Étude des mécanismes psychophysiologiques de la modulation volontaire de la douleur par le biofeedback et la respiration

Although pain is a universal subjective expérience, the way of perceiving and interpreting it is modulated by multiple factors. Several cognitive interventions have proven effective in reducing pain in clinical and experimental conditions. This thesis will focus particularly on psychophysiological mechanisms involved in voluntary strategies of pain modulation. These strategies are relevant because they encourage an individual who suffers from pain conditions, to play an active role in the regulation of pain. The first study examines the effectiveness of biofeedback as a means of voluntary modulation of pain. This allows to determine whether to provide feedback to the amplitude of the RIII-reflex (evoked by electrical stimulation of the sural nerve) during a training induces the participant to adopt strategies for pain modulation and voluntarily activate descending inhibitory control mechanisms of pain. In order to specifically evaluate the changes induced by biofeedback, RIII reflex modulation and pain was compared in three groups (valid biofeedback, sham biofeedback and control group without feedback). In all three groups, participants were encouraged to use cognitive strategies of pain (attention, modulation of breathing, mental imagery and cognitive reappraisal) to increase or decrease their RIII reflex compared to their baseline. The results of our study indicate that the three groups were able to modulate their RIII reflex (p<0.001) as well as their pain évaluation (p<0.001) (intensity and unpleasantness). Biofeedback training was not required to obtain a modulation of the RIII-reflex and pain, suggesting that the use of these strategies may be sufficient to trigger mechanisms of pain control. The second study was interested in the influence of respiratory frequency and phase on spinal nociception, brain activity and perception of pain. Voluntary control of breathing is a common means of regulating emotions, and is frequently used in combination with other techniques (eg, relaxation, meditation) in order to regulate pain. Participants were asked to synchronize their breathing on the cues indicating the time of inspiration and expiration. Three breathing patterns were proposed (breathing at 0.1 Hz with 4 seconds inspiration, breathing at 0.1 Hz with 2 seconds inspiration and breathing at 0.2 Hz with 2 seconds inspiration). Half of stimuli were given during inspiration and the other half during expiration. To assess the effect of these manipulations, the amplitude of the RIII, the subjective evaluation of pain intensity and anxiety elicited by the shock and evoked potentials were measured. The results of this study demonstrate that pain intensity was not affected by the respiratory pattern (p = 0.3), but was statistically lower during inspiration compared to expiration (p = 0.02). A phase effect (p = 0.03) was also observed on evoked potentials during the breathing pattern 0.1 Hz with 2 seconds inspiration compared to the breathing pattern at 0.2 Hz.  However, the amplitude of the RIII reflex was increased during inspiration (p = 0.02) compared to expiration. These results show that the manipulation of phase and frequency with paced respiration has a marginal effect on pain and anxiety ratings, as well as on brain activity and spinal nociception evoked by painful electrical stimulation. This suggests that other mechanisms contribute to the analgesic effects of relaxation and meditation. More broadly, our results indicate the need for further studies with more rigorous methodology to control for nonspecific treatment effects evaluated. A better understanding of the mechanisms underlying each strategy would allow a better selection of the treatment as a function of individual differences and cost-benefit ratio associated to each treatment.

Keyphrases: modulation cognitive, biofeedback, respiration, pain, RIII-reflex, cognitive modulation, analgesia, biofeedback, respiration, descending modulation, somatosensory evoked-potentials