Research Group Health Psychology, KU Leuven, Leuven, Belgium.
Center for Excellence Generalization on Research in Health and Psychopathology, KU Leuven, Leuven, Belgium.
Pain. 2018 Jul;159(7):1268-1276. doi: 10.1097/j.pain.0000000000001207.
Impaired selective fear learning has been advanced as a core mechanism involved in excessive spreading of protective responses such as pain-related fear and avoidance leading to disability in chronic pain conditions. Using the litmus test for selective learning effects, the blocking procedure, we tested the hypothesis that patients with fibromyalgia (FM) show less selective threat learning than healthy controls (HCs). We introduce a novel selective learning task based around a clinical diary scenario. On a trial-by-trial basis, participants rated whether they expected certain situations (A, B, Z, and X) in the diary of a fictive FM patient would trigger pain in that patient. The procedure did not involve any experimental pain induction because the verbal outcomes "pain" or "no pain" were used. During the elemental acquisition phase, one situation was followed by "pain" (A+, eg, "Kim slept badly, and reports pain"), whereas another situation was followed by "no pain" (Z-, eg, "Kim was stressed, and reports no pain"). During the compound acquisition phase, another situation (X), referred to as the blocked stimulus, was presented in compound with a previously pain-eliciting situation and also paired with "pain" (AX+, eg, Kim slept badly" and "Kim has vacuumed," and reports pain). Simultaneously, a novel situation was introduced and also followed by "pain" (B+). Within-group comparisons showed blocking (ie, significant difference between B and X) in the HCs, but not in the patients with FM. This study is the first in directly assessing differences in selective learning between patients with FM and HCs using a blocking procedure.
受损的选择性恐惧学习被认为是一种核心机制，涉及到保护性反应的过度扩散，例如与疼痛相关的恐惧和回避，从而导致慢性疼痛病症的残疾。使用选择性学习效应的试金石程序，即阻断程序，我们测试了纤维肌痛（FM）患者比健康对照组（HCs）表现出较少的选择性威胁学习的假设。我们引入了一种基于临床日记情景的新型选择性学习任务。在每次试验的基础上，参与者评估他们是否期望在虚构的 FM 患者日记中的某些情况（A、B、Z 和 X）会引发该患者的疼痛。该过程不涉及任何实验性疼痛诱导，因为使用了口头结果“疼痛”或“无疼痛”。在元素获取阶段，一种情况之后是“疼痛”（A+，例如“Kim 睡眠不好，并报告疼痛”），而另一种情况之后是“无疼痛”（Z-，例如“Kim 感到压力，报告无疼痛”）。在复合获取阶段，另一种情况（X），称为被阻断的刺激，与先前引起疼痛的情况一起呈现，并与“疼痛”配对（AX+，例如“Kim 睡眠不好”和“Kim 吸尘了，并且报告疼痛”）。同时，引入了一种新的情况，并且也报告了“疼痛”（B+）。在 HCs 中，出现了阻断现象（即 B 和 X 之间存在显著差异），但在 FM 患者中没有出现这种现象。这项研究是首次使用阻断程序直接评估 FM 患者和 HCs 之间选择性学习的差异。
