Brain mechanisms supporting violated expectations of pain.
Brain mechanisms supporting violated expectations of pain.
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支持违反疼痛预期的大脑机制。
DOI：
10.1097/j.pain.0000000000000231
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发表时间：
2015
期刊：
影响因子：
7.4
通讯作者：
Coghill,RobertC
中科院分区：
文献类型：
--
作者：
Zeidan,Fadel;Lobanov,OlegV;Kraft,RobertA;Coghill,RobertC
疼痛的主观体验受到经验、未来预测和传入信息之间相互作用的影响。对强烈疼痛的预期会加剧疼痛，而在持续的有害刺激下，对低疼痛的预期会显著减轻疼痛。然而，与处理预期疼痛和经历疼痛不匹配相关的大脑机制尚不清楚，但对于赋予感官事件显著性以覆盖错误的自上而下的期望介导信息非常重要。这项研究检查了当疼痛预期突然被打破时，与疼痛相关的大脑活动。在参与者对预测低或高疼痛的线索进行条件反射后，在56个刺激试验中给予10个错误的刺激线索，以确定当刺激前的线索与相应的热刺激之间存在高度不一致时，预期对疼痛的影响是否较小。错误提示的刺激产生的疼痛等级和与疼痛相关的大脑激活与安慰剂镇痛、反安慰剂痛觉过敏一致，并且违背了预期。对疼痛的违背预期与下顶叶不同区域的激活有关，包括边缘上回和角回、顶叶内沟、上顶叶、小脑和枕叶。因此，对疼痛的违背预期涉及支持显著性驱动的感觉歧视、工作记忆和联想学习过程的机制。通过超越预期对疼痛的影响，这些大脑机制可能在临床情况下参与，患者对疼痛缓解的不切实际的期望降低了疼痛治疗的效果。因此，这些发现强调了维持现实期望以增强疼痛管理有效性的重要性。
The subjective experience of pain is influenced by interactions between experiences, future predictions, and incoming afferent information. Expectations of high pain can exacerbate pain, whereas expectations of low pain during a consistently noxious stimulus can produce significant reductions in pain. However, the brain mechanisms associated with processing mismatches between expected and experienced pain are poorly understood, but are important for imparting salience to a sensory event to override erroneous top–down expectancy-mediated information. This investigation examined pain-related brain activation when expectations of pain were abruptly violated. After conditioning participants to cues predicting low or high pain, 10 incorrectly cued stimuli were administered across 56 stimulus trials to determine whether expectations would be less influential on pain when there is a high discordance between prestimulus cues and corresponding thermal stimulation. Incorrectly cued stimuli produced pain ratings and pain-related brain activation consistent with placebo analgesia, nocebo hyperalgesia, and violated expectations. Violated expectations of pain were associated with activation in distinct regions of the inferior parietal lobe, including the supramarginal and angular gyrus, and intraparietal sulcus, the superior parietal lobe, cerebellum, and occipital lobe. Thus, violated expectations of pain engage mechanisms supporting salience-driven sensory discrimination, working memory, and associative learning processes. By overriding the influence of expectations on pain, these brain mechanisms are likely engaged in clinical situations in which patients’ unrealistic expectations of pain relief diminish the efficacy of pain treatments. Accordingly, these findings underscore the importance of maintaining realistic expectations to augment the effectiveness of pain management.
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