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。     

疼痛共情的神经机制

疼痛是一种多维度的体验。情感成分和感觉成分是疼痛体验的主要成分,二者有着不同的神经机制。疼痛共情是痛觉"共鸣"的情绪反应,其神经机制的研究也围绕疼痛的情感成分和感觉成分展开。疼痛共情的情感成分的相关脑区主要有前扣带皮层和脑岛等脑区,与自身疼痛时相比,它们的激活位点及所处的神经网络存在差异;疼痛共情的感觉成分主要与初级感觉皮层以及一些其它的躯体感觉皮层有关,对它们的激活情况的研究受技术手段和实验范式的影响较大。未来的研究应从技术手段、分析方法及实验操作上予以关注。     

Catastrophizing as a Cognitive Vulnerability Factor Related to Depression in Workers’ Compensation Patients with Chronic Musculoskeletal Pain

The purpose of this study was to examine the role of catastrophizing as a mediator and moderator between life stress and depression in a sample of workers’ compensation patients with chronic musculoskeletal pain. Pain intensity, life stress (especially work and financial stress), and catastrophizing contributed significantly to depression. Catastrophizing was found to be partially mediating the relationship between life stress and depression and a moderator between social stress and depression. The results supported the role of catastrophizing as a cognitive vulnerability-stress factor related to depression in chronic pain patients. Screening for life stress and intervening early to prevent catastrophizing from occurring in the workers’ compensation rehabilitation process may reduce psychosocial distress and enhance the overall effectiveness of rehabilitation programming for workers’ compensation patients with chronic pain.     

疼痛恐惧的形成及其对疼痛知觉的影响

脑岛、杏仁核是疼痛恐惧形成的重要神经网络中心。疼痛恐惧增强了慢性疼痛患者的疼痛知觉体验, 进而加剧抑郁、焦虑情绪和功能损伤程度。脑岛、杏仁核、前额皮层和前扣带回是疼痛恐惧影响疼痛知觉的重要神经基础。通过认知方法干预疼痛恐惧可以改善患者的抑郁、焦虑情绪, 减少功能损伤。未来研究应拓展疼痛恐惧的测量工具, 采用功能磁共振成像技术进一步揭示疼痛恐惧影响慢性疼痛患者疼痛知觉的神经机制。     

Building bridges between body and mind: The analysis of an adolescent with paralyzing chronic pain

This paper describes the evaluation, initial psychotherapy and subsequent psychoanalysis of an adolescent who presented with a severe psychosomatic process involving total body pain and profound fatigue. The author details the complex and multifaceted nature of the psychosomatic process as it unfolded in the treatment. The psychosomatic problem was not a single entity, but rather was comprised of diverse interwoven elements such as somatization, conversion on pre-oedipal and oedipal levels, conflicts over aggression, sexuality, identity, masochism, secondary gain, anaclitic depression, internalized self-other interactions with a depressed mother and transgenerational transmission of trauma. The author uses the case material to discuss technical approaches to problems that often arise in the analytic treatment of patients with complicated chronic pain and fatigue as the primary complaints. Such approaches include respecting the mind-body split as a primary defense, speaking the language of the body along with the language of the mind and developing the verbal sphere around the non-verbal symptoms. The author emphasizes that complicated chronic pain problems are common and can be helped by psychoanalysis as long as the unique and complex features are understood and reflected in the technical approach.     

Psychoanalytic process and thought: Convergence of Bion and Matte‐Blanco1

Using the convergence between Bion and Matte‐Blanco, in this article the author attempts to stress the view of the psychoanalytical method as promoter of expansion of the ability of the patient to think his emotional experiences. After a brief résumé of the ideas of both Bion and Matte‐Blanco, certain points of congruence between the two are emphasised: the way of perceiving the range of phenomena observed by psychoanalysis, intuition as a method for observing this field, the feelings as the raw material for thinking, and the importance of the concept of infinity in psychoanalysis. The way in which the ideas of Matte‐Blanco assist in the understanding of Bion's propositions is highlighted. Following these correlations, the author discusses certain questions pertinent to the psychoanalytical method and proposes a model in which the analyst acts as a mediator/catalyst in the process of revision of the ways in which the patient has organised his emotional experiences and the theories constructed to support these hypotheses. Samples of clinical material are presented.     

BORGES, IMMORTALITY AND THE CIRCULAR RUINS

The author explores ideas surrounding immortality and death focusing on the interplay between their development in two stories by Borges ('The circular ruins' and 'The immortal') and their manifestation in a patient. With the help of Borges's stories, the author addresses the desperate necessity experienced by some individuals to search for immortality. This is not just an expression of the universal wish to live forever but, at a deeper level, arises from the impossibility of bearing the mental pain of experiencing ordinary human vulnerability and loss - death being the ultimate expression of such vulnerability. It is suggested that the relentless pursuit of immortality in such individuals expresses an omnipotent phantasy of ridding the self of the emotional pain and fear that arises through being alive. It leads to a denial of the emotional significance of passage of time, of separation and sexual differences. In actuality, the individual's state of not feeling approximates to a complete loss of human identity and emotional death, with no place for any meaningful others. The individual him/herself becomes a 'mere image', living in a delusional world peopled by him/herself and his/ her projections, and ending up trapped inside the circular ruins he/she has generated. The horror experienced at the stark awareness of the individual's emotional death and the wish to re-establish contact with the good internal objects that have been attacked sets in motion the long process of searching for the recovery of a sense of temporality (that would still include the wish for immortality) and, with it, a sense of identity.     

Mindfulness-Based Stress Reduction and Sense of Coherence Among Women with Fibromyalgia

Sense of Coherence (SOC) is conceptualized as a disposition to experience life as meaningful and manageable. Research suggests a protective effect of SOC on psychological health in stressful circumstances. This study assessed the capacity of SOC to buffer the effect of illness symptoms on psychological distress among patients with fibromyalgia. Self-reported changes in SOC after participation in a Mindfulness-Based Stress Reduction (MBSR) program were also examined. Ninety-one women with fibromyalgia provided baseline data pertaining to illness symptoms, perceived stress, and depression prior to participation in a randomized trial of MBSR. SOC and fibromyalgia symptoms were independently related to perceived stress and depression at baseline. SOC was not a statistically significant moderator of symptom effects on psychological distress. In comparison with wait-listed controls, program participants reported a significant increase in SOC after MBSR participation. These results provide the first demonstration from a randomized trial that SOC may be enhanced via intervention.     

Is Laughter the Best Medicine? Humor, Laughter, and Physical Health

This article examines research evidence for the popular idea that humor and laughter have beneficial effects on physical health. Potential theoretical mechanisms for such effects are discussed first. Empirical evidence for beneficial effects of humor and laughter on immunity, pain tolerance, blood pressure, longevity, and illness symptoms is then summarized. Overall, the evidence for health benefits of humor and laughter is less conclusive than commonly believed. Future research in this area needs to be more theoretically driven and methodologically rigorous.     

NCCN成人临床癌痛指南中心理问题、精神症状和精神用药的解读

疼痛的体验是主观的,疼痛与痛苦相伴而行。NCCN成人癌痛指南对癌痛的评估和治疗中涉及大量的心理问题与干预、精神症状评估和精神药物应用,本文力求对这方面进行解读,以揭示癌痛治疗中对人的尊重和对“总疼痛”的理解。