A diferença da percepção álgica entre homens e mulheres é, há muito, conhecida e documentada na literatura. Sabe-se também que a sensibilidade feminina varia durante o ciclo menstrual, o que levou à hipótese de que os hormônios ovarianos poderiam estar envolvidosnesse processo. Assim, este estudo teve como objetivo investigar os limiares de sensibilidade somestésica (térmica, dolorosa, tátil, vibratória e elétrica), gustativa e olfativa durante o ciclo menstrual de mulheres saudáveis e a sua relação com as concentrações dos hormônios estrógeno e progesterona na saliva. Foram avaliadas 39 mulheres com idade entre 19 e 47 anos, com ciclos menstruais regulares e sem morbidades associadas à dor. Todas as mulheres foram orientadas quanto aos propósitos desta pesquisa, e somente participaram do estudo aquelas que preencheram os critérios de inclusão e assinaram o termo de consentimento livre e esclarecido. A avaliação foi realizada em três momentos do ciclo menstrual: fase menstrual, fase folicular e fase lútea. Em cada uma dessas fases foram utilizados os seguintes métodos: coleta da saliva no início de cada sessão, para avaliação dos níveis hormonais; avaliação de fluxo salivar; avaliação sensitiva superficial (dor, tato - IITC Woodland Hills, EUA; frio, calor - MSA II e vibratórios - Somedic, Suécia) aplicada na região do ramo maxilar do nervo trigêmeo e na região do antebraço, ambas no lado direito da paciente; e avaliação das sensibilidades gustativa (doce - glicose, salgado - cloreto de sódio, azedo - ácido cítrico e amargo - ureia) e olfativa (isopropanol em diferentes concentrações). Foram observadas oscilações sensitivas em todas as modalidades de acordo com o momento do ciclo menstrual das mulheres avaliadas, sendo que níveis baixos de estrógeno se associaram a altos limiares de dor de profundidade no braço (p=0,008) e na face (p=0,041), altos limiares táteis (p=0,001) e álgicos superficiais (p=0,006) na face. Em contrapartida, altos níveis de progesterona se associaram a altos limiares de dor de profundidade na face (p=0,033) e altos limiares do sabor salgado (p < 0,001). Concluímos que o estrógeno e a progesterona estão envolvidos na neuromodulação da sensibilidade somestésica, gustativa e olfativa de mulheres, durante o ciclo menstrual / There is a sexual difference on pain perception that is supported by the scientific literature. Moreover, sexual hormones seem to be involved in the modulation of sensory detection and there is evidence of sensory variation during the menstrual cycle. Thus, the aim of this study was to investigate the somatosensory (thermal, painful, tactile, vibratory and electric), gustatory (salty, bitter, sweet, sour) and olfactory thresholds during the menstrual cycle in healthy women and verify association with saliva concentration of estradiol and progesterone. We evaluated 39 women aged between 19 and 47 years, with regular menstrual cycles and with no comorbidities related to pain.All women were instructed about the purposes of the study and only those that signed the informed consent were included. The evaluation wasperformed in three moments of the cycle: menstrual phase, follicular phase and luteal phase. In each of these stages, the following methods were used: saliva collection at the beginning of each session, to assess hormone levels; salivary flow measurement; somatosensory evaluation with quantitative sensory testing (pain, tactile - IITC Woodland Hills, USA; cold and warm - MSA II; and vibration - Somedic, Sweden) applied to the right maxillary branch region of the trigeminal nerve and right forearm region; and gustative (sweet - glucose, salt - sodium chloride, sour - citric acid and bitter - urea) and olfactory (isopropanol at different concentrations) thresholds. All sensory thresholds showed fluctuation during the menstrual cycle. Lower estrogen levels were correlated tohigher deep pain thresholds at the forearm (p=0.008) and face (p=0.041); they were also associated with higher tactile thresholds (p=0.001) and higher superficial pain (p=0.006) thresholds at face.High levels of progesterone were associated with high deep pain threshold at the face and high salty threshold (p < 0.001). In conclusion, estrogen and progesterone seems to be involved in sensory neuromodulation in women, during the menstrual cycle

The purpose of this current study is to examine the impact of non-pharmacologic pain interventions administered by trained Child Life professionals in an emergency department on pain perception in children. Results showed no significant decrease in children's pain report during the medical procedure compared to before the medical procedure. However, pain after the medical procedure is significantly less than pain during the medical procedure.

Indiana University-Purdue University Indianapolis (IUPUI) / Chronic pain, defined as pain lasting more than 3 months, is a common and costly health condition. Thirty-three percent of adults and upwards of 35% of children report experiencing pain due to various diseases, disorders, or accidents. Recent research has identified perceived injustice and anger as important constructs in an adult’s pain experience and a possible focus for intervention efforts. The present study explored the extent to which perceived injustice and anger expression operate similarly in children with chronic pain as in adults. This was a retrospective analysis of data from 122 patients seeking treatment at a pediatric pain clinic. Results supported anger expression as a mediator in the relationship between perceived injustice and pain intensity but not psychological distress, suggesting that anger expression operates similarly in children as in adults with chronic pain. Unlike previous findings in adults with chronic pain, injustice did not moderate the relationship between pain intensity and psychological distress, suggesting that injustice operates differently in children with chronic pain compared to adults. The strong association between injustice and pain outcomes (i.e. pain intensity, quality of life, functional disability) suggests that injustice is an important construct to explore in the chronic pain experience of children.

This research was executed as three separate studies. Study 1 focused on the perception of pain and the semantic aspects of pain. Study 2 focused on the measurement of acute pain and mood states. Study 3 focused on the psychological treatment of cancer pain. In Study 1 a group of 66 Setswana-speaking adults were required to describe what they saw, what happened, and what would be the outcome with respect to three visually presented pain scenes using The Pain Apperception Test (PAT) A qualitative analysis of their responses shows that pain is experienced as an all encompassing experience affecting all aspects of their lives, such as the physical, emotional, social, and economic. This was found to be true, irrespective of gender and age with the exception of economic issues. A qualitative analysis of their responses to the Pain Eliciting Incidents Questionnaire (PEIQ) reveals that the Setswana pain descriptors are classifiable according to the three dimensions of pain namely, the sensory-discriminative, affective-motivational, and cognitive-evaluative. Sludy 2 applied the Profile of Mood States (POMS) preoperatively to a group of 58 female laparotomy (gynaecological) patients. These patients were also tested post-operatively with the Visual Analogue Scale (VAS) and the Wisconsin Brief Pain Questionnaire (WBPQ) as pain measures. The pain measures were taken at no medication and at the peak of medication. Factor analysis could not confirm the validity of the six POMS scales. These scales also did not show correlations with post-operative pain. Correlations between the pain measures showed acceptable reliability and validity of the VAS and the WBPQ. In Study 3 three groups of 15 cancer patients each, suffering from chronic pain, were treated over a period of two weeks with either cognitive behavioural therapy plus medication, reassurance therapy plus medication, or medication only. Comparison of before and after treatment pain measures showed that both cognitive behavioural therapy and reassurance therapy had a beneficial effect. Follow-up results three months later showed that the beneficial effect of reassurance therapy did not persist. Patients treated with cognitive behavioral therapy still showed the beneficial effects thereof. / Psychology / D. Litt. et Phil. (Psychology)

A statistical meta-analysis combines the results of several studies that address a set of related research hypotheses, thus increasing the power and reliability of the inference. Meta-analytic methods are over 50 years old and play an important role in science; pooling evidence from many trials to provide answers that any one trial would have insufficient samples to address. On the other hand, the number of neuroimaging studies is growing dramatically, with many of these publications containing conflicting results, or being based on only a small number of subjects. Hence there has been increasing interest in using meta-analysis methods to find consistent results for a specific functional task, or for predicting the results of a study that has not been performed directly. Current state of neuroimaging meta-analysis is limited to coordinate-based meta-analysis (CBMA), i.e., using only the coordinates of activation peaks that are reported by a group of studies, in order to "localize" the brain regions that respond to a certain type of stimulus. This class of meta-analysis suffers from a series of problems and hence cannot result in as accurate results as desired. In this research, we describe the problems that existing CBMA methods are suffering from and introduce a hierarchical mixed-effects image-based metaanalysis (IBMA) solution that incorporates the sufficient statistics (i.e., voxel-wise effect size and its associated uncertainty) from each study. In order to improve the statistical-inference stage of our proposed IBMA method, we introduce a nonparametric technique that is capable of adjusting such an inference for spatial nonstationarity. Given that in common practice, neuroimaging studies rarely provide the full image data, in an attempt to improve the existing CBMA techniques we introduce a fully automatic model-based approach that employs Gaussian-process regression (GPR) for estimating the meta-analytic statistic image from its corresponding sparse and noisy observations (i.e., the collected foci). To conclude, we introduce a new way to approach neuroimaging meta-analysis that enables the analysis to result in information such as “functional connectivity” and networks of the brain regions’ interactions, rather than just localizing the functions.

This research was executed as three separate studies. Study 1 focused on the perception of pain and the semantic aspects of pain. Study 2 focused on the measurement of acute pain and mood states. Study 3 focused on the psychological treatment of cancer pain. In Study 1 a group of 66 Setswana-speaking adults were required to describe what they saw, what happened, and what would be the outcome with respect to three visually presented pain scenes using The Pain Apperception Test (PAT) A qualitative analysis of their responses shows that pain is experienced as an all encompassing experience affecting all aspects of their lives, such as the physical, emotional, social, and economic. This was found to be true, irrespective of gender and age with the exception of economic issues. A qualitative analysis of their responses to the Pain Eliciting Incidents Questionnaire (PEIQ) reveals that the Setswana pain descriptors are classifiable according to the three dimensions of pain namely, the sensory-discriminative, affective-motivational, and cognitive-evaluative. Sludy 2 applied the Profile of Mood States (POMS) preoperatively to a group of 58 female laparotomy (gynaecological) patients. These patients were also tested post-operatively with the Visual Analogue Scale (VAS) and the Wisconsin Brief Pain Questionnaire (WBPQ) as pain measures. The pain measures were taken at no medication and at the peak of medication. Factor analysis could not confirm the validity of the six POMS scales. These scales also did not show correlations with post-operative pain. Correlations between the pain measures showed acceptable reliability and validity of the VAS and the WBPQ. In Study 3 three groups of 15 cancer patients each, suffering from chronic pain, were treated over a period of two weeks with either cognitive behavioural therapy plus medication, reassurance therapy plus medication, or medication only. Comparison of before and after treatment pain measures showed that both cognitive behavioural therapy and reassurance therapy had a beneficial effect. Follow-up results three months later showed that the beneficial effect of reassurance therapy did not persist. Patients treated with cognitive behavioral therapy still showed the beneficial effects thereof. / Psychology / D. Litt. et Phil. (Psychology)

Indiana University-Purdue University Indianapolis (IUPUI) / The presence of a chronic pain condition can have a profound impact on one’s self-concept. Some individuals may have had to make major lifestyle changes. As a result, some people may start to define themselves in terms of their pain, such that their self-schema and pain-schemas become intertwined in a process termed schema-enmeshment. It is thought that schema-enmeshment is related to psychological distress making it a prime target for intervention. Little research has been conducted on interventions to reduce schema-enmeshment. Acceptance-based interventions may be especially appropriate in reducing schema-enmeshment or the connection between self and illness symptoms as these interventions tend to emphasize learning to live with pain and other symptoms and to work toward important life goals rather than continually fighting against the condition and allowing it to control their life. This study is a randomized trial comparing Acceptance and Commitment Therapy (ACT) to education about pain management in a sample of women with Fibromyalgia Syndrome (FMS). The primary aim of this study was to assess the efficacy of ACT in reducing schema-enmeshment between self and pain, as well as enmeshment between self and other symptoms and FMS as a whole. In addition, this study also explored the role of pain acceptance, specifically activity engagement as a mediator of the relationship between treatment group membership and changes in schema-enmeshment. The data was analyzed as an intent-to-treat analysis using the “last measure carried forward” method. Results indicated that the ACT group reported statistically significant differences in self schema-enmeshment with FMS, fatigue, and cognitive symptoms, but not with pain, following the intervention, compared to the educational control group. In each of these cases, the ACT group experienced greater reductions in schema-enmeshment compared to the education group. Interestingly, no statistically significant differences were observed for schema-enmeshment with pain. Statistically significant group differences were also observed for acceptance of pain following the intervention. Finally, a mediational model in which changes in activity engagement (a form of pain acceptance) served as the mediator of the relationship between treatment group and changes in schema-enmeshment with FMS was tested. The model was tested using a bootstrapping method, and results revealed a trend toward a significant indirect effect of changes in activity engagement leading to changes in schema-enmeshment with FMS. Taken together, the results of this study indicate that ACT may be a promising intervention for targeting maladaptive beliefs about the self in relation to illness, especially schema-enmeshment of self with illness and illness symptoms. Additionally, there is evidence that ACT may target key constructs such as activity engagement, which may be related to other cognitive and behavioral changes. Future directions for research and clinical practice related to ACT as an intervention for FMS are discussed in depth.