Background:Patients with fibromyalgia syndrome (FMS) often report prolonged diagnostic pathways and inadequate care, prompting reliance on self-management and online health information. This study aimed to quantify the association between specific clinical experiences and the sources and extent of health information-seeking behaviours in people with FMS. Methods:A cross-sectional online survey was completed by adults who self-reported a diagnosis of FMS. Measures assessed symptom severity, diagnostic and treatment experiences, frequency and duration of symptom flares, perceived stigma and caring from healthcare professionals, and engagement with health information sources, including traditional and digital platforms. Associations between clinical experiences and health information-seeking behaviours were examined using non-parametric tests and hierarchical regression analyses. Results:A total of 384 adults completed the survey (75.3% female; median age 41 years). Most participants reported experiencing symptom flares (88.0%), occurring approximately every 2-3 weeks and lasting a median of 3 days. Participants reported significantly more negative than neutral experiences across multiple diagnostic and treatment variables, including diagnostic difficulty and challenges accessing specialist care. Most respondents (84.1%) actively sought health information, most commonly from healthcare professionals, websites, and online network platforms. Nearly half reported difficulties accessing satisfactory health information. Greater diagnostic difficulty, difficulty finding a specialist, and higher perceived caring from healthcare professionals independently predicted engagement with a wider range of health information sources. Conclusions:Patients with FMS frequently report dissatisfaction with their clinical experiences. Positive and negative diagnostic and treatment experiences are associated with the extent of health information-seeking among people with FMS. These findings highlight the importance of clinical experiences in shaping how patients seek health information and underscore the role of supportive clinical relationships in fostering informed and collaborative care.

Objective Fibromyalgia is a chronic primary pain condition characterised by widespread pain, sleep disturbance, fatigue and cognitive impairment. The diagnostic criteria, aetiology, and legitimacy of symptoms remains contested, leading to poor patient experiences and perceived stigma. This review aimed to synthesise experiences of adults living with fibromyalgia in the United Kingdom, and outline areas of patient care improvement in the National Health Service. Methods A qualitative evidence synthesis was conducted following PRISMA and ENTREQ guidance. Five electronic databases were systematically searched. Data extraction and quality appraisal using the Critical Appraisal Skills Programme were undertaken independently by two reviewers. Data were analysed using inductive thematic synthesis. Results N = 28 studies were included in the thematic synthesis and led to four themes: (1) The constant labour of productivity and self-management in an unreliable body, (2) navigating complex and changing relationships while managing internal turmoil, (3) finding legitimacy and agency within healthcare and welfare systems, and (4) mourning the past, making sense of the present, and negotiating an uncertain future. Combined, these themes show that receiving a diagnosis required persistent work against medical dismissal, but even when diagnosed, their pain was rarely effectively management amid disjointed care. The stigma against the diagnosis was both internal for patients, and perceived from external social, healthcare, and welfare systems. Conclusions These findings highlight the need for pain services that provide psychotherapy and education around fibromyalgia, improved integration of specialised pain care with local healthcare services, and wider training of healthcare clinicians in fibromyalgia diagnosis.

Previous research has demonstrated changes in neural oscillations associated with varying levels of roughness during active-touch exploration of surfaces. In the present study, we aimed to investigate changes in neural oscillatory activity and softness perception during touch exploration of skin. Two experiments were conducted. Study 1 evaluated active touch of artificial skin samples mounted to a purpose-built touch sensor, whereas Study 2 investigated active stroking of one's own forearm. In both experiments, the substrates were treated with commercially available bar soaps to deliver either a soft or draggy skin feel. Oscillatory brain activity was measured using a 129-channel electroencephalography system. In 31 participants, changes in oscillatory band power were evaluated in relevant frequency bands during touch exploration periods. For the artificial skin study, the soft condition led to lower alpha-band power over bilateral somatosensory cortices, which has previously been proposed as a marker of reduced roughness, compared to the draggy condition. Similar results were obtained during the self-touch paradigm, which additionally led to reduced theta-band changes over the frontal and central-parietal electrodes indicating modulation of activity involved in affective (pleasant) touch. Using a novel and highly controlled experimental approach using a novel artificial skin paradigm and active exploration during self-touch of participants own skin, we were able to demonstrate for the first time the neural correlates associated with softness perception of skin and their impact on brain activity associated with affective touch, thereby advancing our understanding of brain oscillatory activity during active-touch exploration of skin. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

In line with the critical role of human olfaction in motivated behavior, positively valenced odors have been shown to boost hedonic perception of visual stimuli, especially facial expressions, compared to unpleasant smells. However, it remains unclear whether pleasant fragrances, which vary in character and subjective affective profile, differentially impact different categories of visual stimuli. We also postulate that individual differences in emotional responses to odors modulate their subsequent effect on hedonic evaluations of images. The current study investigated how (relative to a clean air control) 4 pleasant odors (vanilla, rose, lavender, and lemon) influenced hedonic ratings of different categories of visual images (faces, landscapes, and objects), with each category comprising images of neutral and positive valence. Forty participants (aged 18 to 35) rated the pleasantness of each image during each odor condition presented using a computer-controlled olfactometer. Participants also reported their emotional response to each fragrance on 7 dimensions (happiness, disgust, relaxation, thirstiness, sensuality, energy, and nostalgia) using the Liverpool Emotion and Odor Scale (LEOS), self-report questionnaire. Pleasant odors significantly affected image pleasantness ratings, but the effects of specific fragrances differed by image category. Individual differences in emotional experiences elicited by each fragrance were shown to modulate the impact of odors on hedonic evaluations, and these effects varies across the different image categories. The findings offer new insights into the differential effects of pleasant odors on hedonic evaluations of visual stimuli and the role of individual affective processing in cross-modal olfactory-visual integration.

The R221W mutation on the nerve growth factor gene results in reduced peripheral C-nociceptor density and behavioural indifference to painful stimuli. While functional neuroimaging has revealed altered cortical and sub-cortical pain processing in R221W carriers, structural white matter changes remain unexplored and may suggest an anatomical basis of symptoms. Heterozygous R221W carriers' (n = 11) and matched controls' (n = 11) diffusion MRI data were compared using fixel-based analysis, and complimentary edge and node analyses using graph theory and network-based statistics. Whole-brain and region of interest (ROI) fixel-based analyses revealed significantly reduced fibre density and fibre-bundle cross-section in brainstem motor tracts of R221W carriers, encompassing the corticospinal pathways, corona radiata, external capsule, cerebellar peduncles, and pontine crossing (p < 0.05). Graph theory analysis of pain-processing ROIs demonstrated significantly reduced node degree and betweenness centrality in the Left Anterior Cingulate Cortex (ACC) of R221W carriers, indicating structural isolation of this affective-motivational hub. Network-based statistics identified significantly stronger connectivity between the Right Thalamus and Right ACC in R221W carriers, in contrast to weaker connectivity connecting the Right Thalamus to the Left ACC and Left Insula (p < 0.05). These findings indicate potentially reduced brainstem motor tract integrity and altered cortical network topology, specifically the structural isolation of the Left ACC. This, alongside potentially compensatory right-sided thalamo-cortical connectivity and preserved sensory afferent pathways, supports a model of R221W pain indifference as motor under-reactivity rather than sensory insensitivity.

Machine learning (ML) has been used to predict subjective pain intensity from electroencephalographic (EEG) data. However, few ML models for pain assessment have been externally validated, particularly for continuous pain prediction. We externally validated ML regression models using multi-stage validation to predict pain intensity from single-trial oscillatory EEG features. Ninety-one participants were recruited across three samples. Sample one (n = 40) was used for model development, sample two (n = 51) for cross-subject external validation, and sample three (n = 25), comprising additional recording sessions from sample one participants, for within-subject temporal external validation. Pneumatic pressure stimuli were delivered at 10 graded intensity levels. Single-trial EEG time-frequency features were used to train a Random Forest (RF) model and a long short-term memory (LSTM) network to predict pain intensity. Both models outperformed a random prediction model, with the RF achieving mean absolute errors (MAE) of 19.59, 21.29, and 18.90 for internal validation, cross-subject external validation, and within-subject external validation, respectively. However, neither model outperformed a baseline dummy model predicting the mean training-set rating. We also trained a RF classifier to distinguish low and high pain trials, achieving internal and external validation accuracies up to 64% and 58%, respectively. Overall, our results indicate that predicting continuous pain ratings from oscillatory EEG changes using ML remains highly challenging. Classification models demonstrated above-chance performance across validation samples but remained below clinically meaningful thresholds. Further methodological improvements, particularly the integration of composite measures, are required before ML can achieve clinical utility in pain assessment. PERSPECTIVE: This study provides a rigorous evaluation of EEG-based machine learning for pain assessment, demonstrating that while continuous pain prediction remains unreliable, discrete pain states can be reasonably decoded. These findings represent an important step toward clinical validation and establish realistic performance benchmarks for developing clinically applicable, brain-based pain assessment tools.

Premature reproductive aging is linked to heightened stress sensitivity and psychological maladjustment across the life course. However, the brain dynamics underlying this relationship are poorly understood. Here, to address this issue, we analyzed multimodal data from female participants in the Adolescent Brain and Cognitive Development (longitudinal, N = 441; aged 9–12 years) and Human Connectome-Aging (cross-sectional, N = 130; aged 36–60 years) studies. Age-specific intrinsic functional brain network dynamics mediated the link between reproductive aging and perceptions of greater interpersonal adversity. The adolescent profile overlapped areas of greater glutamatergic and dopaminergic receptor density, and the middle-aged profile was concentrated in visual, attentional and default mode networks. The two profiles showed opposite relationships with patterns of functional neural network variability and cortical atrophy observed in psychosis versus major depressive disorder. Our findings underscore the divergent patterns of brain aging linked to reproductive maturation versus senescence, which may explain developmentally specific vulnerabilities to distinct disorders. Age-specific intrinsic functional brain network dynamics mediates the link between female reproductive aging and perceptions of interpersonal adversity in adolescence and middle adulthood.

Previous research has demonstrated that machine learning (ML) could not effectively decode passive observation of neutral versus pain photographs by using electroencephalogram (EEG) data. Consequently, the present study explored whether active viewing, i.e., requiring participant engagement in a task, of neutral and pain stimuli improves ML performance. Random forest (RF) models were trained on cortical event-related potentials (ERPs) during a two-alternative forced choice paradigm, whereby participants determined the presence or absence of pain in photographs of facial expressions and action scenes. Sixty-two participants were recruited for the model development sample. Moreover, a within-subject temporal validation sample was collected, consisting of 27 subjects. In line with our previous research, three RF models were developed to classify images into faces and scenes, neutral and pain scenes, and neutral and pain expressions. The results demonstrated that the RF successfully classified discrete categories of visual stimuli (faces and scenes) with accuracies of 78% and 66% on cross-validation and external validation, respectively. However, despite promising cross-validation results of 61% and 67% for the classification of neutral and pain scenes and neutral and pain faces, respectively, the RF models failed to exceed chance performance on the external validation dataset on both empathy classification attempts. These results align with previous research, highlighting the challenges of classifying complex states, such as pain empathy using ERPs. Moreover, the results suggest that active observation fails to enhance ML performance beyond previous passive studies. Future research should prioritise improving model performance to obtain levels exceeding chance, which would demonstrate increased utility.

Electroencephalography (EEG) combined with transcranial magnetic stimulation (TMS) provides valuable insights into cortical excitability and connectivity but faces challenges including data artefacts, limited spatial resolution, and the need for standardised synchronisation protocols. This study evaluates three TMS-EEG synchronisation paradigms using the Lab Streaming Layer (LSL) to analyse time intervals and latency. Paradigm 1 employs a software-based approach with simultaneous pulses to both EEG and TMS devices. Paradigm 2, another software-based method, transmits a pulse to the TMS device first, followed by the EEG amplifier. Paradigm 3 uses a hardware-based approach where pulses generated by the TMS device are directly routed to the EEG amplifier. Synchronisation was assessed at frequencies of 1, 5, 10, and 20 Hz, with each frequency tested ten times using 100-pulse trains. Results demonstrate that Paradigm 3 provides superior performance, showing narrower distributions, lower time interval error (TIE) and latency values, and higher precision and accuracy. However, it requires a high sample rate from the EEG amplifier and limits additional device integration. Paradigms 1 and 2, while exhibiting greater variability and lower precision, allow for additional device integration and inter-pulse control via LSL. All paradigms achieved low latency and timing error values within acceptable limits for EEG applications, affirming their viability. The choice of synchronisation paradigm has a significant impact on performance, and the current lack of standardisation in TMS-EEG studies presents ongoing challenges. These findings underscore the necessity of selecting an appropriate synchronisation method based on specific study requirements and resources, potentially advancing standardised protocols for TMS and enhancing the reliability of TMS-EEG research.

Itch is a commonly experienced symptom of skin diseases such as eczema. Topical corticosteroid medications are widely used in chronic itch conditions but can lead to skin thinning, and in certain cases, topical corticosteroid withdrawal. As such, non-pharmaceutical alternatives are being researched. The present research explored affective touch (slow stroking, gentle touch signalled by C-tactile afferents) as a strategy to reduce histamine induced itch. Whilst experiencing histamine induced itch on the volar side of the forearms/wrist, participants (n = 60) were subjected to 3 experimental conditions of modulatory somatosensation applied to the volar aspect of the same forearm relative to the site of itch induction (18 trials of each); 1) affective touch (stroking the forearm with a soft brush at 3 cm/s), 2) non-affective touch (stroking the forearm with a soft brush at 18 cm/s) and 3) active control (static brush tapping on the forearm at 1Hz). Participants were asked to rate the severity of itch, and pleasantness of touch, after each trial. We also investigated whether changes in itch severity scores during the affective touch condition were moderated by individual differences in somatosensory experiences and attitudes as measured on the Touch Experiences and Attitudes Questionnaire (TEAQ), and the Pain Vigilance and Awareness Questionnaire (PVAQ). A linear mixed effects model indicated a main effect of condition on itch severity, whereby affective touch significantly reduced itch severity compared to non-affective touch (p < .001) and active control (p < .001). The TEAQ and PVAQ scores did not correlate significantly with itch scores in the affective touch condition. These results suggest that affective touch has a relieving effect on histamine-induced itch. Our findings lend further credibility to the idea that affective touch might be able to serve as an effective non-pharmaceutical treatment of itch conditions complementing established approaches.

Empathic communication is essential for high-quality healthcare, yet patients must often interpret subtle and ambiguous interpersonal cues during healthcare encounters. In such contexts, prior experiences and cognitive-affective processes may shape interpretations in biased ways. In Fibromyalgia Syndrome (FMS), a frequently stigmatised and 'invisible' condition, such biases may influence how patients perceive unclear messages from healthcare professionals. While interpretation bias for pain-related information has been explored, bias in interpreting social-emotional information has not. This study investigated interpretations of ambiguous social-emotional cues from healthcare professionals in individuals with FMS (n = 65), compared with those with other chronic pain conditions (n = 51) and pain-free controls (n = 77). Participants completed a novel scenario-based task assessing the perceived likelihood of positive, neutral, and negative interpretations of ambiguous clinical situations. Validated self-report measures of psychological distress and perceived clinical empathy were also administered. Results showed that individuals with FMS were significantly more likely to endorse negative interpretations and less likely to endorse positive ones relative to both comparison groups, even after controlling for depression, anxiety, and stress. The FMS group also reported greater psychological distress and lower perceived empathy. Moreover, negative interpretation bias was associated with greater distress and lower perceived clinical empathy, while positive bias showed the opposite pattern. These findings suggest that individuals with FMS interpret ambiguous healthcare communication through a distinct cognitive-affective lens. This highlights that patient-provider interactions are not experienced uniformly across chronic pain populations, and that interpretative biases should be considered to improve healthcare communication. PERSPECTIVE: We explored how individuals with fibromyalgia (compared to other chronic pain and pain-free groups) interpret empathy-related ambiguous cues from healthcare professionals. Controlling for psychological distress, the fibromyalgia group showed a stronger negative interpretation bias than both comparison groups. Understanding these socio-cognitive patterns may help improve communication and empathy in fibromyalgia care.

Fibromyalgia syndrome (FMS) presents a complex and challenging disorder in both the diagnosis and treatment, with emerging evidence suggesting a role of small fibre pathology (SFP) in its pathophysiology. The significance of the role of SFP in FMS remains unclear; however, recent evidence suggests degeneration and dysfunction of the peripheral nervous system, particularly small unmyelinated fibres, which may influence pathophysiology and underlying phenotype. Both skin biopsy and corneal confocal microscopy (CCM) have consistently demonstrated that 50

Congenital insensitivity to pain (CIP) due to the R221W mutation on the nerve growth factor gene results in reduced peripheral C-nociceptor density and behavioural indifference to painful stimuli. While functional neuroimaging has revealed altered cortical and sub-cortical pain processing in R221W carriers, structural white matter changes remain unexplored and may suggest an anatomical basis of symptoms. Heterozygous R221W carriers’ (n = 11) and age-, sex-, education-matched controls’ (n = 11) diffusion tensor imaging data were compared using fixel-based analysis, and complimentary edge and node analyses using graph theory, and network-based statistics. Whole-brain and region of interest (ROI) fixel-based analyses revealed significantly reduced fibre density and fibre-bundle cross-section in brainstem motor tracts of R221W carriers, encompassing the corticospinal pathways, corona radiata, external capsule, cerebellar peduncles, and pontine crossing (p < 0.05). Graph theory analysis of pain-processing ROIs demonstrated reduced local efficiency in right anterior cingulate cortex (ACC) and altered betweenness centrality in bilateral insula and left ACC of R221W carriers. Despite R221W carriers showing higher node degrees in the somatosensory cortex and ACC, these connections had reduced efficiency and integration with cortical network regions. Network-based statistics identified a possible compensatory subnetwork with stronger connectivity from right thalamus to left ACC and left insula in R221W carriers (p < 0.019). These findings suggest that congenitally reduced peripheral nociception could lead to abnormalities in the thalamocortical and motor efferent pathway, but not sensory afferent pathways. The combination of reduced brainstem motor tract integrity and altered cortical network efficiency, alongside potentially compensatory thalamo-cortical connectivity, could support a model of R221W CIP as motor under-reactivity rather than sensory insensitivity. ### Competing Interest Statement The authors have declared no competing interest. Data is made freely available with CC0 licence on Figshare[95][1] and the code is freely accessible on GitHub[96][2]. [1]: #ref-95 [2]: #ref-96

Fibromyalgia syndrome (FMS) is a chronic primary pain condition characterised by widespread pain and hypersensitivities, and symptoms of fatigue, poor sleep and impaired cognition. The current studies were prompted by clinical observations made at a tertiary pain centre, where patients with severe FMS frequently reported having biological children on the autism spectrum. Using multimodal data collection techniques, including a clinical service evaluation (N = 589), an exploratory phenotyping study (N= 59), an online patient survey (N= 728), and a clinical prospective investigation (N = 66), the present study aimed to investigate links that may point to a connection between FMS and autistic offspring. For the clinical and online data collection, the studies used comparator patients with complex regional pain syndrome (CRPS) and a mix of other chronic pain conditions. Maternal factors of interest, including a familial history of neurodivergence and psychological variables, were considered in the analysis. Maternal FMS was consistently found to be associated with an increased likelihood of children with an autism diagnosis, even after accounting for established maternal factors. Meeting and advocating for the support needs of autistic children may require enhanced care, which can lead to greater demands on patients already suffering from FMS or CRPS. The causes for the observed association between maternal FMS and autistic children require further investigation. These findings highlight the importance of being aware of potential neurodivergence among the offspring of patients with FMS and suggest that this should be routinely asked about and documented. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Central University Research Ethics Committee C of the University of Liverpool (Ref: 12195) and the Wales Research Ethics Comittee 2 of the NHS Health Research Authority (Ref: 24/WA/0056) gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.

Psychological and relational processes, including empathy, are increasingly recognised as central to effective pain care. Fibromyalgia Syndrome (FMS), a complex chronic pain condition, poses significant challenges for both patients and healthcare professionals (HCPs) across medical settings. Patients with FMS often report lack of empathy from HCPs, negatively affecting healthcare experiences. Whilst empathic therapeutic relationships are linked to improved satisfaction and reduced pain in FMS, how empathy is conceptualised in practice remains underexplored. Using Q-methodology, 20 HCPs and 20 patients with FMS ranked 40 statements on clinical empathy based on agreement/disagreement. Four factors were identified, explaining 51% of the variance. Factor 1, 'Empathy is about truly connecting-the dominant healthcare professional view', included 75% of the HCPs and emphasised emotional aspects and partnership. The remaining factors captured heterogeneous patient perspectives: Factor 2, 'Empathy cannot be taught; it is something that you have', focussed on behavioural, outcome-oriented aspects; Factor 3, 'Empathy requires communication that goes both ways', prioritised behavioural and cognitive aspects; and Factor 4, 'Lack of empathy makes patients feel abandoned-the dominant patient view', reflected a strong importance of emotional validation and personalised care. These four factors were further mapped onto broader dimensions of affective engagement and reciprocity. HCPs and patients view empathy differently, highlighting the need for interventions grounded in shared understanding. Addressing these perspectives may facilitate better empathic interactions and improve psychologically informed healthcare for FMS.

Brain imaging performed in natural settings is known as mobile brain and body imaging (MoBI). One of the features which distinguishes MoBI and laboratory-based experiments is the body posture. Previous studies pointed to mechanical, autonomic, cortical and cognitive differences between upright stance and sitting or reclining. The purpose of this study was to analyse effects of posture on eye-movement related potentials (EMRP) recorded during free viewing of human faces. A 64-channel wireless EEG was recorded from 14 participants in either standing or reclining postures while they freely viewed pictures of emotional faces displaying fear, anger, sadness, and a neutral emotional state. Eye tracking data was used to insert triggers corresponding to the instant at which the gaze first landed on a face. Spatial filtering of the EEG data was performed using a group independent component analysis (ICA). Grand average EMRPs displayed the post-saccadic lambda component and the face-sensitive N170/vertex positive potential (VPP) complex. The lambda component but not the N170 component was stronger during reclining than upright posture. Emotional expression of faces showed no effects on EMRP components or subjective ratings. Results suggest that posture primarily affects early components of EMRPs recorded using wireless EEG recordings during free viewing of faces. Thus, findings from evoked potential data obtained in seated individuals, e.g., in laboratory experiments, should be interpreted with caution in MoBI experiments with posture affecting primarily the early latency component.

A proportion of people with fibromyalgia demonstrate small fibre pathology (SFP). However, it is unclear how SFP directly relates to pain phenomenology. Thirty-three individuals with FMS and ten healthy volunteers underwent assessment of SFP and sensory phenotyping using corneal confocal microscopy, validated questionnaires and quantitative sensory testing (QST). Corneal nerve fibre length was used to stratify participants with fibromyalgia into with SFP [SFP+] and without SFP [SFP−]. SFP was detected in 50% of the fibromyalgia cohort. Current pain score and QST parameters did not differ between SFP+ and SFP−. Mechanical pain sensitivity (MPS) demonstrated a significant gain-of-function in the SFP− cohort compared to healthy-volunteers (p = 0.014, F = 4.806, η 2 = 0.22). Further stratification revealed a cohort without structural SFP but with symptoms compatible with small fibre neuropathy symptoms and a significant gain in function in MPS (p = 0.020 Chi-square). Additionally, this cohort reported higher scores for both depression (p = 0.039, H = 8.483, η 2 = 0.312) and anxiety (p = 0.022, F = 3.587, η 2 = 0.293). This study confirms that SFP is present in a proportion of people with fibromyalgia. We also show that in a proportion of people with fibromyalgia, small fibre neuropathy symptoms are present in the absence of structural SFP. Greater mechanical pain sensitivity, depression and anxiety are seen in these individuals.

The present study examined whether people higher in psychopathy experienced less self-reported and psychophysiological nociceptive pressure than people lower in psychopathy. We also examined whether psychopathy affects empathy for others' pain via self-reported and psychophysiological measures. Three hundred and sixty-nine students (18-78 years; M = 26, SD = 9.34) were screened for psychopathic traits using the Youth Psychopathy Inventory (YPI). Stratified sampling was used to recruit 49 adults residing in the highest (n = 23) and lowest (n = 26) 20% of the psychopathy spectrum. Using skin conductance response (SCR) and self-report responses, participants responded to individually adjusted intensities of pneumatic pressure and others' pain images and completed self-reported psychopathy and empathy measures (Triarchic Psychopathy Measure, TriPm; Interpersonal Reactivity Index, IRI). People higher in psychopathy self-reported feeling less nociceptive pressure compared to people lower in psychopathy, yet we did not find any differences in SCR to nociceptive pressure. However, when viewing other people in pain, the high psychopathy group displayed lower SCR and lower self-reported empathy compared to those lower in psychopathy. Our results suggest psychopathic traits relate to problems empathising with others' pain, as well as the perception of nociceptive pressure. We also show support for the theory of dual harm which has been receiving increasing attention. Consequently, psychopathy interventions should focus both on recognising and empathising with the pain of others.

Previous research investigated cross-modal influence of olfactory stimuli on perception and evaluation of faces. However, little is known about the neural dynamics underpinning this multisensory perception, and no research examined perception for images of oneself, and others, in presence of fragrances. This study investigated the neural mechanisms of olfactory-visual processing using electroencephalography (EEG) and subjective evaluations of self- and other-images.22 female participants evaluated images of female actors and themselves while being exposed to the fragrance of a commercially available body wash or clean air delivered via olfactometer. Participants rated faces for attractiveness, femininity, confidence and glamorousness on visual analogue scales. EEG data was recorded and event-related potentials (ERPs) associated with onset of face stimuli were analysed to consider effects of fragrance presence on face processing, and interactions between fragrance and self-other image-type.Subjective ratings of confidence, attractiveness and femininity were increased for both image-types in pleasant fragrance relative to clean air condition. ERP components covering early-to-late stages of face processing were modulated by the presence of fragrance. Findings also revealed a cross-modal fragrance-face interaction, with pleasant fragrance particularly affecting ERPs to self-images in mid-latency ERP components.Resultsshowed that the pleasant fragrance of the commercially available body wash impacted how participants perceived faces of self and others. Self- and other-image faces were subjectively rated as more attractive, confident and feminine in the presence of the pleasant fragrance compared to an un-fragranced control. The pleasant fragrance also modulated underlying electrophysiological activity. For the first time, an effect of pleasant fragrance on face perception was observed in the N1 component, suggesting impact within 100 ms. Pleasant fragrance also demonstrated greater impact on subsequent neural processing for self, relative to other-faces. The findings have implications for understanding multisensory integration during evaluations of oneself and others.

In early 2020, countries across the world imposed lockdown restrictions to curb the spread of the Covid-19 coronavirus. Lockdown conditions, including social and physical distancing measures and recommended self-isolation for clinically vulnerable groups, were proposed to disproportionately affect those living with chronic pain, who already report reduced access to social support and increased isolation. Yet, empirical evidence from longitudinal studies tracking the effects of prolonged and fluctuating lockdown conditions, and potential psychological factors mediating the effects of such restrictions on outcomes in chronic pain populations, is lacking. Accordingly, in the present 13-wave longitudinal study, we surveyed pain intensity, pain interference, and tiredness in people with chronic pain over the course of 11 months of the Covid-19 pandemic (April 2020-March 2021). Of N = 431 participants at baseline, average completion rate was similar to 50% of time points, and all available data points were included in linear mixed models. We examined the impact of varying levels of lockdown restrictions on these outcomes and investigated whether psychological distress levels mediated effects. We found that a full national lockdown was related to greater pain intensity, and these effects were partially mediated by depressive symptoms. No effects of lockdown level were found for pain interference and tiredness, which were instead predicted by higher levels of depression, anxiety, pain catastrophising, and reduced exercise. Our findings are relevant for improving patient care in current and future crises. Offering remote management options for low mood could be particularly beneficial for this vulnerable population in the event of future implementation of lockdown restrictions. Perspective: This longitudinal study demonstrates the impact of Covid-19 lockdown restrictions on people with chronic pain. Findings suggest a complex interaction of psychosocial factors that impacted various aspects of pain experience in patients, which offer the potential to inform clinical strategies for remote medicine and future crises. (R) 2024 The Author(s). Published by Elsevier Inc. on behalf of United States Association for the Study of Pain, Inc This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/ 4.0/).