Fear and anxiety: divergent effects on human pain thresholds

Rhudy, Jamie L.; Meagher, Mary W.

doi:10.1016/s0304-3959(99)00183-9

Cited by 752 publications

(513 citation statements)

References 60 publications

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“…The higher postoperative pain scores in patients who were more anxious in the pre-operative period is in agreement with previous research in which high levels of pre-operative anxiety were associated with higher postoperative pain scores [26]. These effects of anxiety on pain scores may be explained by a lower pain threshold [27], hyperalgesic effect induced by anxiety [28] or because patients with higher levels of anxiety become more focused on the pain [29]. The effect of anxiety on pain is consistent with the State-Trait Anxiety theory, in which individuals with high anxiety levels are generally hypersensitive to stimuli and psychologically more reactive [8].…”

Section: ó 2002 Blackwell Science Ltdsupporting

confidence: 91%

Effect of pre‐operative anxiolysis on postoperative pain response in patients undergoing total abdominal hysterectomy

Caumo¹,

Hidalgo²,

Schmidt

et al. 2002

Anaesthesia

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SummaryIn a double blind, placebo-controlled trial, we have assessed the effects of pre-operative anxiolysis on postoperative pain scores in 112 ASA I-II women, aged 18-65 years, scheduled to undergo total abdominal hysterectomy. Subjects were randomly allocated to receive either oral diazepam 10 mg (n ¼ 56) or placebo (n ¼ 56) pre-operatively. Postoperative anxiety, pain scores, analgesic consumption, and sedation were evaluated at several time points during the first 24 h following surgery. Postoperative pain scores were found to be significantly higher in the diazepam group. Trait and state anxiety showed a significant effect on pain scores, independent of the treatment group. No difference was found between the groups in morphine consumption, but there was a significant reduction in morphine consumption with time. The association between anxiety and postoperative pain is well known [1][2][3], and despite the routine use of benzodiazepines (BZD), there is little clinical evidence available on the effects of premedication on postoperative outcomes such as pain scores and analgesic consumption. The effect of premedication has been mainly assessed in relation to: heart rate; blood pressure; neuroendocrine changes; quality of induction of anaesthesia; amnesia and anxiety [4]. It is important that we are aware of the impact that pre-operative anxiety may have on postoperative outcomes [5].The relationship between pre-operative anxiety and postoperative pain is of particular importance, since several pharmacological and non-pharmacological options are available to treat pre-operative anxiety [6]. If increased pre-operative anxiety is associated with increased postoperative pain, then reducing pre-operative anxiety, could reduce postoperative pain.Therefore, the purpose of this study was to assess the effect of pre-operative anxiolysis on postoperative pain scores based on analgesic consumption and pain scores in patients undergoing total abdominal hysterectomy. Methods

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Section: ó 2002 Blackwell Science Ltdsupporting

confidence: 91%

Effect of pre‐operative anxiolysis on postoperative pain response in patients undergoing total abdominal hysterectomy

Caumo¹,

Hidalgo²,

Schmidt

et al. 2002

Anaesthesia

View full text Add to dashboard Cite

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“…This finding contrasts with the results of many previous studies using more intense stressors, which evoked hypoalgesia, and concurs with the consensus view that although fear evoked by intense stress inhibits pain, anxiety evoked by milder stimuli enhances it (see Rhudy and Meagher (2000) and Ford and Finn (2008) for discussions on this point). In our study exposure to mild stress also evoked hyperalgesia in rats undergoing withdrawal from long-term dosing with exogenous progesterone, suggesting that the fall in levels of progesterone that occurs naturally during late diestrus (Butcher et al, 1975) may be the underlying trigger.…”

Section: Discussionsupporting

confidence: 68%

Differential Activation of the Periaqueductal Gray by Mild Anxiogenic Stress at Different Stages of the Estrous Cycle in Female Rats

Devall¹,

Lovick²

2010

Neuropsychopharmacol

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The effect of acute exposure to mild anxiogenic stress on cutaneous nociceptive threshold was investigated in female Wistar rats at different stages of the estrous cycle. Baseline tail flick latencies did not change significantly during the cycle. However after brief exposure to vibration stress (4 Hz for 5 min), rats in late diestrus, but not at other cycle stages, developed a hyperalgesia (decrease in tail flick latency). Animals in late diestrus revealed a more than fivefold increase in the density of Fos-like immunoreactive nuclei in the dorsolateral, lateral, and ventrolateral columns in the caudal half of the periaqueductal gray matter (PAG). There was no change in the density of Fos-like immunoreactive nuclei in the PAG in rats in estrus and early diestrus, although rats in proestrus showed a smaller (50%) but significant increase. Rats undergoing withdrawal from a progesterone dosing regimen (5 mg/kg i.p. twice daily for 6 days) designed to mimic the fall in progesterone that occurs naturally during late diestrus, exhibited a stress-induced hyperalgesia that was similar to animals in late diestrus and a significant increase in Fos-positive cells in the PAG. We suggest that falling levels of progesterone during late diestrus may be a predisposing factor for the development of stress-induced hyperalgesia, which is linked to differential activation of descending pain control circuits in the PAG. Similar changes in women, when progesterone levels fall during the late luteal phase of the menstrual cycle, may contribute to the development of premenstrual symptoms that include increased anxiety and hyperalgesia.

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“…First, clinicians generally accept the distinction between fear, a response to an impending identifiable danger and anxiety, a state of chronic apprehension about future harm, characterized by tension, worry, negative affect, and a feeling of insecurity (Barlow 2000;Rachman 2004). Fear is a surge of physiological arousal, an alarm reaction resulting in reflexive action, fight or flight when possible, or aimed at reducing the impact of the threat, for example by decreasing pain sensitivity (Blanchard et al 1993;Bolles and Fanselow 1980;Carlsson et al 2006;Rhudy and Meagher 2000) when action is thwarted. In contrast, anxiety is elicited by unpredictability and by the perception of potential, unseen, or symbolic threats.…”

Section: Discriminating Fear From Anxietymentioning

confidence: 99%

Models and mechanisms of anxiety: evidence from startle studies

2007

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Rationale-Preclinical data indicates that threat stimuli elicit two classes of defensive behaviors, those that are associated with imminent danger and are characterized by avoidance or fight (fear), and those that are associated with temporally uncertain danger and are characterized by sustained apprehension and hypervigilance (anxiety).Objective-To 1) review evidence for a distinction between fear and anxiety in animal and human experimental models using the startle reflex as an operational measure of aversive states, 2) describe experimental models of anxiety, as opposed to fear, in humans, 3) examine the relevance of these models to clinical anxiety.Results-The distinction between phasic fear to imminent threat and sustained anxiety to temporally uncertain danger is suggested by psychopharmacological and behavioral evidence from ethological studies and can be traced back to distinct neuroanatomical systems, the amygdala and the bed nucleus of the stria terminalis. Experimental models of anxiety, not fear, are relevant to nonphobic anxiety disorders.Conclusions-Progress in our understanding of normal and abnormal anxiety is critically dependent on our ability to model sustained aversive states to temporally uncertain threat.

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Fear and anxiety: divergent effects on human pain thresholds

Cited by 752 publications

References 60 publications

Effect of pre‐operative anxiolysis on postoperative pain response in patients undergoing total abdominal hysterectomy

Effect of pre‐operative anxiolysis on postoperative pain response in patients undergoing total abdominal hysterectomy

Differential Activation of the Periaqueductal Gray by Mild Anxiogenic Stress at Different Stages of the Estrous Cycle in Female Rats

Models and mechanisms of anxiety: evidence from startle studies

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