Bruehl Stephen, Burns John W, Chung Ok Yung, Ward Pamela, Johnson Benjamin
Department of Anesthesiology, Vanderbilt University School of Medicine, Suite 403-G MAB, 1211 Twenty-First Avenue South, Nashville, TN 37232-1557, USA.
Pain. 2002 Sep;99(1-2):223-33. doi: 10.1016/s0304-3959(02)00104-5.
The experience of anger (i.e. trait anger) and anger management style (i.e. anger-in, anger-out) are related to sensitivity to acute and chronic pain stimuli, although underlying mechanisms are unknown. This study tested whether anger variables are associated with impaired endogenous opioid antinociceptive activity, and whether these relationships differed between chronic pain patients and healthy normals. Forty-three chronic low back pain (LBP) sufferers and 45 pain-free normals received opioid blockade (8 mg naloxone i.v.) or placebo blockade (saline) in randomized, counterbalanced order in separate sessions. During each session, subjects participated in a 1-min finger pressure pain task followed by an ischemic forearm pain task (maximum duration 5 min), providing pain intensity ratings during and immediately following each task. As a measure of opioid antinociceptive function, drug effects were derived by subtracting placebo from blockade condition pain ratings. Multivariate general linear model analyses indicated that anger-out, but not anger-in, had significant main effects on both finger pressure drug effects (P < 0.05) and ischemic task drug effects (P < 0.05). As hypothesized, high anger-out scores were associated with an absence of opioid analgesia during the acute pain tasks; low anger-out scores were associated with effective opioid analgesia. A similar non-significant trend was noted for trait anger on finger pressure drug effects (P < 0.06). Anger-out x LBP/normal interactions were non-significant, suggesting that links between anger-out and drug effects were similar for patients and normals. Controlling for depression did not eliminate the significant relationship between anger-out and drug effects. Findings suggest that anger-in and anger-out affect pain sensitivity through different mechanisms: only the effects of anger-out may be mediated by endogenous opioid dysfunction.
愤怒体验（即特质愤怒）和愤怒管理方式（即内向愤怒、外向愤怒）与对急性和慢性疼痛刺激的敏感性有关，尽管其潜在机制尚不清楚。本研究测试了愤怒变量是否与内源性阿片类抗痛觉活动受损有关，以及这些关系在慢性疼痛患者和健康正常人之间是否存在差异。43名慢性下腰痛（LBP）患者和45名无疼痛的正常人在不同的 sessions 中以随机、平衡的顺序接受阿片类药物阻断（静脉注射8毫克纳洛酮）或安慰剂阻断（生理盐水）。在每个 session 中，受试者参与一项1分钟的手指压力疼痛任务，随后是一项缺血性前臂疼痛任务（最长持续时间5分钟），并在每项任务期间及之后立即提供疼痛强度评分。作为阿片类抗痛觉功能的一项指标，通过从阻断条件下的疼痛评分中减去安慰剂评分来得出药物效果。多变量一般线性模型分析表明，外向愤怒而非内向愤怒，对手指压力药物效果（P < 0.05）和缺血任务药物效果（P < 0.05）均有显著的主效应。如所假设的，高外向愤怒得分与急性疼痛任务期间缺乏阿片类镇痛作用相关；低外向愤怒得分与有效的阿片类镇痛作用相关。在手指压力药物效果方面，特质愤怒也有类似的非显著趋势（P < 0.06）。外向愤怒×LBP/正常组的交互作用不显著，表明外向愤怒与药物效果之间的联系在患者和正常人中相似。控制抑郁并没有消除外向愤怒与药物效果之间的显著关系。研究结果表明，内向愤怒和外向愤怒通过不同机制影响疼痛敏感性：只有外向愤怒的影响可能由内源性阿片类功能障碍介导。
