Emotional modulation of pain and spinal nociception in fibromyalgia.
Emotional modulation of pain and spinal nociception in fibromyalgia.
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DOI：
10.1016/j.pain.2013.03.025
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发表时间：
2013-07
期刊：
影响因子：
7.4
通讯作者：
Kerr KL
中科院分区：
文献类型：
--
作者：
Rhudy JL;DelVentura JL;Terry EL;Bartley EJ;Olech E;Palit S;Kerr KL
纤维肌痛（FM）的特征在于广泛的疼痛，以及情感障碍（例如，抑郁症）。鉴于已知情绪过程可以调节疼痛，情绪的中断以及疼痛和伤害感受的情绪调节可能有助于FM。本研究采用一种有效的情感图片观察范式来研究疼痛和脊髓伤害性感受的情绪加工和情绪调节。参与者包括18名FM患者，18名类风湿性关节炎（RA）患者和19名健康无痛对照（HC）。肢解、中性和色情图片分为四个区块;两个区块仅评估生理-情感反应（即，快乐/唤醒等级、皱眉肌EMG、惊吓调制、皮肤电导），并且两个块评估疼痛的情绪反应性和情绪调制以及由腓肠神经上的阈上电刺激诱发的伤害性屈曲反射（NFR，脊髓伤害性感受的生理测量）。在一般情况下，切割图片引起的不满，皱眉活动，主观唤醒，和交感神经激活，而色情图片引起的快乐，主观唤醒，和交感神经激活。然而，FM与食欲激活缺陷相关（例如，减少对色情的愉悦/唤起）。此外，在HC和RA中观察到疼痛的情绪调节，但在FM中没有观察到，尽管所有三组都证明了NFR的调节。此外，FM组的NFR阈值并不低，表明缺乏脊髓致敏。总之，这些结果表明，FM与脊髓上过程的中断有关，这些过程与疼痛的积极影响和情绪调节有关，但与调节脊髓伤害性过程的脑脊髓回路无关。
Fibromyalgia (FM) is characterized by widespread pain, as well as affective disturbance (e.g., depression). Given that emotional processes are known to modulate pain, a disruption of emotion and emotional modulation of pain and nociception may contribute to FM. The present study used a well-validated affective picture-viewing paradigm to study emotional processing and emotional modulation of pain and spinal nociception. Participants were 18 individuals with FM, 18 individuals with rheumatoid arthritis (RA), and 19 healthy pain-free controls (HC). Mutilation, neutral, and erotic pictures were presented in four blocks; two blocks assessed only physiological-emotional reactions (i.e., pleasure/arousal ratings, corrugator EMG, startle modulation, skin conductance) in the absence of pain and two blocks assessed emotional reactivity and emotional modulation of pain and the nociceptive flexion reflex (NFR, a physiological measure of spinal nociception) evoked by suprathreshold electric stimulations over the sural nerve. In general, mutilation pictures elicited displeasure, corrugator activity, subjective arousal, and sympathetic activation, whereas erotic pictures elicited pleasure, subjective arousal, and sympathetic activation. However, FM was associated with deficits in appetitive activation (e.g., reduced pleasure/arousal to erotica). Moreover, emotional modulation of pain was observed in HC and RA, but not FM, even though all three groups evidenced modulation of NFR. Additionally, NFR thresholds were not lower in the FM group, indicating a lack of spinal sensitization. Together, these results suggest that FM is associated with a disruption of supraspinal processes associated with positive affect and emotional modulation of pain, but not brain-to-spinal cord circuitry that modulates spinal nociceptive processes.
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