Influences of Anxiety and Fear on Conditioned Pain Modulationin Healthy Individuals and Pain Patients

焦虑和恐惧对健康个体和疼痛患者条件性疼痛调节的影响

• 批准号: 253382395
• 负责人: Professor Dr. Stefan Lautenbacher
• 金额: --
• 依托单位: Professur für Physiologische Psychologie
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2014
• 资助国家: 德国
• 起止时间: 2013-12-31 至 2019-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/253382395?language=en
• 关键词: Influences; Anxiety; Fear; Conditioned; Pain

The term Conditioned Pain Modulation (CPM) describes the 'pain inhibits pain' phenomenon, which represents a supra-spinal loop effect, with upper centres in the brain stem. It is part of the descending inhibitory control system, which has first been described at a pure physiological level as Diffuse Noxious Inhibitory Controls (DNIC). CPM testing has become very popular because changes in CPM have promised to underlie sex and age differences in pain processing and, even more importantly, seem to belong to the factors contributing to the development of chronic pain as well as to the factors predicting treatment efficacy. Thus, CPM has become a marker for the inhibitory pain processing capacity. With very few exceptions the functional relation of this emerging marker of pain inhibition with higher-order subcortical and cortical networks and psychological influences on CPM effects have yet been neglected although higher-order influences on descending pain inhibitory systems in general have been acknowledged for a long time. To change this situation and start with psychologically critical variables for pain processing, the influences of anxiety (anticipation of threat) and fear (confrontation with threat) as well as of internal (associated with noxious stimulation) and external threat (independent of noxious stimulation) will be investigated. The choice of these factors has been driven by definite knowledge of their efficiency in acting on pain processing in general. The research question here is whether these factors exert their influence on pain via modulation of CPM. Besides healthy control subjects, patients with chronic musculoskeletal pain will be investigated because in these patients the affective influences on CPM are assumed to be more pronounced and potentially of pathogenetic relevance. Due to presumed similarities in pathophysiology (central sensitization) but difference in pain severity (intensity and spread) and psychological accompaniments, patients with fibromyalgia and chronic tension-type headache (CTTH) will be studied as clinical models.

条件性疼痛调节（CPM）一词描述了“疼痛抑制疼痛”的现象，这代表了一种脊髓上回路效应，其中枢位于脑干上部。它是下行抑制控制系统的一部分，该系统首先在纯生理水平上被描述为弥漫性伤害抑制控制（DNIC）。CPM测试已经变得非常受欢迎，因为CPM的变化已经承诺在疼痛处理的性别和年龄差异的基础，更重要的是，似乎属于慢性疼痛的发展以及预测治疗效果的因素。因此，CPM已成为抑制性疼痛处理能力的标志。除了极少数例外，这种新兴的疼痛抑制标记物与高阶皮层下和皮层网络的功能关系以及对CPM效应的心理影响尚未被忽视，尽管高阶对下行疼痛抑制系统的影响已经被承认了很长一段时间。为了改变这种情况，从疼痛处理的心理关键变量开始，将研究焦虑（威胁的预期）和恐惧（面对威胁）以及内部（与伤害性刺激相关）和外部威胁（独立于伤害性刺激）的影响。这些因素的选择是由它们对疼痛处理的作用效率的确切知识驱动的。这里的研究问题是这些因素是否通过调制CPM对疼痛产生影响。除了健康对照受试者外，还将研究慢性肌肉骨骼疼痛患者，因为在这些患者中，对CPM的情感影响被认为更明显，并且可能具有致病相关性。由于假定的病理生理学（中枢致敏）相似，但疼痛严重程度（强度和扩散）和心理障碍不同，将纤维肌痛和慢性紧张型头痛（CTTH）患者作为临床模型进行研究。