Cognitive Modulation Of Pain By Attention: The Role Of Executive Functioning In Aging

Poster (2023, June 09)

Attention is acknowledged as an effective strategy to modulate pain, as shown by various studies of acute and chronic pain. Here executive functioning (EF) plays a key role, with poorer EF related to less ... [more ▼]

Attention is acknowledged as an effective strategy to modulate pain, as shown by various studies of acute and chronic pain. Here executive functioning (EF) plays a key role, with poorer EF related to less successful inhibition of pain, both relying on the prefrontal cortex (PFC). With age, structural and volume changes in the PFC are accompanied by age-related cognitive decline. So far, only a few studies investigated how age-related cognitive decline affect cognitive distraction from pain.In a two-session design, healthy young (18-30 years) and older participants (60+ years) performed four EF tasks shown to either reveal age-related cognitive decline or not. Afterwards, participants performed a pain distraction task, 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. Participants rated them regarding their intensity and unpleasantness. Stimulus-related (EF tasks) and pain-related evoked potentials were recorded with a 64-channel EEG.Preliminary results suggest a similar effective subjective pain relief during high and low working memory load in both age groups, which is reflected in a similar reduced N1-P2 pain-related ERPs in older but not in younger participants. However, including executive functioning showing age-related cognitive decline, revealed less successful pain reduction in the high working memory load condition in older adults. These findings could lead to a better understanding how to adapt pain treatments in the older population by including selective cognitive trainings, optimizing pain modulation settings. [less ▲]

The impact of inhibitory control on the acute stress response comparing young and older adults

Poster (2023, June 09)

Background Inhibitory control is a core executive function. It involves our ability to think before we act and allows an individual to control their automatic impulses. Executive functions are a mechanism ... [more ▼]

Background Inhibitory control is a core executive function. It involves our ability to think before we act and allows an individual to control their automatic impulses. Executive functions are a mechanism of the prefrontal cortex, which is highly stress sensitive. Research suggests that executive functions positively influence the stress response, with higher executive functions supporting a more successful stress regulation, but it is unclear if that is also the case in older age. Methods To investigate this, healthy young (18-30 years) and older participants (65+ years) were asked to perform two inhibitory control tasks (Stroop-Color-Word task and Go/Nogo task) and were then assigned to a stress condition (Trier Social Stress Test) and to the control condition in counterbalanced order in a two-session design. Cardiovascular parameters and self-reported stress were used as indices for the stress response. Results First analyses suggest that better inhibitory control is associated with less agitation for the TSST condition in both, young and older adults. While the relationship between response inhibition and the stress response seems to be age-unrelated, preliminary results suggest an age-depended impact of interference control on the physiological stress response. Conclusion Since cognitive decline comes with age, older people may be more affected by stress, this could be counterbalanced by training executive functions. Therefore, these results highlight the importance of inhibitory control and suggest the possibility that enhancing executive function may improve stress management. [less ▲]

Placebo Analgesia in Aging – the Impact of age-related cognitive decline

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 ▲]

When less is more: Investigating factors influencing the distraction effect of virtual reality from pain

in Frontiers in Pain Research (2022), 2

Distraction from Pain in Aging – the Impact of Acute Stress

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

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 ... [more ▼]

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 psychological strategies of pain modulation. Distraction from pain by cognitive engagement, an efficient pain modulation strategy, relies on the prefrontal cortex (PFC). The PFC, however, is an area affected by age-related cognitive decline, which might lead to reduced pain relief through distraction in older adults. Acute stress, a common concomitant phenomenon of pain, might additionally reduce the pain relief effect by its negative impact on PFC and PFC-based executive functions. Healthy young (18-30 years) and older participants (65+ years) performed a pain distraction task before and after acute stress induction using the Trier Social Stress Test, or a respective control condition. An n-Back working memory task with low and high cognitive load served as the distraction paradigm, during which participants received non-painful and moderately painful stimuli. These stimuli were individually adjusted transdermal electrical pulse trains to the inner forearm and participants rated them regarding their intensity and unpleasantness. Pain-related evoked potentials were recorded with a 64-channel EEG, and several saliva samples were collected to measure hormonal stress responses. First analyses on the currently small sample suggest a negative impact of acute stress on distraction from pain in both age groups. Our final results will contribute to a deeper understanding on the efficacy of pain modulation in aging and potential influencing factors, helping to optimize pain treatments in this population. [less ▲]

Pain Processing in Older Age – Evidence from Event-Related Potentials

Scientific Conference (2021, June)

Aging is known to affect neurobiological and physiological aspects of pain perception and has been associated with reduced pain sensitivity and a deterioration of descending pain inhibitory mechanisms. To ... [more ▼]

Aging is known to affect neurobiological and physiological aspects of pain perception and has been associated with reduced pain sensitivity and a deterioration of descending pain inhibitory mechanisms. To investigate age differences in neural electrophysiological correlates of pain processing, we induced acute pain in healthy older (60 yrs+) and younger adults (18 to 35 yrs), using short transdermal electrical pulses administered to the inner forearm, with individually adjusted stimulation intensities. Participants received alternating blocks of painful and non-painful control stimulation and rated the intensity and unpleasantness of each stimulus on two visual analog scales. Pain-related evoked potentials were recorded with a 64-channel EEG. Preliminary results indicate that younger and older participants rated painful stimuli more intensive and unpleasant compared to the control stimulation, with older adults showing a slight habituation over time. In younger adults, ERP amplitudes (N2, P2 P3) of painful stimulation were enhanced compared to non- painful stimulation. In contrast, older participants showed generally reduced ERPs, no difference between pain and non-painful stimulation and by tendency longer latencies for painful stimulation. This suggests that nociceptive neural processing is altered in aging, while the reported pain perception is unaffected. Given that aging is also associated with a decline of cognitive functions and PFC volume and activity changes, this could have implications for the efficacy of cognitive pain modulation. Altogether, our results highlight the need for a deeper understanding of the mechanisms underlying pain processing in older adults, and how these age-related changes affect (cognitive) pain treatments in this population. [less ▲]

Cognitive distraction from pain: An fMRI study on the role of age and executive functions

Scientific Conference (2021, June)

Completing a cognitive task has been shown to be a powerful strategy to reduce concurrent pain. This reduction in pain is assumed to result from a competition between the painful stimulus and the ... [more ▼]

Completing a cognitive task has been shown to be a powerful strategy to reduce concurrent pain. This reduction in pain is assumed to result from a competition between the painful stimulus and the distractive task for attentional and executive resources mediated by the prefrontal cortex (PFC), a region that is particularly affected by age-related grey matter atrophy. In the present study, we investigated the role of age-related changes in gray matter volume and executive functions in modulating the efficacy of distraction from pain. In a first session, young and older adults completed a battery of neuropsychological tests. In a second session, we acquired functional brain images while participants completed a working memory task with two levels of cognitive load (low vs. high load) and concurrently received individually adjusted heat stimuli (innocuous vs. painful) to their lower arm. While we found no age-related differences in the distraction effect size on the behavioural level, young adults showed a larger neural distraction effect in several regions involved in pain processing, including the insula, caudate and midcingulate cortex. Interestingly, older adults with better executive functions, particularly, better inhibitory control abilities, showed a larger neural distraction effect in the insula, thalamus and primary somatosensory cortex, and more activation in frontal clusters during the high load task. Taken together, these findings suggest that age alters the neural mechanisms underlying cognitive distraction from pain, and that the magnitude of these changes may be dependent on the preservation of executive functions. [less ▲]

Anterior cingulate cortex activity during rest is related to alterations in pain perception in aging

in Frontiers in Aging Neuroscience (2021)

Alterations in Neural Responses and Pain Perception in Older Adults During Distraction

in Psychosomatic Medicine (2020), 82