Anger Expression, Opioid Dysfunction, and Chronic Pain

描述（由申请人提供）：愤怒调节的表达方式（愤怒）与对急性和慢性疼痛的敏感性增加有关。基于内源性阿片类物质在疼痛、应激反应和情绪状态调节中的作用，假设愤怒可能通过内源性阿片系统功能障碍对慢性和急性疼痛产生影响。初步的数据支持这一假设与性格愤怒。然而，最近的研究结果表明，行为愤怒的表达时，愤怒引起的可能是镇痛在高愤怒，这表明检查特质X状态的相互作用可能是至关重要的了解介质的愤怒的健康影响。阿片类药物在这些相互作用的表达中的作用尚不清楚。所提出的研究的具体目的是：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，以及2）确定愤怒的阿片类药物相关作用、体内行为愤怒表达和日常慢性疼痛变量之间的关系。探索临床上重要的愤怒表达现象，因为它影响内源性阿片类药物疼痛调节系统的功能，将提高对可能有助于急性和慢性疼痛反应的心理生物学关系的理解。140例慢性腰痛受试者和80例无痛健康受试者将参加两次实验室检查，一次接受纳洛酮阿片类药物阻滞，一次接受安慰剂。受试者将接受愤怒回忆访谈以引起愤怒唤起和行为愤怒表达，或接受对照非愤怒唤起访谈。接下来，受试者将经历急性指压疼痛和缺血性疼痛刺激。受试者还将在实验室会话之间完成每日电子疼痛和行为愤怒表达日记。结果将揭示是否言语愤怒表达时，引起愤怒触发阿片类镇痛高愤怒的个人。如果已知慢性疼痛强度和愤怒之间的正相关性是由绝对阿片类药物功能障碍介导的，则对急性疼痛的阿片类药物阻滞反应（阿片类药物镇痛功能指数）进行统计学控制应消除这种关系。然而，如果在实验室中通过行为愤怒表达改善了高愤怒者中明显的阿片类药物功能障碍，那么阿片类药物触发对体内行为愤怒表达的慢性疼痛的影响应该在密集的日记数据中很明显。

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.