How positive and negative expectations shape the experience of visceral pain: an experimental pilot study in healthy women.
How positive and negative expectations shape the experience of visceral pain: an experimental pilot study in healthy women.
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DOI：
10.1111/j.1365-2982.2012.01950.x
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发表时间：
2012-10-01
期刊：
影响因子：
--
通讯作者：
Benson, S
中科院分区：
文献类型：
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作者：
Elsenbruch, S;Schmid, J;Benson, S
背景技术背景：为了阐明安慰剂和反安慰剂在内脏痛中的作用，我们分析了积极和消极期望对健康女性直肠痛感知、直肠痛阈值、状态焦虑和皮质醇反应的影响。疼痛性直肠扩张在基线时进行，随后应用惰性物质结合疼痛缓解的积极指示（安慰剂组，N = 15）、疼痛增加的阴性指示（反安慰剂组，N = 17）或中性指示（对照，N = 15）。在基线时、组特定指导后立即和相同指导后第二个研究日（试验日）测定感知疼痛强度、不愉快/厌恶和排便急迫、状态焦虑和血清皮质醇。直肠疼痛阈值测定在基线和测试day.Key结果：而感知疼痛强度显着降低安慰剂组，nocebo组显示显着增加疼痛强度等级，沿着显着更大的预期焦虑的测试日（所有P < 0.05与对照组）。皮质醇浓度显着增加nocebo组治疗后，但不是在测试day.CONCLUSIONS & INFERENCES：腹痛的经验可以通过实验增加或减少诱导积极或消极的期望。Nocebo效应涉及心理应激反应，其特征是预期焦虑增加。这些研究结果进一步强调了认知和情感因素在内脏痛经历中的作用，这对慢性腹部不适患者的病理生理学和治疗具有影响。
BACKGROUND: In order to elucidate placebo and nocebo effects in visceral pain, we analyzed the effects of positive and negative expectations on rectal pain perception, rectal pain thresholds, state anxiety and cortisol responses in healthy women.METHODS: Painful rectal distensions were delivered at baseline, following application of an inert substance combined with either positive instructions of pain relief (placebo group, N = 15), negative instructions of pain increase (nocebo group, N = 17), or neutral instructions (control, N = 15). Perceived pain intensity, unpleasantness/aversion and urge-to-defecate, state anxiety and serum cortisol were determined at baseline, immediately following group-specific instructions and on a second study day after the same instructions (test day). Rectal pain thresholds were determined at baseline and on the test day.KEY RESULTS: Whereas perceived pain intensity was significantly decreased in the placebo group, the nocebo group revealed significantly increased pain intensity ratings, along with significantly greater anticipatory anxiety on the test day (all P < 0.05 vs controls). Cortisol concentrations were significantly increased in the nocebo group following treatment but not on the test day.CONCLUSIONS & INFERENCES: The experience of abdominal pain can be experimentally increased or decreased by inducing positive or negative expectations. Nocebo effects involve a psychological stress response, characterized by increased anticipatory anxiety. These findings further underscore the role of cognitive and emotional factors in the experience of visceral pain, which has implications for the pathophysiology and treatment of patients with chronic abdominal complaints.