PAIN CONTROL METHODS-- EFFECTS OF MORPHINE, DISTRACTION, & MOOD CHANGES ON PAIN

这代表了一系列两项实验室研究，考察了行为疼痛控制的几个组成部分：情绪变化和分心。一个关键的特征是在吗啡存在的情况下检查这些行为成分，吗啡是用于积极药物止痛的原型药物。人们认识到，行为控制疼痛，如果使用的话，将经常与止痛药一起使用。这项研究的具体目的是：(A)研究吗啡和精神分心对正常受试者的疼痛耐受性和强度和不愉快疼痛等级的综合影响，以及(B)考察吗啡和积极情绪诱导对正常受试者疼痛耐受性和强度和不愉快疼痛等级的联合影响。疼痛刺激将由压力测痛仪产生的压力施加到食指上。研究A中的受试者被随机分配到5种情况中的一种：吗啡合并分心、单独使用吗啡、主动安慰剂合并分心、单独使用主动安慰剂和非主动安慰剂。这项研究在赫尔曼医院的大学临床研究中心(CRC)开始。在获奖的第二年，我们在赫尔曼医院的大学临床研究中心(CRC)发起了这项研究。研究A的假设是，分心和吗啡的联合使用对痛觉的影响最大，其次是单独使用吗啡，分心加活性安慰剂(苯海拉明)，活性安慰剂，非活性安慰剂。8名受试者(3名女性，5名男性)参加了试验阶段的研究。有必要对研究程序进行一些细微的调整。紧张性疼痛刺激是来自压力测痛仪的压力刺激。我们最初在测痛仪上使用1.0公斤的重量，但后来将重量增加到2.0公斤。这一增加是因为受试者的基线疼痛耐受性大于压力刺激的5分钟限制。我们还调整了基线抽血的时间，以避免影响受试者的基线疼痛耐受性。此外，为了使任务要求更容易理解，对分心任务的说明做了一些细微的改动。研究B中的受试者将被分配到7种情况中的一种：有积极情绪的吗啡，有中性情绪的吗啡，单独使用吗啡，有积极情绪的积极安慰剂，有中性情绪的积极安慰剂，单独使用积极安慰剂，以及不活跃的安慰剂。主要的结果变量将是疼痛耐受时间的变化。次要结果衡量标准将是疼痛强度和不愉快程度的变化。

This represents a series of two laboratory studies examining several components of behavioral pain control: mood alteration and distraction. A critical feature is the examination of these behavioral components in the presence of morphine, the prototypic drug for aggressive pharmacologic pain management. It is recognized that behavioral control of pain, if used at all, will often be used in conjunction with analgesics. The specific aims of the study are (a) to examine the combined effects of morphine and mental distraction on pain tolerance and pain ratings of intensity and unpleasantness in normal subjects, and (b) to examine the combined effects of morphine and positive mood induction on pain tolerance and pain ratings of intensity and unpleasantness in normal subjects. The pain stimulus will be pressure to the index finger produced by a pressure algometer. Subjects in Study A are randomly assigned to 1 of 5 conditions: morphine with distraction, morphine alone, active placebo with distraction, active placebo alone, and inactive placebo. This study has commenced in the University Clinical Research Center (CRC) at Hermann Hospital. During the second year of the award, we initiated this study in the University Clinical Research Center (CRC) at Hermann Hospital. The hypothesis for Study A is that the combined use of distraction and morphine will have the greatest effect on pain perception, followed in order by: morphine alone, distraction with an active placebo (diphenhydramine), an active placebo, and an inactive placebo. Eight subjects (three females, five males) were enrolled in the pilot phase of the study. Some minor adjustments in the study procedures were necessary. The tonic pain stimulus is pressure stimulation from the pressure algometer. We initially used 1.0 kg of weight on the algometer but subsequently increased the weight to 2.0 kg. This increase was indicated as the subjects' baseline pain tolerance was greater than the 5-minute limit for the pressure stimulus. We also adjusted the timing of the baseline blood draw in order to avoid influencing the subjects baseline pain tolerance. In addition, minor changes were made in the instructions for the distraction task in order to make the task requirements easier to comprehend. Subjects in Study B will be assigned to 1 of 7 conditions: morphine with positive mood, morphine with neutral mood, morphine alone, active placebo with positive mood, active placebo with neutral mood, active placebo alone, and inactive placebo. The primary outcome variable will be change in pain tolerance time. Secondary outcome measures will be changes in pain intensity and unpleasantness ratings.