Alldritt Samuel, Jammoul Mohammad, Makary Meena, Becker Susanne, Maeng Daniel, Keane Brian, Zald David, Geha Paul
Child Mind Institute, New York, New York, United States of America.
Department of Psychiatry, School of Medicine and Dentistry, University of Rochester, 300 Crittenden Blvd. Rochester, New York, United States of America.
PLoS One. 2025 Aug 20;20(8):e0317980. doi: 10.1371/journal.pone.0317980. eCollection 2025.
The motivational and affective properties of chronic pain significantly impact patients' lives and response to treatment but remain poorly understood. Most available phenotyping tools of chronic pain affect rely on patients' self-report. Here we instead directly studied the willingness of chronic low-back pain (CLBP, n = 82) patients to expend effort to win monetary rewards available for wins at different probabilities and different levels of difficulties in comparison to matched pain free controls (n = 43). Consistent with the hypothesis of "negative hedonic shift" in chronic pain we observed that CLBP patients are significantly less willing than pain free controls to expend effort to go for high cost/high reward choices and their reported low-back pain intensity predicted increased effort discounting. Patients' performance was not explained by their self-reported depressive symptoms. Our results present new behavioral evidence characterizing the nature of anhedonia in chronic pain and highlight the importance of recognizing and assessing diminished motivation as an integral component of the chronic pain experience.
慢性疼痛的动机和情感特性对患者的生活及治疗反应有显著影响,但目前仍了解不足。大多数现有的慢性疼痛表型分析工具依赖患者的自我报告。在此,我们转而直接研究慢性下腰痛(CLBP,n = 82)患者与匹配的无疼痛对照组(n = 43)相比,在不同概率和不同难度水平下为赢得金钱奖励而付出努力的意愿。与慢性疼痛中“负性享乐转移”的假设一致,我们观察到CLBP患者比无疼痛对照组明显更不愿意为高成本/高回报选择付出努力,并且他们报告的下腰痛强度预示着努力折扣增加。患者的表现不能用其自我报告的抑郁症状来解释。我们的结果提供了新的行为证据,刻画了慢性疼痛中快感缺失的本质,并强调了认识和评估动机减弱作为慢性疼痛体验不可或缺组成部分的重要性。