Psychological Interventions for Pain Perception

Recruiting at 1 trial location

Overseen By Lauren Y Atlas, Ph.D.

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: National Center for Complementary and Integrative Health (NCCIH)

Must not be taking: Opiates, Antidepressants, Anticonvulsants, others

Disqualifiers: Cardiovascular, Neurological, Mood disorders, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

500 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to explore how different psychological factors affect pain perception. Researchers seek to understand how expectations and treatments, such as pain relief creams, can alter the brain's and body's response to pain. Participants might sample different tastes, perform simple tasks, or experience mild pain through heat or small electric shocks. Healthy individuals who are fluent in English and have no history of chronic pain or major medical conditions may be suitable for this study. As an unphased trial, this study offers a unique opportunity to contribute to groundbreaking research on pain perception.

Do I need to stop my current medications for the trial?

Yes, if you regularly use prescription medications that significantly affect pain or heat perception, you will need to stop taking them to participate in the trial. This includes medications like opiates, antidepressants, anticonvulsants, and others listed in the exclusion criteria.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that mindfulness and attention practices are generally safe, with few reported risks. Most studies focus on their benefits, such as reducing stress and improving focus, rather than any harmful effects.

Research also indicates that expectations about pain can alter the perception of pain. Instructions that promote a sense of safety can help reduce pain, with no known harmful effects from these types of instructions.

Regarding tasting liquids like sweet or salty solutions, studies have shown they do not affect pain perception. No negative effects have been reported from these tastings in the context of pain perception.

For thermal pain, which involves using heat to cause mild discomfort, research suggests it is generally safe when conducted in controlled settings. Studies often use this method to understand pain responses, and no serious side effects have been reported.

Overall, these treatments are well-tolerated according to current research. There is no significant evidence of harmful effects from these psychological and sensory interventions when conducted in a research setting. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how psychological techniques can change the way we perceive pain, which is different from the usual approach of using medications like opioids or NSAIDs. By using methods like attention shifting, instructions, and conditioning with different tastes and temperatures, this trial aims to understand how our brains can be trained to reduce pain without drugs. This could lead to new, drug-free ways to manage pain that have fewer side effects and risks than traditional painkillers. Additionally, understanding the placebo effect and how expectations influence pain perception could transform pain management strategies, making them more personalized and effective.

What evidence suggests that this trial's treatments could be effective for pain perception?

Research shows that thoughts and feelings can affect pain perception. This trial involves participants in various substudies to explore these effects. Mindfulness practices, which improve focus, can reduce pain sensitivity and enhance coping. Some participants will learn through experience, while others will receive instruction or conditioning about specific outcomes, such as heat or sugar. Studies also find that expectations can alter pain experiences, sometimes more than the pain itself. For instance, expecting less pain often results in feeling less pain, regardless of its actual intensity. Sweet tastes like sugar can reduce pain in children, though this effect is not consistent in adults. Overall, these findings suggest that altering thoughts about pain can change its perception. ^{6 7 8 9 10}

Who Is on the Research Team?

Lauren Y Atlas, Ph.D.

Principal Investigator

National Center for Complementary and Integrative Health (NCCIH)

Are You a Good Fit for This Trial?

This trial is for healthy individuals between the ages of 18 and 50 who speak English fluently and can consent to participate. It's not suitable for those with conditions affecting touch sensation, chronic pain history, skin issues in test areas, major medical conditions that affect heat sensitivity or pain thresholds, pregnancy, NCCIH/NIMH employees, or regular use of certain prescription medications.

Inclusion Criteria

You are in good overall health.

Fluent in English

Able to provide written informed consent

Exclusion Criteria

I have or had a pain condition lasting more than six months.

I have a health condition that could affect my sensitivity to heat, pain, or ability to follow study rules.

I have scars, burns, or a recent tattoo that could affect skin sensitivity in the test area.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (in-person)

Study Visits

Participants undergo various tests including MRI scans, taste tests, and pain assessments. Physiological responses are measured.

1-3 hours per visit

1 to 2 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after study visits

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Attention
• Instructions
• Liquid tastants
• Placebo instructions
• Thermal Pain

Trial Overview

The study aims to understand how psychological factors like expectations influence pain perception and decision-making. Participants may undergo MRI scans while experiencing controlled thermal pain or electric shocks, perform tasks, take taste tests, and complete questionnaires during one to two clinic visits over three years.

How Is the Trial Designed?

Group I: Substudy 5: healthy volunteers Experimental Treatment 2 Interventions

Participants experience both placebo and cue-based expectations within subjects

Group II: Substudy 4: healthy volunteers Experimental Treatment 1 Intervention

Participants are instructed to attend toward or away from the stimulus

Group III: Substudy 2: sugar group Experimental Treatment 1 Intervention

Participants learn about sugar outcomes through conditioning

Group IV: Substudy 2: salt group Experimental Treatment 1 Intervention

Participants learn about salt outcomes through conditioning

Group V: Substudy 2: heat group Experimental Treatment 1 Intervention

Participants learn about heat outcomes through conditioning

Group VI: Substudy 1: Uninstructed subjects Experimental Treatment 1 Intervention

Participants learn through experience

Group VII: Substudy 1: Instructed subjects Experimental Treatment 1 Intervention

Participants are instructed about outcomes

Group VIII: Substudy 3: healthy volunteers Active Control 1 Intervention

All participants experience all outcomes, within subjects designs

Who Is Running the Clinical Trial?

National Center for Complementary and Integrative Health (NCCIH)

Lead Sponsor

Trials

886

Recruited

677,000+

Published Research Related to This Trial

Open monitoring (OM) meditation techniques show promise in reducing both sensory and emotional aspects of pain, while focused attention (FA) practices are generally less effective for pain relief.

The neural mechanisms involved in OM suggest that practitioners can focus on pain while suppressing other thoughts, aligning with mindfulness principles, and there is potential for further exploration of compassion meditation as a pain management technique.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Meditative analgesia: the current state of the field. Grant, JA.[2022]

In a study of 153 healthy adults, both mindfulness and sham interventions led to improved pain outcomes compared to no treatment, indicating that any form of intervention can help reduce pain.

The belief in receiving mindfulness treatment significantly predicted increased pain tolerance, suggesting that expectancy and belief may be more influential in pain relief than the specific mindfulness techniques used.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How do placebo effects contribute to mindfulness-based analgesia? Probing acute pain effects and interactions using a randomized balanced placebo design. Davies, JN., Sharpe, L., Day, MA., et al.[2022]

Psychological interventions, such as mindfulness and cognitive coaching, can significantly influence analgesic requirements and improve patient outcomes in managing chronic or acute wound pain, suggesting a complementary role alongside traditional pain medications.

Recent systematic reviews indicate that these interventions may enhance patient experiences and clinical outcomes during and after surgical procedures, highlighting their potential effectiveness in pain management strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychological Methods of Managing Surgical Pain. Bolton, L.[2021]

Chronic pain patients who underwent cognitive treatment showed effective changes in their pain experience, indicating that cognitive strategies can help manage clinical pain.

The study suggests that pain can be viewed as a cognitive label for a general state of arousal, highlighting the importance of mental processes in pain perception.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reinterpretative cognitive strategies in chronic pain management. Blinchik, ER., Grzesiak, RC.[2011]

A pilot study involving 147 persistent pain patients tested a brief mindfulness-based intervention (MBI) and found it feasible to recruit participants, although there were no significant immediate effects on pain severity.

The MBI group reported greater 'usefulness' of the intervention at 1 week and improved pain self-efficacy at 1 month compared to the control group, suggesting potential long-term benefits of mindfulness practices for pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pilot randomised controlled trial of a brief mindfulness-based intervention for those with persistent pain. Howarth, A., Riaz, M., Perkins-Porras, L., et al.[2021]

Distraction techniques, which involve focusing on activities or thoughts other than pain, are effective strategies for pain management, as they help compete for attention against the sensation of pain.

While distraction is generally endorsed for acute pain relief, its effectiveness in chronic pain situations is less clear, suggesting that caution should be exercised when applying these techniques in long-term pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How does distraction work in the management of pain? Johnson, MH.[2022]

Relaxation training effectively reduced distress and verbally reported pain in individuals experiencing acute ischemic pain, while simple relaxation instructions did not show any significant benefits.

The attention-redirection technique was also effective in reducing pain as measured by cross-modality matching, suggesting that focusing attention away from pain can be a useful strategy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Relaxation training and cognitive redirection strategies in the treatment of acute pain. Clum, GA., Luscomb, RL., Scott, L.[2021]

Chronic pain patients with high intensity pain showed significantly impaired performance on attention-demanding tasks compared to those with low pain and normal controls, indicating that high pain levels can negatively affect cognitive function.

The study suggests that low intensity pain patients may cope better by quickly switching their attention between pain and tasks, highlighting the potential for attention-based coping strategies to help manage pain in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Chronic pain and distraction: an experimental investigation into the role of sustained and shifting attention in the processing of chronic persistent pain. Eccleston, C.[2019]

Retraining attentional bias towards neutral stimuli using a short stimulus duration (500 ms) significantly increased pain threshold and tolerance in pain-free volunteers compared to a placebo group.

In contrast, a longer stimulus duration (1250 ms) did not produce any beneficial effects on pain outcomes, indicating that shorter exposure times may be more effective for modifying pain responses.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Attentional bias modification for acute experimental pain: A randomized controlled trial of retraining early versus later attention on pain severity, threshold and tolerance. Bowler, JO., Bartholomew, KJ., Kellar, I., et al.[2018]

The study involved 103 undergraduate students and found that an attention training technique (ATT) reduced hypervigilance to pain-related words, suggesting it can alter cognitive processes related to pain perception.

Participants who received ATT reported pain less quickly than those who underwent progressive muscle relaxation, indicating that ATT may help in managing the initial response to pain, although it did not significantly change overall pain ratings or tolerance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of the effect of attention training and relaxation on responses to pain. Sharpe, L., Perry, NK., Rogers, P., et al.[2022]

A mental strategy that involves shifting attention from painful stimuli to self-generated, less painful images can help modulate the perception of pain intensity, as shown in a study with 18 pain-free participants.

The study found that this focus-and-orient strategy activates specific brain waves (P2, P3, N400, and P600) that correlate with reduced pain ratings, suggesting that maintaining sub-nociceptive images in working memory can effectively alter pain perception.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Orienting attention modulates pain perception: an ERP study. Chan, SC., Chan, CC., Kwan, AS., et al.[2022]

Long-term meditation practitioners experienced a significant reduction in the unpleasantness of pain during Open Monitoring meditation, suggesting that this technique enhances emotional regulation in response to pain.

Focused Attention meditation did not show any significant effects on pain perception, indicating that Open Monitoring may be a more effective approach for managing negative emotional responses to painful stimuli.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Differential effects on pain intensity and unpleasantness of two meditation practices. Perlman, DM., Salomons, TV., Davidson, RJ., et al.[2022]

Cognitive behavioural therapy (CBT) is the most effective psychological intervention for managing chronic pain, showing significant benefits in pain, mood, and disability for adults and adolescents.

Despite its effectiveness, the overall impact of psychological treatments for chronic pain is modest, indicating that while CBT can help, it may not be a complete solution on its own.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychological approaches to chronic pain management: evidence and challenges. Eccleston, C., Morley, SJ., Williams, AC.[2022]

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