初始评价对疼痛的影响：元分析和实验研究

发布时间：2018-09-10 09:44

【摘要】：大量研究表明人们的疼痛信念会影响他们对实验室诱发疼痛和慢性疼痛的反应。压力应对转换模型(R. S. Lazarus,1998; R.S. Lazarus,1999)提供了一个理论模型,来解释信念或评价影响个体面对压力做出的反应,包括疼痛反应的原理。个体在面对潜在的压力时,首先对影响生活的事件进行初始评价。对压力的初始评价或者信念包括将压力事件评价为(1)潜在的、可能的伤害(2)挑战、自我成长的机会。虽然许多研究都探论了初始评价尤其是威胁评价与疼痛适应不良的关系,但是这种效应的大小却莫衷一是。由于文献中存在不一致现象,本研究一旨在通过元分析的方法考察威胁评价和挑战评价与(1)实验室诱发疼痛反应,(2)慢性疼痛的相关结果(即疼痛严重程度,功能障碍和情绪忧虑)之间的关系。并且考察了样本特征和方法学因素对初始评价与疼痛相关结果关系的调节作用；研究二旨在通过操作个体的挑战评价考察挑战评价与疼痛反应的关系。研究一通过系统化文献检索共搜索到2383篇相关文献。由两名作者独立地根据纳入/排除标准对其进行筛选,共纳入22篇实验室诱发疼痛刺激研究(N=2,031)和59篇慢性疼痛研究(N=9,135)。纳入/排除文章的评分者—致性系数为k=0.91,变量编码的评分者一致性系数为k=0.88,都在可接受的范围内。实验室诱发疼痛刺激元分析的数据分析表明高水平的威胁评价与更高的疼痛强度,更短的疼痛忍耐时间和更多的消极应对策略相联系。评价测量方式(实验室操纵vs.自我报告),伤害性刺激的类型(冷vs.热vs.其他)以及伤害性刺激的持续时间(小于30秒vs.大于30秒)对威胁评价与疼痛知觉的关系有调节作用。挑战评价与更长的疼痛忍耐时间和更少的消极应对策略相联系,但是与疼痛强度没有显著关系。对于慢性疼痛的元分析来说,威胁评价与疼痛强度,行动障碍,情绪忧虑和消极应对策略存在显著的正相关,与积极的应对策略呈显著的负相关。挑战评价与上述结果的关系基本上与威胁评价的结果相反。评价测量方式与性别在评价-结果关系中的调节作用是一致的。最后,剪补法分析结果显示矫正发表性偏倚后的效应量与未矫正前的效应量差异并不显著。总的来说,两个元分析的结果都说明,将疼痛评价为潜在的伤害与实验室诱发疼痛和持续的慢性疼痛的相关关系很强健。研究二的目的是考察实验室研究中挑战评价对疼痛知觉和应对策略的影响。在第二个研究中,105名大学生被试,包括37名男性和68名女性参与了实验,被随机分到不同的实验条件下：一组被试阅读的文段内容是在困难任务中的坚持能力与未来成功相关(挑战评价条件)；一组被试阅读的文段是描述长期暴露在冷环境下可能会对机体造成损伤(高威胁条件)；一组阅读的文段是描述CPT的安全(安全条件)。之后被试进行CPT,要求将手尽可能长时间地放入冷水中。本研究的假设是随机分到挑战评价条件下的个体会表现出更长的疼痛忍耐时间,而威胁条件下的被试会表现出最短的疼痛忍耐时间,同时使用最少的认知应对策略。实验结果发现疼痛强度的组间差异显著,F(2,102)=3.906,p=0.023。威胁评价组的被试报告的最强的疼痛、收回手时的疼痛,整体疼痛和平均疼痛强度与安全评价组都有显著的差异。CPT疼痛忍耐时间的组间差异的结果表明,疼痛忍耐时间的组间差异显著,F(2,102)=3.175,p=0.046。挑战评价组的疼痛忍耐时间显著高于威胁评价组的疼痛忍耐时间,但是挑战评价组与安全评价组,威胁评价组与安全评价组之间没有显著差异。挑战组显著的比威胁组和安全评价组更多的使用重解释的应对策略,F (2,102)=3.906,p=0.023;挑战组比安全评价组更多的使用转移注意的应对策略,F (2.102)=3.930,p=0.023。挑战组比威胁组更多的使用自我鼓励的应对策略,F(2,102)=5.431,p=0.006。威胁组比挑战组和安全组都要更少的使用忽略的应对策略,F(2,102)=6.263,p=0.003。而三组在灾难化应对策略和接受策略上没有显著差异(p0.089)。采用威胁评价分数、挑战评价分数与疼痛强度、疼痛忍受时间和应对策略做相关分析,结果发现挑战评价与疼痛忍受时间、积极应对策略呈显著正相关,但是与疼痛强度没有显著相关关系。威胁评价与疼痛强度与灾难化呈显著的正相关,而与疼痛忍受时间呈显著负相关。挑战评价组与安全评价组在疼痛强度上的差异不显著。而挑战评价组比威胁评价组表现出更长的疼痛忍受时间。挑战评价组倾向于使用重解释、转移注意力、自我控制和忽略的应对策略。威胁评价导致个体感受到的疼痛强度更高,并更倾向于使用灾难化的应对策略,同时与更短疼痛忍耐时间相联系。本研究在方法上,创造性的使用元分析的方法对初始评价与疼痛知觉的关系做了定性和定量的综合,得出了强健的合并效应量；并且创造性的操纵了个体对疼痛的挑战评价,考察了挑战评价对疼痛知觉的影响。在理论上,本研究进为压力应对转换模型提供了直接强健的证据。本研究纳入了慢性疼痛的研究,并通过探讨挑战评价对疼痛反应的影响,对缓解疼痛具有实践意义。
[Abstract]:A large number of studies have shown that people's pain beliefs influence their responses to laboratory-induced pain and chronic pain. Stress-coping transition models (R.S. Lazarus, 1998; R.S. Lazarus, 1999) provide a theoretical model to explain beliefs or to evaluate how individuals respond to stress, including the principles of pain responses. Initial assessments of stress or beliefs include assessing stress events as (1) potential, potential harm (2) challenges, and opportunities for self-growth. Although many studies have explored the relationship between initial assessments, especially threat assessments, and pain maladjustment, however The magnitude of this effect is insignificant.
Because of the inconsistencies in the literature, this study examined the relationship between threat assessment and challenge assessment and (1) laboratory-induced pain responses, (2) chronic pain-related outcomes (i.e. pain severity, dysfunction, and emotional anxiety), and examined sample characteristics and methodological factors for initiation. The second study was designed to examine the relationship between challenge assessment and pain response through the challenge assessment of the operator.
A total of 2,383 relevant articles were searched through systematic literature search. Two authors independently screened them according to inclusion/exclusion criteria. A total of 22 laboratory-induced pain stimulation studies (N=2,031) and 59 chronic pain studies (N=9,135) were included in the study. The rater of the inclusion/exclusion articles was k=0.91, and the variable coding was used. Data from laboratory-induced pain stimulus meta-analysis showed that high levels of threat assessment were associated with higher pain intensity, shorter pain tolerance time, and more negative coping strategies. Assessment measures (laboratory manipulation vs. self-reporting), noxious stabbing Types of irritation (cold vs. hot vs. others) and duration of noxious stimuli (less than 30 seconds vs. longer than 30 seconds) moderated the relationship between threat assessment and pain perception. Challenge assessment was associated with longer pain tolerance time and fewer negative coping strategies, but not with pain intensity. Threat assessment was positively correlated with pain intensity, dyskinesia, emotional anxiety and negative coping strategies, and negatively correlated with positive coping strategies. Finally, the clip-and-fill analysis showed that there was no significant difference between the effects of corrected and uncorrected publication bias. Overall, the results of both meta-analyses showed a strong correlation between assessing pain as a potential injury and laboratory-induced pain and persistent chronic pain.
In the second study, 105 College students, including 37 males and 68 females, were randomly assigned to different experimental conditions: one group of subjects read text about persistence in difficult tasks. Related to future success (Challenge Assessment Conditions); a group of subjects read passages describing the possible damage to the body (high-risk conditions) from long-term exposure to cold; a group read passages describing the safety (safety conditions) of CPT. Subjects then performed CPT and asked to put their hands in cold water as long as possible. The hypothesis is that individuals randomly assigned to challenge assessment will show longer pain tolerance time, while subjects under threat condition will show shortest pain tolerance time and use the least cognitive coping strategies. There were significant differences in reported strongest pain, pain at hand withdrawal, overall pain and mean pain intensity between the CPT pain tolerance groups. The results showed significant differences in pain tolerance time between the CPT pain tolerance groups, F (2,102) = 3.175, P = 0.046. There was no significant difference in pain tolerance time between the challenge group and the safety evaluation group, the threat assessment group and the safety assessment group. Simply, F (2.102) = 3.930, P = 0.023. The challenge group used more self-encouraged coping strategies than the threat group, F (2,102) = 5.431, P = 0.006. The threat group used less overlooked coping strategies than the challenge group and the security group, F (2,102) = 6.263, P = 0.003. There was no significant difference in disaster coping strategies and acceptance strategies among the three groups (p0.089). Threat assessment score, challenge assessment score and pain intensity, pain tolerance time and coping strategies were correlated. The results showed that challenge assessment was positively correlated with pain tolerance time and positive coping strategies, but not with pain intensity. The pain tolerance time was negatively correlated. There was no significant difference in pain intensity between the challenge group and the safety group. The challenge group showed longer pain tolerance time than the threat group. The pain was more intense and more likely to use catastrophic coping strategies, which were associated with shorter pain tolerance.
In this study, the relationship between initial evaluation and pain perception was qualitatively and quantitatively synthesized by using the method of meta-analysis creatively, and a robust combination effect was obtained. The challenge assessment of pain was manipulated creatively, and the effect of challenge assessment on pain perception was investigated. This study incorporated the study of chronic pain and explored the impact of challenge assessment on pain response, which is of practical significance in alleviating pain.
【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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