Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, Essen, Germany.
Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany.
Pain. 2022 Aug 1;163(8):1560-1570. doi: 10.1097/j.pain.0000000000002544. Epub 2021 Nov 25.
Pain-related learning mechanisms likely play a key role in the development and maintenance of chronic pain. Previous smaller-scale studies have suggested impaired pain-related learning in patients with chronic pain, but results are mixed, and chronic back pain (CBP) particularly has been poorly studied. In a differential conditioning paradigm with painful heat as unconditioned stimuli, we examined pain-related acquisition and extinction learning in 62 patients with CBP and 61 pain-free healthy male and female volunteers using valence and contingency ratings and skin conductance responses. Valence ratings indicate significantly reduced threat and safety learning in patients with CBP, whereas no significant differences were observed in contingency awareness and physiological responding. Moreover, threat learning in this group was more impaired the longer patients had been in pain. State anxiety was linked to increased safety learning in healthy volunteers but enhanced threat learning in the patient group. Our findings corroborate previous evidence of altered pain-related threat and safety learning in patients with chronic pain. Longitudinal studies exploring pain-related learning in (sub)acute and chronic pain are needed to further unravel the role of aberrant pain-related learning in the development and maintenance of chronic pain.
疼痛相关的学习机制可能在慢性疼痛的发展和维持中起着关键作用。先前较小规模的研究表明，慢性疼痛患者的疼痛相关学习受损，但结果喜忧参半，特别是慢性背痛（CBP）研究较少。在使用痛苦热作为非条件刺激的差异条件作用范式中，我们使用效价和关联性评分以及皮肤电反应，在 62 名 CBP 患者和 61 名无疼痛的男性和女性健康志愿者中检查了与疼痛相关的获得和消退学习。效价评分表明，CBP 患者的威胁和安全性学习明显减少，而关联性意识和生理反应则没有明显差异。此外，该组的威胁学习在患者疼痛时间较长时受损更严重。状态焦虑与健康志愿者的安全性学习增加有关，但与患者组的威胁学习增强有关。我们的发现证实了先前关于慢性疼痛患者疼痛相关威胁和安全性学习改变的证据。需要进行（亚）急性和慢性疼痛中疼痛相关学习的纵向研究，以进一步阐明异常疼痛相关学习在慢性疼痛的发展和维持中的作用。
