Pain Appraisal Research Articles

A brief intervention utilising visual feedback reduces pain and enhances tactile acuity in CLBP patients

Chronic low back pain (CLBP) is a serious health problem in industrialised countries and the efficacy of current treatment options is unsatisfying. The present study examines the effects of a combined intervention that utilizes visual feedback, motion and sensory discrimination training in CLBP patients. Thirty patients of an outpatient orthopaedic rehabilitation unit were randomly assigned to either feedback or control group. In addition to standard treatment, patients of the feedback group received 6 feedback sessions where they watched the image of their back during a brief 2-point discrimination training and, after that, while they were tilting their pelvis up and down on the left and right side using their lumbar musculus multifidus solely. The control group received 6 sessions consisting of 2 units of physiotherapy, relaxation training and movement training (walking) each. A significant effect on self-reported pain and sensory discrimination threshold could be found for the feedback intervention, while, as expected, other pain related variables, like pain anxiety, pain vigilance, depression and cognitive appraisal of pain remained unchanged. These findings imply that very simple feedback interventions without major technical requirements could be a valuable supplement to standard treatment in CLBP.

Not an Aspirin: No Evidence for Acute Anti-Nociception to Laser-Evoked Pain After Motor Cortex rTMS in Healthy Humans

High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) has shown efficacy in relieving neuropathic pain. Whether its analgesic effect also applies to acute physiological nociception remains unclear due to previous contradictory findings. To provide an in-depth investigation of the effects of motor cortex HF-rTMS on acute laser-evoked pain and excitability of nociceptive networks in healthy subjects. Randomized, placebo-controlled, double-blind, cross-over study in 20 healthy participants. Laser heat stimuli at nociceptive threshold were delivered to the right hand, allowing assessment of: (a) subjective pain intensity and unpleasantness; (b) laser-evoked potentials (LEPs, 128 electrodes) and their source model; (c) sympathetic skin responses, and (d) spino-thalamic pathway excitability. Data were collected before and 20 minutes after a session of neuro-navigated 20 Hz rTMS to the contralateral motor cortex. Subjective pain reports to thermal laser pulses, amplitude of late cortical potentials and sympathetic skin responses were decreased after cortical stimulation, to a similar extent whether it was active or placebo. Early cortical potentials and nociceptive network excitability remained identical before and after rTMS, as did anatomical sources of LEPs. Our results do not provide evidence for a genuine anti-nociceptive effect of rTMS on acute physiological pain. We suggest that motor cortex rTMS may act upon high-order networks linked to the emotional and cognitive appraisal of chronic pain, and/or modulate pathologically sensitized networks, rather than change the physiological transmission within an intact nervous system. Such dichotomy is reminiscent of that observed with most drugs used for neuropathic pain.

The Role of Catastrophizing Beliefs in Effective Chronic Pain Treatment

Chronic pain is a serious and complex health issue. Patients dealing with chronic pain demonstrate multifarious behavioral and cognitive responses to their widely varying individual experiences. How can we, as health professionals, best serve these patients? In this paper, we discuss the place of pain within the historical conceptualization of health and normalcy, and the more current biopsychosocial model. We also review contemporary theories on how cognition plays a vital role in the psychological processing of stimuli, including pain. We focus on the significant interactions between catastrophizing appraisals of pain and the chronic pain experience, including increases in pain perception, pain sensitivity, depression and disability. In light of these significant interactions, we assert that catastrophizing must be specifically addressed in the treatment of chronic pain. We therefore explore the mechanisms through which catastrophizing comes to influence the pain experience, and its etiology. Then, with an understanding of cognitive processing of stimuli, along with the causes and consequences of catastrophizing, we suggest several targets of treatment for catastrophizing in chronic pain. We explore how the cognitive models meet or fail to meet those targets. We conclude with suggestions for further research on the topic of catastrophizing and chronic pain.

Reappraisal mitigates overestimation of remembered pain in anxious individuals

Anxiety sensitivity, a trait characterised by fear of anxiety-related body sensations, has been linked to heightened attention to pain, appraising body sensations as threatening, and remembering threat-related information. We assessed whether individuals with greater anxiety sensitivity overestimate in remembering pain. We also assessed whether emotion regulation strategies that direct attention away from pain (distraction), or alter appraisals of pain (reappraisal), alleviate memory bias. Participants (N = 137) were randomly assigned to one of two emotion regulation conditions or to a control condition before taking part in a cold pressor task. Greater anxiety sensitivity was associated with overestimation in remembering pain. Engaging in reappraisal mitigated this memory bias but engaging in distraction did not. This is the first study to examine the relations among anxiety sensitivity, emotion regulation and memory for pain. The findings suggest that health-care practitioners can encourage reappraisal to promote more positive memories of procedural pain, particularly in patients high in anxiety sensitivity.

Awareness of Cancer Pain Management among Nurses in an Albanian Oncologic Hospital

The doctor-patient percentage in Albania as said by World Health Organization (WHO). In 2013, this ratio was 1,2:1000 in contrast the average 1:600, although that of nurse-patient is enhanced, 1:40 compared to WHO standard of 1:6. Occurrence of cancer is universally increasing and the mainstream of the complex cases arise in the developing countries like Albania. Nurses engage in a significant position in efficient ache administration since they have further connection with patients in any healthcare location , appraise the pain and its collision on the patients and relatives, therefore commence acts to supervise the pain. This survey is intended at evaluating the phase of awareness of cancer pain administration between skilled nurses at Oncologic department of University Hospital Centre “Mother Theresa” in Albania. Materials and Methods: Qualified nurses who approved to participate in the survey were examined applying self-administered questionnaire. The surveys comprised 3 main parts that is (a) Demography, (b) Pain appraisal, (c) Cancer Ache administration. The degree of comprehension of cancer pain administration was subsequently evaluated from their reaction to the questionnaires. 63 nurses fulfilled the questionnaire. 54 (85.71%) were twofold trained. About 11 (17.4%) participants had supplementary official instruction in ache management. 50 (79.36) respondents provided right meaning of pain ;only 3 (3%) could confer a good explanation on the administration of cancer pain. 17 (26.9 %) of the participants could apply Visual Analogue Scale (VAS) for ache estimation. Merely 12 (19%) could affirm the application of opioids in cancer pain administration. This survey exposed insufficient comprehension in cancer ache management between the nurses. To attain holistic care for cancer individuals in all health care settings, further preparation in pain management is needed. DOI: 10.5901/jesr.2015.v5n2p35

Associations between Neuroticism and Depression in Relation to Catastrophizing and Pain-Related Anxiety in Chronic Pain Patients.

Several cognitive-affective constructs, including pain catastrophizing and pain-related anxiety, have been implicated in the onset and progression of chronic pain, and both constructs have been identified as key targets for multidisciplinary pain treatment. Both neuroticism and depression have been linked to these constructs (and to each other), but how each may contribute to the pain experience is unknown. This study tested associations between neuroticism, depression, and indices of catastrophizing and pain-related anxiety among persons seeking treatment for chronic non-malignant pain. We hypothesized, as a higher-order personality trait, neuroticism would remain uniquely associated with both pain catastrophizing and pain-related anxiety, even after accounting for current symptoms of depression. A retrospective study design assessed depression (as measured by the Centers for Epidemiologic Studies-Depression scale), neuroticism (measured with the Neuroticism-Extraversion-Openness Personality Inventory), the Pain Catastrophizing Scale, and the Pain Anxiety Symptom Score in a consecutive series of patients (n=595) admitted to a 3-week outpatient pain treatment program from March 2009 through January 2011. Hierarchical regression indicated that neuroticism was independently associated with greater pain catastrophizing and pain-related anxiety, above-and-beyond the contributions of sociodemographic characteristics, pain severity, and depression. A depression by neuroticism interaction was not observed, suggesting that associations between neuroticism and cognitive-affective pain constructs remained stable across varying levels of current depression. These findings represent an early but important step towards the clarification of complex associations between trait neuroticism, current depression, and tendencies toward catastrophic and anxiety-provoking appraisals of pain among persons seeking treatment for chronic pain.

The role of perceived injustice in the prediction of pain and function after total knee arthroplasty

Emerging evidence suggests that the appraisal of pain and disability in terms of justice-related themes contributes to adverse pain outcomes. To date, however, research on the relation between perceived injustice and pain outcomes has focused primarily on individuals with musculoskeletal injuries. The primary aim of this study was to investigate the role of perceived injustice in the prediction of pain and disability after total knee arthroplasty (TKA). The study sample consisted of 116 individuals (71 women, 45 men) with osteoarthritis of the knee scheduled for TKA. Participants completed measures of pain severity, physical disability, perceptions of injustice, pain catastrophizing, and fear of movement before surgery, and measures of pain and disability 1year after surgery. Prospective multivariate analyses revealed that perceived injustice contributed modest but significant unique variance to the prediction of postsurgical pain severity, beyond the variance accounted for by demographic variables, comorbid health conditions, presurgical pain severity, pain catastrophizing, and fear of movement. Pain catastrophizing contributed significant unique variance to the prediction of postsurgical disability. The current findings add to a growing body of evidence supporting the prognostic value of perceived injustice in the prediction of adverse pain outcomes. The results suggest that psychosocial interventions designed to target perceptions of injustice and pain catastrophizing before surgery might contribute to more positive recovery trajectories after TKA.

Relationships Between Physical Symptoms, Emotional Distress, and Pain Appraisal in Fibromyalgia: The Moderator Effect of Alexithymia

ABSTRACTAlexithymia is a personality construct that is frequently identified in fibromyalgia (FM). Previous studies have explored the relationship between alexithymia and emotional distress in this disease. Yet, the additional link with factors of pain appraisal is unknown. This study examined the moderating effect of alexithymia in the relationship between emotional distress and pain appraisal in 97 FM women. A control group of 100 healthy women also participated in the study. All participants completed several self-reports about pain experience, sleep quality, impairment, emotional distress, pain appraisal, and alexithymia. FM women showed significantly more difficulty in identifying and describing feelings, but less externally oriented thinking than healthy women. In the clinical group, difficulty in identifying feelings and difficulty in describing feelings significantly correlated with lower sleep quality, higher anxiety and depression, and increased pain catastrophizing and fear of pain. Difficulty in describing feelings significantly correlated with higher pain experience and vigilance to pain. Externally oriented thinking was not correlated with any of the clinical variables. Difficulty in identifying feelings moderated the relationship between anxiety and pain catastrophizing, and difficulty in describing feelings moderated the relationship between anxiety and fear of pain. Implications of the findings for the optimization of care of FM patients are discussed.

Psychological factors in genital pain: The role of fear-avoidance, pain catastrophizing and anxiety sensitivity among women living in Sweden

ObjectivesOne in five women under the age of 30 report recurrent genital pain and pain during sexual intercourse. Female genital pain negatively affects sexual and general health, as well as dyadic function and quality of life. Although the current field of research and clinical expertise in general agree upon a biopsychosocial conceptualization, there is still a lack of theoretical models describing the psychosocial mechanisms involved in the development of genital pain. Originally developed to outline the transition from acute to chronic back pain, the fear avoidance (FA) model has lately been proposed as a possible tool in illustrating the mechanisms involved in genital pain. However, only few studies have empirically tested the components of the FA model empirically. The aim of the present study is to examine fear avoidance beliefs, pain catastrophizing, and symptoms of depression and anxiety among women reporting genital pain, and to relate these concepts to sexual satisfaction/function and the characteristics of pain. MethodsThe study was a population-based study using a postal questionnaire administered to 4052 women (age 18–35). Of these 944 (response rate: 23%) took part in the study. ResultsGenital pain of six months duration was reported by 16.1% of the women. Women with pain reported elevated levels of symptoms of anxiety, fear avoidance beliefs, pain catastrophizing and anxiety sensitivity. Symptoms of anxiety also predicted pain in the explanatory model together with vaginal tension and fungal infection. Vaginal tension has previously been described as a fear-response to painful intercourse and the results thereby seem to give further support to viewing genital pain from a fear avoidance perspective. Furthermore, fear avoidance beliefs seem to be of similar importance as lack of desire for the experience of sexual satisfaction and could also predict pain during specific activities among women with pain. The results also indicate that sexual satisfaction is related to a specific pain-related fear, rather than a heightened level of general anxiety. ConclusionsThe study had a low response rate, but still indicates that genital pain is common and is associated with several aspects of fear and avoidance. In sum, the results support the FA model by giving strong support for fear reactions (vaginal tension) and fear avoidance beliefs, and moderate support for negative affect. In the model negative affect drives pain catastrophizing. ImplicationsIt seems that the experience of genital pain among women in the general population is common and could be associated with increased levels of anxiety and fear-avoidance beliefs. However, the associations should not be understood in isolation from physiological mechanisms but seem to indicate interactions between, e.g. fungal infections, negative appraisals of pain and symptoms, lack of sexual function and satisfaction and increased pain experience. It is possible that psychological mechanisms work in the transition from acute physiological pain to chronic psychologically maintained pain in terms of secondary reactions to, e.g. repeated fungal infections by adding emotional distress, fear of pain and avoidance behaviours.

A Qualitative Descriptive Study of Risk Reduction for Coronary Disease among the Hong Kong Chinese

Achieving optimal control and reduction in coronary heart disease (CHD) risks in Hong Kong (HK) remains significant and requires exploring. This article addresses the ability to reduce CHD risks among the HK Chinese. Through secondary analysis, a qualitative descriptive design using focus group interviews and content analysis were adopted. Older and younger adults were invited for the study. An interview schedule was used to guide discussions during focus group interviews. Four categories emerged from the data: planning of health actions, control of risk-reducing behavior, perceived opportunities for understanding CHD, and chest pain appraisal. Local culture and population needs play a central role in disease perception and prevention. The findings are essential to target strategies for initiating health acts for younger adults and establish public education resources that underscore understanding of CHD risk, symptom recognition, and disease management, particularly among those middle-aged and older people at high risk and with the diseased populations.

870 WHAT HELPS AND WHY? PREDICTING PATIENT OUTCOMES IN INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME (IC/BPS) WITH PAIN APPRAISALS AND BEHAVIOURAL COPING STRATEGIES

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Interstitial Cystitis1 Apr 2013870 WHAT HELPS AND WHY? PREDICTING PATIENT OUTCOMES IN INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME (IC/BPS) WITH PAIN APPRAISALS AND BEHAVIOURAL COPING STRATEGIES Dean A. Tripp, J. Curtis Nickel, Jillian Mulroy, Laura Katz, Michel Pontari, Robert Moldwin, Mayer Robert, Lesley Carr, Ragi Doggweiler, Claire Yang, Nagendra Mishra, and Jorgen Nordling Dean A. TrippDean A. Tripp Kingston, Canada More articles by this author , J. Curtis NickelJ. Curtis Nickel Kingston, Canada More articles by this author , Jillian MulroyJillian Mulroy Kingston, Canada More articles by this author , Laura KatzLaura Katz Kingston, Canada More articles by this author , Michel PontariMichel Pontari Philadelphia, PA More articles by this author , Robert MoldwinRobert Moldwin New York, NY More articles by this author , Mayer RobertMayer Robert Rochester, NY More articles by this author , Lesley CarrLesley Carr Toronto, Canada More articles by this author , Ragi DoggweilerRagi Doggweiler Knoxville, TN More articles by this author , Claire YangClaire Yang Seattle, WA More articles by this author , Nagendra MishraNagendra Mishra Ahmedabad, India More articles by this author , and Jorgen NordlingJorgen Nordling Herlev, Denmark More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.439AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES IC/BPS is a chronic pelvic pain syndrome. Our previous IC/BPS analysis correlated pain, quality of life (QoL), and psychosocial adjustments with other associated conditions[1], and catastrophizing and behavioural coping strategies (sedentary resting in reaction to pain) have been found to predict pelvic pain outcomes for men and women.[2-5] However, no study has examined a comprehensive list of pain appraisal and behavioural coping strategies as mechanisms in the relationship between pain and QoL in these patients. From a self-regulation perspective, appraisals and coping responses of patients suffering from IC/BPS are important in advancing patient management. METHODS Female patients with IC/BPS (n=190) were recruited from tertiary care urology clinics and completed questionnaires (demographics, O'Leary Sant, McGill Pain Questionnaire, SF12, Chronic Pain Coping Inventory, Pain Catastrophizing Scale). The data was examined for univariate and multivariate normality, and a missing values analysis was conducted. Associations of validated pain appraisals (e.g., catastrophizing) and behavioural coping strategies (e.g., illness focused coping) with outcomes of pain and QoL in IC/BPS were examined. Factor reduction was conducted and resulting variables were input into multivariable mediation models. RESULTS Patients ranged in age from 21-89 years (M=49.8, SD=14.83), were predominantly White (93.7%), with the majority (73%) in a relationship (married or living with partner). Factor analytic analyses revealed a 4-factor solution for these variables (catastrophizing, illness-focused behavioural coping, cognitive coping, and depression), which were used for subsequent mediation analyses. Multivariable mediation analyses for mental QoL showed catastrophizing (P<.0001) was a full and unique mediator of the effect of pain on mental QoL. For physical QoL, illness-focused behavioural coping (i.e., rest/avoidance, seeking assistance)(P<.0001) was a partial and unique mediator between patient pain and physical QoL. CONCLUSIONS These results suggest that catastrophic appraisals and illness-focused behavioural coping act as mechanisms driving the negative association between pain and QoL indices. In fact, the catastrophizing mediation effect supports the hypothesis that symptoms may become mentally disabling through the cognitive mechanisms. These results further support an expanding science emphasizing the importance of biopsychosocial pain/QoL models in Urology. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e359 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dean A. Tripp Kingston, Canada More articles by this author J. Curtis Nickel Kingston, Canada More articles by this author Jillian Mulroy Kingston, Canada More articles by this author Laura Katz Kingston, Canada More articles by this author Michel Pontari Philadelphia, PA More articles by this author Robert Moldwin New York, NY More articles by this author Mayer Robert Rochester, NY More articles by this author Lesley Carr Toronto, Canada More articles by this author Ragi Doggweiler Knoxville, TN More articles by this author Claire Yang Seattle, WA More articles by this author Nagendra Mishra Ahmedabad, India More articles by this author Jorgen Nordling Herlev, Denmark More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1170 UNDERSTANDING THE MECHANISTIC ROLE OF PAIN APPRAISALS AND BEHAVIOURAL COPING STRATEGIES BETWEEN PAIN AND QUALITY OF LIFE IN CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME (CP/CPPS)

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20131170 UNDERSTANDING THE MECHANISTIC ROLE OF PAIN APPRAISALS AND BEHAVIOURAL COPING STRATEGIES BETWEEN PAIN AND QUALITY OF LIFE IN CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME (CP/CPPS) Dean A. Tripp, J. Curtis Nickel, Adrijana Koljuskov, Daniel Shoskes, Michel Pontari, Mark S. Litwin, and Mary F. McNaughton-Collins Dean A. TrippDean A. Tripp Kingston, Canada More articles by this author , J. Curtis NickelJ. Curtis Nickel Kingston, Canada More articles by this author , Adrijana KoljuskovAdrijana Koljuskov Kingston, Canada More articles by this author , Daniel ShoskesDaniel Shoskes Cleveland, OH More articles by this author , Michel PontariMichel Pontari Philadelphia, PA More articles by this author , Mark S. LitwinMark S. Litwin Los Angeles, CA More articles by this author , and Mary F. McNaughton-CollinsMary F. McNaughton-Collins Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.807AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is characterized by pelvic pain and is largely refractory. Studies have correlated pain, depression, catastrophizing and sedentary behavior on quality of life (QoL) or pain, showing the saliency of psychosocial factors. However, no study has examined a comprehensive list of pain appraisal and behavioural coping strategies as mechanisms in the relationship between pain and QoL. From a self-regulation model, understanding how appraisals and coping interact with outcomes like pain and QoL are important in advancing patient management. METHODS Men (n=168) previously enrolled in the NIH Chronic Prostatitis Cohort study in North American tertiary care centers (6-U.S., 1-Canada) completed a one-time survey of validated self-report measures (QoL:SF-12; demographics; pain: McGill; behavioural pain coping:CPCI; catastrophizing:PCS; Social Support:MSPSS). Data were examined for normality and missing values. Associations of validated pain appraisals (Catastrophizing) and behavioural coping (Illness-focused coping) with outcomes of pain and QoL were examined. Multivariable mediation models tested mediation roles between pain and QoL. RESULTS Multivariable mediation analyses for the relationship between pain and physical QoL was run with mediators of Illness-Focused Coping (IF-coping), Wellness-Focused Coping (WF-coping), Social Support and Catastrophizing showing that only IF-coping was a significant mediator of this relationship (<.001). Follow-up analyses of subscales for IF-coping (Guarding, Resting, Asking for Assistance, Medication Use) showed Guarding was a unique mediator. Mediation analyses between pain and mental QoL was run with mediators of IF-coping, Social Support and Catastrophizing showing support and catastrophizing were significant mediators (<.001). Subscale follow-ups for support (Family, Friends, Significant Other) and Catastrophizing (Rumination, Magnification, Helplessness) showed Friends and Helplessness were unique mediators. CONCLUSIONS These results suggest that IF-coping, Helpless Catastrophic pain appraisals and Friends act as mechanisms that drive and buffer the negative association between pain and QoL indices. Due to the nature of these associations, the hypothesis that symptoms may be physically and mentally disabling through behavioural, cognitive and environmental mechanisms is supported. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e478 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dean A. Tripp Kingston, Canada More articles by this author J. Curtis Nickel Kingston, Canada More articles by this author Adrijana Koljuskov Kingston, Canada More articles by this author Daniel Shoskes Cleveland, OH More articles by this author Michel Pontari Philadelphia, PA More articles by this author Mark S. Litwin Los Angeles, CA More articles by this author Mary F. McNaughton-Collins Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Learning about pain through observation: the role of pain-related fear

Observational learning may contribute to development and maintenance of pain-related beliefs and behaviors. The current study examined whether observation of video primes could impact appraisals of potential back stressing activities, and whether this relationship was moderated by individual differences in pain-related fear. Participants viewed a video prime in which back-stressing activity was associated with pain and injury. Both before and after viewing the prime, participants provided pain and harm ratings of standardized movements drawn from the Photograph of Daily Activities Scale (PHODA). Results indicated that observational learning occurred for participants with high levels of pain-related fear but not for low fear participants. Specifically, following prime exposure, high fear participants showed elevated pain appraisals of activity images whereas low fear participants did not. High fear participants appraised the PHODA-M images as significantly more harmful regardless of prime exposure. The findings highlight individual moderators of observational learning in the context of pain.

Greater cardiovascular reactivity to a cold stimulus is due to higher cold pain perception in black Africans

To evaluate the role of pain perception and pain stimulus components for blood pressure responses to stress in the black and the white African population with hypertension. Cardiovascular regulation in response to a cold pressor stimulus was studied in hypertensive black (n = 110) and white (n = 95) Africans. Perception of stressfulness of the task was assessed on a seven-point Likert scale. Chronic stress levels were evaluated by the General Health Questionnaire and the Coping Strategy Indicator was used to assess individual coping behavior. Autonomic and baroreflex function was evaluated by spectral analysis. The cold pressor test elicited significant blood pressure elevations with higher relative increases in the black Africans. The higher blood pressure reactivity in black Africans was accompanied by a substantially greater cardiac response and lower parasympathetic outflow as compared with white Africans. Black Africans also reported higher chronic stress levels and rated the stimulus as more painful than their white counterparts. A significant interaction was observed for cardiovascular responses with pain perception but not with chronic stress. Individuals with high pain perception exhibited less dampening of autonomic cardiac exertion than those with low or moderate pain perception. Black Africans display a more pronounced cold pressor test-induced rise in heart rate and blood pressure, which may be explained by greater pain-related increments in blood pressure. A higher cognitive appraisal of pain and a blunted baroreflex-mediated dampening of autonomic structures may contribute to the exaggerated blood pressure reactivity in black Africans.

Alterations in resting‐state regional cerebral blood flow demonstrate ongoing pain in osteoarthritis: An arterial spin‐labeled magnetic resonance imaging study

Increasing evidence suggests a central nervous system (CNS) component underpinning persistent pain disease states. This study was undertaken to determine regional cerebral blood flow (rCBF) changes representing ongoing pain experienced by patients with painful osteoarthritis (OA) of the carpometacarpal (CMC) joint and to examine rCBF variability across sessions. We used pulsed continuous arterial spin labeling (pCASL), a perfusion magnetic resonance imaging (MRI) technique. The study included 16 patients with CMC OA and 17 matched controls. Two pCASL scans and numerical rating scale (NRS) estimates of ongoing pain were acquired in each of two identical sessions. Voxelwise general linear model analyses were performed to determine rCBF differences between OA and control groups, rCBF differences between sessions within each group, and whether sessionwise rCBF differences were related to variability in perceived ongoing pain. In the OA group, rCBF increases representing ongoing pain were identified in the primary and secondary somatosensory, insula, and cingulate cortices; thalamus; amygdala; hippocampus; and dorsal midbrain/pontine tegmentum, including the periaqueductal gray/nucleus cuneiformis. Sessionwise rCBF differences in the OA group in the postcentral, rostral/subgenual cingulate, mid/anterior insula, prefrontal, and premotor cortices were related to changes in perceived ongoing pain. No significant sessionwise rCBF differences were observed in controls. This is the first quantitative endogenous perfusion MRI study of the cerebral representation of ongoing, persistent pain due to OA. Observed rCBF changes potentially indicate dysregulated CNS appraisal and modulation of pain, most likely the maladaptive neuroplastic sequelae of living with painful OA. Understanding the neural basis of ongoing pain is likely to be important in developing novel treatment strategies.

Alterations in Default Mode Network Connectivity During Pain Processing in Borderline Personality Disorder

Recent neuroimaging studies have associated activity in the default mode network (DMN) with self-referential and pain processing, both of which are altered in borderline personality disorder (BPD). In patients with BPD, antinociception has been linked to altered activity in brain regions involved in the cognitive and affective evaluation of pain. Findings in healthy subjects indicate that painful stimulation leads to blood oxygenation level-dependent signal decreases and changes in the functional architecture of the DMN. To connect the previously separate research areas of DMN connectivity and altered pain perception in BPD and to explore DMN connectivity during pain processing in patients with BPD. Case-control study. University hospital. Twenty-five women with BPD, including 23 (92%) with a history of self-harm, and 22 age-matched control subjects. Psychophysical assessment and functional magnetic resonance imaging during painful heat vs neutral temperature stimulation. Connectivity of DMN as assessed via independent component analysis and psychophysiological interaction analysis. Compared with control subjects, patients with BPD showed less integration of the left retrosplenial cortex and left superior frontal gyrus into the DMN. Higher BPD symptom severity and trait dissociation were associated with an attenuated signal decrease of the DMN in response to painful stimulation. During pain vs neutral, patients with BPD exhibited less posterior cingulate cortex seed region connectivity with the left dorsolateral prefrontal cortex. Patients with BPD showed significant alterations in DMN connectivity, with differences in spatial integrity and temporal characteristics. These alterations may reflect a different cognitive and affective appraisal of pain as less self-relevant and aversive as well as a deficiency in the switching between baseline and task-related processing. This deficiency may be related to everyday difficulties of patients with BPD in regulating their emotions, focusing mindfully on 1 task at a time, and efficiently shifting their attention from one task to another.

Vaginismus: Heightened Harm Avoidance and Pain Catastrophizing Cognitions

Catastrophic appraisal of experienced pain may promote hypervigilance and intense pain, while the personality trait of harm avoidance (HA) might prevent the occurrence of correcting such experiences. Women inflicted with vaginismus may enter a self-perpetuating downward spiral of increasing avoidance of (anticipated) pain. In vaginismus the anticipation of pain may give rise to catastrophic pain ideation. This may establish hypervigilance toward painful sexual stimuli, which consequently results in negative appraisal of sexual cues. This process could impair genital and sexual responding, intensify pain and trigger avoidance, which in turn may contribute to the onset and persistence of symptoms in vaginismus and to certain extent also in dyspareunia. To investigate whether women suffering from vaginismus are characterized by heightened levels of habitual pain catastrophic cognitions, together with higher levels of HA. This study consisted of three groups: a lifelong vaginismus group (N = 35, mean age = 28.4; standard deviation [SD] = 5.8), a dyspareunia group (N = 33, mean age = 26.7; SD = 6.8), and women without sexual complaints (N = 54, mean age = 26.5; SD = 6.7). HA scale of Cloninger's tridimensional personality questionnaire, and the pain catastrophizing scale. Specifically women inflicted with vaginismus showed significantly heightened levels of catastrophic pain cognitions compared with the other two groups, as well as significant enhanced HA vs. the control group, and a trend vs. the dyspareunia group. Both traits were shown to have cumulative predictive validity for the presence of vaginismus. This study focused on the personality traits of catastrophizing pain cognitions and HA in women with lifelong vaginismus. Our findings showed that indeed, women suffering from vaginismus are characterized by trait of HA interwoven with habitual pain catastrophizing cognitions. This study could help in the refinement of the current conceptualization and might shed light on the already available treatment options for women with vaginismus.

Does Pain Necessarily Have an Affective Component? Negative Evidence from Blink Reflex Experiments

Experimental pain research has shown that the affective component of pain is influenced strongly by situational characteristics; affective pain processing appears to be particularly pronounced in situations that provoke a feeling of uncertainty and uncontrollability. To determine whether the affective component of pain can be completely abolished if a 'safe', particularly predictable stimulation paradigm is applied. Forty healthy volunteers recruited at the University of Bamberg (Bamberg, Germany) were assessed in two experiments. Tonic contact heat stimuli staged in three intensities (warmth, heat and pain) relative to the individual pain threshold was applied; these were predictable with regard to intensity and course, and the subjects had easy access to control. The startle reflex was assessed as an objective measure of affective response. In addition, the subjects provided unpleasantness ratings. To compare these results to a gold standard for affective response, affective pictures taken from the International Affective Picture System were presented during temperature stimulation in the second experiment. Both experiments showed no potentiation of the startle reflex under painful heat stimulation compared with the two nonpainful stimulus intensities (heat and warmth), although the painful stimulation was clearly rated as more unpleasant. Results suggest that it is possible to develop a 'safe' noxious stimulus, which is rated as clearly unpleasant, but lacks physiological indication of negative affect. This divergence might be explained by subjective ratings being influenced by the instructions. The possibility of reducing the pain affect by suggesting 'safety' may be of therapeutic interest.

Understanding the relationship between attachment style, pain appraisal and illness behavior in women

Insecure attachment has been hypothesized to be an important factor for understanding the experience of pain. Considering the Attachment-Diathesis Model of Chronic Pain developed by Meredith, Ownsworth, and Strong (2008), this cross-sectional study examines the relationship between attachment style, pain appraisal, and illness behavior. Two hundred healthy women recruited from community contexts completed a battery of self-report measures including the Short-form McGill Pain Questionnaire, Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Vigilance and Awareness Questionnaire, Illness Attitude Scales, Beck Anxiety Inventory, Beck Depression Inventory, and the Experiences in Close Relationships Questionnaire-Revised. The results showed that attachment anxiety was significantly correlated with pain catastrophizing, pain-related fear, depression, and illness behavior. However, attachment anxiety and avoidance were not associated with pain intensity. Attachment anxiety moderated the relationship between pain catastrophizing and illness behavior, and between pain hypervigilance and illness behavior. Pain catastrophizing and pain-related fear partially mediated the effect of attachment anxiety on illness behavior. The findings highlight potential contributions of attachment style and pain appraisal for explaining illness behavior. This study supports earlier reports and suggests the usefulness of assessing attachment style for early identification of people who might exhibit a high risk of dysfunctional responses to pain. Our findings also suggest that increasing people's insight about their attachment style and modifying some associated dysfunctional responses may be important in the treatment of chronic pain.

Dyadic appraisals of pain severity and control and spouse support and criticism

The management of chronic pain is often embedded in a dyadic context.1 Patients and spouses have individual appraisals of pain and these appraisals interact to influence supportive and critical spouse responses. For example, spouse overestimations of patient pain have been associated with patient reports of greater spouse solicitousness whereas similarities in appraisal were associated with patient reports of more satisfying support and fewer negative responses. The current study used a dyadic perspective, measuring couples' appraisals of support and criticism to understand the influence of dyadic appraisals on spouse supportive and critical responses to patients.