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搏动热诱发的强直性疼痛:时间总和机制与感知特性

Tonic pain evoked by pulsating heat: temporal summation mechanisms and perceptual qualities.

作者信息

Lautenbacher S, Roscher S, Strian F

机构信息

Max-Planck-Institute of Psychiatry, Department of Psychiatry, Munich, Federal Republic of Germany.

出版信息

Somatosens Mot Res. 1995;12(1):59-70. doi: 10.3109/08990229509063142.


DOI:10.3109/08990229509063142
PMID:7571943
Abstract

The properties of a newly developed tonic heat pain model (THPM), which makes use of pulsating contact heat, were investigated in 18 young men. The most important feature of this model is that repetitive heat pulses with an intensity of 1 degree C above the individual pain threshold are employed. This approach was used to tailor the tonic pain stimulation to the individual pain sensitivity. In the first of two experiments, the effects of pulse frequencies ranging from 5 to 30 pulses per minute (ppm) on ratings of pain intensity and pain unpleasantness (visual analogue scales) were examined. At all frequencies, both ratings increased steadily over the 5-min test period. Frequencies of 15 ppm or more appeared to enhance pain intensity throughout the test period compared to the lower frequencies, but did not appear to alter pain unpleasantness. This suggests that only pain intensity is influenced by slow temporal summation and that a sort of frequency threshold exists for this kind of summation. In the second experiment, the THPM was compared to a well-established form of tonic pain stimulation, the cold-pressor test (CPT); visual analogue scales were again used, and in addition the McGill Pain Questionnaire was employed. The CPT appeared to produce stronger tonic pain than the THPM. However, as is typical with tonic pain, both tonic pain models induced relatively higher values on the affective pain dimension than on the sensory pain dimension. The time course of pain was dynamic in the CPT, with an increase followed by a plateau phase, at least in those subjects who could tolerate the CPT for more than 60 sec. In contrast, as in the first experiment, the pain ratings in the THPM were characterized by a slow and steady increase over time. Moreover, there was absolutely no indication of a dichotomy between "pain-sensitive" and "pain-tolerant" individuals in the THPM, although such a dichotomy was evident in the CPT. This implies that the distinction between pain-sensitive and pain-tolerant individuals can be made only with the CPT, and that this distinction represents individual differences in peripheral vascular reactions to cold rather than in pain perception. In conclusion, the THPM appears to produce a stable and predictable temporal pattern of tonic pain with a predominant affective component, and to be suitable for application in the majority of individuals without causing undue discomfort.

摘要

在18名年轻男性中研究了一种新开发的利用脉动接触热的强直性热痛模型(THPM)的特性。该模型最重要的特点是采用强度比个体疼痛阈值高1摄氏度的重复热脉冲。这种方法用于根据个体疼痛敏感性调整强直性疼痛刺激。在两个实验中的第一个实验中,研究了每分钟5至30次脉冲(ppm)的脉冲频率对疼痛强度和疼痛不愉快程度评分(视觉模拟量表)的影响。在所有频率下,在5分钟的测试期间,两种评分均稳步增加。与较低频率相比,15 ppm或更高的频率在整个测试期间似乎增强了疼痛强度,但似乎并未改变疼痛不愉快程度。这表明只有疼痛强度受缓慢的时间总和影响,并且这种总和存在某种频率阈值。在第二个实验中,将THPM与一种成熟的强直性疼痛刺激形式——冷加压试验(CPT)进行了比较;再次使用视觉模拟量表,此外还采用了麦吉尔疼痛问卷。CPT似乎比THPM产生更强的强直性疼痛。然而,与强直性疼痛的典型情况一样,两种强直性疼痛模型在情感疼痛维度上诱导的值相对高于感觉疼痛维度。在CPT中,疼痛的时间进程是动态的,先是增加,然后是平台期,至少在那些能够耐受CPT超过60秒的受试者中是这样。相比之下,与第一个实验一样,THPM中的疼痛评分的特点是随时间缓慢而稳定地增加。此外,在THPM中绝对没有迹象表明“疼痛敏感”和 “疼痛耐受”个体之间存在二分法,尽管这种二分法在CPT中很明显。这意味着只有通过CPT才能区分疼痛敏感和疼痛耐受个体,并且这种区分代表了个体对外周血管对寒冷反应的差异,而不是疼痛感知的差异。总之,THPM似乎产生了一种稳定且可预测的强直性疼痛时间模式,其中情感成分占主导,并且适用于大多数个体,不会引起过度不适。

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