Mechanisms of distraction in acute pain perception and modulation
Notice bibliographique
Résumé
1 Common applications and effi cacy of distraction Distraction is a shifting of attention away from pain or painful stimuli to stimuli that are more engaging or enjoyable. Distraction for acute pain can be internal (eg, imagery) or external to the individual; use audio (eg, music), visual (eg, book), or audiovisual (eg, movies) stimuli, require passive or interactive engagement, or involvement of others (eg, health care providers, parents).1 Systematic reviews and metaanalyses generally support use of distraction for acute pain among infants and children, with less consistent evidence for adolescents and adults.1,10,11 2 Mechanisms of distraction for acute pain 2.1 Cognitive Mechanisms of distraction center on it reducing or interfering with attention to pain. The limited attentional capacity theory posits that the more attentional resources used by distraction, the less resources are available for perceiving pain.3,7 According to the multiple resource theory, the more a distracter competes for the same perceptual and spatial resources used to process pain, the more effective the distracter will be.3,7 These theories predict that interactive or multisensory distracters should be more effective, although results are mixed.1 The neurocognitive model of attention suggests that involuntary attention demanded by pain (bottom-up process) is modulated by a voluntary goal-directed effort to prioritize attention to specifi c stimuli (top-down processes).8 These top-down processes are directed by the degree of attentional investment required and what is attended to as goal-relevant information. Consistent with this, distraction seems less effective when pain holds increased salience (ie, high levels of pain catastrophizing, fear of pain, or pain-related threat),6,14 but only in the absence of goal-directed motivation.2,13 2.2 Learning processes A less discussed mechanism relates to behavioral learning theory.3 Individuals are posited to develop a conditioned fear or distress response after pairing of pain with a previously unconditioned stimulus (eg, medical procedure equipment). Distraction is believed to interfere with this process by (1) reducing or avoiding development of a conditioned fear response by deterring attention away from painful stimuli and previously unconditioned stimuli; and (2) eliciting behaviors or affective states incompatible with distress (eg, relaxation). 2.3 Neurobiological Neuroimaging studies examining distraction mechanisms are limited but demonstrate specific changes in brain activation during distraction which correspond to decreased acute pain. These changes are in areas associated with sensory and affective motivational pain processing, including decreased activation in the thalamus, primary and secondary somatosensory cortices, and the insula and anterior cingulate cortex, and increased activation in the periaquaeductal gray, cingulofrontal cortex, and posterior thalamus.4-6,9,12 3 Future directions in distraction for acute pain Despite extensive research, our understanding of what, when, how, and for whom distraction works best for acute pain is surprisingly limited. This is due, in part, to the minimal integration of neuroimaging and attention research with distraction as used in clinical practice. Furthermore, clinical trials offer little investigation regarding mechanisms. Future directions include determining effective distraction for acute pain based on individual, procedural, intervention (eg, novelty), and contextual factors (eg, setting).1
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,008 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».