Attention to breath sensations does not engage endogenous opioids to reduce pain.
Attention to breath sensations does not engage endogenous opioids to reduce pain.
复制标题
对呼吸感觉的关注不会利用内源性阿片类药物来减轻疼痛。
DOI：
10.1097/j.pain.0000000000001865
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发表时间：
2020
期刊：
影响因子：
7.4
通讯作者：
Zeidan,Fadel
中科院分区：
文献类型：
--
作者：
Wells,RebeccaE;Collier,Jason;Posey,Grace;Morgan,Afrayem;Auman,Timothy;Strittmatter,Brian;Magalhaes,Rossana;Adler-Neal,Adrienne;McHaffie,JohnG;Zeidan,Fadel
内源性阿片能系统在疼痛的认知调节中发挥着重要作用。基于缓慢呼吸的技术被广泛用于减轻疼痛的非药物方法。然而，支持这些做法的积极行动机制却很少被描述。越来越多的证据表明，正念冥想是一种通过无反应地关注呼吸感觉来练习的缓慢呼吸技术，它涉及多种独特的神经机制，可以绕过阿片类药物介导的下行通路来减轻疼痛。然而，尚不清楚内源性阿片类药物是否有助于减轻呼吸缓慢引起的疼痛。本双盲、安慰剂对照交叉研究检查了正念冥想（n = 5·19）、假正念冥想（n = 5·20）和慢速呼吸（n = 5·20）期间对有害热量（49°C）和阿片拮抗剂静脉注射（0.15 mg/kg 推注 1·0.1 mg/kg/小时维持输注）期间的行为疼痛反应，纳洛酮和安慰剂盐水。与休息相比，正念显着降低了两次输液过程中的疼痛不适程度，但没有降低疼痛强度。缓慢的呼吸显着降低了纳洛酮期间的疼痛强度和不愉快程度，但输注盐水时却没有。与服用生理盐水相比，纳洛酮对正念冥想和慢速呼吸所产生的疼痛减轻不敏感。相比之下，假正念冥想在盐水输注期间减少了疼痛不愉快，但这种效果被阿片类药物拮抗作用逆转。假正念并没有降低疼痛强度等级。自我报告的“专注于呼吸”被认为是正念冥想和慢节奏呼吸所特有的操作特征，但不是假正念冥想。对于所有个体来说，注意呼吸与纳洛酮不敏感的疼痛缓解有关。这些发现提供的证据表明，缓慢呼吸加上对呼吸的关注可以减轻疼痛，而与内源性阿片类药物无关。
The endogenous opioidergic system is critically involved in the cognitive modulation of pain. Slow-breathing-based techniques are widely used nonpharmacological approaches to reduce pain. Yet, the active mechanisms of actions supporting these practices are poorly characterized. Growing evidence suggest that mindfulness-meditation, a slow-breathing technique practiced by nonreactively attending to breathing sensations, engages multiple unique neural mechanisms that bypass opioidergically mediated descending pathways to reduce pain. However, it is unknown whether endogenous opioids contribute to pain reductions produced by slow breathing. The present double-blind, placebo-controlled crossover study examined behavioral pain responses during mindfulness-meditation (n 5 19), sham-mindfulness meditation (n 5 20), and slow-paced breathing (n 5 20) in response to noxious heat (49 C) and intravenous administration (0.15 mg/kg bolus 1 0.1 mg/kg/hour maintenance infusion) of the opioid antagonist, naloxone, and placebo saline. Mindfulness significantly reduced pain unpleasantness ratings across both infusion sessions when compared to rest, but not pain intensity. Slow-paced breathing significantly reduced pain intensity and unpleasantness ratings during naloxone but not saline infusion. Pain reductions produced by mindfulness-meditation and slow-paced breathing were insensitive to naloxone when compared to saline administration. By contrast, sham-mindfulness meditation produced pain unpleasantness reductions during saline infusion but this effect was reversed by opioidergic antagonism. Sham-mindfulness did not lower pain intensity ratings. Self-reported “focusing on the breath” was identified as the operational feature particularly unique to the mindfulness-meditation and slow paced-breathing, but not sham-mindfulness meditation. Across all individuals, attending to the breath was associated with naloxone insensitive pain-relief. These findings provide evidence that slow breathing combined with attention to breath reduces pain independent of endogenous opioids.