Article

On the Importance of Being Vocal: Saying “Ow” Improves Pain Tolerance

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Abstract

Vocalizing is a ubiquitous pain behavior. Here we investigated whether it helps alleviate pain and sought to discern potential underlying mechanisms. Participants were asked to immerse one hand into painfully cold water. On separate trials, they said "ow", heard a recording of them saying "ow", heard a recording of another person saying "ow", pressed a button, or sat passively. Compared to sitting passively, saying "ow" increased the duration of hand immersion. Although on average, participants predicted this effect, their expectations were uncorrelated with pain tolerance. Like vocalizing, button pressing increased the duration of hand immersion and this increase was positively correlated with the vocalizing effect. Hearing one's own or another person's "ow" were not analgesic. Together, these results provide first evidence that vocalizing helps individuals cope with pain. Moreover, they suggest that motor more than other processes contribute to this effect. Participants immersed their hand into painfully cold water longer when saying "ow" than when doing nothing. Whereas button-pressing had a similar effect, hearing one's own or another person's "ow" did not. Thus, vocalizing in pain is not only communicative. Like other behaviors, it helps cope with pain. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

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... This was not expected as Japanese people are not accustomed to swearing in a pain context and swearing would not cue the scripts which could induce a hypoalgesic effects. Previous research suggests that the act of vocalisation may have a hypoalgesic effect in experimental pain conditions [27]. However, it is unlikely that swearing could moderate pain in the same way as saying "ow" by causing muscle movements known to reduce pain [27]. ...
... Previous research suggests that the act of vocalisation may have a hypoalgesic effect in experimental pain conditions [27]. However, it is unlikely that swearing could moderate pain in the same way as saying "ow" by causing muscle movements known to reduce pain [27]. This is because in the current study both the swearwords and the alternative words are likely to have induced the same muscle movements. ...
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Background: This pre-registered study extends previous findings that swearing alleviates pain tolerance by assessing the effects of a conventional swear word (“fuck”) and two new “swear” words, “fouch” and “twizpipe”.Method: A mixed sex group of participants (N = 92) completed a repeated measures experimental design augmented by mediation analysis. The independent variable was Word with the levels, “fuck” v. “fouch” v. “twizpipe” v. a neutral word. The dependent variables were emotion rating, humour rating, distraction rating, cold pressor pain threshold, cold pressor pain tolerance, pain perception score and change from resting heart rate. Possible mediation effects were assessed for emotion, humour and distraction ratings. Results: For conventional swearing (“fuck”), confirmatory analyses found a 32% increase in pain threshold and a 33% increase in pain tolerance, accompanied by increased ratings for emotion, humour and distraction, relative to the neutral word condition. The new “swear” words, “fouch” and “twizpipe” were rated higher than the neutral word for emotion and humour although these words did not affect pain threshold or tolerance. Changes in heart rate, pain perception and were absent, as were mediation effects.Conclusions: Our data replicate previous findings that repeating a swear word at a steady pace and volume benefits pain tolerance, extending this finding to pain threshold. Our data cannot explain how such effects are manifest, although distraction appears to be of little importance, and emotion is worthy of future study. The new “swear” words did not alleviate pain even though participants rated them as emotion evoking and humorous.
... This was not expected as Japanese people are not accustomed to swearing in a pain context and swearing would not cue the scripts which could induce a hypoalgesic effects. Previous research suggests that the act of vocalisation may have a hypoalgesic effect in experimental pain conditions [27]. However, it is unlikely that swearing could moderate pain in the same way as saying "ow" by causing muscle movements known to reduce pain [27]. ...
... Previous research suggests that the act of vocalisation may have a hypoalgesic effect in experimental pain conditions [27]. However, it is unlikely that swearing could moderate pain in the same way as saying "ow" by causing muscle movements known to reduce pain [27]. This is because in the current study both the swearwords and the alternative words are likely to have induced the same muscle movements. ...
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Background and aims: Research suggests swearing can moderate pain perception. The present study assessed whether changes in pain perception due to swearing reflect a "scripting" effect by comparing swearing as a response to pain in native English and Japanese speakers. Cognitive psychology denotes a 'script' to be a sequence of learnt behaviours expected for given situations. Japanese participants were included as they rarely, if ever, swear as a response to pain and therefore do not possess an available script for swearing in the context of pain. It was hypothesised that Japanese participants would demonstrate less tolerance and more sensitivity to pain than English participants, and - due to a lack of an available script of swearing in response to pain - that Japanese participants would not experience swearword mediated hypoalgesia. Methods: Fifty-six native English (mean age=23 years) and 39 Japanese (mean age=21) speakers completed a cold-pressor task whilst repeating either a swear on control word. A 2 (culture; Japanese, British)×2 (word; swear; non-swear) design explored whether Japanese participants showed the same increase in pain tolerance and experienced similar levels of perceived pain when a swearing intervention was used as British participants. Pain tolerance was assessed by the number of seconds participants could endure of cold-pressor exposure and self-report pain measurements. Levels of perceived pain were assessed using a 120-mm horizontal visual analogue scale anchored by descriptors in the participant's native language of "no pain" (left) and "terrible pain" (right). The participant was asked to mark a 10mm vertical line to indicate overall pain intensity. The score was measured from the zero anchor to the participant's mark. Results: Japanese participants reported higher levels of pain (p<0.005) and displayed lower pain tolerance than British participants (p<0.05). Pain tolerance increased in swearers regardless of cultural background (p<0.001) and no interaction was found between word group and culture (p=0.96), thereby suggesting that swearing had no differential effect related to the cultural group of the participant. Conclusions: The results replicate previous findings that swearing increases pain tolerance and that individuals from an Asian ethnic background experience greater levels of perceived pain than those from a Caucasian ethnic background. However, these results do not support the idea of pain perception modification due to a "scripting" effect. This is evidenced as swearword mediated hypoalgesia occurs irrespective of participant cultural background. Rather, it is suggested that modulation of pain perception may occur through activation of descending inhibitory neural pain mechanisms. Implications: As swearing can increase pain tolerance in both Japanese and British people, it may be suggested that swearword mediated hypoalgesia is a universal phenomenon that transcends socio-cultural learnt behaviours. Furthermore, swearing could be encouraged as an intervention to help people cope with acute painful stimuli.
... Nous ne le savons pas, il faudrait effectuer des études semblables sur les interjections primaires, qui ne contiennent pas cette dimension d'agressivité et donc permettent d'écarter cette interprétation.80 Stephens et collaborateurs (2009) ont une interprétation différente : selon eux, le fait de jurer fait advenir une émotion, puisque cela place le sujet dans une situation d'agressivité, ce qui cause du stress, ce qui a un effet hypoalgésique.LES INTERJECTIONS PRIMAIRES : GESTION DE LA DOULEURUne recherche récente confirme le rôle des productions vocales sur la capacité des individus à gérer une sensation douloureuse(Swee et Schirmer, 2015). L'expérience de cette étude consistait à comparer le temps pendant lequel des participants étaient capables de plonger une main dans de l'eau très froide (4°C) afin de tester leur résistance à la douleur. ...
Thesis
Les définitions actuelles des interjections et des onomatopées ne permettent manifestement pas de circonscrire ces faits de langue avec précision, ce qui aboutit à des classifications hétéroclites dans la littérature et à des extractions d’occurrences contenant nécessairement des faux positifs pour certains et laissant des faux négatifs pour d’autres. Les raisons sont multiples : tout d’abord, parce que les différentes écoles de linguistique ne sont pas prioritairement conçues pour décrire des faits de langue isolés syntaxiquement, ensuite, parce que certaines propriétés traditionnellement attribuées à ces faits de langue font écran à leur description. Par exemple, l’interjection serait la manifestation d’une émotion, elle serait un indice, un marqueur de modalité d’énonciation, quand l’onomatopée serait un signe motivé, iconique, servant à imiter un référent. Nous défendrons l’idée que ces propriétés masquent la fonction première de ces faits de langue, qui est de permettre au locuteur, au moment même de la production effective du discours, de réduire la distance entre l’énoncé qu’il vise (son énoncé idéal) et l’énoncé qu’il parvient à formuler. Nous avons intégralement repris la démarche définitionnelle, en commençant par une définition en intension, élaborée à partir d’un travail à très forte dimension théorique, pour ensuite proposer une classification des types d’interjections et d’onomatopées en fonction des matrices lexicogéniques dont elles sont issues. Cette méthode nous a permis de mettre en lumière une stratégie d’intégration de l’interjection dans la structure phrastique, que nous avons nommée le rattrapage syntaxique. Nous montrerons que cette stratégie est la version syntaxique d’un phénomène que l’on retrouve déjà au niveau du phonème et au niveau du lexème. La dernière partie de notre thèse est consacrée à la description du rattrapage syntaxique et à la recherche des contraintes qui s’y appliquent. Pour ce faire, nous analyserons un corpus d’interjections intégrées à des structures phrastiques et aurons recours à des outils conceptuels élaborés par la Linguistique Générative, la Linguistique Cognitive et la Théorie des Opérations Énonciatives.
... Nous ne le savons pas, il faudrait effectuer des études semblables sur les interjections primaires, qui ne contiennent pas cette dimension d'agressivité et donc permettent d'écarter cette interprétation.80 Stephens et collaborateurs (2009) ont une interprétation différente : selon eux, le fait de jurer fait advenir une émotion, puisque cela place le sujet dans une situation d'agressivité, ce qui cause du stress, ce qui a un effet hypoalgésique.LES INTERJECTIONS PRIMAIRES : GESTION DE LA DOULEURUne recherche récente confirme le rôle des productions vocales sur la capacité des individus à gérer une sensation douloureuse(Swee et Schirmer, 2015). L'expérience de cette étude consistait à comparer le temps pendant lequel des participants étaient capables de plonger une main dans de l'eau très froide (4°C) afin de tester leur résistance à la douleur. ...
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Abstract : The current definitions of interjections and onomatopoeias, which are mainly based on semiotic criteria (interjections are indexes, onomatopoeias are icons), are seemingly not precise enough to draw up a list of items belonging to these categories. This results in heterogeneous classifications in the literature and different data extraction strategies, which in turn entails the presence of items that some will regard as “false positives” or “false negatives”. We will defend the idea that the primary function of these words is to enable the speaker to reduce the distance between their actual speaking performance (the actual utterances) and their intended speech (the ideal utterances). We will devise the defining enterprise from the very beginning, starting with the intension of the words interjection and onomatopoeia. Then, we will focus on their extension and will classify different types of interjections and onomatopoeias. The classification will be based on the word formation process they stem from. We will show that interjections and onomatopoeias have different definitions “en langue”, “en parole” and “en corpus”. “En langue”, these words are tools, “en parole”, they are performances, since the speaker reshapes or moulds his/her vocal production, and “en corpus”, interjections and onomatopoeias are imprints of the above-mentioned performance. Our method will also reveal a word formation strategy that we call “Syntactic Adjustment” (“SA”), and which consists in incorporating interjections into syntactic structures. We will show that this SA is merely the syntactic version of a strategy that can also be observed at the phonemic and at the lexical level and that could be described as a word formation process. In part III of our dissertation, we will describe the SA and will expose some of the rules that restrict its use. To do this, we will compare the SA with converted interjections (yuck! > yucky ; oh God! > to be oh-Godding at something) and will also analyze a corpus of syntactically integrated interjections. We will make use of concepts developed in different theoretical frameworks, mainly in Cognitive Grammar, Generative Linguistics and Theory of Enunciative Operations. Keywords : interjection, onomatopoeia, definition, classification, syntax, inferences
... Swearing often aims for and achieves outcomes similar to those of non-linguistic vocalizations. In a study that follows a protocol much like that of Stephens and colleagues (2009), in which swearing decreased the perception of thermal pain and increased the tolerance to it, Swee and Schirmer (2015) tested the effect of screaming "Ow!" on immersing one's hand in cold water of 4 0 Celsius. They found that the non-linguistic vocalization reduced the pain experience and increased pain tolerance. ...
Chapter
This chapter explores and summarizes the current knowledge about the neurophysiological substrata of the utterance of expletives—its brain regions, pathways, and neurotransmitters, and its interaction with hormones. The chapter presents clinical data that have been gathered directly from patients of aphasia, Tourette syndrome, Alzheimer’s disease, and brain injuries—all are disorders often accompanied with expletives. It also discusses the possible relations between swearing and aggression, swearing and pain, and swearing and social inhibition in the population at large. Finally, the chapter examines the clinical data and the data gathered from the population at large within one frame, and proposes two hypotheses that can serve as possible directions for future research about the biological substrata of swearing. No previous knowledge of the brain is assumed. © editorial matter and organization Keith Allan 2019 and the chapters their several authors 2019.
... In other words, they communicate their distress more intensely when susceptible receivers are around. Sufferers often express their pain through vocalization and their pain tolerance rises when they do so (Stephens et al. 2009;Stephens and Umland 2011;Swee and Schirmer 2015); in other words, pain motivates communication and pain diminishes when this motivation is fulfilled. Accordingly, brain activation in regions associated with pain is reduced when pain communication is increased (Ferris et al. 2016). ...
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... Expressing pain to our ingroup is functional: at a basic level, pain communication can aid the sufferer by limiting exposure to the nociceptive source and minimizing damage, as pain expressions and distress vocalizations provide valuable signals to conspecifics on potential risks, dangers, and ameliorative action required [9,[19][20][21]. Expressing pain can itself serve psychological functions-simply vocalizing pain improves pain tolerance, such as saying "ow" [22] or even swearing [23,24]. Signaling pain is also a way to engender empathy and helping behaviors in others, because seeing others in pain elicits empathy and helping, particularly between ingroup members [25]. ...
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... Results showed that participants in the distraction group reported significantly less pain during the CPT. Swee and Schirmer (2015) provided evidence that even vocalization can help individuals cope with pain, and suggest that motoric processes more so than other processes, contribute to this effect. Jameson et al. (2011) suggested electronic gaming as a pain distraction method for children to improve pain tolerance, because an interactive distraction task (playing a game) includes greater central cognitive processing demands. ...
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... Equally, we should not forget that expressive meaning may sometimes not serve a communicative function at all. Swee and Schirmer (2015) perform a series of experiments which show that uttering ow when your hand is in painfully cold water can actually improve pain tolerance: the cathartic nature of expressives should not be overlooked. ...
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There seem to be two kinds of pain: fundamental “sensory” pain, the intensity of which is a direct function of the intensity of various pain stimuli, and “psychological” pain, the intensity of which is highly modifiable by such factors as hypnotism, placebos, and the sociocultural setting in which the stimulus occurs. Physiological, cognitive, and behavioral theories of pain each have their own view of the nature of the two kinds of pain. According to physiological theory and cognitive theory, “psychological” pain and “sensory” pain are both internal processes, with the former influencing the latter as central processes influence peripheral processes. According to behavioral theory, “sensory” pain is a reflex (a respondent) while “psychological” pain is an instrumental act (an operant). Behavioral theory claims that neither kind of pain is an internal process — that both are overt behaviors. Although both physiological theory and cognitive theory agree with common sense that pain is internal, they disagree with commonsense intuitions at other points. They are no better at explaining the subjective experience of pain than is behavioral theory. They have not generated treatments for pain that are superior to those generated by behavioral theory. There is no basis for the frequent claim by antibehaviorist philosophers and psychologists that behaviorism, because it cannot explain pain, is less capable of explaining mental phenomena than physiology or cognition.
Article
Two studies were conducted to replicate and extend previous work (Leventhal, Brown, Schaham, & Engquist, 1979) on the distress-reducing effects of attention to the sensory aspects of a painful stimulus. In the first study subjects exposed to the cold pressor were randomly assigned to three groups: (1)Attention group, instructed to attend to the sensory components of the cold pressure experience by actively verbalizing the sensations they were experiencing; (2)Distraction group, instructed to name their high school courses and teachers; and (3)Emotive group, instructed to express emotion associated with the cold pressor experience. As predicted, the Attention group reported the least distress, the Emotive group the most, and the Distraction group an intermediate amount. The second study replicated the effects of the Attention and Distraction groups using threshold and tolerance as the main dependent measures. Tolerance but not threshold was significantly increased in the Attention group. A third study also examined subjects' predictions of how given strategies would affect pain tolerance. Subjects predicted that the Attention and Emotive strategies would increase pain, whereas Imagining Numbness and Positive Imagery would decrease pain.
Article
Previous studies found a relationship between response to experimentally-induced pain and scores for the gender role expectations of pain (GREP) questionnaire. Findings were similar in individuals from America, Portugal and Israel suggesting that gender role expectations may be universal. The aim of this study was to translate and validate Arabic GREP using Factor Analysis and to investigate if sex differences to cold-pressor pain in healthy Libyan men and women are mediated through stereotypical social constructs of gender role expectations and/or pain-related anxiety. One hundred fourteen university students (58 women) underwent two cycles of cold pressor pain test to measure pain threshold, tolerance, intensity, and unpleasantness. Participants also completed the Arabic GREP questionnaire and the Pain Anxiety Symptom Scale-Short form (PASS-20). It was found that Libyan men had higher pain thresholds and tolerances than women (mean difference, 95% CI: threshold = 4.69 (s), -0.72 to 10.1, p = 0.005; tolerance = 13.46 (s), 0.5-26.4, p = 0.018). There were significant differences between sexes in 6 out of 12 GREP items (p < 0.004 after Bonferonni adjustment). The results of mediational analysis showed that GREP factors were the mediators of the effects of sex on pain threshold (z = -2.452, p = 0.014 for Self Sensitivity); (z = -2.563, p = 0.01, for Self Endurance) and on pain tolerance (z = -2.538, p = 0.01 for Self Endurance). In conclusion, sex differences in response to pain were mediated by gender role expectations of pain but not pain-related anxiety.
Article
Unlabelled: Previously we showed that swearing produces a pain lessening (hypoalgesic) effect for many people.(20) This paper assesses whether habituation to swearing occurs such that people who swear more frequently in daily life show a lesser pain tolerance effect of swearing, compared with people who swear less frequently. Pain outcomes were assessed in participants asked to repeat a swear word versus a nonswear word. Additionally, sex differences and the roles of pain catastrophizing, fear of pain, and daily swearing frequency were explored. Swearing increased pain tolerance and heart rate compared with not swearing. Moreover, the higher the daily swearing frequency, the less was the benefit for pain tolerance when swearing, compared with when not swearing. This paper shows apparent habituation related to daily swearing frequency, consistent with our theory that the underlying mechanism by which swearing increases pain tolerance is the provocation of an emotional response. Perspective: This article presents further evidence that, for many people, swearing (cursing) provides readily available and effective relief from pain. However, overuse of swearing in everyday situations lessens its effectiveness as a short-term intervention to reduce pain.
Article
The present experiment examined the effect of different approach motivational body postures on relative left frontal cortical activity, which has been linked with approach motivation. Three body postures were manipulated to create three levels of approach motivation. Consistent with the motivational direction model, results indicated that leaning forward with arms extended (high approach) caused greater left frontal cortical activation as compared to reclining backwards (low approach). This is the first experiment to demonstrate this effect, and it suggests that leaning forward as compared to reclining backward increases approach motivation. These results provide important implications for the motivational direction model and embodiment research.
Article
Unlabelled: The aims of this study were: 1) to examine race and sex differences in primary pain appraisals and catastrophizing; 2) to test the unique ability of race, sex, primary pain appraisals, and catastrophizing to predict experimental pain outcomes; and 3) to conduct mediational analyses testing pain appraisals and catastrophizing as explanatory mechanisms for race and sex differences in pain. One hundred and fifty-five college students at The University of Alabama completed a cold pressor experimental pain task and a questionnaire battery. Statistical methods included multivariable regression models and nonparametric bootstrapping methods for tests of mediation. African-Americans reported higher catastrophizing and had lower pain tolerance than white Americans. Males demonstrated higher challenge appraisals, lower pain intensity, and longer pain tolerance. Challenge appraisals were positively related to pain tolerance, threat/harm appraisals were inversely related to pain tolerance, and pain catastrophizing was positively related to both pain intensity and pain unpleasantness. Pain catastrophizing partially mediated race differences in pain tolerance and mediated sex differences in intensity, whereas primary pain appraisals did not significantly mediate race or sex differences in pain variables. Primary appraisals and catastrophizing appear to be separable constructs related to different aspects of the pain experience. Perspective: This study found that important race and sex differences exist in relation to pain appraisals and catastrophizing, and that these cognitive variables play unique roles in different aspects of the pain experience. Cognitive-behavioral therapies for pain may be enhanced by including a focus on both pain appraisals and pain catastrophizing.
Article
Attention is acknowledged as an important factor in the modulation of pain. A recent model proposed that an effective control of pain by attention should not only involve the disengagement of selective attention away from nociceptive stimuli, but should also guarantee that attention is maintained on the processing of pain-unrelated information without being recaptured by the nociceptive stimuli. This model predicts that executive functions are involved in the control of selective attention by preserving goal priorities throughout the achievement of cognitive activities. In the present study, we tested the role of working memory in the attentional control of nociceptive stimuli. In the control condition, participants had to discriminate the color of visually presented circles preceded by tactile distracters. In some trials (20%), tactile stimuli were replaced by novel nociceptive distracters in order to manipulate the attentional capture. In the working memory condition, participants had to respond to the visual stimulus presented one trial before, and were thus required to maintain the color of the visual stimulus in working memory during the entire inter-trial time interval. Results showed that, while novel nociceptive stimuli induced greater distraction than regular tactile stimuli in the control condition, the distractive effect was suppressed in the working memory condition. This suggests that actively rehearsing the feature of pain-unrelated and task-relevant targets successfully prevents attention from being captured by novel nociceptive distracters, independently of general task demands. Working memory can help to inhibit the involuntary capture of attention by pain by preserving cognitive goal priorities.
Article
This study examined whether breathing rate affected self-reported pain and emotion following thermal pain stimuli in women with fibromyalgia syndrome (FM: n=27) or age-matched healthy control women (HC: n=25). FM and HC were exposed to low and moderate thermal pain pulses during paced breathing at their normal rate and one-half their normal rate. Thermal pain pulses were presented in four blocks of four trials. Each block included exposure to both mild and moderate pain trials, and periods of both normal and slow paced breathing. Pain intensity and unpleasantness were recorded immediately following each pain trial, and positive and negative affect were assessed at the end of each block of trials. Compared to normal breathing, slow breathing reduced ratings of pain intensity and unpleasantness, particularly for moderately versus mildly painful thermal stimuli. The effects of slow breathing on pain ratings were less reliable for FM patients than for HCs. Slow versus normal breathing decreased negative affect ratings following thermal pain pulses for both groups, and increased positive affect reports, but only for healthy controls with high trait negative affect. Participants who reported higher levels of trait positive affect prior to the experiment showed greater decreases in negative affect as a result of slow versus normal breathing. These experimental findings provide support for prior reports on the benefits of yogic breathing and mindful Zen meditation for pain and depressed affect. However, chronic pain patients may require more guidance to obtain therapeutic benefit from reduced breathing rates.
Article
Although a common pain response, whether swearing alters individuals' experience of pain has not been investigated. This study investigated whether swearing affects cold-pressor pain tolerance (the ability to withstand immersing the hand in icy water), pain perception and heart rate. In a repeated measures design, pain outcomes were assessed in participants asked to repeat a swear word versus a neutral word. In addition, sex differences and the roles of pain catastrophising, fear of pain and trait anxiety were explored. Swearing increased pain tolerance, increased heart rate and decreased perceived pain compared with not swearing. However, swearing did not increase pain tolerance in males with a tendency to catastrophise. The observed pain-lessening (hypoalgesic) effect may occur because swearing induces a fight-or-flight response and nullifies the link between fear of pain and pain perception.
Article
Human affective reactions to nociceptive electrical stimulation were attenuated by application of a tactile stimulus to the shocked site. No alteration was perceived when the same tactile stimulus was applied to a similar contralateral site. These results and a lack of alteration at sensation threshold demonstrate the effect to be more than simple masking and support the Melzack-Wall theory.
Article
2 studies explored the effects of being confronted by one's own voice. In Study 1, 39 Ss listened to a sample of their own voices and of 19 unfamiliar voices. Physiological responses to those stimuli showed greater activation by own voice, whether or not Ss consciously recognized their own voices. When playback was delayed for 3 mo., the significant activation by own voice persisted for those who recognized their own voices and continued as a tendency for those who did not recognize their own voices. In Study 2, a group of psychiatrists and a group of townspeople produced single-word free associations before and after listening to their own voices. Another group of psychiatrists and townspeople produced free associations before and after listening to a stranger's voice. A 3rd group of psychiatrists free associated twice with no interpolated stimulus voice. The results showed a trend to constriction of associative output after Ss heard their own voices. In addition, psychiatrists showed increased production of affect words, while townspeople showed decreased production of affect words after listening to their own voices. There were no differences between the groups in affect word production following listening to another's voice. Results are interpreted as being consistent with a process of affective impact which mobilizes defensive reactions following listening to one's own voice.
Article
Spatial summation of thermal pain crosses dermatomal boundaries. In this study we examined whether a vibrational stimulus applied to adjacent or remote dermatomes affects thermal pain perception to the volar forearm. Contact heat at 2 degrees C above thermal pain threshold was applied, and a Visual Analog Scale (VAS) was used for pain assessment. We found a significant decrease in mean VAS rating when simultaneous vibratory stimuli were given to the dermatome adjacent to that receiving thermal stimulation, or to the same dermatome on the contralateral side. There was no change in VAS rating when vibration was given two or more dermatomes away. Vibration within the same dermatome also did not yield a significant change in VAS rating, possibly due to difficulty in magnitude assessment of stimuli given simultaneously within a single dermatome. The finding that vibration can reduce pain across dermatomes may allow for more flexible design of stimulation therapy for pain.
Article
Thirty-two patients with refractory central and neuropathic pain of peripheral origin were treated by chronic stimulation of the motor cortex between May 1993 and January 1997. The mean follow-up was 27.3 months. The first 24 patients were operated according to the technique described by Tsubokawa. The last 13 cases (eight new patients and five reinterventions) were operated by a technique including localisation by superficial CT reconstruction of the central region and neuronavigator guidance. The position of the central sulcus was confirmed by the use of intraoperative somatosensory evoked potentials. The somatotopic organisation of the motor cortex was established peroperatively by studying the motor responses at stimulation of the motor cortex through the dura. Ten of the 13 patients with central pain (77%) and ten of the 12 patients with neuropathic facial pain had experienced substantial pain relief (75%). One of the three patients with post-paraplegia pain was clearly improved. A satisfactory result was obtained in one patient with pain related to plexus avulsion and in one patient with pain related to intercostal herpes zooster. None of the patients developed epileptic seizures. The position of the stimulating poles effective on pain corresponded to the somatotopic representation of the motor cortex. The neuronavigator localisation and guidance technique proved to be most useful identifying the appropriate portion of the motor gyrus. It also allowed the establishment of reliable correlations between electrophysiological-clinical and anatomical data which may be used to improve the clinical results and possibly to extend the indications of this technique.
Article
Cortical activity due to a thermal painful stimulus applied to the right hand was studied in the middle third of the contralateral brain and compared to activations for vibrotactile and motor tasks using the same body part, in nine normal subjects. Cortical activity was demonstrated utilizing multislice echo-planar functional magnetic resonance imaging (fMRI) and a surface coil. The cortical activity was analyzed based upon individual subject activity maps and on group-averaged activity maps. The results show significant differences in activations across the three tasks and the cortical areas studied. The study indicates that fMRI enables examination of cortical networks subserving pain perception at an anatomical detail not available with other brain imaging techniques and shows that this cortical network underlying pain perception shares components with the networks underlying touch perception and motor execution. However, the thermal pain perception network also has components that are unique to this perception. The uniquely activated areas were in the secondary somatosensory region, insula, and posterior cingulate cortex. The posterior cingulate cortex activity was in a region that, in the monkey, receives nociceptive inputs from posterior thalamic medial and lateral nuclei that in turn are targets for spinothalamic terminations. Discrete subdivisions of the primary somatosensory and motor cortical areas were also activated in the thermal pain task, showing region-dependent differences in the extent of overlap with the other two tasks. Within the primary motor cortex, a hand region was preferentially active in the task in which the stimulus was painful heat. In the primary somatosensory cortex most activity in the painful heat task was localized to area 1, where the motor and vibratory task activities were also coincident. The study also indicates that the functional connectivity across multiple cortical regions reorganizes dynamically with each task.
Article
The aim of the study was to assess the effect of an active distraction technique that included the repeated breathing and blowing out of air on the pain behavior and facial display of children receiving local anesthesia injections prior to dental treatment. Fifty children between the ages of 3 and 7 years and who were undergoing dental treatment in a pediatric dental clinic were selected for this study. The children were randomly assigned to an intervention group or to a control group. The intervention group of 25 children was told to repeatedly breathe deeply before and during the administration of the injection and to blow the air out. The 25 control group children were given the injection in the slow manner without the repeated breathing and air blowing. Children in the intervention group demonstrated significantly less eyelid squeezing (P = 0.04). Also, more children in the intervention group than in the control group significantly expressed their wish to have the same technique used during the second visit (p = 0.033). Children in the intervention group generally demonstrated less hand and torso movements, less eyebrow bulging, and expressed less pain than in the control group. Boys significantly reported less pain after the injection. The results of this study indicate some advantages of distraction techniques (deep breaths and blowing air) prior to and during the administration of a local anesthetic injection in children.
Article
Laser evoked potentials (LEPs) are brain responses to activation of skin nociceptors by laser heat stimuli. LEPs consist of three components: N1, N2, and P2. Previous reports have suggested that in contrast to earlier activities (N1), LEPs responses after 230-250 ms (N2-P2) are modulated by attention to painful laser stimuli. However, the experimental paradigms used were not designed to specify the attentional processes involved in these LEP modulations. We investigated the effects of selective spatial attention and oddball tasks on LEPs. CO(2) laser stimuli of two different intensities were delivered on the dorsum of both hands of ten subjects. One intensity was frequently presented, and the other rarely. Subjects were asked to pay attention to stimuli delivered on one hand and to count rare stimuli, while ignoring stimuli on the other hand. Frequent and rare attended stimuli evoked enhanced N160 (N1) and N230 (N2) components in comparison to LEPs from unattended stimuli. Both components showed scalp distribution contralateral to the stimulus location. The vertex P400 (P2) was unaffected by spatial attention and stimulus location, but its amplitude increased after rare stimuli, whether attended or unattended. An additional parietal P600 component was induced by the attended rare stimuli. It is suggested that several attentional processes can modify nociceptive processing in the brain at different stages. LEP activities in the time-range of N1 and N2 (120-270 ms) showed evidence of processes modulated by the direction of spatial attention. Conversely, processes underlying P2 (400 ms) were not affected by spatial attention, but by the probability of the stimulus. This probability effect was not due to P3b-related processes that were observed at a later latency (600 ms). Indeed, P600 could be seen as a P3b evoked by conscious detection of rare targets.
Article
A previous meta-analysis of clinical analgesic trial studies showed generally low magnitudes of placebo analgesia (N. Engl. J. Med. 344 (2001) 1594). However, as studies included in their analysis used only placebo as a control condition, we conducted two meta-analyses, one in which 23 studies used only placebo as a control condition, and one in which 14 studies investigated placebo analgesic mechanisms. Magnitudes of placebo analgesic effects were much higher in the latter (mean effect size=0.95) as compared to the former (mean effect size=0.15) and were significantly different (P=0.003). This difference as well as differences in effect sizes within studies of placebo mechanisms may be parsimoniously explained by differences in expected pain levels produced by placebo suggestions and by conditioning. Furthermore, some of the studies of placebo analgesic mechanisms indicate that the magnitude of placebo analgesia is higher when the placebo analgesic effect is induced via suggestion combined with conditioning than via suggestion alone or conditioning alone. Based on these findings, we suggest that placebo analgesic effects are most optimally conceptualized in terms of perception of the placebo agent, and therefore a new definition of placebo response is proposed.
Article
To evaluate the effects of movement on cortical activities evoked by noxious stimulation, we recorded magnetoencephalography following noxious YAG laser stimulation applied to the dorsum of the left hand in normal volunteers. Results of the present study can be summarized as follows: (1) active movement of the hand ipsilateral to the side of noxious stimulation resulted in significant attenuation of both primary and secondary somatosensory cortices (SI and SII) in the hemisphere contralateral to the stimulated hand (cSI and cSII). Activity in the hemisphere ipsilateral to the side of stimulation (iSII) was not affected. (2) Active movement of the hand contralateral to the side of noxious stimulation resulted in significant attenuation of cSII. Activity in cSI and iSII was not affected. (3) Passive movement of the hand ipsilateral to the side of noxious stimulation resulted in significant attenuation of cSI. Activity in cSII and iSII was not affected. (4) Visual analogue scale (VAS) changes showed a similar pattern to the amplitude changes of cSII. These results suggest that activities in three regions are modulated by movements differently. Inhibition in cSI was considered to be mainly due to an interaction in SI by the signals ascending from the stimulated and movement hand. Inhibition in cSII was considered to be mainly due to particular brain activities relating to motor execution and/or movement execution associated with a specific attention effect. In addition, since VAS changes showed a similar relationship with the amplitude changes of cSII, cSII may play a role in pain perception.
Article
Complex regional pain syndrome type 1 (CRPS1) involves cortical abnormalities similar to those observed in phantom pain and after stroke. In those groups, treatment is aimed at activation of cortical networks that subserve the affected limb, for example mirror therapy. However, mirror therapy is not effective for chronic CRPS1, possibly because movement of the limb evokes intolerable pain. It was hypothesised that preceding mirror therapy with activation of cortical networks without limb movement would reduce pain and swelling in patients with chronic CRPS1. Thirteen chronic CRPS1 patients were randomly allocated to a motor imagery program (MIP) or to ongoing management. The MIP consisted of two weeks each of a hand laterality recognition task, imagined hand movements and mirror therapy. After 12 weeks, the control group was crossed-over to MIP. There was a main effect of treatment group (F(1, 11) = 57, P < 0.01) and an effect size of approximately 25 points on the Neuropathic pain scale. The number needed to treat for a 50% reduction in NPS score was approximately 2. The effect of treatment was replicated in the crossed-over control subjects. The results uphold the hypothesis that a MIP initially not involving limb movement is effective for CRPS1 and support the involvement of cortical abnormalities in the development of this disorder. Although the mechanisms of effect of the MIP are not clear, possible explanations are sequential activation of cortical pre-motor and motor networks, or sustained and focussed attention on the affected limb, or both.
Article
Recent theories of embodied cognition suggest new ways to look at how we process emotional information. The theories suggest that perceiving and thinking about emotion involve perceptual, somatovisceral, and motoric reexperiencing (collectively referred to as "embodiment") of the relevant emotion in one's self. The embodiment of emotion, when induced in human participants by manipulations of facial expression and posture in the laboratory, causally affects how emotional information is processed. Congruence between the recipient's bodily expression of emotion and the sender's emotional tone of language, for instance, facilitates comprehension of the communication, whereas incongruence can impair comprehension. Taken all together, recent findings provide a scientific account of the familiar contention that "when you're smiling, the whole world smiles with you."
Rachlin H: Pain and behavior
Rachlin H: Pain and behavior. Behav Brain Sci 8:43-53, 1985.
Ethnic differences in physical pain sensitivity: role of acculturation
  • Myp Chan
  • T Hamamura
  • K Janschewitz
Chan MYP, Hamamura T, Janschewitz K: Ethnic differences in physical pain sensitivity: role of acculturation. Pain 154:119-23, 2013.