The impact of executive functioning and age-related cognitive decline on distraction from pain

in Merz, Simon; Frings, Christian; Leuchtenberg, Bettina (Eds.) et al Abstracts of the 65th TeaP (2023, June 21)

Older people, suffering from pain and its consequences more often than younger people, would benefit significantly from non-pharmacological pain treatment. So far, little is known about how age affects ... [more ▼]

Older people, suffering from pain and its consequences more often than younger people, would benefit significantly from non-pharmacological pain treatment. So far, little is known about how age affects psychological pain modulation strategies. Preliminary findings hint towards a less efficient pain inhibition through cognition-based pain modulation strategies, as cognitive distraction from pain. Here, executive functions (EFs) have been considered a key factor in the age – pain relationship, with age-related cognitive decline in EFs being associated with reduced pain relief through distraction in older adults. We investigated influence of four core EFs on distraction from pain in aging. In a two-session design, healthy young (18-30 years) and older participants (60+ years) performed a Go-Nogo task, the Stroop-Color-Word-Task, the Sternberg-Task, and the Attentional Network Task. Afterwards, participants performed a pain distraction task, namely a n-Back working memory task with low and high cognitive load, during which participants received individually adjusted transdermal electrical pulse trains in non-painful and moderately painful intensities to the inner forearm. Ratings of intensity and unpleasantness were collected and stimulus-related (EF tasks) and pain-related evoked potentials were recorded with a 64-channel EEG. Unexpectedly, first analyses on the currently small sample suggest a more efficient pain relief through distraction under low relative to high cognitive load in older adults. The distraction effect was related to EFs, some of which showed age-related cognitive impairment. Our findings could lead to a better understanding how to adapt pain treatments in this population by including selective cognitive trainings and optimizing distraction task difficulty. [less ▲]

The impact of interoceptive sensibility on the perception of pain

Poster (2023, June 09)

Interoceptive sensibility is the self-perceived dispositional tendency to be internally self-focused and interoceptively cognizant. One would expect that persons with high interoceptive sensibility would ... [more ▼]

Interoceptive sensibility is the self-perceived dispositional tendency to be internally self-focused and interoceptively cognizant. One would expect that persons with high interoceptive sensibility would be more consistent in their subjective ratings to pain stimulation, i.e., the same intensity would be rated similarly across different time points of the session. The present study investigated the relationship between interoceptive sensibility and perception of acute pain, realized by transcutaneous electrical stimulation to the inner forearm, compromising both the subjective pain ratings and the cardiovascular response to the painful stimulation in young healthy adults. To determine the interoceptive sensibility the MAIA-2 was used. In two session design participants received short, individualized pain stimuli in the non-painful to moderate pain range, which they rated regarding subjective intensity and unpleasantness on visual analog scales. The task was repeated three times in one session. Preliminary results suggest a positive relationship between different subscales of the MAIA-2 and the intensity and unpleasantness ratings of painful and non-painful stimulations. Over the three repetitions of stimulation, a differentiated picture forms with respect to possible sensitization or habituation of the participants. These findings suggest that there is an impact of interoceptive sensibility on the perception of pain. Using the MAIA-2 to determine the interoceptive sensibility is an economical approach, since previous studies worked with the heartbeat detection task or other experimental paradigms. Incorporating interoceptive sensitivity could be helpful for future interventions and possible treatments in pain patients. [less ▲]

Cognitive control of pain in Aging – comparison of different pain modulation strategies

Poster (2023, May 12)

Background. While older people report acute and chronic pain more often than younger people, and, therefore, would benefit significantly from non-pharmacological pain treatment, little is known about how ... [more ▼]

Background. While older people report acute and chronic pain more often than younger people, and, therefore, would benefit significantly from non-pharmacological pain treatment, little is known about how age affects different psychological strategies of pain modulation. The few studies on cognitive distraction from pain suggest a reduced pain relief in older adults, whereas studies on placebo analgesia revealed inconsistent results. So far, distraction and hypnotic analgesia have hardly been investigated in aging. Methods. Healthy young and older participants underwent either a cognitive pain distraction task (working memory task), a placebo analgesia realized with a sham TENS intervention, a hypnotic analgesia intervention or a verbal pain distraction intervention, while receiving non-painful and moderate painful individually adjusted transdermal electrical pulse trains to the inner forearm. Pain ratings and pain-related evoked potentials via 64-channel EEG were recorded. Results. First analyses on the currently small sample suggest a differential impact of age on pain modulation strategies. Since the current sample size is too small to draw reliable conclusions, results will be presented and discussed at the conference. Conclusion. Our results will contribute to a deeper understanding on the efficacy of cognitive pain modulation in aging, helping to optimize pain treatments in this population. [less ▲]

RESTING STATE FUNCTIONAL CONNECTIVITY MARKERS FOR THE EFFICACY OF COGNITVE PAIN MODULATION IN AGING

Scientific Conference (2023, March 29)

A growing number of studies suggest that aging is associated with a decrease in efficacy of cognitive pain modulation. Resting state functional connectivity (rsFC) analysis of the brain offers one way of ... [more ▼]

A growing number of studies suggest that aging is associated with a decrease in efficacy of cognitive pain modulation. Resting state functional connectivity (rsFC) analysis of the brain offers one way of investigating the potential neural mechanisms that may underly this age-related decline. In this study, 32 young (26.7 ± 4.3 years) and 32 healthy older (68.3 ± 7.1 years) adults underwent a 6-minute resting state fMRI scan, as well as a pain distraction paradigm. In the latter, participants received painful heat stimuli while performing either an easy or a difficult working memory task. We performed region-of-interest (ROI) to ROI rsFC analysis of the imaging data, focusing on regions implicated in pain processing and descending pain control. We then examined the relationship between rsFC parameters and the magnitude of the distraction effect (the reduction in perceived pain intensity during the difficult vs the easy task). Older adults showed reduced connectivity compared to young adults between several descending pain modulatory regions, including the ACC and PAG, the right secondary somatosensory cortex (SII) and right dorsolateral prefrontal cortex and between the ACC and left amygdala. Importantly, rsFC in older adults correlated positively with the distraction effect, between several regions including the right SI and right amygdala, the left SI and right insula and between the ACC and left amygdala. Our findings thus demonstrate, for the first time, that reduced cognitive pain modulation in older age is directly associated with decreased rsFC within key nodes of the descending pain control network. [less ▲]

Less efficient cognitive pain modulation in healthy older adults – the impact of executive functions, chronic stress, and physical activity

in Heinrichs, Markus; Schönauer, Monika (Eds.) 47. Jahrestagung Psychologie und Gehirn (2022)

Demographic change and the associated increasing prevalence of chronic pain have contributed to increased research interest in the field of aging. Aging has been associated with less efficient pain ... [more ▼]

Demographic change and the associated increasing prevalence of chronic pain have contributed to increased research interest in the field of aging. Aging has been associated with less efficient pain inhibition through cognitive distraction. As pain modulation and executive functioning mainly involve the prefrontal cortical network, which shows age-related atrophy, we hypothesized an association between deteriorating cognitive modulation of pain in healthy older adults and reduced executive functions. As chronic stress can decrease executive functioning through prefrontal cortical impairment, we expected a negative impact on distraction from pain. In contrast, physical activity can have a stress-buffering effect and positively influences executive functions in older age. Therefore, increased physical activity should lead to better distraction from pain. Healthy young (18 -30 years) and older adults (65+ years) took part in a pain distraction paradigm (N-back) while receiving non-painful and moderately painful electric stimuli. Before, we examined executive functions, including response inhibition (Go/No-Go-task), inhibitory control (Stroop task), and working memory (Sternberg task). Additionally, chronic stress and physical activity were assessed using self-report questionnaires, supported by physiological measurements (heart rate variability). Preliminary results indicate a negative impact of chronic stress on distraction from pain particular in young participants, while physical fitness was related to more successful pain modulation in older adults. Our final results will contribute to a more differentiated view on executive functioning and pain modulation in aging, thereby leading to a better understanding of the impact of aging on non-pharmacological pain treatment and to better adapted pain therapies in this population. [less ▲]

Higher cardiovascular activation, but normal heartbeat-evoked potentials and cardiac interoceptive accuracy in somatoform disorders and major depressive disorder

in Psychiatry Research Communications (2022), 2(3), 100052

The perception-filter model posits that the generation of medically-unexplained symptoms is associated with (I.) more intense afferent bodily signals, (II.) impaired filter system activity to ... [more ▼]

The perception-filter model posits that the generation of medically-unexplained symptoms is associated with (I.) more intense afferent bodily signals, (II.) impaired filter system activity to differentiate relevant from irrelevant signals, and (III.) altered perception of bodily signals. We tested these assumptions for cardiac perception in patients with somatoform disorders (SFD), patients with major depressive disorder (MDD) and healthy control (HC) individuals. Heart rate (variability; HR/HRV) and blood pressure served as indicators of bodily signals (I.); heartbeat-evoked potentials (HEPs) assessed during a heartbeat counting task (HCT) and a distraction task indicated filter system activity (II.); interoceptive accuracy (IAc) in the HCT was interpreted as an index of perception (III.). All indicators were assessed before and after a socially-evaluated cold pressor stress task (SECPT) and a control intervention. SFD patients (n ​= ​24) showed higher average HR and diastolic blood pressure, as well as lower HRV than HC individuals (n ​= ​22), but there were no differences in HEPs or IAc. Neither were there significant differences between the SFD and the MDD groups (n ​= ​24), nor any stress effect on HEPs or IAc. Our findings suggest that increased intensity of bodily signals (I.) is the only model assumption that could be supported for patients with fully-developed SFD. [less ▲]

Verbessern Entspannungsverfahren die Interozeptionsfähigkeit? – Eine 1-wöchige Intervention

Poster (2021, June)

Verbessern Entspannungsverfahren die Interozeptionsfähigkeit? – Eine 1-wöchige Intervention Interozeption, die Wahrnehmung und Verarbeitung körpereigener Signale, ist ein zentraler Aspekt von Gesundheit ... [more ▼]

Verbessern Entspannungsverfahren die Interozeptionsfähigkeit? – Eine 1-wöchige Intervention Interozeption, die Wahrnehmung und Verarbeitung körpereigener Signale, ist ein zentraler Aspekt von Gesundheit und Krankheit. Eine gestörte Interozeptionsfähigkeit zeigt sich bei verschieden psychischen Erkrankungen, wie Depression oder auch Essstörungen. In der vorliegenden Studie wurde an 76 gesunden Studenten untersucht, ob sich die interozeptive Genauigkeit und das interozeptive Bewusstsein durch eine 5-tägige körperbezogene Imaginationsübung per Audiodatei verbessern lassen. Als Kontrollbedingung diente eine nicht-körperbezogene Traumreise und nicht-entspannungsbezogene Podcasts der Serie ZeitWissen. Die Erhebung erfolgte online. Vor und nach der 5-tägigen Intervention wurden interozeptive Genauigkeit (Interoceptive Accuracy Scale (IAs)) und interozeptives Bewusstsein (Multidimensional Assessment of Interoceptive Awareness (MAIA)) erfasst. Erste Ergebnisse zeigen eine interventionsunabhängige Zunahme der interozeptiven Genauigkeit und des interozeptiven Bewusstsein nach allen Interventionen. Unabhängig von Intervention und Messzeitpunkt scheinen allerdings depressive, Angst- und Stresssymptome, gemessen mit Depressions-Angst-Stress-Skalen (DASS), sowie psychische Belastungen durch die aktuelle Covid-19 Pandemie insbesondere interozeptives Bewusstsein und in geringerem Ausmaß interozeptive Genauigkeit negativ zu beeinflussen. Die wöchentliche Häufigkeit, mit der generell eigene Achtsamkeits- oder Entspannungsübungen durchgeführt werden, wirkt sich positiv auf das interozeptive Bewusstsein aus. Insgesamt scheint Interozeptionsfähigkeit auch durch eine körperbezogene kurze, intensive imaginative Entspannungsübung in gesunden jungen Erwachsenen nicht verbessert zu werden, im Gegensatz zu regelmäßigem Yoga-, Mediations- oder Achtsamkeitstraining, welches interozeptives Bewusstsein positiv beeinflusst. [less ▲]

Negative mood increases desire to eat, but not event-related potentials, for food images in bulimia nervosa

Scientific Conference (2021, March 12)

Altered interoceptive awareness in high habitual symptom reporters and patients with somatoform disorders

in Frontiers in Psychology (2020), 11(1), 1859

Objective. Altered interoception may play a major role in the etiology of medically unexplained symptoms (MUS). It remains unclear, however, if these alterations concerns noticing of signals or if they ... [more ▼]

Objective. Altered interoception may play a major role in the etiology of medically unexplained symptoms (MUS). It remains unclear, however, if these alterations concerns noticing of signals or if they are limited to the interpretation of signals. We investigated whether individuals with MUS differ in interoceptive awareness as assessed with the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire. Methods. Study 1: 486 individuals completed the Screening for Somatoform Disorders (SOMS-2). 32 individuals each of the upper and lower decile of the SOMS distribution (low symptom reporters/LSR, high symptom reporters/HSR) completed the MAIA. Study 2: MAIA scores of individuals diagnosed with somatoform disorder (SFD; n = 26) were compared to individuals with major depressive disorder (MDD; n = 25) and healthy controls (HC; n = 26). Results. HSR had lower scores than LSR on the MAIA scales Not-Distracting and Not-Worrying. The SFD and MDD groups showed lower scores than HC on the MAIA scales Not-Distracting, Self-Regulation, and Trusting. The MDD group scored lower than the other two groups on the scales Body Listening and Attention Regulation. There were no group differences on the scale Noticing. Conclusion. HSR, SFD and MDD patients do not differ from HC in the awareness of noticing of interoceptive signal processing, whereas cognitive facets of interoception, such as distraction or self-regulation are differentially affected. This highlights the necessity of including specifically targeted interventions, which improve interoceptive awareness, in the prevention and treatment of SFDs. [less ▲]

The role of executive functions in task-related analgesia

Poster (2019, March)

Introduction: Recent research suggests that weaker executive functions may be linked to a higher risk of pain chronicity. However, little is known about how executive functions affect the modulation of ... [more ▼]

Introduction: Recent research suggests that weaker executive functions may be linked to a higher risk of pain chronicity. However, little is known about how executive functions affect the modulation of acute pain. The present study aimed to investigate the impact of inhibitory control on the success of cognitive distraction from pain. Methods: Participants completed a battery of cognitive tasks (Go/NoGo, Color Stroop, Eriksen Flanker), assessing their cognitive inhibition and selective attention abilities. Additionally, self-report measures of pain catastrophizing and fear of pain were administered. In a pain distraction paradigm, participants completed either a cognitively demanding working memory task (2-back task) or a visually matched easy control task (target response task) while receiving warm or painful thermal stimuli to their left forearm. Nociceptive stimulus intensity was individually calibrated for each participant. Moreover, to maintain a similar level of task difficulty across participants, task speed was continuously adapted based on the participant's performance in the previous trials. Following each trial, participants rated the perceived intensity and unpleasantness of the thermal stimuli on visual analogue scales. Results: As expected, preliminary results indicate that the 2-back task, but not the target response task, successfully distracted participants from thermal pain, manifesting in significantly lower intensity and unpleasantness ratings. Importantly, the magnitude of the distraction effect was negatively associated with the Flanker effect. Discussion: In line with previous research, engaging in a cognitively demanding task led to significantly lower pain intensity and unpleasantness ratings when compared to an easy control task. Moreover, results indicate that better interference control abilities may predict greater task-related analgesia. Taken together, the results of the present study suggest that it is crucial to assess executive functions to develop a better understanding of the mechanisms behind cognitive distraction from pain. [less ▲]