Smadar Bustan, Ana Maria Gonzalez-Roldan, Christoph Schommer, Sandra Kamping, Martin Löffler, Mic... more Smadar Bustan, Ana Maria Gonzalez-Roldan, Christoph Schommer, Sandra Kamping, Martin Löffler, Michael Brunner, Herta Flor, Fernand Anton
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.
Löffler, M., Kamping, S., Brunner, M., Bustan, S., Kleinböhl, D., Anton, F., & Flor, H.
Introdu... more Löffler, M., Kamping, S., Brunner, M., Bustan, S., Kleinböhl, D., Anton, F., & Flor, H.
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.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
M. Brunner, M. Löffler, S. Kamping, S. Bustan, A. M. González-Roldán, F. Anton, and Herta Flor
... more M. Brunner, M. Löffler, S. Kamping, S. Bustan, A. M. González-Roldán, F. Anton, and Herta Flor
Abstract. 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.
Keywords: pain-related suffering, pain intensity, pain unpleasantness, fear of pain, private self-consciousness, PRISM
Background: Pain has consistently been viewed as containing two dimensions, a sensory (intensity)... more Background: Pain has consistently been viewed as containing two dimensions, a sensory (intensity) and an emotional (unpleasantness). It has been suggested that pain involves higher order cognitive processes that go beyond unpleasantness. We therefore aimed at extending the assessment of pain by introducing an additional dimension of pain-related suffering and identifying noxious stimulation protocols that are most adequate for its psychophysical and psychophysiological characterization. Methods: Twenty-four healthy volunteers received separate series of tonic and phasic noxious mechanical stimuli. Visual analogue scales were used to rate intensity, unpleasantness and suffering and psychophysiological measurements such as heart rate, skin conductance and corrugator electromyography were recorded. Acoustically evoked startle responses were measured in part of the assessments to obtain additional indicators of pain aversiveness. Results: Spearman's correlation coefficients and partial correlations analyses as well as principal component analyses confirmed that suffering constitutes an integral component of pain processing that is distinct from intensity and unpleasantness. Tonic, rather than phasic, stimulation method was more effective in eliciting pain and suffering and under this condition startle responses where higher during long compared to short stimuli. Conclusions: These results suggest that in acute pain, suffering is a constitutive dimension that might even be more crucial in clinical states of pain.
Background Frailty is characterized by an age-related decline in multiple physiological systems, ... more Background Frailty is characterized by an age-related decline in multiple physiological systems, leading to a high vulnerability to stressors, adverse health outcomes, and low quality of life. Neuroscientific models of pathological aging emphasize the loss of sensorimotor stimulation and reduced neuromodulatory capacities as core processes in age-related cognitive and bodily decline, which may be associated with maladaptive plastic changes in the brain. We plan to increase sensorimotor stimulation in frail persons through a newly developed app-based training program and link the training trials to biological and psychological correlates of age-associated vulnerability and health indices. Methods We will conduct a randomized trial, applying an app-based sensorimotor home training (N = 30) in people suffering from frailty. An app-based relaxation training will serve as an active control condition (N = 30). Both interventions will last for 90 days each. The sensorimotor training includ...
Supplemental Material to the article "Chronic Pain as a Neglected Core Symptom in Mitochondr... more Supplemental Material to the article "Chronic Pain as a Neglected Core Symptom in Mitochondrial Diseases", by Löffler, Gamroth, Becker and Flor.
Figure S2. Images of segmentation results. The colors red, white and purple correspond to the gre... more Figure S2. Images of segmentation results. The colors red, white and purple correspond to the grey matter, white matter and cerebrospinal fluid. Additionally parcellation results of precentral (cyan) and postcentral (yellow) gyrus are depicted. Slice position is given by x, y and z coordinates. (PDF 221 kb)
Supplemental material, Becker_Supplemental_Material_rev for Reward Enhances Pain Discrimination i... more Supplemental material, Becker_Supplemental_Material_rev for Reward Enhances Pain Discrimination in Humans by Susanne Becker, Martin Löffler and Ben Seymour in Psychological Science
European journal of pain (London, England), Jan 7, 2015
Pain has consistently been viewed as containing two dimensions, a sensory (intensity) and an emot... more Pain has consistently been viewed as containing two dimensions, a sensory (intensity) and an emotional (unpleasantness). It has been suggested that pain involves higher order cognitive processes that go beyond unpleasantness. We therefore aimed at extending the assessment of pain by introducing an additional dimension of pain-related suffering and identifying noxious stimulation protocols that are most adequate for its psychophysical and psychophysiological characterization. Twenty-four healthy volunteers received separate series of tonic and phasic noxious mechanical stimuli. Visual analogue scales were used to rate intensity, unpleasantness and suffering and psychophysiological measurements such as heart rate, skin conductance and corrugator electromyography were recorded. Acoustically evoked startle responses were measured in part of the assessments to obtain additional indicators of pain aversiveness. Spearman's correlation coefficients and partial correlations analyses as w...
The notion that reward inhibits pain is a well-supported observation in both humans and animals, ... more The notion that reward inhibits pain is a well-supported observation in both humans and animals, allowing suppression of pain reflexes to acquired rewarding stimuli. However, a blanket inhibition of pain by reward would also impair pain discrimination. In contrast, early counterconditioning experiments implied that reward might actually spare pain discrimination. To test this hypothesis, we investigated whether discriminative performance was enhanced or inhibited by reward. We found in adult human volunteers ( N = 25) that pain-based discriminative ability is actually enhanced by reward, especially when reward is directly contingent on discriminative performance. Drift-diffusion modeling shows that this relates to an augmentation of the underlying sensory signal strength and is not merely an effect of decision bias. This enhancement of sensory-discriminative pain-information processing suggests that whereas reward can promote reward-acquiring behavior by inhibition of pain in some c...
Previous psychophysiological research suggests that pain measurement needs to go beyond the asses... 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 a...
European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 2018
Tetrahydrocannabinol (THC) and Cannabidiol (CBD) are two substances from cannabis sativa that hav... more Tetrahydrocannabinol (THC) and Cannabidiol (CBD) are two substances from cannabis sativa that have beenimplicated in the treatment of mental and neurological disorders. We concentrated on a previously validated neuroimaging phenotype, fronto-striatal connectivity across different striatal seeds, because of this loop's relevance to executive functioning, decision making, salience generation and motivation and its link to various neuropsychiatric conditions. Therefore, we studied the effect of THC and CBD on fronto-striatal circuitry by a seed-voxel connectivity approach using seeds from the caudate and the putamen. We conducted a cross-over pharmaco-fMRI study in 16 healthy male volunteers with placebo, 10 mg oral THC and 600 mg oral CBD. Resting state was measured in a 3 T scanner. CBD lead to an increase of fronto-striatal connectivity in comparison to placebo. In contrast to our expectation that THC and CBD show opposing effects, THC versus placebo did not show any significant...
Previous psychophysiological research suggests that pain measurement needs to go beyond the asses... 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 a...
Smadar Bustan, Ana Maria Gonzalez-Roldan, Christoph Schommer, Sandra Kamping, Martin Löffler, Mic... more Smadar Bustan, Ana Maria Gonzalez-Roldan, Christoph Schommer, Sandra Kamping, Martin Löffler, Michael Brunner, Herta Flor, Fernand Anton
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.
Löffler, M., Kamping, S., Brunner, M., Bustan, S., Kleinböhl, D., Anton, F., & Flor, H.
Introdu... more Löffler, M., Kamping, S., Brunner, M., Bustan, S., Kleinböhl, D., Anton, F., & Flor, H.
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.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
M. Brunner, M. Löffler, S. Kamping, S. Bustan, A. M. González-Roldán, F. Anton, and Herta Flor
... more M. Brunner, M. Löffler, S. Kamping, S. Bustan, A. M. González-Roldán, F. Anton, and Herta Flor
Abstract. 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.
Keywords: pain-related suffering, pain intensity, pain unpleasantness, fear of pain, private self-consciousness, PRISM
Background: Pain has consistently been viewed as containing two dimensions, a sensory (intensity)... more Background: Pain has consistently been viewed as containing two dimensions, a sensory (intensity) and an emotional (unpleasantness). It has been suggested that pain involves higher order cognitive processes that go beyond unpleasantness. We therefore aimed at extending the assessment of pain by introducing an additional dimension of pain-related suffering and identifying noxious stimulation protocols that are most adequate for its psychophysical and psychophysiological characterization. Methods: Twenty-four healthy volunteers received separate series of tonic and phasic noxious mechanical stimuli. Visual analogue scales were used to rate intensity, unpleasantness and suffering and psychophysiological measurements such as heart rate, skin conductance and corrugator electromyography were recorded. Acoustically evoked startle responses were measured in part of the assessments to obtain additional indicators of pain aversiveness. Results: Spearman's correlation coefficients and partial correlations analyses as well as principal component analyses confirmed that suffering constitutes an integral component of pain processing that is distinct from intensity and unpleasantness. Tonic, rather than phasic, stimulation method was more effective in eliciting pain and suffering and under this condition startle responses where higher during long compared to short stimuli. Conclusions: These results suggest that in acute pain, suffering is a constitutive dimension that might even be more crucial in clinical states of pain.
Background Frailty is characterized by an age-related decline in multiple physiological systems, ... more Background Frailty is characterized by an age-related decline in multiple physiological systems, leading to a high vulnerability to stressors, adverse health outcomes, and low quality of life. Neuroscientific models of pathological aging emphasize the loss of sensorimotor stimulation and reduced neuromodulatory capacities as core processes in age-related cognitive and bodily decline, which may be associated with maladaptive plastic changes in the brain. We plan to increase sensorimotor stimulation in frail persons through a newly developed app-based training program and link the training trials to biological and psychological correlates of age-associated vulnerability and health indices. Methods We will conduct a randomized trial, applying an app-based sensorimotor home training (N = 30) in people suffering from frailty. An app-based relaxation training will serve as an active control condition (N = 30). Both interventions will last for 90 days each. The sensorimotor training includ...
Supplemental Material to the article "Chronic Pain as a Neglected Core Symptom in Mitochondr... more Supplemental Material to the article "Chronic Pain as a Neglected Core Symptom in Mitochondrial Diseases", by Löffler, Gamroth, Becker and Flor.
Figure S2. Images of segmentation results. The colors red, white and purple correspond to the gre... more Figure S2. Images of segmentation results. The colors red, white and purple correspond to the grey matter, white matter and cerebrospinal fluid. Additionally parcellation results of precentral (cyan) and postcentral (yellow) gyrus are depicted. Slice position is given by x, y and z coordinates. (PDF 221 kb)
Supplemental material, Becker_Supplemental_Material_rev for Reward Enhances Pain Discrimination i... more Supplemental material, Becker_Supplemental_Material_rev for Reward Enhances Pain Discrimination in Humans by Susanne Becker, Martin Löffler and Ben Seymour in Psychological Science
European journal of pain (London, England), Jan 7, 2015
Pain has consistently been viewed as containing two dimensions, a sensory (intensity) and an emot... more Pain has consistently been viewed as containing two dimensions, a sensory (intensity) and an emotional (unpleasantness). It has been suggested that pain involves higher order cognitive processes that go beyond unpleasantness. We therefore aimed at extending the assessment of pain by introducing an additional dimension of pain-related suffering and identifying noxious stimulation protocols that are most adequate for its psychophysical and psychophysiological characterization. Twenty-four healthy volunteers received separate series of tonic and phasic noxious mechanical stimuli. Visual analogue scales were used to rate intensity, unpleasantness and suffering and psychophysiological measurements such as heart rate, skin conductance and corrugator electromyography were recorded. Acoustically evoked startle responses were measured in part of the assessments to obtain additional indicators of pain aversiveness. Spearman's correlation coefficients and partial correlations analyses as w...
The notion that reward inhibits pain is a well-supported observation in both humans and animals, ... more The notion that reward inhibits pain is a well-supported observation in both humans and animals, allowing suppression of pain reflexes to acquired rewarding stimuli. However, a blanket inhibition of pain by reward would also impair pain discrimination. In contrast, early counterconditioning experiments implied that reward might actually spare pain discrimination. To test this hypothesis, we investigated whether discriminative performance was enhanced or inhibited by reward. We found in adult human volunteers ( N = 25) that pain-based discriminative ability is actually enhanced by reward, especially when reward is directly contingent on discriminative performance. Drift-diffusion modeling shows that this relates to an augmentation of the underlying sensory signal strength and is not merely an effect of decision bias. This enhancement of sensory-discriminative pain-information processing suggests that whereas reward can promote reward-acquiring behavior by inhibition of pain in some c...
Previous psychophysiological research suggests that pain measurement needs to go beyond the asses... 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 a...
European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 2018
Tetrahydrocannabinol (THC) and Cannabidiol (CBD) are two substances from cannabis sativa that hav... more Tetrahydrocannabinol (THC) and Cannabidiol (CBD) are two substances from cannabis sativa that have beenimplicated in the treatment of mental and neurological disorders. We concentrated on a previously validated neuroimaging phenotype, fronto-striatal connectivity across different striatal seeds, because of this loop's relevance to executive functioning, decision making, salience generation and motivation and its link to various neuropsychiatric conditions. Therefore, we studied the effect of THC and CBD on fronto-striatal circuitry by a seed-voxel connectivity approach using seeds from the caudate and the putamen. We conducted a cross-over pharmaco-fMRI study in 16 healthy male volunteers with placebo, 10 mg oral THC and 600 mg oral CBD. Resting state was measured in a 3 T scanner. CBD lead to an increase of fronto-striatal connectivity in comparison to placebo. In contrast to our expectation that THC and CBD show opposing effects, THC versus placebo did not show any significant...
Previous psychophysiological research suggests that pain measurement needs to go beyond the asses... 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 a...
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Scientific Papers by Martin Löffler
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.
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.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Abstract. 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.
Keywords: pain-related suffering, pain intensity, pain unpleasantness, fear of pain, private self-consciousness, PRISM
http://econtent.hogrefe.com/doi/10.1027/2151-2604/a000279
Papers by Martin Löffler
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.
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.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Abstract. 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.
Keywords: pain-related suffering, pain intensity, pain unpleasantness, fear of pain, private self-consciousness, PRISM
http://econtent.hogrefe.com/doi/10.1027/2151-2604/a000279