Theory of Pain Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences (FPSE), Geneva, Switzerland; Geneva Neuroscience Center, Geneva, Switzerland.
Emergency Department, University Hospital of Lausanne (UHL), Lausanne, Switzerland.
Br J Anaesth. 2019 Aug;123(2):e284-e292. doi: 10.1016/j.bja.2019.01.039. Epub 2019 Mar 23.
Pain undertreatment, or oligoanalgesia, is frequent in the emergency department (ED), with major medical, ethical, and financial implications. Across different hospitals, healthcare providers have been reported to differ considerably in the ways in which they recognise and manage pain, with some prescribing analgesics far less frequently than others. However, factors that could explain this variability remain poorly understood. Here, we used neuroscience approaches for neural signal modelling to investigate whether individual decisions in the ED could be explained in terms of brain patterns related to empathy, risk-taking, and error monitoring.
For 15 months, we monitored the pain management behaviour of 70 ED nurses at triage, and subsequently invited 33 to a neuroimaging study involving three well-established tasks probing relevant cognitive and affective dimensions. Univariate and multivariate regressions were used to predict pain management decisions from neural activity during these tasks.
We found that the brain signal recorded when empathising with others predicted the frequency with which nurses documented pain in their patients. In addition, neural activity sensitive to errors and negative outcomes predicted the frequency with which nurses denied analgesia by registering potential side-effects.
These results highlight the multiple processes underlying pain management, and suggest that the neural representations of others' states and one's errors play a key role in individual treatment decisions. Neuroscience models of social cognition and decision-making are a powerful tool to explain clinical behaviour and might be used to guide future educational programs to improve pain management in ED.
在急诊科（ED）中，疼痛治疗不足或少痛觉治疗较为常见，这涉及到重大的医学、伦理和经济问题。据报道，不同医院的医护人员在识别和管理疼痛方面存在很大差异，一些人开止痛药的频率明显低于其他人。然而，导致这种差异的因素仍知之甚少。在这里，我们使用神经科学方法进行神经信号建模，以研究个体在 ED 中的决策是否可以用与同理心、冒险和错误监测相关的大脑模式来解释。
在 15 个月的时间里，我们监测了 70 名 ED 护士在分诊时的疼痛管理行为，随后邀请其中的 33 名护士参加一项神经影像学研究，该研究涉及三个成熟的任务，用于探测相关的认知和情感维度。我们使用单变量和多变量回归来预测这些任务中大脑活动与疼痛管理决策之间的关系。
我们发现，当护士对他人产生同理心时，大脑记录的信号可以预测他们为患者记录疼痛的频率。此外，对错误和负面结果敏感的神经活动可以预测护士记录潜在副作用而拒绝使用止痛药的频率。
这些结果突出了疼痛管理的多个过程，并表明他人状态和个体错误的神经表示在个体治疗决策中起着关键作用。社会认知和决策的神经科学模型是解释临床行为的有力工具，可用于指导未来的教育计划，以改善 ED 中的疼痛管理。
