分散注意力镇痛在慢性疼痛患者中的应用：灾难化的影响。

Distraction analgesia in chronic pain patients: the impact of catastrophizing.

机构信息

From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts (K.L.S., S.G., R.N.J., R.R.E.); Department of Psychiatry and Behavioral Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (C.C., A.D.W.); Department of Anesthesiology and Psychiatry, University of Pittsburgh Medical Center (C.C., A.D.W.); Department of Psychiatry, Brigham and Women's Hospital (M.O.M., R.N.J., R.R.E.); and Center for Pain and the Brain, P.A.I.N. Group, Boston Children's Hospital, Boston, Massachusetts (D.B.).

出版信息

Anesthesiology. 2014 Dec;121(6):1292-301. doi: 10.1097/ALN.0000000000000465.

DOI:10.1097/ALN.0000000000000465

PMID:25264596

Abstract

BACKGROUND

Diverting attention away from noxious stimulation (i.e., distraction) is a common pain-coping strategy. Its effects are variable across individuals, however, and the authors hypothesized that chronic pain patients who reported higher levels of pain catastrophizing would derive less pain-reducing benefit from distraction.

METHODS

Chronic pain patients (n=149) underwent psychometric and quantitative sensory testing, including assessment of the temporal summation of pain in the presence and absence of a distracting motor task.

RESULTS

A simple distraction task decreased temporal summation of pain overall, but, surprisingly, a greater distraction analgesia was observed in high catastrophizers. This enhanced distraction analgesia in high catastrophizers was not altered when controlling for current pain scores, depression, anxiety, or opioid use (analysis of covariance [ANCOVA]: F=8.7, P<0.005). Interestingly, the magnitude of distraction analgesia was inversely correlated with conditioned pain modulation (Pearson R=-0.23, P=0.005).

CONCLUSION

Distraction produced greater analgesia among chronic pain patients with higher catastrophizing, suggesting that catastrophizing's pain-amplifying effects may be due in part to greater attention to pain, and these patients may benefit from distraction-based pain management approaches. Furthermore, these data suggest that distraction analgesia and conditioned pain modulation may involve separate underlying mechanisms.

摘要

背景

转移对有害刺激的注意力（即分散注意力）是一种常见的缓解疼痛的策略。然而，其效果在个体之间存在差异，作者假设报告有更高水平的疼痛灾难化的慢性疼痛患者将从分散注意力中获得较少的减轻疼痛的益处。

方法

慢性疼痛患者（n=149）接受了心理测量和定量感觉测试，包括评估在存在和不存在分散性运动任务时疼痛的时间总和。

结果

一个简单的分散注意力任务总体上降低了疼痛的时间总和，但令人惊讶的是，高灾难化者观察到更大的分散注意力镇痛作用。当控制当前疼痛评分、抑郁、焦虑或阿片类药物使用时（协方差分析 [ANCOVA]：F=8.7，P<0.005），高灾难化者中增强的分散注意力镇痛作用并没有改变。有趣的是，分散注意力镇痛的幅度与条件性疼痛调节呈负相关（Pearson R=-0.23，P=0.005）。