Measuring Fear of Movement/(Re)injury in Chronic Low Back Pain Using Implicit Measures

Fear of movement/(re)injury is assumed to contribute to the development and maintenance of chronic low back pain (CLBP) in a subgroup of patients. Studying fear of movement/(re)injury with implicit attitude measures, without the awareness of the patient, might be a valuable addition to self‐report questionnaires. The aims of the current study were to investigate whether CLBP patients demonstrate more implicit fear of movement/(re)injury than healthy controls, and whether 2 implicit measures are related to each other, and to an explicit self‐report measure of fear of movement/(re)injury. A group of 66 CLBP patients and 30 healthy controls took part in this study. In addition to self‐report questionnaires, fear of movement/(re)injury was implicitly assessed by the Extrinsic Affective Simon Task (EAST) and the Go‐No‐Go‐Association Task (GNAT) that aimed to determine the association between back‐stressing movements and the evaluation “threatening”. On both implicit tasks it was found that neither CLBP patients nor healthy controls demonstrated implicit fear of movement/(re)injury, and that CLBP patients did not differ from healthy controls in their level of implicit fear of movement/(re)injury. In general, no associations were found between the EAST and the GNAT, or between implicitly measured and self‐reported fear of movement/(re)injury. One major caveat in drawing inferences from these findings is the poor reliability of these implicit measures. Research towards the psychometric properties of these measures should first be expanded before modifying, and applying, them to more complex domains such as fear of movement/(re)injury.     

Assessing the Relationship Between Cold Pressor Pain Responses and Dimensions of the Anxiety Sensitivity Profile in Healthy Men and Women

Anxiety sensitivity (AS) has been shown previously to be an important factor in the perception and experience of experimentally induced pain within healthy adults. The aim of the current study was to extend this research by: (i) using the Anxiety Sensitivity Profile (ASP) as an alternative measure of AS; (ii) examining whether different coping instructions affect pain reports; and (iii) investigating potential differences between men and women. Participants were 50 healthy adults (23 males, 27 females) who were required to complete 2 versions of the cold pressor pain task; one version required the use of control instructions, whereas the other made use of acceptance‐based instructions. Although the coping instructions were found to affect pain thresholds (acceptance resulted in lower thresholds), a similar pattern of correlations were found between the pain indexes and AS under both conditions. Of the ASP subscales, the gastrointestinal and cognitive concerns components were found to be the most strongly related to pain experiences. When the analysis was conducted separately for each sex, the ASP scales were related to the self‐report measures of pain in women, whereas they were related to the behavioural measures of pain in men. These results not only confirm that AS is associated with experimental pain, but that there may be sex differences in this relationship.     

Structural Evaluation of the Contemporary Psychological Models of Chronic Pain: Does Fear of Pain Work for All?

The aim of the present study was to test Turk and Okifuji's (2002) model of chronic pain and in particular the moderating role of self-efficacy. We assessed 207 consecutive chronic pain patients (53.1% female) on a range of relevant measures and tested the model using structured equation modelling. The model was supported. These results support Turk and Okifuji's model of chronic pain and suggest that it can account for the relationships between variables in chronic pain patients. In particular, the results support the central role of fear-based avoidance and self-efficacy in chronic pain. Future research should be aimed at testing the alternative contemporary models of chronic pain at different stages of the development and maintenance of chronic pain and over time.     

Attention Modification in Persons with Fibromyalgia: A Double Blind,Randomized Clinical Trial

Contemporary models of chronic musculoskeletal pain emphasize the critical roles of fear, anxiety, and avoidance as well as biases in attention in the development and maintenance of chronic pain disability. Evidence supports the influence of individual difference variables such as anxiety sensitivity, pain-related anxiety, and catastrophizing on the pain experience and on pain-related attentional biases. Changes in attentional biases have been associated with treatment gains in patients with clinically significant anxiety. The Attentional Modification Paradigm (AMP) is a modification of the dot-probe paradigm used to facilitate such changes in attentional biases. Given the relationship between chronic musculoskeletal pain and anxiety, AMP may be effective in reducing pain as well. Participants included persons (n = 17) with fibromyalgia and were randomly assigned to either an AMP condition or a control condition. The participants completed two 15-minute AMP sessions per week for 4 weeks. Those in the AMP condition reported statistically significant and substantial reductions on several individual difference variables relative to those in the control condition, and a greater proportion experienced clinically significant reductions in pain. These preliminary results offer a promising new avenue for treating chronic musculoskeletal pain that warrants additional research. Comprehensive results, limitations, and future directions are discussed.     

The acceptability and feasibility of an anxiety reduction intervention for emergency department patients with non-cardiac chest pain

Despite good physical prognosis, patients who receive a diagnosis of non-cardiac chest pain (NCCP) may experience persistent pain and distress. While cognitive-behavioural interventions have been found to be effective for this group, they are difficult to deliver in busy emergency department (ED) settings. Addressing the acceptability and relevance of self-help interventions is an important initial step in addressing this need. This study sought to examine the acceptability and relevance of an evidence-based self-help intervention for ED patients with persistent NCCP and anxiety. Patient (interviews: N = 11) and specialist chest pain nurse (focus group: N = 4) views on acceptability and feasibility were examined. Data were analysed using thematic analysis. Patients and nurses reported that there was a need for the intervention, as stress and anxiety are common among patients with NCCP, and provision of psychosocial support is currently lacking. Both patients and nurses reported that the intervention was relevant, acceptable, and potentially useful. Some changes to the intervention were suggested. Nurses reported that the intervention could be used within the existing staff resources available in an ED setting. This study represents an important first step towards developing a brief self-help intervention for ED patients with NCCP and anxiety. Further research should seek to determine the efficacy of the intervention in a pilot trial.     

神经科学视角下的共情研究热点

共情是指个体对他人情绪和想法的感受及理解。近年来关于共情神经机制的研究日益增多,但多集中在情感共情、认知共情、生理性疼痛共情等方面,而对社会痛共情、积极共情和不对称共情反应的研究相对较少。且由于研究范式及个体差异等原因,研究结果之间也充满着争议。未来研究可以设计更具生态效度的共情研究范式、进一步深化和细化共情的神经机制研究、从神经机制角度探讨不同共情能力个体的特点及共情反应的调节因素。     

The impact of experiential avoidance on the relations between illness representations,pain catastrophising and pain interference in chronic pain

Objective: The aim of this study was to examine the effects of experiential avoidance (EA) on the indirect relationship of chronic pain patients’ illness representations to pain interference, through pain catastrophising

Design and main outcome measure: The sample consisted of 162 patients diagnosed with an arthritis-related or a musculoskeletal disorder. The effects of EA on the pathway between illness representations, pain catastrophising and pain interference were examined with PROCESS, a computational tool for SPSS

Results: After controlling for patient and illness-related variables and pain severity, the ‘illness representations–pain catastrophising–pain interference’ pathway was interrupted at the higher levels of EA. The reason was that, at the high levels of EA, either the relation of illness representations to pain catastrophising or the relation of pain catastrophising to pain interference was not statistically significant.

Conclusion: The findings indicate that EA is not a generalised negative response to highly aversive conditions, at least as far as the factors examined in this study are concerned. EA may rather reflect a coping reaction, the impact of which depends on its specific interactions with the other aspects of the self-regulation mechanism. At least in chronic pain, EA should become the focus of potential intervention only when its interaction with the illness-related self-regulation mechanism results in negative outcomes.     

Equality,its Basis and Moral Status: Challenging the Principle of Equal Consideration of Interests

The principle of equal consideration of interests (ECOI) is a very popular principle in animal ethics. Peter Singer employs it to ground equal treatment and solve the problem of the basis of equality, namely the problem of why we should grant equal treatment despite the variability of people’s features. In this paper, I challenge Singer’s argument because ECOI does not provide plausible grounds to presume that the interests of diverse individuals are actually equal. Analyzing the case of pain and the interest in not suffering in particular, I contend that there are some insurmountable epistemic and axiological problems in accounting for the equality of interests. Besides criticizing ECOI as a basis of equality, I argue that we need to rely on an equality of moral status. I conclude by providing some considerations on the relation between equality and the principle of proportionality.     

The effects of the behavioral inhibition and activation systems on social inclusion and exclusion

Human beings have a strong fundamental need to form and maintain relationships. Social exclusion therefore evokes social pain in excluded individuals, whereas social inclusion evokes pleasure in those individuals who are included. The present study used near-infrared spectroscopy (NIRS) to investigate whether individual differences in personality, specifically differences in behavioral inhibition and activation system (BIS and BAS) functioning, affect the experiences of social pleasure and pain. Thirty-seven undergraduates participated in an NIRS session that involved both social rejection and inclusion during an online ball-tossing game. People with greater BIS sensitivity experienced more social pain during social exclusion, while people with greater BAS sensitivity reported more social pleasure during social inclusion. BIS sensitivity was negatively correlated with ventrolateral prefrontal cortex (VLPFC) activity during social exclusion. Finally, VLPFC activity partially mediated the relationship between BIS sensitivity and social pain experienced during social exclusion.