Ochsner Kevin N, Ludlow David H, Knierim Kyle, Hanelin Josh, Ramachandran Tara, Glover Gary C, Mackey Sean C
Department of Psychology, Columbia University, Schermerhorn Hall, 1190 Amsterdam Avenue, New York, NY 10027, USA College of Physicians and Surgeons, Columbia University, Schermerhorn Hall, 1190 Amsterdam Avenue, New York, NY, USA Division of Pain Management, Department of Anesthesia, Stanford University, CA, USA Department of Radiology, Stanford University, Stanford, CA, USA.
Pain. 2006 Jan;120(1-2):69-77. doi: 10.1016/j.pain.2005.10.014. Epub 2005 Dec 20.
Although individual differences in fear and anxiety modulate the pain response and may even cause more suffering than the initiating physical stimulus, little is known about the neural systems mediating this relationship. The present study provided the first examination of the neural correlates of individual differences in the tendency to (1) feel anxious about the potentially negative implications of physical sensations, as measured by the anxiety sensitivity index (ASI), and (2) fear various types of physical pain, as indexed by the fear of pain questionnaire (FPQ). In separate sessions, participants completed these questionnaires and experienced alternating blocks of noxious thermal stimulation (45-50 degrees C) and neutral thermal stimulation (38 degrees C) during the collection of whole-brain fMRI data. Regression analyses demonstrated that during the experience of pain, ASI scores predicted activation of a medial prefrontal region associated with self-focused attention, whereas FPQ scores predicted activation of a ventral lateral frontal region associated with response regulation and anterior and posterior cingulate regions associated with monitoring and evaluation of affective responses. These functional relationships cannot be wholly explained by generalized anxiety (indexed by STAI-T scores), which did not significantly correlate with activation of any regions. The present findings may help clarify both the impact of individual differences in emotion on the neural correlates of pain, and the roles in anxiety, fear, and pain processing played by medial and orbitofrontal systems.
尽管恐惧和焦虑的个体差异会调节疼痛反应，甚至可能比最初的身体刺激带来更多痛苦，但对于介导这种关系的神经系统却知之甚少。本研究首次考察了个体差异的神经关联，具体包括：（1）对身体感觉潜在负面影响感到焦虑的倾向，通过焦虑敏感性指数（ASI）来衡量；（2）对各种类型身体疼痛的恐惧，通过疼痛恐惧问卷（FPQ）来衡量。在不同的时段，参与者完成这些问卷，并在收集全脑功能磁共振成像（fMRI）数据期间，交替经历有害热刺激（45 - 50摄氏度）和中性热刺激（38摄氏度）。回归分析表明，在疼痛体验过程中，ASI得分预测了与自我关注相关的内侧前额叶区域的激活，而FPQ得分预测了与反应调节相关的腹外侧额叶区域以及与情感反应监测和评估相关的前扣带回和后扣带回区域的激活。这些功能关系不能完全由广泛性焦虑（由状态 - 特质焦虑量表 - 特质分[STAI - T]得分衡量）来解释，广泛性焦虑与任何区域的激活均无显著相关性。本研究结果可能有助于阐明情绪方面的个体差异对疼痛神经关联的影响，以及内侧和眶额系统在焦虑、恐惧和疼痛处理中所起的作用。
