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See detailBlood pressure and the perception of illusive pain
Scheuren, Raymonde UL; Duschek, Stefan; Schulz, André UL et al

in Psychophysiology (2016), 53(8), 1282-1291

Numerous studies have documented an inverse relationship between blood pressure and sensitivity to experimental nociceptive stimulation. The present study aimed to investigate possible associations ... [more ▼]

Numerous studies have documented an inverse relationship between blood pressure and sensitivity to experimental nociceptive stimulation. The present study aimed to investigate possible associations between blood pressure and the occurrence and intensity of paradoxical pain induced by the thermal grill paradigm. Thirty-one healthy subjects were stimulated three times for 1 minute with the non-noxious temperatures of 15°C and 41°C set at the interlaced cold and warm bars of a water bath-driven thermal grill. Blood pressure and heart rate were recorded concomitantly. On account of previous observations of an association between the sensitivity of the cardiac baroreflex and pain perception, this parameter was additionally obtained. Numerical rating scales were used to quantify subjective pain intensity and pain unpleasantness; subjects were classified as responders and non-responders to thermal grill stimulation based on pain intensity ratings. Responders exhibited lower systolic and diastolic blood pressure than non-responders, and inverse linear associations arose between blood pressure and pain intensity and unpleasantness. Baroreflex sensitivity was unrelated to pain ratings. The findings confirmed the hypothesis of a blood pressure dependence of paradoxical pain and support the notion that the cardiovascular and pain regulatory systems interact not only in the processing of pain elicited by noxious input, but also in non-noxiously generated illusive pain. While this finding is not consistent with the assumption of an involvement of the baroreflex system in mediating the observed interaction, psychological traits and neurochemical factors are alternatively considered. [less ▲]

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See detailVaguely mediated heart rate variability promotes the perception of paradoxical pain
Scheuren, Raymonde UL; Sütterlin, Stefan; Anton, Fernand UL

in Journal of Psychophysiology (2016)

Self-regulation mechanisms are governed by prefrontal inhibitory processes and play a crucial role in the modulation of pain. In the present study the thermal grill paradigm was used to investigate the ... [more ▼]

Self-regulation mechanisms are governed by prefrontal inhibitory processes and play a crucial role in the modulation of pain. In the present study the thermal grill paradigm was used to investigate the association of vagally mediated resting heart rate variability, a psychophysiological marker of trait self-regulatory capacity, with paradoxical pain sensations induced by non-noxious stimulation. This thermal grill illusion is only perceived by part of the tested individuals. The mechanisms underlying the observed inter-individual differences in paradoxical pain sensitivity are largely unknown. During the experimental task, a temperature combination of 15° C and 41° C was set at the glass tubes of the thermal grill. The fifty-two healthy participants placed their dominant hand on the grill for a duration of one minute. The magnitude of sensory and affective pain sensations perceived during stimulation was assessed with numerical rating scales. Before stimulation, a short-term electrocardiogram was recorded to compute vagally mediated heart rate variability at rest. Logistic regression analyses revealed that participants with higher vagal tone were significantly more likely to perceive the thermal grill illusion than subjects displaying lower resting heart rate variability. Paradoxical pain sensations were primarily predicted by normalized respiratory sinus arrhythmia. Our results confirm that the magnitude of vagally mediated resting heart rate variability is associated with the individual disposition to illusive pain perceptions. Since the latter is considered to be a marker of trait self-regulation ability, the present findings may corroborate and complement previous evidence for an impact of psychological characteristics on paradoxical pain sensitivity. [less ▲]

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See detailInter-individual differences in cardiovascular reactivity and the perception of the thermal grill illusion of pain
Scheuren, Raymonde UL; Duschek, Stefan; Schulz, André UL et al

Speeches/Talks (2015)

Background: Evidence has been given that there exists a functional relationship between the cardiovascular and the pain regulatory system. Alterations in blood pressure and concomitant changes in ... [more ▼]

Background: Evidence has been given that there exists a functional relationship between the cardiovascular and the pain regulatory system. Alterations in blood pressure and concomitant changes in baroreceptor activation contribute to the modulation of pain sensitivity It could be shown that blood pressure, baroreflex sensitivity, and cardiac vagal tone (indexed by heart rate variability, HRV) are inversely associated to pain sensitivity. We aimed assessing the same cardiovascular parameters in a thermal grill paradigm to test the assumption of a relationship between inter-individual differences in autonomic cardiac control and the perception of the thermal grill illusion of pain (TGI). Methods: All participants (N = 52) were stimulated three times during one minute with the temperatures of 15°C and 41°C set at the interlaced cold and warm bars of the water-bath driven thermal grill. Blood pressure and heart rate were recorded concomitantly. Numerical rating scales (NRS; 0–100) were used to quantify subjective paradoxical pain intensity and pain unpleasantness perceptions. Results: A positive association between cardiac vagal tone and paradoxical pain sensitivity could be revealed. Higher resting HRV, as expressed by higher respiratory sinus arrhythmia (RSA), made it overall more likely to perceive the TGI. In contrast, blood pressure and the susceptibility to the TGI were inversely related. Volunteers displaying higher spontaneous blood pressure values in the first thermal grill stimulation phase did not feel the illusive pain as compared to those who presented significantly lower sympathetic arousal and perceived the TGI. Conclusion: The present physiological findings complement previous evidence of an impact of psychological characteristics on the individual disposition to paradoxical pain perceptions. [less ▲]

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See detailRelationship between cardiovascular reactivity and the perception of the thermal grill illusion of pain
Scheuren, Raymonde UL; Duschek, Stefan; Schulz, André UL et al

Poster (2015, September 03)

Alterations in blood pressure (BP) and concomitant changes in baroreceptor activation contribute to the modulation of pain sensitivity to warrant homeostatic regulation processes [1][2]. Numerous pain ... [more ▼]

Alterations in blood pressure (BP) and concomitant changes in baroreceptor activation contribute to the modulation of pain sensitivity to warrant homeostatic regulation processes [1][2]. Numerous pain studies have described an inverse relationship between BP and nociceptive sensitivity [3][4][5]. It is not known whether a similar relationship plays a role in the framework of the induction of pain in the absence of noxious stimulation. The thermal grill (TG) paradigm is commonly used to trigger this type of paradoxical pain also termed thermal grill illusion of pain (TGI). The goal of the present study was to explore the relationship between cardiovascular activity/reactivity and paradoxical pain sensitivity to get additional insight in the variability of responsiveness (responders and non-responders) to TG stimulation described in the literature [6][7]. We hypothesized that higher BP would be associated with stronger pain inhibitory effects in participants not perceiving the thermal grill illusion of pain (TGI). We moreover expected that the perception of paradoxical pain in the responder group would be paired with lower BP. We tested this hypothesis by comparing both groups with respect to their spontaneous cardiovascular activity (recorded in resting conditions) and their cardiovascular responses to TG stimulation. [less ▲]

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See detailCognitive Processing of Interoceptive Information and Negative Health Outcomes
Sütterlin, Stefan; Scheuren, Raymonde UL; Mueller, Sven et al

Poster (2015, September 02)

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See detailVagally mediated heart rate variability is a predictor for the occurrence of the thermal grill-induced pain illusion
Scheuren, Raymonde UL; Sütterlin, Stefan UL; Anton, Fernand UL

Poster (2014, October)

Aim: Unpleasantness and negative affect accompany the sensory experience of pain. Both components of pain are heavily influenced by cognitive and emotional processes. In this framework, alterations in ... [more ▼]

Aim: Unpleasantness and negative affect accompany the sensory experience of pain. Both components of pain are heavily influenced by cognitive and emotional processes. In this framework, alterations in baroreceptor reactivity and concomitant changes in cardiac rhythm and blood pressure related to these processes contribute to the modulation of pain sensitivity. Furthermore, self-regulatory capacity has been shown to play a major role in the regulation of cognitive, affective, and behavioural reactions to adverse contexts. These regulatory mechanisms include adjustment of cardiovascular activity and heavily depend on prefrontal cortical processing. Vagally mediated heart rate variability (HRV) at rest is an indicator of the prefrontally modulated vagal activation and has been used as a psychophysiological marker for self-regulatory capacity. The present study investigated the predictive value of the trait self-regulation in the triggering of the thermal grill-induced pain illusion (TGI). We hypothesized inter-individual differences in paradoxical pain perception to be predicted by self-regulatory capacity in a way that participants displaying lower levels of self-regulation should be more likely to perceive the painful grill illusion than subjects with relatively higher self-regulation ability. Methods: A total of 54 healthy participants were recruited among university students and staff. A custom-built, water-bath driven thermal grill device, with interlaced cold and warm glass tubes, was used for the induction of the TGI. A pre-set temperature combination of 15°C and 41°C was applied to the palm of the dominant hand with stimulus durations of 1 min. Subsequent control conditions consisted in the interlaced combination of a baseline temperature of 32°C with one of the stimulus temperatures mentioned above. The procedure was repeated three times. The volunteers used numerical rating scales ranging from 0-100 to rate sensory and affective pain perceptions in intervals of 15 seconds. Vagally mediated HRV at rest was assessed prior to the thermal stimulation protocols. Results: Time-domain components of HRV used as graded indicators of parasympathetic activity and of the extent of self-regulation significantly predicted the possibility of an occurrence of pain and unpleasantness sensations in response to thermal grill stimulation (p <.05). Participants characterized in this way were more likely to express paradoxical pain than subjects not displaying similar levels of HRV. Conclusion: The present results support previous findings indicating an impact of several psychological traits on the individual disposition to paradoxical pain perceptions. Self-regulation ability, operationalized as vagally mediated heart rate variability, can partially explain the probability of perceived pain in response to non-noxious thermal grill stimulation. [less ▲]

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See detailASSESSMENT OF PSYCHOLOGICAL AND PSYCHOPHYSIOLOGICAL CHARACTERISTICS INVOLVED IN THE MODULATION OF ENDOGENOUS PAIN CONTROL PATHWAYS AND IN THE INDUCTION OF PARADOXICAL PAIN
Scheuren, Raymonde UL

Doctoral thesis (2014)

The present doctoral thesis involves three experimental studies on pain processing and its modulation by psychological mechanisms. The first investigation focused on the relationship between associative ... [more ▼]

The present doctoral thesis involves three experimental studies on pain processing and its modulation by psychological mechanisms. The first investigation focused on the relationship between associative learning aspects and the endogenous pain control system referred to as diffuse noxious inhibitory controls (DNIC) or conditioned pain modulation (CPM). The aim of the study consisted in uncovering whether descending pain inhibition may depend on specific environmental or circumstantial cues that have been linked to a reduction of pain sensations through associative learning in pain treatment contexts. A heterotopic noxious counter-stimulation (HNCS) was used to trigger the endogenous pain control system in the experimental context. For the study of the potential impact of associative learning on the pain-inhibits-pain phenomenon, a respondent (Pavlovian) conditioning procedure was realized during the HNCS stimulation. It could be shown that the repeated pairing of a phone signal (conditioned stimulus, CS) with the unconditioned tonic pain stimulus (UCS, HNCS) enabled the CS in the post-conditioning phase to generate a DNIC-like effect similar to the one induced by the tonic pain stimulus. The results demonstrated that learning processes are able to influence endogenous pain modulation processes and decreases in pain perceptions and reflex activity. A thermal grill paradigm was used in the second and third study to examine the influence of psychological characteristics on the individual disposition to display the thermal grill illusion (TGI) of pain. First, the impact of pain-related personality traits like trait anxiety, pain catastrophizing, rumination, pessimism, expectancy of pain, suggestibility and interoceptive accuracy on inter-individual differences in paradoxical pain sensitivity was assessed. Second, the potential influence of dispositional self-regulation ability on illusive pain perceptions was measured. Vagally mediated heart rate variability (HRV) at rest was used as an index of individual self-regulatory strength. The results allowed identifying several psychological factors that are substantially affecting thermal grill-related perceptions. Mainly ruminative and interoceptive accuracy features increased the probability of paradoxical pain perceptions. The likelihood of the TGI elicitation was in addition significantly affected by the magnitude of the HRV-indicator respiratory sinus arrhythmia (RSA). Since thermal grill and neuropathic pain-related pain processing share common neural pathways, the identified psychological effects may be relevant in the context of pathological pain conditions. [less ▲]

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See detailRumination and interoceptive accuracy predict the occurrence of the thermal grill illusion of pain
Scheuren, Raymonde UL; Sütterlin, Stefan UL; Anton, Fernand UL

in BMC Psychology (2014), 2(22),

Background: While the physiological mechanisms of the thermal grill illusion of pain (TGI) are largely understood, psychological determinants remain mainly unknown. The present study aimed to investigate ... [more ▼]

Background: While the physiological mechanisms of the thermal grill illusion of pain (TGI) are largely understood, psychological determinants remain mainly unknown. The present study aimed to investigate whether cognitive and affective personality traits encompassing rumination, interoception and suggestibility contribute to the inducibility of paradoxical pain. Methods: The dominant hand of 54 healthy volunteers was stimulated with a water-bath driven thermal grill providing an interlaced temperature combination of 15 and 41°C. Pain intensity and pain unpleasantness perceptions were rated on a numerical scale (NRS). Traits were assessed via questionnaires, the heartbeat-tracking task, and warmth suggestions. Results: Logistic regression analyses uncovered trait rumination and interoceptive accuracy (IA) as major predictors of the likelihood of the illusive pain occurrence (all p < .05). Rumination and suggestibility had an impact on unpleasant pain perceptions. Conclusion: Our findings demonstrate a significant influence of psychological aspects on the individual disposition to the painful grill illusion (PGI). [less ▲]

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See detailBeep Tones Attenuate Pain following Pavlovian Conditioning of an Endogenous Pain Control Mechanism
Scheuren, Raymonde UL; Anton, Fernand UL; Erpelding, Nathalie et al

in PLoS ONE (2014), 9(2), 88710

Heterotopic noxious counter-stimulation (HNCS) is commonly used to study endogenous pain control systems. The resulting pain inhibition is primarily based on spinal cord-brainstem loops. Recently ... [more ▼]

Heterotopic noxious counter-stimulation (HNCS) is commonly used to study endogenous pain control systems. The resulting pain inhibition is primarily based on spinal cord-brainstem loops. Recently, functional imaging studies have shown that limbic structures like the anterior cingulate cortex and amygdala are also implicated. Since these structures are involved in learning processes, it is possible that the HNCS-induced pain inhibition may depend on specific cues from the environment that have been associated with pain reduction through associative learning. We investigated the influence of Pavlovian conditioning on HNCS-induced pain inhibition in 32 healthy subjects by using a differential conditioning paradigm in which two different acoustic stimuli were either repeatedly paired or unpaired with HNCS. Series of noxious electrical pulse trains delivered to the non-dominant foot served as test stimuli. Diffuse noxious inhibitory control (DNIC)-like effects were induced by concurrent application of tonic HNCS (immersion of the contralateral hand in ice water). Subjective pain intensity and pain unpleasantness ratings and electromyographic recordings of the facial corrugator muscle and the nocifensive RIII flexion reflex were used to measure changes in pain sensitivity. HNCS induced significant pain and reflex inhibitions. In the post-conditioning phase, only the paired auditory cue was able to significantly reduce pain perceptions and corrugator muscle activity. No conditioned effect could be observed in RIII reflex responses. Our results indicate that the functional state of endogenous pain control systems may depend on associative learning processes that, like in the present study, may lead to an attenuation of pain perception. Similar albeit opposite conditioning of pain control mechanisms may significantly be involved in the exacerbation and chronification of pain states. [less ▲]

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See detailRumination, interoceptive awareness and suggestibility predict the occurrence of the thermal grill illusion
Scheuren, Raymonde UL; Sütterlin, Stefan UL; Anton, Fernand UL

Poster (2013, October 10)

ruminationInterposed non-noxious cold and warm cutaneous stimuli applied via a thermal grill have repeatedly been shown to generate a paradoxical pain sensation, also described as ‘thermal grill illusion ... [more ▼]

ruminationInterposed non-noxious cold and warm cutaneous stimuli applied via a thermal grill have repeatedly been shown to generate a paradoxical pain sensation, also described as ‘thermal grill illusion of pain’. According to the ‘central disinhibition theory’ proposed by Craig and Bushnell [1], the pain phenomenon commonly qualified as burning can be explained by “an unmasking of cold-evoked activity of polymodal nociceptive lamina I spinothalamic neurons (activation by polymodal Cnociceptors) resulting from the reduction of normal coldevoked activity of thermoreceptive lamina I spinothalamic neurons (activation by Aδ cooling thermoreceptors) by spatial summation of the simultaneous warm stimuli in the thermoreceptive but not the nociceptive neurons.” Since a significant part of the tested subjects do however not display the thermal grill percept, it may be hypothesized that not only physiological-, but also psychological determinants play a crucial role in the generation of the paradoxical pain. Sad mood [2] and anxiety [3] have already been proposed as relevant psychological factors. The aim of the present research consisted in validating our custom made, water-driven and fMRI compatible thermal grill device [4], in identifying thermal grill ‘responders’ and ‘non-responders’ and in investigating whether different personality traits or states constitute predictors for the elicitation of the thermal grill illusion. [less ▲]

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