Psychological Factors in Experience of Pain During Childbirth.

Pain during delivery is unique because it is accompanied by powerful emotions. Emotions that occur in women during labor and delivery are closely tied to upbringing and culture in which they were raised and consequently with the sensation of experienced pain. According to the Melzack-Wall Theory of Pain, general mood is directly related to the intensity and quality of pain and it is therefore justifiable to presuppose that certain psychosocial factors will be linked with the intensity and quality of pain experienced during childbirth. (Melzack et al., 1981). We endeavored to show the effect of psychosocial factors that influence the intensity and quality of labor pain. Data was collected in a sample of 176 parturient women who delivered without Cesarean sections or epidural anesthesia. The intensity and quality of pain were obtained through the administration of the McGill Pain Questionnaire-Short Form. Psychosocial factors included: number of births, presence of partner, self-evaluation of knowledge of physio-anatomical aspects of birth and the completion of a pregnancy course. Labor and delivery pain is of high intensity anl the quality of pain is most frequently characterized as smarting, cramping, exhausting, and sharp. The presence of a partner and the completion of a pregnancy course is exercised by a small number of parturients. Self-evaluation of preexisting knowledge of physio-anatomical aspects of delivery is predictive of the affective component of intensity of childbirth pain. Psychosocial factors have been shown as significant for the intensity and quality of experienced childbirth pain.

Acute stress disorder versus chronic posttraumatic stress disorder: inhibition of fear as a function of time since trauma.

BACKGROUND: Previous work has shown that inhibition of fear is impaired in posttraumatic stress disorder (PTSD) resulting from both civilian and combat trauma. The purpose of the present study was to investigate the inhibition of learned fear in traumatized individuals diagnosed with either acute stress disorder (ASD) or PTSD. This is the first study to use a conditioned inhibition paradigm with traumatized individuals within a month of trauma exposure. We hypothesized that impaired fear inhibition would be evident in PTSD, but not ASD. METHOD: Using established translational, psychophysiological methods including fear-potentiated startle, and skin conductance, we examined fear acquisition, stimulus discrimination, and the transfer of learned safety in a Croatian population with ASD or PTSD. This cross-sectional study included three age-matched groups: healthy nontrauma controls (n = 27), a group with chronic PTSD (10 or more years since trauma exposure, n = 24), and a group with ASD (30 days or less since trauma exposure, n = 27). RESULTS: The presence of trauma-related psychopathology, whether acute or chronic, was associated with an impaired ability to transfer learned safety based on fear-potentiated startle measures, while healthy control subjects showed significant fear inhibition in the presence of the safety cue compared to the danger cue, F(1,26) = 12.64, P = .001. CONCLUSIONS: These data expand our previously observed findings of PTSD-associated fear inhibition deficits by demonstrating that trauma-related impairments in safety learning are evident within 30 days of trauma exposure.

Quality of pain in herpes zoster patients.

Pain typically accompanies acute herpes zoster and persists well beyond rash healing. Different types of pain are reported by patients with herpes zoster. Current studies show that these types of pain vary with respect to their presence, location, duration, intensity and quality, hence pain needs to be analyzed more thoroughly. The aim of the study was to assess different components of pain in patients with herpes zoster. The study subjects were 46 patients diagnosed with herpes zoster and selected out of 493 patients treated at the Pain Therapy Clinic, the outpatient facility of Zagreb Clinic for Traumatology, in 2010. Measures used to assess pain and daily activities were the following: SF McGill Pain Questionnaire, Visual Analogue Scale, Self-Assessment of Life Satisfaction, Health Satisfaction and Enjoyment in Life. Analgesic treatment together with demographic and clinical characteristics of patients were also taken into account. The results have shown that the patients report about spontaneous pain mostly in terms of the following qualities of high level pain intensity: throbbing, aching, hot-burning and sharp. The results also demonstrate that herpes zoster pain significantly affects the patients' everyday living quality and their emotional health. Comprehensive assessment of pain is necessary for clinical research about the epidemiology, natural history, pathophysiologic mechanisms, treatment, and prevention of pain in herpes zoster.

Do IL-1B and IL-1RN modulate chronic low back pain in patients with post-traumatic stress disorder?

The aim of this study was to analyze the association between single nucleotide polymorphism (SNP) in IL1B (rs1143 634) and IL1RN (rs2234677) with chronic low back pain (LBP) in chronic post-traumatic stress disorder (PTSD). A total of 406 war veterans from 1991-1995 war in Croatia participated in this study. They were divided into four groups, according to psychiatric interview, psychometric testing and the presence of LBP, verified by the imaging of lumbar area, into: (i) war veterans suffering from PTSD and LBP (N = 102), (ii) war veterans suffering from PTSD only (N = 108), (iii) war veterans suffering from LBP only (N = 99) and (iv) healthy controls (N =97). Each subject provided a blood sample for IL1B and IL1RN polymorphism testing. We found no association of rs1143634 in IL1-B with LBP Permutation test showed significant association of rs1143634 in IL1-RN with LBP group and presence of wild type allele A was protective in LBP group. The same SNP (rs1143634) in IL1-B was associated with the intensity of pain. No other associations were observed between these two markers and self-reported measures evaluating PTSD and pain symptoms. These results suggest the potential role of cytokine network in the pathogenesis of chronic PTSD and LBP, although the direct causative pathway remains unclear. The alteration of cytokine network on the level of the brain, spinal medulla and the spine may be responsible for modulation of pain and the occurrence of LBP

Electrophysiological correlates activated during the Wisconsin Card Sorting Test (WCST).

In the present study we investigated changes in Event-Related Potentials (ERPs) during the Wisconsin Card Sorting Test (WCST) in order to identify cognitive processes underlying the set-shifting aspects of the task and to determine test sensitivity for frontal and prefrontal cortical areas. ERP's were recorded from a sample of 20 healthy adults while they performed a computerized version of the Grant & Berg (1948) version of the WCST, using 32-channel electroencephalogram recordings. The ERP waveforms were calculated for the set-shifting trials, or more precisely for the 2nd and the 3rd trials in the WCST series (set change condition) and compared to those associated with the last two trials in a series before the set change (set unchanged condition). The results indicated changes in central frontal and parietal electrodes during attentional set-shifting. More precisely, the P300 effect was replicated in this dataset, confirming the claim that the WCST measures function of prefrontal cortical areas of the brain. However, the obtained wave resembled P3b indicating the working memory component of the task. The results suggest that the frontal and parietal cortical activity is especially involved in set-shifting during WCST performance. Therefore, these electrophysiological results are not consistent with some recent studies that question the specificity of WCST as a measure of frontal and parietal lesions.

Predictors of short-term neurocognitive outcome following coronary revascularisation (CABG) depending on the use of cardiopulmonary bypass.

The purpose of our study was to investigate the association between perioperative cerebral microembolization, expressed as high-intensity transient signals (HITS) and postoperative dynamics of the neuromarker S100P in patients operated using cardiopulmonary bypass, and to assess their impact upon the neurocognitive function in the early postoperative stage. The study involved 62 consecutive male patients aged 60 or above, alls scheduled for elective aortocoronary bypass. The patients were recruited from two groups with respect to the use of CPB: on-pump group (CPB+, N = 30) and off-pump group (CPB-, N = 32). In all patients we performed intraoperative monitoring of cerebral haemodynamics using transcranial Doppler, with the goal of quantifying perioperative cerebral microembolization. The serum levels of the neuromarker S100l were measured immediately after surgery, and then 12, 24 and 48 hours after the surgery. Neurocognitive status was assessed before and after the surgery and in three cognitive domains. Results of the study have shown that with respect to the short-term postoperative neurocognitive outcome there is no significant difference between the on-pump and off-pump surgical technique of coronary revascularization'. Perioperative cerebral microembolization was significantly more pronounced in the on-pump group yet it did not affect early postoperative neurocognitive function, while the increase in the neuromarker S100beta serum level 48 hours after surgery may have prognostic value as a predictor of postoperative neurocognitive dysfunction.