Pain Experience Research Articles

Personal Resources and Total Pain: Exploring the Multiple Mediation of Fear of Recurrence, Meaning-Making, and Coping in Posttreatment Cancer Patients.

People with cancer who have completed treatment still experience negative effects, such as an increased risk of experiencing cancer-related pain. Psychological factors tend to influence cancer patients' ability to cope with pain in various dimensions. Although personal resources are an important factor in buffering total pain, still little is known about the intervening variables and underlying mechanisms. The current study examined the relationship between psychological flexibility, self-esteem, and total pain, while considering fear of recurrence, meaning-making, and coping as potential mediating factors. Adults (N = 304) who completed medical treatment (radiotherapy, chemotherapy, and combined therapy) participated in this study. They completed questionnaires measuring the aforementioned variables. Structural equation models were used to examine mediation effects. Psychological flexibility, and partly self-esteem, were negatively related to the dimensions of total pain. However, to a large extent, these relationships were serially and parallelly mediated by fear of recurrence, meaning-making, and emotion-oriented coping. Consistent with the meaning-making model, cognitive (meaning-making), and affective (fear of recurrence and emotional coping) factors may be potential mechanisms underlying the association between psychological flexibility, self-esteem, and total pain in posttreatment cancer patients. In this study, they tended to interact in the area of physiological and psychosocial experiences of cancer-related pain.

Emotional awareness and expression difficulties in relation to pain experiences in people with brain injury and chronic pain: preliminary investigation

ABSTRACT Objectives Preliminary examination of emotional awareness/expression relationships with pain in people with traumatic brain injury (TBI) and chronic pain (CP) and exploration of psychological factors as mediators or moderators of these relationships. Methods Cross-sectional study in adults (N = 59) with chronic TBI and CP using Toronto Alexithymia Scale-20 Difficulty Identifying and Describing Feelings subscales; Ambivalence over Emotional Expressiveness Questionnaire; Emotional Approach Coping Scale; PROMIS Pain Intensity and Pain Interference scales, Michigan Body Map (pain widespreadness); headache frequency; Pain Catastrophizing Scale; Brief Symptom Inventory-18 (psychological distress), and Post-traumatic Stress Checklist-Civilian. Results Difficulty Identifying Feelings was positively associated with pain intensity, pain interference, and headache frequency. Difficulty Describing Feelings was positively correlated with pain interference and headache frequency. Emotional Approach Coping was inversely correlated with headache frequency. Emotional awareness/expression relationships with pain outcomes were mediated by Pain Catastrophizing; Difficulty Describing Feelings relationships with Pain Interference and headache frequency were mediated by psychological distress; and Difficulty Describing Feelings associations with Pain Interference were mediated by post-traumatic stress. No moderators were identified. Conclusion These preliminary findings suggest that emotional awareness/expression is linked to pain in adults with TBI and CP, which may be connected via pain catastrophizing and psychological distress. If longitudinal studies with larger samples produce similar findings, researchers should explore training emotional awareness/expression for possible pain management after TBI.

Thirty-day outcome of patients who present with chest pain to the emergency department of a tertiary care hospital of Sri Lanka

Background: Patients present with chest pain causes significant burden to the workload in an emergency department (ED). Quick but thorough attention is needed for life threatening emergencies and to minimize unnecessary admissions. We assess the burden of chest pain and 30-day outcome of patients who present with chest pain to the ED. Methodology: Prospective observational study of all adult patients presented to ED over one month with the primary complain of chest pain were evaluated and followed for 30 days. Results: A total of 661 (20.3% of total admissions) patients (mean age 56.7±1 4.9 years, 51% males) were studied. Common causes for the chest pain included gastroesophageal reflux disease (GORD) (29%) and acute coronary syndrome (ACS) (25%). ACS patients included ST-elevation myocardial infarction (STEMI) (10%), Non-ST-elevation myocardial infarction (6.7%) and unstable angina (8.3%). Fifty patients (75% of the STEMI patients) were thrombolysed. Primary angioplasty facility was not available in the hospital during the study period. Five patients (3% of the ACS patients) had coronary revascularization during the follow-up period – 2 patients had angioplasty and 3 patients had coronary bypass surgery. In-hospital mortality was 2.7%. Thirty-day mortality was 3.2%. Thirty three percent of them continued to have recurrent chest pain despite thorough investigation and treatment. Conclusions: Chest pain carries a significant burden to the workload of a busy ED. The commonest causes for chest pain were ACS and GORD. A considerable number of patients continued to experienced chest pain despite investigations and treatment.

The Association Between Chronic Pain, Substance use, and Primary Care Experience Among Veterans with Ongoing or Recent Homelessness.

Chronic pain and problematic substance use are prevalent among Veterans with homeless experience (VHE) and may contribute to a challenging primary care experience. To examine the association of chronic pain and problematic substance use with unfavorable primary care experiences among VHE and to explore the association of pain treatment utilization and unfavorable care experiences in VHE with chronic pain. We surveyed VHE (n = 3039) engaged in homeless-tailored primary care at 29 Veterans Affairs Medical Centers (VAMCs). We assessed unfavorable primary care experiences with four validated Primary Care Quality-Homeless (PCQ-H) scales: multivariable logistic regressions explored associations between unfavorable care experiences for VHE with chronic pain and problematic substance use, chronic pain alone, problematic substance use alone, or neither. We then examined the association between receipt of pain treatments and unfavorable experiences among VHE with chronic pain. Last, we identified PCQ-H items that had the greatest difference in unfavorable response rates between VHE with and without chronic pain. The prevalence of unfavorable primary care experience was higher on all four scales for patients reporting chronic pain (with or without problematic substance use) (all p < 0.001), but not for problematic substance use alone, compared to VHE with neither pain nor problematic substance use. In analyses limited to VHE with chronic pain, those on long-term opioids were less likely to report an unfavorable experience (OR = 0.49, 95%CI 0.34-0.69). Receipt of occupational therapy was associated with lower odds of reporting an unfavorable experience (OR = 0.83, 95%CI 0707-0.98). PCQ-H items related to trust, relationships, and provider communication had the greatest differences in dissatisfaction ratings (all p < 0.001). Chronic pain is associated with unfavorable primary care experiences among VHE, potentially contributing to poor care outcomes. Strategies are needed to enhance patient-provider trust and communication and increase VHE's access to effective pain treatments.

Invited Commentary: Sex-Differences in Post-procedural Pain Experiences after Thermal Liver Ablations for Liver Tumors—A Retrospective Study

Invited Commentary: Sex-Differences in Post-procedural Pain Experiences after Thermal Liver Ablations for Liver Tumors—A Retrospective Study

Anatomic Study and Clinical Application of C7 Nerve Transfer Surgery via the Anterior Vertebral Approach for Central Upper Limb Spastic Paralysis

Objective: To explore the anatomic characteristics of C7 nerve localization, course, and length during cross-transfer surgery of the C7 nerve through the anterior vertebral approach and investigate the feasibility, safety, and clinical efficacy of C7 nerve transfer surgery through the anterior vertebral approach for the treatment of central upper limb spastic paralysis. Methods: Four fresh-frozen adult head and neck samples were selected. C7 nerve transfer surgery was simulated through the anterior vertebral approach. The vertical distance between the C7 nerve and the medial edge of the clavicle, the length of the C7 nerve, and the shortest distance of C7 nerve transfer required through the anterior vertebral approach were measured. This was a retrospective analysis of the clinical data of 2 patients with central upper limb spastic paralysis after C7 nerve transfer surgery at Northern Jiangsu People’s Hospital affiliated with Yangzhou University. The patients were all female, aged 50 to 51 years, with upper limb paralysis on the affected side. The muscle strength was grade 0 or grade 1, and the muscle tension was relatively high. Both patients underwent C7 nerve transfer surgery through the anterior vertebral approach. Upper limb sensation and motor function were observed. Results: Bilateral C7 nerves can be fully exposed and located through the anterior vertebral approach. The C7 nerve runs between the anterior and middle scalene muscles, with a vertical distance of 1.7 to 2.5 (2.1±0.3) cm from the inner edge of the clavicle. The length of the C7 nerve is 5.6 to 6.8 (6.4±0.5) cm, and the shortest distance of C7 nerve transfer through the anterior vertebral approach is 4.8 to 5.7 (5.3±0.4 cm). Two patients with central upper limb paralysis successfully underwent C7 nerve transfer surgery using the anterior vertebral approach. Two patients had normal motor function in the healthy upper limb after surgery but experienced pain and numbness in the healthy upper limb. Both patients recovered within 1 month. Two patients experienced significant relief of spasticity symptoms in the affected upper limb. One patient was followed up for 15 months, and, at the last follow-up, sensation in the affected upper limb was normal, with proximal muscle strength at level 3 and distal muscle strength at level 2. Another patient was followed up for 11 months, and at the last follow-up, sensation in the affected upper limb was normal, with proximal muscle strength at level 1+ and distal muscle strength at level 1. Conclusion: For central upper limb spastic paralysis, C7 nerve transfer surgery through the anterior vertebral approach is safe and feasible and is a good treatment option. Related anatomic research can effectively guide clinical surgery and assist in locating the C7 nerve, and incising the musculus longus colli can shorten the distance of C7 nerve transfer.

Partnership and relationship happiness in endometriosis related chronic pelvic pain: a multicenter case-control study.

Partnership is an important resource in dealing with endometriosis related chronic pain. Hence, our objective was to assess partnership in the context of endometriosis and its symptoms, considering the perspectives of both individuals involved. The study was designed as a multi-center matched case-control study in Switzerland, Germany and Austria. Altogether 381 women with surgically/histologically confirmed endometriosis and 381 control women, 250 male partners of endometriosis-affected women and 229 of control women were evaluated. Partnership quality, partnership happiness, separation thoughts, and areas of conflict were evaluated through the Partnership Questionnaire and a validated list of conflict areas. Quality of partnership was rated as high by 60.1% of the women with endometriosis and 66.7% of the control women, as well as by 45.8 and 50.2% of their respective partners. Women with endometriosis mentioned separation thoughts, mostly related to sexual satisfaction, more often (34.9%/28.3%) and experienced more partnership-related conflicts than control women. Chronic pain, dyspareunia, dissatisfaction with sexuality, fatigue, and infertility were significantly associated with partnership conflicts. Fatigue and infertility but not pain experiences were related to lower partnership quality. Male partners in both groups reported separation thoughts equally often. In men, a high intensity of pain experienced by their partner was associated with reduced partnership happiness. Given the significance of partnership in dealing with chronic diseases and the connection between symptoms of endometriosis and a decrease in partnership quality, it is essential to incorporate strategies that alleviate the negative impacts on relationships for both partners into medical support. identifier NCT02511626.

Characteristics of patients with somatoform pain disorder

AbstractBackgroundPatients with somatoform pain experience physical pain that cannot be attributed to any underlying medical or physiological cause, and it is often thought to be related to psychological factors. Health professionals encounter difficulties identifying this specific type of chronic pain, leading to suboptimal treatment strategies. Therefore, we aimed to describe the characteristics of patients with somatoform pain, to support the identification of affected patients.MethodsWe collected and analyzed a cross‐sectional survey data from 200 patients with somatoform pain admitted to one of three psychosomatic centers in Germany between August 2013 and July 2014. The survey contains 10 different categories, all of them referring to pain‐related topics. Within the survey, we analyzed validated as well as non‐validated questionnaires. Here, we present the following five: Personal data, Body: Pain perception, Cognition: Pain processing, Pain behavior, and Physical complaints.ResultsOur results highlight that most patients with somatoform pain experience it in several body parts and as persisting, lasting &gt;12 h/day (50%), and constantly changing (71%). Furthermore, patients indicate feelings of helplessness, by agreeing to the expressions the pain controls me (70%). Finally, we found that pain is predominantly seen as suffering, failing to convey emotional pain, despite cognitively acknowledging the dependency of emotional and physical pain.ConclusionThe study identified specific and distinctive characteristics in the emotional and behavioral responses of patients with somatoform pain, potentially distinguishing them from other patients with chronic pain.

Pain in Biologic-Treated Rheumatoid Arthritis Patients: The Role of Illness Perception Before and After the COVID-19 Pandemic.

We aimed to assess the role of the COVID-19 pandemic in the association of clinical, physical, and psychological factors with pain in Rheumatoid Arthritis (RA) patients. We included 103 RA patients (81.6% females; mean age 56.1±13.8years). Patients filled out the VAS-pain, GAD-7, PHQ-9, MFI-20, and B-IPQ. Paired sample t-tests, correlations, and multiple regression analyses were used to analyse the data. Our results showed significantly worsened pain in the data collected post-pandemic (p≤0.05). Pre-pandemic, the final regression models showed an association between functional disability (β=0.24; p≤0.05), illness perception (β=0.34; p≤0.05) and pain. In post-pandemic models, significant associations were found between fatigue (β=0.33; p≤0.01) and illness perception (β=0.36; p≤0.01) with pain. Positive illness perception was able to alleviate the associations between fatigue and depression with pain before and after the pandemic. Findings indicate that patients with RA may have been negatively affected by the COVID-19 pandemic given their vulnerability. Even though pharmacological treatment was not interrupted, post-pandemic results showed significantly higher levels of experienced pain. Therefore, in addition to biological therapy, non-pharmacological interventions, including psychological support aimed at diminishing negative illness perception, may be beneficial in reducing RA-related pain, especially when dealing with a crisis.

The pop-up pain: reconceptualizing the perception of short-lived pain among non-injured recreational marathoners

Multiple forms of short-lived pain are common experiences among non-injured recreational marathoners, yet there remains little in-depth qualitative research on the lived experience regarding the sociology of transient pain. This study seeks to fill the lacuna by exploring the relationship between transient pain and its multifaceted consequences within the running social world. Drawing on Leder’s notion of the dys-appearing body, the study investigates how non-injured runners interpret and attribute context-dependent significance to transient pain due to their runs. An ethnographic research design of two years was implemented in two running groups, using participant observation and semi-structured interviews. Three categories of transient pain were identified: (1) “Pre-flow pain” - discomfort at the start of a run before easing into a relaxed state, (2) “Impromptu pain” - unexpected, sharp pain that occurs during the run and (3) “Resurgent pain” - an ache that manifests after the end of a running session as a result of lingering effects from prior injuries. The data presented suggest that transient pain cannot be approached as a self-evident phenomenon occurring in a vacuum. Instead, it should be viewed as a nuanced pain epistemology that encompasses the lived experience of bodily pain within the subjective perception.

Pain in recessive dystrophic epidermolysis bullosa (RDEB): findings of the Prospective Epidermolysis Bullosa Longitudinal Evaluation Study (PEBLES)

BackgroundPain is common in the genetic skin fragility disorder epidermolysis bullosa (EB), from skin and mucosal injury and inflammation as well as extra-mucocutaneous sites. Individuals living with EB have identified pain as a priority for better treatments.ObjectivesThe Prospective EB Longitudinal Evaluation Study (PEBLES) is a prospective register study exploring the natural history of RDEB across all ages from birth to death. Here, we investigated the characteristics and treatment of pain in different RDEB subtypes.MethodsInformation was collected from individuals with different RDEB subtypes over an 8-year period. Data included visual analogue scale (VAS) ratings of background and procedural pain, its location, intensity and impact on sleep, as well as pain medication. Disease severity scores and quality of life measures were correlated to pain scores.ResultsSixty-one participants (13 children, 48 adults) completed a total of 361 reviews. Pain was common, experienced by 93% of participants at index review, with 80% suffering both background and procedural pain. Across all RDEB patients, the median VAS for background pain was 40 (out of 100) [interquartile range 20,60] and for those having regular dressing changes, median procedural pain was 52 [40,80]. Severe (RDEB-S) and pruriginosa (RDEB-Pru) groups had the greatest increase in procedural compared to background pain of 20 and 22 VAS points, respectively. Correlations between disease severity and quality of life impairment were observed across most groups, particularly RDEB-S. Over half of those studied experienced pain frequently or constantly, and in one third pain disturbed sleep at least 4 nights per week. Skin was the commonest source of pain in all subtypes except inversa RDEB where the mouth was the main site. Despite frequent and severe pain, one third of participants used no medication for pain and, in those that did, pain levels remained high suggesting ineffectiveness of current pain management approaches and a significant unmet need in RDEB.ConclusionThe frequency, severity, and impact of pain in all RDEB patients is significant, particularly in RDEB-S and RDEB-Pru. Our findings highlight that current RDEB pain management is poorly effective and that further research is needed to address this symptom.

Veterans in Northern Ireland: Evaluation of chronic pain experience, service type, and physical and mental health functioning

Background Chronic pain is common and associated with disruptions in quality of life (QoL) and psychosocial functioning. These issues are particularly pronounced in veterans, although data in this regard primarily come from the United States Veterans Affairs System, meaning less is known regarding veterans of other countries and regions. The present study evaluated veterans living in Northern Ireland (NI), a region with historic high rates of both chronic pain and psychosocial difficulties associated with the decades-long period of civil and military conflict preceding the 1999 armistice (the Good Friday Agreement). Unique to the Northern Ireland military operation was the initiation of Home Service battalions comprised of local recruits, a role with increased risk due to the conflict’s nature and the fact that they were serving as a military and security presence in their home region. Methods A cross-sectional assessment of veterans living in Northern Ireland ( N = 722) provided details of service type (Home Service vs other service), current health conditions (including chronic pain), and current psychosocial functioning (including physical and mental health QoL, anxiety, depression, and post-traumatic stress disorder [PTSD] symptoms). Results Findings indicated that those with chronic pain had worse QoL, anxiety, depression, and PTSD. Those with chronic pain were also more likely to have served in the Home Services, be unemployed, and be receiving disability payment. Contrary to hypotheses, there was no interaction between chronic pain and service type. Conclusions These results extend previous work with veterans to the unique circumstances of a post-conflict military that engaged in operations within its own country and underscore the need for coordinated, efficacious interventions for co-morbid chronic pain and anxiety, depression, and PTSD.

Utility of the AngelMed Guardian System in myocardial bridging: a case report

BackgroundMyocardial bridging (MB) is a known congenital anomaly in which a segment of the coronary artery transverses from the epicardium through the myocardium. MB may clinically manifest as recurrent angina, acute coronary syndrome, ventricular dysrhythmia, and even sudden cardiac death. On electrocardiogram (EKG), MB can present with findings consistent with significant ST-segment changes. The AngelMed Guardian System (the Guardian device) was developed in an effort to optimize the time from the onset of myocardial ischemia to intervention. The device analyzes myocardial electrical changes and alerts the patient to seek emergent medical evaluation if an acute ST-segment deviation is detected. We describe the first documented case of the Guardian device detecting acute ST-segment changes secondary to myocardial bridging.Case PresentationA 50-year-old male, with a history of percutaneous coronary intervention of the proximal left anterior descending (LAD) artery, presented to his cardiologist’s office with reports of recurrent, atypical chest pain. The Guardian device was implanted. One month after implantation, the patient experienced chest pain and was alerted by the Guardian device to seek emergent medical evaluation. Initial EKG and high-sensitivity troponins were negative for acute ischemia. Guardian device interrogation revealed significant ST depressions, encouraging further ischemic evaluation. The exercise myocardial perfusion imaging revealed an apical reversible defect. Left heart catheterization revealed a large segment of mid-LAD MB with the patient’s previous LAD stent noted to be widely patent along with no evidence of new obstructive coronary disease. Following the identification of the MB, medication regimen adjusted and the patient denied recurrence of chest pain or Guardian alerts.ConclusionsWe describe the first documented case of the Guardian device detecting acute ST-segment changes that were secondary to myocardial bridging. The Guardian device appropriately documented an ischemic event not appreciated with initial EKG or troponin testing. With the assistance of the Guardian device, we were able to rapidly identify MB as the cause for the ischemic EKG changes and subsequent abnormal stress test, optimize medical management, and prevent recurrent atypical chest pain along with office and hospital visits.

"Voiceless Pain"-Assessment of Pain in Patients with Obstetric Brachial Plexus Injuries: A Retrospective, Single Center Analysis.

Obstetric brachial plexus injuries (OBPIs) not only lead to severe and life changing sequelae regarding motor impairment but can also be responsible for multi-characteristic pain. In everyday routine, questions regarding pain of the developing child with an OBPI are often overseen and neglected. We aimed to elucidate this specific question and analyzed all patients with OBPI treated in our center to unmask initially non-observed pain and ultimately put pain in correlation to the surgical reconstructive treatment performed. This single center retrospective study analyzes patients with OBPI treated in our center over the past 20 years. Patients were surveyed by the adolescent pediatric pain tool assessment to evaluate pain over their entire life span by excluding potential postoperative pain episodes. A total of 95 patients were initially contacted of which 78 returned the questionnaire (53.8% female, 46.2% male). In our patient cohort, the vast majority constituting 84.6 percent did not experience pain in the affected upper extremity over the years up to the date of their examination. Most of the patients describing pain had not been microsurgically treated for brachial plexus reconstruction in their neonate period. Merely, 33.3 percent of all OBPI experiencing pain had been microsurgically reconstructed at a median age of 7 months. Pain interrogation in patients with OBPI is often overseen during daily clinical routine. Adequate age-appropriate analgesic therapy regimens adapted to the individual are highly recommended. Timely microsurgical brachial plexus reconstruction may result in reduced lifetime pain experiences.

Implementation of music in the perioperative standard care of colorectal surgery (IMPROVE study).

Patients undergoing surgery experience perioperative anxiety and pain. Music has been shown to reduce perioperative anxiety, pain and medication requirement. This study assessed the feasibility and effectiveness of implementing a perioperative music intervention. A prospective pre- and post-implementation pilot study was conducted to assess adherence to the intervention and the initial effect of music on postoperative pain scores (Numerical Rating Scale, 0-10) compared to a control group. Secondary outcomes encompassed pain scores throughout hospital admission, anxiety levels, medication usage, complications and hospital stay length. Adherence to the music intervention was preoperative 95.2%, intraoperative 95.7%, postoperative 31.9% and overall 29.7%. The intervention did influence postoperative pain. Patient's willingness to receive music was high (73%), they appreciated the intervention (median 8.0, interquartile range 7.0-9.0) and healthcare professionals were willing to apply the intervention. Music significantly reduced postoperative anxiety (2.0 vs. 3.0, p = 0.02) and the consumption of benzodiazepines on the first postoperative day (number of patients: zero [0%] vs. five [10%], p = 0.04). Implementation of music resulted in reduced postoperative anxiety and decreased consumption of benzodiazepines, and the strategy was feasible, but adjustments are needed to improve postoperative adherence. Both patients and healthcare professionals had a positive attitude towards the intervention.

Successful emergency management of hemorrhagic shock due to carotid artery aneurysm: the role of awake intubation in difficult airway control

We describe the clinical scenario, analyze the decision-making process in airway management, and application of the Difficult Airway Society (DAS) guidelines for awake tracheal intubation (ATI) in a patient involving life-threatening bleeding from an internal carotid artery aneurysm caused by a fistula following radiotherapy for tongue cancer at Hong Ngoc Phuc Truong Minh General Hospital, on March, 2024. A 53-year-old male, diagnosed with tongue cancer, underwent surgery. Days before admission, he experienced pain and bleeding from the right lateral neck due to an internal carotid artery aneurysm. An attempt at tracheal intubation for endovascular intervention at another hospital failed. Upon arrival at our emergency department, he exhibited massive neck hemorrhage, remained conscious, pale, with ongoing bleeding from a right neck fistula, and limited cervical motion due to irritation. A treatment strategy for permanent occlusion of the aneurysm was devised. Awake tracheal intubation using a fiberoptic scope via the nasal route was performed. The patient received light sedation with midazolam, and the airway was topicalized with 10% lidocaine spray over the mouth, tongue, and oropharyngeal mucosa. Continuous monitoring of heart rate, ECG, and oxygen saturation showed no decrease in oxygen levels, and the patient maintained spontaneous breathing throughout. Intensive treatment with crystalloid fluids and blood transfusion, along with right internal carotid embolization with a spring coil, effectively prevented massive hemorrhage. The patient was successfully extubated after three days in the ICU and discharged 15 days post-surgery without any neurological deficits. Keywords: Awake Tracheal Intubation; Difficult Airway Management; Fiberoptic Scope; Emergency Airway Management Citation: Ba NTT. Successful emergency management of hemorrhagic shock due to carotid artery aneurysm: the role of awake intubation in difficult airway control. Anaesth. pain intensive care 2024;28(5):955−959. DOI: 10.35975/apic.v28i5.2572 Received: January 03, 2024; Reviewed: May 05, 2024; Accepted: June 11, 2024

The expectations humans have of a pleasurable sensation asymmetrically shape neuronal responses and subjective experiences to hot sauce.

Expectations shape our perception, profoundly influencing how we interpret the world. Positive expectations about sensory stimuli can alleviate distress and reduce pain (e.g., placebo effect), while negative expectations may heighten anxiety and exacerbate pain (e.g., nocebo effect). To investigate the impact of the (an)hedonic aspect of expectations on subjective experiences, we measured neurobehavioral responses to the taste of hot sauce among participants with heterogeneous taste preferences. By identifying participants who "liked" versus those who strongly "disliked" spicy flavors and by providing contextual cues about the spiciness of the sauce to be tasted, we dissociated the effects of positive and negative expectations from sensory stimuli (i.e., visual and gustatory stimuli), which were the same across all participants. Our results indicate that positive expectations lead to modulations in the intensity of subjective experience. These modulations were accompanied by increased activity in brain regions previously linked to information integration and the placebo effect, including the anterior insula, dorsolateral prefrontal cortex, and dorsal anterior cingulate cortex, as well as a predefined "pleasure signature." In contrast, negative expectations decreased hedonic experience and increased neural activity in the previously validated "Neurological Pain Signature" network. These findings demonstrate that hedonic aspects of one's expectations asymmetrically shape how the brain processes sensory input and associated behavioral reports of one's subjective experiences of intensity, pleasure, and pain. Our results suggest a dissociable impact of hedonic information: positive expectations facilitate higher-level information integration and reward processing, while negative expectations prime lower-level nociceptive and affective processes. This study demonstrates the powerful role of hedonic expectations in shaping subjective reality and suggests potential avenues for consumer and therapeutic interventions targeting expectation-driven neural processes.

Contribution of inflammation markers and quantitative sensory testing (QST) indices of central sensitisation to rheumatoid arthritis pain.

Pain, the primary complaint in rheumatoid arthritis (RA), is multifaceted, and may be driven by inflammatory disease activity and central sensitisation. We aimed to ascertain what proportion of RA pain severity is explained by markers of inflammation and quantitative sensory testing (QST) indices of central sensitisation. This was a cross-sectional analysis of data from individuals with clinically active RA. Pain severity was assessed using numerical rating scales and inflammation via 28-joint Disease Activity Score (DAS28) and Ultrasound (Greyscale, Power Doppler). Pain sensitivity was assessed by 'static' (tibialis anterior or brachioradialis pressure pain detection threshold-PPT-TA/PPT-BR) and 'dynamic' (temporal summation-TS, conditioned pain modulation-CPM) QST. Bivariate associations used Spearman's correlation coefficients, and multivariable linear regression models determined relative contributions to pain severity. In bivariate analyses of N = 96 (age 65 ± 10y, 77% females) people with RA, pain severity was significantly associated with inflammation indices (r = 0.20 to 0.55), and CPM (r=-0.26). In multivariable models that included TS, CPM, age, sex, and body mass index, inflammation indices remained significantly associated with pain severity. Multivariable models explained 22 to 27% of pain variance. Heterogeneity was apparent for associations with pain between subscores for pain now, strongest or average over the past 4-weeks. In individuals with clinically active RA, markers of inflammatory disease activity best explain RA pain with only marginal contributions from QST indices of central sensitisation. Although inflammation plays a key role in the experience of RA pain, the greater proportion of pain severity remains unexplained by DAS28 and ultrasound indices of inflammation.

Examining the relationships between pain symptoms and psychosocial functioning among women living with and at risk for human immunodeficiency virus using a cross-sectional psychological network analysis.

Pain is prevalent among women living with HIV (WLWH); however, research on pain experience among WLWH in the United States is limited. This study used a network analysis to simultaneously examine the relationships between pain experience and psychosocial functioning among WLWH and human immunodeficiency virus (HIV)-negative women. A secondary analysis of public data from the Women's Interagency HIV Study, a U.S. longitudinal cohort study of the experiences of WLWH and women at increased risk for HIV (HIV negative), was completed. Data were from Visit 42 in 2015 and included 451 WLWH and 194 HIV-negative women who endorsed experiencing pain in the week prior to the interview. Similar to the sociodemographic characteristics of WLWH in the United States, the majority of women in the sample were racially and/or ethnically minoritized and of low socioeconomic position. Networks were modeled using measures of pain intensity, pain interference, depression symptoms, anxiety/worry symptoms, meaning in life, and emotional support. Network models for WLWH and HIV-negative women were comparable (ps > .05). Depression symptoms were a central construct (strength = 1.82 and 1.77, respectively) within the networks, and pain interference was associated with psychosocial constructs (ps < .05), while pain intensity was not (ps > .05). Meaning in life and emotional support were not directly associated with pain (ps > .05). Network findings suggest that reducing depression symptoms may result in improved pain experience and broader positive impact for WLWH and for women at increased risk of HIV. This finding is consistent with research with other pain-focused populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perceived discrimination and pain outcomes among black adults with chronic musculoskeletal pain: identifying modifiable psychosocial risk factors.

Chronic musculoskeletal pain (CMP) is highly prevalent, frequently associated with negative health outcomes, and disproportionately impacts Black Americans. Perceived racial and ethnic discrimination has emerged as a factor that may influence the experience of chronic pain in this population. Identifying modifiable psychosocial factors that influence the link between perceived discrimination and pain and that can be directly targeted in treatment is vital to reducing the disproportionate burden of CMP among Black individuals. The present study examines the moderating role of five risk factors (i.e., pain avoidance, pain fusion, experiential avoidance, pain catastrophizing, and pain anxiety) on the relationship between perceived discrimination and pain outcomes (i.e., pain intensity and interference) in a sample of 401 Black adults with CMP. We recruited 401 Black individuals (Mage = 35.98, 51.9% female) with self-reported CMP and assessed their self-reported perceived discrimination, pain intensity, pain interference, and pain-related psychosocial risk factors. Results indicated that higher scores on each of the psychosocial risk factors (i.e., pain avoidance, pain fusion, experiential avoidance, pain catastrophizing, and pain anxiety) were significantly associated with greater pain intensity and pain interference (all ps < 0.01). Further, pain avoidance (B = 0.12, p = .006), pain fusion (B = 0.13, p = .002), and pain anxiety (B = 0.13, p = .002) each significantly moderated the relation between perceived discrimination and pain intensity. Greater perceived discrimination was associated with greater pain intensity at higher levels of avoidance and fusion, and was associated with less pain intensity at lower levels of avoidance and pain anxiety. In interaction models predicting pain interference, both pain fusion (B = 0.14, p = .001) and pain anxiety (B = 0.10, p = .01) significantly moderated the relation between perceived discrimination and pain interference. Perceived discrimination was associated with greater pain interference at higher levels of pain fusion and pain anxiety, and was not associated with pain interference at lower levels of pain fusion and pain anxiety. The present findings provide important insights into psychosocial risk factors that moderate the link between perceived discrimination and pain outcomes, providing important clinical implications for the treatment of Black adults with chronic musculoskeletal pain.