疼痛敏感性：心理特质和脑结构关联

发布时间：2018-05-23 22:00

本文选题：疼痛敏感性 + 疼痛恐惧　；参考：《西南大学》2014年硕士论文

【摘要】：疼痛敏感性具有广泛的个体差异,有些人总是更快地察觉疼痛或者疼痛体验更加强烈。已有研究显示心理特质(Leeuw et al.,2007)和脑结构(Emerson et al.,2014)与疼痛敏感性的个体差异有关。本论文旨在更具体地阐明影响疼痛敏感性的心理因素和脑结构。疼痛感知包含感觉区辨成分(疼痛强度)和动机情感成分(不愉快度),二者皆可能被诸如疼痛恐惧、心理忧虑和躯体化的心理特质因素所影响。尽管大量证据表明疼痛恐惧影响疼痛感知以及慢性疼痛(持续时间3个月以上)的发展和维持,但未见研究比较过疼痛恐惧、心理忧虑和躯体化究竟哪个对疼痛感知的影响最大。在方法上,本领域内的研究者往往使用单一量表去测量诸如心理忧虑和疼痛恐惧这般复杂的心理结构;并且多数研究采用慢性疼痛患者,从而难以判断究竟是心理特质加剧了疼痛感知,还是持续的疼痛诱导了心理特质。在无痛的健康大学生群体中,两项横断研究被用来区辨对疼痛感知至关重要的心理因素的相对作用。研究一探索在多个相关量表间是否存在包含躯体化、心理忧虑和疼痛恐惧的三因子结构,并验证其结构效度。研究二根据研究一的结果整合各因子内多个量表的分数作为因子分,并应用实验室疼痛范式比较各因子对疼痛感知的作用。研究三旨在阐明与疼痛敏感性有关的脑结构。在研究一中,653名大学生(455名女性,198名男性)完成一系列自陈量表,包括五项疼痛恐惧量表,三项一般性的心理忧虑量表和两项躯体化量表。在两个对等的分半样本中,分别进行探索性因素分析(EFA)和验证性因素分析(CFA)以判定多量表间的三因子结构是否存在以及结构效度是否良好。EFA结果在其中一个分半样本中发现了与预期一致的三因子结构,而CFA结果在另一分半数据中证明该结构具有良好的拟合度。在研究二中,105名被试(74名女性,31名男性)以顺序平衡的方式先后完成相同的自陈问卷和冷水痛测验(CPT)。CPT要求被试将非利手尽可能长久地放置于冰水中,时间上限为五分钟。疼痛阈限、忍耐时间、自我报告的疼痛强度和不愉快度作为测量疼痛感知水平的四个指标,分层回归模型和调节、中介分析被用来考察三因子对疼痛感知各指标的影响作用。主要结果如下：(1)疼痛恐惧和心理忧虑显著地正向预测疼痛强度和疼痛不愉快度,但心理忧虑的作用被疼痛恐惧完全中介；(2)更高水平的疼痛恐惧与更短的耐受时间在边际水平(p=0.097)显著相关,而躯体化和心理忧虑对耐受力没有影响；(3)对疼痛恐惧水平较高的人来说,躯体化水平越高,疼痛不愉快度越低。总体来看,研究一和研究二的结果说明疼痛恐惧,而非心理忧虑和躯体化是加剧疼痛感知,尤其是疼痛强度和不愉快度的主要特质。疼痛恐惧对心理忧虑和疼痛体验间关系的中介效应暗示心理忧虑完全通过特异于疼痛的情绪性反应来加剧疼痛体验。而躯体化与疼痛不愉快度之间的负相关关系则说明,对于面临疼痛表现出高疼痛恐惧的人来说,躯体化症状可能是机体维持内稳态的适应性保护机制。研究三探讨疼痛敏感性与大脑结构特征之间的相关关系。近来的两项研究假设与疼痛敏感性结构相关的脑区应该在传统的疼痛矩阵结构内,但他们却发现疼痛矩阵在结构上主要与非痛的感觉灵敏性相关,而不是疼痛敏感性(Elsenbruch et al.,2013; Erpelding, Moayedi,Davis,2012)。然而,在全脑范围内探索与疼痛敏感性关联的结构脑(Emerson et al.,2014)和功能脑(Goffaux, Girard-Tremblay, Marchand, Daigle,Whittingstall,2013)的研究却意外地发现默认网络(DMN)与疼痛敏感性显著相关。尤其重要的是,Goffaux等人在全脑范围内发现只有DMN中的左侧楔前叶(PCu)在疼痛刺激下产生的ERP反应与疼痛敏感性显著相关。另外,由于已有研究还发现疼痛矩阵与DMN之间的功能连接显著预测对刺激的疼痛判另(Witting et al.,2001)以及慢性疼痛的发展(Napadow, Kim, Clauw,Harris,2012; Napadow et al.,2010),先前对DMN及其与疼痛矩阵交互作用的忽视就成为理解疼痛感知的发生过程的当务之急。鉴于此,研究三通过对比非痛与疼痛刺激,在疼痛矩阵和DMN中考察与疼痛敏感性相关的脑结构。被试为80名无痛右利手大学生(35名女性,45名男性)。被试先接受结构像MRI扫描,之后在冷、热和表皮电三种刺激模态中进行标准的心理物理测量,从而获得各模态下对非痛刺激和疼痛刺激的敏感性。在疼痛矩阵结构和DMN组成的联合兴趣区内进行基于体素的形态学分析(VBM)。控制年龄、性别和全脑平均结构指标等潜在混淆变量的影响后,以各个心理物理指标为预测变量,对VBM的四个结构指标——灰质密度、灰质体积、白质密度和白质体积——进行回归分析。使用AlphaSim法进行多重比较校正,结果发现疼痛矩阵中的一些脑区——丘脑、脑岛、前扣带回、基底神经节和海马结构)唯一地与温觉模态下的非痛敏感性相关,而DMN中的左侧楔前叶则唯一地与温觉模态下的疼痛敏感性显著相关。这种双分离的结果模式只在冷和热这两种温觉模态下出现。对表皮电刺激来说,疼痛矩阵结构和DMN中都没有脑区与非痛敏感性显著相关,而疼痛矩阵中杏仁核和海马交际处的一个联合组块则与表皮电刺激下的疼痛敏感性显著相关。总之,我们在温觉模态下发现了明确的双分离结构：疼痛矩阵唯一地与对非痛刺激的敏感性相关,而楔前叶则唯一地与对疼痛刺激的敏感性相关。尤其值得一提的是,左侧楔前叶与疼痛敏感性的结构关联是对Goffaux等人(2013)工作在跨方法间的独立重复和验证,后者发现只有左侧楔前叶的ERP反应与疼痛敏感性显著相关。综合以上证据,我们提出疼痛识别的“两阶段模型”以解释疼痛矩阵与楔前叶如何交流信息以完成疼痛识别过程。我们认为：在第一阶段,疼痛矩阵网络整合外界信息产生非疼的感觉表征;第二阶段,感觉表征被投射向楔前叶完成更高级别的整合加工,以决定躯体信号是否应被判别为“疼痛”。该模型并不排斥其它脑结构在功能或结构上与疼痛敏感性显著相关,同时,该模型与其它理论的相容性在研究三进行了深入的讨论。
[Abstract]:Pain sensitivity has a wide range of individual differences, and some people are always more aware of pain or pain more quickly. Studies have shown that psychological traits (Leeuw et al., 2007) and brain structure (Emerson et al., 2014) are associated with individual differences in pain sensitivity. This paper aims to clarify the psychological factors that affect pain sensitivity more specifically. The structure of the brain and the brain.
Pain perception includes sensory area discrimination (pain intensity) and motivational emotional components (unhappiness), and the two may be influenced by psychological traits such as pain fear, psychological anxiety and somatization. Although a large number of evidence suggests that pain fear affects pain perception and slow pain (lasting more than 3 months), the development and maintenance of slow pain (lasting more than 3 months) No study has compared pain fear, psychological anxiety and somatization which has the greatest impact on pain perception. In this way, researchers in this field often use a single scale to measure the complex psychological structure such as psychological anxiety and pain fear; and most of the researchers use chronic pain, which is difficult to judge. Is psychological trait aggravating pain perception or continuous pain inducing psychological characteristics?
In a group of painless healthy college students, two transection studies were used to identify the relative effects of the psychological factors that were critical to pain perception. The study explored whether there was a three factor structure containing somatization, psychological anxiety and pain fear among multiple related scales, and tested its structural validity. The study two was based on the results of study 1. The score of multiple scales within each factor was integrated as a factor, and the effect of various factors on pain perception was compared with the laboratory pain paradigm. Study three aims to elucidate the brain structure associated with pain sensitivity.
In the first study, 653 college students (455 women, 198 men) completed a series of self-contained scales, including five pain and fear scales, three general psychological anxiety scales and two somatization scales. In two peer half samples, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to determine the multi scale. Whether or not the three factor structure exists and whether the structure validity is good.EFA results in one half of the samples found the expected three factor structure, and the CFA results show that the structure has good fitting degree in another half and half data.
In the second study, 105 subjects (74 women, 31 men) completed the same self-contained questionnaire and cold water pain test (CPT).CPT in order to keep the non profit as long as possible in the ice water with an upper limit of five minutes. Pain threshold, tolerance time, self reported pain intensity and unhappiness Four indicators of pain perception, stratified regression model and regulation were measured, and mediator analysis was used to investigate the effects of three factors on the indicators of pain perception. The main results were as follows: (1) pain fear and psychological anxiety were significantly positive predictive of pain intensity and pain unhappiness, but the effect of psychological anxiety was completely affected by pain and fear. (2) higher level of pain and fear and shorter tolerance time were significantly related to the marginal level (p=0.097), while somatization and psychological anxiety had no effect on tolerance; (3) the higher the level of pain and fear, the higher the somatization level and the lower the pain unhappiness.
In general, the results of study one and study two illustrate the fear of pain, but not psychological anxiety and somatization are the main traits that exacerbate pain perception, especially the intensity and displeasure of pain. The mediating effect of pain fear on psychological anxiety and pain experience implies that psychological worry is entirely through the specific emotional response to pain. The negative correlation between somatization and pain unhappiness suggests that somatic symptoms may be an adaptive protective mechanism for the body to maintain homeostasis for people who face pain and fear of pain.
Study three explored the relationship between pain sensitivity and brain structural characteristics. Recent two studies assumed that the brain areas associated with pain sensitive structures should be within the traditional pain matrix structure, but they found that the pain matrix was mainly associated with non painful sensory sensitivity, rather than pain sensitivity (Elsenbruch ET). Al., 2013; Erpelding, Moayedi, Davis, 2012). However, the study of the structural brain associated with pain sensitivity (Emerson et al., 2014) and functional brain (Goffaux, Girard-Tremblay, Marchand, Daigle, Whittingstall, 2013) in the whole brain area was found to be significantly related to the pain sensitivity. Goffaux et al. In the whole brain found that only the ERP response to the left anterior lobe (PCu) in DMN was significantly associated with pain sensitivity. In addition, the functional connection between the pain matrix and DMN was also found to predict the pain of stimuli (Witting et al., 2001) and the development of chronic pain (Na). Padow, Kim, Clauw, Harris, 2012; Napadow et al., 2010), the previous neglect of DMN and its interaction with the pain matrix is an urgent task to understand the process of pain perception.
In view of this, study three examined the brain structures associated with pain sensitivity in the pain matrix and DMN by comparing non pain and pain stimuli. The subjects were 80 painless right hand students (35 women, 45 men). The subjects were first treated with a structural image MRI scan, followed by a standard psychophysical test in the three stimulation modes of cold, heat and skin electricity. Quantity, thus obtaining sensitivity to non pain stimuli and pain stimuli under various modes. In the joint interest area of the pain matrix structure and DMN, the morphologic analysis (VBM) is carried out in the joint interest zone of the pain matrix. After controlling the influence of the potential confusion variables, such as age, sex, and the average structure of the whole brain, each psychophysical index is a predictive variable, and VBM Four structural parameters gray matter density, gray matter volume, white matter density and white matter volume were analyzed by regression analysis.
AlphaSim method was used for multiple comparison correction. It was found that some of the brain regions in the pain matrix - thalamus, insula, anterior cingulate gyrus, basal ganglia and hippocampal structure were only related to the non pain sensitivity under the modality of temperature sense, while the left anterior lobe in DMN was uniquely related to the pain sensitivity under the modality of temperature sense. The results of the separation were only in the two temperature modes of cold and heat. For the epidermal electrical stimulation, there was no significant correlation between the pain matrix structure and the non pain sensitivity in the DMN, while a joint block in the amygdala and hippocampal communication was significantly related to the pain sensitivity of the epidermis.
In conclusion, we found a clear double separation structure under the modality of temperature sense: the pain matrix is uniquely associated with sensitivity to non pain stimuli, while the anterior lobe is uniquely related to the sensitivity to pain stimuli. It is particularly worth mentioning that the left anterior wedge is associated with the structure of pain sensitivity to Goffaux et al. (2013). Independent duplication and validation between the two methods, the latter found that only the ERP response to the left anterior lobe was associated with pain sensitivity. Collaterals integrate external information to produce non painful sensory characterization; in the second stage, the sensory characterization is projected to the anterior lobe of the wedge to complete a higher level of integrated processing to determine whether the body signal should be identified as "pain". This model does not exclude the significant correlation between the other brain structures and the pain sensitivity in function or structure, and the model and others The compatibility of the theory is discussed in depth in research three.
【学位授予单位】：西南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：B842

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