Patrick Coulombe

Biological sex and social setting affects pain intensity and observational coding of other people's pain behaviors.

Summary An experiment examined the impact of sex and the social situational context on ischemic pain intensity and on the observational coding of other’s pain suffering. Observer sex and audience factors affect the evaluation of other people’s pain suffering. ABSTRACT This experiment examines the impact of biological sex and audience composition on laboratory‐induced ischemic pain intensity and observational coding of other people’s pain behaviors. Situational context was manipulated by varying the sex and number of audience stimuli in the laboratory setting during the pain task and during observational evaluations of other people’s pain suffering. The analyses revealed sex differences in felt pain intensity and observable pain behaviors, with male subjects reporting lower pain intensity and evidencing fewer pain behaviors than female subjects on average. Follow‐up analyses revealed that, after controlling for social anxiety, audience composition was linked to felt pain intensity, and this relation was moderated by participant sex and audience sex, such that only male subjects showed decreased pain intensity with increasing number of female audience members. Sex differences were also found in the rating of other people’s pain behaviors, with male observers rating the pain of others lower than female observers. Composition of the audience influenced observers’ pain ratings such that the presence of more male subjects in the audience correlated with lower observer ratings, whereas the presence of more female subjects correlated with higher observer ratings. This is the first study to show that the sex and the composition of the social context in which pain is experienced affects the intensity of felt pain and the evaluation of other people’s pain suffering. Implications of the findings for measuring and interpreting pain suffering in male and female patients by male and female treatment providers in health care settings are discussed.

Maternal touch and infant affect in the Still Face Paradigm: A cross-cultural examination

Touch between mother and infant plays an important role in development starting from birth. Cross-cultural differences surrounding rearing practices have an influence on parent-infant interaction, including types of touch used and the development of emotional regulation. This study was designed to investigate maternal touch and infant emotional regulation in infant-mother dyads from Ecuador (n=25) and Hispanic dyads from the United States (US) (n=26). Mothers and their 4-month-old full-term infants participated in the Still Face Paradigm. Second-by-second coding of maternal touch and infant affect was completed. Overall the analyses showed that Ecuadorian mothers used more nurturing and accompaniment touch and less attention seeking touch than US Hispanic mothers during the pre-stressor (baseline) episode. Lagged multilevel models were used to investigate the effect of the different types of touch on infant emotional regulation in the groups for the episodes. The data suggest that playful touch had a significant increase in infant affect, whereas accompaniment and attention-seeking touch had a significant decrease in infant affect. Overall, this study provides support for the role of touch in mother-infant synchronicity in relation to infants emotional regulation. Identifying touch that is more calming is important to foster emotional regulation in infancy, which can have important implications for development.

Ethnic Disparities in Emergency Severity Index Scores among U.S. Veteran’s Affairs Emergency Department Patients

Background The goal of these analyses was to determine whether there were systematic differences in Emergency Severity Index (ESI) scores, which are intended to determine priority of treatment and anticipate resource needs, across categories of race and ethnicity, after accounting for patient-presenting vital signs and examiner characteristics, and whether these differences varied among male and female Veterans Affairs (VA) ED patients. Methods and Findings We used a large national database of electronic medical records of ED patients from twenty-two U.S. Department of Veterans Affairs ED stations to determine whether ESI assignments differ systematically by race or ethnicity. Multi-level, random effects linear modeling was used to control for demographic characteristics and patient’s vital signs (heart rate, respiratory rate, and pain level), as well as age, gender, and experience of triage nurses. The dataset included 129,991 VA patients presenting for emergency care between 2008 and 2012 (91% males; 61% non-Hispanic White, 28% Black, 7% Hispanic, 2% Asian, <1% American Indian/Alaska Native, 1% mixed ethnicity) and 774 nurses for a total of 359,642 patient/examiner encounters. Approximately 13% of the variance in ESI scores was due to patient characteristics and 21% was due to the nurse characteristics. After controlling for characteristics of nurses and patients, Black patients were assigned less urgent ESI scores than White patients, and this effect was more prominent for Black males compared with Black females. A similar interaction was found for Hispanic males. It remains unclear how these results may generalize to EDs and patient populations outside of the U.S. VA Health Care system. Conclusions The findings suggest the possibility that subgroups of VA patients receive different ESI ratings in triage, which may have cascading, downstream consequences for patient treatment quality, satisfaction with care, and trust in the health equity of emergency care.

Experimenter Effects on Pain Reporting in Women Vary across the Menstrual Cycle

Background. Separate lines of research have shown that menstrual cycling and contextual factors such as the gender of research personnel influence experimental pain reporting. Objectives. This study examines how brief, procedural interactions with female and male experimenters can affect experimentally reported pain (cold pressor task, CPT) across the menstrual cycle. Methods. Based on the menstrual calendars 94 naturally cycling women and 38 women using hormonal contraceptives (M age = 19.83,  SD = 3.09) were assigned to low and high fertility groups. This assignment was based on estimates of their probability of conception given their current cycle day. Experimenters (12 males, 7 females) engaged in minimal procedural interactions with participants before the CPT was performed in solitude. Results. Naturally cycling women in the high fertility group showed significantly higher pain tolerance (81 sec, d = .79) following interactions with a male but not a female experimenter. Differences were not found for women in the low fertility or contraceptive groups. Discussion. The findings illustrate that menstrual functioning moderates the effect that experimenter gender has on pain reporting in women. Conclusion. These findings have implications for standardizing pain measurement protocols and understanding how basic biopsychosocial mechanisms (e.g., person-perception systems) can modulate pain experiences.

Patient Ethnicity Affects Triage Assessments and Patient Prioritization in U.S. Department of Veterans Affairs Emergency Departments.

AbstractEthnic minority patients receive lower priority triage assignments in Veterans Affairs (VA) emergency departments (EDs) compared to White patients, but it is currently unknown whether this disparity arises from generalized biases across the triage assessment process or from differences in how objective and/or subjective institution-level or person-level information is incorporated into the triage assessment process, thus contributing to disparate treatment.The VA database of electronic medical records of patients who presented to the VA ED from 2008 to 2012 was used to measure patient ethnicity, self-reported pain intensity (PI) levels, heart rate (HR), respiratory rate (RR), and nurse-provided triage assignment, the Emergency Severity Index (ESI) score. Multilevel, random effects linear modeling was used to control for demographic and clinical characteristics of patients as well as age, gender, and experience of triage nurses.A total of 359,642 patient/provider encounters between 129,991 VA patients and 774 nurses were included in the study. Patients were 61% non-Hispanic White [NHW], 28% African-American, 7% Hispanic, 2% Asian-American, <1% American Indian/Alaska Native, and 1% mixed ethnicity. After controlling for demographic characteristics of nurses and patients, African-American, Hispanic, and mixed-ethnicity patients reported higher average PI scores but lower HRs and RRs than NHW patients. NHW patients received higher priority ESI ratings with lower PI when compared against African-American patients. NHW patients with low to moderate HRs also received higher priority ESI scoring than African-American, Hispanic, Asian-American, and Mixed-ethnicity patients; however, when HR was high NHWs received lower priority ESI ratings than each of the minority groups (except for African-Americans).This study provides evidence for systemic differences in how patients’ vital signs are applied for determining ESI scores for different ethnic groups. Additional prospective research will be needed to determine how this specific person-level mechanism affects healthcare quality and outcomes.

Club Cell-16 and RelB as Novel Determinants of Arterial Stiffness in Exacerbating COPD Patients

Background Exacerbations of chronic obstructive pulmonary disease (COPD) are acute events of worsened respiratory symptoms that may increase the risk of cardiovascular disease (CVD), a leading cause of mortality amongst COPD patients. The utility of lung-specific inflammatory mediators such as club cell protein-16 (CC-16) and surfactant protein D (SPD) and that of a novel marker of CV outcomes in COPD- RelB- in predicting adverse cardiovascular events during exacerbation is not known. Methods Thirty-eight subjects with COPD admitted to the hospital for severe exacerbation were included in this analysis. Clinical, physiological and arterial stiffness measurements were performed within 72 hours of admission; this was followed by measurements taken every 3 days until hospital discharge, then once a week until 30 days after discharge, and then again at 90 and 180 days. Plasma concentrations of inflammatory mediators were measured from peripheral venous blood taken at admission, and at days 15, 30, 90 and 180. Results CC-16 and RelB concentrations were increased at day 15 of exacerbations whereas SPD concentrations were decreased. The course of change in CC-16 and RelB levels over time was inversely associated with that of carotid-femoral pulse wave velocity, the gold-standard measure of arterial stiffness. Increases in CC-16 could predict a decreased number of subsequent exacerbations during follow-up. Conclusions Lung-specific (CC-16) and novel (RelB) biomarkers are associated with systemic cardiovascular changes over time. CC-16 can predict subsequent exacerbations in subjects with severe COPD and may be an important biomarker of pulmonary and systemic stress in COPD.

Ignoring individual differences in times of assessment in growth curve modeling

Researchers often collect longitudinal data to model change over time in a phenomenon of interest. Inevitably, there will be some variation across individuals in specific time intervals between assessments. In this simulation study of growth curve modeling, we investigate how ignoring individual differences in time points when modeling change over time relates to convergence and admissibility of solutions, bias in estimates of parameters, efficiency, power to detect change over time, and Type I error rate. We manipulated magnitude of the individual differences in assessment times, distribution of assessment times, magnitude of change over time, number of time points, and sample size. In contrast to the correct analysis, ignoring individual differences in time points frequently led to inadmissible solutions, especially with few time points and small samples, regardless of the specific magnitude of individual differences that were ignored. Mean intercept and slope were generally estimated without bias. Ignoring individual differences in time points sometimes yielded overestimated intercept and slope variances and underestimated intercept–slope covariance and residual variance. Parameter efficiency as well as power and Type I error rates for the linear slope were unaffected by the type of analysis.

The Confounding Effect of Assessor Ethnicity on Subjective Pain Reporting in Women

The current study examines how subjective pain reporting is influenced by the concordant and discordant nature of the ethnic identities of pain expressers (participants) and pain assessors (experimenters). Three discomfort conditions that varied in stimuli intensity (Study 1: mild pain; Study 2: severe pain), and distraction components (Study 3) were used to assess whether pain intensity and tolerance reporting differ with the ethnic identification of the participant and the experimenter. Specifically, 87 Hispanic and 74 Non-Hispanic White (NHW) women (18–51 yrs., Mage = 20.0, SD = 4.3) underwent a cold pressor pain task (CPT) after engaging in minimal procedural interactions with one of the 22 research experimenters (47% Hispanic, 42% females). The procedural interactions with the experimenters included only consenting and instructions, with no interaction between experimenter and participant during the actual CPT. Random-effects models showed that between the 0% and 18% of the variance in pain sensitivity (intensity and tolerance scores) was attributable to characteristics of the experimenters. Controlling for self-esteem, baseline pain levels, and the gender of the experimenter, Hispanic subjects showed higher pain sensitivity (as marked by lower pain tolerance and higher pain intensity scores) following interactions with an NHW rather than a Hispanic experimenter in response to the most severe pain intensity stimuli. These results question the validity of common findings of ethnic differences in pain sensitivity from studies that have not accounted for the ethnic identity of the pain assessor (and the general communicative nature of pain reporting).

Neuronal deactivation is equally important for understanding emotional processing.

In their analyses of the neural correlates of discrete emotionality, Lindquist et al. do not consider the numerous drawbacks to inferring psychological processes based on currently available cognitive neurometric technology. The authors also disproportionately emphasize the relevance of neuronal activation over deactivation, which, in our opinion, limits the scope and utility of their conclusions.