疼痛心理韧性的认知神经机制研究

Chronic pain lasting more than three months is widespread and has devastating personal and economic costs that are expected to rise sharply, as China's aging population expands and industrialization, modernization, and rural-to-urban migration continue at a rapid pace. The fear-avoidance model (FAM; Vlaeyen & Linton, 2000) is currently the most widely-used theory used to explain how injuries and acute pain problems become chronic, disabling conditions. The FAM contends that the presence of psychological risk factors determines whether acute pain and injury lead to increased pain and disability or recovery. Specific risk factors for chronic pain and disability include (1) high fear of pain levels which predict (2) attention biases (hyervigilance) towards pain, (3) cognitive appraisal biases related to interpreting internal and external pain stimuli as sources of potential harm/injury, or catastrophe, and (4) escape/avoidance of activity. Due to these risk factors, physical de-conditioning increases, pain continues or worsens, and disability increases. In contrast, the FAM hypothesizes that when these risk factors are absent or at low levels, recovery from both pain and disability result. . Despite general support for the FAM (e.g., see reviews from Leeuw et al., 2007; Vlaeyen & Linton, 2012), researchers have pointed out that the model is incomplete because it cannot explain why some people continue to experience ongoing pain but do not show disability (Widener et al., 2013). This finding indicates that, aside from psychological risk factors, resilience factors that we and others have been studying also determine the degree to which pain is disabling (e.g., Erpelding & Davis, 2013; Jackson et al., 2014a, 2014b; Ramírez-Maestre & Esteve, 2014). Resilience refers to the capacity to successfully adapt to stressful or adverse stimuli and situations, including pain (Smith & Zautra, 2008). Recent clinical and experimental pain studies summarized below indicate high levels of resilience predict lower levels of impairment/disability, emotional distress, and pain severity. However, very little is known about specific cognitive, perceptual, and neural mechanisms that underlie resilience to experiences of acute experimental pain or ongoing chronic pain. The main purpose of the proposed research is to clarify the nature and impact of attentional, perceptual, and neural mechanisms underlying resilience to pain.. The core of the proposal below is organized into six sections. First, research on the prevalence and consequences of pain is described to highlight the often devastating effects of chronic pain, particularly in China and on its people. Second, an overview of research on operationalizations of resilience, their associations with pain outcomes, and a selective critique of resilience studies is presented. Third, based on this review and critique, the main research questions and hypotheses are outlined. Fourth, the purposes and methodology of 11 studies that comprise this grant proposal are summarized. Finally, the main innovations of this work are discussed including a brief description of its theoretical and applied value.

慢性疼痛（如背痛、头痛、关节痛）十分普遍，给社会和个人造成了巨大的经济损失。心理韧性指的是成功适应包括疼痛在内的压力和不利刺激的能力。最近有关疼痛的临床和实验室研究表明，高水平的心理韧性预测低水平的身体功能缺损/残疾，情绪忧虑和疼痛严重程度。但是，很少有研究探讨心理韧性对急性实验室诱发疼痛和持续慢性疼痛的独特的知觉、认知和神经机制。本项目旨在识别疼痛心理韧性的注意、知觉和神经机制的本质及其影响。具体研究为：首先，采用眼动追踪技术和反应时指标，识别疼痛心理韧性的注意偏向。第二，在实验室条件下，操纵心理韧性相关的知觉评价，评估其对疼痛知觉和应对策略的影响。第三，考察在临床样本中，心理韧性过程与恐惧-回避过程对疼痛适应的影响。最后，采用fMRI技术识别疼痛心理韧性的神经机制。该研究对提高中国居民的生活健康质量，减少慢性疼痛带来的经济花费有重要的理论意义和应用价值。

持续三个月及以上的慢性疼痛影响了15%-40％的中国成年人，给患者及社会带来巨大经济负担。有相当一部分患者表现出“慢性疼痛综合症”，具体表现为工作相关功能受损、经济压力、日常活动受干扰、痛苦情绪以及为缓解疼痛需付出高额护理费用。然而，尽管有疼痛，一些患者仍具有心理韧性和良好的日常功能。尽管过去十年对心理韧性的研究增加，但对于疼痛韧性相关的认知神经机制知之甚少。. 为此本项目旨在揭示临床和实验室疼痛样本中，心理韧性相关的神经认知机制。本项目有四个研究目标：（1）通过眼动技术来评估与心理韧性相关的注意偏向；（2）探究心理韧性评估影响实验室研究中的疼痛应对和疼痛知觉的因果关系；（3）检验慢性疼痛样本中，心理韧性、疼痛信念以及功能之间的关系，以及（4）识别非临床和临床疼痛样本的疼痛相关心理韧性的神经机制。. 关于目标1，研究结果表明：（i）暗示潜在疼痛的视觉线索比无明显疼痛的视觉线索更能吸引视觉注意，（ii）与低疼痛心理韧性者相比，疼痛心理韧性较高的人更容易将长时的注意从潜在的疼痛线索转移到威胁性较小的线索上。关于目标2，已发表的论文及会议展板展示表明通过操纵增加对疼痛心理韧性的评估（i）疼痛是一种挑战而不是威胁；（ii）尽管有疼痛但自我仍可以功能适应良好；和/或（iii）错误反应反馈，改变对于忍受疼痛的自我效能感导致了中等却显著的疼痛灾难化程度降低以及认知适应和/或疼痛忍受水平增加。关于目标3，研究将疼痛心理韧性与挑战评估、疼痛自我效能感，认知适应性以及威胁性评价和疼痛灾难性评价的减少联系在一起。关于目标4，ERP研究表明，与高疼痛心理韧性者相比，低疼痛心理韧性者（即高疼痛恐惧者）将更少的认知资源分配在加工体感刺激上。1项已投稿并在审的基于体素形态学的关于非临床和临床疼痛样本的研究，将低疼痛心理韧性与涉及疼痛处理脑区的灰质体积的增加和涉及情绪调节脑区的灰质体积的减少关联起来。