Comparing survival of older ovarian cancer patients treated with neoadjuvant chemotherapy versus primary cytoreductive surgery: Reducing bias through machine learning.

Autonomous sensory meridian response (ASMR) is a multisensory phenomenon, which entails experiencing a scalp-centred tingling sensation which can radiate throughout the body leading to a relaxed and calm state. Recent estimates place the prevalence of ASMR at 20% in the general population suggesting this to be a common phenomenon. Autonomous sensory meridian response can be triggered by stimuli, such as whispering, personal attention, and touch, in day-to-day life and through intentionally created videos and audio recordings containing these triggers. Individuals who engage with ASMR inducing media do so to elicit the pleasurable sensation and to promote relaxation and sleep. Autonomous sensory meridian response has also been linked to elevated mood and reduced heart rate, suggesting the phenomenon has a distinct emotional and physiological component. Barratt and Davis proposed that ASMR can have analgesic properties as 42% of their sample of ASMR experiencers who suffered from chronic pain reported a reduction in pain symptoms for several hours after experiencing the sensation. In our own previous study, we found that compared with controls, ASMR experiencers reported elevated subjective pain appraisal, indexed by visual analogue scale ratings in response to the application of an algometer. No group differences were found in terms of the pain levels measured with tolerance scores. Increased sensitivity to exteroceptive nociceptive tactile stimulation found among ASMR experiencers in our study is intriguing and broadly consistent with neuroimaging findings of heightened activity within brain areas linked with somatosensation and pain processing, and self-reports of increased sensory sensitivity among ASMR experiencers compared to controls. In addition, we found that descriptively the highest pain tolerance and the lowest pain ratings were observed among ASMR experiencers when they were asked to watch an ASMR video compared with a control video and at baseline, pointing to a possibility of the analgesic properties of experiencing ASMR, which is broadly consistent with Barrat and Davis's findings. Interestingly, increased parasympathetic activation, previously linked with lower pain intensity and increased pain tolerance, has also been found to underpin ASMR. However, a simultaneous activation of parasympathetic and sympathetic branches in ASMR has also been reported. The aim of this study was to replicate previous results with a larger sample and to include sex as a variable, given established sex-based differences in pain perception, reporting, and coping, to determine whether ASMR differentially modulates pain experience in men and women. A secondary aim was to establish if previous findings extend to pain threshold in response to the application of an algometer as a related but different pain measurement. Last, we wanted to establish whether ASMR experiencers would show reduced pain levels in the ASMR video condition compared with other conditions, which would further indicate ASMR's potential to alleviate pain.