纤维肌痛症患者的保护性决策与身体相关,但与认知无关

IF 4 2区 医学 Q1 CLINICAL NEUROLOGY
Aleksandra M. Herman , Carolyn Berryman , Tasha R. Stanton
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引用次数: 0

摘要

纤维肌痛是一种慢性疾病,涉及广泛的疼痛、疲劳和认知功能障碍。基于证据的纤维肌痛干预措施,如教育和锻炼,通常需要长期的认知和/或身体上的努力,涉及到延迟收益(改善疼痛/功能)的即时成本(努力)。这些干预措施的启动和坚持往往是困难的,这可能反映了个体对努力和延迟奖励的态度与疼痛相关的改变。在这里,我们探讨了纤维肌痛患者在这种态度上是否与年龄和性别匹配的无痛对照组不同。在横断面研究1中,患有纤维肌痛的个体(N=19)和对照组(N=19)完成了一些任务,这些任务通过实际的身体或认知努力或忍受真正的延迟来提供真正的奖励。尽管根据每个参与者的独特能力将任务难度个性化,但纤维肌痛患者需要更高的动机来参与体力劳动任务(跑步机行走),特别是在更高的努力强度下(OR=1.077, 95%CI[1.003, 1.156]),但在认知努力任务中没有表现出差异,这表明没有普遍的动机缺陷,而是对体力劳动的态度发生了转变。此外,纤维肌痛的参与者表现出更大的等待奖励的意愿(OR=0.726, 95%CI[0.533, 0.990]),特别是在较低的奖励水平,表明奖励驱动的动机增加。在线进行的研究2 (N=43名纤维肌痛患者,N=139名对照组)重复了关于体力劳动的研究结果(t=3.36, 95%CI[0.08, 0.29]),强调纤维肌痛不涉及广泛的动机缺陷。相反,我们发现了体力劳动折扣的具体变化,以及延迟折扣对奖励的敏感性提高的迹象。这些见解可能有助于为纤维肌痛患者提供量身定制的干预策略。这篇文章确定了纤维肌痛患者对体力劳动和延迟奖励的态度改变。这些发现表明,坚持治疗的困难可能源于过度保护身体努力相关的决策,而不是低动机,为个性化教育和临床护理干预策略提供了潜在的目标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Heightened protective decision-making related to physical, but not cognitive, effort in individuals with fibromyalgia
Fibromyalgia is a chronic condition involving widespread pain, fatigue, and cognitive dysfunction. Evidence-based interventions for fibromyalgia, such as education and exercise, often require prolonged, cognitive and/or physical effort, involving immediate costs (effort) for delayed benefits (improved pain/function). Initiation of, and adherence to, these interventions is often difficult, which may reflect pain-related alterations in an individual’s attitudes towards effortful and delayed rewards. Here we explored whether individuals with fibromyalgia differed from age- and sex-matched pain-free controls in such attitudes. In cross-sectional Study 1, individuals with fibromyalgia (N=19) and controls (N=19) completed tasks offering real rewards for performing actual physical or cognitive effort or enduring real delays. Despite individualizing task difficulty to each participant’s unique capacity, those with fibromyalgia required higher incentives to engage in the physical effort task (treadmill walking), especially at higher effort intensities (OR=1.077, 95%CI [1.003, 1.156]), but showed no differences in the cognitive effort task, indicating no general motivation deficit but rather a shift in attitudes toward physical exertion. Additionally, participants with fibromyalgia showed a greater willingness to wait for rewards (OR=0.726, 95%CI [0.533, 0.990]), particularly at lower reward levels, suggesting an increased motivation driven by rewards. Study 2, conducted online (N=43 fibromyalgia, N=139 controls), replicated the findings regarding physical effort (t=3.36, 95%CI [0.08, 0.29]), reinforcing that fibromyalgia does not involve a broad motivational deficits. Instead, we found specific changes in physical effort discounting and indications of heightened sensitivity to rewards in delay discounting. These insights may help inform tailored intervention strategies for individuals with fibromyalgia.

Perspective

This article identifies altered attitudes toward physical effort and delayed rewards in individuals with fibromyalgia. These findings suggest that difficulties with treatment adherence may stem from over-protective physical effort-related decision-making rather than low motivation, offering a potential target for personalized education and intervention strategies in clinical care.
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来源期刊
Journal of Pain
Journal of Pain 医学-临床神经学
CiteScore
6.30
自引率
7.50%
发文量
441
审稿时长
42 days
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.
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