Pain Management: Effects on Pain Perception in Older Adults and College Students

This study examined the relationship between pain perception and meditation among older adults and college students diagnosed with a chronic pain condition. Chronic pain was defined as having pain most days of the week for at least three months. 13 participants were older adults recruited from a local senior center and 18 participants were college students recruited from a local university. Participants attended one intervention that measured the immediate effects of a meditation or education training on perceptual aspects of pain. Pain intensity, sensation and emotional response were measured with the McGill pain questionnaire short-form. Catastrophic thoughts about pain were measured by the pain catastrophizing scale. The depression, anxiety and stress scale was also utilized in this study to measure overall distress. Results showed a marginally significant trend towards meditation decreasing the intensity of pain in older adults. Results also revealed greater reductions in all measures of pain in both older adults and college students who underwent meditation training versus an education group, yet these results did not reach statistical significance. College students showed somewhat greater improvement in comparison to older adults in both control and experimental groups, though not significantly so. This study was limited in its effectiveness because of a small sample size and an unclear sample of individuals with chronic pain conditions. Although the study only yielded significant decreases distress levels in college students, it highlights the overall potential benefits of a meditation intervention as a plausible and effective treatment for chronic pain as well as co-morbid conditions associated with pain

Examining affective-motivational dynamics and behavioral implications within the interpersonal context of pain

Emotional, motivational, and interpersonal dimensions are considered integral to pain experience but have largely been examined separately. In this focus article, we argue that an integrative theoretical account that acknowledges each of these elements is a critical next step to capture the complexity and nuance of interpersonal pain dynamics and to shape future research. The aim of this focus article is to provide a foundation for such an account by drawing upon established insights from appraisal theory of emotion, influential behavioral models, empathy/interpersonal pain research, and social psychology literature to highlight conceptual relationships, potential mechanisms of action, and avenues of inquiry that have not previously been examined in the context of pain. Specifically, we highlight the interpersonal nature of pain and the conceptual relationship between emotion and motivation in pain experience. We discuss an affective-motivational tension between self- and other-oriented goals that can arise within the interpersonal pain context, and how such dynamics may affect the nature and effectiveness of care giving behavior. We then describe the role of emotion regulation and strategies that may facilitate optimal interpersonal pain dynamics and caregiving within a multiple goal context. Finally, we outline a foundation for an integrative theoretical model and directions for future research. Perspective: Drawing upon insights from appraisal theory of emotion, empathy/interpersonal pain research, influential behavioral models, and social psychology literature, this focus article provides a foundation for an integrative affective-motivational account of interpersonal pain dynamics as a basis for theoretical and clinical advancement. (C) 2017 by the American Pain Societ

The impact of modifying attentional bias on vulnerability to pain

The preferential deployment of attention to noxious versus benign information in the internal and external environment - “attentional bias” - is thought to confer vulnerability to pain. The current thesis tested this putative mechanism by modifying the bias using the visual-probe task (attentional bias modification; ABM) and examining effects of this experimental manipulation on attentional bias and critical pain outcomes. Drawing on recent evidence that the impact of pain on attentional bias varies across its temporal components, this thesis additionally tested the component stages of attentional bias implicated in pain experience by manipulating the duration for which visual-probe stimuli were presented. Study 1 confirmed that both rapid and slower attentional orienting was biased in individuals with persistent musculoskeletal pain. Results from Studies 2 and 3 indicated that acute experimentally-induced pain modified the faster bias and that participants whose fast bias was modified had reduced vulnerability to cold pressor pain, in comparison with control participants. This suggested that mechanisms of initial orienting were more active in the acute pain experience. Studies 4 and 5 revealed that concurrently retraining fast and slower bias was optimal for persistent musculoskeletal pain. Results of a systematic review and meta-analysis indicated a small overall statistical effect of ABM on pain severity. Critically, however, whereas ABM had been effective at reducing acute pain severity, this was not the case for persistent pain. Overall, these findings suggest that the faster bias influenced vulnerability to acute pain, indicating a potential therapeutic target for future research. However, retraining the earlier stage of attention alone did not influence persistent pain outcomes, where there appeared to be greater involvement of the slower bias. It was concluded that not only could attentional bias influence critical pain outcomes, but that the optimal timings may vary across temporal pain classifications

Empathy for others' suffering and its mediators in mental health professionals

Empathy is a complex cognitive and affective process that allows humans to experience concern for others, comprehend their emotions, and eventually help them. In addition to studies with healthy subjects and various neuropsychiatric populations, a few reports have examined this domain focusing on mental health workers, whose daily work requires the development of a saliently empathic character. Building on this research line, the present population-based study aimed to (a) assess different dimensions of empathy for pain in mental health workers relative to general-physicians and non-medical workers; and (b) evaluate their relationship with relevant factors, such as moral profile, age, gender, years of experience, and workplace type. Relative to both control groups, mental health workers exhibited higher empathic concern and discomfort for others' suffering, and they favored harsher punishment to harmful actions. Furthermore, this was the only group in which empathy variability was explained by moral judgments, years of experience, and workplace type. Taken together, these results indicate that empathy is continuously at stake in mental health care scenarios, as it can be affected by contextual factors and social contingencies. More generally, they highlight the importance of studying this domain in populations characterized by extreme empathic demands.Fil: Santamaria Garcia, Hernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; ArgentinaFil: Báez Buitrago, Sandra Jimena. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; ArgentinaFil: García, Adolfo Martín. Instituto de Neurología Cognitiva. Laboratorio de Psicología Experimental y Neurociencia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; Argentina. Universidad Nacional de Cuyo. Facultad de Educación Elemental y Especial; ArgentinaFil: Flichtentrei, Daniel. Intramed; ArgentinaFil: Prats, Lucía María. Intramed; Argentina. Centro de Educaciones Médicas e Investigación Clínica "Norberto Quirno"; ArgentinaFil: Mastandueno, Ricardo. Intramed; ArgentinaFil: Sigman, Mariano. Universidad Torcuato di Tella; ArgentinaFil: Matallana, Diana. Pontificia Universidad Javeriana; ColombiaFil: Cetkovich Bakmas, Marcelo Gustavo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; ArgentinaFil: Ibanez Barassi, Agustin Mariano. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; Argentin

Facial expression of pain: an evolutionary account.

This paper proposes that human expression of pain in the presence or absence of caregivers, and the detection of pain by observers, arises from evolved propensities. The function of pain is to demand attention and prioritise escape, recovery, and healing; where others can help achieve these goals, effective communication of pain is required. Evidence is reviewed of a distinct and specific facial expression of pain from infancy to old age, consistent across stimuli, and recognizable as pain by observers. Voluntary control over amplitude is incomplete, and observers can better detect pain that the individual attempts to suppress rather than amplify or simulate. In many clinical and experimental settings, the facial expression of pain is incorporated with verbal and nonverbal vocal activity, posture, and movement in an overall category of pain behaviour. This is assumed by clinicians to be under operant control of social contingencies such as sympathy, caregiving, and practical help; thus, strong facial expression is presumed to constitute and attempt to manipulate these contingencies by amplification of the normal expression. Operant formulations support skepticism about the presence or extent of pain, judgments of malingering, and sometimes the withholding of caregiving and help. To the extent that pain expression is influenced by environmental contingencies, however, "amplification" could equally plausibly constitute the release of suppression according to evolved contingent propensities that guide behaviour. Pain has been largely neglected in the evolutionary literature and the literature on expression of emotion, but an evolutionary account can generate improved assessment of pain and reactions to it

The Establishment of the GENEQOL Consortium to Investigate the Genetic Disposition of Patient-Reported Quality-of-Life Outcomes

To our knowledge, no comprehensive, interdisciplinary initiatives have been taken to examine the role of genetic variants on patient-reported quality-of-life outcomes. The overall objective of this paper is to describe the establishment of an international and interdisciplinary consortium, the GENEQOL Consortium, which intends to investigate the genetic disposition of patient-reported quality-of-life outcomes. We have identified five primary patient-reported quality-of-life outcomes as initial targets: negative psychological affect, positive psychological affect, self-rated physical health, pain, and fatigue. The first tangible objective of the GENEQOL Consortium is to develop a list of potential biological pathways, genes and genetic variants involved in these quality-of-life outcomes, by reviewing current genetic knowledge. The second objective is to design a research agenda to investigate and validate those genes and genetic variants of patient-reported quality-of-life outcomes, by creating large datasets. During its first meeting, the Consortium has discussed draft summary documents addressing these questions for each patient-reported quality-of-life outcome. A summary of the primary pathways and robust findings of the genetic variants involved is presented here. The research agenda outlines possible research objectives and approaches to examine these and new quality-of-life domains. Intriguing questions arising from this endeavor are discussed. Insight into the genetic versus environmental components of patient-reported quality-of-life outcomes will ultimately allow us to explore new pathways for improving patient care. If we can identify patients who are susceptible to poor quality of life, we will be able to better target specific clinical interventions to enhance their quality of life and treatment outcomes.quality of life, self-rated health, pain, fatigue, genetic disposition, Patient-Reported Quality-of-Life Outcomes

The good of boredom

I argue that the state of boredom (i.e., the transitory and non-pathological experience of boredom) should be understood to be a regulatory psychological state that has the capacity to promote our well-being by contributing to personal growth and to the construction (or reconstruction) of a meaningful lif

Systematic review of the behavioural assessment of pain in cats

Objectives The objectives were to review systematically the range of assessment tools used in cats to detect the behavioural expression of pain and the evidence of their quality; and to examine behavioural metrics (considering both the sensory and affective domains) used to assess pain. Methods A search of PubMed and ScienceDirect, alongside articles known to the authors, from 2000 onwards, for papers in English was performed. This was followed by a manual search of the references within the primary data sources. Only peer-reviewed publications that provided information on the assessment tool used to evaluate the behavioural expression of pain in cats, in conscious animals (not anaesthetised cats), were included. Results No previous systematic reviews were identified. One hundred papers were included in the final assessment. Studies were primarily related to the assessment of pain in relation to surgical procedures, and no clear distinction was made concerning the onset of acute and chronic pain. Ten broad types of instrument to assess pain were identified, and generally the quality of evidence to support the use of the various instruments was poor. Only one specific instrument (UNESP-Botucatu scale) had published evidence of validity, reliability and sensitivity at the level of a randomised control trial, but with a positive rather than placebo control, and limited to its use in the ovariohysterectomy situation. The metrics used within the tools appeared to focus primarily on the sensory aspect of pain, with no study clearly discriminating between the sensory and affective components of pain. Conclusions and relevance Further studies are required to provide a higher quality of evidence for methods used to assess pain in cats. Furthermore, a consistent definition for acute and chronic pain is needed. Tools need to be validated that can detect pain in a range of conditions and by different evaluators (veterinary surgeons and owners), which consider both the sensory and emotional aspects of pain

Characteristics and Outcomes of Individuals Self-Selecting Yoga versus Physical Therapy for the Treatment of Chronic Low Back Pain

Chronic low back pain (cLBP) is a significant public health problem that is difficult and costly to treat. Determining whether a patient with cLBP will benefit from a particular treatment approach is challenging, since little is understood about the patient characteristics that predict improved treatment outcomes. Understanding these characteristics could reduce treatment failures and costs of care. This study was designed to explore the demographic, clinical and treatment- related characteristics of individuals self-selecting yoga versus physical therapy (PT) for treatment of cLBP. A growing body of research demonstrates that yoga reduces pain and improves function in persons with cLBP. However, questions remain about how people selecting yoga as a treatment for cLBP differ from persons selecting standard therapies, like PT, and whether pre-treatment differences influence treatment outcomes. A convenience sample of 53 adults ≥ age 18 with cLBP ≥ 3 months enrolling in either a 6 week modified Integral yoga program (n = 27) or a 6 week program of individualized PT (n = 26) participated in the study. Data were collected at baseline and at 6 and 12 weeks after completion of treatment. Study variables included disability (Roland Morris Disability Questionnaire), depression (Beck Depression Inventory-II), health status (RAND Short-Form 36-Item Health Survey 1.0 Questionnaire), fear of movement (Tampa Scale of Kinesiophobia), pain self-efficacy, pain bothersomeness, pain medication use, reasons for treatment choice and satisfaction with care. Group differences were compared using non-parametric statistics. The findings revealed no significant differences between the groups in duration of cLBP (9.02 ± 9.29 years), worst pain in the past 6 months (8.05 ± 1.93 on a 0-10 pain bothersomeness scale), age (50.69 ± 15.56 years), gender (66% female) or education (16 ± 3.05 years). However, PT participants were more likely to be nonwhite, earning ≤ $30,000/yr and selecting PT based on healthcare provider referral or insurance coverage. Yoga participants were more likely to be gainfully employed, earning ≥$70,000/yr and selecting yoga based on personal research. Neither group was depressed at baseline, but PT participants were significantly more disabled, had lower health status, greater pain and twice the pain medication use compared to yoga participants at baseline. At the conclusion of 6 weeks of treatment, both groups had significant improvements in disability and health status with fewer days in pain. PT participants who showed significantly greater pain symptoms at baseline had greater reductions in pain at 6 and 12 weeks compared to yoga participants. At 12 weeks the groups had equivalent pain levels, demonstrating persistent treatment benefits with few adverse effects and high satisfaction with care. Cost was cited as a reason for early termination of treatment for PT participants but was not an issue for yoga participants. The improved outcomes and group differences support the effectiveness of both treatments in reducing pain and disability. The similarities between the groups at 12 weeks and differences in total cost of care suggest the need for further research to examine the long-term costs and benefits of yoga versus PT for treatment of cLBP