Chest pain without coronary artery disease: An exploratory comparison with panic disorder

Recent reports have indicated similarities between patients with persistent chest pain of nonorganic origin and patients with panic disorder. In order to explore this association further, we administered a structured interview and three self-report measures (State-Trait Inventory, Beck Depression Inventory, and SCL90-R) to three subject groups: (1) a sample with persistent chest pain (CP; n=14) who had been screened and found to have normal coronary arteries, (2) a sample of patients with panic disorder (PD; n=14), and (3) a sample of matched normals (n=14). CP patients were considered to be free of coronary artery disease (CAD) following normal cardiac catheterization and/or normal thallium stress tests and were not diagnosed initially with panic disorder. PD patients were diagnosed with a standardized psychiatric interview and were free of organic causes of panic. Using an exploratory data analytic approach, the results indicated that both CP and PD samples reported increased levels of state and trait anxiety (p <.0001), depression (p <.01), and somatization (p <.0001) compared with normals. CP patients differed from PD patients in their less frequent use of anxiolytic medication (p <.01) and lower levels of reported panic anxiety and phobic avoidance (p <.0001). These data suggest that persistent chest pain in the absence of CAD shares some features with panic disorder, yet differs from panic in key ways as well. The results are discussed in light of the role of anxiety in contributing to symptom labeling.This research was supported by Grant 86G-491 from the American Heart Association, Texas Affiliate, to J.G.B. H.T. is the recipient of USPHS Research Career Development Award K04-HL-0122246.     

Money versus pain: experimental study of a conflict in humans.

Ten healthy human males volunteered to be subjects in an experiment in which they were to be paid to endure a painful sensation. This sensation was produced by isometric muscular contraction in the thighs. For each of six sessions the subjects received either a payment that was changed for each session (0.2, 0.5, 1.25, 3.125, 7.8125 French francs per 20 s) or a lump sum. At the beginning of a session, the subjects assumed a seated position against a wall, but without a seat, and the duration for which they could hold this position was the chief variable measured. Heart rate, blood pressure, and magnitude estimation of pain were also recorded periodically throughout each session. Pain was reported after a mean delay of 15 +/- 7 s (SE), and the magnitude estimates then increased linearly with time. The duration of maintaining the painful position increased linearly in relation to the logarithm of the increase in the amount of payment. Thus, utility of money decreased when pitted against pain.     

Cognitive Behavioral Therapy for Postamputation Chronic Pain: A Case Report

Limb amputation has a significant impact on an individual, not only physically but emotionally. Consequences of both traumatic and atraumatic amputations are vast and can result in functional disability, impaired emotional functioning, and changes in overall quality of life. These consequences may be further complicated by the development of chronic pain. Traditional management of postamputation chronic pain often involves invasive procedures and pharmacotherapy. While research notes behavioral interventions, such as cognitive-behavioral therapy (CBT) as a viable treatment alternative for chronic pain, there is no literature supporting CBT for postamputation chronic pain. In this case report, we present a 63-year-old male lower limb amputee complicated with chronic pain who experienced pain reduction and improved quality of life following manualized treatment with CBT for chronic pain. Treatment took place over 12 sessions with fidelity (93%) being measured throughout to ensure accurate utilization of the treatment manual. As part of the treatment manual, self-report measures (Pain Rating Scale, Pain Catastrophizing Scale, Pain Outcomes Questionnaire, and subjective units of distress) were used throughout to track patient progress. All measures showed improvement with the biggest gains being seen in pain ratings and pain catastrophizing.     

Effects of acute endurance,strength, and coordination exercise interventions on attention in adolescents: A randomized controlled study

ObjectivesThe aim of this study was to compare three different modes of an acute bout of exercise – endurance, strength, and coordination – in their effects on adolescents' attention.DesignThis was a preregistered, prospective, randomized intervention study with four groups and two distinct measurement occasions.MethodEighty adolescent students aged 15–18 years were randomized to one of three exercise intervention groups (endurance, strength, coordination) or to a non-exercise, control group. The exercise interventions lasted for 25 min. The random assignment to the study groups was stratified according to participants' age and gender. Before and after the exercise intervention, all participants completed the revised d2-test of attention. A 4 × 2 repeated measures ANOVA with contrast-coded test was used as the main analysis method.ResultsAttentional test performance increased from before to after the exercise intervention for all exercise groups, as compared with the control group. The three exercise groups improved equally and did not differ in their attentional scores after the intervention.ConclusionsAn acute bout of exercise was in general beneficial for adolescent students' attention, while the mode of the provided exercise training was not decisive. School directors and teachers are encouraged to incorporate exercise-related breaks into their school plan.     

Resilience characterized and quantified from physical activity data: A tutorial in R

Consistent physical activity is key for health and well-being, but it is vulnerable to stressors. The process of recovering from such stressors and bouncing back to the previous state of physical activity can be referred to as resilience. Quantifying resilience is fundamental to assess and manage the impact of stressors on consistent physical activity. In this tutorial, we present a method to quantify the resilience process from physical activity data. We leverage the prior operationalization of resilience, as used in various psychological domains, as area under the curve and expand it to suit the characteristics of physical activity time series. As use case to illustrate the methodology, we quantified resilience in step count time series (length = 366 observations) for eight participants following the first COVID-19 lockdown as a stressor. Steps were assessed daily using wrist-worn devices. The methodology is implemented in R and all coding details are included. For each person’s time series, we fitted multiple growth models and identified the best one using the Root Mean Squared Error (RMSE). Then, we used the predicted values from the selected model to identify the point in time when the participant recovered from the stressor and quantified the resulting area under the curve as a measure of resilience for step count. Further resilience features were extracted to capture the different aspects of the process. By developing a methodological guide with a step-by-step implementation, we aimed at fostering increased awareness about the concept of resilience for physical activity and facilitate the implementation of related research.     

Penalized optimal scaling for ordinal variables with an application to international classification of functioning core sets

Ordinal data occur frequently in the social sciences. When applying principal component analysis (PCA), however, those data are often treated as numeric, implying linear relationships between the variables at hand; alternatively, non-linear PCA is applied where the obtained quantifications are sometimes hard to interpret. Non-linear PCA for categorical data, also called optimal scoring/scaling, constructs new variables by assigning numerical values to categories such that the proportion of variance in those new variables that is explained by a predefined number of principal components (PCs) is maximized. We propose a penalized version of non-linear PCA for ordinal variables that is a smoothed intermediate between standard PCA on category labels and non-linear PCA as used so far. The new approach is by no means limited to monotonic effects and offers both better interpretability of the non-linear transformation of the category labels and better performance on validation data than unpenalized non-linear PCA and/or standard linear PCA. In particular, an application of penalized optimal scaling to ordinal data as given with the International Classification of Functioning, Disability and Health (ICF) is provided.     

Pain in the eye of the beholder: Variations in pain visual representations as a function of face ethnicity and culture

Pain experienced by Black individuals is systematically underestimated, and recent studies have shown that part of this bias is rooted in perceptual factors. We used Reverse Correlation to estimate visual representations of the pain expression in Black and White faces, in participants originating from both Western and African countries. Groups of raters were then asked to evaluate the presence of pain and other emotions in these representations. A second group of White raters then evaluated those same representations placed over a neutral background face (50% White; 50% Black). Image-based analyses show significant effects of culture and face ethnicity, but no interaction between the two factors. Western representations were more likely to be judged as expressing pain than African representations. For both cultural groups, raters also perceived more pain in White face representations than in Black face representations. However, when changing the background stimulus to the neutral background face, this effect of face ethnic profile disappeared. Overall, these results suggest that individuals have different expectations of how pain is expressed by Black and White individuals, and that cultural factors may explain a part of this phenomenon     

Linear Analogue Self-Assessment and Procrustean Measurement: A Critical Review of Visual Analogue Scaling in Pain Assessment

Visual analogue scales (VASs) are one of the most widely used self-report measures of clinical pain. This article reviews the empirical literature on linear analogue self-assessment (LASA) and critically examines the features that appear to have made it such an attractive measurement option in pain assessment. It is concluded that analogue scaling does not withstand critical scrutiny as a primary measure of either pain intensity or pain affect and that, in most circumstances, the overall clinical utility of VASs is inferior to that of more structured pain indices.