Pain Cues Research Articles

Large language model-driven sentiment analysis for facilitating fibromyalgia diagnosis

BackgroundFibromyalgia (FM) is a complex disorder with widespread pain and emotional distress, posing diagnostic challenges. FM patients show altered cognitive and emotional processing, with a preferential allocation of attention to...

The Interrelationships Between Cognitive Biases for Pain: An Experimental Study

Contemporary pain models highlight cognitive-processing biases (ie, attention bias [AB], interpretation bias [IB], and memory bias [MB]) as key processes that contribute to poor pain outcomes. However, existing research has yielded inconsistent findings regarding the presence and impact of these biases on pain outcomes. Recognizing the need to explore these biases simultaneously, contemporary pain models suggest that cognitive biases (CBs) are interrelated, and may have a combined impact upon pain problems. The current study aims to investigate the interrelationships between CBs using the PainAIM paradigm, a novel approach enabling simultaneous evaluation of pain-related AB, IB, and MB using cues signaling actual pain rather than symbolic information. We hypothesized the presence and positive associations of biases for pain-related cues and the predictive value of combined AB and IB for poor pain outcomes. Eighty-four healthy participants completed the PainAIM paradigm, followed by a cold pressor task probing pain experience and pain-related task interference. The results indicated an inverse relationship between AB and IB for ambiguous pain cues. In addition, there was a positive association between participants’ AB for ambiguous pain and their MB for the same cues. Contrary to our hypotheses, CB indices did not predict experimental pain outcomes. These findings provide support for the interrelationships between pain-related CBs. However, future research on the temporal order of CBs and their combined impact on pain outcomes is needed. By overcoming the limitations associated with traditional paradigms, the PainAIM paradigm offers a promising research tool for the further study of combined CBs in the context of pain. PerspectiveThe current study provides insight into the associations between pain-related CBs (AB, IB, and MB) using ecologically valid (ambiguous) pain cues. The results indicated an inverse association between pain-related AB and IB, while a positive association was found between AB and MB. CBs did however not predict experimental pain outcomes.

Pain assessment & management decision-making in pediatric critical care

PurposeThe aim of this study was to explore how nurses in the Pediatric Intensive Care Unit (PICU) reach their pain management decisions in children who are mechanically ventilated and chemically paralyzed. Design and methodsA qualitative descriptive design was used following a quantitative phase of a multi-method study. Eighteen PICU nurses participated in semi-structured interviews aiming at understanding how they assess pain and make management decisions. Content analysis was used to guide coding and generate themes. ResultsThree major themes were identified: 1) Assessment or cues that nurses use to trigger a pain assessment; 2) Mental models or patterns that nurses create to interpret cues to guide decision-making; 3) External factors that inhibit or facilitate decision-making. Overall, nurses rely on physiological cues to assess pain. From there, a large amount of variation exists on how nurses interpret those cues to make their pain management decision. External factors such as unit culture, perceived barriers and facilitators, and the nurse's experiences impacted how decisions are made. ConclusionsVariation exists in the mental models' nurses create to make their pain management decision in this population. Nurses reported confusion on pain and sedation scale selection and various documentation practices for pain assessment. “Assume pain present” was identified as a concept and documentation practice that may guide decisions; further research is needed. Practice implicationsDevelopment of clinician decision support tools that not only aid their understanding of reliable pain cues but also help create clear documentation practices may help nurses make pain management decisions.

Vicarious facilitation of facial responses to pain.

Observing facial expressions of pain has been shown to lead to increased subjective, neural and autonomic pain responses. Surprisingly, these vicarious facilitation effects on its corresponding response channel, namely facial responses to pain have mostly been neglected. We aim to examine whether the prior exposure to facial expressions of pain leads to a facilitation of facial responses to experimental pain; and whether this facilitation is linked to the valence (pain vs. neutral expression) or also linked to specific motor-features of the facial pain expressions (different facial muscle movements). Subjective (intensity and unpleasantness ratings) and facial responses (Facial Action Coding System) of 64 participants (34 female) to painful and non-painful heat stimuli were assessed. Before each heat stimulus, video clips of computer-generated facial expressions (three different pain expressions and a neutral expression) were presented. The prior exposure to facial expressions of pain led to increased subjective and facial responses to pain. Further, vicarious pain facilitation of facial responses was significantly correlated with facilitation of unpleasantness ratings. We also found evidence that this vicarious facilitation of facial responses was not only linked to the presentation of pain versus neutral expressions but also to specific motor-features of the pain cue (increase in congruent facial muscle movements). Vicarious pain facilitation was found for subjective and facial responses to pain. The results are discussed with reference to the motivational priming hypothesis as well as with reference to motor priming. Our study uncovers evidence that facial pain responses are not only influenced by motivational priming (similar to other types of pain responses), but also by motor-priming. These findings shed light on the complexity - ranging from social, affective and motor mechanisms - underling vicarious facilitation of pain.

The establishment, maintenance, and adaptation of high- and low-impact chronic pain: a framework for biopsychosocial pain research.

The establishment, maintenance, and adaptation of high- and low-impact chronic pain: a framework for biopsychosocial pain research.

From Oxytocin to Compassion: The Saliency of Distress.

Compassion is a warm response of care and concern for those who are suffering, which drives individuals to devote their resources for the sake of others. A prominent neuroevolutionary framework grounds compassion in the neurobiology of the mammalian caregiving system. Accordingly, it has been suggested that the oxytocinergic system, which plays a central role in parental caregiving and bonding, provides the neurobiological foundation for compassion towards strangers. Yet, the specific role of oxytocin in compassion is far from clear. The current paper aims to target this gap and offer a theoretical framework that integrates the state-of-the-art literature on oxytocin with research on compassion. We suggest that oxytocin mediates compassion by enhancing the saliency of cues of pain and distress and discuss the plausible underlying neurobiological substrates. We further demonstrate how the proposed framework can account for individual differences in compassion, focusing on the effects of attachment on caregiving and support. The proposed framework integrates the current scientific understanding of oxytocin function with compassion-related processes. It thus highlights the largely ignored attentional processes in compassion and taps into the vast variability of responses in social contexts involving pain and suffering.

Electrophysiological indices of pain expectation abnormalities in fibromyalgia patients

Fibromyalgia is a chronic pain syndrome characterized by dysfunctional processing of nociceptive stimulation. Neuroimaging studies have pointed out that pain-related network functioning seems to be altered in these patients. It is thought that this clinical symptomatology may be maintained or even strengthened because of an enhanced expectancy for painful stimuli or its forthcoming appearance. However, neural electrophysiological correlates associated with such attentional mechanisms have been scarcely explored. In the current study, expectancy processes of upcoming laser stimulation (painful and non-painful) and its further processing were explored by event-related potentials (ERPs). Nineteen fibromyalgia patients and twenty healthy control volunteers took part in the experiment. Behavioral measures (reaction times and subjective pain perception) were also collected. We manipulated the pain/no pain expectancy through an S1–S2 paradigm (cue-target). S1 (image: triangle or square) predicted the S2 appearance (laser stimulation: warmth or pinprick sensation). Laser stimuli were delivered using a CO2 laser device. Temporal and spatial principal component analyses were employed to define and quantify the ERP component reliability. Statistical analyses revealed the existence of an abnormal pattern of pain expectancy in patients with fibromyalgia. Specifically, our results showed attenuated amplitudes at posterior lCNV component in anticipation of painful stimulation that was not found in healthy participants. In contrast, although larger P2 amplitudes to painful compared to innocuous events were shown, patients did not show any amplitude change in this laser-evoked response as a function of pain predictive cues (as occurred in the healthy control group). Additionally, analyses of the subjective perception of pain and reaction time indicated that laser stimuli preceded by pain cues were rated as more painful than those signaling non-pain expectancy and were associated with faster responses. Differences between groups were not found. The present findings suggest the presence of dysfunction in pain expectation mechanisms in fibromyalgia that eventually may make it difficult for patients to correctly interpret signs that prevent pain symptoms. Furthermore, the abnormal pattern in pain expectancy displayed by fibromyalgia patients could result in ineffective pain coping strategies. Understanding the neural correlates of pain processing and its modulatory factors is crucial to identify treatments for chronic pain syndromes.

The relation between children's attention bias to pain and children's pain-related memory biases is moderated by parental narrative style

Children's heightened attention to pain and parental narrative style have been linked to the development of negatively-biased pain memories in children (i.e., recalling higher levels of pain and fear than initially reported, which robustly predicts maladaptive pain outcomes). However, the interplay between child attention bias and parental narrative style remains to be assessed. This study aims to fill this gap using enhanced paradigms assessing children's cognitive biases for cues signaling actual pain. Healthy school children (N = 63; 9–15 years old) received painful heat stimuli while performing a spatial cueing task measuring attention bias to cues signaling actual pain. Parent-child interaction upon completion of the painful task, was coded for parental narrative style (i.e., elaboration, repetition and evaluation). Children's pain-related memories were elicited two weeks later. Findings indicated that children showed an attention bias to cues signaling pain. Furthermore, children who were hypervigilant to pain cues benefitted from parents elaborating more about the pain experience, while children who avoided pain cues developed more negatively-biased pain memories if parents had a more elaborative style compared to a more evaluative parental style. In conclusion, this study suggests that optimal ways to talk about children's pain depend upon child characteristics (i.e., children's attention bias to pain).

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.

Testing a Combined Cognitive Bias Hypothesis of Pain and Pain-related Worry in Young People

Cognitive factors are thought to contribute and maintain pain experiences in young people. However, most of these factors have been assessed in isolation. Considering more than 1 cognitive factor could increase explanatory power and identify multiple targets for intervention. Here, we tested a Combined Cognitive Bias Hypothesis (CCBH) that suggests information-processing factors associate with each other and exert either additive and/or interactive influences on pain outcomes. We conducted secondary analysis of data from 243 adolescents aged 16 to 19 years, who had completed a task measuring pain-related attention control impairments (emotion-priming visual search task) and a task measuring biased interpretations towards threatening cues (Adolescent Interpretation of Bodily Threat task). These young people also completed measures of recent pain experiences and pain catastrophizing, which served as primary and secondary outcomes, respectively. Regression analyses revealed that difficulties with attention control (following presentation of pain-related stimuli) and tendencies to endorse threatening interpretations of ambiguous situations had significant additive effects on both pain outcomes. However, correlations between these factors were non-significant. They also did not interact to influence pain outcomes. These findings require replication in broader age ranges and clinical samples but potentially suggest that, measuring multiple cognitive factors increases explanatory power of youth pain outcomes. PerspectiveWeak attention control following exposure to pain cues and tendencies to endorse threat interpretations, uniquely and additively associate with self-reported pain experiences and pain catastrophizing in community youth. Measuring several cognitive factors simultaneously could improve our ability to explain pain outcomes in adolescent populations.

Correction to: How Responsive are Anesthesiologists to Patient Pain? Residents’ Verbal and Nonverbal Responses to Standardized Patient Pain Cues

Correction to: How Responsive are Anesthesiologists to Patient Pain? Residents’ Verbal and Nonverbal Responses to Standardized Patient Pain Cues

How Responsive are Anesthesiologists to Patient Pain? Residents’ Verbal and Nonverbal Responses to Standardized Patient Pain Cues

How Responsive are Anesthesiologists to Patient Pain? Residents’ Verbal and Nonverbal Responses to Standardized Patient Pain Cues

Synchrony with distress in affective empathy and compassion.

Sensitivity to suffering of others is a core factor in social cohesion and evolutionary success. The emergence of such sensitivity may occur via two neuro-functional mechanisms. One is sharing the pain and distress of others, which relies on affective empathy. The other involves a caring concern for others' wellbeing, termed compassion. Both affective empathy and compassion are triggered by cues of pain and distress, exhibited by suffering targets. Yet, the mechanisms underlying distress processing in empathy and compassion are not clear. In the current research, we investigated synchrony with a target's distress, as a putative mechanism for continuous processing of distress cues. Participants viewed a video of a target in distress when given two different instructions: they were asked to continuously rate their distress in the affective empathy condition, or their feelings of care in the compassion condition. We used these dynamic ratings as well as participants' autonomic and facial responses to assess multi-channel synchrony with the target's self-rated distress fluctuations. Dynamic ratings and facial corrugator responses were significantly positively synchronized with the target's distress. For the corrugator responses, synchrony with the target was more pronounced than synchrony with participants' own ratings. Autonomic responses exhibited negative synchrony with the target's distress. Synchrony was higher in the affective empathy than in the compassion condition, across channels. These results point to the key role of subjective and physiological synchrony with the target's distress in empathic sharing of negative experiences. They also highlight the attenuation of embodied resonance with distress in compassionate experiences.

Supportive Interventions to Reduce Pain and Stress During Ophthalmic Examinations for Retinopathy of Prematurity in Premature Infants.

Ophthalmic examinations are a frequent source of pain and stress in premature infants. There is evidence for the use of supportive interventions during infant ophthalmic examinations to reduce pain and stress, but there are no standard recommendations for their implementation. The purpose of this quality improvement project was to implement evidence-based, supportive interventions during ophthalmic examinations in premature infants and evaluate the impact on pain, oxygen saturation, heart rate, bradycardic events, and neonatal stress cues. A preintervention and intervention group design was used. Primary outcomes were pain and oxygen saturation. Secondary outcomes were heart rate, number of bradycardic events, and number of neonatal stress cues. Independent-sample t tests were used to compare means of the measures in the preintervention and intervention groups. Supportive interventions during ophthalmic examinations significantly reduced infant pain (during and after the examination), number of bradycardic events (during and after the examination), and number of neonatal stress cues (before, during, and after the examination). There was also a trend for supportive interventions to decrease pain before the examination. Supportive interventions during ophthalmic examinations are effective in reducing pain, bradycardic events, and neonatal stress cues in premature infants and can be successfully implemented as part of a unit-based protocol. Future research is needed to determine the long-term outcomes associated with supportive interventions during ophthalmic examinations in premature infants.

An Eye Tracking Investigation of Pain Decoding Based on Older and Younger Adults\u2019 Facial Expressions

Nonverbal pain cues such as facial expressions, are useful in the systematic assessment of pain in people with dementia who have severe limitations in their ability to communicate. Nonetheless, the extent to which observers rely on specific pain-related facial responses (e.g., eye movements, frowning) when judging pain remains unclear. Observers viewed three types of videos of patients expressing pain (younger patients, older patients without dementia, older patients with dementia) while wearing an eye tracker device that recorded their viewing behaviors. They provided pain ratings for each patient in the videos. These observers assigned higher pain ratings to older adults compared to younger adults and the highest pain ratings to patients with dementia. Pain ratings assigned to younger adults showed greater correspondence to objectively coded facial reactions compared to older adults. The correspondence of observer ratings was not affected by the cognitive status of target patients as there were no differences between the ratings assigned to older adults with and without dementia. Observers’ percentage of total dwell time (amount of time that an observer glances or fixates within a defined visual area of interest) across specific facial areas did not predict the correspondence of observers’ pain ratings to objective coding of facial responses. Our results demonstrate that patient characteristics such as age and cognitive status impact the pain decoding process by observers when viewing facial expressions of pain in others.

Effects of repeated menstrual pain on empathic neural responses in women with primary dysmenorrhea across the menstrual cycle.

Primary dysmenorrhea (PDM) is cyclic menstrual pain in the absence of pelvic anomalies, and it is thought to be a sex‐hormone related disorder. Existing study has focused on the effects of menstrual cramps on brain function and structure, ignoring the psychological changes associated with menstrual pain. Here we examined whether pain empathy in PDM differs from healthy controls (HC) using task‐based functional magnetic resonance imaging (fMRI). Fifty‐seven PDM women and 53 matched HC were recruited, and data were collected at the luteal and menstruation phases, respectively. During fMRI scans, participants viewed pictures displaying exposure to painful situations and pictures without any pain cues and assessed the level of pain experienced by the person in the picture. Regarding the main effect of the pain pictures, our results showed that compared to viewing neutral pictures, viewing pain pictures caused significantly higher activation in the anterior insula (AI), anterior cingulate cortex, and the left inferior parietal lobule; and only the right AI exhibited a significant interaction effect (group × picture). Post‐hoc analyses confirmed that, relative to neutral pictures, the right AI failed to be activated in PDM women viewing painsss pictures. Additionally, there was no significant interaction effect between the luteal and menstruation phases. It suggests that intermittent pain can lead to abnormal empathy in PDM women, which does not vary with the pain or pain‐free phase. Our study may deepen the understanding of the relationship between recurrent spontaneous pain and empathy in a clinical disorder characterized by cyclic episodes of pain.

Somatosensory attentional modulations during pain-related movement execution.

Pain serves to protect against bodily threat, and therefore initiates protective responses such as attending toward threat-relevant information. Since pain is often exacerbated by executing movements, these motor actions may serve as cues for pain. Up to date, however, pain-related attention during movement remains largely unexplored. While it has been shown that the preparation of a pain-related movement leads to enhanced processing of somatosensory information, it is unclear how the actual execution of a movement interacts with somatosensory attention. In the current study, we examined whether somatosensory processing is enhanced at a moving body part when the movement is expected to be associated with pain. Participants were asked to execute hand movements which were occasionally followed by a pain stimulus. To measure somatosensory attention, a task-irrelevant, innocuous tactile probe was presented on either hand to evoke a somatosensory evoked potential (SEP). The results showed an elevation of the N120 SEP at the hand performing a potentially painful movement, indicating heightened attention toward tactile information at the threatened moving hand compared to the non-threatened hand. Additionally, the P200 SEP also showed enlarged responses when performing a pain-related movement compared to a no-pain-related movement. These results show that not only the anticipation, but also the execution of pain-related movements, may modulate the processing of somatosensory input, driven by attentional processes.

The interaction between pain and attractiveness perception in others

When considering the “beauty-is-good” stereotype, facial attractiveness should facilitate empathy for pain. On the other hand, having in mind the “threat value of pain” hypothesis, pain cues would be more salient, and thus, its processing would not suffer influence by facial attractiveness. The event-related potential (ERP) allows investigating if one of these theories could predict individuals’ responses regarding the perception of pain or attractiveness in others’ faces. We tracked 35 participants’ reactions to pictures depicting more and less attractive faces displayed in a painful and non-painful condition. Each participant completed the following two tasks when presented the images of faces: (1) the Pain Judgment Task, in which participants should rate the pain levels, and (2) the Attractiveness Judgment Task, in which participants should rate the attractiveness. Results showed that participants exhibited differences rating more and less attractive faces in the non-painful pictures, but not in the painful pictures. These results were observed in P3 and LPC amplitudes in the Pain Judgment Task, as well as in N170 and P2 amplitudes in the Attractive Judgment Task. Our results suggested that both explicit and implicit empathic pain processing inhibited the processing of attractiveness perception. These findings supported the “threat value of pain” hypothesis. Besides, in the Attractive Judgment Task, the N170 and P2 amplitudes for more attractive painful pictures were larger than those for more attractive non-painful pictures. In contrast, no significant difference was found between the amplitudes for painful and non-painful, less attractive pictures. Our findings suggest that explicit facial attractiveness processing for more attractive face images potentiates the implicit empathy for pain processing, therefore partly supporting the “beautiful-is-good” stereotype.

Gender differences in attention to pain body postures in a social context: a novel use of the bodies in the crowd task.

Pain signals the presence of potential harm, captures attention, and can inhibit performance on concurrent tasks. What is less well known, however, is whether such attentional capture also occurs in a wider social context, such as when observing people in pain. To explore this possibility, we adopted a novel social-cue detection methodology: the bodies-in-the-crowd task. Two experiments are reported that consider whether nonverbal cues of pain, happiness, and anger as expressed through body postures would capture and hold attention. Both experiments recruited 40 (20 male and 20 female) pain-free individuals. Overall, results show that pain postures do not capture attention any more than happiness or anger postures, but disengagement from pain postures was significantly slower across both studies. Gender differences were also found, and were more likely to be found when crowds comprised both men and women. Male pain postures were more likely to capture attention. However, female observers had faster target detection speed, and were quicker to disengage from distractors. They also showed slower disengagement from female expressions overall. Male observers showed no variation based on target or distractor gender. Implications and potential directions for future research are discussed.

Health Care Professionals' Reports of Cancer Pain Cues Among Older People With Delirium: A Qualitative-Quantitative Content Analysis

ContextHealth care professionals (HCPs) currently judge pain presence and intensity in patients with delirium despite the lack of a valid, standardized assessment protocol. However, little is known about how they make these judgments. This information is essential to develop a valid and reliable assessment tool. ObjectivesTo identify pain cues that HCPs report to judge pain in patients with delirium and to examine whether the pain cues differed based on patient cognitive status and delirium subtype. MethodsMixed qualitative-quantitative design. Doctors and nurses were recruited. All participants provided written informed consent, and before the recorded interview, demographic information was collected; then participants were asked to describe their practices and beliefs regarding pain assessment and management with older patients who are cognitively intact and patients with delirium. Interviews were transcribed verbatim and coded for pain cues. Coded data were imported into SPSS software (IBM SPSS Statistics Version 24; IBM Corporation, Armonk, NY) to conduct bivariate analyses. ResultsThe pain cue self-report was stated more often for intact than for delirium patients (χ2 [1; N = 106] = 22.56; P < 0.001). HCPs stated yelling (χ2 [2; N = 159] = 11.14; P = 0.004), when describing pain in hyperactive than in hypoactive and mixed delirium patients; and significantly more HCPs stated grimace (χ2 [2; N = 159] = 6.88; P = 0.03), when describing pain in hypoactive than hyperactive and mixed patients. ConclusionThis study outlines how HCPs conduct pain assessment in patients who are delirious and, also, identifies pain behavior profiles for the subtypes of delirium.