Pain is a complex experience that integrates sensory, emotional and cognitive dimensions. Understanding how these different dimensions integrate this experience and how each of these dimensions can modulate pain is thus a challenging task. Growing body of evidence showed in the last decades that the central nervous system can increase and decrease the noxious information via the descending pain modulatory system, a conjunction of pro-nociceptive and anti-nociceptive projections tracks that modulate pain. Deficiencies in this system have been proposed has a key element of some chronic pain conditions, mostly in those particularly known to involve central sensitization mechanisms, as Fibromyalgia syndrome. Among several emotional dimensions that can modulate pain, it has been proposed that social distress threatens well being in a similar mode as pain does, and may share neurocognitive resources and mechanisms with physical pain. In this view it would be expected that social distress would significantly modulate pain experience, but this prediction has not been well established in healthy subjects. Furthermore, this was not, to the best of our knowledge, tested in chronic pain, which is a huge public health problem that, according to the International Association for the Study of Pain, is believed to affect more than 20% of the population worldwide. Based on these theoretical grounds, two studies were developed with the aim of investigating how social distress manipulations modulate pain experience in healthy and chronic pain patients. In the first study, we aimed to understand the relationship between social distress and pain intensity and unpleasantness in healthy individuals. Sixty participants were enrolled to one condition of a well validated paradigm that induce social distress, the Cyberball game. Electrical stimulation protocol was induced before and after playing the game. It was found that participants that had a lower electrical unpleasantness threshold were also more distressed by the Cyberball game (p=0.012) and that the manipulation itself affected pain intensity ratings (p=0.001). The relationship between social distress and physical pain was not related to attachment styles or neuroticism. Overall, this study. provided evidence that sensitivity to social distress is related to sensitivity to physical pain and that social distress modulates pain in healthy individuals. In the second study, 90 participants were recruited to a study aimed to further investigate how social distress could modulate the pain experience in response to experimental pain models in healthy and two chronic pain conditions: Fibromyalgia, a condition that although recently recognized to have peripheral abnormalities is classically related to central sensitization mechanisms, and Rheumatoid Arthritis, a condition with a well described peripheral inflammation mechanism but less information regarding central sensitization mechanisms. Each participant played the Inclusion and Exclusion condition of Cyberball while pain was induced before and during each condition. In line with the first study, healthy controls (pain=-13.71±}45.28; unplesentness,=- 20.78±}28.7) and rheumatoid arthritis patients (pain=-7.50}34.54; unplesentness=- 5.60±}38.04) demonstrated a reduction in pain intensity ratings in response to the electrical induced pain in the Inclusion condition, suggesting the recruitment of the antinociceptive projections of the descending pain modulatory system, while in fibromyalgia patients, pain (7.50±}26.04, p=0.019) and unplesentness (2.86±}31.98, p=0.021) were significantly increased during the same condition. This suggests an impairment of the descending pain modulatory system in fibromyalgia. These results are discussed in line with evidence of impaired anti-nociceptive projections and changes related to chronic pain that have been found to occur in brain areas as insula, anterior cingulate and midbrain projections, fundamental areas for social connection. Further studies are needed to collect additional information on the nature of the descending pain modulatory system deficits in fibromyalgia. We hope that the increased knowledge regarding the relationships between social events and pain modulation will provide relevant insights for new social and emotional therapeutic approaches in chronic pain conditions, and ultimately contribute to reducing suffering.

While factors contributing to between-subjects differences in pain have been studied extensively, factors contributing to the within-subjects variability of pain reports are yet unexplored. The aim of this investigation was to assess possible associations between short-term memory and the within-subjects variability of pain reports in healthy and chronic pain patients. Healthy participants were recruited at the University of Haifa, Israel, and Fibromyalgia patients were recruited at a rheumatology department in a central hospital in Lisbon, Portugal. Following consent, both cohorts underwent the same procedures, including the digit-span test, assessing short-term memory, and the FAST procedure, assessing within-subject variability of pain intensity reports in response to experimental pain. One-hundred twenty-one healthy volunteers and 29 Fibromyalgia patients completed the study. While a significant correlation was found between the within-subjects variability and the total score of the short-term memory task (Spearman’s r = 0.394, P = 0.046) in the Fibromyalgia group, a marginal correlation emerged in the healthy cohort (r = 0.174, P = 0.056). A possible interpretation of these results is that in the patients’ group, at least some of the within-subjects variability of pain intensity reports might be due to error measurement derived by poorer short-term memory, rather than true fluctuations in perception.

The subjective nature of pain and the lack of a gold standard for objective measurement hinders effective assessment, diagnosis, and treatment. Some individuals, such as professional dancers, are better in assessing and reporting bodily sensations. This observational study aimed to assess whether dancers report their pain less variably, than other people do. After consenting, subjects completed the focused analgesia selection test (FAST), which assesses subjects’ variability of pain reports. FAST outcomes, ICC and R2 reflect the magnitude of variability of pain reports observed. In addition, subjects underwent a taste task, which similarly assesses variability of tastes (salty and sweet) intensity reports and completed the Multidimensional Assessment of Interoceptive Awareness questionnaire. Thirty-three professional dancers and 33 healthy aged-matched controls were recruited. The dancers exhibited less variability of pain reports then controls (P = .013), but not in case of tastes-reports. Years of practice was positively correlated with pain reporting variability (r = .447, P = .009, and r = .380, P = .029; for FAST ICC and R2, respectively). Multidimensional Assessment of Interoceptive Awareness subscores correlated with pain reporting variability: R2 and ICC with emotional awareness (r = .260, P = .040, and r = .274, P = .030, respectively), and R2 with trusting [r = .254, P = .044]). Perspective: The difference between dancers and controls in the magnitude of variability of pain reports is probably due to the dancers’ extensive training, which focuses on attention to body signals. Our results suggest that training can improve subjective pain reports, which are essential for quality clinical care.

A experiência da dor encontra-se entre as mais intensas e marcantes experiências humanas. É parte integrante da dialéctica com o mundo exterior, estruturando os nossos limites fisiológicos e psicológicos permanentemente. Tem um valor fundamental na sobrevivência, garantindo o afastamento de estímulos e situações que poderiam ameaçar a vida. Conhecida por todos os ser humanos e, infelizmente, presente cronicamente em muitos deles, representa um desafio à compreensão científica. Nos últimos anos as Neurociências têm conseguido caracterizar os processos biológicos envolvidos na dor, bem como o papel que o contexto emocional, social e cultural pode ter nesta experiência. De entre as várias emoções que podem modular o processamento da dor física, a dor social, isto é, a dor que ocorre em situações de perda de relações sociais significativas, partilha processos comportamentais, neurocognitivos e moleculares com a dor física (Eisenberger, 2012). Nesta perspectiva, um indivíduo que seja capaz de antecipar adequadamente os riscos para a sua integridade física, evitando situações em que possa sentir dor, mas não seja capaz de antecipar os perigos sociais, afastando-se ou sendo rejeitado pelo grupo, pode ficar igualmente em situação de risco do ponto de vista do seu bem estar. Diversos estudos têm procurado compreender de que forma estes dois fenómenos se poderão relacionar. São estes estudos que procuramos aqui rever, na expectativa de clarificar a pertinência desta área de investigação e o potencial clínico que o conhecimento das interligações entre estes tipos de dor poderá ter na prática clínica, sobretudo na dor crónica.

While factors contributing to between-subjects differences in pain have been studied extensively, factors contributing to the within-subjects variability of pain reports are yet unexplored. The aim of this investigation was to assess possible associations between short-term memory and the within-subjects variability of pain reports in healthy and chronic pain patients. Healthy participants were recruited at the University of Haifa, Israel, and Fibromyalgia patients were recruited at a rheumatology department in a central hospital in Lisbon, Portugal. Following consent, both cohorts underwent the same procedures, including the digit-span test, assessing short-term memory, and the FAST procedure, assessing within-subject variability of pain intensity reports in response to experimental pain. One-hundred twenty-one healthy volunteers and 29 Fibromyalgia patients completed the study. While a significant correlation was found between the within-subjects variability and the total score of the short-term memory task (Spearman’s r = 0.394, P = 0.046) in the Fibromyalgia group, a marginal correlation emerged in the healthy cohort (r = 0.174, P = 0.056). A possible interpretation of these results is that in the patients’ group, at least some of the within-subjects variability of pain intensity reports might be due to error measurement derived by poorer short-term memory, rather than true fluctuations in perception.

The subjective nature of pain and the lack of a gold standard for objective measurement hinders effective assessment, diagnosis, and treatment. Some individuals, such as professional dancers, are better in assessing and reporting bodily sensations. This observational study aimed to assess whether dancers report their pain less variably, than other people do. After consenting, subjects completed the Focused Analgesia Selection Task (FAST), which assesses subjects' variability of pain reports. FAST outcomes, ICC and R2 reflect the magnitude of variability of pain reports observed. In addition, subjects underwent a taste task, which similarly assesses variability of tastes (salty and sweet) intensity reports and completed the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire. Thirty-three professional dancers and thirty-three healthy aged-matched controls were recruited. The dancers exhibited less variability of pain reports then controls (P=0.013), but not in case of tastes-reports. Years of practice was positively correlated with pain reporting variability (r=0.447, P=0.009, and r=0.380, P=0.029; for FAST ICC and R2, respectively). MAIA sub-scores correlated with pain reporting variability: R2 and ICC with emotional awareness (r=0.260, P=0.040, and r=0.274, P=0.030, respectively), and R2 with trusting [r=0.254, P=0.044]). Perspective The difference between dancers and controls in the magnitude of variability of pain reports is probably due to the dancers' extensive training, which focuses on attention to body signals. Our results suggest that training can improve subjective pain reports, which are essential for quality clinical care.

Na obra de Piaget, os chamados argumentos operatórios, Identidade, Reversibilidade e Compensação, são de grande importância. Acresce ainda a facilidade com que podem ser identificados nos desempenhos das crianças. Estranhamente, e tanto quanto sabemos, Piaget quase não se questionou sobre a psicogénese dos argumentos operatórios, o que pode ter a ver com o facto de não ter recorrido a metodologias longitudinais. Questões desse tipo, contudo, são importantes, quer em termos da própria teoria quer em termos de uma melhor compreensão da emergência do pensamento operatório na criança. Procurámos com este trabalho esclarecer alguns aspectos centrais neste domínio, nomeadamente: (a) Existem diferenças na frequência com que os argumentos são utilizados? (b) Existem diferenças na probabilidade de cada um dos argumentos ser o primeiro a ser utilizado quando a criança transita de um estádio de não conservação para um de conservação? (c) Existem diferenças nas frequências relativas dos argumentos em função das provas? Acompanhámos um grupo de crianças ao longo de quatro meses, com oito momentos de avaliação, utilizando quatro provas diferentes de conservação. Verificou-se que o argumento de Identidade foi o mais frequentemente invocado pelas crianças para justificar a conservação, parecendo ser igualmente aquele que emerge com mais frequência em primeiro lugar na transição para o pensamento operatório. Pelo contrário, o argumento de Reversibilidade é aquele que é menos utilizado. Constatou-se também que o tipo de prova influencia o padrão de utilização dos argumentos. Estes resultados contradizem os invocados por Piaget quando afirma que a emergência dos argumentos não segue uma ordem determinada e que a sua observação nos desempenhos das crianças é igualmente provável. A interpretação dos resultados foi dificultada, porém, pela perda de grande número de crianças da amostra ao longo dos momentos de avaliação, uma vez que da amostra inicial de 68, apenas 17 concluíram todas as avaliações.

Despite extensive research, reliable predictors of the placebo response remain elusive. The within-subject variability (WSV) of pain reports has emerged as a potential predictor, with multiple studies confirming its predictive value. But the results have been mixed. We recently showed that direction of attention moderates WSV's role in predicting the placebo response in patients with chronic back pain. This observational study aims to further examine the relationship between direction of attention, WSV, and the placebo effect in fibromyalgia patients (FM) and healthy controls. Participants completed a demographic questionnaire, clinical pain diaries (for FM), and the revised Self-Consciousness Scale (SCS-R). Afterward, participants underwent two experimental procedures: (1) the Focused Analgesia Selection Test (FAST), assessing experimental WSV of pain reports, and (2) an experimental placebo paradigm. Moderation and regression analyses examined the role of the SCS-R subscales in moderating the prediction of the placebo effect by the WSV of pain reports. Sixty-nine participants (healthy: 37, FM: 32) completed the protocol. Groups did not differ in SCS-R subscales, WSV, or placebo effect magnitude (p≥0.281). At low levels of private self-consciousness (p=0.013) and social anxiety (p=0.017) among FM, clinical WSV played a significant role in predicting the placebo effect. Public self-consciousness for FM showed a similar trend toward significance. These findings underscore attention as a relevant moderator of the placebo effect, emphasizing the need for improved measurement tools to predict the placebo effect. Perspective: We highlight the role of direction of attention in the prediction of the placebo effect. Our current findings validate our previous recent results from a cohort of chronic back pain patients, implying that direction of attention should be used in future attempts to improve the prediction of the placebo effect.