The role of the Amygdala in the perception of reward

This study set out to examine the role of the amygdala in a number of appetitively motivated tasks. Experiment one was a position discrimination task with reversals, which in later reversals involved manipulation of some secondary reinforcers associated with a correct response, and the introduction of a magnitude of reward component. Rats with NMDA-induced amygdala lesions performed at a similar level to shams at the initial discrimination and first three reversals, proceeding to reverse faster than controls in the subsequent three reversals. Manipulation of secondary reinforcers led to an equal and significant decline in performance for both groups, with the lesioned animals retaining their significant superiority in reversal performance. Alteration of the task from a 2 vs 0 pellet discrimination to a 2 vs 1 led to a drastic increase in task difficulty, but both groups completed three reversals and did not differ significantly in performance. Experience of handling the lesioned animals led to the confirmation, in experiment two, that they were significantly more hostile/reactive to handling than shams (using die "blind" ratings of experienced animal handlers). Experiment three attempted to refine die picture of this behavioural change by measuring gross activity levels - no differences between groups were found. The finding of enhanced reversal performance and the absence of a magnitude of reward deficit amongst lesioned animals in experiment one were unanticipated, problematic and demand replication. No strong support was provided for either of the principal contemporary theories of amygdala involvement in secondary reinforcement. Increased reactivity to handling was found to be consistent with a minority of the past literature, and activity levels were as anticipated. It is argued that the notion of "stimulus-reward associations" as an amygdala function is incoherent and unhelpful, and that references to the functions of the amygdale as a whole rather than of subnuclei can be equally misleading

Pain acceptance in adolescents: Development of a short form of the CPAQ-A

© 2018 The Author(s). Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. Objective: Acceptance of pain is a predictor of pain-related disability and treatment outcome in adolescents with pain. This variable has been previously measured using the Chronic Pain Acceptance Questionnaire for Adolescents (CPAQ-A, McCracken, Gauntlett-Gilbert, & Eccleston, European Journal of Pain, 14, 316-320, 2010). We set out to create a short, eight-item, form of this instrument that retained its factor structure and clinical utility. Methods: We used data collected from two independent samples of adolescents attending residential treatment for disabling chronic pain (N = 187 and N = 159). Both groups completed the 20-item CPAQ-A and indices of functioning and distress. We carried out item reduction and confirmatory factor analysis (CFA) on the first sample, repeating this on the second sample and examining the new scale's correlations with clinically relevant variables. Results: An eight-item scale was created with four items assigned to each established factor (Pain Willingness and Activity Engagement). CFA confirmed this factor structure and it replicated in Sample 2. The new scale (the CPAQ-A8) was sensitive to treatment and correlated as well with clinically important variables as its full-length version. Some items in the new scale differed from the adult CPAQ-8. Conclusions: Measures of pain acceptance have been previously developed and validated in pediatric and adult samples. This study showed that pain acceptance can be indexed by a brief, yet factorially valid, short form of the CPAQ-A that uses fewer than 50% of the items of the full-length scale and has demonstrated acceptable validity and sensitivity-to-treatment

The cognitive and motor deficits of Parkinson's disease.

Deficits of attentional and motor set that are seen in patients with PD were investigated in the research reported in this thesis. A deficit of attentional set is a failure of selective attention to one aspect of a complex stimulus. Deficits of motor set manifest as an inability to form a state of motor 'readiness' that can speed movement initiation. Attentional set was investigated with tasks that require patients to shift attention between perceptual dimensions (extradimensional - ED - shifting tasks), and motor set was studied using reaction time (RT) tasks. Study 1 rejected the hypothesis that the mechanism of 'learned irrelevance' causes ED shift deficits in patients with PD. Studies 2 and 3 confirmed that learned irrelevance also plays no role in determining the difficulty of ED shifts in healthy subjects. The experimental manipulation used in Study 4 succeeded in creating changes in scores that resembled those seen in patients with PD. Thus, it appears that patients with PD may have a deficit similar to that induced by the experimental manipulation - that is, an inability to attend to all dimensions present when hypothesis testing after an ED shift. A quantitative analysis of past RT studies of PD showed that the ability to speed movement initiation when given advance information about an upcoming movement - a form of motor set - is intact in patients with PD. In contrast, the motor set that underlies rapid simple RT performance is consistently dysfunctional in patients with PD. Study 5 investigated temporal and spatial motor set in PD, finding that these two mechanisms are functionally separate and that temporal motor set is intact in PD. A final study (Study 6) investigated the cognitive consequences of a novel neurosurgical treatment for PD, finding it to be largely a neuropsychologically 'safe' procedure

Understanding the link between feelings of mental defeat, self-efficacy and the experience of chronic pain

© 2018, © The British Pain Society 2018. Objectives: ‘Mental defeat’ (MD) has been identified among people with chronic pain as a type of self-processing related to social role and rank. Research has linked it to anxiety, pain interference and functional disability. The relationship between MD and other cognitive constructs, such as hopelessness and depression, remains poorly understood. This study considers the association between MD, pain symptomatology and self-efficacy in the context of other cognitive factors. Methods: In total, 59 participants completed a questionnaire pack assessing anxiety, depression, hopelessness, pain catastrophising and MD in order to examine the relationship with pain symptomatology and self-efficacy. Results: Linear multiple regression analyses showed that anxiety was most strongly associated with pain symptomatology, accounting for 26% of the variance, while catastrophising showed the strongest association with sensory pain and MD the strongest association with affective pain. Finally, MD was found to be strongly associated with pain-related self-efficacy, accounting for 47% of the variance. Conclusion: This research has demonstrated the potential importance of assessing MD in chronic pain patients, suggesting that targeting these cognitions during interventions and therapy could be valuable. Furthermore, the study indicates that MD differs from related cognitive constructs involved in pain, such as depression, hopelessness and catastrophising

Emergency Department staff attitudes towards people presenting in chronic pain: a qualitative study

Objective: Patients who experience their non-malignant chronic pain as intolerable sometimes present at Emergency Departments (EDs). However, since emergency medical services are set up to provide rapid treatment for acute injury or illness; there is potential for misunderstanding and disappointment. Literature on the topic of ED staff attitudes towards chronic pain patients is minimal, USA-based and methodologically unsatisfying. We carried out an in-depth, qualitative study identifying the attitudes and narratives of ED staff around people in chronic pain. Design: Focus groups with ED staff; qualitative analysis of the group transcripts Setting: Regional trauma centre in the UK Subjects: Three focus groups, 20 ED clinicians, mean ED experience 8.1 years Results: The clinical challenge of treating patients in the ED stemmed from a mismatch between patients’ needs and what the setting can deliver. Participants reported frustration with the system and with chronic pain patients’ perceived inconsistencies and requirements. However, they also highlighted good practice and acknowledged their frustration around not being able to help this group. Conclusions: ED staff found people presenting at ED with chronic pain to be a challenging and frustrating population to treat. Staff were constrained by the fast-paced nature of their jobs as well as the need to prioritise emergency cases, and so were unable to spend the time needed by chronic pain patients. This was seen as being bad for staff, and for the patient experience. Staff suggested that care could be improved by appropriate information, signposting and with time invested in communication with the patient

Peoples’ experiences of painful diabetic neuropathy: A qualitative interview study

ObjectivePainful diabetic neuropathy (PDN) is a common complication of diabetes. This study explored the experience and impact of living with PDN.DesignPeople with PDN were recruited through local NHS clinics and by national advertisement in diabetes support publications and social media forums. Semi-structured interviews were conducted either in person or by telephone. Data were analysed using inductive thematic analysis.ResultsTwenty-three people (12 female, 13 with Type-2 diabetes; 22 identified as White British) were interviewed who had PDN symptoms for mean 10 years (range 1-24 years). Four superordinate themes were identified from the data: Theexperience of living with PDN, Affects those around me, A range of negative emotions and Life is a constant challenge.ConclusionsPeople with PDN experience a wider range of impacts than those previously reported in research literature, for example: embarrassment, anger, altered diet, reduced intimacy and social isolation. Whilst further research is warranted with a diverse ethnic sample the findings indicate that the wide-ranging impact of PDN on quality of life needs to be recognised in clinical practice and incorporated into future research

Parental behaviour in paediatric chronic pain: A qualitative observational study

Parental behaviour appears to influence the adjustment of children with chronic pain. However, research in this area has failed to produce consistent evidence. Studies have tended to rely on self-report measures derived from adult pain populations. This qualitative, observational research provides descriptive data of parental behaviour in a clinical environment. A qualitative observational study was made of parents and adolescents in a physically stressful setting. Modified grounded theory was used to analyse verbal and non-verbal behaviours. Eight parent–adolescent dyads seeking treatment for chronic pain were videoed during physical exercise sessions. Verbal and non-verbal behaviours were recorded and transcribed. Four overarching categories emerged: ‘monitoring’, ‘protecting’, ‘encouraging’ and ‘instructing’. These often had both verbal and non-verbal aspects. Within these categories, more precise behavioural groups were also identified. This research identifies categories of parental behaviour that were derived directly from observation, rather than imposed on the basis of results from different populations. Four categories of behaviour were derived, which clarify and extend dimensions used in existing self-report instruments. Careful description of parental behaviours showed features that past research has neglected, and highlighted potential drawbacks of apparently positive parental actions