Attentional Focus but Not Distraction or Expectations Influence Conditioned Pain Modulation in Healthy Adults

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2025-06-21 DOI:10.1002/ejp.70058

Amber Billens, Evy Dhondt, Emilyn Dierickx, Stefaan Van Damme, Indra De Greef, Sophie Van Oosterwijck, Mira Meeus, Jessica Van Oosterwijck

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Abstract

Background

Despite extensive research on conditioned pain modulation (CPM), uncertainties remain regarding the role of cognitive mechanisms, such as attentional focus, distraction, and intrinsic a priori expectations, and the most optimal CPM protocol design (parallel vs. sequential). This study examined whether these cognitive factors influence CPM efficacy, and whether CPM magnitude differs between a parallel and sequential protocol.

Methods

Seventy-two healthy adults participated in this randomised cross-over study undergoing CPM evaluation, that is, pain pressure threshold assessment (=test stimulus) in response to hot water immersion (=conditioning stimulus (CS)) during four experimental protocols, that is, a neutral parallel protocol, a neutral sequential protocol, a sequential protocol with attentional focus on the CS-induced pain intensity, and a sequential protocol with attentional distraction from the CS. Pain expectations were recorded before each protocol.

Results

Focusing attention on the CS during CPM assessment resulted in smaller CPM magnitudes compared to no attentional manipulation or distracting from the CS. Distracting from the CS did not affect CPM magnitude compared to no attentional manipulation, nor did a priori expectations. Although CPM magnitudes were not statistically different between the parallel and sequential CPM protocol, a sequential protocol provides higher mean magnitudes and responder rates.

Conclusions

Since attentional focus on the CS reduces CPM efficacy, it is recommended to not rate the CS pain intensity during CS application to prevent a reduction of the inhibitory effect. Furthermore, a sequential protocol is recommended over a parallel protocol as a ‘cleaner’ representation of pain modulation free of attentional sources of biases.

Significance Statement

Conditioned pain modulation (CPM) is an important biomarker reflecting pain processing, however, there is a high variability in CPM response, making it important to gain insight into the influencing factors and mechanisms of CPM. The results of this study suggest that attentional focus on the conditioning stimulus influences CPM magnitude, whereas a distraction task and intrinsic a priori expectations do not. In both therapeutic and preventive approaches, it is of great interest for clinicians to positively address factors influencing CPM.

Trial Registration

ClinicalTrials.gov identifier: NCT05161286

查看原文本刊更多论文

健康成人的条件疼痛调节受注意力集中而非注意力分散或期望影响

尽管对条件疼痛调节（CPM）进行了广泛的研究，但关于认知机制的作用仍然存在不确定性，如注意焦点、分心和内在先验期望，以及最优的CPM方案设计（并行与顺序）。本研究考察了这些认知因素是否影响CPM疗效，以及平行和顺序方案之间的CPM强度是否不同。方法72名健康成人随机交叉试验，在4种实验方案(中性平行方案、中性顺序方案、注意集中于热水浸泡（=条件反射刺激）的疼痛压力阈值评估（=测试刺激）中进行CPM评估，即热水浸泡（=条件反射刺激）的疼痛压力阈值评估（=测试刺激）。以及一套连续的程序，分散CS的注意力。每次治疗前记录疼痛预期。结果在CPM评估过程中，将注意力集中在CS上与不进行注意操作或从CS上分散注意力相比，CPM值较小。与没有注意操作相比，从CS中分散注意力不会影响CPM大小，先验期望也不会。虽然并行CPM和顺序CPM方案之间的CPM震级没有统计学差异，但顺序CPM方案提供更高的平均震级和响应率。结论：由于对神经中枢的注意力集中会降低CPM的疗效，建议在应用神经中枢时不要对神经中枢疼痛强度进行评分，以防止抑制效果的降低。此外，建议采用顺序方案，而不是并行方案，因为它是疼痛调节的“更清晰”的表示，没有注意偏差的来源。条件疼痛调节（conditional pain modulation， CPM）是反映疼痛加工过程的重要生物标志物，但CPM反应具有高度的可变性，因此深入了解其影响因素和机制具有重要意义。本研究结果表明，对条件刺激的注意焦点影响CPM大小，而分心任务和内在先验期望对CPM大小没有影响。在治疗和预防方法中，临床医生对积极解决影响CPM的因素非常感兴趣。临床试验注册。gov标识符：NCT05161286

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.