Tessa Rooney, Louise Sharpe, Jemma Todd, Geert Crombez, Dimitri van Ryckeghem, Ben Colagiuri
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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. 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引用次数: 0
摘要
最近,疼痛的前兆效应(前兆痛觉亢进)受到了广泛关注,其中消极的预期和焦虑被认为是前兆痛觉亢进的解释因素。虽然预期和焦虑都会使注意力产生偏差,但注意力作为一种潜在的机制参与到减轻痛感中却很少被探讨。本研究旨在探索使用沉浸式、生态学上有效的 VR 范例是否能成功诱发注意力偏差(AB)并进而影响预兆痛觉。112 名健康参与者被随机分为 2(AB 训练:趋向疼痛 vs. 远离疼痛)x 2(失效条件:失效 vs. 对照)设计。通过反应时间和凝视来测量,VR 范式成功地改变了与疼痛相关的 AB,并产生了中等到较大的效果。然后,受试者完成一个假说指导和调节程序(假说范式)或一个匹配的对照程序。主要结果是自我报告的疼痛强度。次要结果是注意偏差和自我报告的预期、预期焦虑和状态焦虑。在测试阶段,与对照组相比,消灾法范式诱导的疼痛预期、预期焦虑和疼痛强度都明显高于对照组。在不同的模型中,疼痛预期也完全介导了欺骗组对欺骗性超痛感和预期焦虑的影响。然而,ABM 并不影响假定超痛感或疼痛预期,这让人怀疑 ABM 是否有可能预防假定超痛感。ABM 对状态焦虑和预期焦虑产生了意想不到的影响,远离疼痛的训练加剧了这两种焦虑,因此有必要对其进行进一步研究。视角:本文测试了在虚拟现实中设计的新型注意力偏差修正范式对诱导疼痛相关偏差的有效性,以及这些偏差是否会加剧或抵御无知觉超痛感。虽然成功诱发了与疼痛相关的偏差,但这些偏差与诱发的假性痛觉减退的强度没有关系。
Attention and Nocebo Hyperalgesia: Testing a Novel Virtual Reality Attention Bias Modification Paradigm.
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.
期刊介绍:
The Journal of Pain publishes original articles related to all aspects of pain, including clinical and basic research, patient care, education, and health policy. Articles selected for publication in the Journal are most commonly reports of original clinical research or reports of original basic research. In addition, invited critical reviews, including meta analyses of drugs for pain management, invited commentaries on reviews, and exceptional case studies are published in the Journal. The mission of the Journal is to improve the care of patients in pain by providing a forum for clinical researchers, basic scientists, clinicians, and other health professionals to publish original research.