Research Group Health Psychology, Faculty of Psychology and Educational Sciences, University of Leuven, KU Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, The Netherlands.
Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom.
Behav Res Ther. 2016 Nov;86:23-34. doi: 10.1016/j.brat.2016.08.016. Epub 2016 Aug 31.
Pain is an unpleasant sensory and emotional experience urging the individual to take action to restore the integrity of the body. The transition from a common episode of acute pain to a state of intermittent or chronic pain has been a constant preoccupation of researchers and clinicians alike. In this review, we approach chronic pain from a modern learning perspective that incorporates cognitive, affective, behavioral and motivational aspects. We view pain as a biologically hard-wired signal of bodily harm that competes with other demands in the person's environment. The basic tenet is that pain urges people to interrupt ongoing activity, elicits protective responses that paradoxically increase interference with daily activities, and compromises the sense of self. Here we briefly summarize existing evidence showing how pain captures attention, and how attention for pain can be controlled. We also consider pain as a strong motivator for learning, and review the recent evidence on the acquisition and generalization of pain-related fear and avoidance behavior, which are likely to interfere with daily life activities. We highlight the paradoxical effects of pain avoidance behavior, and review treatment effects of exposure in vivo. A generally neglected area of research is the detrimental consequences of repeated interference by pain with daily activities on one's sense of "self". We end this review with a plea for the implementation of single-case experimental designs as a means to help customize and develop novel cognitive-behavioral treatments for individuals for chronic pain aimed at reducing the suffering of this large group of individuals.
疼痛是一种不愉快的感觉和情绪体验，促使个体采取行动以恢复身体的完整性。从常见的急性疼痛发作到间歇性或慢性疼痛状态的转变一直是研究人员和临床医生共同关注的问题。在这篇综述中，我们从现代学习的角度来探讨慢性疼痛，其中包括认知、情感、行为和动机方面。我们将疼痛视为身体受到伤害的生物固有信号，它与个体环境中的其他需求竞争。其基本原理是，疼痛促使人们中断正在进行的活动，引发保护性反应，而这些反应反而会增加对日常活动的干扰，并损害自我意识。在这里，我们简要总结了现有的证据，展示了疼痛如何吸引注意力，以及如何控制对疼痛的注意力。我们还将疼痛视为学习的强大动力，并回顾了关于疼痛相关恐惧和回避行为的习得和泛化的最新证据，这些行为可能会干扰日常生活活动。我们强调了疼痛回避行为的矛盾影响，并回顾了在体暴露治疗的效果。一个被普遍忽视的研究领域是疼痛反复干扰日常活动对个体“自我”意识的不利后果。我们以呼吁实施单病例实验设计作为帮助为慢性疼痛患者制定和开发新型认知行为治疗方法的手段来结束这篇综述，旨在减少这群大量患者的痛苦。
