Lipoic acid improves nerve blood flow, reduces oxidative stress, and improves distal nerve conduction in experimental diabetic neuropathy.

OBJECTIVE: To determine whether lipoic acid (LA) will reduce oxidative stress in diabetic peripheral nerves and improve neuropathy. RESEARCH DESIGN AND METHODS: We used the model of streptozotocin-induced diabetic neuropathy (SDN) and evaluated the efficacy of LA supplementation in improving nerve blood flow (NBF), electrophysiology, and indexes of oxidative stress in peripheral nerves affected by SDN, at 1 month after onset of diabetes and in age-matched control rats. LA, in doses of 20, 50, and 100 mg/kg, was administered intraperitoneally five times per week after onset of diabetes. RESULTS: NBF in SDN was reduced by 50%; LA did not affect the NBF of normal nerves but improved that of SDN in a dose-dependent manner. After 1 month of treatment, LA-supplemented rats (100 mg/kg) exhibited normal NBF. The most sensitive and reliable indicator of oxidative stress was reduction in reduced glutathione, which was significantly reduced in streptozotocin-induced diabetic and alpha-tocopherol-deficient nerves; it was improved in a dose-dependent manner in LA-supplemented rats. The conduction velocity of the digital nerve was reduced in SDN and was significantly improved by LA. CONCLUSIONS: These studies suggest that LA improves SDN, in significant part by reducing the effects of oxidative stress. The drug may have potential in the treatment of human diabetic neuropathy.

Localization and expression of ciliary neurotrophic factor (CNTF) in postmortem sciatic nerve from patients with motor neuron disease and diabetic neuropathy.

Ciliary neurotrophic factor (CNTF) is thought to play an important role in the maintenance of the mature motor system. The factor is found most abundantly in myelinating Schwann cells in the adult sciatic nerve. Lack of neuronal growth factors has been proposed as one possible etiology of amyotrophic lateral sclerosis (ALS) and spinal muscular atrophy (SMA). Growth factor replacement therapies are currently being evaluated as a treatment for motor neuron disease. In this report we determined whether the expression of CNTF in sciatic nerve differed in patients with motor neuron disease compared to controls or patients with another form of axonopathy. We identified 8 patients (7 with ALS and 1 with SMA) with motor neuron disease and 6 patients with diabetic motor neuropathy who had autopsy material available. Immunoperoxidase staining showed reduced CNTF expression in nerves of patients with motor neuron disease but not in patients with diabetic motor neuropathy. Decreased CNTF appears be associated with primary motor neuron disease rather than a generalized process of axon loss. This result supports suggestions that CNTF deficiency may be an important factor in the development of motor neuron disease.

Pain perception and coping in female tension headache sufferers and headache-free controls.

The purpose of this study was to investigate how headache sufferers and headache-free controls differ in their responses to acute pain. Thirty-three women completed the study (15 headache sufferers and 18 controls). The cold pressor was used to induce pain, and a partially inflated blood pressure cuff was used as a nonpainful comparison task. Headache sufferers reported more discomfort during both tasks; however, the 2 groups did not differ in the number of facial expressions of pain displayed during the tasks. Headache sufferers reported a tendency to catastrophize during both tasks; positive coping did not differ between the 2 groups. These results offer evidence that recurrent tension headache sufferers are more sensitive to both painful and nonpainful stimuli and that they cope differently from controls with these physical stressors.

Effects of 24-hour ambulatory blood pressure monitoring on daily activities.

Compared the self-monitored activities, locations, and postural positions of 28 hypertensives while they wore an alarm watch and then while they wore a 24-hr ambulatory blood pressure monitor (ABPM) to see if wearing the ABPM led to alterations in behavior. Within the limitations of the study (no counterbalancing of order and twice as many ABPM measures as watch measures), we found significant differences in frequency of being at home or in miscellaneous settings, in standing and reclining positions, and in mental, physical and miscellaneous activities between the two occasions.

The USA-USSR collaborative cross-cultural comparison of autogenic training and thermal biofeedback in the treatment of mild hypertension.

We have conducted a cross-cultural (USA and USSR) comparison of thermal biofeedback (TBF) and autogenic training (AT) to a self-relaxation control condition in 59 unmedicated males with mild hypertension. Identical assessment and treatment protocols were carried out in both settings (Albany, New York, and Moscow). Treatments were delivered in small groups on an outpatient basis twice per week for 10 weeks. Results showed comparable, significant (p less than .05), short-term decreases (M = 8.5 mm Hg) in diastolic blood pressure (DBP) for both treatments at both sites. However, the Soviet patients, starting with significantly (p less than .01) higher systolic blood pressures (SBPs), showed significant decreases (M = 12.8 mm Hg) in SBP, whereas the American patients did not change appreciably (M = 4.6 mm Hg). During follow-up, the treated Soviet patients showed significantly (p less than .05) better maintenance of treatment effects, from 3 months to 1 year, than did the American patients. At 1 year, 75% of the treated Soviet patients had DBPs less than 90 mm Hg, whereas only 24% of the American patients had comparable DBPs.

Differences in daily stress, mood, coping, and eating behavior in binge eating and nonbinge eating college women.

This study investigated differences between binge eaters and controls on measures of daily stress, mood, coping, and eating behavior. The same measures were also used to compare binge days to nonbinge days for the binge group. Participants included 20 college women who reported binge eating at least two times per week and 20 women who reported no disturbance in their eating behavior. They were asked to self-monitor their daily stress, coping, mood, and eating behavior for three weeks. Results indicated that the binge group reported more stress and negative mood over the three weeks than the control group. The binge group reported experiencing a similar number of stressful events on binge days as compared to nonbinge days, however, the impact of those events was much greater on binge days. The binge eaters also reported less positive mood and more episodes of eating on binge days. The groups did not differ in the number of coping strategies used. Stress and negative mood appear to be common antecedents for binge eating. The role of coping responses and daily eating behavior (i.e., restraint) on binge eating is somewhat less clear.

Thermal biofeedback treatment of mild hypertension. A comparison of effects on conventional and ambulatory blood pressure measures.

Several studies have produced results suggesting that thermal biofeedback treatment is effective in lowering the blood pressure (BP) of individuals with both mild and moderate essential hypertension. This study used thermal biofeedback to treat 9 unmedicated individuals with mild hypertension. Subjects underwent 24-hour ambulatory BP monitoring both prior to and following the thermal biofeedback treatment regimen. Four of the subjects were considered treatment successes using standard office blood pressure assessments as the success-fail criteria. However, 24-hour ambulatory BP measures showed a markedly different pattern of results, with several subjects who were considered successes under conventional assessment techniques showing an increase in 24-hour ambulatory BP from pre- to posttreatment. There was a significant decrease in diastolic blood pressure for all subjects as measured by the ambulatory method. There was also a significant decrease in systolic and diastolic standing home blood pressure. The implications of these results are discussed.

The comparison of individuals with tension-type headache and headache-free controls on frontal EMG levels: a meta-analysis.

For many years, the dominant theory of tension-type headache has been that individuals who suffer from these headaches have elevations in electromyographic (EMG) activity at rest or during stressful life experiences. This theory has come under increasing attack in recent years. Although the research that is relevant to the controversy has been reviewed previously using box score and voting methods, no one has analyzed the relevant data using a statistical approach. This study used meta-analysis to summarize the studies that have directly compared individuals with tension-type headache to headache-free control subjects on measures of frontal EMG at baseline and during rest. Twenty-three studies were included in the analysis. The overall effect size was .395; however, there was heterogeneity of effect size. Several potential moderator variables were investigated. Perhaps the most interesting moderator variable was whether the studies clearly stated that subjects were headache-free during assessment. This group of studies produced a nonsignificant effect size that had homogeneity of effects. Several interpretations of the results are presented.

Subjective stress and coping in recurrent tension-type headache.

Subjects with tension-type headache and headache-free control subjects completed two mental stressor tasks, solving anagrams and mental arithmetic. During the experimental session, measures of heart rate, muscle tension, and subjective stress ratings were recorded. In addition, all subjects completed a week-long series of questionnaires which monitored headache activity in addition to frequency and intensity of stressful life events. Recurrent tension headache sufferers were found to have higher levels of depression and trait anxiety. Headache and control subjects were not found to respond differently to stressors presented in the laboratory based on measures of EMG, heart rate, or subjective stress ratings, nor were there differences in reports of coping. However, diary questionnaires revealed that headache subjects experienced stressful events more frequently than headache-free controls. Headache subjects also rated these events as causing more stress.

Appraisal and coping strategies in stressful situations: a comparison of individuals who binge eat and controls.

OBJECTIVE: The objective of this study was to investigate whether individuals who engage in binge eating appraise and cope with stressful situations in a different manner than people who do not regularly binge eat. METHOD: Female undergraduates participated in a two-part study. The laboratory portion of the study involved participation in two tasks: an interpersonal stressor and an academic stressor. In the second portion of the study, participants completed a daily stress inventory for 1 week. RESULTS: Individuals in the binge group appraised both the laboratory and natural environment stressors as more stressful than did the controls. Differences were evident in the amount and type of coping strategies used between eating groups. The binge group reported using more positive coping strategies and more catastrophizing in both settings. DISCUSSION: Together, the results suggest that appraisal and coping or stress management components may be useful in treatment packages for individuals who binge eat.

The comparison of individuals with recurrent tension-type headache and headache-free controls in physiological response, appraisal, and coping with stressors: a review of the literature.

It is widely accepted that stress plays an important role in the experience of tension-type headache. This article reviews the literature in which individuals with recurrent tension-type headache are compared to headache-free controls in the experience and appraisal of stress, psychophysiological response to stress, and coping with stress. A modified and extended version of the transactional model of stress as it might apply to tension-type headache is used to organize the relevant literature. In summary, there is evidence to suggest that individuals with recurrent tension-type headache experience more stressful events and are more sensitive and have a lower threshold to pain. There are some suggestions that headache sufferers may use different coping strategies for stress and pain. There is little evidence of differences in physiological responses to stressful events. The shortcomings of this body of literature are addressed and directions for future research are identified.

Tension-type headache and stressful events: the role of selective memory in the reporting of stressors.

This study examined evidence for the role of selective memory for stressful events in women with headache. Previous studies have reported that on retrospective measures of stress, those with tension-type headache report more stressful events and rate the events as more stressful than did headache-free controls. However, when ratings are made concurrently, participants with headache and controls did not differ in their ratings of equivalent stressors presented in the laboratory. One theory for why differences are found in stress ratings made retrospectively, but not concurrently, is that selective memory biases recollection of past events in patients with headache. This study compared self-report ratings of stressful events and their perceived impact made either concurrently or retrospectively to determine if selective memory might explain the discrepancies found in earlier studies. Participants included 20 patients with tension-type headache and 22 headache-free controls. Participants were compared on hourly, daily, and weekly measures of stressors and their perceived impact via hourly and nightly visual analog scale ratings, the Daily Stress Inventory, and the Weekly Stress Inventory. If support was to be offered to the hypothesis that selective memory biases the retrospective memory of patients with headache, then an interaction between group assignment (ie, headache versus control group) and time of rating would be expected. No such interaction occurred. Results from the study suggest that all participants have a tendency to overestimate stress on retrospective measures, but that patients with headache do not do so at a significantly different rate than do headache-free controls. The alternative hypothesis that patients with headache tend to appraise everyday events as more stressful is supported.

Headache-free controls? Evidence of headaches in individuals who deny having headaches during diagnostic screening.

In the course of two studies investigating whether individuals with recurrent tension headache differ from headache-free controls in the frequency and appraisal of stressful life events, subjects were asked to complete a headache diary for 1 week. Subjects in the headache-free control group were screened twice and reported having infrequent headaches (two or less per month). However, 13 of 38 control subjects reported multiple headache days on their headache diaries. These subjects also reported a greater frequency of stressful events and a greater stress impact score. These results suggest that a careful screening of control subjects may be necessary in studies that examine differences between subjects with recurrent headache and headache-free controls. There is also some evidence that the inclusion of these subjects in a control group may bias the sample, making it less likely to find between-group differences.

Appraisal of subjective stress in individuals with tension-type headache: the influence of baseline measures.

These studies investigated appraisal and coping strategies of tension-type headache sufferers and headache-free controls. In study 1, 60 women engaged in an interpersonal stressor. They completed measures that assessed subjective stress and coping strategies. Headache sufferers reported greater levels of stress at baseline than did controls but were not more reactive to a stressful interpersonal situation. All participants reported greater use of disengagement coping during the interpersonal interaction, while the amount of engagement coping strategies did not differ. Participants (30 women) in Study 2 engaged in progressive muscle relaxation. Headache participants again reported higher levels of subjective stress at baseline, this difference was nearly gone following relaxation. Together, the results suggest that individuals with tension-type headache report higher levels of subjective stress than headache-free controls when they make baseline ratings of stress and that this elevation cannot be attributed to the anticipation of a future stressful event.

Predictors of depression among male cancer patients.

The diagnosis of cancer is often associated with a host of negative emotional responses, including depressed mood. Social support and quality of life were used to predict depression in a sample of older male cancer patients. Depression was found to be a common, but not universal, reaction to the diagnosis and treatment of cancer. Almost 40% of subjects reported symptoms of moderate depression and nearly one fifth produced scores indicative of clinical depression. A stepwise multiple regression analysis revealed that our social support and quality of life measures accounted for 31.5% of the variance in total Beck Depression Inventory scores. Quality of life accounted for more of the variance in depression than did social support.

Hand temperature norms for headache, hypertension, and irritable bowel syndrome.

Hand temperature norms are presented for 221 headache patients (migraine, mixed, and tension), 105 hypertensives, 45 irritable bowel syndrome patients, and 56 normal controls under conditions of resting baseline, self-relaxation, volitional handwarming, mental arithmetic, and cold pressor. The two vascular headache groups (migraine and mixed) had significantly lower hand temperatures across conditions.

Subjective experiences associated with thermal biofeedback treatment of hypertension.

Reports of subjective experiences of 73 hypertensive patients who were treated with thermal biofeedback for hand warming were obtained over 16 treatment sessions. Most of the differential responding in subjective report occurred in the first 5 sessions. Differences in reports of throbbing were associated with medication status during treatment (presence of sympatholytic antihypertensive agent). From 4 to 9% of patients report negative subjective experiences at any one session. When short-term clinical successes (either elimination of medication or reduction of BP) were compared with short-term failures, it was found that successes reported more warmth, more likelihood of falling asleep, and more dreamlike experiences. The latter were more likely to occur suddenly for the successes. Correlational analyses revealed consistent positive associations between reports of warmth and relaxation with highest temperature achieved in the session and consistent negative associations between experiencing physical sensations and degree of temperature change within the session.

The relationship of expectancies to outcome in stress management treatment of essential hypertension: results from the Joint USSR-USA Behavioral Hypertension Project.

Outcome expectancy and efficacy expectancy measures were made during the course of a cross-cultural comparison of thermal biofeedback and autogenic training as treatments for mild essential hypertension. There were no differences between groups at either pre- or posttreatment, and expectancy measures were not related to initial success or failure at the completion of treatment. However, both outcome and efficacy expectations were related to relapse over the three months immediately following the completion of treatment. Treatment failures had lower ratings for both outcome and efficacy expectations at the posttreatment assessment in comparison to treatment successes. Implications of these results are discussed.

A preliminary investigation of prediction of mean arterial pressure after self-regulatory treatments.

This study investigated the ability of pretreatment variables from three different domains (social-demographic, psychological, and psychophysiological) to predict posttreatment mean arterial pressure (MAP) for 59 unmedicated males with mild hypertension who were participating in a cross-cultural (USA-USSR) comparison of autogenic training and thermal biofeedback to a self-relaxation control. The overall multiple regression equation consisted of two variables and indicated that higher diastolic blood pressures during a cold pressor task were predictive of greater MAP reductions while higher scores on the Irritability subscale of the Buss-Durkee Hostility Scale were predictive of less MAP reductions. Suggestions for future research in this area are provided.