期刊
PAIN
卷 132, 期 -, 页码 S134-S149出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1016/j.pain.2007.09.001
关键词
pain; sex; endogenous analgesia; distraction; stress; DNIC
资金
- NIAMS NIH HHS [P50 AR049555-05, P50-AR49555, P50 AR049555] Funding Source: Medline
- NIDCR NIH HHS [U01 DE017018] Funding Source: Medline
- NINDS NIH HHS [F31 NS049731-02, F31-NS049731, F31 NS049731, F31 NS049731-01A1] Funding Source: Medline
Sex differences in endogenous pain modulation were tested in healthy volunteers (32 men, 30 women). Painful contact heat stimuli were delivered to the right leg alone, and then in combination with various electrical conditioning stimuli delivered to the left forearm. Four conditioning protocols were applied to each subject in separate sessions: mild, non-painful (control); distracting; stressful-yet-non-painful; strongly painful. Thermal stimuli were rated on visual analog scales for pain intensity (INT) and unpleasantness (UNP). Distracting and painful conditioning stimuli significantly reduced heat pain INT and UNP ratings for both sexes, with significantly larger distraction effects on INT ratings for men than women (p = 0.004). No sex differences in pain-evoked hypoalgesia were detected (p > 0.05). The stress protocol did not consistently reduce heat pain ratings, possibly because the protocol was not sufficiently stressful to activate endogenous modulatory systems. Regression analysis revealed that the magnitude of pain-evoked hypoalgesia was predicted by the perceived distraction (p = 0.003) and stress (p = 0.04) produced by the painful conditioning stimulation, providing evidence that distraction and stress contribute to pain-evoked hypoalgesia. However, the contribution of stress to pain-evoked hypoalgesia differed by sex (p = 0.02), with greater perceived stress associated with greater hypoalgesia in men and the opposite trend in women, suggesting sex differences in the mechanisms underlying pain-evoked hypoalgesia. This study provides indirect evidence that multiple neural mechanisms are involved in endogenous pain modulation and suggests that sex-specific aspects of these systems may contribute to greater pain sensitivity and higher prevalence of many chronic pain conditions among women. (C) 2007 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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