Central nervous activity during an emotional Stroop task in fibromyalgia syndrome.

Fibromyalgia syndrome (FMS) is a chronic condition of widespread pain accompanied by symptoms like depression, fatigue and cognitive impairments. In addition to central nervous pain sensitization, emotional dysregulation may be involved in FMS pathogenesis. This study investigated emotional influences on cognitive processing in FMS. Event-related potentials and theta oscillations were recorded during an emotional Stroop task including positive, negative, and neutral adjectives in 36 FMS patients and 35 controls. Patients had larger P3 amplitudes and greater theta power than controls, independent of the emotional word content. In patients, but not controls, negative words were associated with a larger late positive component (LPC) amplitude than positive words. No group difference was seen for P1, early posterior negativity or N4. Reaction times (RTs) were longer in patients than controls, independent of emotional word content. The P3 and theta oscillation findings suggest greater cognitive effort and attentional mobilization in FMS, which is needed to overcome the reduction of attentional resources resulting from central nervous pain sensitization. Although RTs do not support attentional bias in FMS, emotional modulation of the LPC amplitude may reflect preferential central nervous processing of negative information, which could contribute to pain and affective symptoms characterizing FMS. ACCESS TO RESEARCH DATA: The research data of the study are available to the public via the Open Science Framework repository (OSF: https://osf.io/tsyre/).

Central nervous activity during implicit processing of emotional face expressions in fibromyalgia syndrome.

OBJECTIVE: Fibromyalgia syndrome (FMS) is characterized by chronic widespread pain accompanied by symptoms like fatigue, insomnia, depression, anxiety and cognitive impairments. In addition to central nervous pain sensitization, emotional dysregulation may be involved in FMS pathogenesis. This study investigated central nervous correlates of affective and attentional processing in FMS using an implicit task. METHODS: Event-related potentials (ERPs) of the EEG were recorded in 25 FMS patients and 37 healthy controls while they had to name the frame color of pictures displaying emotional expressions (angry, painful, happy, neutral). The actual picture had to be ingored. Symptoms of pain, depression and anxiety were also assessed. RESULTS: Patients exhibited smaller P2 and late positive potential (LPP) amplitudes, and a greater N250 amplitude, than controls. The N250 amplitude varied according to the emotional expressions displayed in patients, but not in controls. No group differences arose for the P1 or N170 amplitudes. Patients had longer reaction times and made more errors on the task; task performance was more closely related to pain severity than to other symptoms. CONCLUSION: The reduced P2 and LPP amplitudes indicate deficient short-term mobilization of attentional resources and sustained attention in FMS; the greater N250 amplitude may reflect greater engagement in the decoding of complex facial features, which is necessary to compensate for attentional impairments. Affective modulation of the N250 suggests that the neural mechanisms underlying complex visual processes are particularly susceptible to emotional influences in FMS. The behavioral data confirm attentional deficits in the disorder and implicate clinical pain therein.

Self-reported stress and psychophysiological reactivity in paramedics.

BACKGROUND: As an important group of health care professionals, paramedics accomplish sophisticated and frequently stressful tasks. DESIGN: The study investigated self-reported stress burden, self-reported health status, coping strategies, personality traits and psychophysiological reactivity in paramedics. METHODS: 30 paramedics were compared with 30 professionals from other disciplines, in terms of self-reported stress, physical complaints, coping strategies, personality traits and psychophysiological reactivity during aversive visual and acoustic stimuli, and cognitive challenge. Regression analyses were performed for the prediction of stress burden and physical complaints in paramedics according to coping and personality factors. RESULTS: Paramedics reported lower stress and less somatic complaints, and exhibited reduced electrodermal activity and heart rate responses to experimental stimuli, as well as higher respiratory sinus arrhythmia. They indicated less negative coping strategies, reduced empathy, and higher conscientiousness and sensation seeking. Higher self-reported stress burden and more physical symptoms were associated inter alia with more negative coping strategies, less conscientiousness and lower empathy. CONCLUSION: The findings support the notion of reduced self-reported stress burden, and improved general health and stress resistance in paramedics. In addition to health benefits, stress tolerance may contribute to the prevention of performance decline during situations in which health and life are at stake.

Biofeedback Training in Crisis Managers: A Randomized Controlled Trial.

Working in crisis environments represents a major challenge, especially for executive personnel engaged in directing disaster operations, i.e. crisis managers. Crisis management involves operating under conditions of extreme stress resulting, for instance, from high-level decision-making, principal responsibility for personnel, multitasking or working under conditions of risk and time pressure. The present study aimed to investigate the efficacy of a newly developed biofeedback training procedure based on electrodermal activity, especially designed for the target group of crisis managers. The training comprised exercises promoting acquisition of control over sympathetic arousal under resting conditions and during exposure to visual, acoustic and cognitive stressors resembling situations related to crisis management. In a randomized controlled design, 36 crisis managers were assigned to either a biofeedback training group or waiting list control group. Subjective stress was assessed using the Perceived Stress Scale. In the training group, stress level markedly decreased; the decrease remained stable at follow-up 2 months after the training. The results indicate that biofeedback training in crisis management is an effective method for stress management that may help to reduce vulnerability to stress-related performance decline and stress-related disease.

Stress in crisis managers: evidence from self-report and psychophysiological assessments.

Directing disaster operations represents a major professional challenge. Despite its importance to health and professional performance, research on stress in crisis management remains scarce. The present study aimed to investigate self-reported stress and psychophysiological stress responses in crisis managers. For this purpose, 30 crisis managers were compared with 30 managers from other disciplines, in terms of self-reported stress, health status and psychophysiological reactivity to crisis-related and non-specific visual and acoustic aversive stimuli and cognitive challenge. Crisis managers reported lower stress levels, a more positive strain-recuperation-balance, greater social resources, reduced physical symptoms, as well as more physical exercise and less alcohol consumption. They exhibited diminished electrodermal and heart rate responses to crisis-related and non-specific stressors. The results indicate reduced stress and physical complaints, diminished psychophysiological stress reactivity, and a healthier life-style in crisis managers. Improved stress resistance may limit vulnerability to stress-related performance decline and facilitate preparedness for major incidents.

Cognitive impairment in fibromyalgia syndrome: the impact of cardiovascular regulation, pain, emotional disorders and medication.

This study investigated cognitive performance in fibromyalgia syndrome (FMS) and its association with cardiovascular and clinical parameters. Thirty-five patients with FMS and 29 matched healthy controls completed a neuropsychological test measuring attention and arithmetic processing. As possible factors underlying the expected cognitive impairment, clinical pain intensity, co-morbid depression and anxiety disorders, sleep complaints, medication use, as well as blood pressure parameters were investigated. The patients' test performance was substantially reduced, particularly in terms of lower speed of cognitive processing and restricted improvement of performance in the course of the task. While the extent of depression, anxiety, fatigue and sleep complaints was unrelated to test performance, better performance was observed in patients showing lower pain ratings and those using opiate medication. The data corroborate the presence of substantial cognitive impairment in FMS. While the experience of chronic pain is crucial in mediating the deficits, co-morbid depression, anxiety, fatigue and sleep complaints play only a subordinate role. In the control group, but not in the patients, blood pressure was inversely associated with mental performance. This finding is in line with the well known cognitive impairment in hypertension. The lack of this association in FMS confirms previous research showing aberrances in the interaction between blood pressure and central nervous function in the affected patients.

Time-locked association between rapid cerebral blood flow modulation and attentional performance.

OBJECTIVE: The study investigated relationships between rapid cerebral hemodynamic modulation and attentional performance. Based on former results on complex cognitive functioning, a specific association between the first seconds of the hemodynamic response and performance was hypothesized. METHODS: Using transcranial Doppler sonography, blood flow velocities in the middle cerebral arteries of both hemispheres were recorded in 48 healthy subjects. The applied task comprised motor reactions on a visual stimulus which was preceded by an acoustic warning signal (interstimulus interval 5s). Task-induced hemodynamic changes were assessed second-by-second, and related to reaction time using analysis of variance and linear regression. RESULTS: A right dominant blood flow response was observed. Flow velocity increase in the middle fraction of the interstimulus interval, i.e. seconds 2 and 3 after the cuing signal, significantly correlated with reaction time. This was not the case for the very early and late components of the response. CONCLUSIONS: The results suggest a time-locked association between cerebral blood flow increase and attentional performance. This is in accordance with neurophysiological studies that revealed the closest relationship between brain perfusion and cortical activity during a similar time window. SIGNIFICANCE: The study supports the assumption of a specific, relatively early time interval in which relationships between cerebral blood flow and behavior become apparent.

Relationship between baroreceptor cardiac reflex sensitivity and pain experience in normotensive individuals.

In the present study, the relationship between cardiac baroreceptor function and the perception of acute pain was investigated in 60 normotensive subjects. Baroreceptor reflex sensitivity was determined using the sequence method based on continuous blood pressure recordings. A cold pressor test was used for pain induction. Visual analogue scales and a questionnaire were applied in order to quantify sensory and affective pain experience. Moderated multiple regression analysis revealed an inverse relationship between baroreceptor reflex sensitivity assessed during painful stimulation and the intensity of experienced pain. This relationship was moderated by resting blood pressure, with decreasing blood pressure being accompanied by a decrease in the magnitude of the association. Furthermore, resting blood pressure was inversely related to pain intensity. The inverse association between baroreceptor reflex sensitivity and pain experience is discussed as reflecting the well-established pain-inhibiting effect of baroreceptor activity. The finding that this relationship was less pronounced in the case of lower blood pressure suggests that baroreceptor-mediated pain attenuation is reduced in this population.

[Reduced drive and impaired cerebral performance: a new perspective on chronically low blood pressure]. / Antriebsschwäche und beeinträchtigte Hirnleistungen: neue Perspektiven zum chronisch niedrigen Blutdruck.

The scientific literature on mental impairment in persons with chronically low blood pressure (using WHO criteria) is systematically reviewed within its physiological context. Subjective symptoms related to hypotension, especially tiredness and listlessness have been adequately demonstrated. There are consistent findings demonstrating deficits in cognitive functions, especially in the fields of concentration and memory. Additionally, contrary to the current views, recent studies provide evidence for an impaired regulation of cerebral blood flow and reduced cerebral perfusion. The resulting deficits in brain function are also reflected in EEG findings. These findings indicate that the marginal attention paid to chronic hypotension in research and clinical practice is no longer justified.

Epidural bolus clonidine/morphine versus epidural patient-controlled bupivacaine/sufentanil: quality of postoperative analgesia and cost-identification analysis.

UNLABELLED: We compared the costs, quality of analgesia, and side effects of postoperative patient-controlled epidural analgesia (PCEA) with bupivacaine/sufentanil versus an epidural bolus (BOLUS) of clonidine/morphine in 68 patients with pancreatic surgery. Postoperative pain treatment was performed over 4 days: the PCEA pump was filled with bupivacaine 0.25% and sufentanil 2 micrograms/mL and set to 3-mL bolus and 10-min lockout time. BOLUS patients received injections of clonidine 150 micrograms plus morphine 2 mg on demand. Visual analog scale (VAS) score at rest and during coughing, heart rate (HR), systolic arterial pressure (SAP), incidence of postoperative nausea and vomiting, pruritus, duration of intestinal paralysis, hospital treatment, and costs for personnel and material were recorded. VAS scores during coughing (3 +/- 2.5 vs 5 +/- 3, P < 0.001) was higher, and HR (79 +/- 13 vs 89 +/- 15, P < 0.001), and SAP (110 +/- 18 vs 124 +/- 23, P < 0.001) were lower, in the BOLUS compared with the PCEA group. The incidence of hypotension (SAP < 80 mm Hg) was greater (6 vs 0, P < 0.001) in the BOLUS group. The incidence of all other side effects was comparable. The costs of personnel ($204 +/- $40 vs $166 +/- $38, P < 0.001) were higher in the BOLUS group, but the costs of material ($51 +/- $17 vs $87 +/- $18, P < 0.001) were higher in the PCEA group. Total costs ($62 +/- $9 vs $62 +/- $11 per day, P = 0.9) were comparable. We conclude that because of superior analgesia and reduced side effects at analogous costs, PCEA is preferable to the BOLUS technique for the treatment of postoperative pain. IMPLICATIONS: An epidural clonidine/morphine bolus technique resulted in inferior analgesia, more side effects, and comparable costs compared with a bupivacaine/sufentanil patient-controlled regimen in a randomized controlled trial after abdominal surgery.

Exogenously administered interleukin-10 decreases pulmonary neutrophil infiltration in a tumor necrosis factor-dependent murine model of acute visceral ischemia.

INTRODUCTION: Visceral ischemia and reperfusion associated with thoracoabdominal aortic aneurysm (TAAA) repair results in lung injury, which appears to be mediated in part by proinflammatory cytokines. The purpose of this study was to determine the effect of exogenous administration of the antiinflammatory cytokine, recombinant human IL-10 (rhIL-10), on proinflammatory cytokine production (IL-6 and TNF alpha) and pulmonary neutrophil infiltration after acute visceral ischemia-reperfusion. METHODS: Two hours before 25 minutes of supraceliac aortic occlusion, 80 C57BL/6 mice (20 to 22 g) received an intraperitoneal injection of rhIL-10 (0.2 microgram [n = 20], 2 micrograms [n = 20], 5 micrograms [n = 25], or 20 micrograms [n = 15]), and 16 mice received murine anti-IL-10 IgM 200 micrograms. Twenty-five additional mice underwent visceral ischemia-reperfusion without treatment (controls), and 16 mice underwent laparotomy without aortic occlusion (sham). RESULTS: Pretreatment with exogenous rhIL-10 resulted in significant reductions in lung neutrophil infiltration with 0.2 microgram, 2 micrograms, and 5 micrograms per mouse of rhIL-10 compared with lung neutrophil levels in control mice that underwent acute visceral ischemia-reperfusion alone (p < 0.05). In addition, serum TNF alpha was detected in 50% of control mice and in 75% of mice that received murine anti-IL-10, but in none of the mice that received rhIL-10 (2 micrograms per mouse) or the mice that underwent sham operative procedures (p < 0.05 by chi 2 analysis). CONCLUSION: Exogenous IL-10 limits pulmonary neutrophil recruitment and the appearance of TNF alpha in this model of visceral ischemia-reperfusion injury. Thus the use of exogenous IL-10 may offer a novel therapeutic approach to decrease the complications that are associated with TAAA repair.