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.     

Strategic and Automatic Threat Processing in Chronic Musculoskeletal Pain: A Startle Probe Investigation

Attentional bias research with chronic pain samples has yielded conflicting results. In the present investigation the startle paradigm was used to test the postulate that fear‐based mechanisms play an important role in attentional biases for pain‐related threat in chronic pain. Participants, including 31 individuals with chronic musculoskeletal pain and 20 healthy controls, completed a startle task designed to measure attention to different types of words (neutral vs sensory pain vs affective pain vs health catastrophe) presented at different levels of cognitive processing (strategic vs automatic). Measures of fear‐based individual difference variables, including anxiety sensitivity and fear of pain, were also completed. Startle amplitudes and latencies to acoustic startle probes that followed word presentations were recorded. Data were analyzed with repeated measures ANOVAs and correlational analysis. Significant between‐group differences were found indicating that, relative to chronic pain participants, healthy controls had higher startle amplitude index scores for health catastrophe words. There was also a trend among patients with chronic pain for greater startle amplitude index scores for strategic presentations of sensory pain words. In the automatic condition, all participants demonstrated a lower startle latency index for sensory words relative to both affect and health catastrophe words, suggesting participants had more difficulty disengaging from affect and health catastrophe words or were more avoidant of sensory words. Correlational analyses indicated that startle response indices for words related to health catastrophe became more pronounced for chronic pain patients as anxiety sensitivity and fear of pain increased. Implications and directions for future research are discussed.     

Strategic and automatic threat processing in chronic musculoskeletal pain: a startle probe investigation

Attentional bias research with chronic pain samples has yielded conflicting results. In the present investigation the startle paradigm was used to test the postulate that fear-based mechanisms play an important role in attentional biases for pain-related threat in chronic pain. Participants, including 31 individuals with chronic musculoskeletal pain and 20 healthy controls, completed a startle task designed to measure attention to different types of words (neutral vs sensory pain vs affective pain vs health catastrophe) presented at different levels of cognitive processing (strategic vs automatic). Measures of fear-based individual difference variables, including anxiety sensitivity and fear of pain, were also completed. Startle amplitudes and latencies to acoustic startle probes that followed word presentations were recorded. Data were analyzed with repeated measures ANOVAs and correlational analysis. Significant between-group differences were found indicating that, relative to chronic pain participants, healthy controls had higher startle amplitude index scores for health catastrophe words. There was also a trend among patients with chronic pain for greater startle amplitude index scores for strategic presentations of sensory pain words. In the automatic condition, all participants demonstrated a lower startle latency index for sensory words relative to both affect and health catastrophe words, suggesting participants had more difficulty disengaging from affect and health catastrophe words or were more avoidant of sensory words. Correlational analyses indicated that startle response indices for words related to health catastrophe became more pronounced for chronic pain patients as anxiety sensitivity and fear of pain increased. Implications and directions for future research are discussed.     

Affective images: relieving chronic pain and enhancing quality of life for older persons.

With increasing life expectancy, the incidence of chronic illness and chronic pain also increase. Chronic pain robs older people of their quality of life, and limits functional mobility and ambulation, which leads to muscle atrophy. Older people are often reluctant to request pain relief, attempting to endure pain as a "normal" part of ageing. Innovative non-pharmacological interventions in pain management are appealing. In this study, affective images and pictures were used in 15 elderly patients (12 female and three male) in chronic pain who needed to perform stretching and standing exercises in their physiotherapy sessions. Pain scores were measured by the Visual Analogue Scale (VAS), and health-related quality of life was measured by the Medical Outcomes Study Short Form 36 (SF-36). VAS and SF-36 were administered in weeks 1 and in 6. Pain scores were measured during physiotherapy session in the following weeks. There was a significant decreased in VAS from week 1 to week 6 (t = 3.607; df = 14; p < 0.05). Also, a significant decrease in VAS occurred when the patients were watching affective pictures while performing the physiotherapy exercise in weeks 2 and 3, but not in weeks 4 and 5. SF-36 increased in week 6, which indicated an increase in health-related quality of life, though not statistically significant. Affective images and pictures appear to be an effective non-pharmacological intervention in pain management for the older person.     

Anxiety sensitivity and fear of pain in patients with recurring headaches.

Anxiety sensitivity (AS) plays an important role in the cognitive, affective and behavioral profiles of patients with chronic pain related to musculoskeletal injury. However, investigators have not considered whether these findings extend to patients with other classes of chronic pain. The primary purpose of this investigation was to address this issue in 72 patients with recurring headaches who completed a self-report questionnaire inventory during a treatment visit to an outpatient neurology clinic. The mean ASI score for the group (mean = 24; SD = 11) was relatively high. When patients were classified on the basis of ASI scores, 20 (28%) met criteria for high, 41 (57%) for medium and 11 (15%) for low AS. Multivariate analysis of variance confirmed that these groups differed on specific aspects of their cognitive, affective, and behavioral profiles. High AS patients reported greater depression, trait anxiety, pain-related escape/avoidance behavior and fearful appraisals of pain than did patients with medium or low AS. High AS patients also indicated greater cognitive disruption in response to pain than did patients with low AS. Groups did not differ in headache severity, physiological reactivity, change in lifestyle, anger, nor did they differ in use of over-the-counter or prescribed analgesics. Multiple regression analysis identified AS, pain-related cognitive disruption, and sensory pain experience as significant predictors of fear of pain. Lifestyle changes attributed to headache were, on the other hand, predicted by headache severity, physiological and cognitive anxiety and escape/avoidance behavior. These results provide further evidence of the important association between AS and fear responses of patients with chronic pain syndromes. Implications and future directions are discussed.     

Pain-elicited responses and their role in predicting future pain duration and severity.

The first objective of this study was to carry out a prospective investigation of the behavioral and affective responses to headache pain over a 72 hr period. A sample of 74 headache sufferers provided self-reported ratings of affective and behavioral responses as measured by a composite of standardized questionnaires. Highly significant and clinically meaningful levels of both types of responses were found on the headache day. Interestingly, significant levels of behavioral and affective disturbances were also reported 24 hr after pain termination, indicating that responses to pain actually outlasted pain perception by at least 1 day. The second goal of this study was to investigate whether affective or behavioral responses were predictors of future pain intensity, duration or severity. A smaller sample of 25 subjects provided ratings on two sequential headaches. A series of time-lag analyses indicated that, unlike behavioral responses, strong affective responses during a given episode were associated with subsequently longer and more severe headaches. These results suggest that affective pain-elicited responses may be a risk factor for suffering a worse headache during the episode that follows.     

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.     

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.     

Increased use of safety-seeking behaviors in chronic back pain patients with high health anxiety

Many patients with chronic pain also exhibit elevated levels of health anxiety. This study examined the effect of health anxiety on the use of safety-seeking behaviors (SSBs) in pain-provoking situations. Participants were 20 chronic back pain patients with high health anxiety (Group H), 20 with low health anxiety (Group L) and 20 pain-free controls (Group C). Two physical tasks were video recorded, and compared both for overt pain behavior (identified by blind observers following a standardized procedure) and for the occurrence of SSB (identified by showing the participants video playback and asking them to specify motivation for all actions/behaviors displayed during the tasks). While there were no differences in the display of overt pain behaviors, Group H deployed a greater number of SSBs than Groups L and C. This finding held true for both tasks and remained significant when concurrent pain and mood ratings were statistically controlled for. SSB was correlated with catastrophizing thoughts but not pain intensity; pain intensity was correlated with overt pain behavior but not catastrophizing. Taken together, these findings suggest that SSB is distinct from overt pain behavior and may be a defining characteristic of chronic pain patients reporting high levels of health anxiety.     

Private self-consciousness, canned laughter, and responses to humorous stimuli

Sefl-focused attention is hypothesized to (a) intensify emotional responses; (b) diminish susceptibility to suggestion; and (c) increase the consistency of self-report and behavior. These hypotheses were tested by having 82 undergraduates varying in private self-consciousness (PrSC) listen to humorous stimuli presented either with (laugh track group) or without (no laugh track group) canned laughter. Subjects' funniness ratings and overt laughter served as dependent measures. Regression analyses revealed that PrSC and funniness ratings were negatively correlated in the laugh track group, but uncorrelated in the no laugh track group. In contrast, PrSC and overt laughter were positively correlated in both groups. The association between funniness and laughter appeared stronger in high than in low PrSC subjects. Interpreted in light of research indicating that funniness ratings represent affect-free evaluations of humor stimuli, whereas laughter represents amusement, these results suggest that self-focus (a) intensified subjects' amusement; (b) decreased the extent to which their evaluations of the stimuli were biased by canned laughter; and (c) increased the consistency between their (self-reported) cognitive and (overt behavioral) affective responses (although this finding was equivocal).     

Glutamatergic activation of anterior cingulate cortex mediates the affective component of visceral pain memory in rats

Studies of both humans and animals suggest that anterior cingulate cortex (ACC) is important for processing pain perception. We identified that perigenul ACC (pACC) sensitization and enhanced visceral pain in a visceral hypersensitive rat in previous studies. Pain contains both sensory and affective dimensions. Teasing apart the mechanisms that control the neural pathways mediating pain affect and sensation in nociceptive behavioral response is a challenge. In this study, using a rodent visceral pain assay that combines the colorectal distension (CRD)-induced visceromotor response (VMR) with the conditioning place avoidance (CPA), we measured a learned behavior that directly reflects the affective component of visceral pain. When CRD was paired with a distinct environment context, the rats spent significantly less time in this compartment on the post-conditioning test days as compared with the pre-conditioning day. Effects were lasted for 14 days. Bilateral pACC lesion significantly reduced CPA scores without reducing acute visceral pain behaviors (CRD-induced VMR). Bilateral administration of non-NMDA receptor antagonist CNQX or NMDA receptor antagonist AP5 into the pACC decreased the CPA scores. AP5 or CNQX at dose of 400 mM produced about 70% inhibition of CRD-CPA in the day 1, 4 and 7, and completely abolished the CPA in the day 14 after conditioning. We concluded that neurons in the pACC are necessary for the "aversiveness" of visceral nociceptor stimulation. pACC activation is critical for the memory processing involved in long-term negative affective state and prediction of aversive stimuli by contextual cue.     

Gender differences in emotional and overt/covert aggressive responses to stress

We examined the role of stress exposure on gender differences in hostile (emotional and behavioral) reactions within the context of a laboratory paradigm. Aggressive behavior was indexed via the intensity (overt) and the duration (covert) of putative shocks delivered to a confederate. Half of the participants were exposed to a chronic stressor (high stress) and half were not (low stress). Participants' emotional responses were measured via self-report mood ratings before and after the experiment. Men displayed higher aggression in both stress conditions, which corresponded to their ratings of state hostility. On the other hand, women in high stress delivered lower intensity shocks, and this decreased overt aggression was positively correlated with sadness ratings. However, women did not decrease their levels of shock duration (covert aggression) under high stress and showed equivalent shock duration compared with men in high stress. These findings are discussed in terms of differential overt manifestations of distress between men and women.     

海洛因戒治者对疼痛线索的选择性注意加工偏向

研究采用点探测范式,以疼痛线索(感觉疼痛词、情感疼痛词和健康灾难词)和中性线索(中性词)为实验材料,考察接受美沙酮维持治疗的海洛因戒治者对疼痛线索的视觉选择性注意偏向。结果表明:海洛因戒治者对疼痛线索的注意偏向具有普遍性,即对感觉疼痛词、情感疼痛词和健康灾难词等三类疼痛线索均存在注意回避偏向,尤其对健康灾难词的注意回避程度最高;海洛因戒治者还对感觉疼痛词和情感疼痛词存在注意脱离易化倾向。本研究对于有针对性的开展注意偏向矫正以干预疼痛,从而辅助美沙酮的治疗效果、维持患者的戒断状态、降低其复吸风险具有重要意义。     

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.     

Approach/Positive Anticipation,Frustration/Anger,and Overt Aggression in Childhood

ABSTRACT We examined mothers' ratings of children's affective and behavioral aspects of approach tendencies and links with overt aggressive behavior problems while considering the genetic etiology of these processes. Approach/positive anticipation (AP), frustration/anger (FA), and overt aggression in 4–9‐year‐olds were assessed using mothers' reports in a diverse national sample (n=992) and a sample of same‐sex twins (n=195 pairs). AP and FA were positively correlated with each other and with overt aggression (r from .2 to .5), and these associations were very similar for boys and girls. AP and FA provided overlapping as well as independent statistical prediction of aggression. AP statistical prediction of aggression was substantially mediated by FA, an effect that was accounted for by underlying genetic and nonshared environmental influences.     

The Relationship Quality Interview: evidence of reliability, convergent and divergent validity, and incremental utility

Relationship satisfaction and adjustment have been the target outcome variables for almost all couple research and therapies. In contrast, far less attention has been paid to the assessment of relationship quality. The present study introduces the Relationship Quality Interview (RQI), a semistructured, behaviorally anchored individual interview. The RQI was designed to provide a more objective assessment of relationship quality as a dynamic, dyadic construct across 5 dimensions: (a) quality of emotional intimacy in the relationship, (b) quality of the couple's sexual relationship, (c) quality of support transactions in the relationship, (d) quality of the couple's ability to share power in the relationship, and (e) quality of conflict/problem-solving interactions in the relationship. Psychometric properties of RQI ratings were examined through scores obtained from self-report questionnaires and behavioral observation data collected cross-sectionally from a sample of 91 dating participants and longitudinally from a sample of 101 married couples. RQI ratings demonstrated strong reliability (internal consistency, interrater agreement, interpartner agreement, and correlations among scales), convergent validity (correlations between RQI scale ratings and questionnaire scores assessing similar domains of relationship quality), and divergent validity (correlations between RQI scale ratings and (a) behavioral observation codes assessing related constructs, (b) global relationship satisfaction scores, and (c) scores on individual difference measures of related constructs). Clinical implications of the RQI for improving couple assessment and interventions are discussed.     

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.     

The Family Environment in Chronic Pain Patients: Comparison to Controls and Relationship to Patient Functioning

Operant and cognitive-behavioral models of chronic pain have called attention to the importance of examining the marital and family environments of chronic pain patients. In this study, 50 chronic pain patients and their spouses and 33 control participants and their spouses completed measures of the family environment, marital satisfaction, and patient physical and psychological functioning. Patients' overt pain behaviors were coded from videotapes of patient–spouse interactions. Compared to controls, pain patients and their spouses rated their family environments as lower in cohesion and higher in control, and there was a trend for spouses to report more marital dissatisfaction. Chronic pain patient depression was associated negatively with patient-rated family cohesion and expressiveness and spouse-rated family organization and positively with patient-rated family conflict. Overt patient pain behaviors and spouse-rated patient disability were related negatively to spouse-rated family cohesion. Spouse marital satisfaction was associated negatively with patient depression and with spouse ratings of patient disability and pain behaviors.     

Global Assessment of Relational Functioning Scale (GARF): II. Reliability and Validity in a Sample of Families of Bipolar Patients

The companion article by the Group for the Advancement of Psychiatry (GAP) Committee on the Family (see p. 155, this issue) describes the development of the Global Assessment of Relational Functioning (GARF) scale. The present study evaluated the reliability and concurrent validity of a manualized version of the GARF in recently episodic bipolar patients (N = 73 ) participating with family members in laboratory interaction tasks. The GARF was applied with high reliability by raters with little clinical experience. GARF ratings discriminated between families rated high and low in expressed emotion, with families rated as high in emotional overinvolvement showing the lowest relational functioning scores. GARF scores also correlated with affective negativity scores derived from the interactional task-based affective style and coping style coding systems. However, relational ratings were independent of levels of concurrent symptoms or illness chronicity among individual patients. GARF ratings may inform the treatment plans for patients with psychiatric disorders, but the optimal methods of data collection and rater training must be determined.