Health, Medical and Neuropsychology unit, Faculty of Social and Behavioural Sciences, Leiden University, the Netherlands.
Health, Medical and Neuropsychology unit, Faculty of Social and Behavioural Sciences, Leiden University, the Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands; Medical Delta, Leiden University, Technical University Delft and Erasmus University, the Netherlands.
Biol Psychol. 2024 Jul;190:108818. doi: 10.1016/j.biopsycho.2024.108818. Epub 2024 May 17.
Negative expectations can increase pain sensitivity, leading to nocebo hyperalgesia. However, the physiological and psychological factors that predispose individuals to this phenomenon are still not well understood. The present study examined whether stress induced by a social stressor affects nocebo hyperalgesia, and whether this effect is mediated by self-reported and physiological stress responses. We recruited 52 healthy participants (15 men) who were randomly assigned to either the Trier Social Stress Test (TSST) or a control condition (a friendly version of the TSST). Nocebo hyperalgesia was induced using negative suggestions combined with a validated pain conditioning paradigm. We assessed self-reported (anxiety and stress) and physiological (cortisol, alpha-amylase, heart rate, and skin conductance) responses to stress. Both groups exhibited significant nocebo hyperalgesia. The stress group showed higher levels of anxiety, self-reported stress, and cortisol levels compared to the control group while no significant differences were found in other physiological markers. The stress and control groups did not differ in the magnitude of nocebo hyperalgesia, but anxiety levels partially mediated the effects of the stress test on nocebo hyperalgesia. Our findings suggest that an external social stressor does not directly affect nocebo hyperalgesia, but that increased anxiety due to the stressor enhances its magnitude. Thus, it may be worthwhile to investigate whether reducing stress-related anxiety in clinical settings would help alleviate nocebo effects.
负面预期会增加疼痛敏感度，导致反安慰剂痛觉过敏。然而，导致个体易患这种现象的生理和心理因素仍未得到很好的理解。本研究考察了社会应激源引起的应激是否会影响反安慰剂痛觉过敏，以及这种影响是否通过自我报告和生理应激反应来介导。我们招募了 52 名健康参与者（15 名男性），他们被随机分配到 Trier 社会应激测试（TSST）或对照条件（TSST 的友好版本）。使用负面暗示和经过验证的疼痛条件作用范式诱导反安慰剂痛觉过敏。我们评估了应激的自我报告（焦虑和应激）和生理（皮质醇、α-淀粉酶、心率和皮肤电导率）反应。两组都表现出明显的反安慰剂痛觉过敏。与对照组相比，应激组的焦虑、自我报告的应激和皮质醇水平更高，而其他生理标志物没有显著差异。应激组和对照组在反安慰剂痛觉过敏的程度上没有差异，但焦虑水平部分介导了应激测试对反安慰剂痛觉过敏的影响。我们的发现表明，外部社会应激源不会直接影响反安慰剂痛觉过敏，但由于应激源引起的焦虑增加会增强其程度。因此，在临床环境中，是否降低与应激相关的焦虑可能有助于减轻反安慰剂效应，这可能值得进一步研究。
