Rena Gatzounis

Operant Learning Theory in Pain and Chronic Pain Rehabilitation

The application of operant learning theory on chronic pain by Fordyce has had a huge impact on chronic pain research and management. The operant model focuses on pain behaviors as a major component of the pain problem, and postulates that they are subject to environmental contingencies. The role of operant learning in pain behaviors generally has been supported by experimental studies, which are reviewed in the present article. Subsequently, the rationale, goals, and methods of operant behavioral treatment of chronic pain are outlined. Special attention is paid to three therapeutic techniques (graded activity, activity pacing, and time-contingent medication management), which are discussed in detail with regard to their operationalization, effectiveness, and (possible) mechanisms of action. Criticisms of the operant model are presented, as are suggestions for the optimization of (operant) behavioral treatment efficacy.

Interrupted by pain: An anatomy of pain-contingent activity interruptions

http://dx.doi.org/10.1016/j.pain.2014.03.017 0304-3959/ 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. ⇑ Corresponding author at: Research Group Health Psychology, University of Leuven, Tiensestraat 102, Box 3726, B-3000 Leuven, Belgium. Tel.: +32 16 3 73040; fax: +32 16 3 26144. E-mail address: Rena.Gatzounis@ppw.kuleuven.be (R. Gatzounis). Rena Gatzounis a,b,⇑, Martien G.S. Schrooten , Geert Crombez , Johan W.S. Vlaeyen a,b

Forgetting to remember?: Prospective memory within the context of pain

Pain interferes with cognitive functioning in several ways. Among other symptoms, pain patients often report difficulties with remembering future intentions. It remains unclear, however, whether it is the pain per se that impairs prospective remembering or other factors that often characterize people with pain (e.g. poor sleep quality). In this experiment, we investigated whether prospective memory is impaired within the context of pain, and whether this impairment is enhanced when the threat value of pain is increased.

Taking a break in response to pain. An experimental investigation of the effects of interruptions by pain on subsequent activity resumption

Abstract Background and aims Interrupting ongoing activities with the intention to resume them again later is a natural response to pain. However, such interruptions might have negative consequences for the subsequent resumption and performance of the interrupted activity. Activity interruptions by pain may be more impairing than interruptions by non-painful stimuli, and also be subjectively experienced as such. These effects might be more pronounced in people high in pain catastrophizing. These hypotheses were investigated in two experiments. Methods In Experiment 1, healthy volunteers (n = 24) performed an ongoing task requiring a sequence of joystick movements. Occasionally, they received either a painful electrocutaneous or a non-painful vibrotactile stimulus, followed by suspension of the ongoing task and temporary engagement in a different task (interruption task). After performing the interruption task for 30 s, participants resumed the ongoing task. As the ongoing task of Experiment 1 was rather simple, Experiment 2 (n = 30) included a modified, somewhat more complex version of the task, in order to examine the effects of activity interruptions by pain. Results Participants made more errors and were slower to initiate movements (Experiment 1 & 2) and to complete movements (Experiment 2) when they resumed the ongoing task after an interruption, indicating that interruptions impaired subsequent performance. However, these impairments were not larger when the interruption was prompted by painful than by non-painful stimulation. Pain catastrophizing did not influence the results. Conclusions Results indicate that activity interruptions by pain have negative consequences for the performance of an activity upon its resumption, but not more so than interruptions by non-painful stimuli. Potential explanations and avenues for future research are discussed. Implications Interrupting ongoing activities is a common response to pain. In two experiments using a novel paradigm we showed that activity interruptions by pain impair subsequent activity resumption and performance. However, this effect seems to not be specific to pain.

Fear of pain changes movement: Motor behaviour following the acquisition of pain-related fear

According to current fear‐avoidance models, changes in motor behaviour (e.g. avoidance) are a key component in the development and maintenance of chronic pain complaints. Yet, experimental research assessing actual behavioural changes following painful events is relatively sparse. This study investigated the effects of pain anticipation on changes in motor behaviour using a fear conditioning paradigm and robot‐generated standardized movement trajectories of the upper extremities.

Effects of activity interruptions by pain on pattern of activity performance - an experimental investigation

Abstract Background and aims: Suspending an ongoing activity with the intention to resume it again later is a natural response to pain. This response facilitates coping with the pain, but it may also have negative consequences for the resumption and performance of the activity. For example, people with pain problems are often forced to take a break from doing their household chores because of their pain. They might delay resuming their chore, eventually needing longer time to finish it. We investigated how activity interruptions by pain influence the pattern of subsequent activity performance. We expected that when an activity is interrupted by pain (compared to non-pain), people spend longer time away from the activity, need longer time to complete it, and are less motivated to perform it. Methods: Sixty healthy volunteers performed an ongoing task that required them to make joystick movements in different directions according to a specific rule. Occasionally, participants received either a painful electrocutaneous stimulus or a non-painful and non-aversive auditory stimulus (between-subjects) as an interruption cue. The interruption cue was followed by the temporary suspension of the ongoing task and the initiation of a different activity (interruption task). The latter required the categorization of cards and had a maximum duration, but participants could also stop it earlier by pressing a button. We measured time away from the (interrupted) ongoing task, total time to complete the ongoing task (including the interruptions) and self-reported motivation to perform both the ongoing as well as the interruption task. Results: Groups did not differ in the time away from the ongoing task, total time to complete the ongoing task, or self-reported motivation to perform the two tasks. Conclusions: Activity interruptions by pain did not impair the pattern of activity performance more than activity interruptions by non-pain. Potential explanations and suggestions for future research are discussed. Implications: Interrupting ongoing activities is a common response to pain. However, activity interruptions by pain do not appear to influence the pattern of activity performance in a different way than activity interruptions by pain-irrelevant external stimuli.

Behavioural inhibition in the context of pain: Measurement and conceptual issues

In this issue of the Scandinavian Journal of Pain, Mark Jensen nd colleagues [1] publish a study testing two specific predictions ut forward by the Behavioural Inhibition/Behavioural Activation BIS/BAS) two-factor model of chronic pain [2]. First, the authors ypothesized that trait behavioural inhibition, namely the tenency to respond to signals of threat with behavioural withdrawal nd negative emotions [1], would have a direct negative effect n the psychological and physical functioning of people with hronic pain. Second, the authors also hypothesized the existence f an indirect (moderating) effect of trait behavioural inhibition n the relationship between pain-related cognitions and functionng. Cross-sectional self-report data from 88 chronic pain patients howed partial support for these hypotheses. Trait behavioural nhibition was found to have the expected direct negative effect n depression, but not on physical functioning. The expected modrating effect was only shown for the relationship between fear of ovement/re(injury) and depression. This study offers partial suport to a newly proposed theory, thus encouraging research in this rea.

Activity interruptions by pain impair activity resumption, but not more than activity interruptions by other stimuli: An experimental investigation

Abstract Interrupting ongoing activities whilst intending to resume them later is a natural response to pain. Whereas this response facilitates pain management, at the same time it may also disrupt task performance. Previous research has shown that activity interruptions by pain impair subsequent resumption of the activity, but not more than pain-irrelevant interruptions. Ongoing task complexity and pain threat value might influence interruption effects. In this experiment, we adjusted a paradigm from outside the field of pain to investigate how activity interruptions by pain affect task performance. Healthy participants (n = 69) were required to answer a series of questions, in a specific sequence, about presented letter-digit combinations. This ongoing task was occasionally interrupted by painful electrocutaneous or nonpainful vibrotactile stimulation (between-subjects), followed by a typing task. On interruption completion, participants were required to resume the ongoing task at the next step of the question sequence. Results indicate impaired sequence accuracy (less frequent resumption at the correct step of the sequence) but preserved nonsequence accuracy (similarly frequent correct responses to question content) immediately after an interruption. Effects were not larger for interruptions by pain compared with nonpain. Furthermore, participants in the 2 conditions reported similar task experience, namely task motivation, perceived difficulty, and confidence to resume the interrupted task. Pain catastrophizing did not influence the results. As in previous studies, activity interruptions by pain were shown to impair the resumption of a task that requires keeping to a step sequence, but not more than interruptions by nonpainful stimuli. Potential explanations are discussed.

Psychological therapies help reduce headache and non-headache pain in children and adolescents

Commentary on : Eccleston C, Palermo TM, Williams AC, et al. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev 2014;5:CD003968.[OpenUrl][1][PubMed][2] Chronic and recurrent pain, especially in the head, abdomen and limbs affects up to 30% of children and adolescents.1 Pain can be severely disabling, disrupting school and social activities and if left untreated, may extend towards adulthood. Increasing evidence shows that psychological factors are pivotal in the transition from acute to chronic disabling pain. As a result, psychological interventions have been developed to modify the emotional, cognitive and behavioural processes that are considered to maintain pain, disability and distress. Psychological interventions initially designed for adults have been modified and applied to paediatric patients. These include behavioural (eg, relaxation training, biofeedback, operant management) and cognitive treatments (eg, cognitive coping skills training, guided imagery, stress management), or combinations of these. Although previous reviews have documented the effectiveness of psychological treatment for chronic pain in youth, … [1]: {openurl}?query=rft.jtitle%253DCochrane%2BDatabase%2BSyst%2BRev%26rft.volume%253D5%26rft.spage%253DCD003968%26rft_id%253Dinfo%253Apmid%252F24796681%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=24796681&link_type=MED&atom=%2Febmed%2F19%2F6%2F221.atom