Defence response mobilization via interoceptive sensations in children with chronic pain

儿童慢性疼痛障碍严重致残，是一个严重的健康问题，患病率为3%至5%。暴露在严重和无法控制的急性疼痛中可能是一种可怕的经历，根据威胁迫近模型，它会激活立即的防御反应，包括自主觉醒的增加和逃跑的冲动。在患有慢性疼痛障碍的儿童中，伴随疼痛经历的内感受可能成为条件刺激，引发条件防御反应，导致疼痛加重、残疾和焦虑忧虑，随后出现回避行为。越来越多的研究证据强调了内感受过程的重要性，特别是在头痛和功能性腹痛的病因学中，这是儿童主要的疼痛问题。然而，在儿童和成人慢性疼痛的研究中，缺乏内在感受后防御反应的直接证据。提出的研究项目将填补当前国际研究的两个空白：首先，我们将研究良性内感受的感知是否能引起慢性每日头痛（CDH, n=40）、功能性腹痛（FAP, n=40）和健康儿童（HC, n=40）的11至18岁儿童和青少年的防御反应动员。将使用两种类型的线索：局部近端线索和局部远端线索。基于邻近假设，假设来自同一身体区域（近端）的刺激比来自远端身体区域的刺激更有可能唤起防御反应动员。其次，我们将研究特定障碍的内感受厌恶意象是否也能引发防御反应动员。这将在26名患有慢性疼痛障碍的儿童和青少年（11-18岁）的第二次实验中进行研究。假设厌恶的图像比中性的图像更容易唤起防御反应动员。在这两项研究中，防御反应动员将使用一个完善的指示恐惧范式进行研究。儿童的反应将采用最先进的多模式评估方法进行测量，包括自我报告、外周生理反应，包括皮肤电导水平、心率和惊吓增强。目前的项目将是第一个研究慢性疼痛障碍儿童通过感知和想象的内感受触发的防御反应动员，并将对临床儿童和青少年疼痛的实验研究领域做出显著贡献。该研究结果不仅为儿童慢性疼痛的病因和维持提供了重要的知识，而且为开发新的治疗干预措施提供了基础，例如内感受性想象暴露以减少防御反应动员。

Chronic pain disorders in children are highly disabling and a significant health problem with prevalence rates of three to five percent. Exposure to severe and uncontrollable acute pain can be a terrifying experience, which activates an immediate defensive reaction according to the Threat Imminence Model, comprising of increases in autonomic arousal and the urge to escape. In children with chronic pain disorders, interoceptive sensations that accompany the pain experience may become conditioned stimuli that elicit conditioned defensive responses, leading to aggravated pain, disability, and anxious apprehension followed by avoidance behaviour. Increasing research evidence underlines the importance of interoceptive processes, especially in the aetiology of headache and functional abdominal pain, the predominant pain problems in children. However, direct evidence for defensive responses following interoceptive sensations is lacking in chronic pain research in children and adults. The proposed research program will close two gaps of current international research: First, we will study whether the perceptions of benign interoceptive sensations can elicit defence response mobilization in children and adolescents (11 to 18 years) with chronic daily headache (CDH; n=40), functional abdominal pain (FAP; n=40) and healthy children (HC, n=40). Two types of cues will be used: cues that are locally proximal vs. locally distal to the main pain. Based on the proximity hypothesis, it is hypothesized that stimuli from the same body region (proximal) are more likely to evoke defence response mobilization than stimuli from distal body regions. Second, we will investigate whether disorder-specific aversive imagery of interoceptive sensations can also elicit defence response mobilization. This will be studied in a second experiment with 26 children and adolescents (11-18 years) with chronic pain disorders. It is hypothesized that aversive imageries are more likely to evoke defence response mobilization than neutral imageries. In both studies, defence response mobilization will be studied using a well-established instructed fear paradigm. Childrens response will be measured using a state of the art multimodal assessment approach consisting of self-report, peripheral physiological reactivity, including skin conductance level, heart rate and startle potentiation.The present project will be the first to investigate defence response mobilization triggered via perceived and imagined interoceptive sensations in children with chronic pain disorders and will make a salient contribution to the still scant field of experimental research in clinical child and adolescent pain. The results of the study will not only add important knowledge to the aetiology and maintenance of chronic pain in children, but will also provide the basis for the development of new treatment interventions, such as interoceptive imaginal exposure to decrease the defence response mobilization.