The Role of Expectations and Endogenous Opioids in Mindfulness-Based Relief of Experimentally Induced Acute Pain.
The Role of Expectations and Endogenous Opioids in Mindfulness-Based Relief of Experimentally Induced Acute Pain.
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DOI：
10.1097/psy.0000000000000908
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发表时间：
2021-07-01
影响因子：
3.3
通讯作者：
Zeidan F
中科院分区：
文献类型：
--
作者：
Case L;Adler-Neal AL;Wells RE;Zeidan F
期望通过阿片类药物介导的下行抑制作用对认知疼痛调节做出贡献。正念冥想减少疼痛独立于内源性阿片类药物，从事独特的皮质丘脑-皮质机制。然而，它仍然是未知的，是否预期疼痛缓解正念诱导的镇痛预测，如果这些预期被内源性阿片类药物修改。在对先前发表的工作进行的二次分析中，78名无痛参与者（平均年龄27 ± 7岁; 50%为女性）被随机分配到4个阶段的正念冥想或听书方案。在每次干预之前和之后评估干预引起的疼痛缓解的期望。在热毒（49°C）和静脉注射生理盐水-安慰剂或阿片类拮抗剂纳洛酮（0.15 mg/kg推注+ 0.1 mg/kg/h输注）期间，在冥想或休息（对照组）后检查疼痛评级。正念显着降低了盐水和纳洛酮输注过程中的疼痛。正念对疼痛缓解的预期越高，疼痛强度越低，r（40）=-0.41，p = 0.009。在纳洛酮组，与冥想相关的期望值与疼痛强度降低之间的关系得到了证实，r（20）=-0.76，p <0.001，但在生理盐水组，与冥想相关的期望值与疼痛强度降低之间的关系没有得到证实，r（20）=-0.22，p = 0.36。在对照组中，对基于听书的镇痛的期望并不能显著预测生理盐水组的疼痛变化，r（20）=-0.37，p = 0.11或纳洛酮组的疼痛变化，r（18）= 0.26，p = 0.30。这些新的发现表明，期望在基于正念的疼痛缓解中发挥着重要作用。然而，这种作用在生理盐水中最小，在阿片类药物阻滞中更强，尽管疼痛减轻相似。这支持了越来越多的证据表明，正念涉及多种机制来减轻疼痛，这表明正念可能是一种有效的减轻疼痛的技术，即使对于那些对缓解疼痛的期望很低的人来说。
Expectations contribute to cognitive pain modulation through opioidergically-mediated descending inhibition. Mindfulness meditation reduces pain independent of endogenous opioids, engaging unique corticothalamo-cortical mechanisms. However, it remains unknown whether expectations for pain-relief predict mindfulness-induced analgesia and if these expectations are modified by endogenous opioids. In this secondary analysis of previously published work, 78 pain-free participants (mean age 27 ± 7 years; 50% women) were randomized to a 4-session mindfulness meditation or book-listening regimen. Expectations for intervention-induced pain-relief were assessed before and after each intervention. Pain ratings were examined after meditation or rest (control group) during noxious heat (49°C) and intravenous administration of saline-placebo or the opioid antagonist naloxone (0.15 mg/kg bolus + 0.1 mg/kg/h infusion. Mindfulness significantly lowered pain during saline and naloxone infusion. Higher expected pain-relief from mindfulness predicted lower pain intensity, r(40) = −.41, p = 0.009. The relationship between meditation-related expectations and pain intensity reductions were exhibited during naloxone, r(20) = −.76, p < .001 but not saline, r(20) = −.22, p = 0.36. Expectations for book-listening based analgesia did not significantly predict pain changes during saline, r(20) = −.37, p = .11 or naloxone, r(18) = 0.26, p = .30 in the control group. These novel findings demonstrate a significant role for expectations in mindfulness-based pain-relief. However, this role was minimal during saline and stronger during opioid blockade, despite similar pain reductions. This supports growing evidence that mindfulness engages multiple mechanisms to reduce pain, suggesting that mindfulness might be an effective pain-reducing technique even for individuals with low expectations for pain-relief.