hum Brain Mapp 2020; 42:1130-1137. [PMID: 33170528 PMCID: PMC7856635 DOI: 10.1002/hbm.25281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/13/2020] [Accepted: 10/29/2020] [Indexed: 01/28/2023] Open
Abstract
The perception of pain to noxious stimuli, also known as pain sensitivity, varies among individuals. The comprised brain structures and their white matter pathways are complex and elusive. Here, we aimed to investigate whether variation of microstructure of the medial forebrain bundle (MFB), a tract connecting the basal forebrain with the brain stem, is associated with interindividual pain sensitivity. We assessed interindividual pain sensitivity as a rating of pain intensity to heat stimuli (45, 47, and 48.9°C) in 38 healthy men (age: 27.05 ± 5.7 years). We also reconstructed the MFB using multitensor tractography from diffusion magnetic resonance imaging (dMRI) and calculated free‐water corrected dMRI measures of fractional anisotropy (FAt), radial diffusivity (RDt), and axial diffusivity (ADt). Lower ratings of interindividual pain intensity correlated with higher FAt and lower RDt of the MFB. As changes in FAt and RDt may reflect abnormalities in myelination, the results might be interpreted as that a lower pain rating is associated with higher degree of myelination of the MFB and could represent an inhibitory pathway of pain. Our results suggest that alteration of microstructure in the MFB contributes to the interindividual variation of pain perception.
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Affiliation(s)
- Maria Geisler
- Department of Clinical Psychology, Friedrich-Schiller-University Jena, Jena, Germany
| | - Elizabeth Rizzoni
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Nikolaos Makris
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA.,Departments of Radiology and Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Departments of Radiology and Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA.,Departments of Radiology and Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Yogesh Rathi
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA.,Departments of Radiology and Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA.,Departments of Radiology and Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Marco Herbsleb
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University Jena, Jena, Germany
| | - Karl-Jürgen Bär
- Department of Psychosomatic Medicine, University Hospital Jena, Jena, Germany
| | - Thomas Weiss
- Department of Clinical Psychology, Friedrich-Schiller-University Jena, Jena, Germany
| | - Zora Kikinis
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
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9
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Capito ES, Lautenbacher S, Wolstein J, Horn-Hofmann C. Effects of oral alcohol administration on heat pain threshold and ratings of supra-threshold stimuli. Scand J Pain 2020; 20:623-634. [PMID: 32755104 DOI: 10.1515/sjpain-2019-0144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/27/2020] [Indexed: 12/15/2022]
Abstract
Background and aims Evidence for analgesic effects of oral alcohol consumption on heat pain has recently been documented in a placebo-controlled, randomized and double-blind design. We aimed at further investigating these effects and now set the focus on pain threshold and the ratings of supra-threshold pain to cover most of the pain range. Moreover, we now firstly evaluated sex differences in these effects. Methods We investigated 41 healthy participants (22 females) in a randomized, double-blind and placebo-controlled design and targeted two different moderate breath-alcohol levels of 0.06% and 0.08%. Before and after an alcoholic or placebo drink, contact heat was applied at the forearm. Subjects evaluated pain threshold (method of adjustment) and rated pain intensity and pain unpleasantness of supra-threshold stimuli (intensity: threshold +3 °C; duration: 5 s). Results Analgesic effects taking the form of increased pain thresholds were found after both alcohol doses, surprisingly with more pronounced effects for the lower dose. While the high alcohol dose exerted small analgesic effects on pain intensity ratings (i.e. decrease), slightly increased ratings of pain intensity and pain unpleasantness after the low alcohol dose rather suggest pain enhancement. Alcohol did not affect intensity vs. unpleasantness ratings differentially. We found no evidence for sex differences in any of these effects. Conclusions Overall, acute alcohol effects on pain were subtle. Our findings suggest that while low alcohol doses already exert analgesic effects on pain threshold, stronger doses are required for pain reduction on supra-threshold pain levels. Furthermore, sex differences could not be detected within our experimental paradigm but should be further explored in future research. Implications Analgesic effects of sub-toxic alcohol doses - as normally occurring during social drinking - might be weak; however, susceptibility to pain relieving effects of alcohol might be a risk factor for the use of alcohol as self-medication in acute pain states.
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Affiliation(s)
- Eva Susanne Capito
- Physiological Psychology, University of Bamberg, Markusplatz 3, 96045 Bamberg, Germany, Phone: +49 951 863-1847
| | | | - Jörg Wolstein
- Pathopsychology, University of Bamberg, Bamberg, Germany
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10
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Furman AJ, Thapa T, Summers SJ, Cavaleri R, Fogarty JS, Steiner GZ, Schabrun SM, Seminowicz DA. Cerebral peak alpha frequency reflects average pain severity in a human model of sustained, musculoskeletal pain. J Neurophysiol 2019; 122:1784-1793. [PMID: 31389754 PMCID: PMC6843105 DOI: 10.1152/jn.00279.2019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 11/22/2022] Open
Abstract
Heightened pain sensitivity, the amount of pain experienced in response to a noxious event, is a known risk factor for development of chronic pain. We have previously reported that pain-free, sensorimotor peak alpha frequency (PAF) is a reliable biomarker of pain sensitivity for thermal, prolonged pains lasting tens of minutes. To test whether PAF can provide information about pain sensitivity occurring over clinically relevant timescales (i.e., weeks), EEG was recorded before and while participants experienced a long-lasting pain model, repeated intramuscular injection of nerve growth factor (NGF), that produces progressively developing muscle pain for up to 21 days. We demonstrate that pain-free, sensorimotor PAF is negatively correlated with NGF pain sensitivity; increasingly slower PAF is associated with increasingly greater pain sensitivity. Furthermore, PAF remained stable following NGF injection, indicating that the presence of NGF pain for multiple weeks is not sufficient to induce the PAF slowing reported in chronic pain. In total, our results demonstrate that slower pain-free, sensorimotor PAF is associated with heightened sensitivity to a long-lasting musculoskeletal pain and also suggest that the apparent slowing of PAF in chronic pain may reflect predisease pain sensitivity.NEW & NOTEWORTHY Pain sensitivity, the intensity of pain experienced after injury, has been identified as an important risk factor in the development of chronic pain. Biomarkers of pain sensitivity have the potential to ease chronic pain burdens by preventing disease emergence. In the current study, we demonstrate that the speed of pain-free, sensorimotor peak alpha frequency recorded during resting-state EEG predicts pain sensitivity to a clinically-relevant, human model of prolonged pain that persists for weeks.
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Affiliation(s)
- Andrew J Furman
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland
- Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland
| | - Tribikram Thapa
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Simon J Summers
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Rocco Cavaleri
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Jack S Fogarty
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Genevieve Z Steiner
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Siobhan M Schabrun
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - David A Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland
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11
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Martínez E, Aira Z, Buesa I, Aizpurua I, Rada D, Azkue JJ. Embodied pain in fibromyalgia: Disturbed somatorepresentations and increased plasticity of the body schema. PLoS One 2018; 13:e0194534. [PMID: 29624596 PMCID: PMC5889164 DOI: 10.1371/journal.pone.0194534] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 03/05/2018] [Indexed: 11/22/2022] Open
Abstract
Fibromyalgia syndrome (FMS) is a highly prevalent, chronic musculoskeletal condition characterized by widespread pain and evoked pain at tender points. This study evaluated various aspects of body awareness in a sample of 14 women with FMS and 13 healthy controls, such as plasticity of the body schema, body esteem, and interoceptive awareness. To this end, the Rubber Hand Illusion (RHI), the Body Esteem Scale (BES), and the Body Perception Questionnaire (BPQ) were used, respectively. Consistent with increased plasticity of the body schema, FMS patients scored higher, with large or very large effect sizes, across all three domains evaluated in the RHI paradigm, namely proprioceptive drift and perceived ownership and motor control over the rubber hand. Scores on all items addressed by the BES were consistently lower among FMS subjects (2.52, SEM .19 vs 3.89, SEM .16, respectively, p < .01, Cohen’s d = .38-.66). In the FMS sample, BES scores assigned to most painful regions also were lower than those assigned to the remaining body sites (1.58, SEM .19 vs 2.87, SEM .18, respectively, p < .01). Significantly higher scores (p < .01, Cohen’s d = .51-.87) were found in the FMS sample across awareness (3.57 SEM .15 vs 1.87 SEM .11), stress response (3.76 SEM .11 vs 1.78 SEM .11), autonomic nervous system reactivity (2.59 SEM .17 vs 1.35 SEM .07), and stress style 2 (2.73 SEM .27 vs 1.13 SEM .04) subscales of the BPQ. Intensity of ongoing clinical pain was found to be strongly correlated with interoceptive awareness (r = .75, p = .002). The results suggest a disturbed embodiment in FMS, characterized by instability of the body schema, negatively biased cognitions regarding one’s own body, and increased vigilance to internal bodily cues. These manifestations may be interpreted as related with the inability of incoming sensory inputs to adequately update negatively biased off-line somatorepresentations stored as long-term memory.
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Affiliation(s)
- Endika Martínez
- Department of Neurosciences, School of Medicine and Nursery, University of the Basque Country, UPV/EHU Barrio Sarriena s/n, Leioa, Bizkaia, Spain
| | - Zigor Aira
- Department of Neurosciences, School of Medicine and Nursery, University of the Basque Country, UPV/EHU Barrio Sarriena s/n, Leioa, Bizkaia, Spain
| | - Itsaso Buesa
- Department of Neurosciences, School of Medicine and Nursery, University of the Basque Country, UPV/EHU Barrio Sarriena s/n, Leioa, Bizkaia, Spain
- * E-mail:
| | - Ibane Aizpurua
- Department of Neurosciences, School of Medicine and Nursery, University of the Basque Country, UPV/EHU Barrio Sarriena s/n, Leioa, Bizkaia, Spain
| | - Diego Rada
- Preventive Medicine and Public Health Department, School of Pharmacy University of the Basque Country, UPV/EHU Paseo de la Universidad, Vitoria-Gasteiz, Araba, Spain
| | - Jon Jatsu Azkue
- Department of Neurosciences, School of Medicine and Nursery, University of the Basque Country, UPV/EHU Barrio Sarriena s/n, Leioa, Bizkaia, Spain
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12
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Vossen CJ, Luijcks R, van Os J, Joosten EA, Lousberg R. Does pain hypervigilance further impact the lack of habituation to pain in individuals with chronic pain? A cross-sectional pain ERP study. J Pain Res 2018; 11:395-405. [PMID: 29497330 PMCID: PMC5822847 DOI: 10.2147/jpr.s146916] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AIM In chronic pain, habituation is believed to be impaired, and pain hypervigilance can enhance the pain experience. The goal of this study was to determine whether pain hypervigilance further worsens habituation of event-related potentials, measured in a pain-rating protocol of 25 painful somatosensory electrical stimuli, in patients with chronic pain. METHODS Pain hypervigilance was assessed with the Pain Vigilance Awareness Questionnaire and analyzed using the event-related fixed interval areas multilevel technique, which enables one to study within-session habituation. In a cohort of 111 participants, 33 reported chronic pain. This chronic pain group was compared with 33 pain-free individuals, matched for age and sex. RESULTS The relationship between pain status and habituation was not moderated by pain hypervigilance. Chronic pain status affected linear habituation and dishabituation (quadratic function) from 220 to 260 ms for nearly all electrodes, and from 580 to 640 ms for frontal electrodes. The effect of pain hypervigilance on habituation was observed primarily from 480 to 820 ms poststimulus for right-sided and central electrodes. CONCLUSION Pain hypervigilance and chronic pain independently influence habituation to painful stimuli - although not synergistically. To confirm that these effects are mediated by separate pathways, further research is required, in which electroencephalography is combined with other modalities with adequate spatial resolution, such as functional magnetic resonance imaging.
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Affiliation(s)
| | - Rosan Luijcks
- Department of Psychiatry & Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry & Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
- King’s College London, King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK
| | | | - Richel Lousberg
- Department of Psychiatry & Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
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13
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Attentional Avoidance is Associated With Increased Pain Sensitivity in Patients With Chronic Posttraumatic Pain and Comorbid Posttraumatic Stress. Clin J Pain 2018; 34:22-29. [DOI: 10.1097/ajp.0000000000000505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Kunz M, Capito ES, Horn-Hofmann C, Baum C, Scheel J, Karmann AJ, Priebe JA, Lautenbacher S. Psychometric Properties of the German Version of the Pain Vigilance and Awareness Questionnaire (PVAQ) in Pain-Free Samples and Samples with Acute and Chronic Pain. Int J Behav Med 2017; 24:260-271. [PMID: 27481106 PMCID: PMC5344944 DOI: 10.1007/s12529-016-9585-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Purpose The way individuals attend to pain is known to have a considerable impact on the experience and chronification of pain. One method to assess the habitual “attention to pain” is the Pain Vigilance and Awareness Questionnaire (PVAQ). With the present study, we aimed to test the psychometric properties of the German version of the PVAQ across pain-free samples and across patients with acute and chronic pain. Method Two samples of pain-free individuals (student sample (N = 255)/non-student sample (N = 362)) and two clinical pain samples (acute pain patients (N = 105)/chronic pain patients (N = 36)) were included in this cross-sectional evaluation of the German PVAQ. Factor structure was assessed using exploratory and confirmatory factor analyses. Reliability was assessed using internal consistency (Cronbach’s alpha). Construct validity was tested by assessing correlations between PVAQ and theoretically related constructs. Results Exploratory factor analysis (non-student sample) and confirmatory factor analysis (student sample, acute pain patient sample) suggested that a two-factor solution best fitted our data (“attention to pain,” “attention to changes in pain”). Internal consistency ranged from acceptable to good in all four samples. As hypothesized, the PVAQ correlated significantly with theoretically related constructs in all four samples, suggesting good construct validity in pain-free individuals and in pain patients. Conclusion The German PVAQ shows good psychometric properties across samples of pain-free individuals and patients suffering from pain that are comparable to PVAQ versions of other languages. Thus, the German PVAQ seems to be a measure of pain vigilance equally valid as found in other countries.
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Affiliation(s)
- M Kunz
- Physiological Psychology, University of Bamberg, Bamberg, Germany.
- Department of Family Medicine, Geriatrics Section, University Medical Center Groningen, Groningen, the Netherlands.
| | - E S Capito
- Physiological Psychology, University of Bamberg, Bamberg, Germany
| | - C Horn-Hofmann
- Physiological Psychology, University of Bamberg, Bamberg, Germany
| | - C Baum
- Physiological Psychology, University of Bamberg, Bamberg, Germany
- Psychology School, Hochschule Fresenius University of Applied Sciences, Frankfurt, Germany
| | - J Scheel
- Physiological Psychology, University of Bamberg, Bamberg, Germany
| | - A J Karmann
- Physiological Psychology, University of Bamberg, Bamberg, Germany
| | - J A Priebe
- Physiological Psychology, University of Bamberg, Bamberg, Germany
| | - S Lautenbacher
- Physiological Psychology, University of Bamberg, Bamberg, Germany
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15
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Chronic low back pain and the transdiagnostic process: How do cognitive and emotional dysregulations contribute to the intensity of risk factors and pain? Scand J Pain 2017; 17:309-315. [DOI: 10.1016/j.sjpain.2017.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/21/2017] [Accepted: 08/23/2017] [Indexed: 11/23/2022]
Abstract
Abstract
Background and aims
Based on a transdiagnostic approach, this study assesses the impact of cognitive and emotional processes (difficulties in emotional regulation, impulsiveness, rumination and somatosensory amplification) on the psychological risk factors of chronic low-back pain.
Methods
The study was carried out with 256 patients with chronic low-back pain. All the variables were assessed through a booklet of 10 validated questionnaires. Multiple regression analysis and moderation analysis were performed.
Results
Predictors included in multiple regression models explain 3%-42% (adjusted R
2) of the variance in psychological risk factors. Moreover, analyses reveal a significant moderator effect of somatosensory amplification on the link between fear-avoidance beliefs linked to work and pain intensity (F
(3;250) = 12.33; p = .00), of somatosensory amplification and brooding on the link between depression and functional repercussions (FR) on everyday life (F
(3;252) = 13.36; p = .000; F
(1;252) = 12.42; p = .00), of the reflection dimension of rumination on the link between the helplessness dimension of catastrophizing and FRs on sociability (F
(3;252) = 37.02; p = .00). There is also a moderation analysis with a significant trend concerning the lack of emotional awareness and the difficulties in controlling impulsive behaviours.
Conclusions
Our results indicate an important role of some dimensions of difficulties in emotional regulation, somatosensory amplification and rumination in the increase in negative affects and dysfunctional beliefs, and in the links between those psychological risk factors and pain/disability.
Implications
This study identifies some cognitive and emotional dysregulations substantially involved in work-related chronic pain. This contribute to put in place psychotherapeutic protocols to tackle these deficits and dysregulations in a relevant way.
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16
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Horn-Hofmann C, Scheel J, Dimova V, Parthum A, Carbon R, Griessinger N, Sittl R, Lautenbacher S. Prediction of persistent post-operative pain: Pain-specific psychological variables compared with acute post-operative pain and general psychological variables. Eur J Pain 2017; 22:191-202. [PMID: 28940665 DOI: 10.1002/ejp.1115] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Psychological variables and acute post-operative pain are of proven relevance for the prediction of persistent post-operative pain. We aimed at investigating whether pain-specific psychological variables like pain catastrophizing add to the predictive power of acute pain and more general psychological variables like depression. METHODS In all, 104 young male patients undergoing thoracic surgery for pectus excavatum correction were studied on the pre-operative day (T0) and 1 week (T1) and 3 months (T2) after surgery. They provided self-report ratings (pain-related: Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale = PASS, Pain Vigilance and Awareness Questionnaire = PVAQ; general psychological: Screening for Somatoform Symptoms, State-Anxiety Inventory-X1, Center for Epidemiologic Studies Depression Scale = CES-D). Additional predictors (T1) as well as criterion variables (T2) were pain intensity (Numerical Rating Scale) and pain disability (Pain Disability Index). RESULTS Three months after surgery, 25% of the patients still reported clinically relevant pain (pain intensity ≥3) and over 50% still reported pain-related disability. Acute post-operative pain as well as general psychological variables did not allow for a significant prediction of persistent post-operative pain; in contrast, pain-related psychological variables did. The best single predictors were PASS for pain intensity and PVAQ for pain disability. CONCLUSIONS Pain-related psychological variables derived from the fear-avoidance model contributed significantly to the prediction of persistent post-operative pain. The best possible compilation of these measures requires further research. More general psychological variables may become relevant predictors later in the medical history. SIGNIFICANCE Our results suggest that pain-specific psychological variables such as pain anxiety and pain hypervigilance add significantly to the prediction of persistent post-operative pain and might even outperform established predictors such as acute pain and general psychological variables. Clinicians might benefit from the development of time-economic screening tools based on these variables.
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Affiliation(s)
- C Horn-Hofmann
- Physiological Psychology, Otto-Friedrich University Bamberg, Germany
| | - J Scheel
- Physiological Psychology, Otto-Friedrich University Bamberg, Germany
| | - V Dimova
- Physiological Psychology, Otto-Friedrich University Bamberg, Germany
| | - A Parthum
- Pain Center, Friedrich-Alexander University Erlangen, Germany
| | - R Carbon
- Department of Pediatric Surgery, Friedrich-Alexander University Erlangen, Germany
| | - N Griessinger
- Pain Center, Friedrich-Alexander University Erlangen, Germany
| | - R Sittl
- Pain Center, Friedrich-Alexander University Erlangen, Germany
| | - S Lautenbacher
- Physiological Psychology, Otto-Friedrich University Bamberg, Germany
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17
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Raocharernporn S, Boonsiriseth K, Khanijou M, Wongsirichat N. Hemodynamic changes and pain perception-related anxiety after experiencing an impacted-tooth removal: clinical practice outcome. J Dent Anesth Pain Med 2017; 17:105-111. [PMID: 28879337 PMCID: PMC5564143 DOI: 10.17245/jdapm.2017.17.2.105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/03/2017] [Accepted: 04/09/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Dental fear is usually associated with hemodynamic changes. Fear of pain during the surgical removal of a lower impacted third molar might cause patients anxiety, thereby leading to avoidance of any future dental therapy. This study aimed to determine the effect of experiencing a surgical impacted-tooth removal on the pain perception-related anxiety and hemodynamic status. METHODS Twenty-seven healthy patients aged 15-30 years (mean age, 24 years), for whom surgical removal of bilateral lower third molars was advised, were included. This prospective, randomized, controlled, split-mouth study involved operations on both sides of the mandibular arch, with a 1-month washout period in between. Blood pressure and heart rate were measured before the surgical procedure, during and after the injection, preoperatively, and postoperatively. Pain perception was evaluated using a 100-mm visual analog scale during the injection, preoperatively, and postoperatively after the numbness disappeared. Differences in the blood pressure, heart rate, and pain perception between the two appointments were analyzed using the paired t-test. For all statistical analyses, SPSS version 11.5 was used. RESULTS The mean pain perception values during the injection and preoperatively showed no significant differences between the two appointments (P > 0.05); however, significant differences in the blood pressure and heart rate were noted before the surgical procedure; preoperatively, the blood pressure alone showed a significant difference (P < 0.05). CONCLUSIONS There was a significant decrease in the blood pressure and heart rate preoperatively; hence, experiencing a surgical impacted-tooth removal can reduce the subsequent preoperative anxiety in healthy patients.
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Affiliation(s)
- Somchart Raocharernporn
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kiatanant Boonsiriseth
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Manop Khanijou
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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18
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van Heck CH, Oosterman JM, de Kleijn KMA, Jongsma MLA, van Rijn CM. Evidence for a Priori Existence of Attentional Bias Subgroups in Emotional Processing of Aversive Stimuli. Front Behav Neurosci 2017; 11:87. [PMID: 28553210 PMCID: PMC5427543 DOI: 10.3389/fnbeh.2017.00087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/25/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Casper H. van Heck
- Donders Institute for Brain, Cognition, and Behaviour, Radboud UniversityNijmegen, Netherlands
- *Correspondence: Clementina M. van Rijn
| | - Joukje M. Oosterman
- Donders Institute for Brain, Cognition, and Behaviour, Radboud UniversityNijmegen, Netherlands
| | - Kim M. A. de Kleijn
- Donders Institute for Brain, Cognition, and Behaviour, Radboud UniversityNijmegen, Netherlands
| | - Marijtje L. A. Jongsma
- Faculty of Social Sciences/Behavioral Science Institute, Radboud UniversityNijmegen, Netherlands
| | - Clementina M. van Rijn
- Donders Institute for Brain, Cognition, and Behaviour, Radboud UniversityNijmegen, Netherlands
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19
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Feinberg RK, Hu J, Weaver MA, Fillingim RB, Swor RA, Peak DA, Jones JS, Rathlev NK, Lee DC, Domeier RM, Hendry PL, Liberzon I, McLean SA. Stress-related psychological symptoms contribute to axial pain persistence after motor vehicle collision: path analysis results from a prospective longitudinal study. Pain 2017; 158:682-690. [PMID: 28030471 PMCID: PMC5354970 DOI: 10.1097/j.pain.0000000000000818] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Posttraumatic stress disorder (PTSD) symptoms and pain after traumatic events such as motor vehicle collision (MVC) have been proposed to be mutually promoting. We performed a prospective multicenter study that enrolled 948 individuals who presented to the emergency department within 24 hours of MVC and were discharged home after evaluation. Follow-up evaluations were completed 6 weeks, 6 months, and 1 year after MVC. Path analysis results supported the hypothesis that axial pain after MVC consistently promotes the maintenance of hyperarousal and intrusive symptoms, from the early weeks after injury through 1 year. In addition, path analysis results supported the hypothesis that one or more PTSD symptom clusters had an influence on axial pain outcomes throughout the year after MVC, with hyperarousal symptoms most influencing axial pain persistence in the initial months after MVC. The influence of hyperarousal symptoms on pain persistence was only present among individuals with genetic vulnerability to stress-induced pain, suggesting specific mechanisms by which hyperarousal symptoms may lead to hyperalgesia and allodynia. Further studies are needed to better understand the specific mechanisms by which pain and PTSD symptoms enhance one another after trauma, and how such mechanisms vary among specific patient subgroups, to better inform the development of secondary preventive interventions.
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Affiliation(s)
- Rose K Feinberg
- UNC Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Departments of Anesthesiology and
| | - JunMei Hu
- UNC Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Departments of Anesthesiology and
| | - Mark A Weaver
- Medicine and Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Robert A Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey S Jones
- Department of Emergency Medicine, Spectrum Health System, Grand Rapids, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA
| | - David C Lee
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Health System, Ypsilanti, MI, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida, Jacksonville, FL, USA
| | - Israel Liberzon
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Samuel A McLean
- UNC Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Departments of Anesthesiology and
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA
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20
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Lack of predictive power of trait fear and anxiety for conditioned pain modulation (CPM). Exp Brain Res 2016; 234:3649-3658. [DOI: 10.1007/s00221-016-4763-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
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21
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Kunz M, Hennig J, Karmann AJ, Lautenbacher S. Relationship of 5-HTTLPR Polymorphism with Various Factors of Pain Processing: Subjective Experience, Motor Responsiveness and Catastrophizing. PLoS One 2016; 11:e0153089. [PMID: 27043930 PMCID: PMC4820275 DOI: 10.1371/journal.pone.0153089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 03/23/2016] [Indexed: 11/19/2022] Open
Abstract
Although serotonin is known to play an important role in pain processing, the relationship between the polymorphism in 5-HTTLPR and pain processing is not well understood. To examine the relationship more comprehensively, various factors of pain processing having putative associations with 5-HT functioning were studied, namely the subjective pain experience (pain threshold, rating of experimental pain), catastrophizing about pain (Pain Catastrophizing Scale = PCS) and motor responsiveness (facial expression of pain). In 60 female and 67 male participants, heat pain stimuli were applied by a contact thermode to assess pain thresholds, supra-threshold ratings and a composite score of pain-relevant facial responses. Participants also completed the PCS and were grouped based on their 5-HTTLPR genotype (bi-allelic evaluation) into a group with s-allele carriers (ss, sl) and a second group without (ll). S-allele carriers proved to have lower pain thresholds and higher PCS scores. These two positive findings were unrelated to each other. No other difference between genotype groups became significant. In all analyses, “age” and “gender” were controlled for. In s-allele carriers the subjective pain experience and the tendency to catastrophize about pain was enhanced, suggesting that the s-allele might be a risk factor for the development and maintenance of pain. This risk factor seems to act via two independent routes, namely via the sensory processes of subjective pain experiences and via the booster effects of pain catastrophizing.
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Affiliation(s)
- Miriam Kunz
- Department of General Practice, Geriatrics Section, University Medical Center Groningen, Groningen, The Netherlands
- Physiological Psychology, Department of Psychology, University of Bamberg, Bamberg, Germany
- * E-mail:
| | - Jürgen Hennig
- Personality Psychology and Individual Differences, Department of Psychology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Anna J. Karmann
- Physiological Psychology, Department of Psychology, University of Bamberg, Bamberg, Germany
| | - Stefan Lautenbacher
- Physiological Psychology, Department of Psychology, University of Bamberg, Bamberg, Germany
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22
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Dimova V, Lötsch J, Hühne K, Winterpacht A, Heesen M, Parthum A, Weber PG, Carbon R, Griessinger N, Sittl R, Lautenbacher S. Association of genetic and psychological factors with persistent pain after cosmetic thoracic surgery. J Pain Res 2015; 8:829-44. [PMID: 26664154 PMCID: PMC4669922 DOI: 10.2147/jpr.s90434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The genetic control of pain has been repeatedly demonstrated in human association studies. In the present study, we assessed the relative contribution of 16 single nucleotide polymorphisms in pain-related genes, such as cathechol-O-methyl transferase gene (COMT), fatty acid amino hydrolase gene (FAAH), transient receptor potential cation channel, subfamily V, member 1 gene (TRPV1), and δ-opioid receptor gene (OPRD1), for postsurgical pain chronification. Ninety preoperatively pain-free male patients were assigned to good or poor outcome groups according to their intensity or disability score assessed at 1 week, 3 months, 6 months, and 1 year after funnel chest correction. The genetic effects were compared with those of two psychological predictors, the attentional bias toward positive words (dot-probe task) and the self-reported pain vigilance (Pain Vigilance and Awareness Questionnaire [PVAQ]), which were already shown to be the best predictors for pain intensity and disability at 6 months after surgery in the same sample, respectively. Cox regression analyses revealed no significant effects of any of the genetic predictors up to the end point of survival time at 1 year after surgery. Adding the genetics to the prediction by the attentional bias to positive words for pain intensity and the PVAQ for pain disability, again no significant additional explanation could be gained by the genetic predictors. In contrast, the preoperative PVAQ score was also, in the present enlarged sample, a meaningful predictor for lasting pain disability after surgery. Effect size measures suggested some genetic variables, for example, the polymorphism rs1800587G>A in the interleukin 1 alpha gene (IL1A) and the COMT haplotype rs4646312T>C/rs165722T>C/rs6269A>G/rs4633T>C/rs4818C>G/rs4680A>G, as possible relevant modulators of long-term postsurgical pain outcome. A comparison between pathophysiologically different predictor groups appears to be helpful in identifying clinically relevant predictors of chronic pain.
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Affiliation(s)
- Violeta Dimova
- Physiological Psychology, Otto-Friedrich University Bamberg, Frankfurt am Main, Germany ; Pain Center, Friedrich-Alexander University Erlangen, Frankfurt am Main, Germany ; Institute of Clinical Pharmacology, Goethe University, Frankfurt am Main, Germany
| | - Jörn Lötsch
- Institute of Clinical Pharmacology, Goethe University, Frankfurt am Main, Germany
| | - Kathrin Hühne
- Department of Human Genetics, Friedrich-Alexander University Erlangen, Germany
| | - Andreas Winterpacht
- Department of Human Genetics, Friedrich-Alexander University Erlangen, Germany
| | - Michael Heesen
- Department of Anaesthesia, Kantonsspital Baden, Baden, Switzerland
| | - Andreas Parthum
- Physiological Psychology, Otto-Friedrich University Bamberg, Frankfurt am Main, Germany ; Pain Center, Friedrich-Alexander University Erlangen, Frankfurt am Main, Germany
| | - Peter G Weber
- Department of Pediatric Surgery, Friedrich-Alexander University Erlangen, Germany
| | - Roman Carbon
- Department of Pediatric Surgery, Friedrich-Alexander University Erlangen, Germany
| | - Norbert Griessinger
- Pain Center, Friedrich-Alexander University Erlangen, Frankfurt am Main, Germany
| | - Reinhard Sittl
- Pain Center, Friedrich-Alexander University Erlangen, Frankfurt am Main, Germany
| | - Stefan Lautenbacher
- Physiological Psychology, Otto-Friedrich University Bamberg, Frankfurt am Main, Germany
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Hansen MS, Horjales-Araujo E, Dahl JB. Associations between psychological variables and pain in experimental pain models. A systematic review. Acta Anaesthesiol Scand 2015; 59:1094-102. [PMID: 26088747 DOI: 10.1111/aas.12555] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/16/2015] [Accepted: 04/09/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND The association between pain and psychological characteristics has been widely debated. Thus, it remains unclear whether an individual's psychological profile influences a particular pain experience, or if previous pain experience contributes to a certain psychological profile. Translational studies performed in healthy volunteers may provide knowledge concerning psychological factors in healthy individuals as well as basic pain physiology. The aim of this review was to investigate whether psychological vulnerability or specific psychological variables in healthy volunteers are predictive of the level of pain following experimental pain models. METHODS A systematic search on the databases, PubMed, Embase, Cochcrane library, and Clinicaltrials.gov was performed during September 2014. All trials investigating the association between psychological variables and experimental pain in healthy volunteers were considered for inclusion. RESULTS Twenty-nine trials met the inclusion criteria, with a total of 2637 healthy volunteers. The included trials investigated a total of 45 different psychological tests and 27 different types of pain models. The retrieved trials did not present a sufficiently homogenous group to perform meta-analysis. The collected results were diverse. A total of 16 trials suggested that psychological factors may predict the level of pain, seven studies found divergent results, and six studies found no significant association between psychological variables and experimental pain. CONCLUSION Psychological factors may have predictive value when investigating experimental pain. However, due to substantial heterogeneity and methodological shortcomings of the published literature, firm conclusions are not possible.
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Affiliation(s)
- M. S. Hansen
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - E. Horjales-Araujo
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - J. B. Dahl
- Department of Anaesthesia; Bispebjerg and Frederiksberg Hospitals; University of Copenhagen; Copenhagen Denmark
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Mohammadi S, Dehghani M, Khatibi A, Sanderman R, Hagedoorn M. Caregivers' attentional bias to pain: does it affect caregiver accuracy in detecting patient pain behaviors? Pain 2015; 156:123-130. [PMID: 25599308 DOI: 10.1016/j.pain.0000000000000015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Attentional bias to pain among family caregivers of patients with pain may enhance the detection of pain behaviors in patients. However, both relatively high and low levels of attentional bias may increase disagreement between patients and caregivers in reporting pain behaviors. This study aims to provide further evidence for the presence of attentional bias to pain among family caregivers, to examine the association between caregivers' attentional bias to pain and detecting pain behaviors, and test whether caregivers' attentional bias to pain is curvilinearly related to patient and caregiver disagreement in reporting pain behaviors. The sample consisted of 96 caregivers, 94 patients with chronic pain, and 42 control participants. Caregivers and controls completed a dot-probe task assessing attention to painful and happy stimuli. Both patients and caregivers completed a checklist assessing patients' pain behavior. Although caregivers did not respond faster to pain congruent than pain incongruent trials, caregiver responses were slower in pain incongruent trials compared with happy incongruent trials. Caregivers showed more bias toward pain faces than happy faces, whereas control participants showed more bias toward happy faces than pain faces. Importantly, caregivers' attentional bias to pain was significantly positively associated with reporting pain behaviors in patients above and beyond pain severity. It is reassuring that attentional bias to pain was not related to disagreement between patients and caregivers in reporting pain behaviors. In other words, attentional bias does not seem to cause overestimation of pain signals.
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Affiliation(s)
- Somayyeh Mohammadi
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands Families with Special Needs Department, Family Research Institute, Shahid Beheshti University, Tehran, Iran Laboratory of Research on Neuropsychophysiology of Pain, CRIUGM, University of Montreal, Montreal, QC, Canada Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands
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Dimova V, Oertel BG, Kabakci G, Zimmermann M, Hermens H, Lautenbacher S, Ultsch A, Lötsch J. A more pessimistic life orientation is associated with experimental inducibility of a neuropathy-like pain pattern in healthy individuals. THE JOURNAL OF PAIN 2015; 16:791-800. [PMID: 26056011 DOI: 10.1016/j.jpain.2015.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/27/2015] [Accepted: 05/19/2015] [Indexed: 01/31/2023]
Abstract
UNLABELLED The clinical pattern of neuropathic pain, diagnosed using the quantitative sensory testing (QST) battery (German Research Network on Neuropathic Pain), could be partly mimicked in healthy volunteers after topical capsaicin application. However, similar to clinical neuropathic pain that develops in only a subgroup of patients who have a neurologic lesion, this attempt to mimick a neuropathic pain pattern succeeded only in a small fraction (18%) of healthy individuals. In the present assessment, we pursued the hypothesis that the inducible subgroup differed from the other healthy participants with respect to their psychological phenotype. Therefore, in an observational study, participants were assessed using a comprehensive set of psychological variables comprising general psychological and pain-related cognitive-emotional mechanisms. The sum scores of the questionnaires were significantly linearly correlated with each other. Principal component analysis indicated that a major source of variance (46%) could be attributed to dispositional optimism examined via the Life Orientation Test (LOT). The LOT score significantly differed between the groups of participants, either those in whom a neuropathy-like pattern of pain assessed via QST could be partly (50-60% of the 11 QST parameters) induced (n = 20) or not (n = 90; P = .0375). It emerged again as the main selection criterion in a classification and regression tree predicting a participant's group assignment (inducible neuropathy-like QST pattern versus noninducible neuropathy-like QST pattern) at a cross-validated accuracy of 95.5 ± 2.1%. Thus, the few participants in a random sample of healthy volunteers who, after topical capsaicin application, partly resemble (to a degree of about 60%) the clinical pattern of neuropathic pain in the QST test battery, are preselectable on the basis of psychological factors, with a particular emphasis on pessimistic life attitudes. PERSPECTIVE In a small fraction of 18% of healthy volunteers, topical capsaicin application resulted in a neuropathy-like pattern in 50 to 60% of the components of a clinical test battery. These individuals displayed a more pessimistic life attitude as assessed by means of the LOT.
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Affiliation(s)
- Violeta Dimova
- Institute of Clinical Pharmacology, Goethe-University, Frankfurt am Main, Germany; Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Bruno G Oertel
- Institute of Clinical Pharmacology, Goethe-University, Frankfurt am Main, Germany; Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine and Pharmacology TMP, Frankfurt am Main, Germany
| | - Gülden Kabakci
- Institute of Clinical Pharmacology, Goethe-University, Frankfurt am Main, Germany
| | - Michael Zimmermann
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Hanneke Hermens
- Institute of Clinical Pharmacology, Goethe-University, Frankfurt am Main, Germany
| | - Stefan Lautenbacher
- Physiological Psychology, Otto-Friedrich University Bamberg, Bamberg, Germany
| | - Alfred Ultsch
- DataBionics Research Group, University of Marburg, Marburg, Germany
| | - Jörn Lötsch
- Institute of Clinical Pharmacology, Goethe-University, Frankfurt am Main, Germany; Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine and Pharmacology TMP, Frankfurt am Main, Germany.
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Peters ML, Vieler JS, Lautenbacher S. Dispositional and induced optimism lead to attentional preference for faces displaying positive emotions: An eye-tracker study. JOURNAL OF POSITIVE PSYCHOLOGY 2015. [DOI: 10.1080/17439760.2015.1048816] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Asghar MS, Pereira MP, Werner MU, Mårtensson J, Larsson HBW, Dahl JB. Secondary hyperalgesia phenotypes exhibit differences in brain activation during noxious stimulation. PLoS One 2015; 10:e0114840. [PMID: 25615578 PMCID: PMC4304709 DOI: 10.1371/journal.pone.0114840] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 11/14/2014] [Indexed: 01/08/2023] Open
Abstract
Noxious stimulation of the skin with either chemical, electrical or heat stimuli leads to the development of primary hyperalgesia at the site of injury, and to secondary hyperalgesia in normal skin surrounding the injury. Secondary hyperalgesia is inducible in most individuals and is attributed to central neuronal sensitization. Some individuals develop large areas of secondary hyperalgesia (high-sensitization responders), while others develop small areas (low-sensitization responders). The magnitude of each area is reproducible within individuals, and can be regarded as a phenotypic characteristic. To study differences in the propensity to develop central sensitization we examined differences in brain activity and anatomy according to individual phenotypical expression of secondary hyperalgesia by magnetic resonance imaging. Forty healthy volunteers received a first-degree burn-injury (47°C, 7 min, 9 cm2) on the non-dominant lower-leg. Areas of secondary hyperalgesia were assessed 100 min after the injury. We measured neuronal activation by recording blood-oxygen-level-dependent-signals (BOLD-signals) during mechanical noxious stimulation before burn injury and in both primary and secondary hyperalgesia areas after burn-injury. In addition, T1-weighted images were used to measure differences in gray-matter density in cortical and subcortical regions of the brain. We found significant differences in neuronal activity between high- and low-sensitization responders at baseline (before application of the burn-injury) (p < 0.05). After the burn-injury, we found significant differences between responders during noxious stimulation of both primary (p < 0.01) and secondary hyperalgesia (p ≤ 0.04) skin areas. A decreased volume of the right (p = 0.001) and left caudate nucleus (p = 0.01) was detected in high-sensitization responders in comparison to low-sensitization responders. These findings suggest that brain-structure and neuronal activation to noxious stimulation differs according to secondary hyperalgesia phenotype. This indicates differences in central sensitization according to phenotype, which may have predictive value on the susceptibility to development of high-intensity acute and persistent pain.
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Affiliation(s)
- Mohammad Sohail Asghar
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark
| | - Manuel Pedro Pereira
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark
| | - Mads Utke Werner
- Multidisciplinary Pain Centre, Neuroscience Centre, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark
| | - Johan Mårtensson
- Max Planck Institute for Human Development, Berlin, Germany; Department of Psychology, Lund University, Lund, Sweden
| | - Henrik B W Larsson
- Functional Imaging Unit, Hospital, Glostrup, Copenhagen University Hospitals, Glostrup, Denmark
| | - Jørgen Berg Dahl
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark
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Schrooten M, Vancleef L, Vlaeyen J. Attention allocation to ambiguous health/somatic threat cues. Eur J Pain 2014; 19:1002-11. [DOI: 10.1002/ejp.628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2014] [Indexed: 11/10/2022]
Affiliation(s)
- M.G.S. Schrooten
- Center for Health and Medical Psychology (CHAMP); Örebro University; Sweden
- Research Group Health Psychology; University of Leuven; Belgium
| | - L. Vancleef
- Department of Clinical Psychological Science; Maastricht University; The Netherlands
| | - J.W.S. Vlaeyen
- Research Group Health Psychology; University of Leuven; Belgium
- Department of Clinical Psychological Science; Maastricht University; The Netherlands
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Ravn P, Foster DJR, Kreilgaard M, Christrup L, Werner MU, Secher EL, Skram U, Upton R. Pharmacokinetic-pharmacodynamic modelling of the analgesic and antihyperalgesic effects of morphine after intravenous infusion in human volunteers. Basic Clin Pharmacol Toxicol 2014; 115:257-67. [PMID: 24520987 DOI: 10.1111/bcpt.12213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 01/31/2014] [Indexed: 11/29/2022]
Abstract
Using a modelling approach, this study aimed to (i) examine whether the pharmacodynamics of the analgesic and antihyperalgesic effects of morphine differ; (ii) investigate the influence of demographic, pain sensitivity and genetic (OPRM1) variables on between-subject variability of morphine pharmacokinetics and pharmacodynamics in human experimental pain models. The study was a randomized, double-blind, 5-arm, cross-over, placebo-controlled study. The psychophysical cutaneous pain tests, electrical pain tolerance (EPTo) and secondary hyperalgesia areas (2HA) were studied in 28 healthy individuals (15 males). The subjects were chosen based on a previous trial where 100 subjects rated (VAS) their pain during a heat injury (47°C, 7 min., 12.5 cm(2) ). The 33% lowest- and highest pain-sensitive subjects were offered participation in the present study. A two-compartment linear model with allometric scaling for weight provided the best description of the plasma concentration-time profile of morphine. Changes in the EPTo and 2HA responses with time during the placebo treatment were best described by a linear model and a quadratic model, respectively. The model discrimination process showed clear evidence for adding between-occasion variability (BOV) on baseline and the placebo slope for EPTo and 2HA, respectively. The sensitivity covariate was significant on baseline EPTo values and genetics as a covariate on the placebo slope for 2HA. The analgesic and antihyperalgesic effects of morphine were pharmacologically distinct as the models had different effect site equilibration half-lives and different covariate effects. Morphine had negligible effect on 2HA, but significant effect on EPTo.
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Affiliation(s)
- Pernille Ravn
- Department of Drug Design and Pharmacology, Faculty of Medicines and Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Van Ryckeghem DM, Crombez G. Attentional bias and chronic pain: Where to go from here? Pain 2014; 155:6-7. [DOI: 10.1016/j.pain.2013.10.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 10/07/2013] [Accepted: 10/21/2013] [Indexed: 11/25/2022]
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Atypical central pain processing in sensory modulation disorder: absence of temporal summation and higher after-sensation. Exp Brain Res 2013; 232:587-95. [PMID: 24247592 DOI: 10.1007/s00221-013-3767-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 11/05/2013] [Indexed: 12/13/2022]
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Dimova V, Horn C, Parthum A, Kunz M, Schöfer D, Carbon R, Griessinger N, Sittl R, Lautenbacher S. Does severe acute pain provoke lasting changes in attentional and emotional mechanisms of pain-related processing? A longitudinal study. Pain 2013; 154:2737-2744. [PMID: 23933182 DOI: 10.1016/j.pain.2013.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 08/05/2013] [Accepted: 08/05/2013] [Indexed: 11/15/2022]
Abstract
Pain experiences, learning, and genetic factors have been proposed to shape attentional and emotional processes related to pain. We aimed at investigating whether a singular major pain experience also changes cognitive-emotional processing. The influence of acute postoperative pain after cosmetic surgery of the thorax was tested in 80 preoperatively pain-free male individuals. Acute pain was measured as independent variable during the first week postsurgery by pain intensity ratings and the requested analgesic boluses (Patient-Controlled Epidural Analgesia (PCEA)). Pain catastrophizing (Pain Catastrophizing Scale (PCS)), pain anxiety (Pain Anxiety and Symptom Scale (PASS)), pain hypervigilance (Pain Vigilance and Awareness Questionnaire (PVAQ)), and attentional biases to emotionally loaded stimuli (including pain) in a dot-probe task were assessed 1 week, 3 months, and 6 months postsurgery as dependent variables. Hierarchical regression analyses were performed to test whether the 2 acute pain parameters can predict these cognitive-emotional variables. As a rigorous test, significant prediction was required in addition to the prediction of the dependent variables by themselves with lag-1. Acute pain (mainly the pain ratings) appeared to be a significant predictor for PCS, PASS, and PVAQ 1 week after surgery (deltaR(2) = [8.7% to 11.3%]). In contrast, the attentional biases in the dot-probe task could not be predicted by the pain ratings. The levels of pain catastrophizing and pain hypervigilance increased in the acute phase after surgery when influenced by acute pain and declined, along with pain anxiety, during the next 3 months. In conclusion, a one-time intense pain experience, such as acute postoperative pain, appeared to produce at least short-lived changes in the attentional and emotional processing of pain.
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Affiliation(s)
- Violeta Dimova
- Physiological Psychology, Otto-Friedrich University, Bamberg, Germany Pain Center, Friedrich-Alexander University, Erlangen, Germany Department of Pediatric Surgery, Friedrich-Alexander University, Erlangen, Germany
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Crettaz B, Marziniak M, Willeke P, Young P, Hellhammer D, Stumpf A, Burgmer M. Stress-induced allodynia--evidence of increased pain sensitivity in healthy humans and patients with chronic pain after experimentally induced psychosocial stress. PLoS One 2013; 8:e69460. [PMID: 23950894 PMCID: PMC3737255 DOI: 10.1371/journal.pone.0069460] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 06/11/2013] [Indexed: 11/23/2022] Open
Abstract
Background Experimental stress has been shown to have analgesic as well as allodynic effect in animals. Despite the obvious negative influence of stress in clinical pain conditions, stress-induced alteration of pain sensitivity has not been tested in humans so far. Therefore, we tested changes of pain sensitivity using an experimental stressor in ten female healthy subjects and 13 female patients with fibromyalgia. Methods Multiple sensory aspects of pain were evaluated in all participants with the help of the quantitative sensory testing protocol before (60 min) and after (10 and 90 min) inducing psychological stress with a standardized psychosocial stress test (“Trier Social Stress Test”). Results Both healthy subjects and patients with fibromyalgia showed stress-induced enhancement of pain sensitivity in response to thermal stimuli. However, only patients showed increased sensitivity in response to pressure pain. Conclusions Our results provide evidence for stress-induced allodynia/hyperalgesia in humans for the first time and suggest differential underlying mechanisms determining response to stressors in healthy subjects and patients suffering from chronic pain. Possible mechanisms of the interplay of stress and mediating factors (e.g. cytokines, cortisol) on pain sensitivity are mentioned. Future studies should help understand better how stress impacts on chronic pain conditions.
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Affiliation(s)
- Benjamin Crettaz
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Martin Marziniak
- Department of Neurology and Department of Inflammatory Disorders of the Nervous System and Neurooncology, University Hospital Münster, Münster, Germany
| | - Peter Willeke
- Department of Medicine D, Section of Rheumatology, University Hospital Münster, Münster, Germany
| | - Peter Young
- Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Münster, Münster, Germany
| | | | - Astrid Stumpf
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Markus Burgmer
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
- * E-mail:
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Erpelding N, Davis KD. Neural underpinnings of behavioural strategies that prioritize either cognitive task performance or pain. Pain 2013; 154:2060-2071. [PMID: 23792281 DOI: 10.1016/j.pain.2013.06.030] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/03/2013] [Accepted: 06/17/2013] [Indexed: 11/16/2022]
Abstract
We previously discovered that when faced with a challenging cognitive task in the context of pain, some people prioritize task performance, while in others, pain results in poorer performance. These behaviours, designated respectively as A- and P-types (for attention dominates vs pain dominates), may reflect pain coping strategies, resilience or vulnerabilities to develop chronic pain, or predict the efficacy of treatments such as cognitive behavioural therapy. Here, we used a cognitive interference task and pain stimulation in 80 subjects to interrogate psychophysical, psychological, brain structure and function that distinguish these behavioural strategies. During concurrent pain, the A group exhibited faster task reaction times (RTs) compared to nonpain trials, whereas the P group had slower RTs during pain compared to nonpain trials, with the A group being 143 ms faster than the P group. Brain imaging revealed structural and functional brain features that characterized these behavioural strategies. Compared to the performance-oriented A group, the P group had (1) more gray matter in regions implicated in pain and salience (anterior insula, anterior midcingulate cortex, supplementary motor area, orbitofrontal cortex, thalamus, caudate), (2) greater functional connectivity in sensorimotor and salience resting-state networks, (3) less white matter integrity in the internal and external capsule, anterior thalamic radiation and corticospinal tract, but (4) were indistinguishable based on sex, pain sensitivity, neuroticism, and pain catastrophizing. These data may represent neural underpinnings of how task performance vs pain is prioritized and provide a framework for developing personalized pain therapy approaches that are based on behaviour-structure-function organization.
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Affiliation(s)
- Nathalie Erpelding
- Division of Brain, Imaging, and Behaviour-Systems Neuroscience, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Abstract
BACKGROUND It is well known that individual factors are important in the facial recognition of pain. However, it is unclear whether vigilance to pain as a pain-related attentional mechanism is among these relevant factors. OBJECTIVES Vigilance to pain may have two different effects on the recognition of facial pain expressions: pain-vigilant individuals may detect pain faces better but overinclude other facial displays, misinterpreting them as expressing pain; or they may be true experts in discriminating between pain and other facial expressions. The present study aimed to test these two hypotheses. Furthermore, pain vigilance was assumed to be a distinct predictor, the impact of which on recognition cannot be completely replaced by related concepts such as pain catastrophizing and fear of pain. METHODS Photographs of neutral, happy, angry and pain facial expressions were presented to 40 healthy participants, who were asked to classify them into the appropriate emotion categories and provide a confidence rating for each classification. Additionally, potential predictors of the discrimination performance for pain and anger faces - pain vigilance, pain-related catastrophizing, fear of pain--were assessed using self-report questionnaires. RESULTS Pain-vigilant participants classified pain faces more accurately and did not misclassify anger as pain faces more frequently. However, vigilance to pain was not related to the confidence of recognition ratings. Pain catastrophizing and fear of pain did not account for the recognition performance. CONCLUSIONS Moderate pain vigilance, as assessed in the present study, appears to be associated with appropriate detection of pain-related cues and not necessarily with the overinclusion of other negative cues.
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Van Ryckeghem DM, Crombez G, Goubert L, De Houwer J, Onraedt T, Van Damme S. The predictive value of attentional bias towards pain-related information in chronic pain patients: A diary study. Pain 2013; 154:468-475. [DOI: 10.1016/j.pain.2012.12.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 11/14/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
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Van Ryckeghem DM, Crombez G, Van Hulle L, Van Damme S. Attentional bias towards pain-related information diminishes the efficacy of distraction. Pain 2012; 153:2345-2351. [DOI: 10.1016/j.pain.2012.07.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 05/30/2012] [Accepted: 07/30/2012] [Indexed: 11/25/2022]
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Ravn P, Frederiksen R, Skovsen AP, Christrup LL, Werner MU. Prediction of pain sensitivity in healthy volunteers. J Pain Res 2012; 5:313-26. [PMID: 23055774 PMCID: PMC3442738 DOI: 10.2147/jpr.s33925] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The primary objective of the present study was to evaluate predictive parameters of the acute pain score during induction of an inflammatory heat injury. PATIENTS AND METHODS Healthy volunteers (50 females/50 males) were included in the study. The predictive potential of gender, anthropometric (body surface area, body mass index), psychological (anxiety, depression, vulnerability), and psychophysical (quantitative sensory testing, conditioned pain modulation) variables in estimating the pain response to a validated heat injury (47°C, 7 minutes, area 12.5 cm(2)) were investigated. All assessments were made in duplicate sessions separated by 21 days (median). RESULTS There were three main findings in this study. First, a predictive model of pain sensitivity during the heat injury, including both genders and using multiple regression technique, could account for 28% of the variance (P < 0.0001), but gender-related differences in the final model could not be demonstrated. Second, the results confirmed significant gender-related differences in perception of electrical, pressure, and cold pressor stimuli (P < 0.002). Third, positive correlations between anthropometric data and pain perception during electrical and pressure stimuli were demonstrated (P < 0.001 and P < 0.005, respectively). CONCLUSION The study demonstrated predictability of acute pain sensitivity, and although gender-related differences in pain perception were demonstrated, no gender-related differences in pain sensitivity could be shown. Interestingly, positive correlations between anthropometric data and pain perception were shown for the first time.
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Affiliation(s)
- Pernille Ravn
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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Dittmar O, Krehl R, Lautenbacher S. Interrelation of self-report, behavioural and electrophysiological measures assessing pain-related information processing. Pain Res Manag 2011; 16:33-40. [PMID: 21369539 PMCID: PMC3052405 DOI: 10.1155/2011/675785] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION A number of variables reflecting attentional and emotional mechanisms of processing pain-related information have recently attracted interest, ie, fear of pain, pain catastrophizing, hypervigilance and attentional bias to pain. These variables can be assessed by explicit measures based on conscious self-report, or by implicit measures assessing mainly preconscious stages of information processing such as behavioural or electrophysiological tests. Convergent validity within implicit measures was assumed to be high, as was the discriminant validity between implicit and explicit measures. METHOD In the present study, two implicit measures (the dot-probe task for pain words and a word-processing task for pain words allowing event-related brain potential recordings) and three self-report measures (Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale, and Pain Hypervigilance and Awareness Questionnaire) were administered to 27 healthy participants. RESULTS No significant associations were found between the implicit measures, or between the event-related brain potentials of pain words and the explicit measures. A single significant positive correlation was found between the dot-probe pain bias and the Pain Anxiety Symptoms Scale. CONCLUSION All variables appeared to be only weakly associated. The attempt to organize the field of variables targeting attentional and emotional mechanisms of processing pain-related information using concepts such as implicit and explicit measures failed as far as the present test on convergent⁄discriminant validity proved.
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