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Årnes AP, Fjeld MK, Stigum H, Nielsen CS, Stubhaug A, Johansen A, Hopstock LA, Morseth B, Wilsgaard T, Steingrímsdóttir ÓA. Does pain tolerance mediate the effect of physical activity on chronic pain in the general population? The Tromsø Study. Pain 2024; 165:2011-2023. [PMID: 38442413 DOI: 10.1097/j.pain.0000000000003209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/28/2024] [Indexed: 03/07/2024]
Abstract
ABSTRACT Knowledge is needed regarding mechanisms acting between physical activity (PA) and chronic pain. We investigated whether cold pain tolerance mediates an effect of leisure-time physical activity on the risk of chronic pain 7 to 8 years later using consecutive surveys of the population-based Tromsø Study. We included participants with information on baseline leisure-time PA (LTPA) and the level of cold pressor-assessed cold pain tolerance, who reported chronic pain status at follow-up as any of the following: chronic pain for ≥3 months, widespread chronic pain, moderate-to-severe chronic pain, or widespread moderate-to-severe chronic pain. We included 6834 participants (52% women; mean age, 55 years) in counterfactual mediation analyses. Prevalence decreased with severity, for example, 60% for chronic pain vs 5% for widespread moderate-to-severe chronic pain. People with one level higher LTPA rating (light to moderate or moderate to vigorous) at baseline had lower relative risk (RR) of 4 chronic pain states 7 to 8 years later. Total RR effect of a 1-level LTPA increase was 0.95 (0.91-1.00), that is, -5% decreased risk. Total effect RR for widespread chronic pain was 0.84 (0.73-0.97). Indirect effect for moderate-to-severe chronic pain was statistically significant at RR 0.993 (0.988-0.999); total effect RR was 0.91 (0.83-0.98). Statistically significantly mediated RR for widespread moderate-to-severe chronic pain was 0.988 (0.977-0.999); total effect RR was 0.77 (0.64-0.94). This shows small mediation of the effect of LTPA through pain tolerance on 2 moderate-to-severe chronic pain types. This suggests pain tolerance to be one possible mechanism through which PA modifies the risk of moderate-to-severe chronic pain types with and without widespread pain.
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Affiliation(s)
- Anders Pedersen Årnes
- Department of Pain, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Mats Kirkeby Fjeld
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hein Stigum
- Institute of Health and Society, University of Oslo, Norway
| | - Christopher Sivert Nielsen
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Audun Stubhaug
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Aslak Johansen
- Department of Pain, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Bente Morseth
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Salwen-Deremer JK, Horrigan JM, Westvold SJ, Haythornthwaite JA. Feasibility and acceptability of remote administration of the cold pressor test. FRONTIERS IN PAIN RESEARCH 2024; 5:1421709. [PMID: 39228685 PMCID: PMC11368846 DOI: 10.3389/fpain.2024.1421709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/31/2024] [Indexed: 09/05/2024] Open
Abstract
Objective Quantitative sensory testing is often used to investigate pain in the context of experimental and clinical research studies. However, many of the devices used for QST protocols are only available in resource rich environments, thereby inadvertently limiting the possible pool of participants. Development of remote protocols for appropriate QST measures has the potential to reduce barriers to participation in research. Methods Participants with insomnia and Crohn's disease were recruited as part of a clinical trial. We adapted a remote version of the cold pressor test for use during telehealth-based study assessments. Herein, we present data from the baseline assessments including an assessment of feasibility and acceptability of the task. Results 100% of participants (N = 28) were able to complete the remote cold pressor test using a combination of materials from their homes and mailed by the study team. Temperature changes during the test were minimal and fairly evenly balanced between increases and decreases. Correlations between submersion time and both general and disease specific pain trended toward significance. Conclusions We demonstrated that a remote version of the cold pressor test is feasible and acceptable in a clinical population and provided a step-by-step protocol for administration to facilitate use in other studies.
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Affiliation(s)
- Jessica K. Salwen-Deremer
- Departments of Psychiatry & Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Jamie M. Horrigan
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Sarah J. Westvold
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Jennifer A. Haythornthwaite
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Knox PJ, Simon CB, Hicks GE. Preliminary Characterization of Age and Chronic Low Back Pain Effects on Multimodal Pain Sensitivity: A Comparison Study in Older Adults with and Without Chronic Low Back Pain. THE JOURNAL OF PAIN 2024; 25:104509. [PMID: 38484855 PMCID: PMC11283989 DOI: 10.1016/j.jpain.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/20/2024] [Accepted: 03/08/2024] [Indexed: 04/29/2024]
Abstract
Though pain sensitivity impairments contribute to chronic pain in younger adults, it is unclear if pain hypersensitivity manifests with aging and is heightened in the geriatric chronic low back pain population. The cross-sectional study preliminarily addressed this gap by measuring pain sensitivity in older adults with chronic low back pain (n = 25) as well as pain-free sex-matched older (n = 25) and younger adults (n = 25). Pain sensitivity was quantified by 8 distinct measures that were subdivided as static (ie, pressure pain thresholds, heat pain thresholds, fixed mechanical pain, and fixed cold pain) and dynamic pain sensitivity (ie, mechanical temporal summation, thermal ramp and hold, heat pain aftersensations, and conditioned pain modulation). Test-retest reliability values for pain sensitivity ranged from moderate to excellent (intraclass correlation coefficients ≥ .500; p's < .05). The main effect for the group was significant (partial η2 = .413, P < .001), revealing between-group differences in pain sensitivity on 5 out of 8 tests (p's ≤ .043). Predominantly, both older adult groups demonstrated increased pain facilitation and decreased pain inhibition during dynamic pain sensitivity testing compared to pain-free younger adults (p's ≤ .044). Despite qualitative differences, static and dynamic pain sensitivity responses were statistically similar between older adults with and without chronic LBP (p's > .05). Findings suggest pain sensitivity can be reliably measured in older adults and that pain hypersensitivity develops with chronological aging, providing partial support for the theory that pain hypersensitivity may impact geriatric chronic pain populations. Further study is needed to more definitively parse out whether pain hypersensitivity is comparatively heightened in older adults with chronic LBP beyond the influence of chronological aging. PERSPECTIVE: This article establishes that surrogate measures of centrally mediated pain sensitization are heightened with aging. Impaired endogenous pain modulation may influence chronic pain development, maintenance, treatment efficacy, and/or ensuing disability, necessitating research to comprehensively characterize how pain hypersensitivity contributes to geriatric chronic pain conditions.
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Affiliation(s)
- Patrick J. Knox
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Corey B. Simon
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University, Durham, NC
| | - Gregory E. Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE
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Mikkelsen MB, Neumann H, Buskbjerg CR, Johannsen M, O'Toole MS, Arendt-Nielsen L, Zachariae R. The effect of experimental emotion induction on experimental pain: a systematic review and meta-analysis. Pain 2024; 165:e17-e38. [PMID: 37889565 DOI: 10.1097/j.pain.0000000000003073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 07/31/2023] [Indexed: 10/28/2023]
Abstract
ABSTRACT The idea that emotions can influence pain is generally recognized. However, a synthesis of the numerous individual experimental studies on this subject is lacking. The aim of the present systematic review and meta-analysis was to synthesize the existing evidence on the effect of experimental emotion induction on experimental pain in nonclinical adults. PsycInfo and PubMed were searched up until April 10, 2023, for studies assessing differences in self-reported pain between emotion induction groups and/or control groups or between conditions within group. Risk of bias was assessed for the individual studies. The literature search yielded 78 relevant records of 71 independent studies. When compared with control conditions, the pooled results revealed a statistically significant pain-attenuating effect of positive emotion induction (between-group: Hedges g = -0.48, 95% CI: -0.72; -0.25, K = 9; within-group: g = -0.24, 95% CI: -0.32; -0.15, K = 40), and a statistically significant pain-exacerbating effect of negative emotion induction in within-group analyses but not between-group analyses (between-group: g = -0.29, 95% CI: -0.66; 0.07, K = 10; within-group: g = 0.14, 95% CI: 0.06; 0.23, K = 39). Bayesian meta-analysis provided strong support for an effect of positive emotion induction but weak support for an effect of negative emotion induction. Taken together, the findings indicate a pain-attenuating effect of positive emotion induction, while the findings for negative emotion induction are less clear. The findings are discussed with reference to theoretical work emphasizing the role of motivational systems and distraction for pain. Limitations include considerable heterogeneity across studies limiting the generalizability of the findings.
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Affiliation(s)
| | - Henrike Neumann
- Dept. of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | | | - Maja Johannsen
- Dept. of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Mia Skytte O'Toole
- Dept. of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | - Robert Zachariae
- Dept. of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Rodriguez ST, Makarewicz N, Wang EY, Zuniga-Hernandez M, Titzler J, Jackson C, Suen MY, Rosales O, Caruso TJ. Virtual reality facilitated exercise improves pain perception: A crossover study. J Clin Anesth 2023; 91:111257. [PMID: 37708601 DOI: 10.1016/j.jclinane.2023.111257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/26/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
STUDY OBJECTIVE Both virtual reality (VR) and exercise are recognized for their analgesic and anxiolytic properties. The purpose of this study is to evaluate the ability of VR-facilitated exercise to modulate pain. DESIGN Within-subject cross-over clinical trial. SETTING The Stanford Chariot Program conducted this study at Lucile Packard Children's Hospital Stanford (LCPHS). PATIENTS Healthy participants meeting inclusion criteria were recruited by volunteer solicitation from LCPHS. INTERVENTIONS Participants were randomized by hand dominance and subjected to a standardized cold pressor test with no VR or exercise. After a 5-min wash-out period, participants repeated the test on their other hand while experiencing a VR-facilitated exercise condition. Pain sensitivity, pain tolerance, and sympathetic activation data were collected during both conditions. MEASUREMENTS Pain sensitivity was scored 0-10 and collected every 30 s. Pain tolerance was recorded as the duration a participant could endure the painful stimuli. Sympathetic activation was measured by skin conductance response density (SCRD) and recorded in 30 s epochs by a biosensor. In all analyses, data were nested by participant. MAIN RESULTS Forty-one participants completed both interventions. Pain sensitivity was reduced in the VR-facilitated exercise condition (p < 0.0001). There was no difference in pain tolerance between conditions. While both conditions resulted in an increase in sympathetic activity, SCRD was higher at all time points in the VR-facilitated exercise condition. CONCLUSIONS The reduction in pain sensitivity indicates VR-facilitated exercise results in improved pain perception. VR-facilitated exercise may be especially useful for patients with chronic pain or other conditions requiring physical therapy, where pain may be exacerbated by exercise.
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Affiliation(s)
- Samuel T Rodriguez
- Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Nathan Makarewicz
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA; Stanford University School of Medicine, Stanford, CA, USA
| | - Ellen Y Wang
- Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Michelle Zuniga-Hernandez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Janet Titzler
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Christian Jackson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Man Yee Suen
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Oswaldo Rosales
- Stanford University Graduate School of Education, Stanford, CA, USA
| | - Thomas J Caruso
- Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA.
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Flasbeck V, Matthiessen A, Alabowitz A, Rusu AC, Brüne M. Is your pain my pain? A study exploring the relation between pain sensitivity, pain thresholds and empathy for somatic and psychological pain. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:748-761. [PMID: 37605326 DOI: 10.1111/bjc.12436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/14/2023] [Accepted: 08/06/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Research has shown that empathy for both somatic and psychological pain recruits affective components of the so-called pain matrix, a set of brain regions that is activated during the perception of somatic pain. In addition, the subjective evaluation of experimentally induced somatic pain is related to empathy for somatic pain. In contrast, it is unclear whether or not the subjective sensitivity to somatic pain impacts on empathy for psychological pain. METHODS In the present study, 55 healthy participants conducted a pain-pressure-test (PPT) and a cold-pressor test (CPT) in order to assess pain thresholds, pain tolerance and evaluation of pain during the task. They further conducted the social interaction empathy task (SIET), which investigates empathy for somatic as well as psychological pain. All participants completed the interpersonal-reactivity index (IRI) and the pain-sensitivity questionnaire (PSQ). RESULTS Participants who are in general more sensitive to somatic pain, as indicated by high-PSQ scores, showed higher empathy, that is, higher pain ratings, for both somatic and psychological painful situations observed in others as compared to those with low-PSQ scores. High-PSQ scores and high pain and unpleasantness ratings during the CPT were correlated with empathy for pain (both pain conditions), whereas pain thresholds (PPT) and pain tolerance thresholds (CPT) did not correlate with empathy. The IRI subscore 'personal distress' correlated with psychological pain ratings. CONCLUSIONS Thus, empathy for both somatic and psychological pain were related to the subjective evaluation of somatic pain and general pain sensitivity.
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Affiliation(s)
- Vera Flasbeck
- Division of Social Neuropsychiatry and Evolutionary Medicine, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Annegret Matthiessen
- Division of Social Neuropsychiatry and Evolutionary Medicine, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital Bochum, Ruhr University Bochum, Bochum, Germany
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Anne Alabowitz
- Division of Social Neuropsychiatry and Evolutionary Medicine, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital Bochum, Ruhr University Bochum, Bochum, Germany
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Adina Carmen Rusu
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Martin Brüne
- Division of Social Neuropsychiatry and Evolutionary Medicine, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital Bochum, Ruhr University Bochum, Bochum, Germany
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Fanninger S, Plener PL, Fischer MJM, Kothgassner OD, Goreis A. Water temperature during the cold pressor test: A scoping review. Physiol Behav 2023; 271:114354. [PMID: 37717684 DOI: 10.1016/j.physbeh.2023.114354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 09/19/2023]
Abstract
The cold pressor test (CPT) is a commonly used method to induce pain and stress in experimental settings. Previous research has found that the temperature of the water used in the test significantly affects outcome measures such as pain tolerance. Variations in CPT protocols, specifically regarding temperature, have been criticized. Hence, our objective is to investigate water temperature and associated methodological factors through a scoping review of the CPT in adults. Among 331 included trials, the most commonly reported temperature was 1°C (33.8°F). Reporting of the water temperature was adequate (93% of all trials), but a precise range within which the temperature was maintained was reported only in 27% of all trials. Pain measurement was the primary focus for most studies (90%), predominantly utilizing pain tolerance as the main outcome (78%). Water circulation was reported in 44% of studies, and 10% reported manually agitating the water. The most common maximum immersion time (i.e., ceiling time) was 180 s; notably, 64% of trials lacked information on participant awareness of this limit specification. The limb most immersed was the hand (76%). Overall, multiple methodological factors significantly impacting outcome measures were inconsistently implemented or reported. For future studies, we advocate for precise standardization of the water temperature used during the CPT. We suggest using 1°C (33.8°F), especially when assessing pain tolerance. A cooling apparatus allowing precise temperature control and continuous water circulation is advised. At the bare minimum, the temperature should be monitored continuously. While other decisions regarding the implementation of the CPT may differ depending on the specific aims of the respective study, it remains essential to standardize the water temperature and to provide a comprehensive report of the experimental protocol.
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Affiliation(s)
- Selina Fanninger
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria; Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Michael J M Fischer
- Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Andreas Goreis
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria.
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Wilson SC, Shaffer JA, Wachholtz AB. Distress Tolerance in the Comorbid Chronic Pain and Opioid Use Disorder Population. J Addict Med 2023; 17:e164-e171. [PMID: 37267174 PMCID: PMC10148917 DOI: 10.1097/adm.0000000000001106] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The risk of opioid addiction among people with chronic pain is elevated in those using opioids to self-medicate physical or emotional pain or distress. The purpose of this study is to test the main effect of distress tolerance (DT) on opioid use disorder (OUD) status in people with chronic pain, and the potential moderating effect of DT in the relationship between known addiction risk factors and the development of OUD. METHODS One hundred twenty people with chronic pain were recruited to 1 of 3 groups according to their opioid use status (ie, current methadone or buprenorphine/naloxone for OUD [n = 60], history of OUD but current prolonged opioid abstinence [n = 30, mean abstinence = 121 weeks, SD = 23.3], and opioid naive [n = 30]). Participants completed self-report measures and a cold pressor task. Multinomial logistic regression analyses were used to test if DT associated with OUD status in people with chronic pain and to compare DT to other known indicators of OUD risk. Multinomial linear regression analyses were used to test the moderation effects of DT on the relationship between various risk factors and OUD in people with chronic pain. RESULTS Analyses revealed that DT was significantly related to OUD status but did not moderate the effects of most OUD risk factors. CONCLUSIONS These results suggest that decreasing distress (eg, pain levels, craving responses, etc) may be more effective than improving tolerance to distress for the comorbid chronic pain and OUD population.
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Affiliation(s)
- Sarah C Wilson
- From the Department of Psychology, University of Colorado Denver, Denver, CO (SCW, JAS, ABW); Division of Addiction and Psychiatry, University of Colorado Medical School, Aurora, CO (ABW); and Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA (ABW)
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Gray matter volume and pain tolerance in a general population: the Tromsø study. Pain 2023:00006396-990000000-00257. [PMID: 36877481 DOI: 10.1097/j.pain.0000000000002871] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 01/03/2023] [Indexed: 03/07/2023]
Abstract
ABSTRACT As pain is processed by an extensive network of brain regions, the structural status of the brain may affect pain perception. We aimed to study the association between gray matter volume (GMV) and pain sensitivity in a general population. We used data from 1522 participants in the seventh wave of the Tromsø study, who had completed the cold pressor test (3°C, maximum time 120 seconds), undergone magnetic resonance imaging (MRI) of the brain, and had complete information on covariates. Cox proportional hazards regression models were fitted with time to hand withdrawal from cold exposure as outcome. Gray matter volume was the independent variable, and analyses were adjusted for intracranial volume, age, sex, education level, and cardiovascular risk factors. Additional adjustment was made for chronic pain and depression in subsamples with available information on the respective item. FreeSurfer was used to estimate vertexwise cortical and subcortical gray matter volumes from the T1-weighted MR image. Post hoc analyses were performed on cortical and subcortical volume estimates. Standardized total GMV was associated with risk of hand withdrawal (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.71-0.93). The effect remained significant after additional adjustment for chronic pain (HR 0.84, 95% CI 0.72-0.97) or depression (HR 0.82, 95% CI 0.71-0.94). In post hoc analyses, positive associations between standardized GMV and pain tolerance were seen in most brain regions, with larger effect sizes in regions previously shown to be associated with pain. In conclusion, our findings indicate that larger GMV is associated with longer pain tolerance in the general population.
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Silva P, Sebastião R. Using the Electrocardiogram for Pain Classification under Emotional Contexts. SENSORS (BASEL, SWITZERLAND) 2023; 23:1443. [PMID: 36772482 PMCID: PMC9919606 DOI: 10.3390/s23031443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
The adequate characterization of pain is critical in diagnosis and therapy selection, and currently is subjectively assessed by patient communication and self-evaluation. Thus, pain recognition and assessment have been a target of study in past years due to the importance of objective measurement. The goal of this work is the analysis of the electrocardiogram (ECG) under emotional contexts and reasoning on the physiological classification of pain under neutral and fear conditions. Using data from both contexts for pain classification, a balanced accuracy of up to 97.4% was obtained. Using an emotionally independent approach and using data from one emotional context to learn pain and data from the other to evaluate the models, a balanced accuracy of up to 97.7% was reached. These similar results seem to support that the physiological response to pain was maintained despite the different emotional contexts. Attempting a participant-independent approach for pain classification and using a leave-one-out cross-validation strategy, data from the fear context were used to train pain classification models, and data from the neutral context were used to evaluate the performance, achieving a balanced accuracy of up to 94.9%. Moreover, across the different learning strategies, Random Forest outperformed the remaining models. These results show the feasibility of identifying pain through physiological characteristics of the ECG response despite the presence of autonomic nervous system perturbations.
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Affiliation(s)
- Pedro Silva
- DFis, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Raquel Sebastião
- IEETA, DETI, LASI, University of Aveiro, 3810-193 Aveiro, Portugal
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Uzawa H, Ishii H, Ishida T, Shida T, Furuyama H, Nishida Y. Factors Associated with Low Inter-Session Reliability of Conditioned Pain Modulation in Older People with or Without Chronic Musculoskeletal Pain. J Pain Res 2023; 16:1039-1053. [PMID: 36992922 PMCID: PMC10041985 DOI: 10.2147/jpr.s391943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
Purpose Conditioned pain modulation (CPM) is a measurement of the descending pain pathways that inhibit or facilitate afferent noxious stimuli. The reliability of CPM in older individuals with or without chronic musculoskeletal pain has not been sufficiently reported. This study aimed to examine the inter-session reliability of CPM in these cohorts and the factors in CPM reliability. Patients and Methods Individuals aged 65 or older were recruited in Narita, Japan. The measurements were performed on separate days 2 weeks apart (sessions 1 and 2). Each participant's hand was immersed in cold water, and we measured pressure pain threshold (PPT) before and after the immersion. The ratio before and after PPT measurements was presented as CPM index. The autonomic activities (heart rate variability, heart rate, and blood pressure) were simultaneously measured. An absolute reliability of CPM index was analyzed by the adjusted two-way analysis of variance (ANOVA) and the Bland Altman plot, and relative reliability was analyzed by intraclass correlation coefficient (ICC). Spearman's rho correlation and the adjusted multivariate regression analysis were utilized for examining the CPM reliability factors. Results Thirty-two participants were divided into two groups: chronic pain (n=19) and non-chronic pain (n=13) groups. The mean difference between session 1 and 2 in CPM index showed a systematic error in the chronic pain group at 17.3 (confidence interval, CI: 15.0 to 19.7), but none in the non-chronic pain group at 3.7 (CI: -0.02 to 7.4). The adjusted two-way ANOVA for CPM index did not identify any differences. ICC was not significant at p=-0.247 in the non-chronic and 0.167 in chronic pain. Multivariate regression analysis revealed total power and low/high frequencies as significant factors for CPM index. Conclusion This study identified low inter-session reliability in older adults with chronic musculoskeletal pain and autonomic nervous system activities as factors in CPM reliability.
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Affiliation(s)
- Hironobu Uzawa
- Department of Physical Therapy, International University of Health and Welfare, Narita, Chiba, Japan
- Correspondence: Hironobu Uzawa, Department of Physical Therapy, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba, 286-8686, Japan, Tel/Fax +81-746-20-7716, Email
| | - Hideaki Ishii
- Department of Physical Therapy, International University of Health and Welfare, Narita, Chiba, Japan
| | - Takeki Ishida
- Department of Physical Therapy, International University of Health and Welfare, Narita, Chiba, Japan
| | - Takashi Shida
- Department of Medical Technology and Science, International University of Health and Welfare, Narita, Chiba, Japan
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hiroto Furuyama
- Department of Rehabilitation, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
| | - Yusuke Nishida
- Department of Physical Therapy, International University of Health and Welfare, Narita, Chiba, Japan
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12
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Winslow BD, Kwasinski R, Whirlow K, Mills E, Hullfish J, Carroll M. Automatic detection of pain using machine learning. FRONTIERS IN PAIN RESEARCH 2022; 3:1044518. [DOI: 10.3389/fpain.2022.1044518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
Pain is one of the most common symptoms reported by individuals presenting to hospitals and clinics and is associated with significant disability and economic impacts; however, the ability to quantify and monitor pain is modest and typically accomplished through subjective self-report. Since pain is associated with stereotypical physiological alterations, there is potential for non-invasive, objective pain measurements through biosensors coupled with machine learning algorithms. In the current study, a physiological dataset associated with acute pain induction in healthy adults was leveraged to develop an algorithm capable of detecting pain in real-time and in natural field environments. Forty-one human subjects were exposed to acute pain through the cold pressor test while being monitored using electrocardiography. A series of respiratory and heart rate variability features in the time, frequency, and nonlinear domains were calculated and used to develop logistic regression classifiers of pain for two scenarios: (1) laboratory/clinical use with an F1 score of 81.9% and (2) field/ambulatory use with an F1 score of 79.4%. The resulting pain algorithms could be leveraged to quantify acute pain using data from a range of sources, such as ECG data in clinical settings or pulse plethysmography data in a growing number of consumer wearables. Given the high prevalence of pain worldwide and the lack of objective methods to quantify it, this approach has the potential to identify and better mitigate individual pain.
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13
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Zunhammer M, Goltz G, Schweifel M, Stuck BA, Bingel U. Savor the flavor: A randomized double-blind study assessing taste-enhanced placebo analgesia in healthy volunteers. Clin Transl Sci 2022; 15:2709-2719. [PMID: 36088659 PMCID: PMC9652436 DOI: 10.1111/cts.13397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/01/2022] [Accepted: 08/06/2022] [Indexed: 01/26/2023] Open
Abstract
Placebo effects substantially contribute to analgesic treatment outcomes and might be leveraged to enhance gold-standard treatments. The taste of oral medications has been proposed to boost placebo effects. Here, we aimed at estimating how far the taste of an oral medication enhances placebo analgesia. We conducted a randomized, double-blind, between-group, single-visit study, with pre-treatment baseline. Over the course of three substudies, 318 healthy volunteers (297 included) were tested in a clinical trial setting. Participants were subjected to experimental tonic cold water pain (cold pressor test) before and after receiving taste-neutral (water), or bitter (quinine), or sweet (saccharin), or no placebo drops. Pre- versus post-treatment changes in area under the pain rating curve, the main outcome, indicated that placebo treatment showed a small analgesic effect versus no treatment. Added taste induced placebo enhancement in the very small effect size range, but accounted for a substantial portion of the overall placebo effect. No noteworthy advantage of sweet over bitter placebo was observed. An exploration of heart rate (HR) recordings indicated that placebo treatments were associated with an increase in peak HR-response to cold water, but these were not associated with placebo analgesia at an individual level. Placebo treatments were associated with minimal side effects. These results indicate that added taste may be an easy-to-implement, cost-effective, and safe way to optimize treatment outcomes and that taste-neutral preparations may reduce placebo-related outcome variance in clinical trials. Further studies are needed to test if these findings can be translated into clinical scenarios.
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Affiliation(s)
- Matthias Zunhammer
- Department of Neurology, Center for Translational Neuro‐ and Behavioral Sciences (C‐TNBS)University Hospital EssenEssenGermany
| | - Gerrit Goltz
- Department of Neurology, Center for Translational Neuro‐ and Behavioral Sciences (C‐TNBS)University Hospital EssenEssenGermany
| | - Maximilian Schweifel
- Department of Neurology, Center for Translational Neuro‐ and Behavioral Sciences (C‐TNBS)University Hospital EssenEssenGermany
| | - Boris A. Stuck
- Department of Otolaryngology, Head and Neck Surgery, University Hospital MarburgPhilipps‐Universität MarburgMarburgGermany
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro‐ and Behavioral Sciences (C‐TNBS)University Hospital EssenEssenGermany
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14
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Savitha D, Anto T, Thomas T. Effects of repeated exposures to experimental cold pain stimulus on pain perception in healthy young Indian men. Med J Armed Forces India 2022; 78:S238-S245. [PMID: 36147410 PMCID: PMC9485853 DOI: 10.1016/j.mjafi.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/05/2021] [Indexed: 11/15/2022] Open
Abstract
Background The influence of repeated exposures to cold pain stimulus, a surrogate of clinical pain, has remained largely unexplored. The study was planned to test the effect of repeated exposures to cold pain through cold pressor task on pain sensitivity and vascular reactivity. Methods Single-group experimental study. Thirty-seven healthy male volunteers (18-25 years) were exposed to cold pressor tasks for seven consecutive days and on the 14th day on the nondominant hand. The same was repeated on dominant hand on first and seventh days; 31 completed the protocol. Results Pain threshold and tolerance in the nondominant hand increased from day 1 to day 7 (p < 0.001) and were positively correlated on day 1 ( ρ =0.45, p = 0.011) and day 7 ( ρ =0.38, p = 0.036). Diastolic blood pressure response was found to increase by day 7 (p < 0.0024) and positively correlated with tolerance. On the dominant hand, the threshold reduced from day 1 to day 7, while tolerance increased. Both threshold and tolerance remained lower than that of nondominant hand. Day 14 values of threshold and tolerance were in between day 1 and day 7 values but not significantly different from both. Conclusion Habituation in pain threshold and tolerance was observed on repeated exposure to cold pain, which was not significantly retained till the 14th day. The same was not observed with subjective feeling of pain perception. The increased diastolic blood pressure response is suggestive of peripheral vasoconstriction. Increased tolerance in the dominant hand by day 7 demonstrates a systemic effect in habituation.
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Affiliation(s)
- D. Savitha
- Associate Professor (Physiology), St John’s Medical College, St. John’s National Academy of Health Sciences, Bengaluru, India
| | - Taniya Anto
- Tutor/Lecturer (Physiology), St John’s Medical College, St. John’s National Academy of Health Sciences, Bengaluru, India
| | - Tinku Thomas
- Professor (Biostatistics), St John’s Medical College, St. John’s National Academy of Health Sciences, Bengaluru, India
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15
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Quantifying virtual reality pain modulation in healthy volunteers: A randomized, crossover study. J Clin Anesth 2022; 80:110876. [PMID: 35525050 DOI: 10.1016/j.jclinane.2022.110876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE Virtual reality (VR) is an emerging tool to reduce pain and anxiety during procedures. Although VR's clinical benefits are reported, biometric data quantifying VR's effect on pain tolerance is lacking. We used time-lapse, subjective, and biometric data to evaluate VR's effect on modulating pain. DESIGN Randomized, controlled crossover within-subject clinical trial. SETTING This study was conducted in the Chariot Lab at Lucile Packard Children's Hospital and outdoors at Stanford University School of Medicine. PATIENTS 156 healthy volunteers were included. INTERVENTIONS Participants underwent pain-inducing ice immersions while connected to biometric sensors. Participants were randomized to immerse their dominant or non-dominant hand with VR or control (no VR) for one immersion, and then crossed-over to the other hand for the second immersion. We instructed participants to submerge their hand until they reached their pain tolerance or until four minutes elapsed. MEASUREMENTS Outcomes included ice immersion duration, perceived pain scores, and skin conductance response density (SCRD), a marker of sympathetic arousal. We used survival analysis and mixed effects models to compare measurements with and without VR. MAIN RESULTS 153 participants were included in the analysis. Participants with VR were 64% less likely to remove their hands from the ice bath throughout the immersion's duration compared to control (P < 0.001). Participants with VR reported significantly lower pain scores after controlling for dominant hand treatment assignment, VR vs. no VR treatment order, and gender (P < 0.001). SCRD increased as time progressed for both VR and control groups (P = 0.047 combined), with no significant mean group differences. CONCLUSIONS Participants with VR were more likely to survive the 4-min ice bath challenge longer and with lower levels of pain perception, supporting VR's effectiveness as a distraction tool during painful procedures. We observed no differences in sympathetic response when comparing VR to no VR.
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16
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Tonic pain alters functional connectivity of the descending pain modulatory network involving amygdala, periaqueductal gray, parabrachial nucleus and anterior cingulate cortex. Neuroimage 2022; 256:119278. [PMID: 35523367 PMCID: PMC9250649 DOI: 10.1016/j.neuroimage.2022.119278] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 04/07/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Resting state functional connectivity (FC) is widely used to assess functional brain alterations in patients with chronic pain. However, reports of FC accompanying tonic pain in pain-free persons are rare. A network we term the Descending Pain Modulatory Network (DPMN) is implicated in healthy and pathologic pain modulation. Here, we evaluate the effect of tonic pain on FC of specific nodes of this network: anterior cingulate cortex (ACC), amygdala (AMYG), periaqueductal gray (PAG), and parabrachial nuclei (PBN). METHODS In 50 pain-free participants (30F), we induced tonic pain using a capsaicin-heat pain model. functional MRI measured resting BOLD signal during pain-free rest with a 32°C thermode and then tonic pain where participants experienced a previously warm temperature combined with capsaicin. We evaluated FC from ACC, AMYG, PAG, and PBN with correlation of self-report pain intensity during both states. We hypothesized tonic pain would diminish FC dyads within the DPMN. RESULTS Of all hypothesized FC dyads, only PAG and subgenual ACC was weakly altered during pain (F=3.34; p=0.074; pain-free>pain d=0.25). After pain induction sACC-PAG FC became positively correlated with pain intensity (R=0.38; t=2.81; p=0.007). Right PBN-PAG FC during pain-free rest positively correlated with subsequently experienced pain (R=0.44; t=3.43; p=0.001). During pain, this connection's FC was diminished (paired t=-3.17; p=0.0026). In whole-brain analyses, during pain-free rest, FC between left AMYG and right superior parietal lobule and caudate nucleus were positively correlated with subsequent pain. During pain, FC between left AMYG and right inferior temporal gyrus negatively correlated with pain. Subsequent pain positively correlated with right AMYG FC with right claustrum; right primary visual cortex and right temporo-occipitoparietal junction Conclusion: We demonstrate sACC-PAG tonic pain FC positively correlates with experienced pain and resting right PBN-PAG FC correlates with subsequent pain and is diminished during tonic pain. Finally, we reveal PAG- and right AMYG-anchored networks which correlate with subsequently experienced pain intensity. Our findings suggest specific connectivity patterns within the DPMN at rest are associated with subsequently experienced pain and modulated by tonic pain. These nodes and their functional modulation may reveal new therapeutic targets for neuromodulation or biomarkers to guide interventions.
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17
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Grouper H, Löffler M, Flor H, Eisenberg E, Pud D. Increased functional connectivity between limbic brain areas in healthy individuals with high versus low sensitivity to cold pain: A resting state fMRI study. PLoS One 2022; 17:e0267170. [PMID: 35442971 PMCID: PMC9020745 DOI: 10.1371/journal.pone.0267170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The representation of variability in sensitivity to pain by differences in neural connectivity patterns and its association with psychological factors needs further investigation. This study assessed differences in resting-state functional connectivity (rsFC) and its association to cognitive-affective aspects of pain in two groups of healthy subjects with low versus high sensitivity to pain (LSP vs. HSP). We hypothesized that HSP will show stronger connectivity in brain regions involved in the affective-motivational processing of pain and that this higher connectivity would be related to negative affective and cognitive evaluations of pain. METHODS Forty-eight healthy subjects were allocated to two groups according to their tolerability to cold stimulation (cold pressor test, CPT, 1°C). Group LSP (N = 24) reached the cut-off time of 180±0 sec and group HSP tolerated the CPT for an average of 13±4.8 sec. Heat, cold and mechanical evoked pain were measured, as well as pain-catastrophizing (PCS), depression, anxiety and stress (DASS-21). All subjects underwent resting state fMRI. ROI-to-ROI analysis was performed. RESULTS In comparison to the LSP, the HSP had stronger interhemispheric connectivity of the amygdala (p = 0.01) and between the amygdala and nucleus accumbens (NAc) (p = 0.01). Amygdala connectivity was associated with higher pain catastrophizing in the HSP only (p<0.01). CONCLUSIONS These findings suggest that high sensitivity to pain may be reflected by neural circuits involved in affective and motivational aspects of pain. To what extent this connectivity within limbic brain structures relates to higher alertness and more profound withdrawal behavior to aversive events needs to be further investigated.
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Affiliation(s)
- Hadas Grouper
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Martin Löffler
- Medical Faculty Mannheim, Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Herta Flor
- Medical Faculty Mannheim, Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Elon Eisenberg
- The Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel
- Institute of Pain Medicine, Haifa, Israel
| | - Dorit Pud
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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18
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Gajsar H, Meyer M, Hasenbring MI, Vaegter HB. Pain and executive function: no association between remote exercise-induced hypoalgesia and cognitive inhibition in pain-free participants. Scand J Pain 2022; 22:173-185. [PMID: 34364316 DOI: 10.1515/sjpain-2021-0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/13/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Cognitive inhibition, which denotes the ability to suppress predominant or automatic responses, has been associated with lower pain sensitivity and larger conditioned pain modulation in humans. Studies exploring the association between cognitive inhibition and other pain inhibitory phenomena, like exercise-induced hypoalgesia (EIH), are scarce. The primary aim was to explore the association between cognitive inhibition and EIH at exercising (local) and non-exercising (remote) muscles after isometric exercise. The secondary aim was to explore the association between cognitive inhibition and pressure pain sensitivity. METHODS Sixty-six pain-free participants (28.3 ± 8.9 years old, 34 women) completed two cognitive inhibition tasks (stop-signal task and Stroop Colour-Word task), a 3-min isometric wall squat exercise, and a quiet rest control condition with pre- and post-assessments of manual pressure pain thresholds at a local (thigh) and a remote site (shoulder). In addition, cuff pressure pain thresholds, pain tolerance and temporal summation of pain were assessed at baseline. RESULTS No association was found between remote EIH and cognitive inhibition (Stroop interference score: r=0.12, [-0.15; 0.37], p=0.405, BF01=6.70; stop-signal reaction time: r=-0.08, [-0.32; 0.17], p=0.524, BF01=8.32). Unexpectedly, individuals with worse performance on the Stroop task, as indicated by a higher Stroop interference score, showed higher local EIH (r=0.33; [0.10; 0.53], p=0.007, BF01=0.29). No associations were observed between pain sensitivity and any of the cognitive inhibition performance parameters. CONCLUSIONS The present findings do not support previous evidence on positive associations between exercise-induced hypoalgesia and cognitive inhibition, as well as baseline pain sensitivity and cognitive inhibition.
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Affiliation(s)
- Hannah Gajsar
- Department of Medical Psychology and Medical Sociology, Medical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Marcel Meyer
- Psychological Faculty, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Monika I Hasenbring
- Department of Medical Psychology and Medical Sociology, Medical Faculty, Ruhr University Bochum, Bochum, Germany
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Henrik B Vaegter
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Pain Research Group, Pain Center, University Hospital Odense, Odense, Denmark
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19
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Fladseth K, Lindekleiv H, Nielsen C, Øhrn A, Kristensen A, Mannsverk J, Løchen ML, Njølstad I, Wilsgaard T, Mathiesen EB, Stubhaug A, Trovik T, Rotevatn S, Forsdahl S, Schirmer H. Low Pain Tolerance Is Associated With Coronary Angiography, Coronary Artery Disease, and Mortality: The Tromsø Study. J Am Heart Assoc 2021; 10:e021291. [PMID: 34729991 PMCID: PMC8751909 DOI: 10.1161/jaha.121.021291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The initial presentation to coronary angiography and extent of coronary artery disease (CAD) vary greatly among patients, from ischemia with no obstructive CAD to myocardial infarction with 3‐vessel disease. Pain tolerance has been suggested as a potential mechanism for the variation in presentation of CAD. We aimed to investigate the association between pain tolerance, coronary angiography, CAD, and death. Methods and Results We identified 9576 participants in the Tromsø Study (2007–2008) who completed the cold‐pressor pain test, and had no prior history of CAD. The median follow‐up time was 10.4 years. We applied Cox‐regression models with age as time‐scale to calculate hazard ratios (HR). More women than men aborted the cold pressor test (39% versus 23%). Participants with low pain tolerance had 19% increased risk of coronary angiography (HR, 1.19 [95% CI, 1.03–1.38]) and 22% increased risk of obstructive CAD (HR, 1.22 [95% CI, 1.01–1.47]) adjusted by age as time‐scale and sex. Among women who underwent coronary angiography, low pain tolerance was associated with 54% increased risk of obstructive CAD (HR, 1.54 [95% CI, 1.09–2.18]) compared with high pain tolerance. There was no association between pain tolerance and nonobstructive CAD or clinical presentation to coronary angiography (ie, stable angina, unstable angina, and myocardial infarction). Participants with low pain tolerance had increased risk of mortality after adjustment for CAD and cardiovascular risk factors (HR, 1.40 [95% CI, 1.19–1.64]). Conclusions Low cold pressor pain tolerance is associated with a higher risk of coronary angiography and death.
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Affiliation(s)
- Kristina Fladseth
- Cardiovascular Research Group Department of Clinical Medicine UiT The Arctic University of Norway Tromsø Norway.,Department of Cardiology University Hospital of North Norway Tromsø Norway
| | - Haakon Lindekleiv
- Department of Cardiology University Hospital of North Norway Tromsø Norway
| | - Christopher Nielsen
- Department of Community Medicine UiT The Arctic University of Norway Tromsø Norway.,Division of Ageing and Health Norwegian Institute of Public Health Oslo Norway.,Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway
| | - Andrea Øhrn
- Department of Psychology UiT The Arctic University of Norway Tromsø Norway
| | - Andreas Kristensen
- Department of Cardiology University Hospital of North Norway Tromsø Norway
| | - Jan Mannsverk
- Department of Cardiology University Hospital of North Norway Tromsø Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine UiT The Arctic University of Norway Tromsø Norway
| | - Inger Njølstad
- Department of Community Medicine UiT The Arctic University of Norway Tromsø Norway
| | - Tom Wilsgaard
- Department of Community Medicine UiT The Arctic University of Norway Tromsø Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine UiT The Arctic University of Norway Tromsø Norway.,Department of Neurology University Hospital of North Norway Tromsø Norway
| | - Audun Stubhaug
- Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway.,Institute of Clinical Medicine University of Oslo Lørenskog Norway
| | - Thor Trovik
- Department of Cardiology University Hospital of North Norway Tromsø Norway
| | - Svein Rotevatn
- Department of Cardiology Haukeland University Hospital Bergen Norway
| | - Signe Forsdahl
- Department of Radiology University Hospital North Norway Tromsø Norway
| | - Henrik Schirmer
- Cardiovascular Research Group Department of Clinical Medicine UiT The Arctic University of Norway Tromsø Norway.,Institute of Clinical Medicine University of Oslo Lørenskog Norway.,Department of Cardiology Akershus University Hospital Lørenskog Norway
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20
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The role of negative emotions in sex differences in pain sensitivity. Neuroimage 2021; 245:118685. [PMID: 34740794 DOI: 10.1016/j.neuroimage.2021.118685] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/24/2021] [Accepted: 10/25/2021] [Indexed: 01/09/2023] Open
Abstract
Pain perception varies widely among individuals due to the varying degrees of biological, psychological, and social factors. Notably, sex differences in pain sensitivity have been consistently observed in various experimental and clinical investigations. However, the neuropsychological mechanism underlying sex differences in pain sensitivity remains unclear. To address this issue, we quantified pain sensitivity (i.e., pain threshold and tolerance) using the cold pressure test and negative emotions (i.e., pain-related fear, pain-related anxiety, trait anxiety, and depression) using well-established questionnaires and collected magnetic resonance imaging (MRI) data (i.e., high-resolution T1 structural images and resting-state functional images) from 450 healthy subjects. We observed that, as compared to males, females exhibited lower pain threshold and tolerance. Notably, sex differences in pain sensitivity were mediated by pain-related fear and anxiety. Specifically, pain-related fear and anxiety were the complementary mediators of the relationship between sex and pain threshold, and they were the indirect-only mediators of the relationship between sex and pain tolerance. Besides, structural MRI data revealed that the amygdala subnuclei (i.e., the lateral and basal nuclei in the left hemisphere) volumes were the complementary mediators of the relationship between sex and pain-related fear, which further influenced pain sensitivity. Altogether, our results provided a comprehensive picture of how negative emotions (especially pain-related negative emotions) and related brain structures (especially the amygdala) contribute to sex differences in pain sensitivity. These results deepen our understanding of the neuropsychological underpinnings of sex differences in pain sensitivity, which is important to tailor a personalized method for treating pain according to sex and the level of pain-related negative emotions for patients with painful conditions.
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21
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Kleine-Borgmann J, Wilhelmi J, Kratel J, Baumann F, Schmidt K, Zunhammer M, Bingel U. Tilidine and dipyrone (metamizole) in cold pressor pain: A pooled analysis of efficacy, tolerability, and safety in healthy volunteers. Clin Transl Sci 2021; 14:1997-2007. [PMID: 34058081 PMCID: PMC8504837 DOI: 10.1111/cts.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/25/2021] [Accepted: 03/06/2021] [Indexed: 11/30/2022] Open
Abstract
The cold pressor test (CPT) is widely implemented and offers a simple, experimental acute pain model utilizing cold pain. Previous trials have frequently paired the CPT with opioids in order to investigate the mechanisms underlying pharmacological analgesia, due to their known analgesic efficacy. However, opioid side effects may lead to unblinding and raise concerns about the safety of the experimental setting. Despite the established clinical efficacy of dipyrone (metamizole), its efficacy, tolerability, and safety in cold pressor pain has not been systematically addressed to date. This pooled analysis included data of 260 healthy volunteers from three randomized, placebo‐controlled, double‐blind substudies using the CPT following a pre‐test‐post‐test‐design. These substudies allow for comparing a single dose of 800 mg dipyrone with two different doses of the opioid tilidine/naloxone (50/4 mg and 100/8 mg, respectively). Outcomes included pain intensity ratings, pain tolerance, medication‐attributed side effects, as well as changes of blood pressure and heart rate. We demonstrate that both opioid doses and dipyrone had a comparable, significant analgesic effect on cold pressor pain. However, dipyrone was associated with significantly less self‐reported adverse effects and these were not significantly different from those under placebo. These results indicate that the combination of dipyrone and the CPT provides a safe, tolerable, and effective experimental model for the study of pharmacological analgesia. In combination with a CPT, dipyrone may be useful as a positive control, or baseline medication for the study of analgesic modulation.
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Affiliation(s)
- Julian Kleine-Borgmann
- Clinical Neurosciences, Department of Neurology, University Hospital Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Johannes Wilhelmi
- Clinical Neurosciences, Department of Neurology, University Hospital Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Johannes Kratel
- Clinical Neurosciences, Department of Neurology, University Hospital Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Frederik Baumann
- Clinical Neurosciences, Department of Neurology, University Hospital Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Katharina Schmidt
- Clinical Neurosciences, Department of Neurology, University Hospital Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Matthias Zunhammer
- Clinical Neurosciences, Department of Neurology, University Hospital Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Ulrike Bingel
- Clinical Neurosciences, Department of Neurology, University Hospital Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
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22
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Chouchou F, Perchet C, Garcia-Larrea L. EEG changes reflecting pain: is alpha suppression better than gamma enhancement? Neurophysiol Clin 2021; 51:209-218. [PMID: 33741256 DOI: 10.1016/j.neucli.2021.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Suppression of alpha and enhancement of gamma electroencephalographic (EEG) power have both been suggested as objective indicators of cortical pain processing. While gamma activity has been emphasized as the best potential marker, its spectral overlap with pain-related muscular responses is a potential drawback. Since muscle contractions are almost universal concomitants of physical pain, here we investigated alpha and gamma scalp-recorded activities during either tonic pain or voluntary facial grimaces mimicking those triggered by pain. METHODS High-density EEG (128 electrodes) was recorded while 14 healthy participants either underwent a cold pressor test (painful hand immersion in 10 °C water) or produced stereotyped facial/nuchal contractions (grimaces) mimicking those evoked by pain. The scalp distribution of spectral EEG changes was quantified via vector-transformation of maps and compared between the pain and grimacing conditions by calculating the cosine of the angle between the two corresponding topographies. RESULTS Painful stimuli significantly enhanced gamma power bilaterally in fronto-temporal regions and decreased alpha power in the contralateral central scalp. Sustained cervico-facial contractions (grimaces) gave also rise to significant gamma power increase in fronto-temporal regions but did not decrease central scalp alpha. While changes in alpha topography significantly differed between the pain and grimace situations, the scalp topography of gamma power was statistically indistinguishable from that occurring during grimaces. CONCLUSION Gamma power induced by painful stimuli or voluntary facial-cervical muscle contractions had overlapping topography. Pain-related alpha decrease in contralateral central scalp was less disturbed by muscle activity and may therefore prove more discriminant as an ancillary pain biomarker.
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Affiliation(s)
- Florian Chouchou
- NeuroPain Lab, Lyon Neuroscience Research Centre, CRNL - Inserm U 1028/CNRS UMR 5292, University of Lyon, France; IRISSE Laboratory (EA4075), UFR SHE, University of La Réunion, Le Tampon, France.
| | - Caroline Perchet
- NeuroPain Lab, Lyon Neuroscience Research Centre, CRNL - Inserm U 1028/CNRS UMR 5292, University of Lyon, France
| | - Luis Garcia-Larrea
- NeuroPain Lab, Lyon Neuroscience Research Centre, CRNL - Inserm U 1028/CNRS UMR 5292, University of Lyon, France
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Jackson D, Singh S, Zhang-James Y, Faraone S, Johnson B. The Effects of Low Dose Naltrexone on Opioid Induced Hyperalgesia and Fibromyalgia. Front Psychiatry 2021; 12:593842. [PMID: 33664680 PMCID: PMC7921161 DOI: 10.3389/fpsyt.2021.593842] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/26/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives: While opioids temporarily alleviate pain, the overshoot of balancing pain drivers may increase pain, leading to opioid induced hyperalgesia (OIH). Our goal was to find out what chronic opioid treatment does to pain tolerance as measured by the cold pressor test (CPT), an objective measure of pain tolerance, and to find an alternative effective treatment for chronic pain and FM. Materials and Methods: The setting was an academic addiction medicine service that has an embedded pain service. Patients had routine clinical care starting with an evaluation that included assessment of medical and psychiatric conditions. Participants were 55 patients with OIH and 21 patients with fibromyalgia; all had at least two CPTs. Treatment included a single dose of buprenorphine for detoxification. In this open-label case series, patients were treated with low dose naltrexone (LDN), a pure opioid receptor antagonist that, we hypothesize, treats OIH and FM by restoring endogenous opioid tone. Results: Comparing initial and last CPT times, those with OIH more than quadrupled their pain tolerance, and those with FM doubled theirs. This improved pain tolerance for OIH and FM was statistically significant (p < 0.0001 and p = 0.003, respectively) and had a large effect size (r = 0.82 and r = 0.63, respectively). Discussion: Results suggest that patients on chronic opioid therapy should have pain tolerance measured by CPT with detoxification and LDN provided to correct opioid induced hyperalgesia if found. FM may also be treated with LDN. The main limitation of the findings was lack of a randomized control group treated with placebo.
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Affiliation(s)
- Daniel Jackson
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Sunita Singh
- College of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Yanli Zhang-James
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Stephen Faraone
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Brian Johnson
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, United States
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Årnes AP, Nielsen CS, Stubhaug A, Fjeld MK, Hopstock LA, Horsch A, Johansen A, Morseth B, Wilsgaard T, Steingrímsdóttir ÓA. Physical activity and cold pain tolerance in the general population. Eur J Pain 2020; 25:637-650. [PMID: 33165994 DOI: 10.1002/ejp.1699] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The relationship between habitual physical activity (PA) and experimental pain tolerance has been investigated in small samples of young, healthy and/or single-sex volunteers. We used a large, population-based sample to assess this relationship in men and women with and without chronic pain. METHODS We used data from the sixth and seventh Tromsø Study surveys (2007-2008; 2015-2016), with assessed pain tolerance of participants with the cold pressor test (CPT: dominant hand in circulating cold water at 3°C, maximum test time 106 s), and self-reported total amount of habitual PA in leisure time (n = 19,087), exercise frequency (n = 19,388), exercise intensity (n = 18,393) and exercise duration (n = 18,343). A sub-sample had PA measured by accelerometers (n = 4,922). We used Cox regression to compare CPT tolerance times between self-reported PA levels. For accelerometer-measured PA, we estimated hazard ratios for average daily activity counts, and for average daily minutes of moderate-to-vigorous PA done in bouts lasting 10 min or more. Models were tested for PA-sex, and PA-chronic pain and PA-moderate-to-severe chronic pain interactions. RESULTS Leisure-time PA, exercise intensity and exercise duration were positively associated with CPT tolerance (p < .001; p = .011; p < .001). More PA was associated with higher CPT tolerance. At high levels of leisure-time PA and exercise intensity, men had a significantly higher CPT tolerance than women. Accelerometer-measured PA was not associated with CPT tolerance. CONCLUSIONS This study is one of the first to show that higher self-reported habitual PA was connected to higher experimental pain tolerance in a population-based sample, especially for men. This was not found for accelerometer-measured PA. SIGNIFICANCE This study finds that higher level of self-reported leisure-time physical activity is associated with increased cold pressor pain tolerance in a large population-based sample. Though present in both sexes, the association is strongest among men. Despite the robust dose-response relationship between pain tolerance and self-reported activity level, no such relationship was found for accelerometer-measured activity, reflecting a possible discrepancy in the aspect of physical activity measured. Though the study design does not permit causal conclusions, the findings suggest that increasing physical activity may increase pain tolerance in the general population.
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Affiliation(s)
- Anders P Årnes
- Department of Pain, Department of Community Medicine, University Hospital of North Norway, Tromsø, Norway.,Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Christopher S Nielsen
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Audun Stubhaug
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mats K Fjeld
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Laila A Hopstock
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Alexander Horsch
- Department of Computer Science, UiT The Arctic University of Norway, Tromsø, Norway
| | - Aslak Johansen
- Department of Pain, Department of Community Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Bente Morseth
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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25
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Weber A, Busbridge S, Governo R. Evaluation of the Efficacy of Musical Vibroacupuncture in Pain Relief: A Randomized Controlled Pilot Study. Neuromodulation 2020; 24:1475-1482. [PMID: 33029913 DOI: 10.1111/ner.13281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/05/2020] [Accepted: 08/24/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To investigate if skin vibration employing consonant frequencies emitted by skin transducers attached to a combination of acupuncture points and according to musical harmony (musical chord) produces more significant pain relief compared to just a single frequency. MATERIALS AND METHODS Skin vibrostimulation produced by five electromagnet transducers was applied at five acupoints traditionally used to pain relief and anxiety in 13 pain-free healthy volunteers using the cold pressor test (CPT). The study consisted of three randomized sessions conducted on alternate days, with participants receiving either simultaneous frequencies of 32, 48, and 64 Hz that equate those used in a musical chord, hereby defined as musical vibroacupuncture (MVA), a single frequency of 32 Hz, set as vibroacupuncture (VA) and sham procedure (SP). CPT scores for pain thresholds and pain tolerance were assessed using repeated-measures ANOVAs. Pain intensity was evaluated using a numerical rating scale (NRS), while sensory and affective aspects of pain were rated using the short-form McGill Pain Questionnaire (SF-MPQ) and State-Trait Anxiety Inventory (STAI) Y-Form. RESULTS Pain thresholds did not vary significantly between trials. Pain tolerance scores were markedly higher in MVA compared to baseline (p = 0.0043) or SP (p = 0.006) but not for VA. Pain intensity for MVA also differed significantly from the baseline (p = 0.007) or SP (p = 0.027), but not for VA. No significant differences were found in SF-MPQ and STAI questionnaires. CONCLUSIONS These results suggest that MVA effectively increased pain tolerance and reduced pain intensity when compared with all groups, although not significant to the VA group.
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Affiliation(s)
- Augusto Weber
- School of Computing, Engineering and Mathematics, University of Brighton, Brighton, East Sussex, UK
| | - Simon Busbridge
- School of Computing, Engineering and Mathematics, University of Brighton, Brighton, East Sussex, UK
| | - Ricardo Governo
- Brighton and Sussex Medical School (BSMS), University of Sussex, Brighton, East Sussex, UK
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26
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Ren Q, Lu X, Zhao Q, Zhang H, Hu L. Can self-pain sensitivity quantify empathy for others' pain? Psychophysiology 2020; 57:e13637. [PMID: 32686117 DOI: 10.1111/psyp.13637] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 04/08/2020] [Accepted: 06/09/2020] [Indexed: 12/21/2022]
Abstract
Empathy is essential for the survival of social species. In many studies, especially those with animal models, empathy for pain was evaluated by the modulation of pain sensitivity. However, the relationship between pain sensitivity and empathy for pain is not well established. Here, by performing two experiments, we aimed to investigate their relationship at both behavioral and electrophysiological levels. In Experiment 1, we characterized individual pain sensitivity using pain threshold and tolerance in a cold pressor test, self-report empathy using Interpersonal Reactivity Index, and pain-related psychological factors, including pain-related anxiety, depression, pain catastrophizing, and pain-related fear, using well-validated questionnaires. We observed that pain sensitivity was positively correlated with emotional empathy, and their relationship was mediated by pain-related anxiety, pain catastrophizing, and pain-related fear. In Experiment 2, we quantified empathy for pain using pain intensity and unpleasantness as well as event-related potentials (ERPs) in an empathy for pain task. Positive correlations were observed between pain sensitivity and psychophysiological empathic responses (i.e., the P3 component and the late positive potential in ERPs), and their relationship was mediated by pain-related fear. These results suggested that being influenced by some pain-related psychological factors, individuals with higher pain sensitivity tended to have stronger empathy for pain, manifested as stronger emotional reactions to others' pain. Our results indicated that the conventional strategy of using pain sensitivity to quantify empathy should be treated with caution, as their relationship could be disturbed by experimental manipulations or pathological modulations that could influence individual emotional states or cognitive processes.
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Affiliation(s)
- Qiaoyue Ren
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xuejing Lu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Qing Zhao
- Department of Pain Management, The State Key Clinical Specialty in Pain Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huijuan Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Hu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.,Department of Pain Management, The State Key Clinical Specialty in Pain Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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27
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Furman AJ, Prokhorenko M, Keaser ML, Zhang J, Chen S, Mazaheri A, Seminowicz DA. Sensorimotor Peak Alpha Frequency Is a Reliable Biomarker of Prolonged Pain Sensitivity. Cereb Cortex 2020; 30:6069-6082. [PMID: 32591813 DOI: 10.1093/cercor/bhaa124] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/29/2020] [Accepted: 04/21/2020] [Indexed: 01/28/2023] Open
Abstract
Previous research has observed that the speed of alpha band oscillations (8-12 Hz range) recorded during resting electroencephalography is slowed in chronic pain patients. While this slowing may reflect pathological changes that occur during the chronification of pain, an alternative explanation is that healthy individuals with slower alpha oscillations are more sensitive to prolonged pain, and by extension, more susceptible to developing chronic pain. To test this hypothesis, we examined the relationship between the pain-free, resting alpha oscillation speed of healthy individuals and their sensitivity to two models of prolonged pain, Phasic Heat Pain and Capsaicin Heat Pain, at two visits separated by 8 weeks on average (n = 61 Visit 1, n = 46 Visit 2). We observed that the speed of an individual's pain-free alpha oscillations was negatively correlated with sensitivity to both models and that this relationship was reliable across short (minutes) and long (weeks) timescales. Furthermore, the speed of pain-free alpha oscillations can successfully identify the most pain sensitive individuals, which we validated on data from a separate, independent study. These results suggest that alpha oscillation speed is a reliable biomarker of prolonged pain sensitivity with potential for prospectively identifying pain sensitivity in the clinic.
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Affiliation(s)
- Andrew J Furman
- Program in Neuroscience, University of Maryland School of Medicine, Baltimore, MD 21201, USA.,Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, USA.,Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD 21201, USA
| | - Mariya Prokhorenko
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| | - Michael L Keaser
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, USA.,Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD 21201, USA
| | - Jing Zhang
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| | - Shuo Chen
- Department of Epidemiology and Public Health, University of Maryland Baltimore, Baltimore, MD 21201, USA
| | - Ali Mazaheri
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK.,Centre for Human Brain Health, University of Birmingham, Birmingham, B15 2TT, UK
| | - David A Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, USA.,Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD 21201, USA
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Ackerman JM, Goesling J, Krishna A. Pain scales as placebos: Can pain scales change reported pain across measurements? JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2020. [DOI: 10.1016/j.jesp.2020.103961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Støve MP, Hirata RP, Palsson TS. Muscle stretching - the potential role of endogenous pain inhibitory modulation on stretch tolerance. Scand J Pain 2020; 19:415-422. [PMID: 30699073 DOI: 10.1515/sjpain-2018-0334] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 12/18/2018] [Indexed: 11/15/2022]
Abstract
Background and aims The effect of stretching on joint range of motion is well documented and is primarily related to changes in the tolerance to stretch, but the mechanisms underlying this change are still largely unknown. The aim of this study was to investigate the influence of a remote, painful stimulus on stretch tolerance. Methods Thirty-four healthy male subjects were recruited and randomly assigned to an experimental pain group (n=17) or a control group (n=17). Passive knee extension range of motion, the activity of hamstring muscles and passive resistive torque were measured with subjects in a seated position. Three consecutive measures were performed with a 5-min interval between. A static stretch protocol was utilized in both groups to examine the effect of stretching and differences in stretch tolerance between groups. Following this, the pain-group performed a cold pressor test which is known to engage the endogenous pain inhibitory system after which measurements were repeated. Results A significant increase in knee extension range of motion was found in the pain group compared with controls (ANCOVA: p<0.05). No difference was found in muscle activity or passive resistive torque between groups (ANCOVA p>0.091). Conclusions Passive knee extension range of motion following stretching increased when following a distant, painful stimulus, potentially engaging the endogenous pain inhibitory systems. Current findings indicate a link between increased tolerance to stretch and endogenous pain inhibition. Implications The current findings may have implications for clinical practice as they indicate that a distant painful stimulus can influence range of motion in healthy individuals. This implies that the modulation of pain has significance for the efficacy of stretching which is important knowledge when prescribing stretching as part of rehabilitation.
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Affiliation(s)
- Morten Pallisgaard Støve
- Department of Physiotherapy, University College of Northern Denmark (UCN), Selma Lagerløfs Vej 2, 9220 Aalborg East, Denmark, Phone: 004522980862
| | - Rogerio Pessoto Hirata
- SMI® , Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg East, Denmark
| | - Thorvaldur Skuli Palsson
- SMI® , Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg East, Denmark
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Perspective-taking influences attentional deployment towards facial expressions of pain: an eye-tracking study. Pain 2020; 161:1286-1296. [PMID: 32040077 DOI: 10.1097/j.pain.0000000000001827] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Empathetic perspective-taking (PT) may be critical in modulating attention and associated responses to another's pain. However, the differential effects of imagining oneself to be in the pain sufferer's situation ("Self-perspective") or imagining the negative impacts on the pain sufferer's experience ("Other-perspective") on attention have not been studied. The effects of observer PT (Self vs Other) and level of facial pain expressiveness (FPE) upon attention to another person's pain was investigated. Fifty-two adults were assigned to 1 of 3 PT conditions; they were instructed to view pairs of pain expressions and neutral faces and either (1) consider their own feelings (Self-perspective), (2) consider the feelings of the person in the picture (Other-perspective), or (3) received no further instructions (Control). Eye movements provided indices of early (probability and duration of first fixation) and later (total gaze duration) attentional deployment. Pain faces were more likely to be fixated upon first. A significant first fixation duration bias towards pain was observed, which increased with increasing levels of FPE, and was higher in the Self-PT than the Control condition. The proportion of total gaze duration on pain faces was higher in both experimental conditions than the Control condition. This effect was moderated by FPE in the Self-PT condition; there was a significant increase from low to high FPE. When observers attend to another's facial display of pain, top-down influences (such as PT) and bottom-up influences (such as sufferer's FPE) interact to control deployment and maintenance of attention.
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Analgesic Effects of Hydromorphone versus Buprenorphine in Buprenorphine-maintained Individuals. Anesthesiology 2019; 130:131-141. [PMID: 30418214 DOI: 10.1097/aln.0000000000002492] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Managing acute pain in buprenorphine-maintained individuals in emergency or perioperative settings is a significant challenge. This study compared analgesic and abuse liability effects of adjunct hydromorphone and buprenorphine using quantitative sensory testing, a model of acute clinical pain, in persons maintained on 12 to 16 mg sublingual buprenorphine/naloxone. METHODS Participants (N = 13) were enrolled in a randomized within-subject, double-blind, placebo-controlled three-session experiment. Each session used a cumulative dosing design with four IV injections (4, 4, 8, and 16 mg of hydromorphone or 4, 4, 8, and 16 mg of buprenorphine); quantitative sensory testing and abuse liability assessments were measured at baseline and after each injection. The primary analgesia outcome was change from baseline cold pressor testing; secondary outcomes included thermal and pressure pain testing, as well as subjective drug effects and adverse events. RESULTS A significant two-way interaction between study drug condition and dose was exhibited in cold pressor threshold (F10,110 = 2.14, P = 0.027) and tolerance (F10,110 = 2.69, P = 0.006). Compared to after placebo, participants displayed increased cold pressor threshold from baseline after cumulative doses of 32 mg of IV hydromorphone (means ± SD) (10 ± 14 s, P = 0.035) and 32 mg of buprenorphine (3 ± 5 s, P = 0.0.39) and in cold pressor tolerance after cumulative doses of 16 mg (18 ± 24 s, P = 0.018) and 32 mg (48 ± 73 s, P = 0.041) IV hydromorphone; cold pressor tolerance scores were not significant for 16 mg (1 ± 15 s, P = 0.619) or 32 mg (7 ± 16 s, P = 0.066) buprenorphine. Hydromorphone and buprenorphine compared with placebo showed greater ratings on subjective measures of high, any drug effects, good effects, and drug liking. Adverse events were more frequent during the hydromorphone compared with buprenorphine and placebo conditions for nausea, pruritus, sedation, and vomiting. CONCLUSIONS In this acute clinical pain model, high doses of IV hydromorphone (16 to 32 mg) were most effective in achieving analgesia but also displayed higher abuse liability and more frequent adverse events. Cold pressor testing was the most consistent measure of opioid-related analgesia.
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32
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Velkoff EA, Smith AR. Examining Patterns of Change in the Acquired Capability for Suicide Among Eating Disorder Patients. Suicide Life Threat Behav 2019; 49:1032-1043. [PMID: 30125387 DOI: 10.1111/sltb.12505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 05/23/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Several models of suicidal behavior posit that, to transition from suicidal ideation to attempting suicide, individuals must have an acquired capability for suicide (ACS), comprised of fearlessness about death (FAD) and pain tolerance. ACS is hypothesized to increase monotonically through exposure to painful and provocative experiences. However, recent research suggests that ACS can decrease, bringing into question the hypothesis of monotonic increase. This study examined the nature of change in ACS over time within a sample of patients with eating disorder (ED). We predicted that there would be two classes of change in ACS: one high and increasing and one moderate and stable. METHOD One hundred female patients with ED reported on ACS at admission and weekly during treatment. RESULTS Growth mixture modeling to test models of FAD and pain tolerance identified that, for both factors, a one-class intercept-only model was the best-fitting model, suggesting that patients entered treatment with midlevel ACS and experienced no significant linear change over the course of treatment. CONCLUSIONS Acquired capability for suicide demonstrated stability in this study; results highlight the need for additional research examining ACS across different timescales and in varied populations.
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Tu Y, Zhang B, Cao J, Wilson G, Zhang Z, Kong J. Identifying inter-individual differences in pain threshold using brain connectome: a test-retest reproducible study. Neuroimage 2019; 202:116049. [PMID: 31349067 DOI: 10.1016/j.neuroimage.2019.116049] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 05/23/2019] [Accepted: 07/22/2019] [Indexed: 02/07/2023] Open
Abstract
Individuals are unique in terms of brain and behavior. Some are very sensitive to pain, while others have a high tolerance. However, how inter-individual intrinsic differences in the brain are related to pain is unknown. Here, we performed longitudinal test-retest analyses to investigate pain threshold variability among individuals using a resting-state fMRI brain connectome. Twenty-four healthy subjects who received four MRI sessions separated by at least 7 days were included in the data analysis. Subjects' pain thresholds were measured using two modalities of experimental pain (heat and pressure) on two different locations (heat pain: leg and arm; pressure pain: leg and thumbnail). Behavioral results showed strong inter-individual variability and strong within-individual stability in pain threshold. Resting state fMRI data analyses showed that functional connectivity profiles can accurately identify subjects across four sessions, indicating that an individual's connectivity profile may be intrinsic and unique. By using multivariate pattern analyses, we found that connectivity profiles could be used to predict an individual's pain threshold at both within-session and between-session levels, with the most predictive contribution from medial-frontal and frontal-parietal networks. These results demonstrate the potential of using a resting-state fMRI brain connectome to build a 'neural trait' for characterizing an individual's pain-related behavior, and such a 'neural trait' may eventually be used to personalize clinical assessments.
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Affiliation(s)
- Yiheng Tu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Binlong Zhang
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Jin Cao
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Georgia Wilson
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Zhiguo Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
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What makes surgical nerve injury painful? A 4-year to 9-year follow-up of patients with intercostobrachial nerve resection in women treated for breast cancer. Pain 2019; 160:246-256. [PMID: 30234699 PMCID: PMC6319585 DOI: 10.1097/j.pain.0000000000001398] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nerve injury during breast cancer surgery can cause neuropathic pain (NP). It is not known why some, but not all, patients develop chronic postsurgical neuropathic pain (CPSNP) after the same nerve injury. In this study, we examined 251 breast cancer survivors with surgeon-verified intercostobrachial nerve resection to identify factors that associate with CPSNP. The patients were recruited from a previous study of 1000 women treated for breast cancer in 2006 to 2010. This enabled us to analyze preoperative factors that associate with future CPSNP. The patients were re-examined in 2014 to 2016 to diagnose CPSNP using the revised NP diagnostic criteria. Preoperative assessments were pain in the area to be operated on, any chronic pain condition, depressive symptoms, anxiety, sleep, and experimental cold pain sensitivity using the cold pressor test (CPT). Follow-up assessments were CPT, psychological factors, sleep, any chronic pain, and basic laboratory tests. One hundred thirty-seven (55%) patients with intercostobrachial nerve resection fulfilled CPSNP diagnostic criteria after 4 to 9 years. Of them, 30 patients (22%) had moderate to severe pain in self-reports and 86 (63%) presented moderate to severe evoked pain at examination. Preoperative pain in the surgical area, other chronic pains, and breast-conserving surgery were associated with future CPSNP. Other chronic pains, increased psychological burden, and insomnia, both before surgery and at the follow-up, were associated with CPSNP. Preoperative CPT did not associate with future CPSNP. Patients with established CPSNP showed increased pain sensitivity in CPT and higher levels of inflammatory markers, suggesting that central sensitization and inflammation may associate with the maintenance of CPSNP.
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Pouwels S, Van Genderen ME, Kreeftenberg HG, Ribeiro R, Parmar C, Topal B, Celik A, Ugale S. Utility of the cold pressor test to predict future cardiovascular events. Expert Rev Cardiovasc Ther 2019; 17:305-318. [PMID: 30916592 DOI: 10.1080/14779072.2019.1598262] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The cold pressor test (CPT) is a common and extensively validated test, which induces systemic stress involving immersion of an individual's hand in ice water (normally temperature between 0 and 5 degrees Celsius) for a period of time. CPT has been used in various fields, like examining effects of stress on memory, decision-making, pain and cardiovascular health. Areas covered: In terms of cardiovascular health, current research is mainly interested in predicting the occurrence of cardiovascular (CV) events. The objective of this review is to give an overview of the history and methodology of the CPT, and clinical utility in possibly predicting CV events in CAD and other atherosclerotic diseases. Secondly, we will discuss possible future applications of the CPT in clinical care. Expert opinion: An important issue to address is the fact that the physiology of the CPT is not fully understood at this moment. As pointed out multiple mechanisms might be responsible for contributing to either coronary vasodilatation or coronary vasoconstriction. Regarding the physiological mechanism of the CPT and its effect on the measurements of the carotid artery reactivity even less is known.
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Affiliation(s)
- Sjaak Pouwels
- a Department of Surgery , Franciscus Gasthuis & Vlietland , Rotterdam/Schiedam , The Netherlands
| | - Michel E Van Genderen
- b Department of Internal Medicine , Franciscus Gasthuis & Vlietland , Rotterdam/Schiedam , The Netherlands
| | - Herman G Kreeftenberg
- c Department of Internal Medicine , Catharina Hospital , Eindhoven , The Netherlands.,d Department of Intensive Care Medicine , Catharina Hospital , Eindhoven , The Netherlands
| | - Rui Ribeiro
- e Metabolic Patient Multidisciplinary Centre , Clínica de Santo António , Lisbon , Portugal
| | - Chetan Parmar
- f Department of Surgery , Whittington Hospital , London , UK
| | - Besir Topal
- g Department of Cardiothoracic Surgery , OLVG , Amsterdam , The Netherlands
| | - Alper Celik
- h Department of metabolic surgery , Metabolic Surgery Clinic , Istanbul , Turkey
| | - Surendra Ugale
- i Department of Surgery , Virinchi Hospitals , Hyderbad , India
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36
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Sleep extension reduces pain sensitivity. Sleep Med 2019; 54:172-176. [DOI: 10.1016/j.sleep.2018.10.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 02/04/2023]
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Tracy LM, Jarczok MN, Ellis RJ, Bach C, Hillecke TK, Thayer JF, Koenig J. Heart Rate Variability and Sensitivity to Experimentally Induced Pain: A Replication. Pain Pract 2017; 18:687-689. [DOI: 10.1111/papr.12652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Lincoln M. Tracy
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences; Monash University; Melbourne Victoria Australia
- Pain Management & Research Centre; Caulfield Hospital; Caulfield Victoria Australia
| | - Marc N. Jarczok
- Clinic for Psychosomatic Medicine and Psychotherapy; University Hospital Ulm; Ulm
- Institute of Medical Psychology; Center for Psychosocial Medicine; Heidelberg University; Heidelberg Germany
| | - Robert J. Ellis
- School of Computing; National University of Singapore; Singapore Singapore
| | - Claudia Bach
- Department of General Psychiatry; University of Heidelberg; Heidelberg Germany
| | - Thomas K. Hillecke
- School of Therapeutic Sciences; SRH University of Applied Sciences; Heidelberg Germany
| | - Julian F. Thayer
- Department of Psychology; The Ohio State University; Columbus Ohio U.S.A
| | - Julian Koenig
- Department of Psychology; The Ohio State University; Columbus Ohio U.S.A
- Section for Translation Psychobiology in Child and Adolescent Psychiatry; Department of Child and Adolescent Psychiatry; Centre for Psychosocial Medicine; University of Heidelberg; Heidelberg Germany
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A pain in the bud? Implications of cross-modal sensitivity for pain experience. Atten Percept Psychophys 2017; 78:2348-2356. [PMID: 27743264 DOI: 10.3758/s13414-016-1217-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is growing evidence that enhanced sensitivity to painful clinical procedures and chronic pain are related to greater sensitivity to other sensory inputs, such as bitter taste. We examined cross-modal sensitivities in two studies. Study 1 assessed associations between bitter taste sensitivity, pain tolerance, and fear of pain in 48 healthy young adults. Participants were classified as non-tasters, tasters and super-tasters using a bitter taste test (6-n-propythiouracil; PROP). The latter group had significantly higher fear of pain (Fear of Pain Questionnaire) than tasters (p=.036, effect size r = .48). There was only a trend for an association between bitter taste intensity ratings and intensity of pain at the point of pain tolerance in a cold pressor test (p=.04). In Study 2, 40 healthy young adults completed the Adolescent/Adult Sensory Profile before rating intensity and unpleasantness of innocuous (33 °C), moderate (41 °C), and high intensity (44 °C) thermal pain stimulations. The sensory-sensitivity subscale was positively correlated with both intensity and unpleasantness ratings. Canonical correlation showed that only sensitivity to audition and touch (not taste/smell) were associated with intensity of moderate and high (not innocuous) thermal stimuli. Together these findings suggest that there are cross-modal associations predominantly between sensitivity to exteroceptive inputs (i.e., taste, touch, sound) and the affective dimensions of pain, including noxious heat and intolerable cold pain, in healthy adults. These cross-modal sensitivities may arise due to greater psychological aversion to salient sensations, or from shared neural circuitry for processing disparate sensory modalities.
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Belkin M, Reinheimer HS, Levy J, Johnson B. Ameliorative response to detoxification, psychotherapy, and medical management in patients maintained on opioids for pain. Am J Addict 2017; 26:738-743. [DOI: 10.1111/ajad.12605] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 06/25/2017] [Accepted: 07/23/2017] [Indexed: 12/14/2022] Open
Affiliation(s)
- Molly Belkin
- Department of Psychiatry, Hofstra Northwell School of Medicine; The Zucker Hillside Hospital; 75-59 263rd Street, PGY-1 Psychiatry Resident Glen Oaks New York 11004
| | | | - Jordan Levy
- Department of Psychiatry; SUNY Upstate Medical University; 750 East Adams Street Syracuse New York 13210
| | - Brian Johnson
- Department of Psychiatry; SUNY Upstate Medical University; 750 East Adams Street Syracuse New York 13210
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Lara-Cinisomo S, Grewen KM, Girdler SS, Wood J, Meltzer-Brody S. Perinatal Depression, Adverse Life Events, and Hypothalamic-Adrenal-Pituitary Axis Response to Cold Pressor Stress in Latinas: An Exploratory Study. Womens Health Issues 2017; 27:673-682. [PMID: 28780256 DOI: 10.1016/j.whi.2017.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/26/2017] [Accepted: 06/29/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Latinas are disproportionately affected by perinatal depression (PND) as well as by adverse life events (ALEs), an independent predictor of PND. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been seen both in women with PND and with a history of ALEs in non-Latinas. Although some evidence suggests that HPA axis dysregulation may mediate the link between ALEs and PND, this hypothesis has received little attention and there are no studies that have examined these pathways in Latinas. The primary aim of the present study was to explore, in a Latina sample, associations between ALEs, PND, and HPA axis stress reactivity to a physical stressor, the cold pressor test (CPT). The secondary aim was to explore whether HPA axis reactivity and PND were associated with pain sensitivity to the CPT. METHODS Thirty-four Latinas were enrolled in their third trimester of pregnancy and interviewed at 4 and 8 weeks postpartum. Depression status was determined using the Edinburgh Postnatal Depression Scale (≥10). At 8 weeks postpartum, 27 women underwent laboratory-induced pain testing using the CPT. Plasma adrenocorticotropic hormone and cortisol were sampled before and after the CPT to generate a stress reactivity score (post-pre). Pain sensitivity and ALEs were also assessed. RESULTS At enrollment, 26% of women were depressed, and 18% were depressed at 8 weeks postpartum. Fifty-two percent reported at least one childhood ALE. There was a significant and positive association between any childhood ALE and prenatal depression scores (p = .025). Infant-related ALEs were significantly associated with greater adrenocorticotropic hormone reactivity to the CPT (p = .030). Women with a history of any childhood ALE exhibited a blunted cortisol response to the CPT (p = .045). Women with a history of PND at 4 weeks had greater adrenocorticotropic hormone stress reactivity to the CPT (p = .027). No effects of PND were seen for pain sensitivity measures in response to the CPT, although there was a positive and significant correlation between pain tolerance and cortisol response to the CPT in the whole sample. CONCLUSIONS Given the associations between ALEs and PND and their individual effect on HPA axis stress reactivity, future studies on PND should include a larger sample of Latinas to test the mediating effects of HPA axis reactivity on associations between ALEs and PND.
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Affiliation(s)
- Sandraluz Lara-Cinisomo
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois; Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Karen M Grewen
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Susan S Girdler
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jayme Wood
- Bioarchaeology and Forensic Anthropology, University College London, London, UK
| | - Samantha Meltzer-Brody
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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41
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Quan X, Fong DYT, Leung AYM, Liao Q, Ruscheweyh R, Chau PH. Validation of the Mandarin Chinese Version of the Pain Sensitivity Questionnaire. Pain Pract 2017; 18:180-193. [PMID: 28422444 DOI: 10.1111/papr.12587] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/12/2017] [Accepted: 03/09/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM The Pain Sensitivity Questionnaire (PSQ), a self-reported scale, has been used to assess the pain sensitivity level in a Caucasian population. However, a validated Mandarin Chinese version of the PSQ is not available. This study was aimed to translate the PSQ into Mandarin Chinese (PSQ-C) and validate it to measure pain sensitivity among Chinese people. METHODS The English version of the PSQ has been translated into Mandarin Chinese (PSQ-C), according to the standard steps of cross-cultural adaptation of self-reported scales. Three of the 17 items were revised owing to cultural adaptation. The final version was validated on a population of 182 Chinese people in Changsha City, China, during October to December 2015. The participants underwent electrical experimental pain testing. The psychometric properties of the PSQ-C and its subscales were examined. RESULTS The Cronbach's alpha coefficients for the PSQ-C-total, PSQ-C-moderate, and PSQ-C-minor were 0.90, 0.86, and 0.81, respectively. Acceptable test-retest reliability, content validity, and construct validity were demonstrated. Concurrent validity was shown via significant positive correlations between PSQ-C scores and perceived pain intensity at pain threshold and during pain stimulation with a fixed intensity. Convergent validity was shown via significant positive correlations between Pain Catastrophizing Scale scores and PSQ-C scores. Known group validity was demonstrated via higher PSQ-C-total and PSQ-C-moderate scores among those with high neuroticism scores. These results indicate that the PSQ-C has reasonably good psychometric properties, similar to the original English and German versions. CONCLUSION The PSQ-C is a reliable and useful tool to assess pain sensitivity levels in a Chinese population.
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Affiliation(s)
- Xiaoli Quan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.,The First People's Hospital of Huaihua and University of South China, Huaihua City, China
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Qin Liao
- The Third Xiangya Hospital of Central South University, Changsha, China
| | - Ruth Ruscheweyh
- Department of Neurology, University of Munich, Munich, Germany
| | - Pui Hing Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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Koenig J, Rinnewitz L, Warth M, Hillecke TK, Brunner R, Resch F, Kaess M. Psychobiological response to pain in female adolescents with nonsuicidal self-injury. J Psychiatry Neurosci 2017; 42:189-199. [PMID: 28234208 PMCID: PMC5403664 DOI: 10.1503/jpn.160074] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is associated with reduced pain sensitivity and alterations in top-down processing of nociceptive information. The experience of acute pain is characterized by reactivity of the autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis, which to our knowledge has not been systematically investigated in the context of NSSI. METHODS Adolescents fulfilling DSM-5 diagnostic criteria for NSSI and matched healthy controls received cold pain stimulation. We obtained self-reports on psychological distress and measured blood pressure, heart rate variability (HRV) and saliva cortisol. Regression analyses were used to investigate group differences on observed difference scores, adjusting for confounding variables. RESULTS We included 30 adolescents engaging in NSSI and 30 controls in our study. Adolescents in the NSSI group showed a greater pain threshold. Groups significantly differed in their psychological response to pain. In patients with NSSI, mood and body awareness increased after painful stimulation; in controls it decreased. Tension increased in controls only. The HPA axis response to painful stimulation was increased in the NSSI compared with the control group. Analysis of ultra-short-term recordings of HRV revealed significant group differences during the anticipation of pain and recovery. LIMITATIONS Future studies should incorporate multiple measures of saliva cortisol and replicate the present findings in a naturalistic setting. CONCLUSION Compared with controls, individuals engaging in NSSI show psychological benefits in response to pain. Biological findings highlight decreased physiologic arousal before and prolonged arousal (ANS and HPA axis response) after painful stimulation in adolescents engaging in NSSI. Greater pain-inflicted autonomic arousal and cortisol secretion may counteract dissociative states, reduce negative affect and increase body awareness in adolescents engaging in NSSI, lending support for a neurobiological pathomechanism underlying the intraindividual and antisuicide functions of NSSI.
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Affiliation(s)
| | | | | | | | | | | | - Michael Kaess
- Correspondence to: M. Kaess, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Blumenstraße 8, 69115 Heidelberg, Germany;
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43
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Corley AM, Cano A, Goubert L, Vlaeyen JW, Wurm LH. Global and Situational Relationship Satisfaction Moderate the Effect of Threat on Pain in Couples. PAIN MEDICINE 2016; 17:1664-75. [DOI: 10.1093/pm/pnw022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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44
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Johnson MI, Gohil M. An investigation into enlarging and reducing the size of mirror reflections of the hand on experimentally-induced cold-pressor pain in healthy human participants. Scand J Pain 2016; 10:19-25. [PMID: 28361766 DOI: 10.1016/j.sjpain.2015.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/03/2015] [Accepted: 07/05/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Mirror visual feedback may be a useful clinical tool for reducing pain. Research suggests that reducing the size of a non-painful reflected hand can alleviate complex regional pain syndrome in the affected hand that is out of view. In contrast, research on healthy humans exposed to experimentally induced pain suggests that reducing the appearance of the size of a reflected body part can increase pain. The aim of this study was to investigate the effect of enlarging and reducing the visual appearance of the size of a hand using mirror visual feedback on pain threshold, intensity and tolerance in healthy human participants exposed to cold-pressor pain. METHODS Participants were a convenience sample of 20 unpaid, healthy pain free volunteers aged 18 years or above. Each participant took part in one experiment where they completed cold-pressor pain tests whilst observing normal, enlarged and reduced size reflections of a hand congruent to a hand immersed in the ice cold water. A 4×2 factorial repeated measures analysis of variance (ANOVA) was performed on time to pain threshold and pain tolerance, and pain intensity with Condition (four levels: no reflection, reduced reflection, normal reflection, enlarged reflection) being the within-subject factors and Sex (two levels: female, male) between-subject factors. RESULTS There were no significant effects for Condition, Sex, or Condition×Sex interaction for pain threshold, intensity or tolerance (p>0.05). There were no significant differences between the 3 mirror reflection conditions for agreement with the statements: "It felt like I was looking directly at my hand rather than at a mirror image"; "It felt like the hand I was looking at was my hand"; and "Did it seem like the hand you saw was a right hand or a left hand?". CONCLUSION Enlarging or reducing the size of a hand using mirror visual feedback did not alter pain perception in healthy human participants exposed to cold-pressor pain. The different sizes of hands generated by mirror visual feedback created an illusion of looking at their own hand but this was not as strong as looking directly at the hand. IMPLICATIONS In future, investigators and clinicians using mirror visual feedback may consider including an adaptive phase to ensure the reflection has been perceptually embodied. Reasons for the lack of effects are explored to inspire further research in the field.
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Affiliation(s)
- Mark I Johnson
- Faculty of Health and Social Sciences, Leeds Beckett University, BeckettUnited Kingdom
- Leeds Pallium Research Group, BeckettUnited Kingdom
| | - Manish Gohil
- Faculty of Health and Social Sciences, Leeds Beckett University, BeckettUnited Kingdom
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Koenig J, Rinnewitz L, Warth M, Kaess M. Autonomic nervous system and hypothalamic-pituitary-adrenal axis response to experimentally induced cold pain in adolescent non-suicidal self-injury--study protocol. BMC Psychiatry 2015; 15:150. [PMID: 26149450 PMCID: PMC4494168 DOI: 10.1186/s12888-015-0544-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 06/25/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Adolescent non-suicidal self-injury (NSSI) is associated with altered sensitivity to experimentally induced pain. Adolescents engaging in NSSI report greater pain threshold and pain tolerance, as well as lower pain intensity and pain unpleasantness compared to healthy controls. The experience of pain is associated with reactivity of both the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis. However, previous research has not yet systematically addressed differences in the physiological response to experimentally induced pain comparing adolescents with NSSI and age- and sex-matched healthy controls. METHODS/DESIGN Adolescents with NSSI and healthy controls undergo repeated painful stimulation with the cold pressor task. ANS activity is continuously recorded throughout the procedure to assess changes in heart rate and heart rate variability. Blood pressure is monitored and saliva is collected prior to and after nociceptive stimulation to assess levels of saliva cortisol. DISCUSSION The study will provide evidence whether lower pain sensitivity in adolescents with NSSI is associated with blunted physiological and endocrinological responses to experimentally induced pain compared to healthy controls. Extending on the existing evidence on altered pain sensitivity in NSSI, measured by self-reports and behavioural assessments, this is the first study to take a systematic approach in evaluating the physiological response to experimentally induced pain in adolescent NSSI. TRIAL REGISTRATION Deutsche Register Klinischer Studien, Study ID: DRKS00007807; Trial Registration Date: 13.02.2015.
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Affiliation(s)
- Julian Koenig
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany. .,Department of Psychology, The Ohio State University, Columbus, OH, USA.
| | - Lena Rinnewitz
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
| | - Marco Warth
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany.
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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Boerner KE, Noel M, Birnie KA, Caes L, Petter M, Chambers CT. Impact of Threat Level, Task Instruction, and Individual Characteristics on Cold Pressor Pain and Fear among Children and Their Parents. Pain Pract 2015; 16:657-68. [PMID: 26011606 DOI: 10.1111/papr.12306] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/10/2015] [Indexed: 11/27/2022]
Abstract
The cold pressor task (CPT) is increasingly used to induce experimental pain in children, but the specific methodology of the CPT is quite variable across pediatric studies. This study examined how subtle variations in CPT methodology (eg. provision of low- or high-threat information regarding the task; provision or omission of maximum immersion time) may influence children's and parents' perceptions of the pain experience. Forty-eight children (8 to 14 years) and their parents were randomly assigned to receive information about the CPT that varied on 2 dimensions, prior to completing the task: (i) threat level: high-threat (task described as very painful, high pain expressions depicted) or low-threat (standard CPT instructions provided, low pain expressions depicted); (ii) ceiling: informed (provided maximum immersion time) or uninformed (information about maximum immersion time omitted). Parents and children in the high-threat condition expected greater child pain, and these children reported higher perceived threat of pain and state pain catastrophizing. For children in the low-threat condition, an informed ceiling was associated with less state pain catastrophizing during the CPT. Pain intensity, tolerance, and fear during the CPT did not differ by experimental group, but were predicted by child characteristics. Findings suggest that provision of threatening information may impact anticipatory outcomes, but experienced pain was better explained by individual child variables.
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Affiliation(s)
- Katelynn E Boerner
- Departments of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Melanie Noel
- Center for Child Health, Behavior, & Development, Seattle Children's Research Institute, Seattle, Washington, U.S.A
| | - Kathryn A Birnie
- Departments of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Line Caes
- Department of Psychology and Centre for Pain Research, National University of Ireland, Galway, Ireland
| | - Mark Petter
- Victoria Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Christine T Chambers
- Departments of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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Treister R, Nielsen CS, Stubhaug A, Farrar JT, Pud D, Sawilowsky S, Oaklander AL. Experimental comparison of parametric versus nonparametric analyses of data from the cold pressor test. THE JOURNAL OF PAIN 2015; 16:537-48. [PMID: 25801300 DOI: 10.1016/j.jpain.2015.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 02/27/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Parametric statistical methods are common in human pain research. They require normally distributed data, but this assumption is rarely tested. The current study analyzes the appropriateness of parametric testing for outcomes from the cold pressor test (CPT), a common human experimental pain test. We systematically reviewed published CPT studies to quantify how often researchers test for normality and how often they use parametric versus nonparametric tests. We then measured the normality of CPT data from 7 independent small to medium cohorts and 1 study of >10,000 subjects. We then examined the ability of 2 common mathematical transformations to normalize our skewed data sets. Lastly, we performed Monte Carlo simulations on a representative data set to compare the statistical power of the parametric t-test versus the nonparametric Wilcoxon Mann-Whitney test. We found that only 39% of published CPT studies (47/122) mentioned checking data distribution, yet 72% (88/122) used parametric statistics. Furthermore, among our 8 data sets, CPT outcomes were virtually always nonnormally distributed, and mathematical transformations were largely ineffective in normalizing them. The simulations demonstrated that the nonparametric Wilcoxon Mann-Whitney test had greater statistical power than the parametric t-test for all scenarios tested: For small effect sizes, the Wilcoxon Mann-Whitney test had up to 300% more power. PERSPECTIVE These results demonstrate that parametric analyses of CPT data are routine but incorrect and that they likely increase the chances of failing to detect significant between-group differences. They suggest that nonparametric analyses become standard for CPT studies and that assumptions of normality be routinely tested for other types of pain outcomes as well.
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Affiliation(s)
- Roi Treister
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | | | - Audun Stubhaug
- Department of Pain Management and Research, Oslo University Hospital, Norway
| | - John T Farrar
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dorit Pud
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | | | - Anne Louise Oaklander
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Pathology (Neuropathology), Massachusetts General Hospital, Boston, Massachusetts
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48
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Birnie KA, Parker JA, Chambers CT. Relevance of Water Temperature, Apparatus, and Age to Children's Pain during the Cold Pressor Task. Pain Pract 2014; 16:46-56. [PMID: 25385307 DOI: 10.1111/papr.12257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/27/2014] [Accepted: 09/01/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Effective use of experimental pain in research depends on a thorough understanding of factors influencing their use. Although studies using the cold pressor task (CPT) have critically advanced our knowledge of pain mechanisms, assessment, and management in adults and children, the impact of identified methodological variability in its use is not known (ie, water temperature and apparatus); furthermore, whether methodological variations differentially impact children across development. METHODS Pain outcomes were examined in 113 healthy children from three age groups (8- to 9-, 10- to 11-, and 12- to 14-year-olds) who completed three CPTs at different water temperatures (5, 7, 10°C) in counterbalanced order. Children were randomly assigned to one of two apparatus (ice- vs. electric-cooled) for all CPTs. Children's hand was warmed to its baseline temperature between CPTs. RESULTS Colder water (2 to 3°C decreases) was associated with significantly higher pain intensity and unpleasantness, and lower pain tolerance and threshold. Older children (12 to 14 years) reported significantly worse pain intensity and unpleasantness as compared to 8- to 9-year-olds, likely due to longer pain tolerance. Pain outcomes in 10- to 11-year-olds fell between the other age groups, with significant differences for pain unpleasantness and pain tolerance (at 10°C). Higher pain-related fear and pain unpleasantness occurred with the electric-cooled apparatus. Girls had higher pain tolerance and threshold at all temperatures. CONCLUSIONS These results provide critically important information about water temperature, apparatus, and child age on CPT pain responding. It informs design of future CPT studies and directs consideration of methodological variability and child age when interpreting study findings.
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Affiliation(s)
- Kathryn A Birnie
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Jennifer A Parker
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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