Salford Royal NHS Foundation Trust, Salford, United Kingdom.
Psychosom Med. 2010 Oct;72(8):802-9. doi: 10.1097/PSY.0b013e3181f5c021. Epub 2010 Sep 14.
Anxiety at the time of gastrointestinal injury or inflammation increases the risk of developing visceral hyperalgesia. Distal esophageal acidification induces hyperalgesia in the non-acid exposed proximal esophagus, due to the sensitization of spinal dorsal horn neurones. The objective was to determine whether anxiety influences acid-induced hyperalgesia.
A total of 19 healthy volunteers (n = 12 females; age, 22-57 years; mean, 35.7 years) completed a 10-minute mood induction paradigm (anxiety or neutral) with autonomic monitoring (visit 1). On visits 2 and 3, pain thresholds to electrical stimulation, in milliamperes (mA), were determined in the proximal esophagus and foot (control) before and after a 30-minute infusion of 0.15 M of hydrochloric acid. During esophageal acid infusion, the subjects randomly received anxiety or neutral mood induction with autonomic monitoring, in a crossover design. Anxiety and pain ratings were recorded pre and post infusion.
Visit 1: Anxiety induction increased anxiety scores (p < .001), mean arterial pressure (p < .001), and cardiac sympathetic index (p = .007), and reduced parasympathetic measures (cardiac vagal tone [p = .05] and cardiac sensitivity to baroreflex [p = .006)]). Visit 2: Anxiety induction conferred greater acid-induced hyperalgesia compared with neutral (-4.9 mA versus 2.7 mA, p = .009, analysis of covariance). No differences in autonomic measures were found during acid infusion with anxiety or neutral mood induction.
Anxiety induction increases acid-induced esophageal hyperalgesia; anxiety, thus, facilitates central sensitization in the esophagus. Our studies provide a new model for studying the effects of anxiety on esophageal hyperalgesia and may allow testing of therapeutic strategies to reduce this effect.
胃肠道损伤或炎症时的焦虑会增加内脏痛觉过敏的风险。由于脊髓背角神经元的敏化，远端食管酸化会导致非酸性暴露的近端食管痛觉过敏。目的是确定焦虑是否会影响酸诱导的痛觉过敏。
共有 19 名健康志愿者（n = 12 名女性；年龄 22-57 岁；平均 35.7 岁）完成了 10 分钟的情绪诱导范式（焦虑或中性），同时进行自主神经监测（第 1 次就诊）。在第 2 次和第 3 次就诊时，在食管酸灌注前和后，用 30 分钟 0.15 M 盐酸输注，用电刺激测定近端食管和足部（对照）的疼痛阈值（以毫安计）。在食管酸灌注期间，采用交叉设计，在自主神经监测下，受试者随机接受焦虑或中性情绪诱导。在输注前后记录焦虑和疼痛评分。
第 1 次就诊：焦虑诱导增加了焦虑评分（p <.001）、平均动脉压（p <.001）和心脏交感神经指数（p =.007），并降低了副交感神经测量值（心脏迷走神经张力 [p =.05]和心脏对压力反射的敏感性 [p =.006]）。第 2 次就诊：与中性相比，焦虑诱导导致更大的酸诱导痛觉过敏（-4.9 mA 与 2.7 mA，p =.009，协方差分析）。在焦虑或中性情绪诱导下进行酸灌注时，自主神经测量值没有差异。
焦虑诱导增加了酸诱导的食管痛觉过敏；因此，焦虑促进了食管的中枢敏化。我们的研究提供了一个新的模型来研究焦虑对食管痛觉过敏的影响，并可能允许测试减少这种影响的治疗策略。
