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H Gajsar,1 C Titze,1 K Konietzny,1 M Meyer,2 HB Vaegter,3,4 MI Hasenbring1,3 1Mind and Pain in Motion Group, Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany; 2School of Social Sciences, University of Mannheim, Mannheim, Germany; 3Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; 4Pain Research Group, Pain Center, University Hospital Odense, Odense, DenmarkCorrespondence: H GajsarMind and Pain in Motion Group, Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Universitätsstr, 150, Bochum 44809, GermanyEmail Gajsar@medpsych.rub.dePurpose: Exercise-induced hypoalgesia (EIH) is the short-term reduction of pain sensitivity after a single bout of exercise. Descending pain inhibition has been proposed to at least partly underlie EIH. Cognitive inhibition is the ability to inhibit a pre-potent response and has in turn been associated with descending pain inhibition, as indexed by conditioned pain modulation. Therefore, we hypothesized that cognitive inhibition is associated with higher EIH.Methods: In this cross-sectional study, 37 pain-free participants (16 male, age 27.75 ± 9.91) completed a stop-signal task assessing cognitive inhibition ability and a control condition in the first session. In the second session, pre–post-test design EIH was assessed by means of aerobic bicycling (15 min., 75% VO2max) and isometric knee extension (90 sec, 30% MVC). EIH was assessed with pressure pain thresholds (PPT) and temporal summation of pain (TSP), each at the hand and at the leg. Correlational analyses quantified the associations between cognitive inhibition and EIH change scores.Results: Better cognitive inhibition correlated with EIH change scores in PPTs after aerobic bicycling at the hand (r = − 0.35, 95% CI: − 0.57; − 0.08, p = 0.021), but not at the leg (rho = − 0.10, 95% CI: − 0.36; 0.18, p = 0.277). No correlations between cognitive inhibition and change in PPTs after isometric knee extension at the hand (rho = − 0.03, 95% CI: − 0.30; 0.25, p = 0.857) nor at the leg (rho = − 0.03, 95% CI: − 0.25; 0.30, p = 0.857) were observed. There were no EIH effects after isometric exercise and, generally, no effects of exercise on TSP.Conclusion: This study provides preliminary evidence for the notion that cognitive inhibition might play a supportive role in EIH. Although these results are clearly in need of replication, they accord well with previously reported associations between cognitive inhibition, experimental pain and descending pain inhibition.Keywords: descending pain inhibition, exercise-induced hypoalgesia, response inhibition, stop-signal task, pressure pain threshold, temporal summation of pain

Background: Recent evidence has shown that chronic back pain (CBP) can lead to functional alterations in the circuitry underlying the cognitive control of pain. Thought suppression (TS) is a common type of cognitive control of pain. Previous research has shown that TS has paradoxical effects that may increase the awareness of pain. Pain-related TS may also increase individuals' attention to pain, which may also increase pain sensation, but thus far, the relationship between pain-related TS and structural brain alterations is unknown.Methods: In this study, we investigated a group of 30 patients 6 months after lumbar disc surgery by applying voxel-based morphometry (VBM) to identify brain regions correlated with TS scores.Results: Since pain-related TS has been positively correlated with depression, all calculations were controlled for depression and age. VBM revealed a negative correlation between the TS score and regional grey matter volume (GMV) in the left superior temporal gyrus (LSTG) and the left middle temporal gyrus (L MTG), which is part of the left temporoparietal junction (L TPJ). In addition, a mediation analysis revealed a significant mediation effect of the pain-related TS on the association between GMV of the left TPJ and reported pain intensity in the last 7 days.Conclusions: These findings are consistent with previous research on the dysfunctional cognitive control of pain and may therefore provide potential insights into the neural substrates of obstructive cognitive control in chronic low back pain, with a special emphasis on pain-related TS.Significance: The link between pain-related thought suppression and brain morphology may provide a new perspective on the understanding of cognitive control of pain in chronic low back pain, which may help improve cognitive behavioural therapy. [ABSTRACT FROM AUTHOR]

Background: Depression and suicidal ideation are important health problems in athletes suffering from pain. Dysfunctional pain cognitions, that is, pain-related thought suppression (PTS), may play an important role in their aetiology. Thought suppression was shown to increase depressive mood, particularly in highly stressed individuals. This cross-sectional study examines the relationship between PTS and stress on depression and suicidal ideation in athletes with pain.Methods: A total of 159 athletes with non-specific low back pain completed a set of questionnaires to measure PTS, depression and stress. Participants were split into groups with high and low stress, and high and low PTS. Two-way ANOVA calculated main effects for PTS, stress and a PTS*stress interaction, with depressive symptoms as dependent. Subsequently, distribution tests were calculated, investigating if the presence of clinically relevant depression and suicidal ideation is dependent of conditions of high/low PTS and stress.Results: A main effect of stress demonstrated higher depression scores in highly stressed athletes. Further, a significant PTS*stress interaction showed elevated depression scores in athletes with high PTS and high stress. Distribution analysis revealed positive associations between PTS, stress and depression, with depression being most frequent among athletes with high PTS and high stress. Suicidal ideation was not significantly associated with PTS and only weakly correlated with stress.Conclusions: Our findings show that PTS is the most common pain response in athletes with pain. The results indicate a higher prevalence of depression and elevated depressive symptoms in athletes experiencing high stress, seemingly more pronounced when highly engaging in PTS.Significance: This study contributes to the understanding of depression in athletes with pain, suggesting stress and pain-related thought suppression to increase symptoms and prevalence of depression. As athletes often experience acute or chronic pain, understanding the impact of pain cognitions on health outcomes is an important step in the optimization of treatments. [ABSTRACT FROM AUTHOR]

Introduction: Germany and the European Union have experienced successive waves of refugees since 2014, resulting in over 1.6 million arrivals, including families with young children. These vulnerable populations often face xenophobia, discrimination, substandard living conditions and limited healthcare access, contributing to a high prevalence of mental health problems (MHP). Our primary goal is to proactively address MHP in refugee parents and prevent its potential impact on their children through effective early interventions. Using a low-threshold, primary care-based approach, we aim to enhance parenting skills and address parental psychopathology, creating a supportive environment for parents and children., Methods and Analysis: In this randomised controlled trial, 188 refugee parents of 6-year-old children or younger who meet the clinical cut-off on the MHP scale will participate. They are randomly assigned to either the experimental psychotherapeutic intervention, delivered by general practitioners (10-week Improve intervention), or treatment as usual, in a ratio of 1:1. The randomisation will be masked only for outcome assessors. Improve includes face-to-face sessions with general practitioners, an interactive online parenting programme (Triple P Online) and regular protocol-based telephone calls by psychologists. Primary outcomes will assess the intervention's effects on parental and child MHP and parenting skills, with secondary outcomes including psychosocial and physical health indicators. Outcomes will be assessed at pre, post and at 3-month and 6-month follow-ups. The study is scheduled to run from February 2019 to July 2025., Ethics and Dissemination: The project Improve-MH (application number 602) was approved by the local ethics committee of Ruhr-University of Bochum and is being conducted in accordance with the Declaration of Helsinki. The study is also conducted in full accordance with the German Data Protection Act, and the Good Clinical Practice guideline (GCP) and is sensitive to specific ethical considerations. Results will be disseminated at scientific conferences, published in peer-reviewed journals and provided to consumers of healthcare., Trial Registration Number: The trial was prospectively registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien, DRKS-ID: DRKS00019072) on 16 March 2020., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Exercise-induced pain and exercise-induced hypoalgesia (EIH) are well described phenomena involving physiological and cognitive mechanisms. Two experiments explored whether spontaneous and instructed mindful monitoring (MM) were associated with reduced exercise-induced pain and unpleasantness, and increased EIH compared with spontaneous and instructed thought suppression (TS) in pain-free individuals., Methods: Eighty pain-free individuals participated in one of two randomized crossover experiments. Pressure pain thresholds (PPTs) were assessed at the leg, back and hand before and after 15 min of moderate-to-high intensity bicycling and a non-exercise control condition. Exercise-induced pain and unpleasantness were rated after bicycling. In experiment 1 (n=40), spontaneous attentional strategies were assessed with questionnaires. In experiment 2, participants (n=40) were randomly allocated to use either a TS or MM strategy during bicycling., Results: In experiment 1, the change in PPTs was significantly larger after exercise compared with quiet rest (p<0.05). Higher spontaneous MM was associated with less exercise-induced unpleasantness (r=-0.41, p<0.001), whereas higher spontaneous TS was associated with higher ratings of exercise-induced unpleasantness (r=0.35, p<0.05), but not with pain intensity or EIH. In experiment 2, EIH at the back was increased in participants using instructed TS compared with participants using instructed MM (p<0.05)., Conclusions: These findings suggest that spontaneous and presumably habitual (or dispositional) attentional strategies may primarily affect cognitive-evaluative aspects of exercise, such as feelings of exercise-induced unpleasantness. MM was related to less unpleasantness, whereas TS was related to higher unpleasantness. In terms of brief experimentally-induced instructions, TS seems to have an impact on physiological aspects of EIH; however, these preliminary findings need further research., (© 2023 the author(s), published by De Gruyter, Berlin/Boston.)

Purpose: Mild depression has been shown as a precursor and as a consequence of low back pain, even in early phases of acute or subacute pain. Chronic daily life stress as well as dysfunctional pain-related cognitions such as thought suppression (TS) seem to play a role in the pain-depression cycle; however, the mechanisms of these associations are less understood. Experimentally induced TS, conceived as the attempt to directly suppress sensations such as pain, has been shown to paradoxically cause a delayed and non-volitional return of the suppressed thoughts and sensations and to increase affective distress. These dysfunctional processes are supposed to increase under high cognitive load, such as high stress., Method: In the present cross-sectional study, we for the first time sought to examine a possible interaction between habitual TS and stress on depression in N = 177 patients with subacute low back pain (SLBP), using the following questionnaires: Subscale Thought Suppression from Avoidance-Endurance Questionnaire, Beck Depression Inventory, and Kiel Interview of Subjective Situation. A three-way ANOVA was conducted with two groups of TS (high/low), stress (high/low) and sex as independent factors and depression as dependent., Results: Results indicated a significant three-way interaction with highest depression scores in female patients showing high TS and high stress. Overall main effects for sex and stress indicated higher depression in women and in highly stressed patients., Conclusion: Our findings support the hypothesis that TS heightens depressive mood under conditions of high cognitive load especially in female patients with SLBP indicating a special vulnerability for depressive mood in women with SLBP.

This article was updated to correct the author names. Family and given names are in the correct order.

Introduction: Pain catastrophizing (PC), the increased attention to harmful aspects of pain (magnification), and the belief of low controllability (helplessness) has been shown to be important in the maintenance of pain. A growing research on structural alterations in chronic pain revealed an association between PC and brain areas that are involved in affective and cognitive pain processing. However, little is known about a differential effect of the components magnification and helplessness., Objective: The aim of this study was to identify brain regions associated with overall PC and with the single components of magnification and helplessness., Methods: We investigated 29 patients 6 months after lumbar disk surgery using voxel-based morphometry. Magnification and helplessness were assessed with subscales of the Avoidance-Endurance Questionnaire (AEQ); overall PC was computed using the sum score. The structural brain imaging data were preprocessed and analyzed using SPM8 and VBM8. Multiple regression analyses were performed with PC scales as predictors and depression as covariate., Results: Pain catastrophizing was significantly associated with cortical gray matter in brain areas involved in processing attentional, sensory, and affective aspects of pain, including the left posterior cingulate cortex, supplementary motor area, and medial frontal gyrus. In addition, we provide preliminary evidence for brain structure association related to magnification and helplessness., Conclusion: This study provides evidence for PC-related structural alterations in patients with low back pain, which are consistent with findings from previous research in different chronic pain disorders. This study is the first to evaluate brain changes related to differential domains of PC., Competing Interests: Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.