Department of Kinesiotherapy and Special Methods in Physiotherapy, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland; Department of Orthopaedic and Trauma Surgery, Pain & Exercise Research Luebeck, University of Luebeck, Luebeck, Germany; Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland.
Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland.
J Pain. 2019 Aug;20(8):861-875. doi: 10.1016/j.jpain.2019.01.009. Epub 2019 Jan 25.
Learning processes have been discussed in the context of pain chronicity for decades. Particularly, operant conditioning has been used to experimentally induce and modulate pain in healthy humans. In this systematic review and meta-analysis, research findings on pain facilitation (hyperalgesic effect) and pain elicitation (allodynic effect) are evaluated. The review was performed according to the PRISMA guideline and an a priori published protocol. Nine databases were searched for relevant publications: PubMed, Cochrane Register of Controlled Trials (CENTRAL), Web of Science, ScienceDirect, EBSCO, PsycINFO, MEDLINE, PsycARTICLES, and CINAHL. Studies were included if they investigated pain-free humans, exposed to an operant conditioning procedure of pain. Two independent assessors screened publications against eligibility criteria and assessed the risk of bias with the Cochrane risk of bias scale. A total of 3155 records were screened, of which 8 were included in the qualitative (401 participants) and 5 into the quantitative (110 participants) synthesis. Results showed that hyperalgesic (standardized mean difference = -0.80, 95% confidence interval = -1.33 to -0.27, P = .003) and allodynic effects (standardized mean difference = -1.27, 95% confidence interval = -2.46 to -0.08, P = .04) can be induced in healthy humans, indicating that pain can be shaped by contingencies of reinforcement. However, the uncertainty of the effect is relatively high, mostly owing to the small number of included studies, demand characteristics, and the risk of bias. This is especially relevant for studies on allodynic effects where the decrease in nociception should be more rigorously controlled. PERSPECTIVE: Operant conditioning can be a mechanism of pain chronicity. All experimental studies investigating this hypothesis have been identified and summarized. It has been demonstrated that allodynic and hyperalgesic effects can be induced by operant conditioning.
几十年来，人们一直在探讨学习过程与疼痛持续性之间的关系。特别是，操作性条件作用已被用于在健康人群中进行实验性诱发和调节疼痛。在本次系统综述和荟萃分析中，评估了疼痛促进（痛觉过敏效应）和疼痛诱发（感觉异常效应）的研究结果。本综述是根据 PRISMA 指南和预先发表的方案进行的。为了查找相关文献，我们在 9 个数据库中进行了搜索：PubMed、Cochrane 对照试验登记册（CENTRAL）、Web of Science、ScienceDirect、EBSCO、PsycINFO、MEDLINE、PsycARTICLES 和 CINAHL。如果研究涉及到接受操作性条件作用程序的无痛人类，则将其纳入研究。两名独立评估员根据纳入标准筛选出版物，并使用 Cochrane 偏倚风险量表评估偏倚风险。共筛选了 3155 条记录，其中 8 条被纳入定性（401 名参与者）和 5 条定量（110 名参与者）综合分析。结果表明，在健康人群中可以诱导出痛觉过敏（标准化均数差= -0.80，95%置信区间= -1.33 至 -0.27，P=.003）和感觉异常（标准化均数差= -1.27，95%置信区间= -2.46 至 -0.08，P=.04）效应，这表明疼痛可以通过强化的偶然性来塑造。然而，这种效果的不确定性相对较高，主要是由于纳入研究的数量较少、需求特征和偏倚风险。这在感觉异常效应的研究中尤其相关，因为应该更严格地控制对伤害性感受的降低。观点：操作性条件作用可能是疼痛持续性的一种机制。所有研究这一假设的实验性研究都已被识别并总结。已经证明，操作性条件作用可以引起痛觉过敏和感觉异常效应。
