Filtern
Dokumenttyp
Sprache
- Englisch (4) (entfernen)
Volltext vorhanden
- ja (4) (entfernen)
Schlagworte
- Schmerz (4) (entfernen)
Institut
- Psychologie (3)
- Anglistik (1)
Background
Identifying pain-related response patterns and understanding functional mechanisms of symptom formation and recovery are important for improving treatment.
Objectives
We aimed to replicate pain-related avoidance-endurance response patterns associated with the Fear-Avoidance Model, and its extension, the Avoidance-Endurance Model, and examined their differences in secondary measures of stress, action control (i.e., dispositional action vs. state orientation), coping, and health.
Methods
Latent profile analysis (LPA) was conducted on self-report data from 536 patients with chronic non-specific low back pain at the beginning of an inpatient rehabilitation program. Measures of stress (i.e., pain, life stress) and action control were analyzed as covariates regarding their influence on the formation of different pain response profiles. Measures of coping and health were examined as dependent variables.
Results
Partially in line with our assumptions, we found three pain response profiles of distress-avoidance, eustress-endurance, and low-endurance responses that are depending on the level of perceived stress and action control. Distress-avoidance responders emerged as the most burdened, dysfunctional patient group concerning measures of stress, action control, maladaptive coping, and health. Eustress-endurance responders showed one of the highest levels of action versus state orientation, as well as the highest levels of adaptive coping and physical activity. Low-endurance responders reported lower levels of stress as well as equal levels of action versus state orientation, maladaptive coping, and health compared to eustress-endurance responders; however, equally low levels of adaptive coping and physical activity compared to distress-avoidance responders.
Conclusions
Apart from the partially supported assumptions of the Fear-Avoidance and Avoidance-Endurance Model, perceived stress and dispositional action versus state orientation may play a crucial role in the formation of pain-related avoidance-endurance response patterns that vary in degree of adaptiveness. Results suggest tailoring interventions based on behavioral and functional analysis of pain responses in order to more effectively improve patients quality of life.
Stress and pain are common experiences in human lives. Both, the stress and the pain system have adaptive functions and try to protect the organism in case of harm and danger. However, stress and pain are two of the most challenging problems for the society and the health system. Chronic stress, as often seen in modern societies, has much impact on health and can lead to chronic stress disorders. These disorders also include a number of chronic pain syndromes. However, pain can also be regarded as a stressor itself, especially when we consider how much patients suffer from long-lasting pain and the impact of pain on life quality. In this way, the effects of stress on pain can be fostered. For the generation and manifestation of chronic pain symptoms also learning processes such as classical conditioning play an important role. Processes of classical conditioning can also be influenced by stress. These facts illustrate the complex and various interactions between the pain and the stress systems. Both systems communicate permanently with each other and help to protect the organism and to keep a homeostatic state. They have various ways of communication, for example mechanisms related to endogenous opioids, immune parameters, glucocorticoids and baroreflexes. But an overactivation of the systems, for example caused by ongoing stress, can lead to severe health problems. Therefore, it is of great importance to understand these interactions and their underlying mechanisms. The present work deals with the relationship of stress and pain. A special focus is put on stress related hypocortisolism and pain processing, stress induced hypoalgesia via baroreceptor related mechanisms and stress related cortisol effects on aversive conditioning (as a model of pain learning). This work is a contribution to the wide field of research that tries to understand the complex interactions of stress and pain. To demonstrate the variety, the selected studies highlight different aspects of these interactions. In the first chapter I will give a short introduction on the pain and the stress systems and their ways of interaction. Furthermore, I will give a short summary of the studies presented in Chapter II to V and their background. The results and their meaning for future research will be discussed in the last part of the first chapter. Chronic pain syndromes have been associated with chronic stress and alterations of the HPA axis resulting in chronic hypocortisolism. But if these alterations may play a causal role in the pathophysiology of chronic pain remains unclear. Thus, the study described in Chapter II investigated the effects of pharmacological induced hypocortisolism on pain perception. Both, the stress and the pain system are related to the cardiovascular system. Increase of blood pressure is part of the stress reaction and leads to reduced pain perception. Therefore, it is important for the usage of pain tests to keep in mind potential interferences from activation of the cardiovascular system, especially when pain inhibitory processes are investigated. For this reason we compared two commonly and interchangeably used pain tests with regard to the triggered autonomic reactions. This study is described in chapter III. Chapter IV and V deal with the role of learning processes in pain and related influences of stress. Processes of classical conditioning play an important role for symptom generation and manifestation. In both studies aversive eyeblink conditioning was used as a model for pain learning. In the study described in Chapter IV we compared classical eyeblink conditioning in healthy volunteers to patients suffering from fibromyalgia, a chronic pain disorder. Also, differences of the HPA axis, as part of the stress system, were taken in account. The study of Chapter V investigated effects of the very first stress reaction, particularly rapid non-genomic cortisol effects. Healthy volunteers received an intravenous cortisol administration immediately before the eyeblink conditioning. Rapid effects have only been demonstrated on a cellular level and on animal behavior so far. In general, the studies presented in this work may give an impression of the broad variety of possible interactions between the pain and the stress system. Furthermore, they contribute to our knowledge about theses interactions. However, more research is needed to complete the picture.
Although it has been demonstrated that nociceptive processing can be modulated by heterotopically and concurrently applied noxious stimuli, the nature of brain processes involved in this percept modulation in healthy subjects remains elusive. Using functional magnetic resonance imaging (fMRI) we investigated the effect of noxious counter-stimulation on pain processing. FMRI scans (1.5 T; block-design) were performed in 34 healthy subjects (median age: 23.5 years; range: 20-31 yrs.) during combined and single application (duration: 15 s; ISI=36 s incl. 6 s rating time) of noxious interdigital-web pinching (intensity range: 6-15 N) and contact-heat (45-49 -°C) presented in pseudo-randomized order during two runs separated by approx. 15 min with individually adjusted equi-intense stimuli. In order to control for attention artifacts, subjects were instructed to maintain their focus either on the mechanical or on the thermal pain stimulus. Changes in subjective pain intensity were computed as percent differences (∆%) in pain ratings between single and heterotopic stimulation for both fMRI runs, resulting in two subgroups showing a relative pain increase (subgroup P-IN, N=10) vs. decrease (subgroup P-DE, N=12). Second level and Region of Interest analysis conducted for both subgroups separately revealed that during heterotopic noxious counter-stimulation, subjects with relative pain decrease showed stronger and more widespread brain activations compared to subjects with relative pain increase in pain processing regions as well as a fronto-parietal network. Median-split regression analyses revealed a modulatory effect of prefrontal activation on connectivity between the thalamus and midbrain/pons, supporting the proposed involvement of prefrontal cortex regions in pain modulation. Furthermore, the mid-sagittal size of the total corpus callosum and five of its subareas were measured from the in vivo magnetic resonance imaging (MRI) recordings. A significantly larger relative truncus size (P=.04) was identified in participants reporting a relative decrease of subjective pain intensity during counter-stimulation, when compared to subjects experiencing a relative pain increase. The above subgroup differences observed in functional and structural imaging data are discussed with consideration of potential differences in cognitive and emotional aspects of pain modulation.
In Beloved, Jazz and Paradise, Toni Morrison negotiates ways of individual and collective identity formation through figurations of space and trauma. In geographical spaces that are public and private, open and closed, inclusive and exclusive, space of the past and spaces of the present, Morrison writes discursive spaces in which to create individual and communal African American history and identity, based on the traumatic hi-stories at the core of the Black American experience: the Middle Passage, slavery, Jim Crow and the Civil Rights Movement, just to name a few. In the three novels, Toni Morrison subscribes to a postmodern notion of space and place, presenting it as relative to the individual- frame of mind. Places are used as metonymies for the protagonists" traumatized minds and their different ways of dealing with trauma. Trauma that is not worked through and transcended is presented by Morrison as impacting the protagonists- ability to fashion a home out of a vast and often hostile space. The physical and mental space of Morrison- protagonists is occupied by historical traumata that disables the protagonists to find a place in the present without revisiting the places of their troubled past. While this burdens their lives, it also opens up a historical and metahistorical discourse that allows the revision of mainstream historiography to include minority histories of oppression and trauma. Morrison reconfigures the American historical landscape by emphasizing the subjectivity of any history and offering alternatives to historical grand narratives through her historiographic metafiction. All three novels explore the possibility of reconciliation between past trauma and present life. Doing so requires Morrison to send her protagonists on strenuous journeys through time and space in order to visit the past trauma that keeps them from making a home in the here and now. The protagonists venture back to the primal scenes that bear major significance for their lives but have been suppressed for being too painful to remember. Their pain thus awakens anew, but out of it grow the possibility of a life in the present and the hope for a future. The pasts Morrison thus digs up serve as anchors to situate the African American place in the American historical landscape. Those primal places have a geographical as well as a historical and psychological quality, as places in Morrison- novels are often used as metonymies for the protagonists" traumatized minds, containing the memory of the traumatic past. By spatializing time, Morrison makes history accessible to a communal working through, thus countering the modernist impulse to treat memory as a private faculty embedded in the individual- psyche. This makes it difficult, for African Americans with individual recollections of slavery and racist oppression for example, to use traumatic memory as the basis for a common sense of identity. Morrison uses spatialized time as a forum to discover this basis, to allow for the establishment of a common historical bond. At the same time, she warns against instrumentalizing a common history to exclude those who do not share it. Any history, for Morrison, should be open and flexible enough to accommodate different perspectives. Essentially, Morrison suggests that western historiography is a discursive construct. By allowing, in all three novels, a polyphonic weaving of different equal histories to destablize a single, authoritative, hegemonic historiography, Morrison gives African Americans the power to construct her own past, her own present, and thereby claim back her identity. Moreover, Morrison destabilizes the duality of private space and public space that has long served to distinguish subjective individual memory from objective communal history and thus to legitimize certain accounts of history at the expense of others. The gendered as well as the racial other, by virtue of being excluded from the public sphere, have been excluded from their own historicization. By opening up the private sphere of personal trauma and loss, Morrison spatializes personal memory in a way that it forms a parallel public sphere in which African Americans may negotiate their historicity, move out of the timelessness of the private into the historicized public. By opening up the traditionally private sphere of the home to the public and turning it into a deeply political place, Morrison redefines home in a way that it does not necessarily conform to the classic view of a closed-off shelter but rather a transient place with flexible boundaries that allows for the formation of liberated individual and communal identities out of (hi)stories of pain and trauma.