Background Preoperative anxiety (prevalent in 60-80% in adult patients) describes an unpleasant state of tension resulting from a patient's doubts or fears before surgery, and may play an important...Show moreBackground Preoperative anxiety (prevalent in 60-80% in adult patients) describes an unpleasant state of tension resulting from a patient's doubts or fears before surgery, and may play an important role in one’s anesthetic preference, as anesthesia seemed to be the main cause of preoperative anxiety (62%) rather than the surgery (15%). Preoperative anxiety was associated with increased complications during the preoperative and postoperative period, thus implies the importance of reducing this anxiety while examining anesthetic choice. Aim To examine the role of preoperative anxiety (in the form of fear of needles, fear of pain and fear of losing control) in a patient’s preference in anesthetic choice between general (GA) or spinal anesthesia (SA), after the patient is adequately educated on the risks and benefits of both techniques. Hypotheses included that if the patient has a higher fear of needles, a higher fear of pain, an external health locus of control (HLC) or a high degree of trust in physicians, the patient will prefer GA over SA. Method This prospective exploratory study examined fear of needles, fear of pain and fear of losing control using several questionnaires: Injection Phobia Scale-Short Form (IPS-SF), Fear of Pain Questionnaire-9 (FPQ-9), Multidimensional Health Locus of Control Scale (MHLC) and Amsterdam Preoperative Anxiety and Information Scale (APAIS). Patients of preoperative anesthesiology outpatient clinic (N = 484) of Albert Sweitzer participated and twelve binary logistic regression analyses were executed. Results 68.8% of participants preferred GA over SA. IPS-SF (OR 0.91 (95% CI 0.85-0.96, p<0.001), FPQ-9 (OR 0.94 (95% CI 0.91-0.98), p=0.006), and physician scale of MHLC (OR 0.94 (95% CI 0.90-0.98), p=0.007) reported to be statistically significant associated with anesthesia. Discussion Fear of needles, fear of pain and trust in physicians played a significant role in a patient’s anesthetic preference. Suggestions for future research include reassessment of the used information videos, specify study inclusion to those who could choose their anesthetic and inclusion of detailed information of a patient’s previous anesthetic experience. This study also highlighted the importance of health care professionals and their efforts to reassure the patient in minimizing preoperative anxiety on an educational level and implementing interventions specifically aimed at fear of needles and fear of pain.Show less
Introduction: Parkinson’s Disease (PD) is a neurodegenerative, progressive motor disorder. Receiving this diagnosis can be impactful for patients. PD patients have reported dissatisfaction with the...Show moreIntroduction: Parkinson’s Disease (PD) is a neurodegenerative, progressive motor disorder. Receiving this diagnosis can be impactful for patients. PD patients have reported dissatisfaction with the diagnostic process, which may partly result from a perceived lack of active involvement during medical decision-making. Neurologists are expected to inform and involve patients based on the ethical imperative of patient autonomy. Yet, insight into how medical decisions are actually made is scarce, particularly which types of medical decisions, the extent of patient involvement, and how this affects their satisfaction. This study aimed to get more insight into medical decision-making by observing PD diagnostic consultations in current clinical practice. Hypotheses: Firstly, it was expected that medical decisions were related to topics such as follow-up appointments and PD medication (H1). Secondly, it was expected that the level of patient involvement was low during PD diagnostic consultations (H2). Thirdly, it was hypothesized that patient involvement and overall satisfaction were positively associated (H3). Fourthly, it was hypothesized that female, younger, and more highly educated patients were more substantially involved compared to male, older, and more lowly educated patients (H4, H5 & H6). Methods: This prospective longitudinal study used both quantitative (i.e., questionnaires, structured observational coding) and qualitative (i.e., explorative observational coding) data. PD patients (N=12) visiting neurology outpatient departments in the Netherlands were included upon referral. Diagnostic consultations were video-recorded and patients filled in questionnaires. Types of medical decisions were identified using an adapted existing coding scheme. The observed level of involvement was scored using the OPTION-12 for the most frequently and crucial occurring medical decision. Patients’ overall satisfaction with their consultations was measured six weeks after their last consultation. Statistical analyses included non-parametric tests and multiple regressions. Results: Topics of medical decisions most frequently concerned: follow-up appointments, PD medication and diagnostic testing. Patient involvement was low (M = 9.8; 0-100), indicating that neurologists exhibited few attempts to involve patients during medical decisions about PD medication. Patient involvement was not predictive for patients’ overall satisfaction (p = .23), nor did patients’ demographic characteristics predict the level of patient involvement (p = .29). Conclusion: Medical decisions during PD diagnostic consultations mainly pertained to follow-up appointments, diagnostic testing, and PD medication. PD patients are rarely involved in decisions about PD medication. These results should be interpreted with caution due to a small sample. We recommend repeating this study with a larger sample and investigating what neurologists think is necessary and feasible in terms of patient involvement for the various identified types of medical decisions.Show less
Chronische pijn gaat vaak gepaard met stress gerelateerde klachten. Eerdere studies hebben gevonden dat subjectieve stress gerelateerd is aan pijngevoeligheid in zowel de gezonde als klinische...Show moreChronische pijn gaat vaak gepaard met stress gerelateerde klachten. Eerdere studies hebben gevonden dat subjectieve stress gerelateerd is aan pijngevoeligheid in zowel de gezonde als klinische populatie. In deze studie is onderzoek gedaan naar de relatie tussen subjectieve stress, pijntolerantie en pijndrempel. Voor het eerst werden deze relaties onderzocht door pijn aan te brengen middels een cold pressor test. Pijndrempel werd gemeten als de tijd in seconden totdat het pijn deed en pijntolerantie werd gemeten als tijd in seconden totdat de participant de pijn niet meer kon verdragen. Subjectieve stress is gemeten met vragen over huidige stress. De eerste hypothese was dat er een negatieve relatie is tussen subjectieve stress en pijntolerantie. De tweede hypothese was dat er een negatieve relatie is tussen subjectieve stress en pijndrempel. De huidige studie is uitgevoerd op gezonde vrijwilligers (N = 38) tussen 18 en 26 jaar. Er is een significante negatieve relatie gevonden tussen subjectieve stress en pijntolerantie (τ = -.25, p = .015), maar geen relatie tussen subjectieve stress en pijndrempel (τ = -.07, p = .269). In lijn met de eerste hypothese is er een negatieve relatie gevonden tussen subjectieve stress en pijntolerantie. Tegenstrijdig met de tweede hypothese is er geen relatie tussen subjectieve stress en pijndrempel. In nader onderzoek zou de focus gelegd kunnen worden op hoe we de huidige kennis over subjectieve stress en pijngevoeligheid kunnen toepassen, met het doel om zowel stress als pijn te verminderen.Show less
To improve treatments for patients with chronic pain, research into the experience of pain is valuable. Several factors have been found to influence pain experience, including self-efficacy and...Show moreTo improve treatments for patients with chronic pain, research into the experience of pain is valuable. Several factors have been found to influence pain experience, including self-efficacy and fear of pain. Researching relations between these factors and pain tolerance might contribute to an improvement of pain treatments. This study aimed to answer two research questions regarding this topic: “Does self-efficacy influence pain tolerance?” and “Does fear of pain influence this relation?”. The first hypothesis was that self-efficacy would influence pain tolerance. The second hypothesis was that the relation between self-efficacy and pain tolerance would be mediated by fear of pain. The study was performed on 38 healthy participants between the ages of 16 and 35 years old. Self-efficacy was manipulated using verbal suggestions, pain tolerance was measured using a Cold-Pressor Test, and fear of pain was measured using the Fear of Pain Questionnaire III. This study found no significant effect of self-efficacy on pain tolerance (p = .784), and no significant effect of fear of pain on the relation between self-efficacy and pain tolerance (Effect = 6.78, 95% C. I. (-7.56, 26.30). Therefore, the hypotheses for this study were not confirmed, which could imply that self efficacy and fear of pain might not be targets for treatment. Strengths and limitations of this study were presented in the discussion. Future research could focus on the effects of factors such as gender on pain tolerance, on methods of manipulating self-efficacy, and on the relation between fear of pain and pain tolerance.Show less
Pain catastrophizing, which is an exaggerated negative mental state during actual pain or the expectation of pain, has shown to contribute to a more intense pain response and to increase emotional...Show morePain catastrophizing, which is an exaggerated negative mental state during actual pain or the expectation of pain, has shown to contribute to a more intense pain response and to increase emotional distress, but the literature on the topic is inconsistent. The present study aimed to establish whether higher levels of pain catastrophizing are related to lower levels of pain tolerance. This study tested the hypothesis that pain catastrophizing is negatively predicting pain tolerance in an experimental setting with healthy participants. Thirty-eight healthy participants, including 26 women, participated in this study. Pain catastrophizing was measured with the Pain Catastrophizing Scale (PCS), while pain tolerance was measured with the Cold Pressor Test (CPT), which was used to induce experimental pain. Simple linear regression analysis showed that the PCS-score did not significantly predict pain tolerance, F(1, 36) = 3.95, p = .055, which led to rejection of the predefined hypothesis. It is advised to further research the relation between pain catastrophizing and pain tolerance, while minimalizing the effects of other variables, for example weight. In addition, it might be useful to do more research on how pain catastrophizing distinguishes itself from other mood-related concepts, such as anxiety, or more cognition based concepts, such as worrying. More research on pain catastrophizing might be beneficial when evaluating strategies for pain management. It could give more insight into which factors to focus on when improving pain management interventions.Show less
Eerdere onderzoeken hebben aangetoond dat positieve psychologische factoren pijn kunnen verlagen. Deze studie onderzocht of zelfeffectiviteit en optimisme pijntolerantie verhogen, om te bepalen of...Show moreEerdere onderzoeken hebben aangetoond dat positieve psychologische factoren pijn kunnen verlagen. Deze studie onderzocht of zelfeffectiviteit en optimisme pijntolerantie verhogen, om te bepalen of het bij pijnbehandelingen waardevol is om op deze factoren te focussen. De onderzoeksvragen waren “Is pijntolerantie verschillend voor mensen met een hoge en een lage zelfeffectiviteit?” en “Wordt dit verschil gemedieerd door optimisme?”. Er werd verondersteld dat mensen met hoge zelfeffectiviteit een hogere pijntolerantie hadden dan mensen met lage zelfeffectiviteit. Verder werd een mediatie door optimisme verondersteld, waarbij hoge niveaus van optimisme het verschil in pijntolerantie tussen mensen met hoge en lage zelfeffectiviteit zouden versterken. Dit is onderzocht bij gezonde participanten (n = 38) in de leeftijdscategorie 16-35 jaar. Zelfeffectiviteit werd verbaal gemanipuleerd, pijntolerantie werd gemeten met de cold pressor task (CPT) en optimisme werd gemeten met de Life Orientation Test-Revised (LOT-R). Uit de Mann Whitney U toets bleek dat er geen significant verschil was in pijntolerantie voor mensen met hoge en lage zelfeffectiviteit (p = .784). Uit de mediatieanalyse, uitgevoerd met Process macro, bleek dat er geen mediatie was door optimisme (Effect = 13.17, 95% CI [-9.61, 38.33]). Deze bevindingen kwamen niet overeen met de veronderstellingen. Al met al kan uit deze studie niet worden geconcludeerd dat manipulatie van zelfeffectiviteit pijntolerantie beïnvloedt en dat zelfeffectiviteit en optimisme een gecombineerde invloed hebben op pijntolerantie. Toekomstige studies kunnen deze mediatie opnieuw onderzoeken met een grotere steekproef en geslacht als extra variabele. Bovendien kan onderzoek worden gedaan naar manipulatiemethoden voor zelfeffectiviteit en de relatie tussen optimisme en pijntolerantie.Show less
Geslachtsverschillen in reactie op experimentele pijnstimuli worden steeds vaker in de literatuur beschreven, waarbij vrouwen over het algemeen een lagere pijntolerantie vertonen dan mannen. Een...Show moreGeslachtsverschillen in reactie op experimentele pijnstimuli worden steeds vaker in de literatuur beschreven, waarbij vrouwen over het algemeen een lagere pijntolerantie vertonen dan mannen. Een psychologisch construct die deze geslachtsverschillen in pijntolerantie zou kunnen verklaren, is zelfeffectiviteit. Voorgaand onderzoek suggereert namelijk dat een hogere mate van zelfeffectiviteit kan zorgen voor een hogere pijntolerantie, maar dat deze relatie anders is afhankelijk van geslacht. Het huidige onderzoek heeft deze hypothese onderzocht door middel van een zelfeffectiviteit manipulatie, waarbij willekeurig aan 26 vrouwen en 12 mannen werd gesuggereerd dat zij wel (hoge zelfeffectiviteit conditie) of niet (lage zelfeffectiviteit conditie) goed met stressvolle stimuli konden omgaan. Er werd verwacht dat een hogere mate van zelfeffectiviteit voor een hogere pijntolerantie zorgt en dat dit effect groter is bij mannen dan bij vrouwen. Hiernaast werd verwacht dat mannen een hogere pijntolerantie hebben dan vrouwen. Pijntolerantie is gemeten met de Cold Pressor Test (CPT). De hypotheses zijn getoetst met een tweeweg ANOVA. De resultaten hebben niet kunnen aantonen dat een hogere mate van zelfeffectiviteit voor een hogere pijntolerantie zorgt (p = .876) en dat dit effect groter is bij mannen dan bij vrouwen (p = .780). Het bleek wel dat mannen een hogere pijntolerantie hadden dan vrouwen (p = .006). Er is voorgesteld om in vervolgonderzoek te onderzoeken of een op gender-gerichte zelfeffectiviteit manipulatie wellicht voor andere resultaten zorgt. De resultaten van het huidige onderzoek, samen met die van vervolgonderzoek, kunnen meer informatie leveren voor het ontwikkelen van pijn-interventies gericht op zelfeffectiviteit, zodat de geslachtsongelijkheid in pijn wellicht kan worden verkleind.Show less
Pain represents a significant problem in modern society. Personality factors have been suggested to play a role in the experience of pain, though much remains unknown about this relationship, with...Show morePain represents a significant problem in modern society. Personality factors have been suggested to play a role in the experience of pain, though much remains unknown about this relationship, with many previous studies yielding somewhat contradictory results. This study looks at the influence of neuroticism on pain tolerance specifically. It was hypothesized that neuroticism scores would be negatively associated with tolerance times. Participants in this study were 38 healthy students between 18 and 26 years old. Neuroticism was measured using the revised short-form Eysenck personality questionnaire and pain tolerance was measured using the cold pressor test. Participants submerged their hand in cold water for as long as they could. This time was recorded as the pain tolerance. The assumptions of a linear regressions were violated, so a logistic regression was used instead with neuroticism scores as the independent variable and pain tolerance times as the dependent variable. To transform pain tolerance times into a dichotomous variable that could be used in logistic regression, tolerance times were divided into a high and a low category split at the median score. Analysis revealed a significant association between neuroticism and pain tolerance (p = .030), with individuals who score higher in neuroticism exhibiting lower tolerance for pain. The model managed to explain approximately 13% of the variance in tolerance times based on neuroticism scores. This finding may prove useful in the development of individualized interventions for chronic pain, by providing valuable information on how individual characteristics contribute to the experience of pain.Show less
Research on the neural processing of reward and punishment thus far has indicated the complex and constant role it plays in decision making and behaviour. Current findings suggest that an action...Show moreResearch on the neural processing of reward and punishment thus far has indicated the complex and constant role it plays in decision making and behaviour. Current findings suggest that an action can be incentivised by the desire to avoid punishment as well to gain reward. A means of gauging how effective a financial incentive is to motivate behaviour is via the neural response it elicits using EEG data. This study uses the Monetary Incentive Delay task (MIDt) to examine financial incentive-driven behavior. Due to loss aversion, we expected a greater neural response (feedback related negatively; FRN), in punishing conditions where money is lost compared to reward or control where it is not. We investigate how reward and punishment sensitivity of the participant could moderate this relationship between FRN and the type of incentive, assuming that higher punishment sensitivity will predict an increased FRN amplitude generated in the punishment compared to reward conditions. This thesis is a preliminary analysis, involving university students with no substance abuse or problematic gambling histories (N = 21) that complete the MIDt while EEG was being recorded. The short Sensitivity to Punishment and Sensitivity to Reward Questionnaire was administered pre-experiment and all money earned during the MIDt was awarded to the participants upon completion. Data was analyzed using repeated measures ANOVA, with contrasts as follows: control vs gain; control vs loss; gain vs loss. A moderation analysis was run of punishment/reward sensitivity (SP/SR) on gain versus loss with FRN amplitude as outcome using PROCESS in SPSS. Data is still being obtained at this point in time to achieve necessary power for this study. This is potentially why our preliminary results were non-significant for our hypotheses. However, the trends shown in the FRN absolute values indicate a greater neural response in punishment conditions where money is lost compared to either the reward or neutral counterparts. Additional analysis is required to fully ascertain how punishment and reward sensitivity impact the neural correlates of financial incentives and how this finding can be applied when using such incentives practically.Show less
