Kutlu Kağan TÜRKARSLAN, Deniz Canel ÇINARBAŞ

Can conscious guilt feelings incite nocebo pain?

Objectives: Psychodynamically, chronic pain problems with no organic cause have been conceptualized as a punishment through physical pain for guilt feelings. This study aimed to investigate the effcts of conscious guilt feelings on nocebo pain responses and whether the resultant nocebo pain would affct conscious guilt feelings in the form of expiation through the pain. Methods: An experiment was conducted with 100 participants. There were two independent variables, which were guilt induction (guilt-no guilt) and nocebo manipulation (nocebo-no nocebo). Nocebo manipulation was done by telling the participants that they would receive electricity from an EEG cap. In addition, they watched a video in which a confederate imitates having pain during the procedure. There were two dependent variables, guilt feelings, and experienced pain. Guilt feelings were measured using Positive and Negative Affct Scale twice, once after guilt induction and once after nocebo pain manipulation. Subjective pain scores were measured by using a basic 0 to 10 visual pain scale, on which the participants reported how much pain they experienced. Results: The fidings revealed that only the main effct of nocebo was signifiant. Conclusion: The participants reported mild headaches in the absence of any physical stimulation after nocebo manipulations. The effct was observed in a standard laboratory environment. Non-physical nocebo pain induction could create pain, but conscious guilt induction did not increase the amount of reported nocebo pain, and resultant pain did not function as a punishment. Limitations and implications of the study were discussed.

Suçluluk duyguları nosebo ağrı tepkilerini güçlendirebilir mi?

Amaç: Organik sebepleri tespit edilemeyen kronik ağrı problemleri psikodinamik literatürde, kişinin fiziksel ağrıyı kullanarak hissettiği suçluluk duyguları sebebiyle kendisini cezalandırması orası olarak kavramsallaştırılmıştır. Bu çalışmanın amaçları bilinçli suçluluk duygularının nocebo ağrılarının oluşumu üzerindeki etkilerinin ve ortaya çıkan nocebo ağrılarının bilinçli suçluluk duyguları üzerindeki etkisinin incelemektir. Gereç ve Yöntem: Bu çalışmada deney 100 katılımcı ile yürütülmüştür. Çalışmanın suçluluk uyandırılması ve nocebo manipü- lasyonu olmak üzere iki bağımsız değişkeni vardır. Nocebo manipülasyonu katılımcılara başlarında taktıkları bir EEG şapkasından kendilerine elektrik verileceğinin söylenmesi ve ağrı çekiyormuş gibi taklit yapan bir katılımcının bu prosedürü gerçekleş- tirirken ki videosunun izletilmesiyle yapılmıştır. Çalışmanın bağımlı değişkenleri suçluluk duyguları ve nocebo manipülasyonu sonrası deneyimlenen ağrıdır. Suçluluk duygularını Pozitif ve Negatif Duygu Ölçeği kullanılarak ilk olarak suçluluk uyandırılması sonrası, daha sonra nocebo manipülasyonu sonrası iki kere ölçülmüştür. Suçluluk duyguları katılımcılara ne kadar ağrı hissettiklerini 0 ile 10 arasında göstermelerini isteyen basit görsel bir ölçekle ölçülmüştür. Bulgular: Yapılan analizler sonucu sadece nocebo değişkeninin ana etkisi anlamlı bulunmuştur. Sonuç: Katılımcılar herhangi bir fiziksel uyarıma maruz kalmadan hafif baş ağrısı deneyimlediklerini rapor etmişlerdir. Bu etki standart bir laboratuvar ortamında gözlemlenmiştir. Bilinçli suçluluk duygularının hissedilen nocebo ağrısını üzerinde anlamlı bir etkisi olmadığı bulunmuştur. Ayrıca ortaya çıkan nocebo ağrısı bir cezalandırma işlevi gördüğünü hipotezi de desteklenememiştir. Çalışmanın kısıtlılıkları ve implikasyonları tartışılmıştır

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1. Crook J, Tunks E, Rideout E, Browne G. Epidemiologic comparison of persistent pain suffrers in a specialty pain clinic and in the community. Arch Phys Med Rehabil 1986;67(7):451–5.

2. Andersson HI, Ejlertsson G, Leden I, Rosenberg C. Chronic pain in a geographically defied general population: studies of diffrences in age, gender, social class, and pain localization. Clin J Pain 1993;9(3):174–82.

3. Blyth FM, March LM, Brnabic AJ, Jorm LR, Williamson M, Cousins MJ. Chronic pain in Australia: a prevalence study. Pain 2001;89(2-3):127–34.

4. Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The prevalence of chronic pain in United States adults: results of an Internet-based survey. J Pain 2010;11(11):1230–9.

5. van Hecke O, Torrance N, Smith BH. Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013;111(1):13–8.

6. Erdine S, Hamzaoğlu O, Özkan Ö, Balta E, & Domac M. Pain prevalance among adults in Turkey. Ağrı, 2001;13(2):22–30.

7. Melzack R. Evolution of the neuromatrix theory of pain. The Prithvi Raj Lecture: presented at the third World Congress of World Institute of Pain, Barcelona 2004. Pain Pract 2005;5(2):85–94.

8. IASP. Guide to Pain Management in Low-Resource Settings. Traue HC, Jerg-Bretzke L, Pfigsten M, Hrabal V. Psychological Factors in Chronic Pain. Available at: http://ebooks. iasp-pain.org/guide_to_pain_management_in_low_resource_settings.

9. Mayou R. Medically unexplained physical symptoms. BMJ 1991;303(6802):534–5.

10. Engel GL. Psychogenic pain and pain-prone patient. Am J Med 1959;26(6):899–918.

11. Apkarian AV, Baliki MN, Geha PY. Towards a theory of chronic pain. Prog Neurobio. 2009;87(2):81–97.

12. Benedetti F, Lanotte M, Lopiano L, Colloca L. When words are painful: unraveling the mechanisms of the nocebo effect. Neuroscience 2007;147(2):260–71.

13. Data-Franco J, Berk M. The nocebo effct: a clinicians guide. Aust N Z J Psychiatry 2013;47(7):617–23.

14. Schweiger A, Parducci A. Nocebo: the psychologic induction of pain. Pavlov J Biol Sci 1981;16(3):140–3.

15. Johansen O, Brox J, Flaten MA. Placebo and Nocebo responses, cortisol, and circulating beta-endorphin. Psychosom Med 2003;65:786–90.

16. Colloca L, Sigaudo M, Benedetti F. The role of learning in nocebo and placebo effcts. Pain 2008;136(1-2):211–8.

17. Vögtle E, Barke A, Kröner-Herwig B. Nocebo hyperalgesia induced by social observational learning. Pain 2013;154(8):1427–33.

18. Jensen KB, Kaptchuk TJ, Kirsch I, Raicek J, Lindstrom KM, Berna C, et al. Nonconscious activation of placebo and nocebo pain responses. Proc Natl Acad Sci U S A 2012;109(39):15959–64.

19. Petersen GL, Finnerup NB, Colloca L, Amanzio M, Price DD, Jensen TS, Vase L. The magnitude of nocebo effcts in pain: a meta-analysis. Pain 2014;155(8):1426–34.

20. Benedetti F, Amanzio M, Casadio C, Oliaro A, Maggi G. Blockade of nocebo hyperalgesia by the cholecystokinin antagonist proglumide. Pain 1997;71(2):135–40.

21. Benedetti F, Amanzio M, Vighetti S, Asteggiano G. The biochemical and neuroendocrine bases of the hyperalgesic nocebo effct. J Neurosci 2006;26(46):12014–22.

22. Keltner JR, Furst A, Fan C, Redfern R, Inglis B, Fields HL. Isolating the modulatory effct of expectation on pain transmission: a functional magnetic resonance imaging study. J Neurosci 2006;26(16):4437–43.

23. Chua P, Krams M, Toni I, Passingham R, Dolan R. A functional anatomy of anticipatory anxiety. Neuroimage 1999;9(6 Pt 1):563–71.

24. Hsieh JC, Stone-Elander S, Ingvar M. Anticipatory coping of pain expressed in the human anterior cingulate cortex: a positron emission tomography study. Neurosci Lett 1999;262(1):61–4.

25. Tangney JP, Wagner P, Gramzow R. Proneness to shame, proneness to guilt, and psychopathology. J Abnorm Psychol 1992;101(3):469–78.

26. Breuer J, Freud S, Strachey J. Studies on hysteria. New York : Basic Books; 1957.

27. Blum A. Shame and guilt, misconceptions and controversies: A critical review of the literature. Traumatology 2008:14;91–102.

28. Freud S. The neuro-psychosis of defence. In: Strachey J, editor. The Standard Edition of the Complete Psychological Works of Sigmund Freud. New York: W.W. Norton & Company; 1976.

29. Freud S. The Ego and The Id. In: Phillips A, Reddick J, editors. Beyond the pleasure principle and other writings. London, England: Penguin Books; 2003.

30. Freud S. Some character types met in psycho-analytic work. In: Strachey J editor. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XIV (1914-1916): On the History of the Psycho-Analytic Movement, Papers on Metapsychology and Other Works. London, England: Hogard Press; 1957. p. 309–33.

31. Freud S. Civilization and its discontents. New York: W. W. Norton; 2010.

32. Bastian B, Jetten J, Fasoli F. Cleansing the soul by hurting the flsh: the guilt-reducing effct of pain. Psychol Sci 2011;22(3):334–5.

33. Nelissen RM. Guilt-induced self-punishment as a sign of remorse. Social Psychological and Personality Science 2012:3;139–44.

34. Mete HE, Noyan A, Sertöz ÖÖ. Psychosocial aspects of pain. Agri 2006;18(1):20–5.

35. Burns JW, Quartana PJ, Bruehl S. Anger inhibition and pain: conceptualizations, evidence and new directions. J Behav Med 2008;31(3):259–79.

36. Dersh J, Polatin PB, Gatchel RJ. Chronic pain and psychopathology: research fidings and theoretical considerations. Psychosom Med 2002;64(5):773–86.

37. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientifi advances and future directions. Psychol Bull 2007;133(4):581–624.

38. Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affct: the PANAS scales. J Pers Soc Psychol 1988;54(6):1063–70.

39. Gençöz, T. Pozitif ve negatif duygu ölçeği: Geçerlik ve güvenirlik çalışması. Türk Psiko Der 2000:15(46);19–6.

40. Englund CE, Reeves DL, Shingledecker CA, Thorne DR, Wilson KP, Hegge FW. Unifid Tri-Service Cognitive Performance Assessment Battery (UTC-PAB) I. Design and Specifiation of the Battery; Report No. 87-10. Naval Health Research Center, Naval Medical Research and Development Command; 1987.

41. Mayers A. Introduction to Statistics and SPSS in Psychology. Pearson; 2013.

42. Manikandan S. Data transformation. J Pharmacol Pharmacother 2010;1(2):126–7.

43. Spiegel H. Nocebo: the power of suggestibility. Prev Med 1997;26(5 Pt 1):616–21.

44. McCambridge J, de Bruin M, Witton J. The effcts of demand characteristics on research participant behaviours in non-laboratory settings: a systematic review. PLoS One 2012;7(6):e39116.

45. Blumer D, Heilbronn M. The pain-prone disorder: a clinical and psychological profie. Psychosomatics 1981;22(5):395– 7.

46. Quartana PJ, Burns JW. Painful consequences of anger suppression. Emotion 2007;7(2):400–14.

47. Villemure C, Bushnell MC. Cognitive modulation of pain: how do attention and emotion inflence pain processing? Pain 2002;95(3):195–9.

48. DeWall CN, Baumeister RF. Alone but feeling no pain: Effects of social exclusion on physical pain tolerance and pain threshold, affctive forecasting, and interpersonal empathy. J Pers Soc Psychol 2006;91(1):1–15.

49. Macdonald G, Leary MR. Why does social exclusion hurt? The relationship between social and physical pain. Psychol Bull 2005;131(2):202–23.

50. Baumeister RF, Stillwell AM, Heatherton TF. Guilt: an interpersonal approach. Psychol Bull. 1994;115(2):243-67.

51. Wong Y, Tsai T. Cultural models of shame and guilt. In: The Self-Conscious Emotions: Theory and Research. Guilford Press 2007:209–23.

52. Eisenberger NI, Lieberman MD, Williams KD. Does rejection hurt? An FMRI study of social exclusion. Science 2003;302(5643):290–2.

53. Foltz EL, White LE. The role of rostral cingulumotomy in “pain” relief. Int J Neurol 1968;6(3-4):353–73.

54. Rainville P, Duncan GH, Price DD, Carrier B, Bushnell MC. Pain affct encoded in human anterior cingulate but not somatosensory cortex. Science 1997;277(5328):968–71.

55. Jankowski KF, Takahashi H. Cognitive neuroscience of social emotions and implications for psychopathology: examining embarrassment, guilt, envy, and schadenfreude. Psychiatry Clin Neurosci 2014;68(5):319–36.

56. Strelan P. Who forgives others, themselves, and situations? The roles of narcissism, guilt, self-esteem, and agreeableness. Pers Individ Dif 2007;42:259–69.

57. Pennebaker JW. Expressive Writing in Psychological Science. Perspect Psychol Sci 2018;13(2):226–9.

58. Lepore SJ, Smyth JM. The Writing Cure, How Expressive Writing Promotes Health and Emotional Well-being. Amer Psychological Assn; 2002.

59. Rebega OL., Apostol L, Benga O, Miclea M. Inducing Guilt: A Literature Review. Procedia Soc Behav Sci 2013;78:536– 40.

60. Hancı V, İkiz B, Günenç E, Sangare M, Özbilgin Ş, Erkin Y, et al. An evaluation of the psychosocial characteristics of patients admitted to a pain clinic and their relatives. Agri 2015;27(3):143–8.

61. Tarakcı E, Zenginler Y, Kaya Mutlu E. Chronic pain, depression symptoms and daily living independency level among geriatrics in nursing home. Agri 2015;27(1):35–41.

62. Güleç G, Güleç S. Pain and pain behavior. Agri 2006;18(4):5– 9.

63. Katon W, Egan K, Miller D. Chronic pain: lifetime psychiatric diagnoses and family history. Am J Psychiatry 1985;142(10):1156–60.

64. Magni G, Moreschi C, Rigatti-Luchini S, Merskey H. Prospective study on the relationship between depressive symptoms and chronic musculoskeletal pain. Pain 1994;56(3):289–97.

65. Green S, Lambon Ralph MA, Moll J, Deakin JF, Zahn R. Guiltselective functional disconnection of anterior temporal and subgenual cortices in major depressive disorder. Arch Gen Psychiatry 2012;69(10):1014–21.

66. Rhudy JL., Meagher MW. The role of emotion in pain modulation. Current Opinion in Psychiatry 2001;14(3):241–5.