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Author (up) Benedetti, F. file  url
  Title The opposite effects of the opiate antagonist naloxone and the cholecystokinin antagonist proglumide on placebo analgesia Type Journal Article
  Year 1996 Publication Pain Abbreviated Journal Pain  
  Volume 64 Issue 3 Pages 535-543  
  Abstract Discovery of the involvement of endogenous opiates in placebo analgesia represents an important step in understanding the mechanisms underlying placebo response. In the present study, we investigated the effects of the opiate antagonist naloxone and the cholecystokinin antagonist proglumide on placebo analgesia in a human model of experimentally induced ischemic pain. First, we found that part of the placebo response was reversed by naloxone, confirming previous studies on the role of opioids in the placebo phenomenon. Second, since it was demonstrated that the action of exogenous and endogenous opiates is potentiated by proglumide, we analysed the effects of this cholecystokinin antagonist on placebo response and found that it enhanced placebo analgesia. The placebo effect can thus be modulated in two opposite directions: it can be partially abolished by naloxone and potentiated by proglumide. The fact that placebo potentiation by proglumide occurred only in placebo responders, but not in non-responders, suggests that activation of an endogenous opiate system is a necessary condition for the action of proglumide. These results suggest an inhibitory role for cholecystokinin in placebo response, although the low affinity of proglumide for cholecystokinin receptors does not rule out the possibility of other mechanisms.

Subject Headings: Opiate; Naloxone; Cholecystokinin; Proglumide; Placebo

analgesia; Pain

Keywords: The opposite effects of the opiate antagonist naloxone and the cholecystokinin antagonist proglumide on placebo analgesia
  Call Number Serial 2389  
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Author (up) Campbell, P.; Jordan, K.P.; Dunn, K.M. file  url
  Title The role of relationship quality and perceived partner responses with pain and disability in those with back pain Type Journal Article
  Year 2012 Publication Pain Medicine (Malden, Mass.) Abbreviated Journal Pain Med  
  Volume 13 Issue 2 Pages 204-214  
  Keywords Adjustment Disorders/*epidemiology/*psychology/rehabilitation; Adult; Aged; Caregivers/*psychology; Cohort Studies; Comorbidity/trends; Cross-Sectional Studies; Empathy; Female; Humans; Longitudinal Studies; Low Back Pain/*epidemiology/*psychology/rehabilitation; Male; Middle Aged; *Social Support; Spouses/*psychology  
  Abstract OBJECTIVE: The objectives of this study were to investigate the associations of key constructs of relationship quality (cohesion, consensus, and satisfaction) and perceived partner responses to pain behavior (e.g., solicitous and negative responses) with the outcomes of pain and disability in those with long-term low back pain, and to explore the role of the patient's depressive symptom mood state on those associations. METHODS: Self-report questionnaires on pain intensity, disability, relationship quality, perceived partner reactions to pain, and depressive symptoms were collected from participants (N = 174) taking part in a longitudinal study on low back pain within a primary care sample. RESULTS: Participants reporting more consensus (e.g., agreement about sexual intimacy, level of affection) in their relationships had significantly higher pain intensity (P = 0.03), and solicitous partner responses (P = 0.04) were significantly positively associated with disability levels. However, the findings for pain intensity were only present in those with higher levels of depression, while the association of solicitous responses with disability was only significant in those with lower levels of depression, indicating a suppression effect of depression on pain and disability. CONCLUSIONS: Depressive symptoms play a significant role in determining the associations between relationship quality, perceived partner reactions, and pain and disability. The relationship construct of consensus and perceived solicitous responses were associated with pain and disability. These findings illustrate the importance of social context and patient mood state on the outcomes for those with low back pain.  
  Call Number Serial 2069  
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Author (up) Christiansen, S.; Oettingen, G.; Dahme, B.; Klinger, R. file  url
  Title A short goal-pursuit intervention to improve physical capacity: a randomized clinical trial in chronic back pain patients Type Journal Article
  Year 2010 Publication Pain Abbreviated Journal Pain  
  Volume 149 Issue 3 Pages 444-452  
  Keywords Adult; Chronic Disease; Cognitive Therapy/*methods; Exercise Therapy/*methods; Exercise Tolerance/*physiology; Female; *Goals; Humans; Infectious Disease Transmission, Patient-to-Professional; Low Back Pain/physiopathology/psychology/*rehabilitation; Male; Middle Aged; Muscle Weakness/physiopathology/psychology/*rehabilitation; Pain Measurement/methods; Physical Fitness/*physiology; Treatment Outcome  
  Abstract The present study tested a short intervention using goal-pursuit strategies to increase physical capacity in pain patients. Sixty chronic back pain patients were randomly assigned to intervention or control conditions. Both groups followed a 3-week conventional back pain program at an outpatient back pain center. Instead of routine treatment, the intervention group received a one-hour intervention consisting of a combination of (a) a goal-setting strategy (i.e., mental contrasting, MC) aimed at commitment to improved physical capacity, (b) a short cognitive behavioral therapy-oriented problem-solving approach (CBT) to help patients overcome the obstacles associated with improving physical capacity, and (c) a goal-pursuit strategy, i.e., implementation intentions (II) aimed at performing physical exercise regularly. At two follow-ups (3 weeks after discharge and 3 months after returning home) the MCII-CBT group had increased its physical capacity significantly more than the control group as measured by both behavioral measures (ergometer, lifting) and subjective ratings. Findings are discussed with relation to the use of the intervention as a specific treatment to increase chronic pain patients' motivation to be physically active.  
  Call Number Serial 2070  
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Author (up) Coll, M.-P.; Budell, L.; Rainville, P.; Decety, J.; Jackson, P.L. file  url
  Title The role of gender in the interaction between self-pain and the perception of pain in others Type Journal Article
  Year 2012 Publication The Journal of Pain : Official Journal of the American Pain Society Abbreviated Journal J Pain  
  Volume 13 Issue 7 Pages 695-703  
  Keywords Adult; Empathy; Facial Expression; Female; Humans; Male; Pain--psychology; Pain Perception; Photic Stimulation; Self Concept; Sex Characteristics; Social Perception  
  Abstract While self-pain motivates protective behaviors and self-oriented feelings, the perception of others' pain often motivates concern and prosocial behaviors toward the person suffering. The conflicting consequences of these 2 states raise the question of how pain is perceived in others when one is actually in pain. Two conflicting hypotheses could predict the interaction between these 2 signals: the threat value of pain hypothesis and the shared-representation model of pain empathy. Here, we asked 33 healthy volunteers exposed to acute experimental pain to judge the intensity of the pain felt by models expressing different levels of pain in video clips. Results showed that compared to a control warm stimulus, a stimulus causing self-pain increased the perception of others' pain for clips depicting male pain expressions but decreased the perceived intensity of female high pain expressions in both male and female participants. These results show that one's own pain state influences the perception of pain in others and that the gender of the person observed influences this interaction. PERSPECTIVE: By documenting the effects of self-pain on pain perception in others, this study provides a better understanding of the shared mechanisms between self-pain and others' pain processing. It could ultimately provide clues as to how the health status of health care professionals could affect their ability to assess their patients' pain.  
  Call Number Serial 546  
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Author (up) Colloca, L.; Benedetti, F. file  url
doi  openurl
  Title How prior experience shapes placebo analgesia Type Journal Article
  Year 2006 Publication Pain Abbreviated Journal Pain  
  Volume 124 Issue 1-2 Pages 126-133  
  Keywords Adult; Analgesia/methods; Analysis of Variance; Child; Electroshock/adverse effects; Female; Humans; Male; Pain/*drug therapy/etiology/physiopathology/*psychology; Pain Measurement/methods/psychology; Pain Threshold/drug effects; *Placebo Effect; Placebos/*therapeutic use  
  Abstract Some studies indicate that placebo analgesia is stronger when pre-conditioning with effective analgesic treatments is performed, thereby suggesting that the placebo response is a learning phenomenon. Here we further tested this hypothesis in order to better understand when and how previous experience affects the placebo analgesic response. To do this, we used a conditioning procedure whereby the intensity of painful stimulation was reduced surreptitiously, so as to make the subjects believe that an analgesic treatment was effective. This procedure induced strong placebo responses after minutes, and these responses, albeit reduced, lasted up to 4-7 days. In addition, in a second group of subjects we repeated the same conditioning procedure 4-7 days after a totally ineffective analgesic treatment, and found that the placebo responses were remarkably reduced compared to the first group. Thus we obtained small, medium and large placebo responses, depending on several factors, such as the previous positive or negative experience of an analgesic treatment and the time lag between the treatment and the placebo responses. We also ran extinction trials, and found that these effects did not undergo extinction in a time span of several minutes. These findings indicate that placebo analgesia is finely tuned by prior experience and these effects may last, albeit reduced, several days. These results emphasize that the placebo effect is a learning phenomenon in which many factors come into play, and may explain the large variability of the placebo responses that is found in many studies.  
  Call Number Serial 205  
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Author (up) Klinger, R.; Matter, N.; Kothe, R.; Dahme, B.; Hofmann, U.G.; Krug, F. file  url
  Title Unconditioned and conditioned muscular responses in patients with chronic back pain and chronic tension-type headaches and in healthy controls Type Journal Article
  Year 2010 Publication Pain Abbreviated Journal Pain  
  Volume 150 Issue 1 Pages 66-74  
  Keywords Analysis of Variance; Back Pain/*physiopathology; Conditioning, Classical/*physiology; Electric Stimulation; Electrocardiography; Electromyography; Humans; Muscle, Skeletal/*physiopathology; Pain Threshold/physiology; Tension-Type Headache/*physiopathology  
  Abstract Muscular tension is assigned an important role in the development and maintenance of chronic pain syndromes. It is seen as a psychophysiological correlate of learned fear and avoidance behavior. Basic theoretical models emphasize classical conditioning of muscular responses as a mechanism of pain chronification. However, the empirical basis for this field is very small. Our aim was to investigate muscular factors in relation to unconditioned and conditioned pain stimuli. An experimental study was conducted using a differential classical conditioning paradigm with 18 patients with chronic back pain (BP) and tension-type headache (TTH), and 18 healthy controls (HC). A high-pitched sound served as the CS+, paired with an intracutaneous electric pain stimulus (US), while a neutral sound was used as the CS-. Simultaneously, integrated surface electromyograms (iEMGs) were recorded for seven muscle sites. Our hypothesis was that the pain patients would demonstrate enhanced conditionability. Baseline values between patients (TTH, BP) and HC showed no significant differences. Although the perception and pain thresholds were balanced, both patient groups revealed a higher number of significant muscular responses to the pain stimulus (UR) than the HC. All participants showed significant conditioned muscular responses, however, the patients displayed a higher number than the healthy controls. Furthermore a significant relation was found between muscular responses and the experience of pain 1day after the experiment. Muscular responses can be learned via classical conditioning. TTH and BP patients revealed a higher number of unconditioned and conditioned responses.  
  Call Number Serial 1748  
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Author (up) Kuhajda, M.C.; Thorn, B.E.; Klinger, M.R.; Rubin, N.J. file  url
  Title The effect of headache pain on attention (encoding) and memory (recognition) Type Journal Article
  Year 2002 Publication Pain Abbreviated Journal Pain  
  Volume 97 Issue 3 Pages 213-221  
  Abstract Memory is a key cognitive variable in pain management. This study examined the effect of headaches on participants' encoding of words (attention) and later memory for words. The dependent measures were response time during encoding and recognition memory; headache pain was the independent measure. Eighty participants were randomized to one of four groups: two groups had the same condition (headache pain or no headache pain) for both the encoding and memory tasks and two groups had mixed conditions (i.e. pain during encoding/no pain during recognition; no pain during encoding/pain during recognition). Participants with pain during encoding judged words significantly slower (177.53ms) than participants without pain during encoding. Participants with pain during the memory task recognized significantly fewer words (5.4%) than participants without pain during the memory task, regardless of pain condition during encoding. Results from this and other pain and memory studies conducted in this laboratory suggest that pain, as it adversely affects memory, may operate at a threshold level rather than on a dose-response continuum.

Subject Headings: Acute Disease; Adult; Attention/*physiology; Cold Temperature; Female; Headache/*physiopathology; Humans; Male; Nociceptors/physiology; Pain Threshold/physiology; Reaction Time; Recognition (Psychology)/*physiology

Keywords: The effect of headache pain on attention (encoding) and memory (recognition)
  Call Number Serial 2617  
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Author (up) McMurtry, C.M.; Noel, M.; Taddio, A.; Antony, M.M.; Asmundson, G.J.G.; Riddell, R.P.; Chambers, C.T.; Shah, V. file  url
  Title Interventions for Individuals With High Levels of Needle Fear: Systematic Review of Randomized Controlled Trials and Quasi-Randomized Controlled Trials Type Journal Article
  Year 2015 Publication The Clinical Journal of Pain Abbreviated Journal Clin J Pain  
  Volume 31 Issue 10 Suppl Pages S109-23  
  Abstract BACKGROUND: This systematic review evaluated the effectiveness of exposure-based psychological and physical interventions for the management of high levels of needle fear and/or phobia and fainting in children and adults. DESIGN/METHODS: A systematic review identified relevant randomized and quasi-randomized controlled trials of children, adults, or both with high levels of needle fear, including phobia (if not available, then populations with other specific phobias were included). Critically important outcomes were self-reported fear specific to the feared situation and stimulus (psychological interventions) or fainting (applied muscle tension). Data were pooled using standardized mean difference (SMD) or relative risk with 95% confidence intervals. RESULTS: The systematic review included 11 trials. In vivo exposure-based therapy for children 7 years and above showed benefit on specific fear (n=234; SMD: -1.71 [95% CI: -2.72, -0.7]). In vivo exposure-based therapy with adults reduced fear of needles posttreatment (n=20; SMD: -1.09 [-2.04, -0.14]) but not at 1-year follow-up (n=20; SMD: -0.28 [-1.16, 0.6]). Compared with single session, a benefit was observed for multiple sessions of exposure-based therapy posttreatment (n=93; SMD: -0.66 [-1.08, -0.24]) but not after 1 year (n=83; SMD: -0.37 [-0.87, 0.13]). Non in vivo e.g., imaginal exposure-based therapy in children reduced specific fear posttreatment (n=41; SMD: -0.88 [-1.7, -0.05]) and at 3 months (n=24; SMD: -0.89 [-1.73, -0.04]). Non in vivo exposure-based therapy for adults showed benefit on specific fear (n=68; SMD: -0.62 [-1.11, -0.14]) but not procedural fear (n=17; SMD: 0.18 [-0.87, 1.23]). Applied tension showed benefit on fainting posttreatment (n=20; SMD: -1.16 [-2.12, -0.19]) and after 1 year (n=20; SMD: -0.97 [-1.91, -0.03]) compared with exposure alone. CONCLUSIONS: Exposure-based psychological interventions and applied muscle tension show evidence of benefit in the reduction of fear in pediatric and adult populations.

Subject headings: Adolescent; Adult; Databases, Bibliographic/statistics & numerical data; Fear/*psychology; Humans; Needles/*adverse effects; Phobic Disorders/*etiology/psychology; Psychotherapy/*methods; *Randomized Controlled Trials as Topic

Keywords: interventions for individuals with high levels of needle fear: systematic review of randomized controlled trials and quasi-randomized controlled trials
  Call Number Serial 2938  
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Author (up) Miltner, W.; Johnson, R.J.; Braun, C.; Larbig, W. file  url
  Title Somatosensory event-related potentials to painful and non-painful stimuli: effects of attention Type Journal Article
  Year 1989 Publication Pain Abbreviated Journal Pain  
  Volume 38 Issue 3 Pages 303-312  
  Keywords Adult; Attention/*physiology; Electric Stimulation; Evoked Potentials, Somatosensory/*physiology; Female; Humans; Male; Pain/*physiopathology; Pain Measurement/*methods  
  Abstract In order to determine the effects of attention and distraction on painful and non-painful stimuli, the amplitude changes of 3 components (N150, P200, P300) of the somatosensory event-related potential (SERP) elicited by painful and non-painful electrical stimuli were investigated. Painful and non-painful stimuli were determined using a visual analog scale. SERPs were recorded from 16 healthy volunteers at 5 midline and 4 left and 4 right hemispheric sites. The differences between the amplitudes of attended and ignored stimuli were quantified with a baseline-to-peak measure. ANOVA results revealed no significant attention or stimulus intensity effects for N150 but highly significant differences in P200 and P300 amplitudes between attended and ignored stimuli. In addition, P200 and P300 amplitudes were larger for strong stimuli than for weak stimuli, with no significant differences between non-painful and painful stimuli. These findings are consistent with the existence of a relative, rather than an absolute, relationship between SERP component amplitudes and subjective pain reports. Furthermore, the data give evidence that attentional manipulations represent a powerful method to decrease the perception of pain and that, when used with subjective and behavioral measures, the SERP represents a valuable asset in the multidimensional approach to pain measurement and assessment.  
  Call Number Serial 156  
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Author (up) Price, D.D.; Milling, L.S.; Kirsch, I.; Duff, A.; Montgomery, G.H.; Nicholls, S.S. file  url
  Title An analysis of factors that contribute to the magnitude of placebo analgesia in an experimental paradigm Type Journal Article
  Year 1999 Publication Pain Abbreviated Journal Pain  
  Volume 83 Issue 2 Pages 147-156  
  Keywords Administration, Topical; Adult; Affect; Analgesics/administration & dosage/*therapeutic use; Conditioning (Psychology); Female; Forearm; Humans; Male; Pain/drug therapy/*physiopathology/psychology; Pain Measurement; *Placebo Effect; Skin Temperature  
  Abstract Placebo analgesia was produced by conditioning trials wherein heat induced experimental pain was surreptitiously reduced in order to test psychological factors of expectancy and desire for pain reduction as possible mediators of placebo analgesia. The magnitudes of placebo effects were assessed after these conditioning trials and during trials wherein stimulus intensities were reestablished to original baseline levels. In addition, analyses were made of the influence of these psychological factors on concurrently assessed pain and remembered pain intensities. Statistically reliable placebo effects on sensory and affective measures of pain were graded according to the extent of surreptitious lowering of stimulus strength during the manipulation trials, consistent with conditioning. However, all of these effects were strongly associated with expectancy but not desire for relief. These results show that although conditioning may be sufficient for placebo analgesia, it is likely to be mediated by expectancy. The results further demonstrated that placebo effects based on remembered pain were 3 to 4 times greater than those based on concurrently assessed placebo effects, primarily because baseline pain was remembered as being much more intense than it actually was. However, similar to concurrent placebo effects, remembered placebo effects were strongly associated with expected pain levels that occurred just after conditioning. Taken together, these results suggest that magnitudes of placebo effect are dependent on multiple factors, including conditioning, expectancy, and whether analgesia is assessed concurrently or retrospectively.  
  Call Number Serial 240  
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