Efficient pain assessment in clinical settings.

The need for efficient and practical assessment techniques of the multidimensional nature of chronic pain remains paramount in clinical settings. Visual analogue scales (VASs) and simple behavioral observation methods have been proposed as efficient, reliable, and valid measures of the subjective (sensory and affective) and overt behavioral aspects of the pain experience. The relationships among VASs and the UAB Pain Behavior Scale were examined among 48 chronic pain patients. Ratings of overt behavior were significantly related to both the VAS sensory and VAS affective ratings. Regression analysis indicated that the VAS scores accounted for significant amount of the variance (27.7%) in UAB scores. Moreover, the affective dimension of self-reported pain tended to be more strongly related to the visible manifestations of pain than were ratings of pain intensity.     

Pain language of bone marrow transplantation patients.

Previous studies have shown that hypnosis may be effective in reducing intensity of pain among bone marrow transplantation patients whereas cognitive behavioral intervention without imagery was not effective for this group of patients. Since hypnosis alters patients' perception of pain and cognitive behavioral intervention changes patients' beliefs and improves their coping with pain, we hypothesized that sensory pain is more important than affective pain in understanding the pain experience of patients undergoing bone marrow transplantation. To test this hypothesis we administered the McGill Pain Questionnaire longitudinally to 50 consecutive eligible recipients of bone marrow transplantation during hospitalization to assess the different dimensions of pain they experienced. Consistent with our hypothesis, sensory pain fluctuated with treatment stages, and the pattern was consistent with previous findings. Patients reported significantly higher sensory pain than affective pain at all assessment points. In contrast, affective pain remained low and stable throughout the treatment. Our results contribute to the understanding of the nature of pain in bone marrow transplantation and suggest pain management strategies that focus on sensory pain as in hypnosis are more useful for such patients.     

Love and Power,and the Development of the Brain,Mind, and Agency

In drawing on my own research and collaborative work with Karl Pribram, I show that love (affective attachment) and power (social control) play a central role in psychosocial evolution. When these relations are coupled in a self-regulating system of cooperative interactions, brain growth is stimulated, mind and agency develop, and stable forms of collective social organization are generated. Focusing on the endogenous dynamics of social collectives, the article is organized in four parts. (A "social collective" is defined as a durable arrangement of relations among two or more individuals that is distinguished by shared membership and collaboration in relation to a common function or goal.) Part I summarizes evidence from developmental neuropsychology and social science to show that stable psychosocial organization, across the human life span, is associated with social interaction organized along two dimensions. One dimension involves love, positive affective attachment, and the second involves power, social regulation of the aroused affective energy. Part II draws on Piaget's theory of cooperation and Bradley and Pribrams' theory of communication to describe how mind and agency are generated, and how stable organization is produced, respectively, from the relations involved in the arousal and regulation of affective energy. Combining elements of the two theories, Part III presents a sketch of a holographic model of collective organization in which goal-directed behavior is generated by a feed-forward process involving imaging and information processing of interaction along the two dimensions. Part IV shows how the model accounts for the emergence of human agency within the context of a more general evolutionary theory, such as Laszlo's. The article concludes with a discussion of my approach for building a "fully human theory of evolution."     

The reality of phantom limbs

This paper evaluates the joint influence of peripheral neurophysiological factors and higher-order cognitive and affective processes in triggering or modulating a variety of phantom limb experiences, including pain. Part 1 outlines one way in which the sympathetic nervous system may influence phantom limb pain. A model involving a sympathetic-efferent somatic-afferent cycle is presented to explain fluctuations in the intensity of sensations referred to the phantom limb. In part 2, the model is extended to explain the puzzling finding that onlyafter amputation are thoughts and feelings capable of evoking referred sensations to the (phantom) limb. While phantom pains and other sensations frequently are triggered by thoughts and feelings, there is no evidence that the painful or painless phantom limb is a symptom of a psychological disorder. In part 3, the concept of a pain “memory” is introduced and described with examples. The data show that pain experienced prior to amputation may persist in the form of a memory referred to the phantom limb causing continued suffering and distress. It is argued that two independent and potentially dissociable memory components underlie the unified experience of a pain memory. This conceptualization is evaluated in the context of the surgical arena, raising the possibility that under certain conditions postoperative pain may, in part, reflect the persistent central neural memory trace left by the surgical procedure. It is concluded that the experience of a phantom limb is determined by a complex interaction of inputs from the periphery and widespread regions of the brain subserving sensory, cognitive, and affective processes.     

The utility of McGill pain questionnaire subscales for discriminating psychologica disorder in chronic pain patients

Abstract

The practice of separately scoring the sensory, affective and evaluative suhscules of the McGill Pain Questionnaire has not bccn unequivocally supported hy rcsearch, While there is moderate support for the three-factor Structure of this scale, recent studies have revealed strong intercorrelations among these factors and have not supported thcir differential predictive ahility. Present factor analytic results provide support for solutions involving a global factor in conjunction with either two or three subscale factors. The differential relationships of the sensory and affective factors to the Minnesota Multiphasic Personality Inventory and Zung Dcpression Inventory demonstrate support for the validity of separately scoring the two factors in chronic pain patients. Preliminary guidelines are provided for the clinical use of the MPQ to discriminate psychological disorder in chronic pain patients.     

疼痛共情的神经机制

疼痛是一种多维度的体验。情感成分和感觉成分是疼痛体验的主要成分,二者有着不同的神经机制。疼痛共情是痛觉"共鸣"的情绪反应,其神经机制的研究也围绕疼痛的情感成分和感觉成分展开。疼痛共情的情感成分的相关脑区主要有前扣带皮层和脑岛等脑区,与自身疼痛时相比,它们的激活位点及所处的神经网络存在差异;疼痛共情的感觉成分主要与初级感觉皮层以及一些其它的躯体感觉皮层有关,对它们的激活情况的研究受技术手段和实验范式的影响较大。未来的研究应从技术手段、分析方法及实验操作上予以关注。     

Independent effects of emotion and attention on sensory and affective pain perception

The present study investigated whether attention and emotion independently influence sensory and affective pain ratings. Fifty-four (27 female) participants rated sensory and affective pain in response to painful mechanic pressure stimulation while exposed to positive, neutral and negative slides from the International Affective Picture System. In doing so, participants were assigned to one of three groups, which focused attention either on the pictures or on the sensory or on the affective aspects of the pressure stimulation. Consistent with the motivational priming hypothesis, sensory and affective pain ratings were generally lower during exposure to positive compared to negative and neutral slides. In line with our assumptions, attention modulated sensory pain ratings with lowest ratings in the picture focusing group and highest in the affective pain focusing group. No attention effect for affective pain ratings and no interactions between emotional and attentional effects on pain perception were found.     

Affective deficits and pain insensitivity in schizophrenia

Affective deficits have long been considered a prominent feature of schizophrenia and play a central role in recent theory and research on the pathophysiology of this disorder. However, it has recently been argued that current approaches to the conceptualization and assessment of affective flattening in schizophrenia are confounded by the social and neuromotor deficits that are also prevalent in this disorder. Insensitivity to pain in individuals with schizophrenia — a phenomenon that has been reported frequently but never systematically investigated — provides one approach to examining affective flattening unconfounded by social and neuromotor deficits. Two studies are described in which signal detection theory measures of thermal pain sensitivity were examined in patients with schizophrenia, mood disorder, and normal controls; in addition, in the patients with schizophrenia, the relationships between these measures and measures of affective deficits were examined. Patients with schizophrenia had significantly poorer sensory discrimination of painful thermal stimuli than control subjects, but did not differ from controls with respect to their response criterion for reports of pain; patients with mood disorder had a significantly higher (i.e., more stoical) criterion for reports of pain than controls. As predicted, among the patients with schizophrenia, higher response criterion was significantly correlated with greater affective flattening and less intense affective experience (as well as with fewer positive symptoms and poorer premorbid adjustment). The results of these studies suggest that pain insensitivity in schizophrenia may reflect affective as well as sensory abnormalities, and that pain insensitivity in schizophrenia may provide a method for studying affective flattening in this disorder that is relatively independent of the social and neuromotor deficits that confound existing measures of this symptom. Continued examination of the relationship between pain insensitivity and affective deficits in schizophrenia is also important because numerous clinical reports have suggested that pain insensitivity is detrimental to health and can have life-threatening consequences in individuals with this disorder.This research was supported, in part, by research grants from the National Institute of Neurological Disorders and Stroke to Robert H. Dworkin (NS-30714) and W. Crawford Clark (NS-09263, NS-20248).     

SDT analysis of binary decisions and sensory intensity ratings to noxious thermal stimuli

During three sessions, each of 24 Ss responded to noxious thermal stimuli, using the following judgments: binary decision, S responded “high” or “low”; sensory intensity rating, S rated his sensory experience along a thermal intensity continuum; and concurrent report, S’s binary decision was followed by an intensity rating. The binary-decision d’ was significantly higher than the rating d′, suggesting that Ss could not maintain multiple thermal criteria in a consistent fashion. The criteria for pain obtained with single and concurrent intensity rating judgments did not differ. These results suggest that the most efficacious and valid method for the study of experimental pain is to obtain concurrent responses, and to use binary decisions to compute d’ and sensory intensity ratings to locate S’s criterion for reporting pain.     

二语情绪概念理解中的空间隐喻

采用空间启动范式考察二语情绪概念理解中是否激活空间信息, 即是否存在空间隐喻。实验1探讨单通道二语情绪概念理解中的空间隐喻, 实验2则探讨跨通道二语情绪概念理解中的空间隐喻。实验1中让32名母语为汉语的汉-英双语者先看一个英文情绪词, 接着进行视觉空间位置判断, 最后再让被试判断之前呈现的情绪词是积极词还是消极词。实验2中40名母语为汉语的汉-英双语者完成跟实验1类似的任务, 不同之处为英文情绪词以听觉形式呈现。两个实验的结果表明, 跨语言和跨通道的情绪词的空间隐喻受到空间位置方向的影响。垂直位置方向上, 二语情绪词在单通道和跨通道中都表现出了空间隐喻; 水平位置方向上, 二语情绪词没有表现出空间隐喻。该结果说明了情绪概念的空间隐喻会受到个体经验的影响, 进一步支持了知觉符号理论。     

A collaborative approach in the treatment of chronic pain

The impact of chronic pain on patients and their families can be devastating, with significant disruption and progressive deterioration of many life functions and roles. Typically, chronic pain patients have exhausted all standard medical treatment alternatives without finding relief from the pain. For chronic pain patients and their families, this leads to dependency on the health-care system which leaves patients and their families feeling helpless and hopeless in their struggle to survive their pain experiences. Assessment and treatment of chronic pain requires a comprehensive approach based on a multidimensional conceptualisation of pain that addresses cognitive, affective, behavioural, as well as sensory factors in the pain experience. A cognitive-behavioural treatment programme consisting of (a) a comprehensive multidimensional assessment, (b) a reconceptualisation aspect, (c) a skills acquisition phase, (d) a skills application, maintenance, and generalisation component, and (e) relapse prevention, is outlined. Emphasis is given to the important inter-related roles of the collaborative therapeutic relationship, reconceptualisation of the pain experience, and coping skills training, leading to self-management of life with pain as the ultimate treatment objective.     

Cognitive operations associated with individual differences in affect intensity

There are wide individual differences in the characteristic intensity of affective response to the same emotion-evoking event. The processes whereby individuals come to experience strong or mild emotional responses when exposed to the same affect-provoking stimuli are still unclear. In these studies, we propose that individual differences in affect intensity are associated with certain cognitive operations used during exposure to emotion-relevant stimuli. Specifically, cognitive operations that involve personalizing, generalizing, and selective abstraction were hypothesized to discriminate subjects high and low in affect intensity. Two studies replicated support for the hypothesis that subjects high on the affect-intensity dimension engage in more personalizing/empathic and more generalizing/elaborative cognitive operations than do subjects low on the affect-intensity dimension. The same cognitive operations discriminated groups high and low in affect intensity in response to both positive and negative emotional stimuli. Also, the cognitions that discriminated subjects high and low in affect intensity occurred only in response to affective stimuli; neutral stimuli did not evoke divergent cognitive operations for these two groups. Finally, a high degree of consistency was found in the use of emotion-relevant cognitive operations across positive and negative affective stimuli.     

Pain catastrophizing mediates the relationship between worry and pain suffering in patients with irritable bowel syndrome

Although separate lines of behaviorally oriented pain research have drawn attention to the importance of pain catastrophizing and trait worry, little is known about how they work together to influence aspects of chronic pain. Integrating pain research with the broader anxiety, cognitive science, and learning literature, we hypothesized that the process (vs. content) of worry influences pain through catastrophizing. One hundred and eighty-six consecutive patients diagnosed (Rome II) with irritable bowel syndrome completed measures of three dimensions of pain (sensory pain, affective pain, long-term suffering), pain intensity, trait anxiety, worry, catastrophizing, and somatization during baseline assessment of an NIH-funded clinical trial of two psychological treatments. Worry was most strongly associated with the emotionally unpleasant aspects of pain, particularly suffering. Multivariate mediational analyses showed that catastrophizing mediated the link between worry and suffering. Worry, catastrophizing and control variables accounted for 46% of the variance in suffering. Chronic pain patients who worry excessively engage in more catastrophic thinking and through this cognitive process experience more intensely the suffering component of pain. Data are consistent with the notion that worry functions as an "experiential avoidance" strategy for aversive features of pain. Findings are discussed with respect to their relevance to behavioral models for understanding and treating anxiety-related chronic pain disorders.     

The relationship of depression and somatic focus to experimental and clinical pain in chronic pain patients

Abstract

The present study examined Fields' proposal that depression increases the sensory experience of pain in part through greater somatic focus. Experimental and clinical pain measures were compared to self-report of depression and somatic focus in 60 chronic pain patients. Depression scores were unrelated to pain threshold or tolerance on the cold-pressor test. However, as hypothesized by Fields, path analytic models suggested that depression had a direct influence on the evaluative and affective aspects of pain, but the relationship between depression and sensory pain was mediated by somatic focus. These results provide partial support for Fields' neurobiological model of pain and depression.     

Measuring pain: an introspective look at introspection

The measurement of pain depends upon subjective reports, but we know very little about how research subjects or pain patients produce self-reported judgments. Representationalist assumptions dominate the field of pain research and lead to the critical conjecture that the person in pain examines the contents of consciousness before making a report about the sensory or affective magnitude of pain experience as well as about its nature. Most studies to date have investigated what Fechner termed "outer psychophysics": the relationship between characteristics of an external stimulus and the magnitude and nature of pain experience. In contrast, Fechner originally envisioned that "inner psychophysics" should investigate the relationship between physiological states and subjective experience. Despite the lack of established research tradition, inner psychophysics has a potential utility in elucidating underlying mechanisms for the production of phenomenal self-report. We illustrate this, using causal modeling analyses of the accuracy of self-reported pain ratings from our laboratory. We submit that the results are inconsistent with representationalist assumptions. Converging trends from several domains of consciousness studies seem to suggest that we need to abandon the unquestioned doctrine of representationalism and search for a more viable framework for understanding the generation of subjective self-report.     

Shifts in attention biases in response to acute pain induction: examination of a model of "conversion" among repressors

Unlike most people, those who are characterized by a repressive coping style report high levels of physical (sensory) pain but low levels of emotional distress (affective pain), which is a discrepancy that may suggest a "conversion" process. In two studies, we tested an attention allocation model, proposing that repressors direct attention away from threatening negative affective information and toward nonthreatening physical pain information during emotionally arousing (painful) situations. In Study 1, 84 participants underwent a cold pressor and then recovered. Repressors reported greater pain during recovery than low- and high-anxious participants, but they reported lower distress than high-anxious participants. Repressors reported significant and large discrepancies between high pain and low distress, whereas these differences were less pronounced for other groups. In Study 2, 77 participants underwent an ischemic pain task while performing a modified dot-probe task with sensory and negative affective pain words as stimuli. Repressors showed increasing biases away from affective pain words and toward sensory pain words as the pain task continued, whereas low- and high-anxious participants did not show these shifts in attention. The results support the notion that conversion among repressors may involve a process by which attention is directed away from emotional distress during noxious stimulation and is focused instead on sensory information from pain.     

Nietzsche on the sociality of emotional experience

In this paper, I explore the sociality of emotional experience in the work of Friedrich Nietzsche. Specifically, I describe four key mechanisms through which an individual's sociocultural context shapes her emotional experience on Nietzsche's view—emotional contagion as habitual affective mimicry, the production of emotions' felt character through the assimilation of dominant social beliefs and norms, affective interpretation à la Christopher Fowles, and the imposition of dominant notions of emotional appropriateness—fleshing out a dimension of Nietzsche's thought which is largely taken for granted but remains undertreated. After detailing these mechanisms, I argue that attending to the sociality of emotional experience in Nietzsche's thought is crucial not only for understanding key elements of his moral psychology (including certain of his reflections on freedom and self-transformation), but also for understanding his interpretation of nihilism as a psychological-affective phenomenon produced by the society to which one belongs. On Nietzsche's view, attending to the sociality of emotion helps individuals recognize the way in which the sociocultural contexts they inhabit might undermine their flourishing—and also helps them envision the conditions (especially sociocultural conditions) requisite for healthier, more empowering emotional lives.     

Does War Hurt? Effects of Media Exposure After Missile Attacks on Chronic Pain

This study focused on the effects of exposure to terrorist missile attacks on the physical and mental well being of chronic pain patients. In this prospective and longitudinal design, 55 chronic pain patients treated at a specialty pain clinic completed self-report questionnaires regarding their pain, depression and anxiety pre- and post a three week missile attack on the southern region of Israel. In addition, levels of direct and indirect exposure to the attacks were measured. Results of regression analyses showed that exposure to the attacks through the media predicted an increase in pain intensity and in the sensory component of pain during the pre-post war period, but did not predict depression, anxiety or the affective component of pain. These findings contribute to the understanding of the effects of terrorism on physical and emotional distress and identify chronic pain patients as a vulnerable population requiring special attention during terrorism-related stress.