Age as a moderator in the interplay among locus of control, coping, and quality of life of people with chronic pain.

OBJECTIVE: Identifying the factors that determine the quality of life of patients with chronic pain is an integral part of developing interventions to reduce the negative impact of persistent pain. Locus of control (LoC) could play an important role in adaptation to prolonged pain, but the results of studies are inconsistent. We examined the link between pain LoC and quality of life. Moreover, we investigated whether the relationship between LoC and quality of life is mediated by passive and active coping, and whether age moderates the LoC-coping relationship. METHODS: The study was cross-sectional, and variables (internal, chance and powerful-others LoC, pain coping strategies, average pain intensity, and quality of life) were assessed via questionnaires in a sample of 594 individuals (67% females) with chronic pain who were 18-72 (mean: 36) years of age. RESULTS: Mediation and moderated mediation analyses were conducted. Internal and external LoC were associated, respectively, with better and with worse quality of life. Passive coping mediated the association between the powerful-others dimension of LoC and poor quality of life. Additionally, indirect effects of internal LoC on quality of life via passive and active coping were found. The relationship between the powerful-others dimension of LoC and coping was stronger for middle-aged and older individuals than for younger individuals. CONCLUSIONS: This study contributes to a better understanding of the mechanisms linking LoC with quality of life of patients with chronic pain. Depending on the age, control beliefs might translate differently into strategies used to cope with pain, and thus into quality of life.

Can observational learning reinforce open-label placebo hypoalgesia?

ABSTRACT: Previous research has indicated that an open-label placebo can reduce pain in both healthy participants and patients with chronic pain. Because nondeceptive placebos seem to be an effective and more ethical alternative to deceptive placebos, optimizing this kind of treatment is essential. Observational learning was previously shown to induce the deceptive placebo effect; therefore, this study aimed to verify its effectiveness in fortifying the open-label placebo effect. Healthy volunteers (N = 117) were randomly assigned to 4 groups: open-label placebo with observational learning (OLP + OBL), open-label placebo (OLP), deceptive placebo with observational learning (OBL), or control group. Participants underwent baseline and testing measurements, during which they self-reported pain induced by heat stimulation. Between assessments, placebo cream was openly administered in the OLP and OLP + OBL groups. The OLP + OBL group next watched a model experiencing hypoalgesia after cream application. In the OBL group, participants received placebo cream with no information about its effect, and then they watched the model. The placebo effect was successfully evoked in all experimental groups (OLP + OBL, OLP, and OBL), which confirms the effectiveness of both open-label and deceptive placebo interventions for pain reduction. However, the hypoalgesic effect was of similar magnitude in the OLP and OLP + OBL groups, which indicates that observation did not contribute to the effect. The results showed that reinforcing the open-label placebo by observational learning may be redundant, but more research is needed to confirm these findings.

Treatment of last resort? Psychological therapy seeking in chronic pain patients.

OBJECTIVE: Our goal was to assess how many chronic pain patients seek psychological treatment for their condition and what psychological and demographic characteristics are associated with that decision. METHODS: The association between pain intensity, quality of life and psychological treatment seeking was tested in two hypothetical models which differed according to beliefs about either external or internal control over pain. RESULTS: A minority of patients had experience with psychological treatment of chronic pain. Patients who had that experience were younger, suffered from more intense pain, and applied many more coping strategies than patients who never tried this kind of treatment. Intense pain and low quality of life motivated chronic pain patients to seek psychological treatment only if they believed that doctors could control their pain. DISCUSSION: The study results stress the importance of diversifying the methods used to treat chronic pain and educating patients about the benefits of psychological treatment. Low numbers of chronic pain patients who take advantage of psychological treatment indicate that encouragement from medical professionals might be necessary.

From past pain to future pain through the pain of others: Information about other people's pain ratings can alleviate our subsequent pain.

BACKGROUND: Previous studies have shown that pain memories have a profound impact on subsequent pain experiences. This study investigated whether pain ratings derived from other people can modify an individual's memory of past pain. This study also examined whether pain memory modified by others' pain ratings determines subsequent pain experiences. METHODS: Participants were divided into two groups: an experimental group and a control group. Participants in both groups were exposed to pain stimulation; then, they recalled its intensity twice over a period of time; after a break, they were again exposed to pain stimulation of the same intensity. The final sample consisted of 53 participants. The only difference between the experimental group and the control group was that in the former the pain ratings of other alleged participants were presented between the two consecutive pain recalls. These ratings suggested that other people experienced the same pain as less intense. RESULTS: The pain ratings derived from other people did not alter the pain memory; nevertheless, they affected an individual's next pain experience even for a certain period of time after their presentation. This type of pain-related information shaped participants' subsequent pain experiences regardless of their empathy, conformity, and susceptibility to social influence. CONCLUSIONS: Information on pain derived from other people not only shapes the response to a novel stimulation but also substantially modifies the subsequent experience of that stimulation. SIGNIFICANCE: The study demonstrates the importance of social information on pain and provides evidence that this type of information substantially modifies the subsequent experience of the same pain. These results suggest that social information on pain can be used to alleviate pain associated with recurring medical procedures and thus increase patients' willingness to continue treatment.

Red induces hyperalgesia and white induces hypoalgesia regardless of pain modality.

Colors are an important factor that influences different aspects of people's lives. However, little is known about the effects of colors on pain. This preregistered study aimed to investigate whether the type of pain affects the impact of colors on pain intensity. 74 participants were randomly divided into 2 groups according to the type of pain: electrical or thermal. In both groups, pain stimuli of the same intensity were preceded by different colors. Participants rated the pain intensity induced by each pain stimulus. Additionally, pain expectations related to each color were rated at the beginning and the end of the procedure. A significant effect of color on pain intensity ratings was found. Pain was most intense in both groups after red, whereas the lowest ratings were given after white. A similar pattern of results was observed for pain expectations. Expectations also correlated with and were found to be a predictor of experienced pain for white, blue, and green. The study shows that white can reduce, while red can alter the experienced pain. Moreover, it shows that the effect of colors is affected to a greater extent by the pain expectations rather than the pain modality. We conclude that the way colors influence pain broadens the current knowledge on effects of colors on human behavior and could help in the future both patients and practitioners.

When one suffers less, all suffer less: Individual pain ratings are more effective than group ratings in producing placebo hypoalgesia.

BACKGROUND: Placebo hypoalgesia can be induced by observing a person (model) whose pain relief is the result of the use of an inert substance or procedure. This study examined whether verbal modelling, that is, showing pain ratings provided by other people, is sufficient to induce placebo hypoalgesia. METHODS: Participants from the experimental groups were acquainted with pain ratings (presented on VASs) derived from a single person (groups 1 and 3) or a group of people (groups 2 and 4) that were allegedly subjected to the same painful procedure. The ratings of pain stimuli that were allegedly applied with placebo were lower than the ratings of stimuli applied without placebo. In two of the experimental groups (group 3 and 4), participants also watched a video recording showing individuals who allegedly provided pain ratings; however, they did not observe them undergoing pain stimulation. The control group did not undergo any manipulation. Then, the participants received a series of the same thermal pain stimuli that were applied either with or without placebo and rated their intensity. RESULTS: Placebo hypoalgesia was induced only in participants presented with pain ratings provided by a single person, regardless of whether this person was previously seen. However, the pain ratings presented to the participants generally decreased individual pain sensations, regardless of whether they came from a group of people or a single person. CONCLUSIONS: Verbal modelling can produce placebo hypoalgesia and reduce pain sensations. It may be effectively used in clinical practice to modify patients' responses to pain treatment. SIGNIFICANCE: This study shows that knowledge about pain ratings provided by another person is sufficient to induce placebo hypoalgesia; thus, neither direct nor indirect observation of a person experiencing pain is necessary to induce this effect. Pain ratings derived from a group of people can decrease pain sensations but they do not produce placebo hypoalgesia.

Development and cross-national investigation of a model explaining participation in WHO-recommended and placebo behaviours to prevent COVID-19 infection.

To protect themselves from COVID-19, people follow the recommendations of the authorities, but they also resort to placebos. To stop the virus, it is important to understand the factors underlying both types of preventive behaviour. This study examined whether our model (developed based on the Health Belief Model and the Transactional Model of Stress) can explain participation in WHO-recommended and placebo actions during the pandemic. Model was tested on a sample of 3346 participants from Italy, Japan, Poland, Korea, Sweden, and the US. It was broadly supported: objective risk and cues to action showed both direct and indirect (through perceived threat) associations with preventive behaviours. Moreover, locus of control, decision balance, health anxiety and preventive coping moderated these relationships. Numerous differences were also found between countries. We conclude that beliefs about control over health and perceived benefits of actions are critical to the development of interventions to improve adherence to recommendations.

The Role of the Observers' Perception of a Model's Self-Confidence in Observationally Induced Placebo Analgesia.

The aim of this study was to investigate the effect of a model's self-confidence as well as the observer's self-esteem and self-efficacy on observationally acquired placebo analgesia. In addition, we aimed to verify the stability of the placebo effect induced by observational learning. Participants (n = 60) were randomly assigned to one of three groups: a self-confident model, an unself-confident model, and a control group. In the experimental groups, participants watched a videotaped model who rated the intensity of electrocutaneous pain stimuli applied in the placebo condition as lower than those applied in the non-placebo condition. The different levels of self-confidence in these groups were manifested in the body posture and facial expressions of the model as well as in specific behavior that accompanied the assessment of pain. Then, 16 electrocutaneous pain stimuli of the same intensity, preceded by the placebo or non-placebo, were applied to participants. In both experimental groups, in contrast to the control group, participants experienced less pain in the placebo than in the non-placebo condition. Although the magnitude of placebo analgesia did not differ between the experimental groups, multiple regression analysis revealed that the perceived self-confidence of the model, but not the self-efficacy or self-esteem of the observer, was a significant predictor of the placebo effect. Moreover, placebo analgesia induced by observational learning did not extinguish over the course of the experiment. These results support the premise that the observers' perception of a model's self-confidence plays a significant role in placebo effects. PERSPECTIVE: The results of this study open the discussion on the role of model's features in the effectiveness of observational learning in the induction of placebo effects. The study provides the very first suggestion that the perceived self-confidence of the model may be related to the magnitude of the observationally induced placebo analgesia. It suggests that self-confidence of other patients and medical staff might affect individual pain experiences.