PAIN CONTROL METHODS--EFFECTS OF MORPHINE, DISTRACTION, & MOOD CHANGES

这代表了一系列的两个实验室研究，检查了行为疼痛控制的几个组成部分：情绪改变和注意力分散。一个关键的特征是在吗啡的存在下检查这些行为成分，吗啡是侵略性药物疼痛管理的原型药物。人们认识到，如果要对疼痛进行行为控制，通常会与镇痛药一起使用。本研究的具体目的是：(a)检查吗啡和精神分散对正常受试者的疼痛耐受性和疼痛强度和不愉快程度评分的综合影响，(b)检查吗啡和积极情绪诱导对正常受试者的疼痛耐受性和疼痛强度和不愉快程度评分的综合影响。疼痛刺激将是压力计对食指产生的压力。研究A中的受试者被随机分配到5个条件中的一个：吗啡伴分心、吗啡单独、有效安慰剂伴分心、单独有效安慰剂和无效安慰剂。这项研究在Hermann医院的大学临床研究中心（CRC）开始。在获得该奖项的第二年，我们在Hermann医院的大学临床研究中心（CRC）启动了这项研究。研究A的假设是，分散注意力和吗啡的联合使用对疼痛感知的影响最大，其次是：吗啡单独使用、分散注意力与有效安慰剂（苯海拉明）、有效安慰剂和无效安慰剂。8名受试者（3名女性，5名男性）参加了试验阶段的研究。对研究程序作一些小的调整是必要的。强直性疼痛刺激是来自压力计的压力刺激。我们最初使用的重量为1.0 kg，但随后将重量增加到2.0 kg。这种增加表明受试者的基线疼痛耐受性大于压力刺激的5分钟限制。我们还调整了基线抽血的时间，以避免影响受试者的基线疼痛耐受性。此外，为了使任务要求更容易理解，分散注意力任务的说明也做了一些小改动。研究B的受试者将被分配到7个条件中的1个：吗啡伴积极情绪、吗啡伴中性情绪、吗啡单独、有效安慰剂伴积极情绪、有效安慰剂伴中性情绪、单独有效安慰剂和无效安慰剂。主要结局变量是疼痛耐受时间的变化。次要结果测量将是疼痛强度和不愉快评分的变化。

This represents a series of two laboratory studies examining several components of behavioral pain control: mood alteration and distraction. A critical feature is the examination of these behavioral components in the presence of morphine, the prototypic drug for aggressive pharmacologic pain management. It is recognized that behavioral control of pain, if used at all, will often be used in conjunction with analgesics. The specific aims of the study are (a) to examine the combined effects of morphine and mental distraction on pain tolerance and pain ratings of intensity and unpleasantness in normal subjects, and (b) to examine the combined effects of morphine and positive mood induction on pain tolerance and pain ratings of intensity and unpleasantness in normal subjects. The pain stimulus will be pressure to the index finger produced by a pressure algometer. Subjects in Study A are randomly assigned to 1 of 5 conditions: morphine with distraction, morphine alone, active placebo with distraction, active placebo alone, and inactive placebo. This study has commenced in the University Clinical Research Center (CRC) at Hermann Hospital. During the second year of the award, we initiated this study in the University Clinical Research Center (CRC) at Hermann Hospital. The hypothesis for Study A is that the combined use of distraction and morphine will have the greatest effect on pain perception, followed in order by: morphine alone, distraction with an active placebo (diphenhydramine), an active placebo, and an inactive placebo. Eight subjects (three females, five males) were enrolled in the pilot phase of the study. Some minor adjustments in the study procedures were necessary. The tonic pain stimulus is pressure stimulation from the pressure algometer. We initially used 1.0 kg of weight on the algometer but subsequently increased the weight to 2.0 kg. This increase was indicated as the subjects' baseline pain tolerance was greater than the 5-minute limit for the pressure stimulus. We also adjusted the timing of the baseline blood draw in order to avoid influencing the subjects baseline pain tolerance. In addition, minor changes were made in the instructions for the distraction task in order to make the task requirements easier to comprehend. Subjects in Study B will be assigned to 1 of 7 conditions: morphine with positive mood, morphine with neutral mood, morphine alone, active placebo with positive mood, active placebo with neutral mood, active placebo alone, and inactive placebo. The primary outcome variable will be change in pain tolerance time. Secondary outcome measures will be changes in pain intensity and unpleasantness ratings.