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Funcionamento cognitivo e sistema modulador descendente da dor : comparação entre indivíduos saudáveis e com fibromialgia
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A dor pode ser caracterizada como uma experiência sensorial e emocional desagradável associada a uma lesão real ou potencial nos tecidos. Ao nível neuroanatómico, a dor é detetada e codificada para que seja enviada ao sistema nervoso central, e pode ainda ser modulada, fenómeno que influencia a sua experiência. A modulação da dor, por sua vez, é mediada por diversos fatores, como por exemplo a cognição e as emoções. No caso da Fibromialgia (FM), ainda está por esclarecer a natureza desta relação. O presente estudo teve como objetivo investigar a relação entre o funcionamento cognitivo, mais precisamente as funções executivas, e a eficácia do sistema modulador descendente da dor, comparando indivíduos saudáveis e com FM. Utilizou-se um desenho experimental quantitativo, transversal e comparativo que integrou dados de dois estudos distintos (Estudo 1 com 23 indivíduos saudáveis e Estudo 2 com 29 mulheres com FM). A metodologia utilizada envolveu o preenchimento de questionários, a aplicação de provas neuropsicológicas e a realização do paradigma psicofisiológico Conditioned Pain Modulation (CPM). No grupo de controlo, observou-se que um melhor desempenho cognitivo, particularmente nas tarefas de memória de trabalho e funções executivas, se associou a uma maior eficácia da modulação descendente da dor. Comparativamente, o grupo com FM apresentou uma analgesia endógena menos eficiente em resposta aos estímulos térmicos tónicos. Verificou-se ainda uma diferença significativa entre grupos na relação entre cognição e modulação da dor: nos indivíduos saudáveis, um melhor desempenho na memória de trabalho associou-se positivamente à eficácia inibitória da dor, relação que não se observou na FM, sugerindo uma alteração na integração entre processos cognitivos e mecanismos inibitórios da dor. Estes dados sugerem uma disfunção na integração entre os processos cognitivos e os mecanismos inibitórios da dor na FM, evidenciando um padrão diferente daquele que se apresenta no grupo de indivíduos saudáveis. Este estudo fornece uma base para futuras investigações que aprofundem a relação entre cognição e mecanismos inibitórios da dor, podendo contribuir para o desenvolvimento de abordagens clínicas focadas em melhorar a modulação descendente e a experiência da dor nesta população.
Pain can be characterized as an unpleasant sensorial and emotional experience associated to an existent or potential injury. At a neuroanatomical level, pain is detected and coded as means to be sent to the central nervous system, and can also be modulated, a phenomenon that changes its experience at a sensorial level. Pain modulation is mediated by many factors, for example cognition and emotions. In conditions like Fibromyalgia (FM), the nature of this relationship remains unclear. The present study investigated the relationship between cognitive functioning, more specifically executive functions, and the effectiveness of the descending pain modulatory system, comparing healthy controls and FM patients. We used a quantitative, cross-sectional and comparative study design integrating data from two different studies (Study 1 with 23 healthy controls and Study 2 with 29 women with FM). The methodology used involved completing questionnaires, administering neuropsychological tests, and performing the Conditioned Pain Modulation (CPM) psychophysiological experimental paradigm. In the control group, we found an improved cognitive performance, particularly in working memory and executive function tasks, which was associated with greater effectiveness in descending pain modulation. Comparatively, the FM group showed less effective endogenous analgesia in response to tonic thermic stimuli. There was also a significant difference between groups regarding the relationship between cognition and pain modulation: a better performance in working memory in healthy controls was positively correlated with pain inhibition, a correlation that was not found in FM patients, suggesting a shift in the integration of cognitive processes and pain-inhibiting mechanisms. These data suggests the existence of a dysfunctional interaction between cognitive processes and pain-inhibiting mechanisms in FM, showing a different pattern from the one present in the group of healthy individuals. This study provides a basis for future research that delves deeper into the relationship between cognitive processes and the descending pain modulatory system and may contribute to the development of clinical approaches focused on the improvement of descending modulation and the experience of pain in this population.
Pain can be characterized as an unpleasant sensorial and emotional experience associated to an existent or potential injury. At a neuroanatomical level, pain is detected and coded as means to be sent to the central nervous system, and can also be modulated, a phenomenon that changes its experience at a sensorial level. Pain modulation is mediated by many factors, for example cognition and emotions. In conditions like Fibromyalgia (FM), the nature of this relationship remains unclear. The present study investigated the relationship between cognitive functioning, more specifically executive functions, and the effectiveness of the descending pain modulatory system, comparing healthy controls and FM patients. We used a quantitative, cross-sectional and comparative study design integrating data from two different studies (Study 1 with 23 healthy controls and Study 2 with 29 women with FM). The methodology used involved completing questionnaires, administering neuropsychological tests, and performing the Conditioned Pain Modulation (CPM) psychophysiological experimental paradigm. In the control group, we found an improved cognitive performance, particularly in working memory and executive function tasks, which was associated with greater effectiveness in descending pain modulation. Comparatively, the FM group showed less effective endogenous analgesia in response to tonic thermic stimuli. There was also a significant difference between groups regarding the relationship between cognition and pain modulation: a better performance in working memory in healthy controls was positively correlated with pain inhibition, a correlation that was not found in FM patients, suggesting a shift in the integration of cognitive processes and pain-inhibiting mechanisms. These data suggests the existence of a dysfunctional interaction between cognitive processes and pain-inhibiting mechanisms in FM, showing a different pattern from the one present in the group of healthy individuals. This study provides a basis for future research that delves deeper into the relationship between cognitive processes and the descending pain modulatory system and may contribute to the development of clinical approaches focused on the improvement of descending modulation and the experience of pain in this population.
Descrição
Palavras-chave
Dor Cognição Sistema modulador descendente Analgesia endógena Fibromialgia Pain Cognition Descending pain modulatory system Endogenous analgesia Fibromyalgia
Contexto Educativo
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Licença CC
Sem licença CC