Percorrer por autor "Agostinho, Mariana"
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- Disentangling interoception and its links to cognitive functioning in fibromyalgiaPublication . Agostinho, Mariana; Capelas, Manuel Luís; Pimentel-Santos, Fernando Manuel; Canaipa, RitaPatients with fibromyalgia experience pain, cognitive dysfunction, and atypical interoception. However, it is still unclear whether the changes in interoceptive processes have consequences in managing cognitive tasks. The current study investigates the relationship between interoception and cognition in fibromyalgia. Twenty-nine fibromyalgia patients completed clinical questionnaires, the Digit-span, and the Stroop test. Interoceptive Accuracy (IAc) was measured by the heartbeat detection task, Interoceptive Awareness (IAw) via confidence ratings, and Interoceptive Sensibility (IS) via the Multidimensional Assessment of Interoceptive Awareness questionnaire. IAc was found to be positively associated with Digit-span forward (p = 0.008), total (p = 0.004), and Stroop scores (all p ? 0.045). IS correlated negatively with Digit-span backward (p ? 0. ? 0.022) while IAw was negatively associated with Digit-span forward (p ? 0.034), total (p ? 0.008), and Stroop scores (all p ? 0.038). Moderation analysis revealed that IAc predicts Digit-span backward as symptom severity increases (p = 0.045). Despite the absence of a control group, this study provides evidence of the detailed relationships between interoception and cognitive abilities in fibromyalgia. While detecting and efficiently using body signals may be an essential tool for self-regulation in managing cognitive tasks, a higher ability to regulate body signals may exhaust cognition and predispose the patients to lower cognitive performance.
- En pointe: dancers report their pain less variably than do controlsPublication . Canaipa, Rita; Mendonça, Diogo; Agostinho, Mariana; Nascimento, Vanda; Honigman, Liat; Treister, RoiThe 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.
- Expectations, conditioning, and the placebo effect do not differ between fibromyalgia patients and healthy controls but might be differently associatedPublication . Emergui, Galia; Agostinho, Mariana; Canaipa, Rita; Treister, RoiIntroduction: Individuals with chronic pain such as fibromyalgia (FM) are often experiencing disappointing outcomes from clinical therapies, which theoretically should condition them to experience low placebo analgesia. However, no consistent differences in the placebo effect were found between healthy controls (HC) and chronic pain patients. This study examined the expectations, conditioning, and placebo effect in HC and FM, and the relationships between these factors in both groups. Methods: Female HC and FM patients were recruited, provided demographic and clinical information and underwent the experimental placebo paradigm. This paradigm has the advantage of measuring expectations (baseline, reinforced, and after placebo), conditioning, and placebo effect. Mixed factorial ANCOVAs, correlational analysis, stepwise and moderation regression analysis were employed. Results: Thirty-seven HC and 32 FM patients participated. Three Mixed factorial ANCOVAs showed no main effects of group or interactions for expectations (p = .692), conditioning (p = .357), or placebo effect (p = .819). Reinforced expectations predicted the conditioning strength (r = .48, p = .008) and placebo effect (r = .44, p = .014) in HC but not in FM participants. In FM, duration of pain predicted the reinforced expectations (r = −.38, p = .035) and moderated the prediction of the placebo effect by the conditioning strength (b = .04, p = .011). Conclusion: While the classical placebo theorem is supported in healthy controls, with conditioning influencing expectations, which in turn predict the placebo effect, these associations are not observed in fibromyalgia, where prior clinical experience plays a more significant role. These findings underscore the impact of previous negative clinical experiences on the placebo effect and, possibly, on responses to effective treatments.
- Is anxiety related to higher vulnerability to a body illusion? Results from the classical rubber hand illusion paradigmPublication . Santos, Duarte; Agostinho, Mariana; Canaipa, Rita
- No relationships between the within-subjects' variability of pain intensity reports and variability of other bodily sensations reportsPublication . Agostinho, Mariana; Canaipa, Rita; Honigman, Liat; Treister, RoiPurpose: The subjective nature of pain assessment and its large variance negatively affect patient-health care provider communication and reduce the assay sensitivity of pain clinical trials. Given the lack of an objective gold standard measure, identifying the source (true or error) of the within-subject variability of pain reports is a challenge. By assessing the within-subjects variability of pain and taste reports, alongside with interoceptive measures, the current study is aimed to investigate if the ability to reliably report bodily sensations is a cross-modal characteristic. Patients and Methods: This prospective study enrolled healthy volunteers from local universities. After consenting, subjects underwent the Focus Analgesia Selection Task (FAST), to assess within-subjects variability of pain reports in response to experimental noxious stimuli; a taste task, which similarly assesses within-subjects variability of tastes (salty and sweet) intensity reports; and the heartbeat perception task, an interoceptive task aimed to assess how accurate subjects are in monitoring and reporting their own heartbeat. In addition, all subjects completed the Multidimensional Assessment of Interoceptive Awareness (MAIA), the Perceived Stress Scale (PSS), and Hospital Anxiety and Depression Scale (HADS). Spearman's correlations were used to assess relations between all measures. Results: Sixty healthy volunteers were recruited. Variability of intensity reports of different modalities were independent of each other (P > 0.05 for all correlations). The only correlation found was within modality, between variability of intensity reports of salt and sweet tastes (Spearman's r = 0.477, P < 0.001). No correlations were found between any of the task results and questionnaire results. Conclusion: Within-subjects variability of pain reports do not relate to variability of reports of other modalities or to interoceptive awareness. Further research is ongoing to investigate the clinical relevance of within-subjects' variability of pain reports.
- The prediction of the analgesic placebo effect is moderated by direction of attention: results from fibromyalgia and healthy controlsPublication . Agostinho, Mariana; Emergui, Galia; Canaipa, Rita; Treister, RoiDespite 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.
- Relations between short-term memory and the within-subject variability of experimental pain intensity reportsPublication . Canaipa, Rita; Khallouf, Amira; Magalhães, Ana Rita; Teodoro, Rafael; Pão-Mole, Vanessa; Agostinho, Mariana; Pimentel-Santos, Fernando; Honigman, Liat; Treister, RoiWhile 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.
- Reliability of the within-subjects variability of pain reports as assessed by the focused analgesia selection test (fast)Publication . Agostinho, Mariana; Shehab, Ons; Hidjazi, Sondos; Canaipa, Rita; Treister, Roi
- Test-retest and interrater reliability of experimental within-subject variability of pain reports as assessed by the focused analgesia selection testPublication . Agostinho, Mariana; Shani, Adi; Canaipa, Rita; Treister, RoiIntroduction: Within-subject variability (WSV) of pain intensity reports has been shown to predict the placebo response. The focused analgesia selection test (FAST), which allows to experimentally assess WSV of pain reports, has been used as a screening tool to identify participants who are likely to have a strong placebo response in drug-development clinical trials. Yet, the reliability of FAST has not been reported. Objectives: To assess test–retest and interrater reliability of the FAST outcomes. To mimic pharma-sponsored clinical trials, we enlisted inexperienced assessors who underwent limited training. Methods: Healthy volunteers performed the FAST twice within a week and were randomly assigned to either the test–retest group or the interrater group. T-tests, partial Pearson correlations, intraclass correlations (ICC), and Bland–Altman plots were generated to assess FAST outcomes’ reliability. Results: Sixty-three participants completed the study and were assigned to the test–retest (N 5 33) or interrater (N 5 30) arms. No statistically significant differences in the FAST outcomes were detected between the 2 sessions, except for the FAST covariance (FAST CoV) in the interrater assessment (P 5 0.009). Test–retest reliabilities of the FAST-main outcomes were r 5 0.461, ICC 5 0.385 for the FAST R2 and r 5 0.605, ICC 5 0.539 for the FAST ICC and in the interrater cohort, they were FAST R2 : r 5 0.321, ICC 5 0.337 and FAST ICC: r 5 0.355, ICC 5 0.330. Conclusion: Using inexperienced assessors, the FAST outcomes test–retest ranged from moderate to strong, whereas the interrater reliability ranged from weak to poor. These results highlight the importance of adequately training study staff members before using this tool in multicentre clinical trials.
- The power of a good word: enhancing the efficacy of analgesics in clinical settingsPublication . Treister, Roi; Cohen, Vered; Issa, Limor; Wiegler, Karine Beiruti; Izakson, Alexander; Agostinho, MarianaIntroduction: Communication between medical staff and patients about treatment efficacy elicits expectations of benefit and improves treatment outcomes. While demonstrated in multiple studies via different research methodologies, uniform communication protocols have not been adopted in clinical practice. Here, we summarize the results of two sister studies aimed at bridging this gap. Methods: Women undergoing C-section (study 1, randomized controlled trial) and patients undergoing general or otolaryngologic surgeries (study 2, control group design) were recruited and assigned to the “regular communication” (RC) or “enhanced communication” (EC) arms. The EC arm received positive information about treatment, while the RC arm received no such information. In both studies, the primary outcome was change in pain intensity; in study 2, an additional outcome was morphine consumption. Results: Eighty women successfully completed study 1, and 102 patients successfully completed study 2. In both studies, significant time*group interactions were observed (p < 0.001). The analgesic effect was virtually twice as large in the EC arm compared to the RC arm. In study 2, in the last two timepoints of assessment, participants in the EC arm also consumed fewer doses of opioids than participants in the RC arm (p < 0.001). No significant differences were found in vital signs. Conclusions: We provide ecological evidence that positive information about treatment significantly decreases pain and opioid consumption during routine clinical care. This study and others could encourage healthcare providers to harness the powerful effects of patients’ expectations of benefit to improve analgesics outcomes and, potentially, the outcomes of other symptoms.