From the Department of Psychology, The University of Tulsa, Tulsa, Oklahoma.
Psychosom Med. 2018 Nov/Dec;80(9):861-868. doi: 10.1097/PSY.0000000000000567.
Sexual assault (SA) is associated with an increased risk for chronic pain and affective distress. Given that emotional processes modulate pain (e.g., negative emotions enhance pain, positive emotions inhibit pain), increased pain risk in SA survivors could stem from a disruption of emotional modulation processes.
A well-validated affective picture-viewing paradigm was used to study emotional modulation of pain in 33 healthy, pain-free SA survivors and a control group of 33 healthy, pain-free individuals with no reported history of SA (matched on age, sex, race, and number of non-SA traumas). Unpleasant (mutilation), neutral, and pleasant (erotic) pictures were presented, while painful electrocutaneous stimulations were delivered at the ankle. Pain intensity ratings and nociceptive flexion reflex (NFR) magnitudes (a physiologic measure of spinal nociception) were recorded in response to electric stimuli. Multilevel models were used to analyze the data with group (SA versus non-SA) and content (mutilation, neutral, erotic) as independent variables.
Both groups demonstrated similar emotional modulation of pain (FGroupbyContent(2,646.52) = 0.44, p = .65), but a main effect of group (FGroup(1,65.42) = 4.24, p = .043) indicated the SA group experienced more overall pain from electric stimuli (hyperalgesia). A significant group by content interaction for NFR (p = .035) indicated that emotional modulation of NFR was present for the non-SA group (FContentSimpleEffect(2,684.55) = 12.43, p < .001), but not the SA group (FContentSimpleEffect(2,683.38) = 1.71, p = .18).
These findings suggest that SA survivors have difficulty emotionally engaging brain-to-spinal cord mechanisms to modulate spinal nociception. A disruption of descending inhibition plus hyperalgesia could contribute to comorbidity between sexual trauma and chronic pain.
性侵犯（SA）与慢性疼痛和情感困扰的风险增加有关。鉴于情绪过程调节疼痛（例如，负面情绪增强疼痛，积极情绪抑制疼痛），SA 幸存者的疼痛风险增加可能源于情绪调节过程的中断。
使用经过充分验证的情感图片观看范式研究了 33 名健康无痛的 SA 幸存者和 33 名健康无痛的个体的情感对疼痛的调节，后者没有报告 SA 病史（匹配年龄、性别、种族和非 SA 创伤的数量）。呈现不愉快（肢解）、中性和愉快（色情）的图片，同时在脚踝处施加疼痛的电皮肤刺激。记录疼痛强度评分和伤害性屈反射（NFR）幅度（脊髓伤害感受的生理测量）作为对电刺激的反应。使用多级模型分析数据，其中组（SA 与非 SA）和内容（肢解、中性、色情）为独立变量。
两组对疼痛的情绪调节均相似（FGroupbyContent(2,646.52) = 0.44, p =.65），但组的主要效应（FGroup(1,65.42) = 4.24, p =.043）表明 SA 组对电刺激的总体疼痛反应更强烈（痛觉过敏）。NFR 的显著组内容交互作用（p =.035）表明，非 SA 组的 NFR 情绪调节存在（FContentSimpleEffect(2,684.55) = 12.43, p <.001），但 SA 组不存在（FContentSimpleEffect(2,683.38) = 1.71, p =.18）。
这些发现表明，SA 幸存者在情感上难以参与大脑脊髓机制来调节脊髓伤害感受。下行抑制和痛觉过敏的中断可能导致性创伤和慢性疼痛之间的共病。
