Perceived Sensitivity to Pain and Responsiveness to Non-noxious Sensation in Substance Use Disorder

OBJECTIVE

This comparative cross-sectional study aimed to characterize individuals with substance use disorder (SUD) in self-perception of pain sensitivity, experimental auditory aversiveness, and non-noxious sensory responsiveness, as well as examine the associations with SUD.

METHODS

Therapeutic community (TC) individuals with SUD (N = 63, male 88.9%) and healthy controls (N = 60, male 86.7%) completed the Pain Sensitivity Questionnaire (PSQ) and the Sensory Responsiveness Questionnaire-Intensity Scale (SRQ-IS), followed by a psychophysical auditory battery, the Battery of Averseness to Sounds (BAS)-Revised.

RESULTS

The SUD group scored higher on the PSQ (P < 0.0001), BAS-R aversiveness (P < 0.0001), BAS-R-unpleasantness (P < 0.0001), and on the aftersensation of auditory aversiveness (P < 0.0001) and unpleasantness (P < 0.000). Fifty-four percent of the SUD group vs 11.7% of the control group were identified as having sensory modulation dysfunction (SMD; P < 0.0001). Logistic regression modeling revealed that the SRQ-IS-Aversive score had a stronger relationship, indicating a 12.6-times odds ratio for SUD (P = 0.0002). Finally, a risk score calculated from a linear combination of the logistic regression model parameters is presented based on the PSQ and SRQ.

CONCLUSIONS

This is the first study to explore sensory and aversive domains using experimental and self-reporting in situ, revealing pain perception alteration that co-occurs with high prevalence of SMD, specifically of the over-responsive type. Findings may be significant in clinical practice for treating pain, and for expanding therapeutic modalities as part of broader rehabilitation in TC and beyond, to better meet personalized therapy.

Sensory Modulation Disorder (SMD) and Pain in Substance-Use Disorder (SUD)

Date Presented 04/04/19

SUD impacts the individual and his family's daily occupations while posing a massive health and societal concern. OTs may contribute a unique perspective in understanding this phenomenon. This is the first study to explore pain sensitivity and SMD in SUD. Findings demonstrate that while pain and SMD coexist, SMD may serve as a risk factor for having SUD, thus indicating a potential additive value for OTs in SUD therapy.

Primary Author and Speaker: Tami Bar-Shalita

Additional Authors and Speakers: Naama Asayag

Contributing Authors: Yoram Bonneh, Shula Parush

Perceptual learning in autism: over-specificity and possible remedies

Inflexible behavior is a core characteristic of autism spectrum disorder (ASD), but its underlying cause is unknown. Using a perceptual learning protocol, we observed initially efficient learning in ASD that was followed by anomalously poor learning when the location of the target was changed (over-specificity). Reducing stimulus repetition eliminated over-specificity. Our results indicate that inflexible behavior may be evident ubiquitously in ASD, even in sensory learning, but can be circumvented by specifically designed stimulation protocols.

Comparing the executive attention of adult females with ADHD to that of females with sensory modulation disorder (SMD) under aversive and non-aversive auditory conditions

Certain behavioral expressions of sensory modulation disorder (SMD) such as distractibility, hyperactivity, and impulsivity are often similar to those of attention deficit/hyperactivity disorder (ADHD) in pediatric and adult populations. There is also a high comorbidity rate between these two diagnoses and absence of research regarding the objective neuropsychological differentiation between them. In the present study we employed a factorial design which enabled us to: (a) systematically examine the effects of SMD and ADHD on executive attention in a sample of adult females using a Stroop-like task, and (b) measure the effect of aversive conditions (sounds) on executive attention. The experimental measures used were the Stroop-like Location-Direction Task (SLDT) to assess executive attention and the battery of aversiveness to sounds (BAS), a standardized measure of aversive sounds that was developed for this study and enabled individual customization of aversive auditory sounds. Results revealed, as expected, a specific core deficit in executive attention for the ADHD factor. In addition to that, the present study provides an important, pioneering finding of SMD impairment in a unique combination of a cognitively demanding task with aversive sounds, providing preliminary objective evidence differentiating SMD from ADHD.

On the possible roles of microsaccades and drifts in visual perception

During natural viewing large saccades shift the visual gaze from one target to another every few hundreds of milliseconds. The role of microsaccades (MSs), small saccades that show up during long fixations, is still debated. A major debate is whether MSs are used to redirect the visual gaze to a new location or to encode visual information through their movement. We argue that these two functions cannot be optimized simultaneously and present several pieces of evidence suggesting that MSs redirect the visual gaze and that the visual details are sampled and encoded by ocular drifts. We show that drift movements are indeed suitable for visual encoding. Yet, it is not clear to what extent drift movements are controlled by the visual system, and to what extent they interact with saccadic movements. We analyze several possible control schemes for saccadic and drift movements and propose experiments that can discriminate between them. We present the results of preliminary analyses of existing data as a sanity check to the testability of our predictions.

Training-induced recovery of low-level vision followed by mid-level perceptual improvements in developmental object and face agnosia

Long-term deprivation of normal visual inputs can cause perceptual impairments at various levels of visual function, from basic visual acuity deficits, through mid-level deficits such as contour integration and motion coherence, to high-level face and object agnosia. Yet it is unclear whether training during adulthood, at a post-developmental stage of the adult visual system, can overcome such developmental impairments. Here, we visually trained LG, a developmental object and face agnosic individual. Prior to training, at the age of 20, LG's basic and mid-level visual functions such as visual acuity, crowding effects, and contour integration were underdeveloped relative to normal adult vision, corresponding to or poorer than those of 5–6 year olds (Gilaie-Dotan, Perry, Bonneh, Malach & Bentin, 2009). Intensive visual training, based on lateral interactions, was applied for a period of 9 months. LG's directly trained but also untrained visual functions such as visual acuity, crowding, binocular stereopsis and also mid-level contour integration improved significantly and reached near-age-level performance, with long-term (over 4 years) persistence. Moreover, mid-level functions that were tested post-training were found to be normal in LG. Some possible subtle improvement was observed in LG's higher-order visual functions such as object recognition and part integration, while LG's face perception skills have not improved thus far. These results suggest that corrective training at a post-developmental stage, even in the adult visual system, can prove effective, and its enduring effects are the basis for a revival of a developmental cascade that can lead to reduced perceptual impairments.

Seeing with profoundly deactivated mid-level visual areas: non-hierarchical functioning in the human visual cortex

A fundamental concept in visual processing is that activity in high-order object-category distinctive regions (e.g., lateral occipital complex, fusiform face area, middle temporal+) is dependent on bottom-up flow of activity in earlier retinotopic areas (V2, V3, V4) whose main input originates from primary visual cortex (V1). Thus, activity in down stream areas should reflect lower-level inputs. Here we qualify this notion reporting case LG, a rare case of developmental object agnosia and prosopagnosia. In this person, V1 was robustly activated by visual stimuli, yet intermediate areas (V2-V4) were strongly deactivated. Despite this intermediate deactivation, activity in down stream visual areas remained robust, showing selectivity for houses and places, while selectivity for faces and objects was impaired. The extent of impairment evident in functional magnetic resonance imaging and electroencephalography activations was somewhat larger in the left hemisphere. This pattern of brain activity, coupled with fairly adequate everyday visual performance is compatible with models emphasizing the role of nonlinear local "amplification" of neuronal inputs in eliciting activity in ventral and dorsal visual pathways as well as perceptual experience in the human brain. Thus, while the proper functioning of intermediate areas appears essential for specialization in the cortex, daily visual behavior and reading are maintained even with deactivated intermediate visual areas.

Extinction is not a natural consequence of unilateral spatial neglect: Evidence from contrast detection experiments

To investigate whether the expression of visual extinction is dependent upon the contralesional low saliency existing in neglect, we tested stroke patients with neglect and extinction, as well as normal controls, on detection of a peripheral Gabor patch, while a competing patch was presented simultaneously on the other side. To compensate for uneven saliency we set the contrast level relative to the detection threshold on each side. Patients showed contralesional extinction even for stimuli set at threshold level. They differed from controls in their sensitivity to changes in relative contrast between sides, showing stronger tendency for extinction and requiring much higher contrast increments in the target patch in order to eliminate extinction. The differences between normal and pathological extinction, shown despite compensation for contralesional perceptual attenuation due to neglect, suggest an additional extinction-specific deficit related to an abnormal interplay between the bilaterally presented stimuli. These findings have important theoretical implications concerning the relationship between neglect and extinction. They demonstrate that the hypothetical 'attentional gradient', taken to explain reduced saliency of stimuli in the neglected side, cannot fully account for the phenomenon of extinction.

Sensory and decisional factors in motion-induced blindness

The processes underlying motion-induced blindness (MIB) are widely debated. Ultimately, however, they must reduce to a sensitivity drop and/or to an upward shift of the decision criterion. The first possibility was tested by assessing the detection threshold for a contrast (or luminance) increment applied to the MIB target under its visible and suppressed phases. This was performed over a whole range of reference target contrasts (yielding the standard Threshold vs. Contrast [TvC] function) with a 2AFC staircase procedure. The second possibility was tested with a Yes/No procedure, allowing the assessment of both the sensitivities (d') and decision criteria (c) yielded by four contrast increments applied to a fixed reference target contrast (the psychometric function). The 2AFC procedure yielded a global upward shift of the TvC function of about 5.3 dB (a factor of 1.84) under the suppressed phase. The Yes/No procedure yielded a commensurate d' drop (of about 0.8 sigma) under the suppressed phase with no change in the slope of the psychometric function and an upward shift of c of about 0.7 sigma. The presently observed vertical shift (in log-log coordinates) of the TvC function in the suppressed phase is indicative of a divisive inhibition occurring after the transducing stage. The invariance of the psychometric function slope under the visible and suppressed MIB phases supports this conclusion. The present experiments cannot settle the issue of whether the upward shift of the decision criteria is yet another cause of the MIB or a consequence of its underlying inhibitory process. Instead, they make clear that MIB (and perhaps other unstable perceptual phenomena) is associated with both sensory and decisional processes.

Implicit integration in a case of integrative visual agnosia

We present a case (SE) with integrative visual agnosia following ischemic stroke affecting the right dorsal and the left ventral pathways of the visual system. Despite his inability to identify global hierarchical letters [Navon, D. (1977). Forest before trees: The precedence of global features in visual perception. Cognitive Psychology, 9, 353-383], and his dense object agnosia, SE showed normal global-to-local interference when responding to local letters in Navon hierarchical stimuli and significant picture-word identity priming in a semantic decision task for words. Since priming was absent if these features were scrambled, it stands to reason that these effects were not due to priming by distinctive features. The contrast between priming effects induced by coherent and scrambled stimuli is consistent with implicit but not explicit integration of features into a unified whole. We went on to show that possible/impossible object decisions were facilitated by words in a word-picture priming task, suggesting that prompts could activate perceptually integrated images in a backward fashion. We conclude that the absence of SE's ability to identify visual objects except through tedious serial construction reflects a deficit in accessing an integrated visual representation through bottom-up visual processing alone. However, top-down generated images can help activate these visual representations through semantic links.

Development of sensitivity to texture and contour information in the human infant

Texture discrimination and bounding contour extraction are essential parts of the object segmentation and shape discrimination process. As such, successful texture and contour processing are key components underlying the development of the perception of both objects and surfaces. By recording visual-evoked potentials, we investigate whether young infants can detect orientation-defined textures and contours. We measured responses to an organized texture comprised of many Gabor patches of the same orientation, alternated with images containing the same number of patches, but all of random orientation. These responses were compared with a control condition consisting of the alternation between two independently random configurations. Significant difference potentials were found as early as 2-5 months, as were significant odd harmonics in the test conditions. Responses were also measured to Gabor patches organized either as circles (all patches tangent to an imaginary circular path) alternated with pinwheels (all patches having a fixed orientation offset from the path). Infants between 6 and 13 months also showed sensitivity to the global organization of the elements along contours. Differential responses to our texture and contour stimuli and their controls could only have been generated by mechanisms that are capable of comparing the relative orientation of 2 or more patches, as no local information at a single patch distinguished the random and organized textures or the circle and pinwheel configurations.

Spatial interactions in amblyopia: Effects of stimulus parameters and amblyopia type

Adults with amblyopia were recently shown to perform abnormally in tasks requiring integration of local features into global percepts. Moreover, spatial interactions in amblyopic patients, though often found to be abnormal, showed marked variability. Here we measured collinear lateral interactions using Gabor patches in a large number of amblyopic (N=75) and normal subjects (N=25), testing four spatial frequencies (1.5, 3, 6, 9 cpd). We used the lateral masking paradigm, in which the contrast-detection threshold is measured in the presence of high-contrast flankers at different distances from a central target. Whereas in normal subjects spatial interaction patterns were evident across all spatial frequencies, amblyopic subjects showed abnormal spatial interactions and increasing deficiencies with increasing spatial frequencies. These abnormalities depended on the axis of astigmatism (in meridional amblyopia) and were more pronounced in strabismic than in anisometropic amblyopia. Spatial interactions were independent on the contrast-detection thresholds. Thus, adults with amblyopia might perform as well as normal observers for some stimulus parameters and abnormally for others. Our results indicate a close relationship between abnormal visual input to the visual cortex during development and abnormal functionality of the collinear spatial interactions in adults with amblyopia.

Suppression of monocular visual direction under fused binocular stimulation: evoked potential measurements

Visual evoked potentials (VEPs) were recorded in response to a vernier onset/offset target presented to one eye that was combined with matching static targets in the other eye. The monocular response was dominated by a negative peak at 160 ms that occurred after a set of offsets was introduced into a one-dimensional random bar pattern. The static targets produced no discernible VEP response by themselves, but when fused binocularly with the oscillating vernier target, they produced shifts in perceived visual direction that influenced the VEP response. A vernier target fused with static vertical bars was perceived to alternate in depth between a flat surface and one broken into two interleaved surfaces. The response to this "surface-breaking" was as large or larger than the response to the monocular vernier offset. This response was much reduced when the oscillating vernier was fused with a static offset vernier (5' offset) that produced a percept of segregated regions moving in depth. Apparently, the VEP is strongly driven by shifts in visual direction that alter surface, texture, or contour contiguity.

Collinear interactions and contour integration

The visibility of a local target is influenced by the global configuration of the stimulus. Collinear configurations are a specific case in which facilitation or suppression of the target has been found to be dependent on the contrast threshold of the target. The role of collinear interactions in perceptual grouping, especially in contour integration, is still controversial. In the current study, the role of collinear interactions in noise was investigated using experimental conditions similar to those utilized in studies of contour integration. The contrast detection paradigm in the presence of similar Gabor elements presented in the background was used. The results show that contrast detection threshold of the target alone is increased (suppression) when it is embedded in randomly oriented background elements. However, when the target is flanked by two collinear Gabor elements, the target is facilitated even at higher target contrast levels. Facilitation is not found for orthogonal configurations. The results suggest that the response to a local element in a contour is modified by lateral facilitative and suppressive inputs from elements comprising the smooth contour and randomly oriented background elements, respectively. Thus, detection of elements along a contour should be considered as integration of global neuronal activity rather than as the output of local and individual neurons.