Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States.
Department of Psychology, Central Michigan University, Mt. Pleasant, MI, United States.
Pain. 2024 Jul 1;165(7):1559-1568. doi: 10.1097/j.pain.0000000000003162. Epub 2024 Feb 7.
People with chronic pain often attempt to manage pain and concurrent emotional distress with analgesic substances. Habitual use of such substances-even when not opioid-based-can pose side effect risks. A negative reinforcement model has been proposed whereby relief of pain and emotional distress following medication consumption increases the likelihood that the experience of elevated pain and distress will spur further medication use. People with chronic low back pain (N = 105) completed electronic diary assessments 5 times/day for 14 consecutive days. Lagged and cross-lagged analyses focused on links between time 1 pain and negative affect (NA) and time 2 analgesic medication use and vice versa. Sex differences were also explored. Primary results were as follows: (1) participants on average reported taking analgesic medication during 41.3% of the 3-hour reporting epochs (29 times over 14 days); (2) time 1 within-person increases in pain and NA predicted time 2 increases in the likelihood of ingesting analgesic medications; (3) time 1 within-person increases in medication use predicted time 2 decreases in pain and NA; and (4) lagged associations between time 1 pain/NA and time 2 medication use were strongest among women. Findings suggest that the use of analgesic medications for many people with chronic pain occurs frequently throughout the day. Results support the validity of a negative reinforcement model where pain and distress lead to pain medication use, which in turn leads to relief from pain and distress.
患有慢性疼痛的人通常会尝试使用镇痛物质来控制疼痛和并发的情绪困扰。习惯性地使用这些物质——即使不是基于阿片类药物——也会带来副作用风险。已经提出了一种负强化模型，即药物使用后缓解疼痛和情绪困扰会增加体验到更高水平的疼痛和困扰从而进一步使用药物的可能性。105 名慢性下背痛患者连续 14 天每天 5 次完成电子日记评估。滞后和交叉滞后分析侧重于时间 1 疼痛和负性情绪（NA）与时间 2 镇痛药物使用之间以及反之亦然的联系。还探讨了性别差异。主要结果如下：（1）参与者平均报告在 3 小时报告时段中有 41.3%（14 天内 29 次）服用了镇痛药；（2）时间 1 个体内疼痛和 NA 的增加预测了时间 2 摄入镇痛药的可能性增加；（3）时间 1 个体内药物使用的增加预测了时间 2 疼痛和 NA 的减少；（4）时间 1 疼痛/NA 和时间 2 药物使用之间的滞后关联在女性中最强。研究结果表明，许多慢性疼痛患者在一天中经常使用镇痛药物。结果支持了负强化模型的有效性，即疼痛和困扰导致使用止痛药，而止痛药又缓解了疼痛和困扰。
