The Dynamics of Pain: Evidence for Simultaneous Site-Specific Habituation and Site-Nonspecific Sensitization in Thermal Pain
The Dynamics of Pain: Evidence for Simultaneous Site-Specific Habituation and Site-Nonspecific Sensitization in Thermal Pain
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DOI：
10.1016/j.jpain.2014.02.010
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发表时间：
2014-07-01
期刊：
影响因子：
4
通讯作者：
Wager, Tor D.
中科院分区：
文献类型：
--
作者：
Jepma, Marieke;Jones, Matt;Wager, Tor D.
由于外周和中枢神经系统的多重适应过程，反复暴露于有害刺激会改变它们的疼痛感。有些矛盾的是，反复的刺激可以增加（敏感化）或减少（习惯化）疼痛。适应过程也可能是身体部位特异性的或跨身体部位操作，考虑这种区别可能有助于解释习惯化与敏化发生的条件。为了分离部位特异性和部位非特异性适应过程的影响，我们研究了100名参与者在多个皮肤部位进行有害热刺激的平衡序列时报告的疼痛。对疼痛等级的分析揭示了两种相反的顺序效应：同一皮肤部位的重复刺激产生温度依赖的习惯化，而不同部位的重复刺激产生致敏化。刺激试验间隔20秒，致敏性与连续刺激部位之间的距离无关，表明既不发生时间累积，也不发生空间累积。为了解释这些影响，我们提出了一个包含两个适应过程的动态模型，一个是位点特异性的，另一个是位点非特异性的。在控制当前刺激温度后，该模型解释了93%的组平均疼痛评分差异，其估计参数显示了部位特异性过程的习惯化和部位非特异性过程的敏化的证据。本研究揭示的两种疼痛适应过程，以及解开它们的能力，可能是理解多种疼痛调节机制及其在慢性疼痛综合征中的干扰的关键。观点：本文提出了热痛中同时发生的位点特异性习惯化和位点非特异性敏化的新证据，这些证据可以通过动态模型来解开（并估计每个过程的方向和强度）。位点特异性和位点非特异性适应过程的分离可能是理解健康人群和患者群体中多种疼痛调节机制的关键。(C) 2014年由美国疼痛学会出版
Repeated exposure to noxious stimuli changes their painfulness, due to multiple adaptive processes in the peripheral and central nervous systems. Somewhat paradoxically, repeated stimulation can produce an increase (sensitization) or a decrease (habituation) in pain. Adaptation processes may also be body-site-specific or operate across body sites, and considering this distinction may help explain the conditions under which habituation versus sensitization occurs. To dissociate the effects of site-specific and site-nonspecific adaptation processes, we examined reported pain in 100 participants during counterbalanced sequences of noxious thermal stimulation on multiple skin sites. Analysis of pain ratings revealed 2 opposing sequential effects: repeated stimulations of the same skin site produced temperature-dependent habituation, whereas repeated stimulations across different sites produced sensitization. Stimulation trials were separated by 20 seconds, and sensitization was unrelated to the distance between successively stimulated sites, suggesting that neither temporal nor spatial summation occurred. To explain these effects, we propose a dynamic model with 2 adaptation processes, one site-specific and the other site-nonspecific. The model explains 93% of the variance in the group-mean pain ratings after controlling for current stimulation temperature, with its estimated parameters showing evidence for habituation for the site-specific process and sensitization for the site-nonspecific process. The 2 pain adaptation processes revealed in this study, and the ability to disentangle them, may hold keys to understanding multiple pain-regulatory mechanisms and their disturbance in chronic pain syndromes.Perspective: This article presents novel evidence for simultaneous site-specific habituation and site-nonspecific sensitization in thermal pain, which can be disentangled (and the direction and strength of each process estimated) by a dynamic model. The dissociation of site-specific and site-nonspecific adaptation processes may hold keys to understanding multiple pain-regulatory mechanisms in both healthy and patient populations. (C) 2014 by the American Pain Society