Autonomic Arousal as a Mechanism of the Persistence of Nocebo Hyperalgesia
Autonomic Arousal as a Mechanism of the Persistence of Nocebo Hyperalgesia
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DOI：
10.1016/j.jpain.2017.12.006
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发表时间：
2018-05-01
期刊：
影响因子：
4
通讯作者：
Quinn, Veronica F.
中科院分区：
文献类型：
--
作者：
Colagiuri, Ben;Quinn, Veronica F.
安慰剂和反安慰剂机制可导致临床显著的疼痛调节。虽然学习被认为是安慰剂镇痛和反安慰剂痛觉过敏的广泛机制，但它们的具体机制存在重大差异。其中最有趣的是，安慰剂镇痛似乎是相对短暂的，而反安慰剂痛觉过敏似乎更不易消失，经常无限期地持续下去。目前的研究调查了为什么反安慰剂痛觉过敏比安慰剂镇痛持续时间更长。60名健康志愿者被随机分为安慰剂组、反安慰剂组和无条件组，他们使用的是一种实验性疼痛模型，在训练过程中，疼痛刺激与假治疗相结合，暗中减少（安慰剂组）和增加（反安慰剂组）。然后在测试阶段评估疼痛，在相同的疼痛刺激下进行假治疗和不进行假治疗。调节过程成功地诱导了相关组的安慰剂镇痛和反安慰剂痛觉过敏，反安慰剂痛觉过敏持续时间超过安慰剂镇痛，证实了反安慰剂痛觉过敏的抗消失性。最有趣的是，反安慰剂治疗提高了预期焦虑等级和自主神经觉醒。此外，自主神经觉醒完全介导了反安慰剂与安慰剂训练对消退的影响，这表明增强的自主神经觉醒可能是反安慰剂痛觉过敏持续存在的重要机制。观点：以自主神经觉醒升高的形式出现的预期性焦虑的增强可能解释了为什么相对于安慰剂镇痛，反安慰剂痛觉过敏持续存在。因此，减少预期焦虑的干预措施可以减轻持续性反安慰剂痛觉过敏的负担。(C) 2017年由美国疼痛协会发布。
Placebo and nocebo mechanisms can lead to clinically significant modulation of pain. Although learning is considered to be the broad mechanism underlying placebo analgesia as well as nocebo hyperalgesia, critical differences have emerged in their specific mechanisms. One of the most interesting of these is that whereas placebo analgesia seems to be relatively short-lived, nocebo hyperalgesia appears more resistant to extinction, often persisting indefinitely. The current study examined why nocebo hyperalgesia persists longer than placebo analgesia. Sixty healthy volunteers were randomized to receive placebo conditioning, nocebo conditioning, or no conditioning using an experimental pain model with surreptitious decreases (placebo group) and increases (nocebo group) in pain stimulation paired with sham treatment during training. Pain was then assessed in a test phase with and without the sham treatment at equal pain stimulation. The conditioning procedure successfully induced placebo analgesia as well as nocebo hyperalgesia in the relevant groups, with nocebo hyperalgesia outlasting placebo analgesia, confirming nocebo hyperalgesia's resistance to extinction. Most interestingly, nocebo treatment led to heightened anticipatory anxiety ratings and autonomic arousal. Further, autonomic arousal completely mediated the effect of nocebo versus placebo training on extinction, suggesting that heightened autonomic arousal may be an important mechanism in the persistence of nocebo hyperalgesia.Perspective: Heightened anticipatory anxiety in the form of elevated autonomic arousal may explain why nocebo hyperalgesia persists relative to placebo analgesia. As such, interventions that reduce anticipatory anxiety could reduce the burden of persistent nocebo hyperalgesia. (C) 2017 by the American Pain Society.