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The influence of different pain states on pain perception and cognitive functions
Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of this thesis was to investigate the effect of different pain stateson pain perception and cognition.In the first study, the effect of different pain qualities (duration, persistence, andintensity) on deep pressure pain thresholds in a pain-free body part among patientswith acute pain, long-lasting regularly recurrent pain, and long-lasting persistentpain, and pain-free controls was investigated. Such general deep pressure painthresholds were only significantly lower in the group with long-lasting persistentpain when compared to the healthy controls, suggesting that deep tissuehypersensitivity primarily occurs in patients with long-lasting, persistent pain.In the second study, the relationship between the same pain qualities and cognitiveperformance in the form of sustained attention, cognitive control, and psychomotorability was investigated. Overall, patients with long-lasting, persistent pain showedcognitive impairment on a wider range of cognitive tasks compared to patients withacute or long-lasting, regularly recurrent pain, using pain free controls asbenchmark. The results further suggest that persistence and duration, rather thanpain intensity, contribute to impaired cognitive function in clinical musculoskeletalpain states.In the third study, the effect of acute, experimental pain on abstraction wasexamined in a laboratory experiment where pain was induced with a cold pressorapparatus. The results were consistent with the null hypothesis, suggesting thatabstraction is immune to acute, experimental pain.In the fourth study, the correlation between clinical pain, abstraction and selfcontrolwas examined in patients suffering from musculoskeletal pain of differentduration, persistence and intensity. The results suggest that abstract thinking isreduced with increasing pain intensity and pain persistence. This was also the casefor self-control, although depression seems to mediate this relationship.In conclusion, compared to other pain states, patients who experience long-term,persistent pain, seem to suffer from a broader range of impaired cognitive abilities.Further, deep tissue hypersensitivity seems to develop in patients with long-termpersistent pain, but not in other pain states, which may contribute to the impairedcognitive performance observed in this patient group. The results have importantpractical implications for patients in the clinic and their everyday lives.

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2018.
Series
Linnaeus University Dissertations ; 323/2018
Keywords [en]
Persistent pain, Musculoskeletal pain, Cognitive impairment, Abstraction, Pain Thresholds
National Category
Psychology (excluding Applied Psychology)
Research subject
Social Sciences, Psychology
Identifiers
URN: urn:nbn:se:lnu:diva-73789ISBN: 978-91-88761-65-1 (electronic)ISBN: 978-91-88761-64-4 (print)OAI: oai:DiVA.org:lnu-73789DiVA, id: diva2:1203528
Public defence
2018-06-15, Myrdal, Hus K, äxjö, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2018-05-03 Created: 2018-05-03 Last updated: 2018-09-20Bibliographically approved
List of papers
1. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
Open this publication in new window or tab >>Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
2016 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 13, p. 1-5Article in journal (Refereed) Published
Abstract [en]

BackgroundPressure pain thresholds (PPTs) in a non-painful body area are known to be affected in some chronic pain states. The aim of this study is to investigate PPTs in a pain-free body part in relation to pain persistence and intensity in patients with musculoskeletal pain. MethodsPatients with musculoskeletal pain were divided into three different pain groups: acute pain (pain duration < 3 months, n = 38), regularly recurrent pain (regularly recurrent pain duration > 3 months, n = 56), persistent pain (persistent pain duration > 3 months, n = 52) and a healthy control group (n = 51). PPT measures were conducted over the tibialis anterior muscle on the right leg in all groups. ResultsThe persistent pain group showed significantly lower PPTs over the tibialis anterior muscle compared to controls. No significant differences were found between the acute and regularly recurrent pain groups compared to healthy controls. Significant correlations, albeit small, were found between pain intensity and PPTs. ConclusionsIncreased deep pain sensitivity was found in patients with persistent musculoskeletal pain, but not in regularly recurrent pain or in acute pain. Yet, a limitation of the study is that it did not have sufficient power to detect small levels of increased deep pain sensitivity among the latter groups when compared to healthy controls. Implications: Knowledge about increased general hypersensitivity in persistent musculoskeletal pain could be important in clinical treatment.

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Central sensitization, Deep pain sensitivity, Persistent pain, Pressure pain threshold
National Category
Neurology
Research subject
Natural Science, Medicine; Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-56062 (URN)10.1016/j.sjpain.2016.05.032 (DOI)000391261500001 ()28850505 (PubMedID)2-s2.0-84973340677 (Scopus ID)
Available from: 2016-09-16 Created: 2016-08-31 Last updated: 2018-05-03Bibliographically approved
2. Impaired psychomotor ability and attention in patients with persistent pain: a cross-sectional comparative study
Open this publication in new window or tab >>Impaired psychomotor ability and attention in patients with persistent pain: a cross-sectional comparative study
2016 (English)In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 9, p. 825-835Article in journal (Refereed) Published
Abstract [en]

Background and aims: Patients with pain have shown cognitive impairment across various domains. Although the pain qualities vary among patients, research has overlooked how cognitive performance is affected by the duration and persistence of pain. The current study sought to fill this gap by examining how qualitatively different pain states relate to the following cognitive functions: sustained attention, cognitive control, and psychomotor ability. Patients and methods: Patients with musculoskeletal pain in primary care were divided into three pain groups: acute pain (duration <3 months), regularly recurrent pain (duration >3 months), and persistent pain (duration >3 months). These groups were then compared with healthy controls. The MapCog Spectra Test, the Color Word Test, and the Grooved Pegboard Test were used to measure sustained attention, cognitive control, and psychomotor ability, respectively. Results: Patients with persistent pain showed significantly worse sustained attention and psychomotor ability compared with healthy controls. The acute pain group showed a significant decrease in psychomotor ability, and the regularly recurrent pain group showed a significant decrease in sustained attention. These results remained unchanged when age, education, and medication were taken into account. Conclusion: Persistent musculoskeletal pain seems to impair performance on a wider range of cognitive tasks than acute or regularly recurrent pain, using pain-free individuals as a benchmark. However, there is some evidence of impairment in psychomotor ability among patients with acute pain and some impairment in sustained attention among patients with regularly recurrent pain.

Keywords
persistent pain, cognitive impairment, musculoskeletal pain, psychomotor ability, attention, cognitive control
National Category
Psychology Neurosciences
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-59730 (URN)10.2147/JPR.S114915 (DOI)000389837700001 ()27799814 (PubMedID)2-s2.0-84992482345 (Scopus ID)
Available from: 2017-01-10 Created: 2017-01-10 Last updated: 2018-05-03Bibliographically approved
3. Does physical pain impair abstract thinking?
Open this publication in new window or tab >>Does physical pain impair abstract thinking?
2017 (English)In: Journal of Cognitive Psychology, ISSN 2044-5911, E-ISSN 2044-592X, Vol. 29, no 6, p. 748-754Article in journal (Refereed) Published
Abstract [en]

The ability to think abstractly constitutes a fundamental dimension of human cognition. Although abstraction has been extensively studied, its emotional and affective antecedents have been largely overlooked. One experiment was conducted to examine whether physical pain affects abstraction. Drawing on Construal Level Theory [Trope, Y., & Liberman, N. (2010). Construal-level theory of psychological distance. Psychological Review117, 440–463] and Loewenstein’s [(1996). Out of control: Visceral influences on behavior. Organizational Behavior and Human Decision Processes65, 272–292] visceral factors theory, we hypothesised that pain impairs abstraction because pain constricts people’s mental horizons and lead to a concrete, inward-focus toward oneself in the here and now. Physical pain was manipulated between subjects (N = 150). The participants either kept their left hand immersed in cold (painful) water or neutral (painless) water while we measured abstract versus concrete behaviour identification, categorisation, and perceptual processing. Bayesian statistical analyses indicate substantial evidence against the hypothesis that pain impairs abstraction. In contrast to many other previously studied cognitive outcomes (e.g. attention), abstraction appears to be largely immune to acute, experimentally induced pain.

Place, publisher, year, edition, pages
Taylor & Francis, 2017
Keywords
Abstraction, Physical pain, Construal level
National Category
Psychology (excluding Applied Psychology)
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-61089 (URN)10.1080/20445911.2017.1304941 (DOI)
Available from: 2017-03-06 Created: 2017-03-06 Last updated: 2018-05-03Bibliographically approved

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Gunnarsson, Helena E. M.

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