Harvold Mathea, MacLeod Colin, Vaegter Henrik B
Department of Psychology, Faculty of Health Sciences.
School of Psychology, The University of Western Australia, Crawley, Australia.
Clin J Pain. 2018 Jan;34(1):22-29. doi: 10.1097/AJP.0000000000000505.
Posttraumatic stress disorder (PTSD) is common in chronic posttraumatic pain. Theoretical models suggest that attentional biases (AB) contribute to the development and maintenance of chronic pain and PTSD; however, the influence of AB on clinical and heat pain sensitivity in chronic posttraumatic pain patients is unknown. This study investigated AB for linguistic pain-related stimuli and trauma-related stimuli, and clinical and thermal sensitivity in patients with chronic posttraumatic pain with and without PTSD.
In total, 34 patients with chronic posttraumatic cervical pain performed the visual attentional probe task assessing patterns of selective attentional responding to trauma cues and to pain cues. The task used short (500 ms) and long (1250 ms) stimulus exposure durations to ensure sensitivity to both the orienting and maintenance of attention. Heat pain threshold was assessed at the nonpainful hand. Clinical pain intensity, psychological distress (anxiety, depression, and disability), and PTSD symptomatology were assessed with questionnaires.
The Pain/PTSD group (N=14) demonstrated increased clinical and heat pain sensitivity as well as psychological distress compared with the Pain/No-PTSD group (N=20; P<0.05). AB scores were significantly different between groups (P=0.04). Irrespective of stimulus exposure duration, the Pain/PTSD group demonstrated attentional bias away from trauma and pain cues (avoidance), whereas the Pain/No-PTSD group demonstrated attentional bias toward pain cues (vigilance). Attentional avoidance of pain cues was associated with increased pain intensity and heat pain sensitivity (P<0.02).
These results suggest that attentional avoidance is associated with increased chronic posttraumatic pain. The causal contribution of attentional avoidance to pain outcomes remains unclear.
创伤后应激障碍（PTSD）在慢性创伤后疼痛中很常见。理论模型表明，注意偏向（AB）有助于慢性疼痛和PTSD的发生和维持；然而，AB对慢性创伤后疼痛患者临床和热痛敏感性的影响尚不清楚。本研究调查了伴有和不伴有PTSD的慢性创伤后疼痛患者对语言性疼痛相关刺激和创伤相关刺激的注意偏向，以及临床和热敏感性。
总共34例患有慢性创伤后颈部疼痛的患者进行了视觉注意探针任务，以评估对创伤线索和疼痛线索的选择性注意反应模式。该任务使用短（500毫秒）和长（1250毫秒）的刺激暴露持续时间，以确保对注意定向和维持的敏感性。在无痛的手上评估热痛阈值。用问卷评估临床疼痛强度、心理困扰（焦虑、抑郁和残疾）以及PTSD症状。
与疼痛/无PTSD组（N = 20；P < 0.05）相比，疼痛/PTSD组（N = 14）表现出更高的临床和热痛敏感性以及心理困扰。两组之间的AB得分有显著差异（P = 0.04）。无论刺激暴露持续时间如何，疼痛/PTSD组表现出对创伤和疼痛线索的注意偏向（回避），而疼痛/无PTSD组表现出对疼痛线索的注意偏向（警觉）。对疼痛线索的注意回避与疼痛强度增加和热痛敏感性增加相关（P < 0.02）。
这些结果表明，注意回避与慢性创伤后疼痛增加有关。注意回避对疼痛结果的因果作用仍不清楚。
