The journal of pain : official journal of the American Pain Society
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Vulvodynia is a prevalent vulvovaginal pain condition that disrupts the sexual and psychological health of affected women and their partners. Cross-sectional and daily experience studies suggest that partner responses to this pain influence the psychological and sexual sequelae of affected couples. However, their daily impact on pain and anxiety remain unknown. Using a daily diary method, 69 women (M age = 28.12, SD = 6.68) diagnosed with vulvodynia and their cohabiting partners (M age = 29.67, SD = 8.10) reported on male partner responses to women's pain and anxiety symptoms on sexual intercourse days (M = 6.54, SD = 4.99) over 8 weeks. Women also reported their pain during intercourse. Results indicated that women reported greater pain on days when they perceived higher solicitous and negative male partner responses, and on days when their male partner reported greater solicitous and lower facilitative responses. Women indicated higher anxiety symptoms on days when they perceived more negative male partner responses; men's anxiety symptoms were greater on days when they reported higher negative male partner responses. Targeting partner responses may enhance the quality and efficacy of interventions aimed at reducing pain in women with vulvodynia and couples' psychological distress. ⋯ This article examines the daily associations among male partner responses, women's pain during intercourse, and anxiety in couples coping with vulvodynia. Targeting male partner responses may enhance the quality of interventions aimed at reducing women's pain and the psychological distress of couples coping with vulvodynia.
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Randomized Controlled Trial Comparative Study
Comparing counterconditioning and extinction as methods to the reduce fear of movement-related pain.
Cognitive-behavioral treatments for chronic pain typically target pain-related fear; exposure in vivo is a common treatment focusing on disconfirming harm expectancy of feared movements. Exposure therapy is tailored on Pavlovian extinction; an alternative fear reduction technique that also alters stimulus valence is counterconditioning. We compared both procedures to reduce pain-related fear using a voluntary joystick movement paradigm. Participants were randomly allocated to the counterconditioning or extinction group. During fear acquisition, moving the joystick in 2 directions (conditioned stimulus [CS+]) was followed by a painful electrocutaneous stimulus (pain-unconditioned stimulus [US]), whereas moving the joystick in 2 other directions was not (CS-). During fear reduction, 1 CS+ was extinguished, but another CS+ was still followed by pain in the extinction group; in the counterconditioning group, 1 CS+ was extinguished and followed by a monetary reward-US, and another CS+ was followed by both USs (pain-US and reward-US). The results indicate that counterconditioning effectively reduces pain-related fear but that it does not produce deeper fear reduction than extinction. Adding a reward-US to a painful movement attenuated neither fear nor the intensity/unpleasantness of the pain. Both procedures changed stimulus valence. We contend that changing the affective valence of feared movements might improve fear reduction and may prevent relapse. ⋯ This article reports no immediate differences between counterconditioning and extinction in reducing pain-related fear in the laboratory. Unexpectedly, both methods also altered stimulus valence. However, we cautiously suggest that methods explicitly focusing on altering the affective valence of feared movements may improve the long-term effectiveness of fear reduction and prevent relapse.
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Refractory to most types of treatment, neuropathic pain (NP) is a major problem for people living with spinal cord injury (SCI). The underlying mechanisms among problems related to treatment are poorly understood. The aim of the present study was to investigate the association between cortical reorganization and NP after SCI. Twenty-four individuals with sensorimotor complete and incomplete paraplegia and tetraplegia (12 with NP, 13 pain free) and 31 healthy individuals were examined. Functional magnetic resonance imaging was used to assess activation in primary somatosensory and motor cortices in response to motor (ie, active and passive wrist extension) and sensory (ie, heat and brushing) tasks applied on the dorsum of the hand. In individuals with SCI, there were no group-level differences in task-related activation (ie, movement or sensory) compared with the healthy controls. However, based on the Euclidean distance measure, individuals with SCI demonstrated a lateral shift of peak activity in primary sensory and motor cortices (P < .05). Among those with NP, chronic pain intensity inversely correlated with the magnitude of the shift in the primary motor cortex during active wrist extension. The findings reveal that NP in motor and sensory tasks at or above the level of the lesion is not associated with increased plasticity. In line with previous studies, changes in somatotopy and activation after SCI are rather limited and the influence of NP on plasticity remains controversial. ⋯ Using functional magnetic resonance imaging, we have provided novel evidence that reorganization (i.e., topographical shifts in peak activity) in the primary motor cortex after spinal cord injury is limited to individuals without neuropathic pain.
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Humans are expert at recognizing facial features whether they are variable (emotions) or unchangeable (gender). Because of its huge communicative value, pain might be detected faster in faces than unchangeable features. Based on this assumption, we aimed to find a presentation time that enables subliminal discrimination of pain facial expression without permitting gender discrimination. For 80 individuals, we compared the time needed (50, 100, 150, or 200 milliseconds) to discriminate masked static pain faces among anger and neutral faces with the time needed to discriminate male from female faces. Whether these discriminations were associated with conscious reportability was tested with confidence measures on 40 other individuals. The results showed that, at 100 milliseconds, 75% of participants discriminated pain above chance level, whereas only 20% of participants discriminated the gender. Moreover, this pain discrimination appeared to be subliminal. This priority of pain over gender might exist because, even if pain faces are complex stimuli encoding both the sensory and the affective component of pain, they signal a danger. This supports the evolution theory relating to the necessity of quickly reading aversive emotions to ensure survival but might also be at the basis of altruistic behavior such as help and compassion. ⋯ This study shows that pain facial expression can be processed subliminally after brief presentation times, which might be helpful for critical emergency situations in clinical settings.
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Most, but not all, limb amputees develop phantom limb pain (PLP) or residual limb pain (RLP), and large interindividual differences in pain intensity and course are apparent. The present cross-sectional study of 122 double amputees investigated the possible role of genetic factors in PLP and RLP, assuming that strong individual predisposition results in high intraindividual concordance in pain phenotype. Intraindividual concordance was observed in 116 (95%) patients for development of PLP and in 110 patients (90%) for development of RLP. For both pain types, high intraindividual concordance was also observed for remission and current intensity. Moderate association for lifetime history and current intensity of PLP and RLP was observed both within and between limbs. The high intraindividual concordance in pain phenotypes suggests strong individual predisposition for PLP and RLP development. However, the finding of only moderate association between PLP and RLP suggests that susceptibility to these pain phenomena involves distinct, as well as common, risk factors. Genome-wide studies in large samples of single amputees may facilitate the dissection of these phenotypes and their underlying mechanisms. ⋯ The observation of high intraindividual concordance for PLP and RLP in 122 double amputees suggests that individual factors contribute to post-amputation pain. The relatively low intraindividual association between PLP and RLP suggests that these factors are at least partially specific for each pain type.