Neural correlates of individual differences in pain-related fear and anxiety

Ochsner, Kevin N.; Ludlow, David; Knierim, Kyle; Hanelin, Josh; Ramachandran, Tara; Glover, G.; Mackey, Sean

doi:10.1016/j.pain.2005.10.014

Cited by 203 publications

(127 citation statements)

References 78 publications

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“…Stress and anxiety responses vary considerably inter-individually and are related to underlying neuroendocrine and psychological factors, including the cortisol response, the level of arousal and the impact of individual trait differences. 51 In our healthy controls a close correlation existed between trait anxiety, stress and depression levels and increased visceral pain inside the scanner, in accordance with the above-mentioned susceptibility factors. Such a correlation was not evident in IBS patients, who already had elevated anxiety and stress scores outside the scanner.…”

Section: Discussionsupporting

confidence: 77%

Visceral pain perception in patients with irritable bowel syndrome and healthy volunteers is affected by the MRI scanner environment

Wong

Oudenhove

et al. 2016

UEG Journal

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Background: The MRI scanner environment induces marked psychological effects, but specific effects on pain perception and processing are unknown and relevant to all brain imaging studies. Objectives and methods: We performed visceral and somatic quantitative sensory and pain testing and studied endogenous pain modulation by heterotopic stimulation outside and inside the functional MRI scanner in 11 healthy controls and 13 patients with irritable bowel syndrome. Results: Rectal pain intensity (VAS 0-100) during identical distension pressures increased from 39 (95% confidence interval: 35-42) outside the scanner to 53 (43-63) inside the scanner in irritable bowel syndrome, and from 42 (31-52) to 49 (39-58), respectively, in controls (ANOVA for scanner effect: p ¼ 0.006, group effect: p ¼ 0.92). The difference in rectal pain outside versus inside correlated significantly with stress (r ¼ À0.76, p ¼ 0.006), anxiety (r ¼ À0.68, p ¼ 0.02) and depression scores (r ¼ À0.67, p ¼ 0.02) in controls, but not in irritable bowel syndrome patients, who a priori had significantly higher stress and anxiety scores. ANOVA analysis showed trends for effect of the scanner environment and subject group on endogenous pain modulation (p ¼ 0.09 and p ¼ 0.1, respectively), but not on somatic pain (p > 0.3). Conclusion: The scanner environment significantly increased visceral, but not somatic, pain perception in irritable bowel syndrome patients and healthy controls in a protocol specifically aimed at investigating visceral pain. Psychological factors, including anxiety and stress, are the likely underlying causes, whereas classic endogenous pain modulation pathways activated by heterotopic stimulation play a lesser role. These results are highly relevant to a wide range of imaging applications and need to be taken into account in future pain research. Further controlled studies are indicated to clarify these findings.

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Section: Discussionsupporting

confidence: 77%

Visceral pain perception in patients with irritable bowel syndrome and healthy volunteers is affected by the MRI scanner environment

Wong

Oudenhove

et al. 2016

UEG Journal

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“…50,51 In this region, individual differences in sensitivity to pain are associated with differences in activity. 52 In addition, the thalamus is an important relay centre for the reticular ascending system, which regulates arousal and alertness. [53][54][55] Thalamic perfusion is associated with alertness levels 25,56 and is substantially reduced during sleep.…”

Section: Discussionmentioning

confidence: 99%

CYP2D6 in the brain: genotype effects on resting brain perfusion

et al. 2010

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The cytochrome P450 2D6 (CYP2D6) is a genetically polymorphic enzyme involved in the metabolism of several psychoactive drugs. Beside its expression in the liver, CYP2D6 is highly expressed in several regions of the brain, such as the hippocampus, thalamus, hypothalamus and the cortex, but its function in the brain is not well understood. The CYP2D6 enzyme may also have a physiological role due to its involvement in neurotransmitter biotransformation. In this study, CYP2D6 genotyping was performed in N = 188 healthy individuals and compared with brain perfusion levels at rest, which may reflect an ongoing biological process regulating the reactivity of the individual to emotional stimuli and the detection of signals evoking fear. Relative to N = 42 matched extensive metabolizers, N = 14 poor metabolizers were associated with 15% higher perfusion levels in the thalamus (P = 0.03 and 0.003). Effects were also present in the whole (N = 188) sample divided into metabolizer groups, or finely graded into seven CYP2D6 activity levels. A weaker effect was observed in the right hippocampus (P = 0.05). An exploratory analysis, extended to the whole brain, suggested the involvement of CYP2D6 in regions associated with alertness or serotonergic function. These findings support the hypothesis of a functional role of CYP2D6 in the brain.

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“…Firstly, an emergency transport is likely more stressful than our relatively calm pre-operative holding unit. Second, pain has a strong influence on .............................................................................................................................................................................................................. [43,44] and pain relief due to warming inevitably has a major anxiolytic effect. It is thus notable that pain was a major component in all the above-mentioned studies in which warming apparently reduced anxiety.…”

Section: Discussionmentioning

confidence: 99%

The effect of skin surface warming on pre‐operative anxiety in neurosurgery patients*

2007

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SummarySkin surface warming of patients not only improves thermal comfort, but has been shown to reduce anxiety in a pre-hospital setting. We tested the hypothesis that pre-operative warming can reduce pre-operative anxiety as effectively as a conventional dose of intravenous midazolam in patients undergoing neurosurgery. We randomly allocated 80 patients to four groups in the pre-operative holding area. Treatment was applied for 30-45 min with (1) passive insulation and placebo; (2) passive insulation and intravenous midazolam (30 lg.kg )1 ); (3) warming with forced-air and placebo; and (4) warming with forced-air and intravenous midazolam (30 lg.kg )1 ). Thermal comfort levels (VAS 0-100 mm) and anxiety levels (VAS 0-100 mm, Spielberger State-Trait Anxiety Inventory) were assessed twice: before the designated treatment was started and before induction of anaesthesia. In the midazolam and the midazolam ⁄ warming groups, anxiety VAS and Spielberger state anxiety scores decreased by ) 19 (95% CI: ) 29 to ) 9, p < 0.01) and ) 10 (95% CI: ) 14 to ) 6, p < 0.01), respectively. In the warming and the combined groups, thermal VAS increased by + 26 (95% CI: 17-34, p < 0.01). [7], and prolonged hospitalisation [5]. Pre-operative warming before induction can prevent redistribution hypothermia and can improve thermal comfort by keeping the patient warm during the preoperative period [8,9]. This benefit of pre-operative warming has been demonstrated in several studies during regional [10] and general anaesthesia [8,11,12]. The administration of pre-operative warming has even been shown to abolish completely the need for any additional intra-operative warming in certain patient populations [13,14].There is, however, another potential benefit of preoperative warming: it may reduce anxiety. In four recent studies, minor trauma victims [15], patients with lower back pain [16], patients with renal colic [17] and cholelithiasis pain [18] were assigned to passive insulation or carbon-fibre warming: The warmed patients had improved thermal comfort, less pain, and were significantly less anxious.For the reduction of pre-operative anxiety, patients typically receive medications such as oral or intravenous benzodiazepines, yet these medications are not always effective and can be associated with respiratory depression and delayed discharge [19][20][21][22][23]. Thus, several non-pharmacological methods to reduce pre-operative anxiety have been considered, including music therapy [24,25], supply of in-depth information with leaflets [26] or videos

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Neural correlates of individual differences in pain-related fear and anxiety

Cited by 203 publications

References 78 publications

Visceral pain perception in patients with irritable bowel syndrome and healthy volunteers is affected by the MRI scanner environment

Visceral pain perception in patients with irritable bowel syndrome and healthy volunteers is affected by the MRI scanner environment

CYP2D6 in the brain: genotype effects on resting brain perfusion

The effect of skin surface warming on pre‐operative anxiety in neurosurgery patients*

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