Rooney Tessa, Sharpe Louise, Todd Jemma, Crombez Geert, van Ryckeghem Dimitri, Colagiuri Ben
School of Psychology, The University of Sydney, Australia.
School of Psychology, The University of Sydney, Australia.
J Pain. 2025 Jan;26:104705. doi: 10.1016/j.jpain.2024.104705. Epub 2024 Oct 24.
Nocebo effects in pain (nocebo hyperalgesia) have received significant attention recently, with negative expectancies and anxiety proposed to be explanatory factors. While both expectancy and anxiety can bias attention, attention has been rarely explored as a potential mechanism involved in nocebo hyperalgesia. The present study aimed to explore whether attention bias modification (ABM) using an immersive, ecologically valid VR paradigm successfully induced attention biases (AB) and subsequently influenced nocebo hyperalgesia. One-hundred and two healthy participants were randomised in a 2 (AB training: towards vs. away from pain) x 2 (nocebo condition: nocebo vs. control) design. Pain-related AB was successfully changed by the VR paradigm as measured by reaction time and gaze, with moderate to large effects. Participants then completed either a nocebo instruction and conditioning procedure (nocebo paradigm) or a matched control procedure. The primary outcome was self-reported pain intensity. Secondary outcomes were attention bias and self-reports of expectancy, anticipatory anxiety, and state anxiety. The nocebo paradigm induced significantly greater pain expectancy, anticipatory anxiety and pain intensity during the test phase for the nocebo group compared to control. Pain expectancy also fully mediated the effect of the nocebo group on nocebo hyperalgesia and anticipatory anxiety in separate models. ABM did not, however, affect nocebo hyperalgesia or pain expectancy, casting doubt on the potential for ABM to inoculate against nocebo hyperalgesia. Unexpected effects of ABM were observed for state anxiety and anticipatory anxiety, whereby training away from pain exacerbated each, which necessitates further exploration. PERSPECTIVE: This article tests the efficacy of a novel attention bias modification paradigm, designed in virtual reality, for inducing pain-related biases, and whether these biases exacerbate or inoculate against nocebo hyperalgesia. While pain-related biases were successfully induced, there was no relationship with the strength of induced nocebo hyperalgesia.
疼痛中的反安慰剂效应（反安慰剂痛觉过敏）最近受到了广泛关注，消极预期和焦虑被认为是其解释因素。虽然预期和焦虑都可能使注意力产生偏差，但注意力作为反安慰剂痛觉过敏潜在机制的研究却很少。本研究旨在探讨使用沉浸式、具有生态效度的虚拟现实范式进行的注意力偏差修正（ABM）是否能成功诱导注意力偏差（AB），并随后影响反安慰剂痛觉过敏。102名健康参与者被随机分配到一个2（AB训练：朝向疼痛与远离疼痛）×2（反安慰剂条件：反安慰剂组与对照组）的设计中。通过反应时间和注视测量，虚拟现实范式成功改变了与疼痛相关的AB，效应中等至较大。参与者随后完成了反安慰剂指令和条件程序（反安慰剂范式）或匹配的对照程序。主要结果是自我报告的疼痛强度。次要结果是注意力偏差以及预期、预期焦虑和状态焦虑的自我报告。与对照组相比，反安慰剂范式在测试阶段使反安慰剂组的疼痛预期、预期焦虑和疼痛强度显著增加。在单独的模型中，疼痛预期也完全介导了反安慰剂组对反安慰剂痛觉过敏和预期焦虑的影响。然而，ABM并没有影响反安慰剂痛觉过敏或疼痛预期，这使人对ABM预防反安慰剂痛觉过敏的潜力产生怀疑。观察到ABM对状态焦虑和预期焦虑有意外影响，即远离疼痛的训练加剧了这两种焦虑，这需要进一步探索。观点：本文测试了一种在虚拟现实中设计的新型注意力偏差修正范式诱导与疼痛相关偏差的效果，以及这些偏差是否会加剧或预防反安慰剂痛觉过敏。虽然成功诱导了与疼痛相关的偏差，但与诱导的反安慰剂痛觉过敏强度无关。
