本文選題：疼痛敏感性 + 疼痛恐懼��； 參考：《西南大學(xué)》2014年碩士論文

【摘要】：疼痛敏感性具有廣泛的個(gè)體差異,有些人總是更快地察覺疼痛或者疼痛體驗(yàn)更加強(qiáng)烈。已有研究顯示心理特質(zhì)(Leeuw et al.,2007)和腦結(jié)構(gòu)(Emerson et al.,2014)與疼痛敏感性的個(gè)體差異有關(guān)。本論文旨在更具體地闡明影響疼痛敏感性的心理因素和腦結(jié)構(gòu)。 疼痛感知包含感覺區(qū)辨成分(疼痛強(qiáng)度)和動(dòng)機(jī)情感成分(不愉快度),二者皆可能被諸如疼痛恐懼、心理憂慮和軀體化的心理特質(zhì)因素所影響。盡管大量證據(jù)表明疼痛恐懼影響疼痛感知以及慢性疼痛(持續(xù)時(shí)間3個(gè)月以上)的發(fā)展和維持,但未見研究比較過疼痛恐懼、心理憂慮和軀體化究竟哪個(gè)對(duì)疼痛感知的影響最大。在方法上,本領(lǐng)域內(nèi)的研究者往往使用單一量表去測(cè)量諸如心理憂慮和疼痛恐懼這般復(fù)雜的心理結(jié)構(gòu);并且多數(shù)研究采用慢性疼痛患者,從而難以判斷究竟是心理特質(zhì)加劇了疼痛感知,還是持續(xù)的疼痛誘導(dǎo)了心理特質(zhì)。 在無痛的健康大學(xué)生群體中,兩項(xiàng)橫斷研究被用來區(qū)辨對(duì)疼痛感知至關(guān)重要的心理因素的相對(duì)作用。研究一探索在多個(gè)相關(guān)量表間是否存在包含軀體化、心理憂慮和疼痛恐懼的三因子結(jié)構(gòu),并驗(yàn)證其結(jié)構(gòu)效度。研究二根據(jù)研究一的結(jié)果整合各因子內(nèi)多個(gè)量表的分?jǐn)?shù)作為因子分,并應(yīng)用實(shí)驗(yàn)室疼痛范式比較各因子對(duì)疼痛感知的作用。研究三旨在闡明與疼痛敏感性有關(guān)的腦結(jié)構(gòu)。 在研究一中,653名大學(xué)生(455名女性,198名男性)完成一系列自陳量表,包括五項(xiàng)疼痛恐懼量表,三項(xiàng)一般性的心理憂慮量表和兩項(xiàng)軀體化量表。在兩個(gè)對(duì)等的分半樣本中,分別進(jìn)行探索性因素分析(EFA)和驗(yàn)證性因素分析(CFA)以判定多量表間的三因子結(jié)構(gòu)是否存在以及結(jié)構(gòu)效度是否良好。EFA結(jié)果在其中一個(gè)分半樣本中發(fā)現(xiàn)了與預(yù)期一致的三因子結(jié)構(gòu),而CFA結(jié)果在另一分半數(shù)據(jù)中證明該結(jié)構(gòu)具有良好的擬合度。 在研究二中,105名被試(74名女性,31名男性)以順序平衡的方式先后完成相同的自陳問卷和冷水痛測(cè)驗(yàn)(CPT)。CPT要求被試將非利手盡可能長久地放置于冰水中,時(shí)間上限為五分鐘。疼痛閾限、忍耐時(shí)間、自我報(bào)告的疼痛強(qiáng)度和不愉快度作為測(cè)量疼痛感知水平的四個(gè)指標(biāo),分層回歸模型和調(diào)節(jié)、中介分析被用來考察三因子對(duì)疼痛感知各指標(biāo)的影響作用。主要結(jié)果如下：(1)疼痛恐懼和心理憂慮顯著地正向預(yù)測(cè)疼痛強(qiáng)度和疼痛不愉快度,但心理憂慮的作用被疼痛恐懼完全中介；(2)更高水平的疼痛恐懼與更短的耐受時(shí)間在邊際水平(p=0.097)顯著相關(guān),而軀體化和心理憂慮對(duì)耐受力沒有影響；(3)對(duì)疼痛恐懼水平較高的人來說,軀體化水平越高,疼痛不愉快度越低。 總體來看,研究一和研究二的結(jié)果說明疼痛恐懼,而非心理憂慮和軀體化是加劇疼痛感知,尤其是疼痛強(qiáng)度和不愉快度的主要特質(zhì)。疼痛恐懼對(duì)心理憂慮和疼痛體驗(yàn)間關(guān)系的中介效應(yīng)暗示心理憂慮完全通過特異于疼痛的情緒性反應(yīng)來加劇疼痛體驗(yàn)。而軀體化與疼痛不愉快度之間的負(fù)相關(guān)關(guān)系則說明,對(duì)于面臨疼痛表現(xiàn)出高疼痛恐懼的人來說,軀體化癥狀可能是機(jī)體維持內(nèi)穩(wěn)態(tài)的適應(yīng)性保護(hù)機(jī)制。 研究三探討疼痛敏感性與大腦結(jié)構(gòu)特征之間的相關(guān)關(guān)系。近來的兩項(xiàng)研究假設(shè)與疼痛敏感性結(jié)構(gòu)相關(guān)的腦區(qū)應(yīng)該在傳統(tǒng)的疼痛矩陣結(jié)構(gòu)內(nèi),但他們卻發(fā)現(xiàn)疼痛矩陣在結(jié)構(gòu)上主要與非痛的感覺靈敏性相關(guān),而不是疼痛敏感性(Elsenbruch et al.,2013; Erpelding, Moayedi,Davis,2012)。然而,在全腦范圍內(nèi)探索與疼痛敏感性關(guān)聯(lián)的結(jié)構(gòu)腦(Emerson et al.,2014)和功能腦(Goffaux, Girard-Tremblay, Marchand, Daigle,Whittingstall,2013)的研究卻意外地發(fā)現(xiàn)默認(rèn)網(wǎng)絡(luò)(DMN)與疼痛敏感性顯著相關(guān)。尤其重要的是,Goffaux等人在全腦范圍內(nèi)發(fā)現(xiàn)只有DMN中的左側(cè)楔前葉(PCu)在疼痛刺激下產(chǎn)生的ERP反應(yīng)與疼痛敏感性顯著相關(guān)。另外,由于已有研究還發(fā)現(xiàn)疼痛矩陣與DMN之間的功能連接顯著預(yù)測(cè)對(duì)刺激的疼痛判另(Witting et al.,2001)以及慢性疼痛的發(fā)展(Napadow, Kim, Clauw,Harris,2012; Napadow et al.,2010),先前對(duì)DMN及其與疼痛矩陣交互作用的忽視就成為理解疼痛感知的發(fā)生過程的當(dāng)務(wù)之急。 鑒于此,研究三通過對(duì)比非痛與疼痛刺激,在疼痛矩陣和DMN中考察與疼痛敏感性相關(guān)的腦結(jié)構(gòu)。被試為80名無痛右利手大學(xué)生(35名女性,45名男性)。被試先接受結(jié)構(gòu)像MRI掃描,之后在冷、熱和表皮電三種刺激模態(tài)中進(jìn)行標(biāo)準(zhǔn)的心理物理測(cè)量,從而獲得各模態(tài)下對(duì)非痛刺激和疼痛刺激的敏感性。在疼痛矩陣結(jié)構(gòu)和DMN組成的聯(lián)合興趣區(qū)內(nèi)進(jìn)行基于體素的形態(tài)學(xué)分析(VBM)�？刂颇挲g、性別和全腦平均結(jié)構(gòu)指標(biāo)等潛在混淆變量的影響后,以各個(gè)心理物理指標(biāo)為預(yù)測(cè)變量,對(duì)VBM的四個(gè)結(jié)構(gòu)指標(biāo)——灰質(zhì)密度、灰質(zhì)體積、白質(zhì)密度和白質(zhì)體積——進(jìn)行回歸分析。 使用AlphaSim法進(jìn)行多重比較校正,結(jié)果發(fā)現(xiàn)疼痛矩陣中的一些腦區(qū)——丘腦、腦島、前扣帶回、基底神經(jīng)節(jié)和海馬結(jié)構(gòu))唯一地與溫覺模態(tài)下的非痛敏感性相關(guān),而DMN中的左側(cè)楔前葉則唯一地與溫覺模態(tài)下的疼痛敏感性顯著相關(guān)。這種雙分離的結(jié)果模式只在冷和熱這兩種溫覺模態(tài)下出現(xiàn)。對(duì)表皮電刺激來說,疼痛矩陣結(jié)構(gòu)和DMN中都沒有腦區(qū)與非痛敏感性顯著相關(guān),而疼痛矩陣中杏仁核和海馬交際處的一個(gè)聯(lián)合組塊則與表皮電刺激下的疼痛敏感性顯著相關(guān)。 總之,我們?cè)跍赜X模態(tài)下發(fā)現(xiàn)了明確的雙分離結(jié)構(gòu)：疼痛矩陣唯一地與對(duì)非痛刺激的敏感性相關(guān),而楔前葉則唯一地與對(duì)疼痛刺激的敏感性相關(guān)。尤其值得一提的是,左側(cè)楔前葉與疼痛敏感性的結(jié)構(gòu)關(guān)聯(lián)是對(duì)Goffaux等人(2013)工作在跨方法間的獨(dú)立重復(fù)和驗(yàn)證,后者發(fā)現(xiàn)只有左側(cè)楔前葉的ERP反應(yīng)與疼痛敏感性顯著相關(guān)。綜合以上證據(jù),我們提出疼痛識(shí)別的“兩階段模型”以解釋疼痛矩陣與楔前葉如何交流信息以完成疼痛識(shí)別過程。我們認(rèn)為：在第一階段,疼痛矩陣網(wǎng)絡(luò)整合外界信息產(chǎn)生非疼的感覺表征;第二階段,感覺表征被投射向楔前葉完成更高級(jí)別的整合加工,以決定軀體信號(hào)是否應(yīng)被判別為“疼痛”。該模型并不排斥其它腦結(jié)構(gòu)在功能或結(jié)構(gòu)上與疼痛敏感性顯著相關(guān),同時(shí),該模型與其它理論的相容性在研究三進(jìn)行了深入的討論。
[Abstract]:Pain sensitivity has a wide range of individual differences, and some people are always more aware of pain or pain more quickly. Studies have shown that psychological traits (Leeuw et al., 2007) and brain structure (Emerson et al., 2014) are associated with individual differences in pain sensitivity. This paper aims to clarify the psychological factors that affect pain sensitivity more specifically. The structure of the brain and the brain.
Pain perception includes sensory area discrimination (pain intensity) and motivational emotional components (unhappiness), and the two may be influenced by psychological traits such as pain fear, psychological anxiety and somatization. Although a large number of evidence suggests that pain fear affects pain perception and slow pain (lasting more than 3 months), the development and maintenance of slow pain (lasting more than 3 months) No study has compared pain fear, psychological anxiety and somatization which has the greatest impact on pain perception. In this way, researchers in this field often use a single scale to measure the complex psychological structure such as psychological anxiety and pain fear; and most of the researchers use chronic pain, which is difficult to judge. Is psychological trait aggravating pain perception or continuous pain inducing psychological characteristics?
In a group of painless healthy college students, two transection studies were used to identify the relative effects of the psychological factors that were critical to pain perception. The study explored whether there was a three factor structure containing somatization, psychological anxiety and pain fear among multiple related scales, and tested its structural validity. The study two was based on the results of study 1. The score of multiple scales within each factor was integrated as a factor, and the effect of various factors on pain perception was compared with the laboratory pain paradigm. Study three aims to elucidate the brain structure associated with pain sensitivity.
In the first study, 653 college students (455 women, 198 men) completed a series of self-contained scales, including five pain and fear scales, three general psychological anxiety scales and two somatization scales. In two peer half samples, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to determine the multi scale. Whether or not the three factor structure exists and whether the structure validity is good.EFA results in one half of the samples found the expected three factor structure, and the CFA results show that the structure has good fitting degree in another half and half data.
In the second study, 105 subjects (74 women, 31 men) completed the same self-contained questionnaire and cold water pain test (CPT).CPT in order to keep the non profit as long as possible in the ice water with an upper limit of five minutes. Pain threshold, tolerance time, self reported pain intensity and unhappiness Four indicators of pain perception, stratified regression model and regulation were measured, and mediator analysis was used to investigate the effects of three factors on the indicators of pain perception. The main results were as follows: (1) pain fear and psychological anxiety were significantly positive predictive of pain intensity and pain unhappiness, but the effect of psychological anxiety was completely affected by pain and fear. (2) higher level of pain and fear and shorter tolerance time were significantly related to the marginal level (p=0.097), while somatization and psychological anxiety had no effect on tolerance; (3) the higher the level of pain and fear, the higher the somatization level and the lower the pain unhappiness.
In general, the results of study one and study two illustrate the fear of pain, but not psychological anxiety and somatization are the main traits that exacerbate pain perception, especially the intensity and displeasure of pain. The mediating effect of pain fear on psychological anxiety and pain experience implies that psychological worry is entirely through the specific emotional response to pain. The negative correlation between somatization and pain unhappiness suggests that somatic symptoms may be an adaptive protective mechanism for the body to maintain homeostasis for people who face pain and fear of pain.
Study three explored the relationship between pain sensitivity and brain structural characteristics. Recent two studies assumed that the brain areas associated with pain sensitive structures should be within the traditional pain matrix structure, but they found that the pain matrix was mainly associated with non painful sensory sensitivity, rather than pain sensitivity (Elsenbruch ET). Al., 2013; Erpelding, Moayedi, Davis, 2012). However, the study of the structural brain associated with pain sensitivity (Emerson et al., 2014) and functional brain (Goffaux, Girard-Tremblay, Marchand, Daigle, Whittingstall, 2013) in the whole brain area was found to be significantly related to the pain sensitivity. Goffaux et al. In the whole brain found that only the ERP response to the left anterior lobe (PCu) in DMN was significantly associated with pain sensitivity. In addition, the functional connection between the pain matrix and DMN was also found to predict the pain of stimuli (Witting et al., 2001) and the development of chronic pain (Na). Padow, Kim, Clauw, Harris, 2012; Napadow et al., 2010), the previous neglect of DMN and its interaction with the pain matrix is an urgent task to understand the process of pain perception.
In view of this, study three examined the brain structures associated with pain sensitivity in the pain matrix and DMN by comparing non pain and pain stimuli. The subjects were 80 painless right hand students (35 women, 45 men). The subjects were first treated with a structural image MRI scan, followed by a standard psychophysical test in the three stimulation modes of cold, heat and skin electricity. Quantity, thus obtaining sensitivity to non pain stimuli and pain stimuli under various modes. In the joint interest area of the pain matrix structure and DMN, the morphologic analysis (VBM) is carried out in the joint interest zone of the pain matrix. After controlling the influence of the potential confusion variables, such as age, sex, and the average structure of the whole brain, each psychophysical index is a predictive variable, and VBM Four structural parameters gray matter density, gray matter volume, white matter density and white matter volume were analyzed by regression analysis.
AlphaSim method was used for multiple comparison correction. It was found that some of the brain regions in the pain matrix - thalamus, insula, anterior cingulate gyrus, basal ganglia and hippocampal structure were only related to the non pain sensitivity under the modality of temperature sense, while the left anterior lobe in DMN was uniquely related to the pain sensitivity under the modality of temperature sense. The results of the separation were only in the two temperature modes of cold and heat. For the epidermal electrical stimulation, there was no significant correlation between the pain matrix structure and the non pain sensitivity in the DMN, while a joint block in the amygdala and hippocampal communication was significantly related to the pain sensitivity of the epidermis.
In conclusion, we found a clear double separation structure under the modality of temperature sense: the pain matrix is uniquely associated with sensitivity to non pain stimuli, while the anterior lobe is uniquely related to the sensitivity to pain stimuli. It is particularly worth mentioning that the left anterior wedge is associated with the structure of pain sensitivity to Goffaux et al. (2013). Independent duplication and validation between the two methods, the latter found that only the ERP response to the left anterior lobe was associated with pain sensitivity. Collaterals integrate external information to produce non painful sensory characterization; in the second stage, the sensory characterization is projected to the anterior lobe of the wedge to complete a higher level of integrated processing to determine whether the body signal should be identified as "pain". This model does not exclude the significant correlation between the other brain structures and the pain sensitivity in function or structure, and the model and others The compatibility of the theory is discussed in depth in research three.
【學(xué)位授予單位】：西南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：B842

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