恐惧的代价：疼痛恐惧、心理忧虑和躯体化对疼痛感知预测作用的比较

首次在无痛群体中比较疼痛恐惧、心理忧虑和躯体化对疼痛感知的预测作用大小及调节和中介关系。以多个同类量表得分的Z分数加和作为三者的因子分,以冷压痛觉测验（CPT）疼痛指标（阈限、耐受性、强度、不愉快度）为目标变量,通过分层回归及调节和中介作用分析,发现疼痛恐惧对疼痛不愉快度的预测作用最强,心理忧虑对疼痛体验（强度、不愉快度）的预测作用被疼痛恐惧完全中介,躯体化只有在高疼痛恐惧条件下才显著负向预测疼痛不愉快度。综上,疼痛恐惧是三因素中预测CPT疼痛体验的主要因素。     

Pain intensity and pain unpleasantness in triathletes: A study examining their associations with pain catastrophizing and pain expectations

ObjectiveTriathletes represent a growing and unique population of individuals willing to endure significant mental and physical stress to practice the sport they love. However, little is known about the pain experienced while training for and competing in a triathlon and how psychological factors influence this experience. This study will assess pain experienced by triathletes in training and competition, and investigate the association between pain catastrophizing and pain expectations with triathlon pain intensity and pain unpleasantness.DesignIn this observational study, a sample of 261 triathletes completed two online surveys before and after participating in a triathlon.ResultsModerate levels of pain intensity and pain unpleasantness were reported during training and competition. Pain catastrophizing was positively associated with expected and actual triathlon pain unpleasantness, but not with pain intensity. Expected pain intensity was also significantly associated with pain intensity experienced while competing, whereas expected pain unpleasantness was significantly related to both triathlon pain intensity and unpleasantness. Finally, regression analysis revealed pain catastrophizing and pain expectations to be unique predictors of triathlon pain intensity and pain unpleasantness.ConclusionThis study highlights the important role of psychological factors in triathletes' experience of pain and could eventually help tailor interventions aimed at improving the practice of triathlon.     

Menstrual cycle, beta-endorphins, and pain sensitivity in premenstrual dysphoric disorder.

This study examined pain sensitivity and pain modularity mechanisms (e.g., beta-endorphin levels, blood pressure) in women with premenstrual dysphoric disorder (PMDD; n = 27) and healthy controls (n = 27) during the follicular and luteal phases of the menstrual cycle. Physiological measures were taken during rest and ischemic pain testing. In both cycle phases, PMDD women (a) displayed lower resting cortisol and beta-endorphin levels and (b) exhibited shorter pain threshold and tolerance times and greater pain unpleasantness ratings during pain. PMDD women also reported greater pain unpleasantness and intensity and had lower beta-endorphin levels in their luteal phase and tended to display higher blood pressure levels at rest and during pain testing. Results suggest that endogenous opioids may be pathophysiologically relevant to PMDD and that the hypothalamic-pituitary-gonadal axis may modulate pain sensitivity in PMDD.     

Memory of pain induced by physical exercise

The aim of this study was to assess the memory of pain induced by running a marathon and the factors that influence it. Sixty-two marathon runners participated in the study, which comprised two phases. Immediately after a participant had reached the finishing line of the marathon, they were asked to rate the intensity and the unpleasantness of their pain and the emotions they felt at that time. Either three or six months later they were asked again to rate the intensity and the unpleasantness of the same pain experience. Regardless of the length of recall delay, participants underestimated both recalled pain intensity and unpleasantness. The pain and negative affect reported at the time of the pain experience accounted for 24% of the total variance in predicting recalled pain intensity and 22% of the total variance in predicting recalled pain unpleasantness. Positive affect at the time of pain experience was not a significant predictor of both the recalled pain intensity and pain unpleasantness. It is concluded that pain induced by physical exercise is not remembered accurately and the pain and negative affect experienced influence recall. Further research is needed on the influence of positive affect on the memory of pain.     

Memory of pain and affect associated with migraine and non-migraine headaches

The main aims of this study were to assess memory of pain and pain-related affect in headache sufferers and to compare the pain memories of individuals who suffer from migraines and those who experience non-migraine headaches. A total of 313 women participated in the study, 86 of whom had a diagnosis of migraine headache. The women rated their state anxiety about having a headache, the intensity and unpleasantness of headache pain, and their emotions while actually experiencing a headache. Either three or six months later, the participants were asked to recall their state anxiety, the intensity and unpleasantness of pain, and the emotions they had felt. Regardless of the length of recall delay or migraine diagnosis, participants accurately remembered both pain intensity and unpleasantness. Together, recalled anxiety, experienced pain and recalled positive affect were the most important predictors of memories for headache, accounting for 41% and 37% of the total variance in recalled pain intensity and unpleasantness, respectively. However, participants overestimated recalled positive and negative affect. The effect of recalled affect on memory of headache, together with the overestimation of recalled affect, suggests that although memory of headache is accurate, it is influenced by distorted memories of affect.     

Experimental comparison of dyspnea and pain

Dyspnea and pain are similarly unpleasant, alarming physical sensations, but studies examining both sensations in combination are lacking. In the present study, dyspnea was induced in 7 healthy volunteers by breathing through inspiratory resistive loads and the effects were compared with those of a heat pain stimulus. End-tidal partial pressures of carbon dioxide (PET_CO2), inspiratory time (Ti), breathing frequency (f), experienced unpleasantness, and intensity were measured. No difference was observed between dyspnea and pain in experienced intensity and unpleasantness (p >.05). During dyspneic stimulation, slightly higherTi was found than for pain (p<.08). PET_CO2 showed slight increases during the dyspneic versus the baseline and painful conditions (ΔPET_CO2=1.5 and 1.3 mmHg, respectively;p<.01 andp<.05). This study shows that the effects of dyspnea and heat pain can be compared within one experiment; both stimuli can be presented with similar intensity and unpleasantness, which is a prerequisite for comparing responses to them. The changes in PET_CO2 between our conditions were minimal, allowing an application of the present design to future fMRI studies.     

Big Five personality traits contribute to prosocial responses to others’ pain

ObjectivesTwo studies examined whether observers’ personality traits contribute to prosocial responses to others’ facial expression of pain. Experiment 1 examined the personality traits that could account for observers’ variability in estimating others’ pain intensity. Experiment 2 questioned to what extent the contribution of personality traits on inclination to help people in pain depend on observers’ beliefs about pain’ characteristics.Method59 (experiment 1) and 76 (experiment 2) participants observed to 3-D realistic synthetic face movements mobilizing action units of pain, in order to estimate others’ pain. In experiment 2, painful localizations (e.g., chest, hand) were also manipulated. In each experiment, Big Five personality traits were assessed.ResultsExperiment 1 revealed that agreeableness and conscientiousness contributed to observers’ pain estimates across the increase of facial expression intensity. Experiment 2 showed that conscientiousness contributed to observers’ judgments whatever pain’ characteristics. Neuroticism was only salient for pain referring to life-threatening pain.ConclusionProsocial response to others’ pain depends on agreeableness, conscientiousness and neuroticism. However, these links are modulated by the pain behavior elicited and observers’ belief about the characteristic of pain.     

Presurgery distress and specific response expectancies predict postsurgery outcomes in surgery patients confronting breast cancer.

Prior to scheduled surgery, patients frequently experience particularly high levels of distress and expect a variety of postsurgery symptoms. Surgery patients who confront breast cancer are no exception. It has been suggested that such presurgery distress and response expectancies are predictive of postsurgery outcomes. To test the contribution of presurgery distress and expectancies to common postsurgery symptom outcomes (pain, nausea, fatigue, and discomfort), 63 female patients undergoing breast cancer surgery were recruited to a prospective study. Results indicated that presurgery distress uniquely contributed to patients' postsurgery nausea, fatigue, and discomfort; specific expectancies uniquely contributed to pain intensity, pain unpleasantness, and fatigue (ps < .05). Consistent with expectancy theory, associations between response expectancies and postsurgery outcomes were not due to presurgery distress.     

Oral behavioral patterns in facial pain, headache and non-headache populations

Patterns of oral behavior have been suggested as factors leading to head and facial pain. The present study evaluated the frequency with which certain oral habits were self-reported by five groups of Ss: Facial Pain. Tension Headache, Migraine Headache, Combined Migraine and Tension Headache and No Pain. Four oral behavior patterns were found to be significantly different among groups. These were diurnal bruxism. thrusting the jaw forward, cupping the chin in the hand and resting the hand on the side of the face. When Ss were reclassified into those reporting no facial pain, temporomandibular joint (TMJ) pain, or a combination of TMJ and jaw muscle pain, the variables of diurnal bruxism and resting the hand on the side of the face were found to predict significantly both pain groups. However, the resting the hand factor was negatively weighted for the TMJ Pain group only. One other factor, nocturnal bruxism. was found to be self-reported at a significantly higher frequency in the Combined Facial Pain group compared to the No Facial Pain and TMJ Pain groups. Discussion focuses on the implications of the present findings on research in the facial pain and headache areas.     

激活右腹外侧前额叶提高抑郁症患者对社会疼痛的情绪调节能力：一项TMS研究

负性人际交往经历和负性社会事件是抑郁症的重要诱导因素, 而社会功能受损是抑郁症患者的重要特征之一, 患者通常表现出对社会疼痛的情绪失调。为了提高抑郁症患者在负性社交情境中或面对负性社会事件时的情绪调节能力, 本研究采用经颅磁刺激技术(transcranial magnetic stimulation, TMS), 考察抑郁症患者在腹外侧前额叶(the ventrolateral prefrontal cortex, VLPFC)被激活后其情绪调节能力的改变。结果表明, 当右侧VLPFC被TMS激活且患者采用认知重评策略调节情绪时, 实验组患者(n = 64)比对照组患者(n = 63)在社会排斥情境下报告了更弱的负性情绪体验, 这说明激活右侧VLPFC可以有效提高患者对社会疼痛的外显性情绪调节能力。本研究是采用TMS提高抑郁症患者情绪调节能力的首次尝试, 实验发现不但支持了VLPFC与认知重评策略的因果关系, 还为临床改善抑郁症等社会功能障碍患者的情绪调节能力提供了明确的神经治疗靶点。后续研究还需探讨多疗程TMS刺激方案、改变社会疼痛的诱发方式、对比左右侧VLPFC的治疗效果、尝试使用其他的情绪调节策略, 进一步验证本研究的结论, 优化TMS治疗方案。     

Trauma symptoms,temperament traits,social support and the intensity of pain in a Polish sample of patients suffering from chronic pain

The aim of the current study was to investigate the relationship between the intensity of pain, treated as the explained variable, and the level of trauma symptoms, as appear in posttraumatic stress disorder (PTSD), temperament traits postulated by the Regulative Theory of Temperament and aspects of social support among patients suffering from chronic pain (arthritis and low-back pain). To assess the intensity of pain among participants we used the Numerical Rating Scale (NRS-11). The level of trauma symptoms was assessed with the PTSD Factorial Version inventory (PTSD-F). Temperament was measured with the Formal Characteristics of Behaviour – Temperament Inventory (FCB-TI). Social support was tested with the Berlin Social Support Scales (BSSS). The results of our study suggest that significant predictors of pain intensity among chronic pain sufferers were trauma symptoms. We also noticed that some temperament traits (i.e., emotional reactivity) increased the level of global trauma symptoms, which, in turn, intensified the level of pain. In addition, we showed that global trauma symptoms decreased the support participants actually received.     

Perceived unpleasantness and facial reactions to auditory stimuli

This study examined whether facial electromyographic (EMG) reactions differentiate between identical tone stimuli which subjects perceive as differently unpleasant. Subjects were repeatedly exposed to a 1000 Hz 75 dB tone stimulus while their facial EMG from the corrugator and zygomatic muscle regions were measured. Skin conductance and heart rate responses were also measured. The subjects rated the unpleasantness of the stimulus and based on these ratings they were divided into two groups, High and Low in perceived unpleasantness. As predicted the facial EMG activity reflected the perceived unpleasantness. That is, the High group but not the Low group reacted with an increased corrugator response. The autonomic data, on the other hand, did not differ between groups. The results are consistent with the proposition that the facial muscles function as a readout system for emotional reactions and that facial muscle activity is intimately related to the experiential level of the emotional response system.     

Emotional flexibility and recovery from pain

This study aimed to investigate the relationship between two aspects of emotional flexibility (EF, i.e. flexible emotional responsiveness and affective flexibility) and tolerance for, and recovery from, experimentally-induced pain. Fifty-two adults completed a flexible emotional responsiveness task in which emotional responses on multiple dimensions were registered while watching positive and negative pictures. Affective flexibility was measured using a switching task with positive and negative pictures. Pain tolerance was assessed as the time participants endured an ischemic pain task and total time until recovery in terms of pain intensity and pain unpleasantness was registered. Flexible emotional responsiveness—reflected in divergent corrugator responses to positive and negative stimuli—was associated with faster recovery from pain unpleasantness. Affective flexibility was associated with recovery in terms of pain intensity, with faster switches from neutral towards affective aspects of positive stimuli being predictive of faster recovery. Results did not provide evidence for an association between EF and pain tolerance. The findings suggest that EF may protect against pain persistence.

     

TEMPORAL INTEGRATION OF PERCEPTUAL RESPONSE TO SUPRALIMINAL ELECTRICAL STIMULATION

E kman , G., F röberg , J. & F rankenhaeuser , M. Temporal integration of perceptual response to supraliminal electrical stimulation. Scand. J. Psychol ., 1968, 9, 83–88.—The effect of duration of electrical stimulation on perceived unpleasantness was investigated in 10 subjects. Duration of stimulation ranged from 0.05 to 3.00 sec. Three levels of intensity were investigated representing 2, 3, and 4 times the individual sensation threshold. For all stimulus intensities perceived unpleasantness was a simple logarithmic function of stimulus duration over the whole temporal range. This relation describes the trend of both the group data and the data from most individual subjects. The results support previous findings over a narrower temporal range and agree with results recently obtained in several additional sense modalities.     

Negative beliefs about low back pain are associated with persistent high intensity low back pain

While previous cross-sectional studies have found that negative beliefs about low back pain are associated with pain intensity, the relationship between back beliefs and persistent low back pain is not well understood. This cohort study aimed to examine the role of back beliefs in persistent low back pain in community-based individuals. A hundred and ninety-two participants from a previous musculoskeletal health study were invited to take part in a two-year follow-up study. Beliefs about back pain were assessed by the Back Beliefs Questionnaire (BBQ) at baseline and low back pain intensity was measured by the Chronic Pain Grade Questionnaire at baseline and follow-up. Of the 150 respondents (78.1%), 16 (10.7%) reported persistent high intensity low back pain, 12 (8.0%) developed high intensity low back pain, in 16 (10.7%) their high intensity low back pain resolved and 106 (70.7%) experienced no high intensity low back pain. While participants were generally positive about low back pain (BBQ mean (SD) = 30.2 (6.4)), those with persistent high intensity pain reported greater negativity (BBQ mean (SD) = 22.6 (4.9)). Negative beliefs about back pain were associated with persistent high intensity low back pain after adjusting for confounders (M (SE) = 23.5 (1.6) vs. >30.1 (1.7), p < .001). This study found negative back beliefs were associated with persistent high intensity low back pain over 2 years in community-based individuals. While further longitudinal studies are required, these findings suggest that targeting beliefs in programs designed to treat and prevent persistent high intensity low back pain may be important.     

海洛因戒治者对疼痛线索的选择性注意加工偏向

研究采用点探测范式,以疼痛线索(感觉疼痛词、情感疼痛词和健康灾难词)和中性线索(中性词)为实验材料,考察接受美沙酮维持治疗的海洛因戒治者对疼痛线索的视觉选择性注意偏向。结果表明:海洛因戒治者对疼痛线索的注意偏向具有普遍性,即对感觉疼痛词、情感疼痛词和健康灾难词等三类疼痛线索均存在注意回避偏向,尤其对健康灾难词的注意回避程度最高;海洛因戒治者还对感觉疼痛词和情感疼痛词存在注意脱离易化倾向。本研究对于有针对性的开展注意偏向矫正以干预疼痛,从而辅助美沙酮的治疗效果、维持患者的戒断状态、降低其复吸风险具有重要意义。     

疼痛表征在自我和他人间的一致性效应

在以往研究中“pain matrix”被认为是加工自我和他人疼痛信息的特异性神经机制, 也可能是个体对他人疼痛共情的原因。但是最近的研究发现非疼痛的感觉刺激也能激活该脑区, 因此疼痛表征在自我和他人间是否存在一致性受到质疑。研究采用启动范式从两个方面入手探索自身疼痛和疼痛共情间是否存在一致性关系。实验一使用疼痛和非疼痛图片为启动刺激, 疼痛或热刺激为靶刺激, 发现相对于非疼痛图片, 疼痛图片启动下被试对自身疼痛刺激的反应时减少, 疼痛水平和情绪反应增强。实验二使用疼痛和热刺激为启动刺激, 疼痛或非疼痛图片为靶刺激, 发现相对于热刺激, 疼痛刺激启动下被试对疼痛图片的反应时减少。同时, 在两个实验中非疼痛的靶刺激都不受启动刺激的影响。这说明疼痛表征在自我和他人间存在一致性效应。     

Relation of Self-Efficacy to Reported Pain and Pain Medication Usage During Labor

We studied the relationship of self-efficacy to reported labor pain and pain medication usage among 43 women. Self-efficacy ratings were judgments of confidence regarding successful completion of tasks involved in labor and delivery (e.g., doing breathing exercises) and in overcoming barriers (e.g., nonsupportive partner). Multiple regression analyses revealed that self-efficacy significantly contributed to predicting labor pain beyond other relevant variables (e.g., age, amount of menstrual pain), with barrier self-efficacy the strongest predictor. Results are discussed in the context of increasing women's confidence in overcoming barriers by incorporating relevant interventions in childbirth education.     

The role of pain behaviour and family caregiver responses in the link between pain catastrophising and pain intensity: A moderated mediation model

Objectives: This study investigated the mediating role of pain behaviours in the association between pain catastrophising and pain intensity and explored the moderating role of family caregivers’ responses to pain in the link between pain behaviours and pain intensity.

Methods: The sample consisted of 154 chronic pain patients and their family caregivers. Patients completed questionnaires regarding pain intensity, pain catastrophising, pain behaviours and their caregivers’ responses to their pain. Family caregivers reported their responses to the patients’ pain.

Results: Pain catastrophising was associated with pain intensity (r = 0.37) and pain behaviours partly mediated this association. The positive association between pain behaviours and pain intensity was significant only if patients reported that their family caregivers showed high levels of solicitous (effect = .49) and distracting responses (effect = .58), and if caregivers reported to show high levels of solicitous responses (effect = .51). No support was found for negative responses as a moderator neither based on patients’ perception of negative responses nor based on caregivers’ perception of negative responses.

Conclusions: The findings are in line with the idea that family caregivers’ solicitous and distracting responses convey to patients that their condition is serious, which may reinforce patients’ pain and pain behaviours, especially in those who catastrophise.     

Odors and the perception of hygiene

Although certain odors, such as lemon, are commonly associated with cleanliness and positive hygiene, empirical assessment of such associations for other odors and attributes is generally lacking. Moreover, differences between men and women in such associations have not been established. In this study of lemon, onion, pine, and smoke odors, ratings were obtained from 142 men and 336 women (M age= 30.1 yr., SD = 12.3) for odor intensity, gender association (masculine/feminine), and the success, sociability, intelligence, cleanliness, and attractiveness of a hypothetical person whose clothes smell like the odor in question. Ratings of the pleasantness or unpleasantness one would attribute to each odor in various rooms of the home were obtained, as well as a specification of whether such ratings are influenced by laundry habits, e.g., whether laundry is smelled before or after washing. Numerous associations were found. For example, a hypothetical person whose clothes smell of pine was rated as relatively more successful, intelligent, sociable, sanitary, and attractive than one whose clothes smelled of lemon, onion, or smoke. Sex differences, as well as differences between people who reported smelling their own laundry, were also found.