Habituation to pain : a motivational-ethological perspective

Habituation to pain is mainly studied using external pain stimuli in healthy volunteers, often to identify the underlying brain mechanisms, or to investigate problems in habituation in specific forms of pain (eg, migraine). Although these studies provide insight, they do not address one pertinent question: Why do we habituate to pain? Pain is a warning signal that urges us to react. Habituation to pain may thus be dysfunctional: It could make us unresponsive in situations where sensitivity and swift response to bodily damage are essential. Early theories of habituation were well aware of this argument. Sokolov argued that responding to pain should not decrease, but rather increase with repeated exposure, a phenomenon he called “sensitization.” His position makes intuitive sense: Why would individuals respond less to pain that inherently signals bodily harm? In this topical review, we address this question from a motivational ethological perspective. First, we describe some core characteristics of habituation. Second, we discuss theories that explain how and when habituation occurs. Third, we introduce a motivational-ethological perspective on habituation and explain why habituation occurs. Finally, we discuss how a focus on habituation to pain introduces important methodological, theoretical, and clinical implications, otherwise overlooked

Politieke Analyse in de Europese Unie

Wil een bedrijf voortreffelijke resultaten voorleggen, dient het een wel overdachte strategie te ontwikkelen die niet alleen haar relaties met klanten, concurrenten en leveranciers bepaalt, maar ook rekening houdt met de aanwezigheid van politici, regulerende instanties en belangengroepen in haar omgeving. Het uitbouwen van zo'n strategie vereist een grondige kennis van de politieke besluitvorming en van de belangen die bij een zaak betrokken zijn. Dit artikel analyseert in deze context de besluitvorming binnen de Europese Unie en gaat wat nader in op de recente E.U. chocolade-richtlijn.

Using stratified medicine to understand, diagnose, and treat neuropathic pain

Neuropathic pain (NeuP) is defined as pain arising from a lesion or disease of the somatosensory nervous system. NeuP is common, affecting approximately 6-8% of the general population and currently treatment is inadequate due to both poor drug efficacy and tolerability. Many different types of injury can cause neuropathic pain including genetic (e.g. SCN9A gain of function variants), metabolic (e.g. diabetic polyneuropathy), infective (e.g. HIV associated neuropathy, hepatitis), traumatic and toxic (e.g. chemotherapy induced neuropathy) causes. Such injurious events can impact on anatomically distinct regions of the somatosensory nervous system ranging from the terminals of nociceptive afferents (in small fiber neuropathy) to the thalamus (in post-stroke pain). Classification of neuropathic pain using etiology and location remains an important aspect of routine clinical practice; however, pain medicine is coming to the realization that we need more precision in this classification. The hope is that improved classification will lead to better understanding of risk, prognosis and optimal treatment of NeuP

The role of concern about falling on stepping performance during complex activities

Background There is limited understanding of the underlying mechanisms explaining the role of concern about falling on fall risk in older people. Anxiety is known to interact with cognitive resources and, as people get older, they require more cognitive resources to maintain balance. This might affect an individual's ability to perform cognitive-motor tasks concurrently. The aim of this study was to investigate the effect of a visuospatial dual-task on stepping performance in older people with and without concern about falling and the impact of repeating this task in those with high concern about falling. Methods Three-hundred-eight community-dwelling older people, aged 70 to 90 years old, participated in the study. Participants were asked to perform a Choice Stepping Reaction Time (CSRT) task in two conditions; once without any other tasks (single task condition), and once while simultaneously performing a visuospatial task (dual-task condition). Participants were asked to rate their levels of concern and confidence specifically related to each of the 25 stepping trials (before/after). We also measured general concern about falling, affect, and sensorimotor and cognitive functioning. Results Total stepping reaction times increased when participants also performed the visuospatial task. The relation between general concern about falling and stepping reaction time, was affected by sensorimotor and executive functioning. Generalised linear mixed models showed that the group with moderate to high levels of general concern about falling had slower total stepping reaction times than those with lower levels of concern about falling, especially during the dual-task condition. Individuals with greater general concern about falling showed reduced confidence levels about whether they could do the stepping tasks under both conditions. Repeatedly performing the stepping task reduced the immediate task-specific concern about falling levels and increased confidence in all participants. Conclusions These findings reveal that people with higher general concern about falling experienced more difficulties during a dual-task condition than people with lower levels of concern. Of further interest, better sensorimotor and cognitive functioning reduced this effect. Graded exposure has potential to reduce concern about falling during fear-evoking activities, especially in conjunction with therapies that improve balance, mood and cognitive function

Are the spatial features of bodily threat limited to the exact location where pain is expected?

Previous research has revealed that anticipating pain at a particular location of the body prioritizes somatosensory input presented there. The present study tested whether the spatial features of bodily threat are limited to the exact location of nociception. Participants judged which one of two tactile stimuli, presented to either hand, had been presented first, while occasionally experiencing a painful stimulus. The distance between the pain and tactile locations was manipulated. In Experiment 1, participants expected pain either proximal to one of the tactile stimuli (on the hand; near condition) or more distant on the same body part (arm; far condition). In Experiment 2, the painful stimulus was expected either proximal to one of the tactile stimuli (hand; near) or on a different body-part at the same body side (leg; far). The results revealed that in the near condition of both experiments, participants became aware of tactile stimuli presented to the "threatened" hand more quickly as compared to the "neutral" hand. Of particular interest, the data in the far conditions showed a similar prioritization effect when pain was expected at a different location of the same body part as well as when pain was expected at a different body part at the same body side. In this study, the encoding of spatial features of bodily threat was not limited to the exact location where pain was anticipated but rather generalized to the entire body part and even to different body parts at the same side of the body

National Parliamentary Control and Voting in the Council of the European Union

This article explores the different ways governments express dissent in the Council of the European Union (EU) through ‘No’ votes, abstentions and recorded negative statements. A game‐theoretical model is presented that studies voting behaviour and analyses how the national parliaments’ levels of control over their governments’ EU policies affect it. It is concluded that governments that are strongly controlled by their parliaments are not more likely to express dissent. However, when they do express dissent, they vote ‘No’ more often. Parliamentary control depends on the presence of formal oversight institutions as well as the motivation of parliamentarians to hold their governments accountable. Empirical support is found in an analysis of votes on 1,387 legislative proposals that represent more than a decade of Council decision making in the period 2004–2014. This article contributes to the discussion on the involvement of national parliaments in EU affairs, and clearly distinguishes the different forms of dissent in Council decision making.The Legitimacy and Effectiveness of Law & Governance in a World of Multilevel Jurisdiction

Ambiguity, multiple streams, and EU policy

The multiple streams framework draws insight from interactions between agency and institutions to explore the impact of context, time, and meaning on policy change and to assess the institutional and issue complexities permeating the European Union (EU) policy process. The authors specify the assumptions and structure of the framework and review studies that have adapted it to reflect more fully EU decision-making processes. The nature of policy entrepreneurship and policy windows are assessed to identify areas of improvement. Finally, the authors sketch out a research agenda that refines the logic of political manipulation which permeates the lens and the institutional complexity which frames the EU policy process

Low-cost consumer-based trackers to measure physical activity and sleep duration among adults in free-living conditions : validation study

Background: Wearable trackers for monitoring physical activity (PA) and total sleep time (TST) are increasingly popular. These devices are used not only by consumers to monitor their behavior but also by researchers to track the behavior of large samples and by health professionals to implement interventions aimed at health promotion and to remotely monitor patients. However, high costs and accuracy concerns may be barriers to widespread adoption. Objective: This study aimed to investigate the concurrent validity of 6 low-cost activity trackers for measuring steps, moderate-to-vigorous physical activity (MVPA), and TST: Geonaut On Coach, iWown i5 Plus, MyKronoz ZeFit4, Nokia GO, VeryFit 2.0, and Xiaomi MiBand 2. Methods: A free-living protocol was used in which 20 adults engaged in their usual daily activities and sleep. For 3 days and 3 nights, they simultaneously wore a low-cost tracker and a high-cost tracker (Fitbit Charge HR) on the nondominant wrist. Participants wore an ActiGraph GT3X+ accelerometer on the hip at daytime and a BodyMedia SenseWear device on the nondominant upper arm at nighttime. Validity was assessed by comparing each tracker with the ActiGraph GT3X+ and BodyMedia SenseWear using mean absolute percentage error scores, correlations, and Bland-Altman plots in IBM SPSS 24.0. Results: Large variations were shown between trackers. Low-cost trackers showed moderate-to-strong correlations (Spearman r=0.53-0.91) and low-to-good agreement (intraclass correlation coefficient [ICC]=0.51-0.90) for measuring steps. Weak-to-moderate correlations (Spearman r=0.24-0.56) and low agreement (ICC=0.18-0.56) were shown for measuring MVPA. For measuring TST, the low-cost trackers showed weak-to-strong correlations (Spearman r=0.04-0.73) and low agreement (ICC=0.05-0.52). The Bland-Altman plot revealed a variation between overcounting and undercounting for measuring steps, MVPA, and TST, depending on the used low-cost tracker. None of the trackers, including Fitbit (a high-cost tracker), showed high validity to measure MVPA. Conclusions: This study was the first to examine the concurrent validity of low-cost trackers. Validity was strongest for the measurement of steps; there was evidence of validity for measurement of sleep in some trackers, and validity for measurement of MVPA time was weak throughout all devices. Validity ranged between devices, with Xiaomi having the highest validity for measurement of steps and VeryFit performing relatively strong across both sleep and steps domains Low-cost trackers hold promise for monitoring and measurement of movement and sleep behaviors, both for consumers and researchers