Individual differences in momentary pain-affect coupling and their associations with mental health in patients with chronic pain

Artificially Sweetened Food Mediates the Perception of Chronic Pain in Individuals With Neuroticism Traits: A Mendelian Randomization Study

BACKGROUND

Previous studies have shown that neuroticism and artificially sweetened food all play essential roles in chronic pain to varying degrees. However, it is unclear precisely the causal relationship between neuroticism traits and chronic pain and whether an unhealthy sweetened food is a mediator in this process.

METHODS

This study employed rigorous research methods to ensure the validity of the findings. We utilized Mendelian randomization (MR) to examine the causal relationships between neuroticism traits, artificially sweetened food, and chronic pain. The data encompass four neuroticism traits (neuroticism, experiencing mood swings, depressed affect, and worry), consumption levels of nine artificially sweetened foods, and seven types of chronic pain. The primary statistical method employed was inverse variance weighting (IVW). Eventually, we explored whether artificially sweetened food serves as a mediator in the relationship between neuroticism traits and chronic pain.

RESULTS

We found that genetic predisposition to higher neuroticism traits and the consumption of artificial sweeteners is associated with an increased risk of chronic pain across multiple sites. Reverse MR analysis also confirms that chronic pain at multiple sites similarly increases the risk of neuroticism traits. Two-step MR suggests the mediating effects of five artificial sweeteners on sciatica: low back pain, thoracic pain, low back pain, joint pain, and muscular pain. These findings could inform interventions and treatments for chronic pain.

CONCLUSION

Neuroticism traits and chronic pain have causal relationships, with artificially sweetened food mediating the pathway from neuroticism traits to chronic pain.

Heterogeneity in Temporal Dynamics of Pain and Affect Among Individuals With Chronic Back Pain and Associations With Risk for Future Opioid-Related Problems

Chronic low back pain (CLBP) is a biopsychosocial phenomenon involving complex relationships between pain and psychosocial factors. In preregistered analyses, we examined dynamic relationships between pain and negative affect among individuals with CLBP (N = 87). We found that increased negative affect was concurrently and prospectively associated with increased pain for individuals on average. However, there was significant and meaningful between-persons variability in these effects such that risk for future opioid-related problems was positively associated with the within-persons correlation between pain and negative affect (β = 0.290, 95% credible interval [CI] = [0.071, 0.485]), the degree to which pain predicted increased negative affect (β = 0.439, 95% CI = [0.044, 0.717]), and the autoregressive effect of negative affect over 4-hr lags (β = 0.255, 95% CI = [0.007, 0.478]). These results suggest that variability in within-persons symptom dynamics may help identify chronic pain patients who are at greater risk of opioid-related problems.

Soreness Reminds Me of Grief: Patients With Chronic Pain Show Less Differentiated Representations of Emotional Feelings and Bodily States

People experience similarities between emotional feelings and bodily states on a daily basis, but both the magnitude and pervasiveness of this experiential similarity vary across individuals. Inspired by previous findings that chronic pain (CP) is characterized by strengthened pain-affect coupling and reduced interoceptive accuracy, we conducted 2 cross-sectional studies to examine whether patients with CP would exhibit less differentiated perception and mental representation of emotional feelings and bodily states. In study 1 (N = 500), patients with CP and healthy controls (HCs) completed a self-report questionnaire that asked explicitly about the perceived similarity between 5 basic emotion categories and a series of bodily states. In study 2 (N = 73), a specially designed false memory test was administered to examine whether patients with CP would have reduced differentiation of concepts of negative emotion and somatic distress. We found that patients with CP perceived greater and more pervasive similarities between emotional feelings and bodily states, as indicated by higher questionnaire scores and denser, less specialized bipartite emotion-body networks, both associated with lower subjective interoceptive accuracy. Furthermore, patients with CP formed false memories of negative emotion words (eg, grief) more readily than HCs after memorizing somatic distress words (eg, soreness), as if they represented negative emotion and somatic distress as a single, enmeshed semantic category. Our findings extend previous literature by demonstrating reduced discrimination between emotional and bodily experiences in CP that is not restricted to pain-related emotional and sensory experiences and may be related to a fundamentally less differentiated interoception. PERSPECTIVES: This study shows that patients with chronic pain have a profoundly less differentiated perception and implicit conceptualization of emotional feelings and bodily states, which appears to be associated with altered interoception. These findings may provide new perspectives on why they often experience a stronger pain-affect coupling.

Cognitive-affective changes mediate the mindfulness-based intervention effect on endometriosis-related pain and mental health: A path analysis approach

BACKGROUND

There is poor knowledge about the therapeutic mechanisms of the conservative interventions for endometriosis. We hypothesized that the effects of a brief mindfulness-based intervention (bMBI) on pelvic pain intensity (PPI), pain unpleasantness (PU) and quality of life mental health (QoL-MH) are mediated by direct and indirect paths of changes in pain catastrophizing (PC), positive affect (PA) and negative affect (NA).

METHODS

A secondary analysis of a pilot randomized controlled trial of women with endometriosis, assigned to standard medical treatment (n = 32) and standard medical treatment plus bMBI (n = 31). We tested a series of parallel and serial mediators (PC, PA and NA) of the relationship between bMBI and outcomes (PPI, PU and QoL-MH).

RESULTS

The bMBI group demonstrated improvement in PA (Cohen's f2  = 0.12 [0.01, 0.36]), decreases in NA (Cohen's f2  = 0.06 [0.00, 0.24]) and PC (Cohen's f2  = 0.16 [0.02, 0.42]). The PC reduction mediated the effect of the bMBI on PPI and PU directly; however, the PC effect through PA increase mediated the PU marginally but not PPI changes. bMBI effect on Qol-MH was mediated directly by PA and NA. The PC improved Qol-MH through PA increase and Pain decrease but not via NA.

CONCLUSIONS

Our findings showed that bMBI impacts pain through changes in pain-related cognitive-affective factors. bMBI can improve QoL-MH by multiple pathways, including but not limited to pain reduction, highlighting the independent potential of improvement in affect to restore mental health in endometriosis.

SIGNIFICANCE

Brief mindfulness-based intervention improves endometriosis pain through pain-related cognitive-affective factors and quality of life mental health via pain and affect changes unrelated to pain.

Effects of Nursing Care Using a Fast-Track Surgery Approach in 49 Patients with Early-Stage Hepatocellular Carcinoma Undergoing First-Line Treatment with Radiofrequency Ablation: A Retrospective Study

BACKGROUND Fast-track surgery (FTS), also known as enhanced recovery after surgery (ERAS), includes a coordinated perioperative approach to patient care that aims to facilitate postoperative recovery. The role of nursing care is central to the concept of FTS. This retrospective study aimed to evaluate the effects of nursing care using an FTS approach in 49 patients with early-stage hepatocellular carcinoma (HCC) undergoing first-line treatment with radiofrequency ablation (RFA). MATERIAL AND METHODS A retrospective analysis was made of 49 patients with early-stage hepatocellular carcinoma who underwent first-line treatment with radiofrequency ablation in the Department of Hepatobiliary Surgery in our hospital from January 2020 to December 2021. The nurses have been nursing the patients in accordance with the requirements of FTS from 2021. Compared with the data of patients receiving traditional nursing, the detailed differences in postoperative recovery, pain score, complication rate, liver and kidney function, and nursing satisfaction were analyzed. RESULTS After applying the FTS nursing model, the patients had significantly shorter time to first flatus, infusion, postoperative hospital stay, and lower total hospitalization expenses (P<0.05). Moreover, the Numerical Pain Rating Scale score was lower than that in the control group, the postoperative complications in the 2021 group were lower than those in the 2020 group, and the nursing satisfaction was also better than that of the 2020 group (P<0.05). CONCLUSIONS Nursing care using a fast-track surgery approach with early-stage hepatocellular carcinoma patients undergoing first-line treatment with radiofrequency ablation is better than conventional nursing, and improves recovery of patients.

The roles of caregivers and friends in adolescent daily emotion dynamics

Daily emotion dynamics provide valuable information about individuals' emotion processes as they go about their lives. Emotion dynamics such as emotion levels (mean), emotion variability (degree of fluctuation), and emotion network density (strength of temporal connections among emotions) are associated with risks for various psychopathology in youth and adults. Prior work has shown that caregivers and friends play crucial socializing roles in adolescent emotional well-being, but less is known about their roles in daily emotion dynamics. This study examined whether caregiver emotion coaching, caregiver-adolescent closeness, and friendship quality were associated with adolescents' emotion levels, emotion variability, and emotion network density. Further, we examined whether caregiver-adolescent closeness moderated the associations between coaching and emotion dynamics. Participants were 150 adolescents (61% girls; Mage = 14.75) and one of their caregivers (95% female; Mage = 43.35) who completed a baseline survey and 21 daily surveys. Results showed that caregiver emotion coaching interacted with caregiver-adolescent closeness in predicting emotion levels and variability. Specifically, when closeness was higher, emotion coaching was significantly associated with lower sadness and anger levels, higher happiness levels, and lower happiness variability. Caregiver emotion coaching, independent of closeness, was also associated with lower anxiety levels, lower sadness variability, and lower emotion network density. Friendship quality was significantly associated with lower levels of sadness, anxiety, and anger, higher levels of happiness, and lower variability in anxiety and anger. These findings suggest that caregivers and friends are central to everyday emotion levels and variability and a more flexible emotion system in adolescents.

Exploring the digital footprint of depression: a PRISMA systematic literature review of the empirical evidence

BACKGROUND

This PRISMA systematic literature review examined the use of digital data collection methods (including ecological momentary assessment [EMA], experience sampling method [ESM], digital biomarkers, passive sensing, mobile sensing, ambulatory assessment, and time-series analysis), emphasizing on digital phenotyping (DP) to study depression. DP is defined as the use of digital data to profile health information objectively.

AIMS

Four distinct yet interrelated goals underpin this study: (a) to identify empirical research examining the use of DP to study depression; (b) to describe the different methods and technology employed; (c) to integrate the evidence regarding the efficacy of digital data in the examination, diagnosis, and monitoring of depression and (d) to clarify DP definitions and digital mental health records terminology.

RESULTS

Overall, 118 studies were assessed as eligible. Considering the terms employed, "EMA", "ESM", and "DP" were the most predominant. A variety of DP data sources were reported, including voice, language, keyboard typing kinematics, mobile phone calls and texts, geocoded activity, actigraphy sensor-related recordings (i.e., steps, sleep, circadian rhythm), and self-reported apps' information. Reviewed studies employed subjectively and objectively recorded digital data in combination with interviews and psychometric scales.

CONCLUSIONS

Findings suggest links between a person's digital records and depression. Future research recommendations include (a) deriving consensus regarding the DP definition and (b) expanding the literature to consider a person's broader contextual and developmental circumstances in relation to their digital data/records.

High- and Low-Arousal Daily Affect Dynamics Vary Across the Adult Lifespan

OBJECTIVES

Age differences in affective experience across adulthood are widely documented. According to the circumplex model of affect consists of 2 aspects-valence (positive vs negative) and arousal (low activation vs high activation). Prior research on age differences has primarily focused on the valence aspect. However, little is known about age differences in daily affect of high and low arousal.

METHOD

The present study examined age differences in daily dynamics (i.e., mean levels, variability, and inertia) of negative affect (NA) and positive affect (PA) of high and low arousal in a sample of 492 adults aged 21-91. Participants completed daily affect ratings for 21 consecutive days.

RESULTS

Age was negatively and linearly related to mean levels of both high-arousal and low-arousal NA. Both high-arousal and low-arousal PA mean levels showed increases after middle age. Further, age was related to lower variability in both NA and PA regardless of arousal. Additionally, high-arousal NA inertia showed a linear decrease with age, whereas low-arousal PA inertia showed an inverted-U pattern with age. After controlling for mean levels of affect, the associations between age and affect variability remained significant, whereas the associations between age and affect inertia did not.

DISCUSSION

The affective profile of older age is characterized by lower mean levels of NA, higher mean levels of PA, lower affect variability, and less persistence in high-arousal NA and low-arousal PA in daily life. Our results contribute to a nuanced understanding of which affective processes improve with age and which do not.

Momentary Associations of Osteoarthritis Pain and Affect: Depression as Moderator

OBJECTIVE

This research examined main and moderating effects of global depressive symptoms upon in-the-moment associations of pain and affect among individuals with knee osteoarthritis (OA). Effects of depression on short-term change in pain and affect were also examined.

METHOD

Older adults with physician-confirmed OA (N=325) completed a baseline interview tapping global depressive symptoms, followed by an experience sampling protocol that captured momentary pain and affect 4 times daily for 7 days. Multilevel models controlling demographics and health conditions examined main and moderating effects of depression on momentary associations of pain with positive (PA) and negative affect (NA). Similar methods addressed short-term change in pain and affect. Auxiliary analyses explored broad associations of depressive symptoms with person-level averages and variability in pain and affect.

RESULTS

Global depression predicted current pain, PA, and NA as well as change in pain and affect over a 3-8 hour period. Further, both in the moment and over short periods, the association of pain and NA was stronger among persons higher in depressive symptoms. No moderating effect for the PA-pain association was found. Depressive symptoms were also associated with variability in pain and affect, particularly NA.

DISCUSSION

Results confirm previous work on the relation of chronic pain with both global depressive symptoms and short-term affect. This research further demonstrates a unique moderating role of depression on the association of momentary pain with NA, and suggests that the causal path may be stronger from pain to affect than vice versa.

An informatics approach to examine decision-making impairments in the daily life of individuals with depression

Mental health informatics studies methods that collect, model, and interpret a wide variety of data to generate useful information with theoretical or clinical relevance to improve mental health and mental health care. This article presents a mental health informatics approach that is based on the decision-making theory of depression, whereby daily life data from a natural sequential decision-making task are collected and modeled using a reinforcement learning method. The model parameters are then estimated to uncover specific aspects of decision-making impairment in individuals with depression. Empirical results from a pilot study conducted to examine decision-making impairments in the daily lives of university students with depression are presented to illustrate this approach. Future research can apply and expand on this approach to investigate a variety of daily life situations and psychiatric conditions and to facilitate new informatics applications. Using this approach in mental health research may generate useful information with both theoretical and clinical relevance and high ecological validity.

The role of affect in chronic pain: A systematic review of within-person symptom dynamics

OBJECTIVE

Chronic pain is conceptualized as a biopsychosocial phenomenon that involves both physical and emotional processes. The vast majority of research regarding these facets of chronic pain characterizes differences between individuals. In this review, we describe problems with assuming that differences between persons accurately characterize within-person processes. We also provide a systematic review of studies that have examined within-person relationships between pain and affect among individuals with chronic pain.

METHOD

Articles published by December 2020 that pertained to within-person assessment of pain and emotion, affect, or mood were identified. Data regarding study design, adherence, and concurrent and prospective relationships among pain and affect variables were extracted and summarized.

RESULTS

Of 611 abstracts, 55 studies met inclusion criteria. Results suggest that individuals with chronic pain tend to experience increased negative affect and decreased positive affect when experiencing more severe pain (r_pooled = .18 and - .19, respectively). However, the size of these effects appeared smaller than between-person associations, and there was evidence of significant variability between individuals. Examination of predictive relationships between pain and affect largely suggested the tendency of symptoms to predict themselves, rather than pain predicting affect or vice versa.

CONCLUSIONS

Consistent with group-level relationships, experiencing more severe pain relative to an individual's average seems to be associated with more negative affect and less positive affect. However, individuals vary in the size and even direction of these effects. More research is necessary to understand the implications of such variability for the assessment and treatment of chronic pain.