How Pain Shapes Depression and Anxiety: A Hybrid Self-regulatory/Predictive Mind Perspective

Burning Mouth Syndrome May Essentially Be Related To Psychoneuroimmunology: Mechanism Hypothesis

BACKGROUND

Burning mouth syndrome (BMS) is a chronic intraoral dysesthesia with elusive aetiology, only few studies have been carried out on immune function in BMS patients. We aimed to investigate the role immune function paly in the pathogenesis of BMS by psychoneuroimmunology (PNI).

METHOD

We recruited 44 BMS patients and 31 controls. We measured the anxiety and depression levels by the Zung' Self-rating Anxiety Scale (SAS) and Zung' Self-rating Depression Scale (SDS), respectively. Serological immunity included cellular immunity, humoral immunity and autoantibody. Visual analogue scale (VAS) was used to quantify pain levels. We used the Pearson correlation analysis to analyse the relationship between pain, psychology and immune function.

RESULTS

BMS exhibited higher levels of anxiety and depression (***p < 0.001 for both). In BMS, the CD3+ cells, CD4+ cells were lower (*p = 0.028, 0.046 and 0.033, respectively), IgE and antinuclear antibody (ANA) was higher (*p = 0.035). The average VAS score among BMS was approximately 3.7. Pearson correlation analysis revealed positive correlations between VAS, SAS and SDS; negative correlations between these scores of VAS, SAS, SDS and the levels of CD3+ cells, CD4+ cells, CD8+ cells.

CONCLUSIONS

BMS were more painful, anxious, depressive, and immunity dysfunction than controls. We proposed a mechanism hypothesis that the BMS may essentially be an immunological disease.

Experiential Avoidance as a Factor in Generalized Psychological Vulnerability: In the Relationship Between Chronic Pain and Pain Anxiety With Pain Disability

BACKGROUND

Pain is a major socio-psychological problem worldwide. Chronic pain has a negative effect on areas of psychological functioning such as depression, anxiety, and perceived stress.

AIM

The present study investigated the mediating role of experiential avoidance in the relationship between chronic pain and pain anxiety with pain disability.

METHODS

Participants were treatment-seeking patients (N = 361) at an outpatient pain clinic in Shiraz (Fars, Iran). The Multidimensional Pain Inventory (MPI), Pain Anxiety Symptom Scale (PASS-20), Pain Disability Questionnaire (PDQ), and Acceptance and Action Questionnaire-II (AAQ-II) were used to measure multidimensional pain, anxiety, pain disability, experiential avoidance, and pain severity.

RESULTS

The results of the correlation revealed that a significant relationship exists between multidimensional pain and pain anxiety, pain disability, and experiential avoidance. Experiential avoidance mediated the associations from multidimensional pain and pain disability significantly. Also, experiential avoidance moderated associations between pain anxiety and pain disability significantly. In general, Structural Equation Modeling (SEM) showed that experiential avoidance mediated the relationship between multidimensional pain and pain anxiety with pain disability.

CONCLUSION

In general, the results revealed that experiential avoidance can mediate the relationship among pain, pain anxiety, and pain disability as a maladaptive regulation strategy. The results obtained from this study seem to introduce experiential avoidance as a vulnerability factor effectively.

Personality systems interactions theory: an integrative framework complementing the study of the motivational and volitional dynamics underlying adjustment to chronic pain

In the endeavor to advance our understanding of interindividual differences in dealing with chronic pain, numerous motivational theories have been invoked in the past decade. As they focus on relevant, yet different aspects of the dynamic, multilevel processes involved in human voluntary action control, research findings seem fragmented and inconsistent. Here we present Personality Systems Interactions theory as an integrative meta-framework elucidating how different motivational and volitional processes work in concert under varying contextual conditions. PSI theory explains experience and behavior by the relative activation of four cognitive systems that take over different psychological functions during goal pursuit. In this way, it may complement existing content-related explanations of clinical phenomena by introducing a functional, third-person perspective on flexible goal management, pain acceptance and goal maintenance despite pain. In line with emerging evidence on the central role of emotion regulation in chronic pain, PSI theory delineates how the self-regulation of positive and negative affect impacts whether behavior is determined by rigid stimulus-response associations (i.e., habits) or by more abstract motives and values which afford more behavioral flexibility. Along with testable hypotheses, multimodal interventions expected to address intuitive emotion regulation as a central process mediating successful adaptation to chronic pain are discussed.

Parenting Styles, Mental Health, and Catastrophizing in Women with Chronic Pelvic Pain: A Case-Control Study

Chronic pelvic pain (CPP) in women is a highly prevalent condition worldwide and requires multimodal treatment. Adverse childhood experiences have been associated with CPP in women, while allodynia and poor outcomes have been linked to pain catastrophizing in these patients. Pain perception has been associated with parenting style during childhood. The objective of this study was to investigate the association between parenting style, pain catastrophizing, anxiety, depression and CPP in women. A case-control study was conducted between May 2018 and August 2021 with 123 women with CPP and 123 pain-free controls. Questionnaires were used to collect participants' data. The association between parenting style and CPP was assessed using multiple logistic regression, with odds ratios (OR) and 95% confidence intervals (CI) being calculated. The correlation between catastrophizing, pain intensity, pain duration, anxiety, depression, and parenting style in women with CPP was assessed using Spearman's rank correlation coefficient (r). A higher frequency of low maternal care (60.7% versus 45.2%; p = 0.026), anxiety (79.7% versus 56.9%; p < 0.001), depression (73.2% versus 56.1%; p = 0.008) and physical violence (31.7% versus 14.6%; p = 0.003) was found in the CPP group compared to the controls. There was no association between parenting style and CPP in the adjusted analysis. A positive correlation was found between catastrophizing and pain intensity (r = 0.342; p < 0.001), anxiety (r = 0.271; p = 0.002), depression (r = 0.272; p = 0.002), and maternal overprotection (r = 0.185; p = 0.046). A negative correlation was found between anxiety and maternal (r = -0.184; p = 0.047) and paternal (r = -0.286; p = 0.006) care and between depression and maternal (r = -0.219; p = 0.018) and paternal (r = -0.234; p = 0.026) care. The present results suggest a significant but weak association of parenting style with pain catastrophizing, the mental health of women with CPP, and the way in which they experience pain.

What are the prevalence of and factors independently associated with depression and anxiety among patients with posttraumatic elbow stiffness? A cross-sectional, multicenter study

BACKGROUND

Joint stiffness is a common complication after articular-related trauma in the elbow, resulting in significant limb disability, psychological stress, and a negative impact on daily life. No previous study has reported the impact of post-traumatic elbow stiffness (PTES) on psychological health. This study aims to (1) investigate the depression and anxiety levels and (2) identify factors independently associated with depression and anxiety symptoms in patients with PTES.

METHODS

A total of 108 patients with PTES presenting to 4 collaborative municipal hospitals were consecutively enrolled from September to December 2020. Sociodemographic and clinical characteristics were collected through questionnaires and medical records. The Depression Anxiety Stress Scale-21 was used to assess depression and anxiety status. Ordinal logistic regression analysis was performed to identify factors independently associated with depression and anxiety symptoms.

RESULTS

The detection rates of mild-to-moderate depression and anxiety are 40.7% and 27.8%, and severe-to-extremely severe levels are 23.1% and 25.9%, respectively. Regression results show that factors independently associated with depression include elbow flexion (odds ratio [OR]_{per 1° loss} = 1.021, 95% confidence interval [CI]: 1.001-1.041, P = .035), elbow pain on movement (OR_{per 1 point increase} = 1.236, 95% CI: 1.029-1.484, P = .023), family relationship (OR_{less close/very close} = 10.059, 95% CI: 2.170-46.633, P = .003), and self-care ability (OR_unable/able = 3.858, 95% CI: 1.244-11.961, P = .019). Factors independently associated with anxiety are elbow flexion (OR_{per 1° loss} = 1.031, 95% CI: 1.009-1.052, P = .005), elbow pain on movement (OR_{per 1 point increase} = 1.212, 95% CI: 1.003-1.465, P = .047), and clinically significant heterotopic ossification around elbow (OR_yes/no = 2.344, 95% CI: 1.048-5.243, P = .038).

CONCLUSION

Patients with PTES exhibit significant depression and anxiety symptoms. Several sociodemographic and clinical characteristics are independently associated with depression and anxiety levels. Identifying and addressing these factors may be of particular benefit during PTES management. Future research might address whether depression and anxiety affect the outcome after stiff elbow surgery.

Modeling the onset of a depressive episode: A self-regulation perspective

Major depression is an episodic disorder which, for many individuals, has its onset in a distinct change of emotional state which then persists over time. The present article explores the utility of combining a dynamical systems approach to depression, focusing specifically on the change of state associated with episode onset, with a self-regulation perspective, which operationalizes how feedback received in the ongoing process of goal pursuit influences affect, motivation, and behavior, for understanding how a depressive episode begins. The goals of this review are to survey the recent literature modeling the onset of a depressive episode and to illustrate how a self-regulation perspective can provide a conceptual framework and testable hypotheses regarding episode onset within a dynamical systems model of depression.

Pharmacological Blockade of PPARα Exacerbates Inflammatory Pain-Related Impairment of Spatial Memory in Rats

Peroxisome proliferator-activated receptors (PPARs) are ligand-dependent transcription factors that exist in three isoforms: PPARα, PPARβ/δ and PPARγ. Studies suggest that the PPAR signalling system may modulate pain, anxiety and cognition. The aim of the present study was to investigate whether endogenous signalling via PPARs differentially modulates innate anxiety responses and mnemonic function in the presence and absence of inflammatory pain. We examined the effects of intraperitoneal administration of GW6471 (PPARα antagonist), GSK0660 (PPARβ/δ antagonist), GW9662 (PPARγ antagonist), and N-palmitoylethanolamide (PEA) on rat behaviour in the elevated plus maze (EPM), open field (OF), light-dark box (LDB), and novel object recognition (NOR) tests in the presence or absence of chronic inflammatory pain. Complete Freund’s Adjuvant (CFA)-injected rats exhibited impaired recognition and spatial mnemonic performance in the NOR test and pharmacological blockade of PPARα further impaired spatial memory in CFA-treated rats. N-oleoylethanolamide (OEA) levels were higher in the dorsal hippocampus in CFA-injected animals compared to their counterparts. The results suggest a modulatory effect of CFA-induced chronic inflammatory pain on cognitive processing, but not on innate anxiety-related responses. Increased OEA-PPARα signalling may act as a compensatory mechanism to preserve spatial memory function following CFA injection.

Adaptive Homeostatic Strategies of Resilient Intrinsic Self-Regulation in Extremes (RISE): A Randomized Controlled Trial of a Novel Behavioral Treatment for Chronic Pain

Current treatments for chronic pain have limited benefit. We describe a resilience intervention for individuals with chronic pain which is based on a model of viewing chronic pain as dysregulated homeostasis and which seeks to restore homeostatic self-regulation using strategies exemplified by survivors of extreme environments. The intervention is expected to have broad effects on well-being and positive emotional health, to improve cognitive functions, and to reduce pain symptoms thus helping to transform the suffering of pain into self-growth. A total of 88 Veterans completed the pre-assessment and were randomly assigned to either the treatment intervention (n = 38) or control (n = 37). Fifty-eight Veterans completed pre- and post-testing (intervention n = 31, control = 27). The intervention covered resilience strengths organized into four modules: (1) engagement, (2) social relatedness, (3) transformation of pain and (4) building a good life. A broad set of standardized, well validated measures were used to assess three domains of functioning: health and well-being, symptoms, and cognitive functions. Two-way Analysis of Variance was used to detect group and time differences. Broadly, results indicated significant intervention and time effects across multiple domains: (1) Pain decreased in present severity [F ( 1, 56) = 5.02, p < 0.05, η2 p = 0.08], total pain over six domains [F ( 1, 56) = 14.52, p < 0.01, η2 p = 0.21], and pain interference [F ( 1, 56) = 6.82, p < 0.05, η2 p = 0.11]; (2) Affect improved in pain-related negative affect [F ( 1, 56) = 7.44, p < 0.01, η2 p = 0.12], fear [F ( 1, 56) = 7.70, p < 0.01, η2 p = 0.12], and distress [F ( 1, 56) = 10.87, p < 0.01, η2 p = 0.16]; (3) Well-being increased in pain mobility [F ( 1, 56) = 5.45, p < 0.05, η2 p = 0.09], vitality [F ( 1, 56) = 4.54, p < 0.05, η2 p = 0.07], and emotional well-being [F ( 1, 56) = 5.53, p < 0.05, η2 p = 0.09] Mental health symptoms and the cognitive functioning domain did not reveal significant effects. This resilience intervention based on homeostatic self-regulation and survival strategies of survivors of extreme external environments may provide additional sociopsychobiological tools for treating individuals with chronic pain that may extend beyond treating pain symptoms to improving emotional well-being and self-growth. Clinical Trial Registration: Registered with ClinicalTrials.gov (NCT04693728).

Interdisciplinarity and Integration: An Introduction to the Special Issue on Psychopathology in Medical Settings

As the world views, incredulously, the calamitous consequences of the COVID-19 pandemic, the inseparable connections between body and mind become more and more apparent, even for the heretics (i.e., biological determinists). Such realizations also bolster the understanding of the close link between medical conditions and psychopathology. Launched prior to the COVID-19 epidemic, this special issue sets out to illuminate the prevalence, course, etiology, and responses to a myriad of psychopathological conditions in medical conditions. The 13 articles in this special issue address a variety of medical conditions (chronic illness and chronic pain, Pica, cancer, acute delirium, factitious disorders, functional neurological symptoms, sleep disorders, fetal conditions), mental disorders (depression, anxiety, suicidality, eating disorders, personality disorders, PTSD), medical settings (primary care vs. specialty clinics), and developmental levels (children, adolescents, and adults). The overarching theme emanating from reading these articles is that clinical-health psychology, or clinical psychology in medical settings, is an ever-needed field of inquiry, epitomizing interdisciplinarity and science/practice integration.