Impending Pain Research Articles

A Cross-Sectional Survey on Pain Management in Dermal Filler Injections from Physicians' and Patients' Perspectives.

Hyaluronic acid (HA) dermal fillers injection is a common procedure in patients with cosmetic needs. Concomitant pain is a major complaint among patients undergoing HA filler injections. Relevant research is limited and there is no consensus on pain management of dermal filler injection. To assist physicians in determining a more appropriate treatment approach, and to better provide treatment suggestions. A nationwide (China) cross-sectional survey was conducted using questionnaires designed for physicians and patients, respectively. A total of 62 semi-structured questionnaires were administered to aesthetic physicians via face-to-face interview, whereas 123 online-based questionnaires were collected from patients who have ever undergone HA treatment. The collected questionnaire information was analyzed using descriptive statistics and content analysis. 42 (67.74%) physicians observed that over 50% of their patients were concerned about pain during injection. 101 (82.11%) of patients were concerned about impending pain ≥5 points (a total score is 10) before injection. For preferred pain relief modalities, 48 (77.42%) physicians would choose a hyaluronic acid dermal filler with lidocaine, and 82 (66.67%) patients would choose anesthetic-containing products. 59 (95.16%) physicians who injected lidocaine-containing hyaluronic acid found patients had a comfortable treatment experience. Pain management during hyaluronic acid dermal fillers injection is important from both perspectives of physicians and patients. This survey showed that compared with other analgesic methods, lidocaine-containing hyaluronic acid has offered a more satisfying experience. It also provides insights to physicians and patients in pain management. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Top-down threat bias in pain perception is predicted by higher segregation between resting-state networks.

Top-down processes such as expectations have a strong influence on pain perception. Predicted threat of impending pain can affect perceived pain even more than the actual intensity of a noxious event. This type of threat bias in pain perception is associated with fear of pain and low pain tolerance, and hence the extent of bias varies between individuals. Large-scale patterns of functional brain connectivity are important for integrating expectations with sensory data. Greater integration is necessary for sensory integration; therefore, here we investigate the association between system segregation and top-down threat bias in healthy individuals. We show that top-down threat bias is predicted by less functional connectivity between resting-state networks. This effect was significant at a wide range of network thresholds and specifically in predefined parcellations of resting-state networks. Greater system segregation in brain networks also predicted higher anxiety and pain catastrophizing. These findings highlight the role of integration in brain networks in mediating threat bias in pain perception.

MEASUREMENT OF STRESS LEVEL IN BUFFALOES BY THE EFFECT OF REPEATED RECTAL PALPATION IN TEACHING ENVIRONMENT

Livestock contributed 60.1 percent to the agriculture value added and 11.5 % in overall GDP during 2020-21 (Economic Survey 2020-21). Livestock plays a major and vital role in socio economic development of rural region of country. According to economic survey of Pakistan, 42.4 million buffalo population is present in Pakistan. Small holding buffalo farming system is present in rural areas of Pakistan. Rectal palpation is the most useful method for conducting pregnancy diagnosis, artificial inseminations and detection of various reproductive anomalies in large domestic animals like cows and buffaloes. This procedure, however, can prove to be stressful and painful for these animals which raise an animal health and welfare issue. Blood picture in terms of changed levels of cortisol, glucose, cholesterol and blood cells may occur in animals subjected to this procedure. Similarly, behavioral symptoms of elevated heart rate and respiratory rates may also occur. The aim of the current project, therefore, was to study the effects of repeated rectal palpation-related stress response in blood constituents in buffaloes so that the appropriate counter measures could be adapted to save the animals from impending pain and stress. The study was conducted on ten buffaloes divided into two groups each i.e. experimental and control. Buffaloes were subjected to rectal palpation procedure. Blood samples were collected before and after rectal palpation for serum cortisol and complete blood cells count. Blood samples were also collected from buffaloes of control group without rectal palpation. Physical parameters were also noted. No statistically significant difference found in cortisol levels, CBC or physical parameters i.e. TPR that demonstrates that rectal palpation procedure inflicts no harm to buffaloes and can be used for the training of students.

Testing links between pain-related biases in visual attention and recognition memory: An eye-tracking study based on an impending pain paradigm.

Although separate lines of research have evaluated pain-related biases in attention or memory, laboratory studies examining links between attention and memory for pain-related information have received little consideration. In this eye-tracking experiment, we assessed relations between pain-related attention biases (ABs) and recognition memory biases (MBs) among 122 pain-free adults randomly assigned to impending pain (n = 59) versus impending touch (n = 63) conditions, wherein offsets of trials that included pain images were followed by subsequent possibly painful and non-painful somatosensory stimulation, respectively. Gaze biases of participants were assessed during presentations of pain-neutral (P-N) and happy-neutral (H-N) face image pairs within these conditions. Subsequently, condition differences in recognition accuracy for previously viewed versus novel pained and happy face images were examined. Overall gaze durations were significantly longer for pain (vs. neutral) faces that signalled impending pain than impending non-painful touch, particularly among the less resilient in the former condition. Impending pain cohorts also exhibited comparatively better recognition accuracy for both pained and happy face images. Finally, longer gaze durations on pain faces that signalled potential pain, but not potential touch, were related to more accurate recognition of previously viewed pain faces. In sum, pain cues that signal potential personal discomfort maintain visual attention more fully and are subsequently recognised more accuracy than are pain cues that signal non-painful touch stimulation.

Top-down threat bias in pain perception is predicted by intrinsic structural and functional connections of the brain

Top-down processes such as expectations play a key role in pain perception. In specific contexts, inferred threat of impending pain can affect perceived pain more than the noxious intensity. This biasing effect of top-down threats can affect some individuals more strongly than others due to differences in fear of pain. The specific characteristics of intrinsic brain characteristics that mediate the effects of top-down threat bias are mainly unknown. In this study, we examined whether threat bias is associated with structural and functional brain connectivity. The variability in the top-down bias was mapped to the microstructure of white matter in diffusion weighted images (DWI) using MRTrix3. Mean functional connectivity of five canonical resting state networks was tested for association with bias scores and with the identified DWI metrics. We found that the fiber density of the splenium of the corpus callosum was significantly low in individuals with high top-down threat bias (FWE corrected with 5000 permutations, p < 0.05). The mean functional connectivity within the language/memory and between language/memory and default mode networks predicted the bias scores. Functional connectivity within language memory networks predicted the splenium fiber density, higher pain catastrophizing and lower mindful awareness. Probabilistic tractography showed that the identified region in the splenium connected several sensory regions and high-order parietal regions between the two hemispheres, indicating the splenium's role in sensory integration. These findings demonstrate that individuals who show more change in pain with changes in the threat of receiving a stronger noxious stimulus have lower structural connectivity in the pathway necessary for integrating top-down cue information with bottom-up sensory information. Conversely, systems involved in memory recall, semantic and self-referential processing are more strongly connected in people with top-down threat bias.

Visual attention to pain cues for impending touch versus impending pain: An eye tracking study.

In this eye tracking study, we evaluated pain-related biases in orienting and maintenance of gaze within impending touch versus impending pain tasks and examined features of pain resilience as individual difference influences on potential biases. Gaze preferences of healthy adults (25 women and 39 men) were assessed during standardized pain-neutral (P-N) image pair presentations (2,000ms) of an impending touch task versus an impending pain task whereby image pair offsets were followed by potential non-painful touch and potential pain stimulation, respectively. Within each task, participants were significantly more likely to fixate first upon pain images in P-N pairs and maintain gaze on these images for longer overall durations during trials. Between task comparisons indicated pain-related biases in orienting and maintenance were significantly stronger when image pairs signalled potential pain rather than impending touch. Finally, within the impending pain task, higher scores on the behaviour perseverance dimension of pain resilience were related to shorter first fixation durations and overall gaze durations towards pain images. Supporting specific threat interpretation model premises, comparatively more threatening external pain cues for impending pain were characterized by gaze biases reflecting pronounced early attentional capture and subsequent prolonged vigilance. However, elevations in self-reported behavioural perseverance in spite of pain corresponded to an increased capacity to disengage from pain images that signalled potential pain. Gaze biases were assessed within a comparatively benign "impending touch" paradigm versus a higher threat, impending pain task. Early capture and maintenance of gaze towards pain images were more pronounced on the latter task, although pain resilient participants were able to disengage more easily from pain images signalling possible pain.

Effects of higher versus lower threat contexts on pain-related attention biases: An eye-tracking study.

Threat is hypothesized to affect the degree to which pain captures attention but little is known about its impact on dynamic courses of attention towards pain. In this eye-tracking study, we evaluated pain-related visual attention biases during image pair presentations in comparatively lower versus higher threat conditions. Gaze biases of healthy adults (47 women, 35 men) were assessed during image presentation phases standardized across (1) a modified visual dot-probe task featuring painful-neutral (pain) and neutral-neutral contrast (neutral) image pair blocks (lower threat context); and (2) an impending pain task wherein the same image pair blocks, respectively, cued potentially painful postoffset somatosensory stimuli (higher threat context) and its absence. Across tasks, participants were more often oriented towards, gazed longer at, and fixated more times on pain images in pain block trials, although trait fear of pain was not related to any gaze biases. Critically, however, participants reported more state fear and displayed significantly fewer initial fixations, longer first and overall gaze durations, and more unique fixations on pain images when image pairs signalled possible postoffset pain stimulation. Results underscored stronger overall attention maintenance on visual pain cues in a higher threat (impending pain) context. Through considering gaze parameters during image presentation phases of dot-probe and impending pain tasks, possible effects of lower versus higher threat contexts on attention biases were elucidated. Participants reported more fear and gazed longer at painful than neutral images in the higher threat context whereby image pairs cued possible pain.

Effects of Higher Versus Lower Threat Contexts on Pain-Related Visual Attention Biases: An Eye-Tracking Study of Chronic Pain

In this research, we examined effects of higher versus lower threat contexts on attention biases in more and less pain-fearful chronic pain subgroups via eye-tracking methodology. Within a mixed chronic pain sample (69 women, 29 men), biases in orienting and maintenance of visual attention were assessed during the standardized image pair presentation phase (2,000 ms) of a modified visual dot probe task featuring painful-neutral (P-N) image pairs (lower threat context) and a parallel task in which these P-N pairs cued potential pain (higher threat context). Across both tasks, participants more often oriented toward, gazed longer at, and made more unique fixations upon pain images during P-N pair presentations. Although trait-based fear of pain was not related to any gaze bias index in either task, between task analyses indicated the sample reported more state fear, directed their initial gaze less often, and displayed longer overall gaze durations toward pain images in the higher threat context in which P-N trials signaled potential pain. Results supported the threat interpretation model premise that persons with chronic pain have difficulty disengaging from moderately threatening visual painful cues. PerspectiveThrough integrating dot-probe and impending pain task paradigms, we assessed effects of lower versus higher threat contexts on visual attention biases of persons with chronic pain via eye tracking. Under higher threat conditions featuring possible pain, state fear levels were elevated and maintenance of attention on painful depictions was more prolonged.

Uncertainty about the intensity of impending pain increases ensuing pain responses in congenital blindness

We have shown that congenitally blind individuals are more sensitive to painful heat compared to their sighted counterparts. This hypersensitivity might be at least partly mediated by psychological and cognitive factors, such as pain expectation and anxiety. Here we investigate whether uncertainty about the intensity of a pending painful stimulus affects pain differently in congenitally blind and sighted control subjects. We measured pain and anxiety in a group of 11 congenitally blind and 11 age- and sex-matched normal sighted control participants. Painful stimuli were delivered under two psychological conditions, whereby participants were either certain or uncertain about the intensity of a pending noxious stimuli. Although both blind and sighted participants had increased anxiety ratings in the uncertain condition, pain ratings increased only in the congenitally blind participants. Our data therefore indicate that increased anxiety levels have a stronger influence on the perceived pain intensity in blind individuals, possibly because they allocate greater attention to signals of external threat.

Simple Psychological Interventions for Reducing Pain From Common Needle Procedures in Adults: Systematic Review of Randomized and Quasi-Randomized Controlled Trials.

This systematic review evaluated the effectiveness of simple psychological interventions for managing pain and fear in adults undergoing vaccination or related common needle procedures (ie, venipuncture/venous cannulation). Databases were searched to identify relevant randomized and quasi-randomized controlled trials. Self-reported pain and fear were prioritized as critically important outcomes. Data were combined using standardized mean difference (SMD) or relative risk (RR) with 95% confidence intervals (CI). No studies involving vaccination met inclusion criteria; evidence was drawn from 8 studies of other common needle procedures (eg, venous cannulation, venipuncture) in adults. Two trials evaluating the impact of neutral signaling of the impending procedure (eg, "ready?") as compared with signaling of impending pain (eg, "sharp scratch") demonstrated lower pain when signaled about the procedure (n=199): SMD=-0.97 (95% CI, -1.26, -0.68), after removal of 1 trial where self-reported pain was significantly lower than the other 2 included trials. Two trials evaluated music distraction (n=156) and demonstrated no difference in pain: SMD=0.10 (95% CI, -0.48, 0.27), or fear: SMD=-0.25 (95% CI, -0.61, 0.10). Two trials evaluated visual distraction and demonstrated no difference in pain (n=177): SMD=-0.57 (95% CI, -1.82, 0.68), or fear (n=81): SMD=-0.05 (95% CI, -0.50, 0.40). Two trials evaluating breathing interventions found less pain in intervention groups (n=138): SMD=-0.82 (95% CI, -1.21, -0.43). The quality of evidence across all trials was very low. There are no published studies of simple psychological interventions for vaccination pain in adults. There is some evidence of a benefit from other needle procedures for breathing strategies and neutral signaling of the start of the procedure. There is no evidence for use of music or visual distraction.

Parceling Human Accumbens into Putative Core and Shell Dissociates Encoding of Values for Reward and Pain

In addition to their well-established role in signaling rewarding outcomes and reward-predictive cues and in mediating positive reinforcement, there is growing evidence that nucleus accumbens (NAc) neurons also signal aversive events and cues that predict them. Here we use diffusion tractography to subdivide the right NAc into lateral-rostral (putative core, pcore) and medial-caudal (putative shell, pshell) subdivisions in humans. The two subregions exhibited differential structural connectivity, based on probabilistic tractography, to prefrontal cortical and subcortical limbic regions. We also demonstrate unique roles for each of the two subdivisions for monetary reward and thermal pain perception tasks: pshell signaling impending pain and value predictions for monetary gambles and pcore activating with anticipation of cessation of thermal pain (signaling reward value of analgesia). We examined functional connectivity for resting state, monetary reward, and thermal pain tasks, and for all three conditions observed that pcore and pshell of right NAc exhibit distinct patterns of synchrony (functional connectivity) to prefrontal cortical and subcortical limbic targets within the right hemisphere. To validate the NAc segregation, we mirrored the coordinates of right NAc pcore and pshell onto the left hemisphere and examined structural and resting state connectivity in the left hemisphere. This latter analysis closely replicated target-specific connections we obtained for the right hemisphere. Overall, we demonstrate that the human NAc can be parceled based on structural and functional connectivity, and that activity in these subdivisions differentially encodes values for expected pain relief and for expected monetary reward.

Nonpain goal pursuit inhibits attentional bias to pain

Although dealing with pain is a vital goal to pursue, most individuals are also engaged in the pursuit of other goals. The aim of the present experiment was to investigate whether attentional bias to pain signals is inhibited when one is pursuing a concurrent salient but nonpain task goal. Attentional bias to pain signals was measured in pain-free volunteers (n=63) using a spatial cueing task with pain cues and neutral cues. The pursuit of a concurrent goal was manipulated by including additional trials in which a digit appeared at the middle of the screen. Half of the participants (goal group) were instructed to name these additional stimuli aloud. In order to increase the affective-motivational value of this non-pain-related goal, monetary reward and punishment were made contingent upon the performance of this task. Participants of the control group did not perform the additional task. As predicted, the results show attentional bias to pain signals in the control group, but not in the goal group. This indicates that attentional bias to signals of impending pain is inhibited when one is engaged in the pursuit of another salient but nonpain goal. The results of this study underscore a motivational view on attention to pain, in which the pursuit of multiple goals, including nonpain goals, is taken into account.

Fibromyalgia unique temporal brain activation during experimental pain: a controlled fMRI Study

Studies with functional neuroimaging support the hypothesis of central pain augmentation in fibromyalgia syndrome (FMS) with functional differences in areas of the medial pain system. To clarify whether these findings are unique to patients with FMS, BOLD-signal patterns during and before tonic experimental pain were compared to healthy controls and patients with rheumatoid arthritis (RA) as a chronic pain disorder of somatic origin. We expected different BOLD-signal patterns in areas of the medial pain system that were most pronounced in patients with FMS. An fMRI-block design before, during and after an incision was performed in patients with FMS (n = 17), RA (n = 16) and in healthy controls (n = 17). A 2-factorial model of BOLD-signal changes was designed to explore significant differences of brain activation between the groups during the pain stimulus. Additionally, the correlation of brain activity during the anticipation of pain with the amount of the impending pain was determined. We observed a FMS-unique temporal brain activation of the frontal cortex in patients with FMS. Moreover, areas of the motor cortex and the cingulate cortex presented a FMS-specific relation between brain activity during pain anticipation and the magnitude of the subsequent pain experience. Our results support the hypothesis that central mechanisms of pain processing in the frontal cortex and cingulate cortex may play an important role in patients with FMS.

Dissociating nociceptive modulation by the duration of pain anticipation from unpredictability in the timing of pain

Objective Waiting longer to receive pain increases its perceived unpleasantness by inducing ‘dread’. However, it is not clear how unpredictability in the timing of the impending pain stimulus interacts with dread and whether the two factors show differential effects on the neural generators of the pain-evoked response. Methods We manipulated the duration of anticipation of laser-induced pain independently of unpredictability of stimulus delivery timing, to observe the relative effect on P2 amplitudes of the laser-evoked potential (LEP) response and its estimated sources. Results Subjects ( n = 12) reported increased pain ratings after longer pain anticipation, irrespective of unpredictability in the timing of stimulus delivery. By contrast, unpredictability in stimulus timing increased the amplitude of the P2 irrespective of anticipation duration. The modulation of P2 amplitude by unpredictability was localized to midcingulate cortex (MCC) and ipsilateral secondary somatosensory (S2) areas. Greater anticipation duration increased activity in a hippocampal-insula-prefrontal network but not in MCC areas. Conclusions Distinct neural networks contribute to the P2 and are differentially affected by pain anticipation duration and unpredictability in stimulus timing. Significance ERP research into dread should be careful to appreciate the neural generators of pain-evoked responses and their potential modulation by unpredictability.

Is it better to have controlled and lost than never to have controlled at all? An experimental investigation of control over pain

Trying to control pain is a common human goal. But little is know about what happens when one loses control over pain. This paper reports an experiment with 74 healthy volunteers, half of whom were given control over a pain stimulus and subsequently lost control, and half of whom never had control over the pain. This study investigates whether having had control and lost it would result in a more unpleasant pain experience, more fear about impending pain, a heightened vigilance to pain, and greater interference on a secondary task. Participants in the experimental group first learned to avoid a painful stimulus by correctly responding to a card sorting task, but later on lost control over the painful stimulus. In the yoked comparison group, participants had no control over the painful stimulus from the beginning. Results indicated that losing control over pain and, relatedly, attempting to control uncontrollable pain have significant costs such as a higher fear of the impending pain stimulus and retarded performance on a secondary task. When attempts to avoid pain are blocked, individuals persist in their avoidance attempts, try harder, and narrow their focus of attention upon the problem to be solved. These findings are discussed within the context of a dual process model of coping with uncontrollable adverse events [Brandtstädter J, Renner G. Tenacious goal pursuit and flexible goal adjustment: explication and age-related analysis of assimilative and accommodative strategies of coping. Psychol Aging 1990;5:58–67] and possible mechanisms for perseverance with ineffective solutions.

Nocebo hyperalgesia: how anxiety is turned into pain

Nocebo hyperalgesia is a phenomenon that is opposite to placebo analgesia and whereby expectation of pain increase plays a crucial role. In recent times, both the neuroanatomical and the neurochemical bases of the nocebo effect and of nocebo-related effects have begun to be explored. Here, we highlight recent advances in our understanding of the neurobiology of the nocebo hyperalgesic effect. A typical nocebo hyperalgesic response occurs following the administration of an inert substance which the subject believes to be a hyperalgesic agent (negative placebo or nocebo). It has been shown that the subject's negative expectations of pain worsening induce anticipatory anxiety about the impending pain increase and this triggers the activation of cholecystokinin that, in turn, facilitates pain transmission. Accordingly, cholecystokinin antagonists have been found to prevent this anxiety-induced hyperalgesia. Brain-imaging studies have shown that the perceived intensity of a painful stimulus following negative expectations of pain increase is higher than in the absence of negative expectations and this is associated with changes in activation of specific brain regions. Since pain appears to be amplified by anxiety through the activation of cholecystokininergic systems, new therapeutic strategies, such as new cholecystokinin antagonists, can be envisaged whenever pain has an important anxiety component.

Modulation of pain ratings by expectation and uncertainty: Behavioral characteristics and anticipatory neural correlates

Expectations about the magnitude of impending pain exert a substantial effect on subsequent perception. However, the neural mechanisms that underlie the predictive processes that modulate pain are poorly understood. In a combined behavioral and high-density electrophysiological study we measured anticipatory neural responses to heat stimuli to determine how predictions of pain intensity, and certainty about those predictions, modulate brain activity and subjective pain ratings. Prior to receiving randomized laser heat stimuli at different intensities (low, medium or high) subjects ( n = 15) viewed cues that either accurately informed them of forthcoming intensity (certain expectation) or not (uncertain expectation). Pain ratings were biased towards prior expectations of either high or low intensity. Anticipatory neural responses increased with expectations of painful vs. non-painful heat intensity, suggesting the presence of neural responses that represent predicted heat stimulus intensity. These anticipatory responses also correlated with the amplitude of the Laser-Evoked Potential (LEP) response to painful stimuli when the intensity was predictable. Source analysis (LORETA) revealed that uncertainty about expected heat intensity involves an anticipatory cortical network commonly associated with attention (left dorsolateral prefrontal, posterior cingulate and bilateral inferior parietal cortices). Relative certainty, however, involves cortical areas previously associated with semantic and prospective memory (left inferior frontal and inferior temporal cortex, and right anterior prefrontal cortex). This suggests that biasing of pain reports and LEPs by expectation involves temporally precise activity in specific cortical networks.

Levels of appraisal: A medial prefrontal role in high-level appraisal of emotional material

Appraisal refers to the evaluation of the meaning of emotional stimuli and is considered causal in the generation of an emotional response. Cognitive neuroscience has paid little attention to a theoretical distinction between low-level appraisal, considered to be automatic and preattentive, and high-level appraisal that requires attentional and working memory resources. To disentangle low-level from high-level appraisal, we varied cognitive load in a concurrent, unrelated working memory task, while anxiety was induced through anticipation of impending pain. Confirming theoretical predictions, we show that anxiety-related activity in dorsal medial prefrontal/rostral anterior cingulate cortex (dorsal MPFC/ACC) is attenuated under high, relative to low, cognitive load. Lateral prefrontal regions previously implicated in reappraisal and cognitive emotion regulation show a similar interaction between anxiety and cognitive load. Critically, there were no changes in physiological and subjective measures of low-level appraisal outcome and emotional response generation as a function of load, allowing us to conclude that MPFC/ACC and lateral PFC activity during anticipatory anxiety reflects high-level appraisal. Our data provide neurobiological evidence for a distinction between low-level and high-level appraisal mechanisms.

How to Use PAP to Make AYP under NCLB

Today's educators live in fear of draconian consequences of to make yearly under No Child Left Behind Act. Mr. Popham offers sage advice on how to comply with law and not get hurt. ONE OF B. F. Skinner's little-known principles of reinforcement states, If any organism, human or subhuman, discerns prospect of impending pain, that organism will attempt to avoid such This principle, often shunned by strict behaviorists because it seems corrupted by cognitive overtones, was first articulated in 1965 in an unpublished essay. The essay is known chiefly because of Skinner's concluding comment that inside every fat rat is a thin rat yearning for food pellets. Skinner's pain-avoidance principle was somewhat unimaginatively identified by Skinner as pain-avoidance principle. In referring to it, reinforcement theorists typically use its initials: PAP. Pain Potential of a Federal Law PAP, then, describes proclivity of organisms to avoid upcoming pain. And if ever there was a law that possessed enormous potential for inflicting pain, it is surely No Child Left Behind (NCLB) Act. Signed into law in early 2002, this federal statute is thought by some analysts to be, in fact, an enormous pile of pap. The NCLB pain to be avoided, of course, is associated with formidable set of aversive consequences that kick in when a public school fails to get its students to make adequate yearly progress (AYP), as measured by improvements on approved achievement tests. At best, a school that fails to make AYP is merely regarded by public as ineffectual. However, those failing schools that receive Title I funds are placed on an improvement track that, in time, can improve a school right out of existence. In following analysis, I offer guidance to my public school colleagues who, yearning to dodge distress brought on by NCLB, sometimes operate solely on basis of PAP. First, I will identify a number of tactics currently being employed to escape pain of NCLB and then describe a set of tactics -- not yet widely in use -- that show considerable PAP potential. Following inspirational insight of Stephen Potter, who in 1947 introduced us to gamesmanship as the art of winning games without actually cheating, I shall refer to all of these tactics -- sometimes psychometric, sometimes psychological, sometimes psychotic -- as ploys. More specifically, I will dub them NCLB PAP Ploys. I won't spend much space on array of NCLB PAP Ploys that are already in widespread use. Clearly, word is getting around regarding which tactics can help evade AYP-induced failure. As more educators learn about these federally sanctioned schemes to avoid pain, we can safely predict that education profession's mimicry machine will kick into high gear. My chief purpose here is to introduce educators to a set of inchoate, innovative tactics that, if employed adroitly, will stave off a great deal of suffering. NCLB PAP Ploys Now in Use 1. Challenge chopping. Because a state's yearly NCLB tests must, by federal law, be based directly on a state's challenging goals, and because students' low scores on those tests will lead to AYP failure, some states have tried to minimize NCLB-induced casualties simply by lowering challenge levels of their state curricula. Many educators have already learned to their distress that -- from a public relations perspective -- such wholesale reductions in a state's aspirations must be labeled with consummate care. For obvious reasons, these sorts of endeavors should not be described as expectation lowering, standard softening, or dreaded dumbing down. Indeed, there is even some risk in referring to such an overhaul of state as curriculum revision. Revision, after all, could go either way. The best label for such challenge chopping currently appears to be curricular refinement. …

Pain catastrophizing and the underestimation of impending acute pain

Pain catastrophizing and the underestimation of impending acute pain