基于人格特质分层的“预期因素”在镇痛与致痛作用中的脑网络机制研究

"预期”等心理因素对疼痛的影响正受到广泛关注。若患者相信治疗有效，就可能产生镇痛效果（安慰剂效应）。而不良暗示或不信任则导致或加重疼痛（反安慰剂效应）。且该效应因人而异，性格固执者效果不明显。.目前，疼痛安/反安慰剂效应的脑机制及个体差异机理不明（科学问题），严重制约疼痛的治疗。我们发现假针刺，甚至言语安慰，只要患者预感“治疗”有效，也可镇痛，以及与真实镇痛治疗相似的疼痛矩阵网络改变。据此，我们设想安慰镇痛与反安慰致痛效应的实质是预期等心理因素引起疼痛网络功能重组，以“自上而下”方式调控疼痛信号传导，个体差异源于人格特质相关的脑功能结构差异（科学假说）。.本课题拟以腰痛被试为研究对象，按人格特质分层控制异质性，以“治疗预期”为干预措施，以脑功能成像及TBS为研究手段，以VAS、fMRI、VBM等数据为分析指标，揭示疼痛安/反安慰剂效应的脑网络机制，为疼痛治疗提供新的理论依据和方法指导。

The impact of "anticipation" and other psychological factors on pain is attracting widespread attention. If a patient believes that a treatment is effective, it will produce an analgesic effect (placebo effect). However, when the patients had the distrust of doctor or negative hints, it would lead to or aggravate pain(nocebo effect). This effect varies from person to person and is not obvious for stubborn people..Currently, the brain mechanisms and individual differences in placebo/nocebo effect are unclear ( scientific problems), which severely impedes the treatment of pains. We found that, as long as a patient anticipates that the "treatment" is effective, sham-acupuncture or even verbal consolation can produce an analgesic effect and change the pain matrix just as a real analgesic treatment does. Therefore, we assumed that the essence of placebo/nocebo effect was that anticipation and other psychological factors caused a reorganization of pain network and regulated the pain signaling in a "top-down" manner and that individual differences were originated from the brain functional structure differences associated with personality traits. .This study plans to use low back pain (LBP) subjects as the research object and control heterogeneity by layer based on personality traits stratification. It also plans to use "treatment anticipation" as the intervening measure, brain functional imaging and TBS as the research means, VAS, fMRI, and VBM data as the analysis indexes in order to reveal the brain network mechanism of placebo/nocebo effect and provide new theoretical and methodological guidance for improving analgesic effects.