돌발통 유무에 따른 만성통증 환자의 주의편향: 안구운동측정장비를 사용하여
Pain-related Attentional Bias in Breakthrough Pain Patients with Chronic Pain: Using an Eyetracker
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
이 연구에서는 안구운동측정장비를 사용하여 만성통증 환자의 돌발통 유무와 단어 유형(감각통증단어, 정서통증단어)이 주의편향에 미치는 영향을 검증하고자 했다. 이 연구는 수원 소재 대학병원 신경통증클리닉에 통증치료를 목적으로 내원한 환자 중 돌발통이 있는 만성통증 환자 17명과 돌발통이 없는 만성통증 환자 25명을 대상으로 실시했다. 참여자들이 감각통증단어-중립단어, 정서통증단어-중립단어, 중립단어-중립단어 자극쌍으로 구성된 free-viewing 과제를 수행하는 동안 이들의 안구운동이 측정되었다. 주의편향 지표(주의지향, 주의유지)에 대해 각각 2(집단: 돌발통-무, 돌발통-유)*2(자극: 감각통증단어, 정서통증단어) 반복측정 분산분석을 실시했다. 연구 결과는 다음과 같다. 첫 고정까지 걸린 시간에서 돌발통-유 집단이 중립단어보다 감각통증단어 및 정서통증단어를 경계하는 것으로 나타났다. 또한, 첫 250ms동안 자극응시시간에서 돌발통-유 집단이 돌발통-무 집단에 비해 정서통증단어를 경계하며, 돌발통-유 집단 내에서도 감각통증단어에 비해 정서통증단어를 더 경계하는 것으로 나타났다. 마지막으로, 주의유지 지표를 살펴보면 AOI에 응시한 총 시간에서 돌발통-무 집단은 중립단어보다 감각통증단어 및 정서통증단어로부터 주의이탈의 어려움을 보였고, 돌발통-유 집단은 중립단어보다 정서통증단어로부터 주의이탈의 어려움을 보였다. 연구 결과는 기존 경계-회피 패턴에 대한 수정이 필요하고, 주의편향 수정 프로그램에서 만성통증 환자의 돌발통 유무 및 단어 유형과 같은 특성이 고려되어야 한다는 것을 시사한다.
Abstract
Breakthrough pain (BTP) is temporary and considerably severe. Thus, patients with BTP are more likely to perceive pain-related stimuli as a threat than those without BTP. The purpose of this study was to investigate the differences in attentional bias in patients with and without BTP. This study recruited 17 patients and 25 patients with and without BTP, respectively, from among patients with chronic pain at a university hospital in Suwon, Republic of Korea. The participants’ eye movements were recorded using an eye tracker during a free viewing task that features sensory pain-neutral, affective pain-neutral, and neutral-neutral word pairs. Two-way ANOVA(group*word type) was conducted on the attentional bias indices. The results were as follows: First of all, looking at the attentional-orientation index, it was found that in the time taken until the first fixation, patients with BTP were more vigilant towards sensory pain words and affective pain words than patients without BTP. In addition, during the first 250ms, patients with BTP was more vigilant towards affective pain words than patients without BTP. Finally, looking at the attentional-maintenance index, in the total time for taking the Area Of Interest (AOI), the patients without BTP showed more difficulty with distraction for sensory pain words than patients with BTP. The patients with BTP showed more difficulty with distraction for affective pain words than the patients without BTP. The results of the study provide the need for correction of the existing vigilance-avoidance pattern, and they suggest that characteristics, such as the presence or absence of BTP and word type in chronic pain patients, should be considered in the attention bias modification (ABM) program.
참고문헌 (32)
- 김덕일, "감정카드" (2013), 학지사
- "현대 국어 사용 빈도 조사 2" (2005), 국립국어원[URL]
- 민경준, "병원 불안-우울척도 에관한 표준화 연구: 정상, 불안, 우울 집단간의 비교", 대한신경정신의학회지, 38(2), pp.289~296 (1999)
- 진병주, "통증위협과 주의편향 간의 관계에서 자아고갈이 미치는 조절효과: 안구운동 추적 연구", 한국심리학회지: 건강, 23(4), pp.963~979 (2018), 한국건강심리학회[DOI]
- Fear-avoidance models of chronic pain: an overview, Understanding and Treating Fear of Pain, "Asmundson, G. J.", 3~24 (2004)
- Bowler, J., "Attentional bias modification for acute experimental pain: A randomized controlled trial of retraining early versus later attention on pain severity, threshold and tolerance", European Journal of Pain, 21(1), pp.112~124 (2017)
- Caraceni, A., "Breakthrough pain characteristics and syndromes in patients with cancer pain", Palliative Medicine, 18(3), pp.177~183 (2004)
- Carr, D. B., "Safety and efficacy of intranasal ketamine for the treatment of breakthrough pain in patients with chronic pain : a randomized, double-blind, placebo-controlled, crossover study", Pain, 108(1), pp.17~27 (2004)
- Cho, S., "Psychometric properties of a Korean version of the Pain Anxiety Symptoms Scale-20 in chronic pain patients", International Journal of Behavioral Medicine, 17(2), pp.108~117 (2010)
- Crombez, G., "Attentional bias to pain-related information : a meta-analysis", Pain, 154(4), pp.497~510 (2013)
- Davies, A. N., "The management of cancer-related breakthrough pain : Recommendations of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland", European Journal of Pain, 13(4), pp.331~338 (2009)
- Eccleston, C., "Pain demands attention : A cognitive–affective model of the interruptive function of pain", Psychological Bulletin, 125(3), pp.356~366 (1999)
- Haggman, S. P., "Attentional biases toward sensory pain words in acute and chronic pain patients", The Journal of Pain, 11(11), pp.1136~1145 (2010)
- Melzack, R, "The McGill Pain Questionnaire : major properties and scoring methods", Pain, 1(3), pp.277~299 (1975)
- Öhman, A, "Preferential preattentive processing of threat in anxiety: Preparedness and attentional biases", Current Controversies in The Anxiety Disorders, 2, pp.253~290 (1996)
- Pincus, T., "Cognitive-processing bias in chronic pain : a review and integration", Psychological Bulletin, 127(5), pp.599~617 (2001)
- Portenoy, R. K, "Treatment of temporal variations in chronic cancer pain", Paper presented at the Seminars in oncology (1997)
- Portenoy, R. K., "Prevalence and characteristics of breakthrough pain in opioid-treated patients with chronic noncancer pain", The Journal of Pain, 7(8), pp.583~591 (2006)
- Portenoy, R. K., "Breakthrough pain : characteristics and impact in patients with cancer pain", Pain, 81(1), pp.129~134 (1999)
- Priebe, J., "Gaze behaviour when monitoring pain faces : An eye-tracking study", European Journal of Pain, 19(6), pp.817~825 (2015)
- Schoth, D. E., "Eye movements during visual search for emotional faces in individuals with chronic headache", European Journal of Pain, 19(5), pp.722~732 (2015)
- Schoth, D. E., "Attentional bias towards pain-related information in chronic pain; a meta-analysis of visual-probe investigations", Clinical Psychology Review, 32(1), pp.13~25 (2012)
- Sharpe, L., "Threat and fear of pain induces attentional bias to pain words : An eye-tracking study", European Journal of Pain, 21(2), pp.385~396 (2017)
- Sharpe, L., "Avoidance of affective pain stimuli predicts chronicity in patients with acute low back pain", Pain, 155(1), pp.45~52 (2014)
- Sharpe, L., "Is there a potential role for attention bias modification in pain patients? Results of 2randomised, controlled trials", Pain, 153(3), pp.722~731 (2012)
- Todd, J., "The effect of threat on cognitive biases and pain outcomes : An eye-tracking study", European Journal of Pain, 20(8), pp.1357~1368 (2016)
- Todd, J., "Towards a new model of attentional biases in the development, maintenance, and management of pain", Pain, 156(9), pp.1589~1600 (2015)
- Villemure, C., "Supraspinal pain processing : Distinct roles of emotion and attention", Neuroscientist, 16, pp.276~284 (2010)
- Vlaeyen, J. W., "Fearavoidance and its consequences in chronic musculoskeletal pain : a state of the art", Pain, 85(3), pp.317~332 (2000)
- Yang, Z., "Effects of chronic pain and pain-related fear on orienting and maintenance of attention : an eye movement study", The Journal of Pain, 14(10), pp.1148~1157 (2013)
- Yang, Z., "Identifying selective visual attention biases related to fear of pain by tracking eye movements within a dot-probe paradigm", Pain, 153(8), pp.1742~1748 (2012)
- Yun, Y. H., "Development of a cancer pain assessment tool in Korea : a validation study of a Korean version of the brief pain inventory", Oncology, 66(6), pp.439~444 (2004)