School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia.
J Pain. 2024 Apr;25(4):946-961. doi: 10.1016/j.jpain.2023.10.016. Epub 2023 Oct 24.
Nocebo effects in pain (nocebo hyperalgesia) have been thoroughly researched, and negative expectancies have been proposed as a key factor in causing nocebo hyperalgesia. However, little is known about the psychological mechanisms by which expectations exacerbate the perception of pain. A potential mechanism that has been proposed within wider pain research is pain-related attention. The aim of the present study was thus to explore whether attention bias (AB) to pain influenced nocebo hyperalgesia. One-hundred and thirty-four healthy participants were randomized in a 2 (AB training: towards vs away from pain) × 2 (nocebo condition: nocebo vs control) design. Pain-related AB was manipulated through a novel, partially gaze-contingent dot-probe task. Participants then completed either a nocebo instruction and conditioning paradigm or a matched control condition. Primary outcomes were measures of expectancy, anticipatory anxiety, and pain intensity completed during a nocebo test phase. Results showed that the AB manipulation was unsuccessful in inducing ABs either toward or away from pain. The nocebo paradigm induced significantly greater expectancy, anticipatory anxiety, and pain intensity for the nocebo groups compared to the control groups. In a posthoc analysis of participants with correctly induced ABs, AB towards pain amplified nocebo hyperalgesia, expectancy, and anticipatory anxiety relative to AB away from pain. The results are consistent with the expectancy model of nocebo effects and additionally identify anticipatory anxiety as an additional factor. Regarding AB, research is needed to develop reliable means to change attention sample-wide to corroborate the present findings. PERSPECTIVE: This article explores the role of AB, expectancy, and anticipatory anxiety in nocebo hyperalgesia. The study shows that expectancy can trigger anticipatory anxiety that exacerbates nocebo hyperalgesia. Further, successful AB training towards pain heightens nocebo hyperalgesia. These findings identify candidate psychological factors to target in minimizing nocebo hyperalgesia.
疼痛的反安慰剂效应（反安慰剂性痛觉过敏）已得到充分研究，负面预期被认为是导致反安慰剂性痛觉过敏的关键因素。然而，对于期望如何加剧疼痛感知的心理机制知之甚少。在更广泛的疼痛研究中提出的一个潜在机制是与疼痛相关的注意力。因此，本研究旨在探讨注意力偏向（AB）对疼痛是否会影响反安慰剂性痛觉过敏。134 名健康参与者按照 2（AB 训练：朝向疼痛 vs 远离疼痛）×2（反安慰剂条件：反安慰剂 vs 对照）的设计随机分组。通过一种新颖的、部分基于注视的点探测任务来操纵与疼痛相关的 AB。然后，参与者完成反安慰剂指令和条件作用范式或匹配的对照条件。主要结果是在反安慰剂测试阶段完成的期望、预期焦虑和疼痛强度的测量。结果表明，AB 操作未能成功地诱导对疼痛的 AB 朝向或远离。与对照组相比，反安慰剂范式显著增加了反安慰剂组的期望、预期焦虑和疼痛强度。在对具有正确诱导 AB 的参与者进行的事后分析中，相对于远离疼痛的 AB，朝向疼痛的 AB 增强了反安慰剂性痛觉过敏、期望和预期焦虑。这些结果与反安慰剂效应的期望模型一致，并进一步确定了预期焦虑是另一个因素。关于 AB，需要开展研究以开发可靠的方法来改变注意力的样本范围，以验证本研究的发现。观点：本文探讨了 AB、期望和预期焦虑在反安慰剂性痛觉过敏中的作用。研究表明，期望可以引发预期焦虑，从而加剧反安慰剂性痛觉过敏。此外，成功的朝向疼痛的 AB 训练会加剧反安慰剂性痛觉过敏。这些发现确定了候选的心理因素，可作为减轻反安慰剂性痛觉过敏的目标。
