Mindfulness intervention effect on endometriosis-related pain dimensions and its mediator role on stress and vitality: a path analysis approach.

Endometriosis-related pain is supposedly mainly responsible for generating psychological stress and deteriorating the quality of life. However, the interaction between these factors has not been investigated, considering its multidimensional nature and through the path of effects of psychosocial approaches. The present study aims to investigate the effect of a brief mindfulness-based intervention (bMBI) on pain dimensions and its mediator role on psychological stress and QoL-Vitality improvement. A secondary analysis of a pilot randomized controlled trial using a series of parallel and serial mediators was carried out. The results showed that bMBI improves the sensory (B = -6.09 [-9.81, -2.52], ß = -0.42) and affective (B = -3.40 [-5.02, -1.80], ß = -0.47) pain. The bMBI effect on psychological stress reduction was mediated by these changes in sensory (B = -2.81 [-6.06, -0.41], ß = -0.21) and affective (B = -1.97 [-5.07, -0.17], ß = -0.15) pain. Serial sensory pain and psychological stress reduction (B = 2.27 [0.11, 5.81], ß = -0.09) mediated the bMBI effect on quality of life vitality. Meditation training promotes additional improvement in affective and sensory pain characteristics through which psychological stress is reduced. The sensory pain dimension must be positively impacted in combination with psychological stress for the bMBI improves women's vitality. Adding a psychosocial intervention like meditation training to the standard treatment plan may be required for some women to achieve the needed changes to restore well-being.

Cognitive-affective changes mediate the mindfulness-based intervention effect on endometriosis-related pain and mental health: A path analysis approach.

BACKGROUND: There is poor knowledge about the therapeutic mechanisms of the conservative interventions for endometriosis. We hypothesized that the effects of a brief mindfulness-based intervention (bMBI) on pelvic pain intensity (PPI), pain unpleasantness (PU) and quality of life mental health (QoL-MH) are mediated by direct and indirect paths of changes in pain catastrophizing (PC), positive affect (PA) and negative affect (NA). METHODS: A secondary analysis of a pilot randomized controlled trial of women with endometriosis, assigned to standard medical treatment (n = 32) and standard medical treatment plus bMBI (n = 31). We tested a series of parallel and serial mediators (PC, PA and NA) of the relationship between bMBI and outcomes (PPI, PU and QoL-MH). RESULTS: The bMBI group demonstrated improvement in PA (Cohen's f2 = 0.12 [0.01, 0.36]), decreases in NA (Cohen's f2 = 0.06 [0.00, 0.24]) and PC (Cohen's f2 = 0.16 [0.02, 0.42]). The PC reduction mediated the effect of the bMBI on PPI and PU directly; however, the PC effect through PA increase mediated the PU marginally but not PPI changes. bMBI effect on Qol-MH was mediated directly by PA and NA. The PC improved Qol-MH through PA increase and Pain decrease but not via NA. CONCLUSIONS: Our findings showed that bMBI impacts pain through changes in pain-related cognitive-affective factors. bMBI can improve QoL-MH by multiple pathways, including but not limited to pain reduction, highlighting the independent potential of improvement in affect to restore mental health in endometriosis. SIGNIFICANCE: Brief mindfulness-based intervention improves endometriosis pain through pain-related cognitive-affective factors and quality of life mental health via pain and affect changes unrelated to pain.

Obliviate! Reviewing Neural Fundamentals of Intentional Forgetting from a Meta-Analytic Perspective.

Intentional forgetting (IF) is an important adaptive mechanism necessary for correct memory functioning, optimal psychological wellbeing, and appropriate daily performance. Due to its complexity, the neuropsychological processes that give birth to successful intentional forgetting are not yet clearly known. In this study, we used two different meta-analytic algorithms, Activation Likelihood Estimation (ALE) & Latent Dirichlet Allocation (LDA) to quantitatively assess the neural correlates of IF and to evaluate the degree of compatibility between the proposed neurobiological models and the existing brain imaging data. We found that IF involves the interaction of two networks, the main "core regions" consisting of a primarily right-lateralized frontal-parietal circuit that is activated irrespective of the paradigm used and sample characteristics and a second less constrained "supportive network" that involves frontal-hippocampal interactions when IF takes place. Additionally, our results support the validity of the inhibitory or thought suppression hypothesis. The presence of a neural signature of IF that is stable regardless of experimental paradigms is a promising finding that may open new venues for the development of effective clinical interventions.

A single-blind, randomized, pilot study of a brief mindfulness-based intervention for the endometriosis-related pain management.

BACKGROUND: Women with endometriosis suffer from frequent symptoms despite multiple treatments in tertiary care. Although there is a need for a biopsychosocial perspective on endometriosis treatment, few conservative treatments have been investigated. We aimed to investigate the effects of a brief Mindfulness-Based Intervention (bMBI) in women with deep endometriosis who remain symptomatic despite undergoing conventional medical treatment. METHODS: A randomized controlled trial was performed with two groups: a standard medical treatment plus bMBI program and only standard medical treatment as a control. A total of 63 eligible participants were randomized to bMBI and control groups. The primary outcome was endometriosis-related pain, and secondary outcomes were quality of life and stress perception post-treatment. Analyses were carried out using multiple regression models. RESULTS: The results show that bMBI significantly improved pain unpleasantness (Cohen's f2  = 0.67, NNT = 3.2), pelvic pain (Cohen's f2  = 0.16, NNT = 5.3) and dyschezia (Cohen's f2  = 0.23, NNT = 2.9) immediately post-treatment and decreased all endometriosis-related pain (Cohen's f2 ranging from 0.20 to 0.60 and NNT ranging from 5 to -9) after the follow-up. We found an extensive positive effect of bMBI on the mental health dimension in the two time point measures (Cohen's f2  = 0.34 and 0.25, NNT = 3.5 and 2.3) and vitality (Cohen's f2  = 0.22, NNT = 2.1) after the follow-up. CONCLUSIONS: Our study suggests that bMBI is useful for managing endometriosis-related pain and restoring women's psychological well-being. SIGNIFICANCE: Brief Mindfulness-Based Intervention (bMBI) improved endometriosis-related pain and mental health compared to standard medical care. The present findings contribute to the applicability of MBI in visceral pain patients.

Association between severity of pain, perceived stress and vagally-mediated heart rate variability in women with endometriosis.

Chronic pelvic pain is the main symptom in women with endometriosis. Evidence suggests that psychological stress and autonomic regulation contribute to symptoms and pathophysiological modulation. We investigated the relationship between endometriosis-related pain severity, perceived stress, and autonomic balance in a sample of 81 women suffering chronic pelvic pain with deep endometriosis. Perceived stress and pelvic pain symptoms were assessed using the 10-item version of the Perceived Stress Scale (PSS-10) and the Numeric Pain Rating Scale (NPRS), respectively. Autonomic nervous system regulation was evaluated using vagally mediated components of the heart rate variability (vmHRV). Our results showed that pain unpleasantness and perceived stress were positively correlated, and women with mood disorders had higher perceived stress. The women with low resting vmHRV experience more intense pelvic pain, pain unpleasantness, and a higher number of severe endometriosis-related pain descriptors. The positive association between perceived stress, mood disorder, and pain unpleasantness demonstrates the additive effect between these aversive experiences. The inverse association between parasympathetic tone and pain suggests contributions of the Descending Inhibitory Pain pathway efficiency to symptom severity in women with endometriosis.

Application of long-interval paired-pulse transcranial magnetic stimulation to motion-sensitive visual cortex does not lead to changes in motion discrimination.

The perception of visual motion is dependent on a set of occipitotemporal regions that are readily accessible to neuromodulation. The current study tested if paired-pulse Transcranial Magnetic Stimulation (ppTMS) could modulate motion perception by stimulating the occipital cortex as participants viewed near-threshold motion dot stimuli. In this sham-controlled study, fifteen subjects completed two sessions. On the first visit, resting motor threshold (RMT) was assessed, and participants performed an adaptive direction discrimination task to determine individual motion sensitivity. During the second visit, subjects performed the task with three difficulty levels as TMS pulses were delivered 150 and 50 ms prior to motion stimulus onset at 120% RMT, under the logic that the cumulative inhibitory effect of these pulses would alter motion sensitivity. ppTMS was delivered at one of two locations: 3 cm dorsal and 5 cm lateral to inion (scalp-based coordinate), or at the site of peak activation for "motion" according to the NeuroSynth fMRI database (meta-analytic coordinate). Sham stimulation was delivered on one-third of trials by tilting the coil 90°. Analyses showed no significant active-versus-sham effects of ppTMS when stimulation was delivered to the meta-analytic (p = 0.15) or scalp-based coordinates (p = 0.17), which were separated by 29 mm on average. Active-versus-sham stimulation differences did not interact with either stimulation location (p = 0.12) or difficulty (p = 0.33). These findings fail to support the hypothesis that long-interval ppTMS recruits inhibitory processes in motion-sensitive cortex but must be considered within the limited parameters used in this design.

The challenge of forgetting: Neurobiological mechanisms of auditory directed forgetting.

Directed forgetting (DF) is considered an adaptive mechanism to cope with unwanted memories. Understanding it is crucial to develop treatments for disorders in which thought control is an issue. With an item-method DF paradigm in an auditory form, the underlying neurocognitive processes that support auditory DF were investigated. Subjects were asked to perform multi-modal encoding of word-stimuli before knowing whether to remember or forget each word. Using functional magnetic resonance imaging, we found that DF is subserved by a right frontal-parietal-cingulate network. Both qualitative and quantitative analyses of the activation of this network show converging evidence suggesting that DF is a complex process in which active inhibition, attentional switching, and working memory are needed to manipulate both unwanted and preferred items. These results indicate that DF is a complex inhibitory mechanism which requires the crucial involvement of brain areas outside prefrontal regions to operate over attentional and working memory processes. Hum Brain Mapp 39:249-263, 2018. © 2017 Wiley Periodicals, Inc.

Impact of repetitive theta burst stimulation on motor cortex excitability.

Theta burst stimulation (TBS) alters cortical excitability in inhibitory or facilitatory directions depending on the pattern of stimulation used. Although continuous TBS (cTBS) decreases motor cortex excitability, intermittent TBS (iTBS) increases excitability by introducing an 8-second stimulation interval after 2 seconds of TBS. The after-effects induced by TBS last from 30 minutes up to 1 hour. Optimization of TBS techniques might be possible through manipulation of a variety of parameters such as number of pulses, stimulus intensity, duration of stimulation, and repetitive stimulation. The aim of this study was to assess the after-effects induced by introducing an interval between two TBS interventions to identify more efficient protocols. The study was divided in two groups, iTBS protocols and cTBS protocols, each of them with four sessions: classical TBS, TBS - 2 minutes - TBS, TBS - 5 minutes - TBS, TBS - 20 minutes - TBS. Our results show that cTBS - 20 minutes - cTBS and iTBS - 2 minutes - iTBS resulted in similar after-effects as those accomplished by a single TBS session, whereas a suppression of after-effects was observed in the other break durations. Repeated TBS with short break durations does not seem to be suitable to prolong the duration of excitability changes accomplished by single TBS. These results might be relevant for clinical applications of TBS, when long-lasting excitability alterations are needed.

Simply longer is not better: reversal of theta burst after-effect with prolonged stimulation.

From all rTMS protocols at present, the theta burst stimulation (TBS) is considered the most efficient in terms of number of impulses and intensity required during a given stimulation. The aim of this study was to investigate the effects of inhibitory and excitatory TBS protocols on motor cortex excitability when the duration of stimulation was doubled. Fourteen healthy volunteers were tested under four conditions: intermittent theta bust stimulation (iTBS), continuous theta burst stimulation (cTBS), prolonged intermittent theta bust stimulation (ProiTBS) and prolonged continuous theta burst stimulation (ProcTBS). The prolonged paradigms were twice as long as the conventional TBS protocols. Conventional facilitatory iTBS converted into inhibitory when it was applied for twice as long, while the normally inhibitory cTBS became facilitatory when the stimulation duration was doubled. Our results show that TBS-induced plasticity cannot be deliberately enhanced simply by prolonging TBS protocols. Instead, when stimulating too long, after-effects will be reversed. This finding supplements findings at the short end of the stimulation duration range, where it was shown that conventional cTBS is excitatory in the first half and switches to inhibition only after the full length protocol. It is relevant for clinical applications for which an ongoing need for further protocol improvement is imminent.

Electrical estimulation of retinal pigment epithelial cells.

We investigated and characterized the effect of externally applied electric fields (EF) on retinal pigment epithelial (RPE) cells by exposing primary cultures of human RPE cells (hRPE) and those from the ARPE19 immortalized cell line to various strengths of EF (EF-treated cells) or to no EF (control cells) under different conditions including presence or absence of serum and gelatin and following wounding. We evaluated changes in RPE cell behavior in response to EF by using a computer based image capture and analysis system (Metamorph). We found that RPE cells responded to externally applied EFs by preferential orientation perpendicular to the EF vector, directed migration towards the anode, and faster translocation rate than control, untreated cells. These responses were voltage-dependent. Responses were observed even at low voltages, of 50-300 mV. Furthermore, the migration of hRPE cell sheets generated by wounding of confluent monolayers of cells at early and late confluence could be manipulated by the application of EF, with directed migration towards the anode observed at both sides of the wounded hRPE. In conclusion, RPE cell behaviour can be controlled by an externally applied EF. The potential for externally applied EF to be used as a therapeutic strategy in the management of selected retinal diseases warrants further investigation.

Efectividad de la relajacion fisica y mental en pacientes con hipertension inducida por el embarazo / Effectiveness of physical and mental relaxation in patients with pregnancy induced by hypertension

Estudio clinico experimental realizado en 15 mujeres con 22-42 semanas de embarazo y diagnostico hipertension inducida por el embarazo, sin historia de enfermedad cardiovascular o renal que no se encontraban en la fase aguda de la enfermedad, pero estaban hospitalizadas en el Hospital Regional Simon Bolivar de Bogota. Durante el estudio entre Febrero y Julio de 1989, como complemento del tratamiento medico-farmacologico, la enfermera implemento en el cuidado tecnicas de relajacion 2 veces durante un solo dia. Se evaluaron los niveles de ansiedad mediante el test de Hamilton, la presion arterial y las frecuencias cardiacas maternas y fetales como indicadores de la eficacia de este manejo en la reduccion de estres, considerado como factor predisponente o agravante de esta complicacion del embarazo. Las mujeres en quienes se realizo el estudio tenian entre 22 y 33 anos, a 10 de ellas se les habia hecho diagnostico de preeclampsia leve, a 4 de preeclampsia grave y a 1 de eclampsia. 9 eran primigestantes y 6 multigestantes. Antes de la relajacion la presion arterial sistolica se encontro entre 190 y 120 mm de Hg. y la diastolica entre 130-80 mm de Hg. comparativamente con las mediciones posteriores. Se evidencio disminucion mayor en la presion arterial diastolica continuado hasta 6 horas despues en el 13.3 por ciento . La ansiedad detectada en el 46.6 por ciento disminuyo o desaparecio inmediatamente despues del tratamiento. Las frecuencias cardiacas maternas y fetales no se aumentaron significativamente, por el contrario se mantuvo constante (mama) y en el 86.6 por ciento de los bebes. 6 ..