Pain Center, Division of Anesthesiology, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland,
Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, United Kingdom.
J Neurosci. 2018 Oct 17;38(42):9047-9058. doi: 10.1523/JNEUROSCI.0854-18.2018. Epub 2018 Sep 10.
Pain is regulated endogenously through both opioid and non-opioid mechanisms. We hypothesized that two novel pain modulation tasks, one drawing on context/expectations and one using voluntary reappraisal, would show differing levels of opioid dependence. Specifically, we expected that naloxone would block context-related analgesia, whereas mental imagery-based pain reappraisal would be opioid-independent.A double-blind, placebo-controlled intravenous naloxone versus saline crossover design was used. Twenty healthy volunteers completed the two modulation tasks with acute heat stimuli calibrated to induce moderate pain. In the mental imagery task, participants imagined either a "pleasant" or a "comparison" scenario during painful heat. In the relative relief task, moderate heat stimuli coincided with visual cues eliciting relief from the expectation of intense pain, and were compared with moderate heat stimuli delivered under the expectation of non-painful warmth. Both "pleasant imagery" and "relative relief" conditions significantly improved ratings of pain intensity and pleasantness during saline treatment. Indeed, the target stimuli in both tasks, which had been calibrated to induce moderate pain, were rated as mildly pleasant. Furthermore, consistently with the main hypothesis, blocking endogenous opioid signaling with naloxone did not significantly affect imagery-induced regulation of pain intensity or pleasantness. In contrast, the relative relief-induced pain regulation (i.e., context/expectation) was blocked by naloxone. We conclude that endogenous opioid signaling is necessary for expectation-related relative relief analgesia, but not for pain reappraisal through mental imagery. These results support mental imagery as a powerful and clinically relevant strategy for regulating pain affect also in patients where endogenous opioid mechanisms might be compromised. Neurotransmitter systems in the human brain can be probed through antagonist drugs. Studies using the opioid antagonist naloxone have demonstrated that the brain relies on both opioid and non-opioid mechanisms to downregulate pain. This holds clinical relevance given altered endogenous opioid processes in many chronic pain conditions. The present study used a double-blinded, placebo-controlled naloxone blockage of endogenous opioids in healthy humans to show differential opioid involvement in two pain modulation tasks. Context/expectation-driven (relative relief-related) analgesia was blocked by naloxone. In contrast, pain reappraisal through mental imagery was intact despite opioid receptor blockade, suggesting opioid independence. These results support mental imagery as a powerful, clinically relevant strategy for regulating pain as it does not rely on a functioning opioidergic system.
疼痛是通过内源性阿片肽和非阿片肽机制调节的。我们假设,两种新的疼痛调制任务,一种利用上下文/期望,另一种使用自愿重新评估,将显示不同程度的阿片类药物依赖。具体来说,我们预计纳洛酮会阻断与上下文相关的镇痛作用,而基于心理意象的疼痛重新评估则是非阿片类药物依赖的。采用双盲、安慰剂对照的静脉内纳洛酮与生理盐水交叉设计。20 名健康志愿者在急性热刺激下完成两种调制任务,刺激强度可引起中度疼痛。在心理意象任务中,参与者在疼痛的热刺激下想象“愉快”或“比较”情景。在相对缓解任务中,中度热刺激与引起缓解预期的强烈疼痛的视觉提示同时出现,并与在预期无痛温暖下给予的中度热刺激进行比较。在生理盐水治疗期间,“愉快的想象”和“相对缓解”两种条件均显著改善了疼痛强度和愉悦度的评分。事实上,在两个任务中,目标刺激被校准以产生中度疼痛,但被评为轻度愉悦。此外,与主要假设一致,用纳洛酮阻断内源性阿片肽信号并不显著影响意象诱导的疼痛强度或愉悦度调节。相比之下,相对缓解诱导的疼痛调节(即上下文/期望)被纳洛酮阻断。我们的结论是,内源性阿片肽信号对于与期望相关的相对缓解镇痛是必要的,但对于通过心理意象进行的疼痛重新评估则不是。这些结果支持心理意象作为一种强大且与临床相关的策略,用于调节疼痛影响,即使在可能受损的内源性阿片肽机制的患者中也是如此。人类大脑中的神经递质系统可以通过拮抗剂药物进行探测。使用阿片受体拮抗剂纳洛酮的研究表明,大脑依赖于阿片肽和非阿片肽机制来下调疼痛。鉴于许多慢性疼痛疾病中内源性阿片肽过程的改变,这具有临床相关性。本研究使用双盲、安慰剂对照的纳洛酮阻断内源性阿片肽在健康人中,显示两种疼痛调制任务中阿片类药物的不同参与程度。上下文/期望驱动(相对缓解相关)镇痛被纳洛酮阻断。相比之下,通过心理意象进行的疼痛重新评估尽管阿片受体被阻断,但仍然完整,表明阿片类药物独立。这些结果支持心理意象作为一种强大的、与临床相关的策略,用于调节疼痛,因为它不依赖于功能正常的阿片系统。
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