Better Executive Functions Are Associated With More Efficient Cognitive Pain Modulation in Older Adults: An fMRI Study

in Frontiers in Pain Research (2022), 14

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 ▲]

Brief mindfulness training can mitigate the influence of prior expectations on pain perception

in European Journal of Pain (2021), 25(9), 2007-2019

Distraction from Pain: An fMRI Study on the Role of Age-related Changes in Executive Functions

Scientific Conference (2021, June)

Even though aging is associated with increased and prolonged episodes of pain, little is known about potential age-related changes in the "top-down" modulation of pain, such as cognitive distraction from ... [more ▼]

Even though aging is associated with increased and prolonged episodes of pain, little is known about potential age-related changes in the "top-down" modulation of pain, such as cognitive distraction from pain. The hypoalgesic effect of distraction results from a competition for attentional and executive resources mediated by the prefrontal cortex (PFC). Given that age-related grey matter atrophy is particularly prominent in the PFC, older adults may benefit less from distraction to reduce pain than young adults. The aim of this study was to investigate the influence of aging on task-related hypoalgesia and its neural mechanisms, with a focus on the role of executive functions in distraction from pain. 64 participants (32 young adults: 26.69 ± 4.14 years; 32 older adults: 68.28 ± 7.00 years) first completed a battery of neuropsychological tests. In a second session, we administered a pain distraction paradigm while functional brain images were acquired. In this paradigm, participants completed a low (0-back) and a high (2-back) load condition of a working memory task while receiving either innocuous or painful heat stimuli to their lower arm. To control for age-related differences in sensitivity to pain and perceived task difficulty, stimulus intensity and task speed were individually calibrated. Both age groups showed significantly reduced activity in a network of regions involved in pain processing when performing the high compared to the low load distraction task; however, young adults showed a larger neural distraction effect in several of these regions, including the insula, caudate and midcingulate cortex. Moreover, in older adults, better executive functions – in particular inhibitory control abilities – were associated with a larger neural distraction effect in the insula, thalamus and primary somatosensory cortex, and with more activation in several prefrontal cortex regions during the high load task. These findings clearly demonstrate that the top-down control of pain is altered by age and could explain the higher vulnerability of older adults to developing chronic pain. Moreover, our findings suggest that the assessment of executive functions may be a useful tool for predicting the efficacy of cognitive pain modulation strategies in older adults. [less ▲]

Intact pain modulation through manipulation of controllability and expectations in aging

in European Journal of Pain (2021)

Distraction from pain: The role of selective attention and pain catastrophizing

in European Journal of Pain (2020), 24(10), 1880-1891

Age-Related Changes in Pain Perception Are Associated With Altered Functional Connectivity During Resting State

in Frontiers in Aging Neuroscience (2020), 12(116),

Placebo Analgesie im Alter

Scientific Conference (2020, January)

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 ▲]

Painful decisions: How classifying sensations can change the experience of pain

in European Journal of Pain (2017)

Background: Categorizing perceptual stimuli is a mechanism for facilitating the processing of sensory input from our environment. This facilitation of perception is achieved through generalization ... [more ▼]

Background: Categorizing perceptual stimuli is a mechanism for facilitating the processing of sensory input from our environment. This facilitation of perception is achieved through generalization (assimilation) of stimulus characteristics within categories and accentuation between categories. These categorization processes have been demonstrated in visual, auditory, tactile and social perception, but never in pain perception. Method: We presented participants with six thermal noxious stimuli, increasing in steps of 0.5 °C. In an experimental group, stimuli were assigned to two categories labelled A and B containing the three lower (A1, A2, A3) and three higher (B1, B2, B3) stimuli. A control group did not receive such category information (stimuli were labelled S1–S6). In a first part of the experiment, participants simply rated pain intensity and unpleasantness for all stimuli. In a second part, we presented stimuli without labels and participants had to identify the label of each stimulus. Results: We found evidence for categorization effects in both pain ratings and stimulus identification data. In particular, unpleasantness ratings within categories were more similar to each other, and ratings between categories less similar, in the experimental compared to control group. Participants in the experimental group also confused stimuli more often within than between categories, and were more confident about category membership of stimuli at the category border, compared to participants in the control group. Conclusions: Mere category information, using abstract category labels, significantly changes pain perception. Implications for our understanding of cognitive pain modulation mechanisms, as well as clinical implications of categorization effects are discussed. Significance: Categorization effects in pain perception are demonstrated. Classifying and labelling painful events can modulate early perceptual processes, lead to under- or overestimation of pain symptoms and affect decision-making behaviour related to pain. [less ▲]