Distraction from Pain in Aging – the Impact of Acute Stress

in Heinrichs, Markus; Schönauer, Monika (Eds.) 47. Jahrestagung Psychologie und Gehirn (2022)

While older people report acute and chronic pain more often than younger people, and, therefore, would benefit significantly from non-pharmacological pain treatment, little is known about how age affects ... [more ▼]

While older people report acute and chronic pain more often than younger people, and, therefore, would benefit significantly from non-pharmacological pain treatment, little is known about how age affects psychological strategies of pain modulation. Distraction from pain by cognitive engagement, an efficient pain modulation strategy, relies on the prefrontal cortex (PFC). The PFC, however, is an area affected by age-related cognitive decline, which might lead to reduced pain relief through distraction in older adults. Acute stress, a common concomitant phenomenon of pain, might additionally reduce the pain relief effect by its negative impact on PFC and PFC-based executive functions. Healthy young (18-30 years) and older participants (65+ years) performed a pain distraction task before and after acute stress induction using the Trier Social Stress Test, or a respective control condition. An n-Back working memory task with low and high cognitive load served as the distraction paradigm, during which participants received non-painful and moderately painful stimuli. These stimuli were individually adjusted transdermal electrical pulse trains to the inner forearm and participants rated them regarding their intensity and unpleasantness. Pain-related evoked potentials were recorded with a 64-channel EEG, and several saliva samples were collected to measure hormonal stress responses. First analyses on the currently small sample suggest a negative impact of acute stress on distraction from pain in both age groups. Our final results will contribute to a deeper understanding on the efficacy of pain modulation in aging and potential influencing factors, helping to optimize pain treatments in this population. [less ▲]

Less efficient cognitive pain modulation in healthy older adults – the impact of executive functions, chronic stress, and physical activity

in Heinrichs, Markus; Schönauer, Monika (Eds.) 47. Jahrestagung Psychologie und Gehirn (2022)

Demographic change and the associated increasing prevalence of chronic pain have contributed to increased research interest in the field of aging. Aging has been associated with less efficient pain ... [more ▼]

Demographic change and the associated increasing prevalence of chronic pain have contributed to increased research interest in the field of aging. Aging has been associated with less efficient pain inhibition through cognitive distraction. As pain modulation and executive functioning mainly involve the prefrontal cortical network, which shows age-related atrophy, we hypothesized an association between deteriorating cognitive modulation of pain in healthy older adults and reduced executive functions. As chronic stress can decrease executive functioning through prefrontal cortical impairment, we expected a negative impact on distraction from pain. In contrast, physical activity can have a stress-buffering effect and positively influences executive functions in older age. Therefore, increased physical activity should lead to better distraction from pain. Healthy young (18 -30 years) and older adults (65+ years) took part in a pain distraction paradigm (N-back) while receiving non-painful and moderately painful electric stimuli. Before, we examined executive functions, including response inhibition (Go/No-Go-task), inhibitory control (Stroop task), and working memory (Sternberg task). Additionally, chronic stress and physical activity were assessed using self-report questionnaires, supported by physiological measurements (heart rate variability). Preliminary results indicate a negative impact of chronic stress on distraction from pain particular in young participants, while physical fitness was related to more successful pain modulation in older adults. Our final results will contribute to a more differentiated view on executive functioning and pain modulation in aging, thereby leading to a better understanding of the impact of aging on non-pharmacological pain treatment and to better adapted pain therapies in this population. [less ▲]

Cognitive distraction from pain: An fMRI study on the role of age and executive functions

Scientific Conference (2021, June)

Completing a cognitive task has been shown to be a powerful strategy to reduce concurrent pain. This reduction in pain is assumed to result from a competition between the painful stimulus and the ... [more ▼]

Completing a cognitive task has been shown to be a powerful strategy to reduce concurrent pain. This reduction in pain is assumed to result from a competition between the painful stimulus and the distractive task for attentional and executive resources mediated by the prefrontal cortex (PFC), a region that is particularly affected by age-related grey matter atrophy. In the present study, we investigated the role of age-related changes in gray matter volume and executive functions in modulating the efficacy of distraction from pain. In a first session, young and older adults completed a battery of neuropsychological tests. In a second session, we acquired functional brain images while participants completed a working memory task with two levels of cognitive load (low vs. high load) and concurrently received individually adjusted heat stimuli (innocuous vs. painful) to their lower arm. While we found no age-related differences in the distraction effect size on the behavioural level, young adults showed a larger neural distraction effect in several regions involved in pain processing, including the insula, caudate and midcingulate cortex. Interestingly, older adults with better executive functions, particularly, better inhibitory control abilities, showed a larger neural distraction effect in the insula, thalamus and primary somatosensory cortex, and more activation in frontal clusters during the high load task. Taken together, these findings suggest that age alters the neural mechanisms underlying cognitive distraction from pain, and that the magnitude of these changes may be dependent on the preservation of executive functions. [less ▲]

Negative mood increases desire to eat, but not event-related potentials, for food images in bulimia nervosa

Scientific Conference (2021, March 12)

Altered interoceptive awareness in high habitual symptom reporters and patients with somatoform disorders

in Frontiers in Psychology (2020), 11(1), 1859

Objective. Altered interoception may play a major role in the etiology of medically unexplained symptoms (MUS). It remains unclear, however, if these alterations concerns noticing of signals or if they ... [more ▼]

Objective. Altered interoception may play a major role in the etiology of medically unexplained symptoms (MUS). It remains unclear, however, if these alterations concerns noticing of signals or if they are limited to the interpretation of signals. We investigated whether individuals with MUS differ in interoceptive awareness as assessed with the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire. Methods. Study 1: 486 individuals completed the Screening for Somatoform Disorders (SOMS-2). 32 individuals each of the upper and lower decile of the SOMS distribution (low symptom reporters/LSR, high symptom reporters/HSR) completed the MAIA. Study 2: MAIA scores of individuals diagnosed with somatoform disorder (SFD; n = 26) were compared to individuals with major depressive disorder (MDD; n = 25) and healthy controls (HC; n = 26). Results. HSR had lower scores than LSR on the MAIA scales Not-Distracting and Not-Worrying. The SFD and MDD groups showed lower scores than HC on the MAIA scales Not-Distracting, Self-Regulation, and Trusting. The MDD group scored lower than the other two groups on the scales Body Listening and Attention Regulation. There were no group differences on the scale Noticing. Conclusion. HSR, SFD and MDD patients do not differ from HC in the awareness of noticing of interoceptive signal processing, whereas cognitive facets of interoception, such as distraction or self-regulation are differentially affected. This highlights the necessity of including specifically targeted interventions, which improve interoceptive awareness, in the prevention and treatment of SFDs. [less ▲]

The role of executive functions in task-related analgesia

Poster (2019, March)

Introduction: Recent research suggests that weaker executive functions may be linked to a higher risk of pain chronicity. However, little is known about how executive functions affect the modulation of ... [more ▼]

Introduction: Recent research suggests that weaker executive functions may be linked to a higher risk of pain chronicity. However, little is known about how executive functions affect the modulation of acute pain. The present study aimed to investigate the impact of inhibitory control on the success of cognitive distraction from pain. Methods: Participants completed a battery of cognitive tasks (Go/NoGo, Color Stroop, Eriksen Flanker), assessing their cognitive inhibition and selective attention abilities. Additionally, self-report measures of pain catastrophizing and fear of pain were administered. In a pain distraction paradigm, participants completed either a cognitively demanding working memory task (2-back task) or a visually matched easy control task (target response task) while receiving warm or painful thermal stimuli to their left forearm. Nociceptive stimulus intensity was individually calibrated for each participant. Moreover, to maintain a similar level of task difficulty across participants, task speed was continuously adapted based on the participant's performance in the previous trials. Following each trial, participants rated the perceived intensity and unpleasantness of the thermal stimuli on visual analogue scales. Results: As expected, preliminary results indicate that the 2-back task, but not the target response task, successfully distracted participants from thermal pain, manifesting in significantly lower intensity and unpleasantness ratings. Importantly, the magnitude of the distraction effect was negatively associated with the Flanker effect. Discussion: In line with previous research, engaging in a cognitively demanding task led to significantly lower pain intensity and unpleasantness ratings when compared to an easy control task. Moreover, results indicate that better interference control abilities may predict greater task-related analgesia. Taken together, the results of the present study suggest that it is crucial to assess executive functions to develop a better understanding of the mechanisms behind cognitive distraction from pain. [less ▲]

Impact of a hypnotic trance on the physiological and subjective stress response to an acute stressor

in Kirschbaum, C. (Ed.) 45. Jahrestagung Psychologie und Gehirn - Abstractban (2019)

Clinical hypnosis is a valuable therapeutic tool in the treatment of phobias and acute pain. These conditions have in common that stress constitutes a crucial factor in the genesis and frightening or ... [more ▼]

Clinical hypnosis is a valuable therapeutic tool in the treatment of phobias and acute pain. These conditions have in common that stress constitutes a crucial factor in the genesis and frightening or painful situations. The present study was aimed to investigate whether hypnotic trance has a positive immediate impact on the psychological and physiological responses to an acute stressor. 48 men and women underwent the socially-evaluated cold pressor test and a warm water control procedure in two separated sessions. Beforehand, hypnotic suggestibility was tested with the Harvard Group Scale of Hypnotic Susceptibility. Participants were randomly assigned to three groups: to a hypnotic trance group, an active control group, and a natural history group. Before the stress and the control procedures, the hypnotic trance group received a hypnotic trance strengthening stress resilience and stress coping. The active control group received a non-fictional text together with a suggestion to strengthen resilience. The natural history group received no intervention. After both procedures, participants performed a working memory task. Hormonal, cardiovascular, respiratory, and subjective measures were taken throughout the sessions. Results show that the hypnotic trance affected hormonel and cardiovascular parameters differently. While cortisol and alpha amylase were generally reduced in the hypnotic trance group, cardiovascular parameters and subjective stress were specifically altered in the stress procedure and modulated by suggestibility. Our results show the potential of a short hypnotic intervention to positively influence the stress response and the restoration of the homeostasis. [less ▲]

Late heartbeat-evoked potentials are associated with survival after cardiac arrest

in Resuscitation (2018), 126(1), 7-13

RATIONALE: Cardiac arrest (CA) is a serious condition characterized by high mortality rates, even after initial successful resuscitation, mainly due to neurological damage. Whether brain-heart ... [more ▼]

RATIONALE: Cardiac arrest (CA) is a serious condition characterized by high mortality rates, even after initial successful resuscitation, mainly due to neurological damage. Whether brain-heart communication is associated with outcome after CA is unknown. Heartbeat-evoked brain potentials (HEPs) represent neurophysiological indicators of brain-heart communication. The aim of this study was to address the association between HEPs and survival after CA. METHODS: HEPs were calculated from resting EEG/ECG in 55 CA patients 24 hours after resuscitation. All patients were treated with targeted temperature management and a standardized sedation protocol during assessment. We investigated the association between HEP amplitude (180- 320 ms, 455-595 ms, 860-1000 ms) and 6-month survival. RESULTS: Twenty-five of 55 patients (45%) were still alive at 6-month follow-up. Survivors showed a higher HEP amplitude at frontopolar and frontal electrodes in the late HEP interval than non-survivors. This effect remained significant after controlling for between-group differences in terms of age, Fentanyl dose, and time lag between resuscitation and EEG assessment. There were no group differences in heart rate or heart rate variability. CONCLUSION: Brain-heart communication, as reflected by HEPs, is associated with survival after CA. Future studies should address the brain-heart axis in CA. [less ▲]

Sensing Your Body: Interoceptive Awareness and Medically Unexplained Symptoms

in Abtracts of the 32nd Annual Conference of the European Health Psychology Society (2018)

According to contemporary theories of medically unexplained symptoms (MUS), alterations in interoception play a major role in symptom development and maintenance. Nevertheless, the mechanisms underlying ... [more ▼]

According to contemporary theories of medically unexplained symptoms (MUS), alterations in interoception play a major role in symptom development and maintenance. Nevertheless, the mechanisms underlying this relationship remains unclear. To address this unresolved issue, we investigated whether individuals with varying degrees of MUS differ in different facets of interoceptive awareness as assessed with the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire. In study 1, 486 individuals were screened with an online version of the Screening for Somatoform Disorders (SOMS-2). Individuals with a SOMS index below 5 (low reporter, n=32) and above 20 (high reporter, n=32) were invited to fill in the MAIA. High symptom reporter had lower scores on the Not-Distracting, Not-Worrying, and Trusting subscales, and higher scores on the Emotional Awareness subscale (Cohen´s d=.70–1.16). In study 2, individuals with DSM-IV somatoform disorder (SFD; n=25) were compared to individuals with major depressive disorder (MDD; n=24) and healthy controls (HC; n=25). The SFD and MDD groups had lower scores on the Not-Distracting, Attention Regulation, Self-Regulation, and Trusting subscales than HC. The MDD group had lower scores than the SFD and HC groups on the Body Listening subscale (partial eta-squared=.18-.26). No differences with regard to Noticing of bodily sensations were found. Groups with subclinical SFD, SFD and MDD do not differ from healthy individuals in terms of actual body perception, whereas cognitive facets of interoception, such as distraction or self-regulation are differentially affected. This highlights the necessity of including specifically targeted mindfulness-based interventions [less ▲]

Impaired filter function in patients with somatoform disorders and major depression, as reflected by auditory evoked potentials in an oddball and an active distraction paradigm

in Abstractband Psychologie und Gehirn 2018 (2018)

Introduction: In the in influential perception-filter model of somatoform disorders (SD), three stages of symptom perception are postulated: (1) bodily signals, which may be amplified by stress, (2) a ... [more ▼]

Introduction: In the in influential perception-filter model of somatoform disorders (SD), three stages of symptom perception are postulated: (1) bodily signals, which may be amplified by stress, (2) a filter system, which distinguishes between relevant and irrelevant stimuli, and (3) cortical perception of physical symptoms. As there is dearth of evidence so far supporting the relationship between (1) bodily signals and (2) filter processes in SD, this study investigated if filter processes are altered in SD and if stress may affect filter mechanisms. Methods: Twenty-four patients with SD, 24 with depression and 24 healthy control individuals were assessed. Event-related potentials (ERPs) with two different auditory distraction procedures were recorded over four blocks, one before and three after either a socially evaluated cold pressor test (SECPT) or a control procedure. We manipulated both the frequency of and the attentional focus on stimuli to reflect filter processes. Results: We found smaller P3b amplitudes (reflecting memory storage) in patients with depression and SD, as compared to healthy controls. Furthermore, both patient groups showed a smaller P3a amplitude (reflecting attention), when counting the infrequent tone ("Oddball task") and a smaller N1 amplitude when counting the frequent tone ("active distraction"). In patients with SD, the SECPT had a decreasing effect on P3a amplitudes. Conclusions: Both late filter processes, reflecting attention (P3a) and memory storage (P3b), may be impaired in SD and depression. As acute stress affected attention in SD patients only, the impact of bodily signals (1) on filter processes (2) may be specific for SD. [less ▲]