Anger Expression, Opioid Dysfunction, and Chronic Pain

描述(申请人提供)：愤怒调节(愤怒)的表达风格与对急性和慢性疼痛的敏感度增加有关。根据内源性阿片类药物对疼痛、应激反应和情绪状态的调节作用，推测愤怒可能通过内源性阿片系统功能障碍对慢性疼痛和急性疼痛产生影响。初步数据支持这一关于性情激怒的假设。然而，最近的研究表明，愤怒被激发时的行为愤怒表达在高愤怒状态下可能是止痛的，这表明对特质X状态交互作用的研究对于理解愤怒对健康影响的中介因素至关重要。阿片类药物在表达这些相互作用中的作用尚不清楚。这项研究的具体目的是：1)确定高愤怒中的行为愤怒表达是否触发阿片类药物介导的镇痛；2)确定愤怒相关的阿片类药物效应、体内行为愤怒表达和日常慢性疼痛变量之间的关系。探索愤怒表达对内源性阿片类疼痛调节系统功能的影响这一临床上重要的现象，将有助于加深对急性和慢性疼痛反应的心理生物学关系的理解。140名慢性下腰痛患者和80名无痛健康患者将参加两个实验室会议，一次是纳洛酮阿片类药物阻断，另一次是安慰剂。受试者将接受一次愤怒回忆访谈，以引发愤怒唤起和行为愤怒表达，或者接受一次非愤怒唤起的对照访谈。接下来，受试者将接受急性指压疼痛和缺血性疼痛刺激。受试者还将在实验室课程之间完成每日的电子疼痛和行为愤怒表达日记。结果将揭示当愤怒被唤起时，言语愤怒表达是否会在高愤怒个体中触发阿片类止痛。如果已知的慢性疼痛强度和愤怒之间的正相关关系是由绝对阿片类药物功能障碍介导的，那么对阿片类药物对急性疼痛的阻断反应(阿片类止痛功能的指标)的统计控制应该会消除这种关系。然而，如果高愤怒中明显的阿片类药物功能障碍可以通过实验室中的行为愤怒表达得到改善，那么在密集的日记数据中，阿片类药物触发对慢性疼痛的反应应该在密集的日记数据中是明显的。

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.