Unconscious activation of negative emotional memories increases pain unpleasantness.

OBJECTIVE: The influence of unconscious emotional processes on pain remains poorly understood. The present study tested whether cues to forgotten unpleasant images might amplify pain (i.e., in the absence of conscious recall). METHODS: 72 healthy female adults (19 to 34 years) performed an adapted Think/No-think paradigm (T/NT) using 72 combinations of neutral face images (cues) paired with 36 neutral & 36 unpleasant images. After completion of the T/NT task, cues associated with forgotten neutral or unpleasant images were identified. Cues to either neutral or unpleasant images from the NT condition were then presented in randomized order while participants received intermediate-level thermal pain stimulation on the left hand. Ratings of both pain intensity and unpleasantness were acquired after each trial. RESULTS: Mean pain unpleasantness ratings were greater during presentation of cues to forgotten negative vs. neutral images (5.52 [SD = 2.06] vs. 5.23 [SD = 2.10]; p = 0.02). This pattern was also present when comparing cues to remembered negative vs. neutral images (5.62 [SD = 1.94] vs. 5.04 [SD = 1.90]; p < .001). Mean pain intensity ratings were higher for cues to negative vs. neutral images when remembered (5.48 [SD = 1.79] vs. 5.00 [SD = 1.69]; p < .001), but not when forgotten (5.27 [SD = 1.96] vs. 5.16 [SD = 1.93]; p = 0.30). CONCLUSIONS: Using an adapted T/NT-Pain paradigm, this study demonstrated that cues to non-recallable (but potentially unconsciously activated) negative emotional memories amplify pain unpleasantness, similar to known effects of conscious negative emotions.

Autonomous Nervous Response During Sedation in Colonoscopy and the Relationship With Clinician Satisfaction.

Background: Nurse assisted propofol sedation (NAPS) is a common method used for colonoscopies. It is safe and widely accepted by patients. Little is known, however, about the satisfaction of clinicians performing colonoscopies with NAPS and the factors that negatively influence this perception such as observer-reported pain events. In this study, we aimed to correlate observer-reported pain events with the clinicians' satisfaction with the procedure. Additionally, we aimed to identify patient biosignals from the autonomic nervous system (B-ANS) during an endoscopy that correlate with those pain events. Methods: Consecutive patients scheduled for a colonoscopy with NAPS were prospectively recruited. During the procedure, observer-reported pain events, which included movements and paralinguistic sounds, were simultaneously recorded with different B-ANS (facial electromyogram (EMG), skin conductance level, body temperature and electrocardiogram). After the procedure, the examiners filled out the Clinician Satisfaction with Sedation Instrument (CSSI). The primary endpoint was the correlation between CSSI and observer-reported pain events. The second primary endpoint was the identification of B-ANS that make it possible to predict those events. Secondary endpoints included the correlation between CSSI and sedation depth, the frequency and dose of sedative use, polyps resected, resection time, the duration of the procedure, the time it took to reach the coecum and the experience of the nurse performing the NAPS. ClinicalTrials.gov: NCT03860779. Results: 112 patients with 98 (88.5%) available B-ANS recordings were prospectively recruited. There was a significant correlation between an increased number of observer-reported pain events during an endoscopy with NAPS and a lower CSSI (r = -0.318, p = 0.001). Additionally, the EMG-signal from facial muscles correlated best with the event time points, and the signal significantly exceeded the baseline 30 s prior to the occurrence of paralinguistic sounds. The secondary endpoints showed that the propofol dose relative to the procedure time, the cecal intubation time, the time spent on polyp removal and the individual nurse performing the NAPS significantly correlated with CSSI. Conclusion: This study shows that movements and paralinguistic sounds during an endoscopy negatively correlate with the satisfaction of the examiner measured with the CSSI. Additionally, an EMG of the facial muscles makes it possible to identify such events and potentially predict their occurrence.

"What About Automated Pain Recognition for Routine Clinical Use?" A Survey of Physicians and Nursing Staff on Expectations, Requirements, and Acceptance.

Background: Over the last 12 years, the fundamentals of automated pain recognition using artificial intelligence (AI) algorithms have been investigated and optimized. The main target groups are patients with limited communicative abilities. To date, the extent to which anesthetists and nurses in intensive care units would benefit from an automated pain recognition system has not been investigated. Methods: N = 102 clinical employees were interviewed. To this end, they were shown a video in which the visionary technology of automated pain recognition, its basis and goals are outlined. Subsequently, questions were asked about: (1) the potential benefit of an automated pain recognition in clinical context, (2) preferences with regard to the modality used (physiological, paralinguistic, video-based, multimodal), (3) the maximum willingness to invest, (4) preferences concerning the required pain recognition rate and finally (5) willingness to use automated pain recognition. Results: The respondents expect the greatest benefit from an automated pain recognition system to be "to avoid over- or undersupply of analgesics in patients with limited communicative abilities," a total of 50% of respondents indicated that they would use automated pain recognition technology, 32.4% replied with "perhaps" and 17.4% would not use it. Conclusion: Automated pain recognition is, in principle, accepted by anesthetists and nursing staff as a possible new method, with expected benefits for patients with limited communicative skills. However, studies on automated pain recognition in a clinical environment and proof of its acceptance and practicability are absolutely necessary before such systems can be implemented.

[Radicular low back pain: is there a relationship between the treatment regimen and outcome?]. / Lumbale Radikulopathien--Zusammenhang zwischen Therapieintensität und Behandlungserfolg?

OBJECTIVE: To identify a possible relationship between the non-surgical treatment regimen and outcome. METHODS: In a sample of 170 patients with sciatica due to a herniated disk the intensity of a conservative multimodal inpatient treatment in a neurological department was extracted. The outcome was examined using two prospective cohorts (183 patients). These results were compared with published data from orthopaedic inpatient rehabilitation in Germany. RESULTS: The neurological inpatient treatment regimen was more intense than the orthopaedic inpatient rehabilitation, especially with regard to physiotherapy. In contrast, physical therapy was applied more often in orthopaedic rehabilitation. A better short-term outcome with regard to pain intensity was found after multimodal conservative treatment. CONCLUSIONS: Further studies are needed to compare different treatment regimens in patients with sciatica.

[Radicular Low Back Pain: Evaluation of Conservative Multimodal Treatment] / Evaluation der konservativ-multimodalen Therapie lumbaler radikulärer Schmerzsyndrome.

OBJECTIVE: In this summary, the preliminary results of studies evaluating medical therapy of radicular low back pain are reported. METHODS: In two prospective cohorts (183 patients) the conservative multimodal inpatient treatment was examined, using the newly developed "Radicular Low Back Pain Score" for the standardized measurement of the radiculopathy. In another sample of 116 patients the preceeding outpatient treatment was documented. RESULTS: A significant short-term improvement with regard to the pain intensity and the radiculopathy was observed after approximately two weeks of therapy. The preceeding outpatient treatment did not comply with recent guidelines. Moreover, it did not influence the outcome of the multimodal inpatient therapy. CONCLUSIONS: The "Radicular Low Back Pain Score" seems to be a suitable instrument for measuring therapy effectiveness. Multimodal medical treatment is an important treatment approach for sciatica, especially after failed outpatient therapy.

[Evaluation of conservative combined modality therapy of lumbar radicular pain syndrome]. / Evaluation der konservativ-multimodalen Therapie lumbaler radikulärer Schmerzsyndrome.

OBJECTIVE: In this summary, the preliminary results of studies evaluating medical therapy of radicular low back pain are reported. METHODS: In two prospective cohorts (183 patients) the conservative multimodal inpatient treatment was examined, using the newly developed "Radicular Low Back Pain Score" for the standardized measurement of the radiculopathy. In another sample of 116 patients the preceding outpatient treatment was documented. RESULTS: A significant short-term improvement with regard to the pain intensity and the radiculopathy was observed after approximately two weeks of therapy. The preceding outpatient treatment did not comply with recent guidelines. Moreover, it did not influence the outcome of the multimodal inpatient therapy. CONCLUSIONS: The "Radicular Low Back Pain Score" seems to be a suitable instrument for measuring therapy effectiveness. Multimodal medical treatment is an important treatment approach for sciatica, especially after failed outpatient therapy.