Pain catastrophizing contributes to heightened levels of pain and disability. Previous evidence d... more Pain catastrophizing contributes to heightened levels of pain and disability. Previous evidence demonstrates that non-Hispanic Blacks (NHB) report higher levels of both pain and catastrophizing than non-Hispanic whites (NHW). The current study investigates whether pain catastrophizing mediates the relationship between ethnicity/race and pain, disability and physical function in individuals with knee osteoarthritis (OA). Furthermore, this study examined whether catastrophizing predicts pain and disability at 2-year follow-up. Participants included 187 (96 NHB, 91 NHW) community-dwelling adults with unilateral or bilateral knee pain who screened positive for knee OA. Participants completed several measures at baseline and 2-year follow-up including the Coping Strategies Questionnaire-Revised Pain Catastrophizing subscale, Short-form McGill Pain Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, Graded Chronic Pain Scale, and Short Physical Performance Batte...
BackgroundChronic low back pain (cLBP) is the leading cause of disability among older adults and ... more BackgroundChronic low back pain (cLBP) is the leading cause of disability among older adults and one of the top reasons for seeking healthcare, resulting in significant decrements in physical functioning. Because older adults are among the fastest growing cohorts in the USA, both the incidence and burden of cLBP are expected to increase considerably, rendering geriatric pain management a top health priority. Resilience is defined as a process allowing individuals to adapt and recover from adverse and stressful conditions, and it has been highlighted as a crucial factor in positive health-related functioning. While a growing body of literature supports the use of resilience-based interventions in chronic pain, research examining their effectiveness in older adults with cLBP remains limited. The primary aims of the study are to assess the feasibility and acceptability of a psychologically oriented resilience intervention among aging adults with cLBP.MethodsIn this article, we describe...
Disparities in health care associated with patients’ gender, race, and age are well documented. P... more Disparities in health care associated with patients’ gender, race, and age are well documented. Previous studies using virtual human (VH) technology have demonstrated that provider characteristics may play an important role in pain management decisions. However, these studies have largely emphasized group differences. The aims of this study were to examine dentists’ and physicians’ use of VH characteristics when making clinical judgments (i.e., cue use) and to identify provider characteristics associated with the magnitude of the impact of these cues (β‐weights). Providers (N=152; 76 physicians, 76 dentists) viewed video vignettes of VH patients varying in gender (male/female), race (white/black), and age (younger/older). Participants rated VH patients’ pain intensity and unpleasantness and then rated their own likelihood of administering non‐opioid and opioid analgesics. Compared to physicians, dentists had significantly lower β‐weights associated with VH age cues for all ratings (...
Telomere length, a measure of cellular aging, is inversely associated with chronic pain severity.... more Telomere length, a measure of cellular aging, is inversely associated with chronic pain severity. While psychological resilience factors (e.g., optimism, acceptance, positive affect, and active coping) are associated with lower levels of clinical pain and greater physical functioning, it is unknown whether resilience may buffer against telomere shortening in individuals with chronic pain. Additionally, a broader conceptualization of resilience that includes social and biobehavioral factors may improve our understanding of the relationship between resilience, chronic pain, and health outcomes. In individuals with and without chronic knee pain, we investigated whether (1) psychological resilience would be positively associated with telomere length and if (2) a broader conceptualization of resilience including social and biobehavioral factors would strengthen the association. Seventy-nine adults, 45 to 85 years of age, with and without knee pain completed demographic, health, clinical pain, psychological, social, and biobehavioral questionnaires. Resilience levels were determined by summing the total number of measures indicating resilience based on published clinical ranges and norms. Blood samples were collected, and telomere length was determined. In regression analyses controlling for sex, race, age, and characteristic pain intensity, greater psychological resilience and psychosocial/biobehavioral resilience were associated with longer telomeres (p ¼ .0295 and p ¼ .0116, respectively). When compared, psychosocial/biobehavioral resilience was significantly more predictive of telomere length than psychological resilience (p < .0001). Findings are promising and encourage further investigations to enhance understanding of the biological interface of psychosocial and biobehavioral resilience factors in individuals with musculoskeletal chronic pain conditions.
Objective To assess conditioned pain modulation efficiency in persons with and without migraine h... more Objective To assess conditioned pain modulation efficiency in persons with and without migraine headaches. Design Cross-sectional assessment of experimental pain. Setting University campus and surrounding community in a large Midwestern US city. Subjects Twenty-three adults with and 32 without a history of migraine headaches participated in the study. Participants were mostly female (N = 40) with an average age of 23 years. Methods Four electrocutaneous stimulations of the supraorbital branch of the left trigeminal nerve were delivered at 150% of an individually determined pain threshold. Conditioned pain modulation was assessed by applying a noxious counterstimulus (forearm ischemia) and delivering four more electrocutaneous stimulations. After each stimulation, pain and the nociceptive blink reflex were assessed. Depression and pain catastrophizing were assessed to control for the potential influence of these variables on pain modulation. Results Participants with and without migr...
Purpose of review.-Osteoarthritis (OA) is one of the most common and disabling forms of arthritis... more Purpose of review.-Osteoarthritis (OA) is one of the most common and disabling forms of arthritis worldwide, with joint pain being a primary symptom. Given that clinical symptoms often show poor concordance with tissue damage in OA, processes other than joint remodeling likely play a role in the condition. Using the biopsychosocial model of pain as a guiding framework, the purpose of this review is to highlight the extra-articular mechanisms that contribute to pain and dysfunction in OA, with a specific focus on resilience. Recent findings.-Whereas previous research has mostly focused on risk factors for worsening of OA pain, recently emerging evidence places greater emphasis on the identification of protective mechanisms that enhance pain adaptation and palliate the negative effects of joint pain. Summary.-In view of this new and important research, more emphasis should be placed on endogenous pain modulation, and in particular, pain attenuation. The result of such work could serve as a basis for optimizing treatment in the OA population.
Premenstrual dysphoric disorder (PMDD) is characterized by severe affective and physical symptoms... more Premenstrual dysphoric disorder (PMDD) is characterized by severe affective and physical symptoms, such as increased pain, during the late-luteal phase of the menstrual cycle. The mechanisms underlying hyperalgesia in women with PMDD have yet to be identified, and supraspinal pain modulation has yet to be examined in this population. The present study assessed endogenous pain inhibitory processing by examining conditioned pain modulation (CPM, a painful conditioning stimulus inhibiting pain evoked by a test stimulus at a distal body site) of pain and the nociceptive flexion reflex (NFR, a spinally-mediated withdrawal reflex) during the mid-follicular, ovulatory, and late-luteal phases of the menstrual cycle. Methods: Participants were regularly-cycling women (14 without PMDD; 14 with PMDD). CPM was assessed by delivering electrocutaneous test stimuli to the sural nerve before, during, and after a painful conditioning ischemia task. Participants rated their pain to electrocutaneous stimuli, and NFR magnitudes were measured. A linear mixed model analysis was used to assess the influence of group and menstrual phase on CPM. Results: Compared with controls, women with PMDD experienced greater pain during the late-luteal phase and enhanced spinal nociception during the ovulation phase, both of which were independent of CPM. Both groups showed CPM inhibition of pain that did not differ by menstrual phase. Only women with PMDD evidenced CPM inhibition of NFR. Conclusion: Endogenous modulation of pain and spinal nociception is not disrupted in women with PMDD. Additionally, greater NFR magnitudes during ovulation in PMDD may be due to tonically-engaged descending mechanisms that facilitate spinal nociception, leading to enhanced pain during the premenstrual phase .
Pain is often poorly managed, highlighting the need to better understand and treat patients' pain... more Pain is often poorly managed, highlighting the need to better understand and treat patients' pain. Research suggests that pain is assessed and treated differently depending on patient sex, race, and/or age. Perspective-taking, whereby one envisions the perspective of another, has been found to reduce racial disparities in pain management. This study used virtual human (VH) technology to examine whether a perspective-taking intervention impacts pain management decisions. Methods: Ninety-six participants were randomized to an online treatment or control group and viewed 16 video clips of VHs with standardized levels of pain. Participants provided ratings on the VHs' pain intensity and their willingness to administer opioids to them. The intervention group received a brief perspective-taking intervention that consisted of having participants imagine how the patient's suffering could affect his/her life, whereas the control group was asked to wait for the next VH videos to load. A LENS model analysis was used to investigate both group level (nomothetic) and individual level (idiographic) decision policies. A LENS model of analysis is typically used as an analog method for capturing how groups of people and individuals use information in their environment to form judgments. Results: Nomothetic results found that participants rated pain higher and were more likely to prescribe opioids to VHs postintervention, irrespective of group. Idiographic results, however, found that the use of cues to make pain management decisions was mitigated by the perspectivetaking group. The participants in the perspective-taking group were more likely to think about pain and the patients' perspective during the intervention, while control participants were more likely to reflect on the VHs' sex, race, or age. Conclusion: A brief intervention may alter participants' pain management decisions. These results indicate that a brief intervention might be an initial step toward aligning observers' pain management ratings with those of the patient. Future research is needed to replicate findings in a health care population.
Symptomatic knee osteoarthritis (OA) is a condition commonly associated with increased pain, disa... more Symptomatic knee osteoarthritis (OA) is a condition commonly associated with increased pain, disability, and functional limitations. Given the poor correspondence between radiographic evidence and clinical pain, central sensitization has been implicated as a potential mechanism underlying pain facilitation in knee OA. Sex may be a moderator of centrally-mediated changes in knee OA pain; however, few studies have systematically assessed this. Therefore, the aim of this study was to examine differences in peripheral and central sensitization in men and women with symptomatic knee OA, as well as to determine whether these differences vary across age (middle-age vs. older-age). Participants (N=288) between the ages of 45 and 85 completed a battery of quantitative sensory pain procedures assessing sensitivity to contact heat, cold pressor, mechanical pressure, and punctate stimuli. Differences in temporal summation (TS) were examined, as well as measures of clinical pain and functional p...
Objective: Premenstrual dysphoric disorder (PMDD) is associated with increased pain, but there ha... more Objective: Premenstrual dysphoric disorder (PMDD) is associated with increased pain, but there has been a lack of well-controlled research assessing pain responsivity, sex hormones, and their relationships in this group. This study was designed to address this gap in the literature. Materials and Methods: Healthy, regularly cycling participants (14 PMDD, 14 non-PMDD) attended pain testing sessions during the mid-follicular, ovulatory, and late-luteal phases of the menstrual cycle (order counterbalanced) and salivary estradiol, progesterone, and testosterone were assessed at each testing session. Pain sensitivity was measured from electrocutaneous threshold/tolerance, ischemic threshold/tolerance, sensory and affective ratings of electrocutaneous and ischemic stimuli, and the nociceptive flexion reflex threshold (NFR, a measure of spinal nociception). Results: Women with PMDD had higher sensory pain ratings of electrocutaneous stimuli and trends for lower ischemic thresholds and higher affective pain ratings of electrocutaneous stimuli. However, there were no group differences observed in NFR threshold. Testosterone levels were also lower during the mid-follicular and ovulatory phases in PMDD. Correlations between pain outcomes and estradiol and testosterone indicated that these hormones are hypoalgesic, with estradiol having a greater hypoalgesic effect within the PMDD group. Discussion: Overall, women with PMDD may have a phase-independent hyperalgesia, with pain amplification likely occurring at the supraspinal level rather than the spinal level, given the lack of group differences in NFR threshold. Because testosterone was hypoalgesic and lower in women with PMDD, and there were strong associations between pain and estradiol in PMDD, sex hormones may play a role in PMDD-related hyperalgesia.
The prevalence of knee osteoarthritis is increasing with the aging population and is exacerbated ... more The prevalence of knee osteoarthritis is increasing with the aging population and is exacerbated by the growing numbers of obese older adults. Low levels of vitamin D, measured by serum 25-hydroxyvitamin D (25(OH)D), in older adults and obese individuals are correlated with several negative health conditions, including chronic pain. This cross-sectional study sought to examine the interactive influence of 25(OH)D levels and obesity on knee osteoarthritis pain and functional performance measures. The sample consisted of 256 (63% female) racially-diverse (55% Black/African Americans) middle-aged and older adults (mean age 56.8 y). Blood was collected for analysis of 25(OH)D by high performance liquid chromatography. Participants provided self-report regarding knee osteoarthritis pain and underwent a lower extremity functional performance test. Results demonstrated that obesity was associated with lower levels of 25(OH)D. Participants with adequate 25(OH)D levels reported significantly...
Physiological reactions to noxious stimuli are often used to make inferences about pain, but few ... more Physiological reactions to noxious stimuli are often used to make inferences about pain, but few studies have thoroughly examined the intra‐ and interindividual relationships between them. In the present study (N=104), multilevel analyses was used to assess relations between physiological (nociceptive flexion reflex magnitude [NFR], blink reflex magnitude, skin conductance response [SCR], heart rate [HR]) and subjective reactions to electrocutaneous stimuli. All physiological reactions were significant predictors of ratings when entered alone, explaining 1% (SCR) to 29% (NFR) of the variance; but only NFR, blink, and HR were significant in a multivariate predictor model. Significant interindividual variability in slopes was found for blink and HR, but not NFR. A final trimmed model that included NFR, blink, and the blink random slope explained 35% of the variance in ratings.
The Emotional Controls of Nociception (ECON) paradigm involves the presentation of emotionally-ch... more The Emotional Controls of Nociception (ECON) paradigm involves the presentation of emotionally-charged pictures during which painful stimuli are delivered. Across several ECON studies, unpleasant pictures enhanced pain and nociception, whereas pleasant pictures inhibited pain and nociception. However, at this time it is unknown whether emotional valence (unpleasant, neutral, pleasant) influences the habituation or sensitization of pain responses that occurs within a testing session. Indeed, ECON assumes that emotional valence modulation of pain is consistent throughout testing; otherwise the interpretation of valence modulation (unpleasant&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;neutral&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;pleasant) could be threatened. To address this issue, the present study (N=120) presented 108 pictures that varied in emotional valence. During and in between pictures, 52 suprathreshold electrocutaneous stimuli were delivered to evoke pain, the nociceptive flexion reflex [NFR], and pain-evoked skin conductance response [SCR]. Mixed effects ANOVAs verified that within-subject changes in pain responses were influenced by stimulus repetition (NFR and SCR habituated, pain ratings sensitized) and emotional valence (responses were highest during unpleasant pictures, intermediate during neutral pictures, and lowest during pleasant pictures). However, habituation/sensitization slopes were unaffected by emotional valence, thus indicating emotional valence modulation was consistently observed throughout the testing session. These results provide additional validation for the ECON paradigm and suggest that the circuit responsible for emotional modulation of pain and nociception is less susceptible to habituation or sensitization than the circuits responsible for responses to suprathreshold shocks.
Studies in the United States have found that patients' sex, race, and age influence the pain asse... more Studies in the United States have found that patients' sex, race, and age influence the pain assessment and treatment decisions of laypeople and medical professionals. However, there is limited research as to whether people of other nationalities make pain management decisions differently based on demographic characteristics. Therefore, the purpose of the following study was to compare pain assessment and treatment decisions of undergraduate students in Jordan and the United States as a preliminary examination of nationality as a potential proxy for cultural differences in pain decisions. Methods: Virtual human (VH) technology was used to examine the influences of patients' sex (male or female), race (light-skinned or dark-skinned), and age (younger or older) on students' pain management decisions. Seventy-five American and 104 Jordanian undergraduate students participated in this web-based study. Results: American and Jordanian students rated pain intensity higher in females and older adults and were more likely to recommend medical help to these groups, relative to males and younger adults. Furthermore, Jordanian participants rated pain intensity higher and were more likely to recommend medical help for all patient demographic groups (ie, sex, race, age) than American participants. Conclusion: This is the first cross-national study that compares pain decisions between undergraduate students. The results suggest that sex, race, and age cues are used in pain assessment and treatment by both Americans and Jordanians, with Jordanians more likely to rate pain higher and recommend medical help to patients. Additional research is needed to determine the cultural determinants of these differences.
Slow breathing is used as a means to reduce pain, yet the mechanisms responsible for respiration-... more Slow breathing is used as a means to reduce pain, yet the mechanisms responsible for respiration-induced hypoalgesia are poorly understood. The present study asked 30 healthy participants (M age = 21 years, M education = 15 years, 80% white non-Hispanic) to breathe at normal, slow (50% normal), and fast (125% normal) rates while constant-intensity, suprathreshold electric stimulations were delivered to the sural nerve to elicit pain and the nociceptive flexion reflex (NFR, a measure of spinal nociception). Stimulations were equally balanced across inhalations and exhalations to determine whether parasympathetic activation during exhalations contributes to hypoalgesia. Respiration rate, heart rate variability (HRV, a measure of parasympathetic activity), heart rate, and subjective arousal were assessed as manipulation checks. Slow breathing reduced pain relative to normal breathing and fast breathing, but NFR was not influenced by breathing. Further, pain and NFR did not differ between exhalations and inhalations, and changes in HRV did not correlate with changes in pain or NFR. Together, these findings suggest that respiration-induced hypoalgesia does not require gating of spinal nociception or changes in parasympathetic activity. Perspective: Slow breathing reduced pain relative to normal and fast breathing. This respirationinduced hypoalgesia does not appear to be due to gating of spinal nociception or changes in parasympathetic activity.
Existing evidence indicates that pain catastrophizing is associated with enhanced pain reports an... more Existing evidence indicates that pain catastrophizing is associated with enhanced pain reports and lower pain threshold/tolerance levels, but is not significantly related to nociceptive flexion reflex (NFR) threshold in healthy and clinical pain samples. This suggests pain catastrophizing may modulate pain threshold at a supraspinal level without influencing descending modulation of spinal nociceptive inputs. To examine this issue further, the present study assessed NFR threshold, electrocutaneous pain threshold, and electrocutaneous pain tolerance, as well as subjective ratings of noxious stimuli in a sample of 105 healthy adults. Pain catastrophizing was assessed prior to testing using traditional instructions and after pain testing with instructions to report on cognitions during testing (situation-specific catastrophizing). As expected, NFR threshold was correlated with pain sensitivity measures, but uncorrelated with both measures of catastrophizing. Although situationspecific catastrophizing was correlated with some pain outcomes, neither catastrophizing measure (traditional or situation specific) moderated the relationship between NFR and pain sensitivity. These findings confirm and extend existing evidence that catastrophizing influences pain reports through supraspinal mechanisms (eg, memory, report bias, attention) without altering transmission of spinal nociceptive signals. Perspective: Assessing catastrophic thoughts related to a specific painful event (situation-specific catastrophizing) provides important additional information regarding the negative cognitions that influence pain-related processes. However, neither situation-specific nor traditionally measured pain catastrophizing appear to enhance pain by engaging descending controls to influence spinal nociceptive processes.
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are
Pain catastrophizing contributes to heightened levels of pain and disability. Previous evidence d... more Pain catastrophizing contributes to heightened levels of pain and disability. Previous evidence demonstrates that non-Hispanic Blacks (NHB) report higher levels of both pain and catastrophizing than non-Hispanic whites (NHW). The current study investigates whether pain catastrophizing mediates the relationship between ethnicity/race and pain, disability and physical function in individuals with knee osteoarthritis (OA). Furthermore, this study examined whether catastrophizing predicts pain and disability at 2-year follow-up. Participants included 187 (96 NHB, 91 NHW) community-dwelling adults with unilateral or bilateral knee pain who screened positive for knee OA. Participants completed several measures at baseline and 2-year follow-up including the Coping Strategies Questionnaire-Revised Pain Catastrophizing subscale, Short-form McGill Pain Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, Graded Chronic Pain Scale, and Short Physical Performance Batte...
BackgroundChronic low back pain (cLBP) is the leading cause of disability among older adults and ... more BackgroundChronic low back pain (cLBP) is the leading cause of disability among older adults and one of the top reasons for seeking healthcare, resulting in significant decrements in physical functioning. Because older adults are among the fastest growing cohorts in the USA, both the incidence and burden of cLBP are expected to increase considerably, rendering geriatric pain management a top health priority. Resilience is defined as a process allowing individuals to adapt and recover from adverse and stressful conditions, and it has been highlighted as a crucial factor in positive health-related functioning. While a growing body of literature supports the use of resilience-based interventions in chronic pain, research examining their effectiveness in older adults with cLBP remains limited. The primary aims of the study are to assess the feasibility and acceptability of a psychologically oriented resilience intervention among aging adults with cLBP.MethodsIn this article, we describe...
Disparities in health care associated with patients’ gender, race, and age are well documented. P... more Disparities in health care associated with patients’ gender, race, and age are well documented. Previous studies using virtual human (VH) technology have demonstrated that provider characteristics may play an important role in pain management decisions. However, these studies have largely emphasized group differences. The aims of this study were to examine dentists’ and physicians’ use of VH characteristics when making clinical judgments (i.e., cue use) and to identify provider characteristics associated with the magnitude of the impact of these cues (β‐weights). Providers (N=152; 76 physicians, 76 dentists) viewed video vignettes of VH patients varying in gender (male/female), race (white/black), and age (younger/older). Participants rated VH patients’ pain intensity and unpleasantness and then rated their own likelihood of administering non‐opioid and opioid analgesics. Compared to physicians, dentists had significantly lower β‐weights associated with VH age cues for all ratings (...
Telomere length, a measure of cellular aging, is inversely associated with chronic pain severity.... more Telomere length, a measure of cellular aging, is inversely associated with chronic pain severity. While psychological resilience factors (e.g., optimism, acceptance, positive affect, and active coping) are associated with lower levels of clinical pain and greater physical functioning, it is unknown whether resilience may buffer against telomere shortening in individuals with chronic pain. Additionally, a broader conceptualization of resilience that includes social and biobehavioral factors may improve our understanding of the relationship between resilience, chronic pain, and health outcomes. In individuals with and without chronic knee pain, we investigated whether (1) psychological resilience would be positively associated with telomere length and if (2) a broader conceptualization of resilience including social and biobehavioral factors would strengthen the association. Seventy-nine adults, 45 to 85 years of age, with and without knee pain completed demographic, health, clinical pain, psychological, social, and biobehavioral questionnaires. Resilience levels were determined by summing the total number of measures indicating resilience based on published clinical ranges and norms. Blood samples were collected, and telomere length was determined. In regression analyses controlling for sex, race, age, and characteristic pain intensity, greater psychological resilience and psychosocial/biobehavioral resilience were associated with longer telomeres (p ¼ .0295 and p ¼ .0116, respectively). When compared, psychosocial/biobehavioral resilience was significantly more predictive of telomere length than psychological resilience (p < .0001). Findings are promising and encourage further investigations to enhance understanding of the biological interface of psychosocial and biobehavioral resilience factors in individuals with musculoskeletal chronic pain conditions.
Objective To assess conditioned pain modulation efficiency in persons with and without migraine h... more Objective To assess conditioned pain modulation efficiency in persons with and without migraine headaches. Design Cross-sectional assessment of experimental pain. Setting University campus and surrounding community in a large Midwestern US city. Subjects Twenty-three adults with and 32 without a history of migraine headaches participated in the study. Participants were mostly female (N = 40) with an average age of 23 years. Methods Four electrocutaneous stimulations of the supraorbital branch of the left trigeminal nerve were delivered at 150% of an individually determined pain threshold. Conditioned pain modulation was assessed by applying a noxious counterstimulus (forearm ischemia) and delivering four more electrocutaneous stimulations. After each stimulation, pain and the nociceptive blink reflex were assessed. Depression and pain catastrophizing were assessed to control for the potential influence of these variables on pain modulation. Results Participants with and without migr...
Purpose of review.-Osteoarthritis (OA) is one of the most common and disabling forms of arthritis... more Purpose of review.-Osteoarthritis (OA) is one of the most common and disabling forms of arthritis worldwide, with joint pain being a primary symptom. Given that clinical symptoms often show poor concordance with tissue damage in OA, processes other than joint remodeling likely play a role in the condition. Using the biopsychosocial model of pain as a guiding framework, the purpose of this review is to highlight the extra-articular mechanisms that contribute to pain and dysfunction in OA, with a specific focus on resilience. Recent findings.-Whereas previous research has mostly focused on risk factors for worsening of OA pain, recently emerging evidence places greater emphasis on the identification of protective mechanisms that enhance pain adaptation and palliate the negative effects of joint pain. Summary.-In view of this new and important research, more emphasis should be placed on endogenous pain modulation, and in particular, pain attenuation. The result of such work could serve as a basis for optimizing treatment in the OA population.
Premenstrual dysphoric disorder (PMDD) is characterized by severe affective and physical symptoms... more Premenstrual dysphoric disorder (PMDD) is characterized by severe affective and physical symptoms, such as increased pain, during the late-luteal phase of the menstrual cycle. The mechanisms underlying hyperalgesia in women with PMDD have yet to be identified, and supraspinal pain modulation has yet to be examined in this population. The present study assessed endogenous pain inhibitory processing by examining conditioned pain modulation (CPM, a painful conditioning stimulus inhibiting pain evoked by a test stimulus at a distal body site) of pain and the nociceptive flexion reflex (NFR, a spinally-mediated withdrawal reflex) during the mid-follicular, ovulatory, and late-luteal phases of the menstrual cycle. Methods: Participants were regularly-cycling women (14 without PMDD; 14 with PMDD). CPM was assessed by delivering electrocutaneous test stimuli to the sural nerve before, during, and after a painful conditioning ischemia task. Participants rated their pain to electrocutaneous stimuli, and NFR magnitudes were measured. A linear mixed model analysis was used to assess the influence of group and menstrual phase on CPM. Results: Compared with controls, women with PMDD experienced greater pain during the late-luteal phase and enhanced spinal nociception during the ovulation phase, both of which were independent of CPM. Both groups showed CPM inhibition of pain that did not differ by menstrual phase. Only women with PMDD evidenced CPM inhibition of NFR. Conclusion: Endogenous modulation of pain and spinal nociception is not disrupted in women with PMDD. Additionally, greater NFR magnitudes during ovulation in PMDD may be due to tonically-engaged descending mechanisms that facilitate spinal nociception, leading to enhanced pain during the premenstrual phase .
Pain is often poorly managed, highlighting the need to better understand and treat patients' pain... more Pain is often poorly managed, highlighting the need to better understand and treat patients' pain. Research suggests that pain is assessed and treated differently depending on patient sex, race, and/or age. Perspective-taking, whereby one envisions the perspective of another, has been found to reduce racial disparities in pain management. This study used virtual human (VH) technology to examine whether a perspective-taking intervention impacts pain management decisions. Methods: Ninety-six participants were randomized to an online treatment or control group and viewed 16 video clips of VHs with standardized levels of pain. Participants provided ratings on the VHs' pain intensity and their willingness to administer opioids to them. The intervention group received a brief perspective-taking intervention that consisted of having participants imagine how the patient's suffering could affect his/her life, whereas the control group was asked to wait for the next VH videos to load. A LENS model analysis was used to investigate both group level (nomothetic) and individual level (idiographic) decision policies. A LENS model of analysis is typically used as an analog method for capturing how groups of people and individuals use information in their environment to form judgments. Results: Nomothetic results found that participants rated pain higher and were more likely to prescribe opioids to VHs postintervention, irrespective of group. Idiographic results, however, found that the use of cues to make pain management decisions was mitigated by the perspectivetaking group. The participants in the perspective-taking group were more likely to think about pain and the patients' perspective during the intervention, while control participants were more likely to reflect on the VHs' sex, race, or age. Conclusion: A brief intervention may alter participants' pain management decisions. These results indicate that a brief intervention might be an initial step toward aligning observers' pain management ratings with those of the patient. Future research is needed to replicate findings in a health care population.
Symptomatic knee osteoarthritis (OA) is a condition commonly associated with increased pain, disa... more Symptomatic knee osteoarthritis (OA) is a condition commonly associated with increased pain, disability, and functional limitations. Given the poor correspondence between radiographic evidence and clinical pain, central sensitization has been implicated as a potential mechanism underlying pain facilitation in knee OA. Sex may be a moderator of centrally-mediated changes in knee OA pain; however, few studies have systematically assessed this. Therefore, the aim of this study was to examine differences in peripheral and central sensitization in men and women with symptomatic knee OA, as well as to determine whether these differences vary across age (middle-age vs. older-age). Participants (N=288) between the ages of 45 and 85 completed a battery of quantitative sensory pain procedures assessing sensitivity to contact heat, cold pressor, mechanical pressure, and punctate stimuli. Differences in temporal summation (TS) were examined, as well as measures of clinical pain and functional p...
Objective: Premenstrual dysphoric disorder (PMDD) is associated with increased pain, but there ha... more Objective: Premenstrual dysphoric disorder (PMDD) is associated with increased pain, but there has been a lack of well-controlled research assessing pain responsivity, sex hormones, and their relationships in this group. This study was designed to address this gap in the literature. Materials and Methods: Healthy, regularly cycling participants (14 PMDD, 14 non-PMDD) attended pain testing sessions during the mid-follicular, ovulatory, and late-luteal phases of the menstrual cycle (order counterbalanced) and salivary estradiol, progesterone, and testosterone were assessed at each testing session. Pain sensitivity was measured from electrocutaneous threshold/tolerance, ischemic threshold/tolerance, sensory and affective ratings of electrocutaneous and ischemic stimuli, and the nociceptive flexion reflex threshold (NFR, a measure of spinal nociception). Results: Women with PMDD had higher sensory pain ratings of electrocutaneous stimuli and trends for lower ischemic thresholds and higher affective pain ratings of electrocutaneous stimuli. However, there were no group differences observed in NFR threshold. Testosterone levels were also lower during the mid-follicular and ovulatory phases in PMDD. Correlations between pain outcomes and estradiol and testosterone indicated that these hormones are hypoalgesic, with estradiol having a greater hypoalgesic effect within the PMDD group. Discussion: Overall, women with PMDD may have a phase-independent hyperalgesia, with pain amplification likely occurring at the supraspinal level rather than the spinal level, given the lack of group differences in NFR threshold. Because testosterone was hypoalgesic and lower in women with PMDD, and there were strong associations between pain and estradiol in PMDD, sex hormones may play a role in PMDD-related hyperalgesia.
The prevalence of knee osteoarthritis is increasing with the aging population and is exacerbated ... more The prevalence of knee osteoarthritis is increasing with the aging population and is exacerbated by the growing numbers of obese older adults. Low levels of vitamin D, measured by serum 25-hydroxyvitamin D (25(OH)D), in older adults and obese individuals are correlated with several negative health conditions, including chronic pain. This cross-sectional study sought to examine the interactive influence of 25(OH)D levels and obesity on knee osteoarthritis pain and functional performance measures. The sample consisted of 256 (63% female) racially-diverse (55% Black/African Americans) middle-aged and older adults (mean age 56.8 y). Blood was collected for analysis of 25(OH)D by high performance liquid chromatography. Participants provided self-report regarding knee osteoarthritis pain and underwent a lower extremity functional performance test. Results demonstrated that obesity was associated with lower levels of 25(OH)D. Participants with adequate 25(OH)D levels reported significantly...
Physiological reactions to noxious stimuli are often used to make inferences about pain, but few ... more Physiological reactions to noxious stimuli are often used to make inferences about pain, but few studies have thoroughly examined the intra‐ and interindividual relationships between them. In the present study (N=104), multilevel analyses was used to assess relations between physiological (nociceptive flexion reflex magnitude [NFR], blink reflex magnitude, skin conductance response [SCR], heart rate [HR]) and subjective reactions to electrocutaneous stimuli. All physiological reactions were significant predictors of ratings when entered alone, explaining 1% (SCR) to 29% (NFR) of the variance; but only NFR, blink, and HR were significant in a multivariate predictor model. Significant interindividual variability in slopes was found for blink and HR, but not NFR. A final trimmed model that included NFR, blink, and the blink random slope explained 35% of the variance in ratings.
The Emotional Controls of Nociception (ECON) paradigm involves the presentation of emotionally-ch... more The Emotional Controls of Nociception (ECON) paradigm involves the presentation of emotionally-charged pictures during which painful stimuli are delivered. Across several ECON studies, unpleasant pictures enhanced pain and nociception, whereas pleasant pictures inhibited pain and nociception. However, at this time it is unknown whether emotional valence (unpleasant, neutral, pleasant) influences the habituation or sensitization of pain responses that occurs within a testing session. Indeed, ECON assumes that emotional valence modulation of pain is consistent throughout testing; otherwise the interpretation of valence modulation (unpleasant&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;neutral&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;pleasant) could be threatened. To address this issue, the present study (N=120) presented 108 pictures that varied in emotional valence. During and in between pictures, 52 suprathreshold electrocutaneous stimuli were delivered to evoke pain, the nociceptive flexion reflex [NFR], and pain-evoked skin conductance response [SCR]. Mixed effects ANOVAs verified that within-subject changes in pain responses were influenced by stimulus repetition (NFR and SCR habituated, pain ratings sensitized) and emotional valence (responses were highest during unpleasant pictures, intermediate during neutral pictures, and lowest during pleasant pictures). However, habituation/sensitization slopes were unaffected by emotional valence, thus indicating emotional valence modulation was consistently observed throughout the testing session. These results provide additional validation for the ECON paradigm and suggest that the circuit responsible for emotional modulation of pain and nociception is less susceptible to habituation or sensitization than the circuits responsible for responses to suprathreshold shocks.
Studies in the United States have found that patients' sex, race, and age influence the pain asse... more Studies in the United States have found that patients' sex, race, and age influence the pain assessment and treatment decisions of laypeople and medical professionals. However, there is limited research as to whether people of other nationalities make pain management decisions differently based on demographic characteristics. Therefore, the purpose of the following study was to compare pain assessment and treatment decisions of undergraduate students in Jordan and the United States as a preliminary examination of nationality as a potential proxy for cultural differences in pain decisions. Methods: Virtual human (VH) technology was used to examine the influences of patients' sex (male or female), race (light-skinned or dark-skinned), and age (younger or older) on students' pain management decisions. Seventy-five American and 104 Jordanian undergraduate students participated in this web-based study. Results: American and Jordanian students rated pain intensity higher in females and older adults and were more likely to recommend medical help to these groups, relative to males and younger adults. Furthermore, Jordanian participants rated pain intensity higher and were more likely to recommend medical help for all patient demographic groups (ie, sex, race, age) than American participants. Conclusion: This is the first cross-national study that compares pain decisions between undergraduate students. The results suggest that sex, race, and age cues are used in pain assessment and treatment by both Americans and Jordanians, with Jordanians more likely to rate pain higher and recommend medical help to patients. Additional research is needed to determine the cultural determinants of these differences.
Slow breathing is used as a means to reduce pain, yet the mechanisms responsible for respiration-... more Slow breathing is used as a means to reduce pain, yet the mechanisms responsible for respiration-induced hypoalgesia are poorly understood. The present study asked 30 healthy participants (M age = 21 years, M education = 15 years, 80% white non-Hispanic) to breathe at normal, slow (50% normal), and fast (125% normal) rates while constant-intensity, suprathreshold electric stimulations were delivered to the sural nerve to elicit pain and the nociceptive flexion reflex (NFR, a measure of spinal nociception). Stimulations were equally balanced across inhalations and exhalations to determine whether parasympathetic activation during exhalations contributes to hypoalgesia. Respiration rate, heart rate variability (HRV, a measure of parasympathetic activity), heart rate, and subjective arousal were assessed as manipulation checks. Slow breathing reduced pain relative to normal breathing and fast breathing, but NFR was not influenced by breathing. Further, pain and NFR did not differ between exhalations and inhalations, and changes in HRV did not correlate with changes in pain or NFR. Together, these findings suggest that respiration-induced hypoalgesia does not require gating of spinal nociception or changes in parasympathetic activity. Perspective: Slow breathing reduced pain relative to normal and fast breathing. This respirationinduced hypoalgesia does not appear to be due to gating of spinal nociception or changes in parasympathetic activity.
Existing evidence indicates that pain catastrophizing is associated with enhanced pain reports an... more Existing evidence indicates that pain catastrophizing is associated with enhanced pain reports and lower pain threshold/tolerance levels, but is not significantly related to nociceptive flexion reflex (NFR) threshold in healthy and clinical pain samples. This suggests pain catastrophizing may modulate pain threshold at a supraspinal level without influencing descending modulation of spinal nociceptive inputs. To examine this issue further, the present study assessed NFR threshold, electrocutaneous pain threshold, and electrocutaneous pain tolerance, as well as subjective ratings of noxious stimuli in a sample of 105 healthy adults. Pain catastrophizing was assessed prior to testing using traditional instructions and after pain testing with instructions to report on cognitions during testing (situation-specific catastrophizing). As expected, NFR threshold was correlated with pain sensitivity measures, but uncorrelated with both measures of catastrophizing. Although situationspecific catastrophizing was correlated with some pain outcomes, neither catastrophizing measure (traditional or situation specific) moderated the relationship between NFR and pain sensitivity. These findings confirm and extend existing evidence that catastrophizing influences pain reports through supraspinal mechanisms (eg, memory, report bias, attention) without altering transmission of spinal nociceptive signals. Perspective: Assessing catastrophic thoughts related to a specific painful event (situation-specific catastrophizing) provides important additional information regarding the negative cognitions that influence pain-related processes. However, neither situation-specific nor traditionally measured pain catastrophizing appear to enhance pain by engaging descending controls to influence spinal nociceptive processes.
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are
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