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See detailCognitive distraction from pain: An fMRI study on the role of age and executive functions
Rischer, Katharina Miriam UL; Dierolf, Angelika UL; González-Roldán, Ana M. et al

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 ▲]

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See detailPain Processing in Older Age – Evidence from Event-Related Potentials
Dierolf, Angelika UL; Rischer, Katharina Miriam UL; González-Rolán, Ana Maria et al

Scientific Conference (2021, June)

Aging is known to affect neurobiological and physiological aspects of pain perception and has been associated with reduced pain sensitivity and a deterioration of descending pain inhibitory mechanisms. To ... [more ▼]

Aging is known to affect neurobiological and physiological aspects of pain perception and has been associated with reduced pain sensitivity and a deterioration of descending pain inhibitory mechanisms. To investigate age differences in neural electrophysiological correlates of pain processing, we induced acute pain in healthy older (60 yrs+) and younger adults (18 to 35 yrs), using short transdermal electrical pulses administered to the inner forearm, with individually adjusted stimulation intensities. Participants received alternating blocks of painful and non-painful control stimulation and rated the intensity and unpleasantness of each stimulus on two visual analog scales. Pain-related evoked potentials were recorded with a 64-channel EEG. Preliminary results indicate that younger and older participants rated painful stimuli more intensive and unpleasant compared to the control stimulation, with older adults showing a slight habituation over time. In younger adults, ERP amplitudes (N2, P2 P3) of painful stimulation were enhanced compared to non- painful stimulation. In contrast, older participants showed generally reduced ERPs, no difference between pain and non-painful stimulation and by tendency longer latencies for painful stimulation. This suggests that nociceptive neural processing is altered in aging, while the reported pain perception is unaffected. Given that aging is also associated with a decline of cognitive functions and PFC volume and activity changes, this could have implications for the efficacy of cognitive pain modulation. Altogether, our results highlight the need for a deeper understanding of the mechanisms underlying pain processing in older adults, and how these age-related changes affect (cognitive) pain treatments in this population. [less ▲]

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See detailDistraction from Pain: An fMRI Study on the Role of Age-related Changes in Executive Functions
Rischer, Katharina Miriam UL; González-Roldán, Ana M.; Montoya, Pedro et al

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 ▲]

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See detailIntact pain modulation through manipulation of controllability and expectations in aging
González-Roldán, Ana María; Terrasa, Juan Lorenzo; Prats-Sedano, Maria Angeles et al

in European Journal of Pain (2021)

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See detailAnterior cingulate cortex activity during rest is related to alterations in pain perception in aging
Terrasa, Juan L.; Montoya, Pedro; Sitges, Carolina et al

in Frontiers in Aging Neuroscience (2021)

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See detailAlterations in Neural Responses and Pain Perception in Older Adults During Distraction
Gonzalez-Roldan, Ana Maria; Terrasa, Juan Lorenzo; Sitges, Carolina et al

in Psychosomatic Medicine (2020), 82

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See detailDistraction from pain: The role of selective attention and pain catastrophizing
Rischer, Katharina Miriam UL; Gonzalez-Roldan, Ana Maria; Montoya, Pedro et al

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

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See detailAge-Related Changes in Pain Perception Are Associated With Altered Functional Connectivity During Resting State
Gonzalez-Roldan, Ana Maria; Terrasa, Juan Lorenzo; Sitges, Carolina et al

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

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See detailThe destruction of distraction? Neural mechanisms of reduced task-related analgesia with aging.
Rischer, Katharina Miriam UL; Dierolf, Angelika UL; Gonzalez-Roldan, Ana Maria et al

Poster (2019, September 06)

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See detailThe role of executive functions in task-related analgesia
Rischer, Katharina Miriam UL; Gigl, Sandra; Dierolf, Angelika UL et al

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 ▲]

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See detailThe Generation of suffering related items: A process integrating consensus experts and Sorensen’s similarity analysis.
Bustan, Smadar; Anton, Fernand; Odero, Angela UL et al

in 33 nd Annual Conference on the European Health Psychology Society. Methodology.Publisher: EHPS (2019)

Health psychology and public health aspire to find ways for evaluating the suffering of patients. Quantitative assessment of pain-related suffering exists, but methodological frameworks implying ... [more ▼]

Health psychology and public health aspire to find ways for evaluating the suffering of patients. Quantitative assessment of pain-related suffering exists, but methodological frameworks implying qualitative approach based on a direct communication with participants are missing. Our aim was to analyse the procedure generating pain and suffering-related items and explore the validity of their content. Volunteers were all right-handed and of European origin. After received information concerning the aims of the study, they signed a consent to accept the experimental pain stimulation protocols and to receive financial compensation. Descriptors of pain-related suffering were gathered through 106 semi-structured interviews of 31 particpants (16 men ;15 women), age 18-33 years. A thematic categorical content analysis on the transcriptions was conducted. Verbatim were extracted and classified under categories. Cluster analysis on word of verbatim using the index of Sorensen was performed with N’Vivo12. The content of each category was validated through consensus by multidisciplinary experts (some have lived the experimental pain stimulation). Then they formulated 70 items to capture the overall pain-related suffering experience. In accordance to theories and with the help of the Sorensen’s similarity analysis, a conceptual framework with different dimensions (physical, mental, etc.) has been discussed and elaborated. The list obtained constitutes a first classification for laboratory use and a basis for the development of a routine clinical suffering assessment tool. This generation process should guarantee that the items are acceptable, comprehensive and relevant (reflecting the lived experience of the participants) ensuring a content validity of the future questionnaire [less ▲]

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See detailImpact of controllability on pain and suffering
Löffler, Martin; Kamping, Sandra; Brunner, Michael et al

in Pain Reports (2018)

Introduction: Chronic pain and pain-related suffering are major health problems. The lack of controllability of experienced pain seems to greatly contribute to the extent of suffering. This study examined ... [more ▼]

Introduction: Chronic pain and pain-related suffering are major health problems. The lack of controllability of experienced pain seems to greatly contribute to the extent of suffering. This study examined how controllability affects the perception of pain and pain related suffering, and the modulation of this effect by beliefs and emotions such as locus of control of reinforcement, pain catastrophizing, and fear of pain. Methods: Twenty-six healthy subjects received painful electric stimulation in both controllable and uncontrollable conditions. Visual analogue scales and the “Pictorial Representation of Illness and Self Measure” were used to assess pain intensity, unpleasantness, pain-related suffering, and the level of perceived control. We also investigated nonverbal indicators of pain and suffering such as heart rate, skin conductance, and corrugator electromyogram. Results: Controllability selectively reduced the experience of pain-related suffering, but did not affect pain intensity or pain unpleasantness. This effect was modulated by chance locus of control but was unrelated to fear of pain or catastrophizing. Physiological responses were not affected by controllability. In a second sample of 25 participants,we varied the instruction. The effect of controllability on pain-related suffering was only present when instructions focused on the person being able to stop the pain. Discussion: Our data suggest that the additional measure of pain-related suffering may be important in the assessment of pain and may be more susceptible to the effects of perceived control than pain intensity and unpleasantness. We also show that this effect depends on personal involvement. [less ▲]

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See detailReduced modulatory effects of distraction on pain due to aging
Siquier, A; Prats, MA; Montoya, P et al

Scientific Conference (2018, July)

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See detailPsychological, cognitive factors and contextual influences in pain and pain-related suffering as revealed by a combined qualitative and quantitative assessment approach
Bustan S; Gonzalez-Roldan AM; Schommer, Christoph UL et al

in PLoS ONE (2018)

Previous psychophysiological research suggests that pain measurement needs to go beyond the assessment of Pain Intensity and Unpleasantness by adding the evaluation of Pain-Related Suffering. Based on ... [more ▼]

Previous psychophysiological research suggests that pain measurement needs to go beyond the assessment of Pain Intensity and Unpleasantness by adding the evaluation of Pain-Related Suffering. Based on this three-dimensional approach, we attempted to elucidate who is more likely to suffer by identifying reasons that may lead individuals to report Pain and Pain-Related Suffering more than others. A sample of 24 healthy participants (age range 18±33) underwent four different sessions involving the evaluation of experimentally induced phasic and tonic pain. We applied two decision tree models to identify variables (selected from psychological questionnaires regarding pain and descriptors from post-session interviews) that provided a qualitative characterization of the degrees of Pain Intensity, Unpleasantness and Suffering and assessed the respective impact of contextual influences. The overall classification accuracy of the decision trees was 75% for Intensity, 77% for Unpleasantness and 78% for Pain-Related Suffering. The reporting of suffering was predominantly associated with fear of pain and active cognitive coping strategies, pain intensity with bodily competence conveying strength and resistance and unpleasantness with the degree of fear of pain and catastrophizing. These results indicate that the appraisal of the three pain dimensions was largely determined by stable psychological constructs. They also suggest that individuals manifesting higher active coping strategies may suffer less despite enhanced pain and those who fear pain may suffer even under low pain. The second decision tree model revealed that suffering did not depend on pain alone, but that the complex rating-related decision making can be shifted by situational factors (context, emotional and cognitive). The impact of coping and fear of pain on individual Pain-Related Suffering may highlight the importance of improving cognitive coping strategies in clinical settings. [less ▲]

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See detailCONSEQUENCES OF EARLY LIFE STRESS FOR PAIN PROCESSING AND COPING WITH STRESS IN LATER LIFE: BEHAVIOURAL AND BIOCHEMICAL STUDIES IN THE RAT
Genty, Julien UL

Doctoral thesis (2018)

Stress is commonly defined as the response to a non-specific situation presenting a psychological and/or physical challenge. In order to react in an appropriate manner to environmental threats the body ... [more ▼]

Stress is commonly defined as the response to a non-specific situation presenting a psychological and/or physical challenge. In order to react in an appropriate manner to environmental threats the body will trigger a wide range of defence mechanisms. However cases where challenges are sustained and the individual does not have the ability to cope with the stress are nowadays believed to be a main factor for the onset and exacerbation of a broad range of disorders. Among these are psychiatric disorders such as depression but also pain affections. Pain is described by the International Association for the study of Pain (IASP) as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. As for stress, this system aiming at preserving the body integrity can become defective and enhance pain sensitivity or foster the development of chronic pain. These two health problems categories each represent a considerable issue of public health. Indeed the World Health Organization (WHO) estimates that 27% of the European adult population had experienced at least one episode of mental disorder and the IASP reported that 19% of the pan-European population experienced chronic pain (Macfarlane, Pain 2016). Furthermore, chronic pain and stress-related disorders are greatly comorbid, having deleterious effects on the efficacy of treatments. Despite the raising awareness of clinical and pre-clinical research on their overlapping pathways, common mediators and interactions, the nature of the relationship between chronic pain conditions and stress-related disorders is not yet elucidated. The studies I undertook during my Ph.D. aimed to understand how chronic stress, with an emphasis on early-life stress, is linked to altered nociceptive transmission and to modified chronic pain vulnerability. Early life stress (ELS) was of particular interest as this period of life is subjected to an intense neuronal plasticity of notably stress and pain systems. Furthermore it is increasingly accepted that early life factors are linked to the susceptibility to develop chronic pain conditions in adulthood. As pain is a multidimensional system, I had to restrict my studies to one of the relay stations for the transmission of pain. In the context of chronic stress, most of the work was done on the brain circuits underlying the affective part of pain but little is known about the effect of chronic pain on spinal nociceptive processes. Since chronic stress is a broad phenomenon altering not only processing at the brain level, I focused my studies on spinal dorsal horn noxious transmission. The first stage of my work was to assess the impact of ELS on neuropathic pain, a type of chronic pain arising from nerve lesions. In a second step, I sought to determine if the results obtained in this first study were specific to the type of pain (neuropathic) or also were valid for another type of chronic pain, e.g. chronic inflammatory pain. The third study aimed to determine if ELS would predispose to enhanced vulnerability to stress exposure later in life and to concomitant alterations of chronic pain. To finish, during the last year of my Ph.D. I investigated the possible mechanisms underlying the behavioural results using pharmacological manipulations and initiated a separate project devoted to in vivo electrophysiological characterization of the response behaviour of nociceptive spinal dorsal horn neurons. In the following introduction, I will give an overview of the stress systems, focusing on the hypothalamo-pituitary adrenal (HPA) axis and early life stress. Then I will outline the different part of the pain system and concepts of central sensitization involved in chronic pain. [less ▲]

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See detailEarly life stress reduces neuropathic pain in adulthood -is alteration of spinal microglial reactivity critically involved?
Genty, Julien UL; Tetsi Nomigni, Milène UL; Anton, Fernand UL et al

Poster (2017, November 14)

Growing evidence underlines the association between early life adversity and persistent alterations of neural, endocrine and immune functions that may be accompanied by a host of disease patterns such as ... [more ▼]

Growing evidence underlines the association between early life adversity and persistent alterations of neural, endocrine and immune functions that may be accompanied by a host of disease patterns such as chronic pain in later life. Neuropathy is a debilitating condition presenting a substantial cooccurrence with stress related disorders. Despite the established overlapping of biochemical pathways involved in the etiology of these disorders, the intricacy of their mutual interdependence remains. In this context, immunocompetent cells are largely affected during chronic stress and are a key factor in the sensitization of nociceptive dorsal horn neurons. The goal of the present study was to investigate the impact of maternal separation (MS), a wellestablished model of early life stress in rodents, on chronic constriction injury (CCI)induced neuropathic pain and to reveal the relevance of spinal microglia activation and proinflammatory cytokine regulation. For this purpose 12 groups of rats were exposed to different combinations of stress condition, CCIinjury and pharmacological treatment. Noxious sensitivity was tested during baseline conditions as well as during subsequent neuropathic and pharmacological treatment conditions. Von Frey hair and the cold plate tests were used for the assessment of mechanical and cold hyperalgesia/allodynia. Amphotericin B, a substance known to activate monocytes and macrophages in the periphery and microglial cells in the CNS was administered to subgroups of animals. At the end of the protocol, rats were sacrificed to assess microglial activation using qPCR and immunohistochemistry. Our main finding was that maternal separation led to a reduction of CCIrelated pain hypersensitivity (thermal and mechanical hyperalgesia/allodynia). We concomitantly observed a downregulation of Iba 1, mRNA a marker of microglial cells, and of IL1β mRNA, a proinflammatory cytokine that may be released by microglia. According to preliminary results, Amphotericin B in turn seemed to enhance CCI related pain sensitivity, possibly via an activation of microglia. Our results show that MS may lead to a reduction of neuropathy relatedpain in adult age. Stress related dampening of spinal microglial reactivity may play a critical role in this context. [less ▲]

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See detailAssessing suffering in experimental pain models: psychological and psychophysiological correlates
Brunner, Michael; Loeffler, Martin; Kamping, Sandra et al

in Zeitschrift für Psychologie (2017), 225(1), 45-53

Although suffering is a central issue in pain, there is only little research on this topic. The aim of this study was to assess suffering in an experimental context using various stimulation methods and ... [more ▼]

Although suffering is a central issue in pain, there is only little research on this topic. The aim of this study was to assess suffering in an experimental context using various stimulation methods and durations, and to examine which psychological or psychophysiological measures covary with pain-related suffering. Twenty-one healthy volunteers participated in two experiments in which we used tonic thermal and phasic electric stimuli with short and long stimulus durations. The participants rated pain intensity, unpleasantness, and pain-related suffering on separate visual analog scales (VAS) and completed the Pictorial Representation of Illness and Self Measure (PRISM), originally developed to assess suffering in chronic illness. We measured heart rate, skin conductance responses (SCRs), and the electromyogram (EMG) of the musculus corrugator supercilii. For both heat and electric pain, we obtained high ratings on the suffering scale confirming that suffering can be evoked in experimental pain conditions. Whereas pain intensity and unpleasantness were highly correlated, both scales were less highly related to suffering, indicating that suffering is distinct from pain intensity and unpleasantness. Higher suffering ratings were associated with more pronounced fear of pain and increased private self-consciousness. Pain-related suffering was also related to high resting heart rate, increased SCR, and decreased EMG during painful stimulation. These results offer an approach to the assessment of suffering in an experimental setting using thermal and electric pain stimulation and shed light on its psychological and psychophysiological correlates. [less ▲]

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