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Efecto de las expectativas, inducidas mediante instrucciones, en la percepción del dolor: un estudio de pupilometría.

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2022
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El dolor es un fenómeno complejo, en el que tanto los aspectos emocionales (ansiedad,miedo, depresión) como las cogniciones (actitudes, creencias) juegan un papel muy relevante. La dilatación pupilar en condiciones constantes de luz es una medida válida del dolor, que parece ser sensible tanto a los aspectos emocionales como cognitivos del mismo. El objetivo de este estudio es analizar la influencia de las instrucciones y las expectativas de dolor en la percepción del dolor. Para ello, antes de la estimulación dolorosa, se indujeron situaciones de expectativa de dolor, de no- dolor y neutras mediante videos instructivos en 18 participantes sanos. La posterior estimulación nociceptiva se realizó palpando el masetero con un algómetro; la intensidad de la palpación se calibró agregando un 10% al umbral de dolor de cada participante. Las respuestas de dolor se midieron mediante la escala analógica visual (EVA) y la pupilometría. Se observaron diferencias significativas para el EVA donde las instrucciones de dolor diferían de las de no dolor y las neutras, no encontrándose diferencias entre estas dos últimas. Sin embargo, la pupilometría no arrojó diferencias significativas dependiendo del tipo de instrucciones, quizá por el tamaño reducido de la muestra. Aunque, se observaron mayores dilataciones pupilares para los eventos de palpación y post-palpación en relación con el resto del procedimiento, confirmando su utilidad como medida de dolor. Por tanto, la inducción de la expectativa de dolor probablemente implica respuestas emocionales y cognitivas que afectan la percepción final del dolor. Nuestros hallazgos respaldan los modelos que resaltan la importancia de los aspectos cognitivos, emocionales y conductuales en la percepción del dolor, en línea con la definición actual de dolor propuesta por la IASP.
Pain is a complex phenomenon, in which both emotional aspects (anxiety, fear, depression) and cognitions (attitudes, beliefs) play a very relevant role. Pupil dilation under constant light conditions is a valid measure of pain, which appears to be sensitive to both the emotional and cognitive aspects of pain. The aim of this study is to analyze the influence of pain instructions and expectations on pain perception. To this aim,before a painful stimulation, pain expectation, non-pain and neutral situations were induced through instructional videos in 18 healthy participants. Subsequent nociceptive stimulation was performed by palpating the masseter with an algometer; palpation intensity was calibrated by adding 10% to each participant's pain threshold. Pain responses were measured by visual analogue scale (VAS) and pupillometry. Significant differences were observed for the VAS, where the pain instructions differed from the no�pain and neutral instructions, with no differences between the latter two. However, pupil size did not show significant differences depending on the type of instructions, perhaps due to the small size of the sample. However, greater pupillary dilations were observed for palpation and post-palpation events in relation to the rest of the procedure, confirming its usefulness as a pain measure. Therefore, the induction of pain expectancy probably involves emotional and cognitive responses affecting the final perception of pain. Therefore, our results support the models that highlight the importance of cognitive, emotional, and behavioral aspects in pain perception, in line with the current definition of pain proposed by the IASP.
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