Defensive High-Anxious Individuals Demonstrate Difference Responses to Pain Management to Those with Lower Levels of Defensiveness and Anxiety

© 2017 World Institute of Pain. Objectives: Few studies have considered the effect of Weinberger et al.'s personality types on the management of pain. The aims of this study were to (1) identify whether the relationships between pain intensity, cognitive factors, and disability at 3 and 6 months postbaseline differ as a result of personality type; and (2) identify whether personality type affects the likelihood of achieving a minimal clinically important change in pain intensity or disability at 3 and 6 months. Method: Patients completed a set of validated questionnaires assessing personality type, cognitive factors, pain intensity, and disability at 3 and 6 months postbaseline. Results: A greater proportion of defensive high-anxious individuals reported improvement for both pain (3 months = 25%; 6 months = 38%) and disability (3 months = 35%; 6 months = 50%) and showed stronger links between improvements in pain and disability and baseline psychological factors than nonextreme individuals. Conclusions: The high proportion of defensive high-anxious individuals highlights the need for psychologically based interventions to be delivered earlier in the care process. Stratifying the population, based on personality type, may allow for more targeted interventions, which could be more cost effective and reduce the number of patients remaining in the care system

A qualitative investigation of factors that matter to individuals in the pain management process

Objective: Chronic musculoskeletal pain is a complex condition to manage with widespread consequences including physical disability, psychosocial effects and increased use of healthcare. Previous research has found patients’ experiences within health care can be influenced by factors such as expectations, therapist characteristics and treatment process. This study used patient interviews to identify the key factors that influence individuals’ experiences in the management of chronic pain. Design: Qualitative study using semi-structured interviews in either a home or hospital setting. Methods: Semi-structured interviews were conducted on eight participants attending hospital-based pain management. Participants were asked about their experiences of pain management and living with a chronic pain condition. Interviews were transcribed and analysed thematically. Results: Three main themes were identified; impact of their condition on daily life, clinical interactions and the pain management process. Understanding the condition was a key factor for the patients, in particular, explanation by the clinician. The temporality of their pain meant timing of appointments was critical. Patients reported factors such as family days and follow-up sessions would improve their treatment experience. Conclusions: This study highlighted important factors for healthcare professionals and patients in the management of chronic pain. Participants indicated a desire to understand their condition and learn strategies for selfmanagement to allow them to cope better. As patients found benefit from being involved in the management process, discussions around the options for treatment may enhance management and rehabilitation. It is important we continue to research factors important to individuals with musculoskeletal pain to find an effective, evidence-based framework for understanding and managing this condition

Defensive high-anxious individuals with chronic back pain demonstrate different treatment choices and patient persistence

The aim of this study is to determine whether the experience of, and response to chronic back pain was different for defensive high-anxious individuals than other personality types (defensive high-anxious, high-anxious, repressor and low-anxious). Participants (n = 111) were recruited from a heterogeneous sample of individuals who had reported back pain within the last 6 months. Self-report measures of trait anxiety and defensiveness were used to determine personality type. In addition, pain, treatment history, disability, depression and satisfaction with treatment were recorded. Despite reporting similar levels of pain to other personality groups, defensive high-anxious individuals reported significantly greater disability and depression (p < 0.01). Of the defensive high-anxious individuals, 92% sought more than one intervention. In comparison, repressors predominantly self-managed their pain with only 10% utilising more than one intervention. Surprisingly, there were no differences in treatment satisfaction between the four groups. The present study suggests that personality type is an important factor influencing patients’ treatment options, with defensive high anxious individuals substantially more likely to seek multiple interventions and remain within the care system. The present study provides a basis for future research into the role of personality type in the management of chronic pain

Anxiety symptom interpretation and performance expectations in high-anxious, low-anxious, defensive high-anxious and repressor individuals

To date, no research has investigated score predictions and anxiety interpretation in high-anxious, low-anxious, defensive high-anxious and repressor individuals. This study examined Eysenck’s (1997) predictions for cognitive biases on future performance expectations in all four groups. This study was conducted in an ecologically-valid sporting environment. Competitive shooters completed the Marlowe–Crowne Social Desirability Scale and the Sport Anxiety Scale prior to a major competition. Percentile splits identified the four defensiveness/anxiety groups. The modified Competitive Sport Anxiety Inventory-2 was used to assess the intensity and direction of anxiety prior to competition. Participants predicted their expected shooting score. The hypothesis that repressors would interpret their anxiety as more facilitative to performance compared to low-anxious individuals was partially supported. Repressors were more optimistic in their performance prediction in contrast to defensive high-anxious performers who, in turn, were more pessimistic compared to the other two groupings. High-anxious performers, contrary to predictions, demonstrated optimism in their future performance. The findings of this study corroborate the theoretical predictions and the evidence from previous studies with sport performers. Future research should continue to investigate the influence of cognitive biases on performance predictions in sporting environments using Weinberger et al.’s classifications

Personality Type Influences Attentional Bias in Individuals with Chronic Back Pain

Attentional biases reflect an individual’s selective attention to salient stimuli within their environment, for example an experience of back pain. Eysenck suggests that different personality types show different attentional biases to threatening information. This study is the first to test Eysenck’s theory within a chronic back pain population by investigating the attentional biases of four different personality types using a back pain specific dot-probe paradigm. Participants were 70 volunteers (45 female) recruited from a back rehabilitation program at an NHS Trust. The four groups were selected on their trait anxiety and defensiveness scores: defensive high-anxious; high-anxious; repressor and non-extreme. Participants completed a dot probe task comprising 20 practice trials and 250 experimental trials. The experimental trials contained 100 threat-neutral pairs, 100 positive-neutral pairs and 50 neutral-neutral image pairings. The threat images were taken from the Photograph Series of Daily Activities (PHODA) and the neutral and positive images from the International Affective Picture System (IAPS) image bank. The results provided partial support for Eysenck’s theory; defensive high-anxious individuals showed an attentional bias for threatening information compared to high-anxious individuals who demonstrated no bias. Repressors showed an avoidant bias to threatening images and an attentional bias to positive stimuli relative to neutral images. The clear difference in responses demonstrated by high-anxious individuals who vary in defensiveness highlight the need for separate investigation of these heterogeneous groups and help to explain the cognitive processes of defensive high-anxious individuals within a pain population. The demonstration of an attentional bias in this group to threatening information could explain why defensive high-anxious individuals are more likely to re-present for treatment

Corticospinal excitability is facilitated by combined action observation and motor imagery of a basketball free throw

Copyright © 2018 The Authors. Objectives: This experiment investigated the extent to which independent action observation, independent motor imagery and combined action observation and motor imagery of a sport-related motor skill elicited activity within the motor system. Design and method: Eighteen, right-handed, male participants engaged in four conditions following a repeated measures design. The experimental conditions involved action observation, motor imagery, or combined action observation and motor imagery of a basketball free throw, whilst the control condition involved observation of a static image of a basketball player holding a basketball. In all conditions, single pulse transcranial magnetic stimulation was delivered to the forearm representation of the left motor cortex. The amplitude of the resulting motor evoked potentials were recorded from the flexor carpi ulnaris and extensor carpi ulnaris muscles of the right forearm and used as a marker of corticospinal excitability. Results: Corticospinal excitability was facilitated significantly by combined action observation and motor imagery of the basketball free throw, in comparison to both the action observation and control conditions. In contrast, the independent use of either action observation or motor imagery did not facilitate corticospinal excitability compared to the control condition. Conclusions: The findings have implications for the design and delivery of action observation and motor imagery interventions in sport. As corticospinal excitability was facilitated by the use of combined action observation and motor imagery, researchers should seek to establish the efficacy of implementing combined action observation and motor imagery interventions for improving motor skill performance and learning in applied sporting settings

A tool for measuring mental workload during prosthesis use: The Prosthesis Task Load Index (PROS-TLX)

When using a upper-limb prosthesis, mental, emotional, and physical effort is often experienced. These have been linked to high rates of device dissatisfaction and rejection. Therefore, understanding and quantifying the complex nature of workload experienced when using, or learning to use, a upper-limb prosthesis has practical and clinical importance for researchers and applied professionals. The aim of this paper was to design and validate a self-report measure of mental workload specific to prosthesis use (The Prosthesis Task Load Index; PROS-TLX) that encapsulates the array of mental, physical, and emotional demands often experienced by users of these devices. We first surveyed upper-limb prosthetic limb users who confirmed the importance of eight workload constructs taken from published literature and previous workload measures. These constructs were mental demands, physical demands, visual demands, conscious processing, frustration, situational stress, time pressure and device uncertainty. To validate the importance of these constructs during initial prosthesis learning, we then asked able-bodied participants to complete a coin-placement task using their anatomical hand and then using a myoelectric prosthesis simulator under low and high mental workload. As expected, using a prosthetic hand resulted in slower movements, more errors, and a greater tendency to visually fixate the hand (indexed using eye-tracking equipment). These changes in performance were accompanied by significant increases in PROS-TLX workload subscales. The scale was also found to have good convergent and divergent validity. Further work is required to validate whether the PROS-TLX can provide meaningful clinical insights to the workload experienced by clinical users of prosthetic devices

Locomotor recovery following contusive spinal cord injury does not require oligodendrocyte remyelination

The contribution of oligodendrocytes to remyelination in functional recovery after spinal cord injury is not fully understood. Here, the authors show that oligodendrocyte progenitor cell differentiation is not required for functional recovery after spinal cord injury in mice

BMP-6 promotes E-cadherin expression through repressing δEF1 in breast cancer cells

<p>Abstract</p> <p>Background</p> <p>Bone morphogenetic protein-6 (BMP-6) is critically involved in many developmental processes. Recent studies indicate that BMP-6 is closely related to tumor differentiation and metastasis.</p> <p>Methods</p> <p>Quantitative RT-PCR was used to determine the expression of BMP-6, E-cadherin, and δEF1 at the mRNA level in MCF-7 and MDA-MB-231 breast cancer cells, as well as in 16 breast cancer specimens. Immunoblot analysis was used to measure the expression of δEF1 at the protein level in δEF1-overexpressing and δEF1-interfered MDA-MB-231 cells. Luciferase assay was used to determine the rhBMP-6 or δEF1 driven transcriptional activity of the E-cadherin promoter in MDA-MB-231 cells. Quantitative CHIP assay was used to detect the direct association of δEF1 with the E-cadherin proximal promoter in MDA-MB-231 cells.</p> <p>Results</p> <p>MCF-7 breast cancer cells, an ER⁺cell line that expressed high levels of BMP-6 and E-cadherin exhibited very low levels of δEF1 transcript. In contrast, MDA-MB-231 cells, an ER^-cell line had significantly reduced BMP-6 and E-cadherin mRNA levels, suggesting an inverse correlation between BMP-6/E-cadherin and δEF1. To determine if the same relationship exists in human tumors, we examined tissue samples of breast cancer from human subjects. In 16 breast cancer specimens, the inverse correlation between BMP-6/E-cadherin and δEF1 was observed in both ER⁺cases (4 of 8 cases) and ER^-cases (7 of 8 cases). Further, we found that BMP-6 inhibited δEF1 transcription, resulting in an up-regulation of E-cadherin mRNA expression. This is consistent with our analysis of the E-cadherin promoter demonstrating that BMP-6 was a potent transcriptional activator. Interestingly, ectopic expression of δEF1 was able to block BMP-6-induced transactivation of E-cadherin, whereas RNA interference-mediated down-regulation of endogenous δEF1 in breast cancer cells abolished E-cadherin transactivation by BMP-6. In addition to down-regulating the expression of δEF1, BMP-6 also physically dislodged δEF1 from E-cadherin promoter to allow the activation of E-cadherin transcription.</p> <p>Conclusion</p> <p>We conclude that repression of δEF1 plays a key role in mediating BMP-6-induced transcriptional activation of E-cadherin in breast cancer cells. Consistent with the fact that higher level of δEF1 expression is associated with more invasive phenotype of breast cancer cells, our collective data suggests that δEF1 is likely the switch through which BMP-6 restores E-cadherin-mediated cell-to-cell adhesion and prevents breast cancer metastasis.</p

Resistance to MPTP-Neurotoxicity in α-Synuclein Knockout Mice Is Complemented by Human α-Synuclein and Associated with Increased β-Synuclein and Akt Activation

Genetic and biochemical abnormalities of α-synuclein are associated with the pathogenesis of Parkinson's disease. In the present study we investigated the in vivo interaction of mouse and human α-synuclein with the potent parkinsonian neurotoxin, MPTP. We find that while lack of mouse α-synuclein in mice is associated with reduced vulnerability to MPTP, increased levels of human α-synuclein expression is not associated with obvious changes in the vulnerability of dopaminergic neurons to MPTP. However, expressing human α-synuclein variants (human wild type or A53T) in the α-synuclein null mice completely restores the vulnerability of nigral dopaminergic neurons to MPTP. These results indicate that human α-synuclein can functionally replace mouse α-synuclein in regard to vulnerability of dopaminergic neurons to MPTP-toxicity. Significantly, α-synuclein null mice and wild type mice were equally sensitive to neurodegeneration induced by 2′NH2-MPTP, a MPTP analog that is selective for serotoninergic and noradrenergic neurons. These results suggest that effects of α-synuclein on MPTP like compounds are selective for nigral dopaminergic neurons. Immunoblot analysis of β-synuclein and Akt levels in the mice reveals selective increases in β-synuclein and phosphorylated Akt levels in ventral midbrain, but not in other brain regions, of α-synuclein null mice, implicating the α-synuclein-level dependent regulation of β-synuclein expression in modulation of MPTP-toxicity by α-synuclein. Together these findings provide new mechanistic insights on the role α-synuclein in modulating neurodegenerative phenotypes by regulation of Akt-mediated cell survival signaling in vivo