疼痛恐惧的形成、泛化与消退

疼痛恐惧源于把疼痛等同于伤害的灾难化信念及对疼痛的负性解释, 它在慢性疼痛和能力丧失的发生和发展过程中起着重要作用。疼痛恐惧可以通过联合学习和观察学习等方式获得, 并且在具有相似特征的刺激中存在泛化现象。通过教育干预和等级暴露疗法等可以成功消退疼痛恐惧, 在消退过程中要控制安全信息等因素的不良影响。在疼痛恐惧的获得与消退中, 主要有杏仁核, 脑岛和前扣带皮层等脑区参与。未来的研究可以集中在深入探讨疼痛恐惧形成中的泛化及消退后的恢复、再巩固等现象, 加强其临床上的应用, 并综合心理、生物和认知神经科学, 研究疼痛恐惧的获得、泛化与消退的深层机制。

The acquisition,generalization and extinction of fear of pain

Fear of pain (FOP), an experience associated with pain catastrophizing beliefs and interpretations of actual and potential pain as threat to body tissue, plays an important role in the development and maintenance of chronic pain. Recent evidence has found fear of pain can be acquired through associative learning, observational learning and verbal threat information. Acquired fear of pain can generalized new stimuli sharing features with original fear stimuli. Fortunately, fear of pain can be reduced successfully by extinction procedures including in vivo graded exposure to laboratory and “real-world” pain sensations. Brain regions including the amygdale, insula, and anterior cingulate cortex, are involved in the acquisition, extinction and reinstatement of FOP. Future research should investigate how FOP is reinstated and reconsolidated after its extinction neural mechanisms underpinning the phenomenon, and treatment implications to patients with chronic pain.