Anger Expression, Opioid Dysfunction, and Chronic Pain

描述（由申请人提供）：一种表达型的愤怒调节（愤怒-发泄）与对急性和慢性疼痛的敏感性增加有关。基于内源性阿片在调节疼痛、应激反应和情绪状态中的作用，我们假设愤怒可能通过内源性阿片系统功能障碍对慢性和急性疼痛产生影响。初步数据支持这一关于性格愤怒的假设。然而，最近的研究结果表明，当愤怒被激起时，行为愤怒表达可能在高愤怒情绪中具有镇痛作用，这表明检查特质X状态的相互作用对于理解愤怒情绪对健康影响的中介至关重要。阿片类药物在这些相互作用的表达中的作用尚不清楚。本研究的具体目的是：1)确定高愤怒情绪的行为愤怒表达是否触发阿片介导的镇痛；2)确定愤怒情绪的阿片相关效应、体内行为愤怒表达和日常慢性疼痛变量之间的关系。探索临床上重要的愤怒表达现象，因为它影响内源性阿片类疼痛调节系统的功能，将提高对可能有助于急性和慢性疼痛反应的心理生物学关系的理解。140名患有慢性腰痛的受试者和80名无痛的健康受试者将参加两个实验阶段，一次用纳洛酮进行阿片类药物阻断，一次用安慰剂。被试将接受一个愤怒回忆访谈以引起愤怒唤起和行为愤怒表达，或一个控制不引起愤怒的访谈。接下来，受试者将经历急性手指压痛和缺血性疼痛刺激。受试者还将在实验期间完成每日电子疼痛和行为愤怒表达日记。结果将揭示当愤怒被激起时的言语愤怒表达是否会触发高愤怒个体的阿片类镇痛。如果已知的慢性疼痛强度和愤怒情绪之间的正相关是由阿片样物质绝对功能障碍介导的，那么统计控制阿片样物质对急性疼痛的阻断反应（阿片样物质镇痛功能指数）应该消除这种关系。然而，如果在实验室中行为性愤怒表达可以改善高愤怒情绪中明显的阿片功能障碍，那么在体内行为性愤怒表达时，阿片触发对慢性疼痛的影响应该在大量日记数据中得到证实。

DESCRIPTION (provided by applicant): An expressive style of anger regulation (anger-out) is related to increased sensitivity to acute and chronic pain. Based on the role of endogenous opioids in modulation of pain, stress responsiveness, and emotional state, it was hypothesized that anger-out may exert its effects on chronic and acute pain via dysfunction in endogenous opioid systems. Preliminary data support this hypothesis with regard to dispositional anger-out. However, recent finding indicate that behavioral anger expression when anger is aroused may be analgesic in high anger-outs, suggesting that examination of Trait X State interactions could be crucial for understanding mediators of anger-out's health effects. The role of opioids in expression of these interactions is unknown. The specific aims of the proposed study are: 1) determine whether behavioral anger expression in high anger-outs triggers opioid-mediated analgesia, and 2) determine the relationships between opioid- related effects of anger-out, in vivo behavioral anger expression, and daily chronic pain variables. Exploration of the clinically important phenomenon of anger expression as it impacts on endogenous opioid pain regulatory system function will improve understanding of the psychobiological relationships that may contribute to both acute and chronic pain responsiveness. One hundred forty subjects with chronic low back pain and 80 pain-free healthy subjects will participate in two laboratory sessions, once under opioid blockade with naloxone and once under placebo. Subjects will undergo either an anger recall interview to elicit anger arousal and behavioral anger expression, or a control non anger-arousing interview. Next, subjects will undergo acute finger pressure pain and ischemic pain stimuli. Subjects will also complete a daily electronic pain and behavioral anger expression diary between laboratory sessions. Results will reveal whether verbal anger expression when anger is aroused triggers opioid analgesia in high anger-out individuals. If the known positive relationship between chronic pain intensity and anger-out is mediated by absolute opioid dysfunction, statistical control of opioid blockade responses to acute pain (index of opioid analgesic function) should eliminate this relationship. However, if the apparent opioid dysfunction in high anger-outs is ameliorated by behavioral anger expression in the lab, the effects of opioid triggering on chronic pain in response to in vivo behavioral anger expression should be evident in intensive diary data.