慢性疼痛共患抑郁症的研究进展^*

Advancements in the study of comorbid depressed symptoms in chronic pain

摘要

抑郁症与慢性疼痛常同时出现, 称为慢性疼痛共患抑郁症。这种共病会加剧患者的病情, 导致疼痛持续时间更长、程度更严重, 并显著降低患者的生活质量。抑郁症与慢性疼痛之间存在复杂的生理和病理机制, 涉及多个神经递质以及大脑的多个关键区域。此外, 这些患者的神经环路和大脑奖赏系统也常常表现异常, 导致快感缺失和动机下降。尽管针对抑郁症的药物和疼痛管理方案有所进展, 但针对两者共病的治疗效果依然有限。目前的治疗方案大多基于单一疾病的治疗, 未能有效解决共病的复杂性。本综述旨在系统分析慢性疼痛共患抑郁症的病理生理学机制、神经递质及神经回路机制, 并讨论未来可能的研究方向和治疗策略, 以期为临床提供更有效的治疗手段。

Abstract

Depression and chronic pain frequently coexist and are referred to as comorbid depressive symptoms in chronic pain. This comorbidity intensifies the patient's condition, leading to prolonged and more intense pain, and markedly diminishing the patient's quality of life. Complex physiological and pathological links exist between depression and chronic pain, involving numerous neurotransmitters and several critical brain areas. Moreover, the neuronal networks and the brain's reward system frequently exhibit dysfunction in these patients, leading to anhedonia and diminished motivation. Notwithstanding advancements in pharmacotherapy and pain management strategies for depression, the efficacy of treatments for comorbid conditions diseases continues to be constrained. Existing therapy modalities predominantly focus on individual diseases and inadequately tackle the intricacies of comorbidities. This review aims to systematically examine the pathophysiological mechanism, neurotransmitter involvement, and neural circuit dynamics of comorbid depressive symptoms in chronic pain, while also exploring potential future research direction and treatment strategies to enhance clinical interventions.

关键词

慢性疼痛共患抑郁症 / 神经回路 / 大脑奖赏系统 / 神经递质

Key words

Comorbid depressive symptoms in chronic pain / Neural circuit / Brain reward system / Neurotransmitter

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基金资助

^*安徽医科大学第三附属医院基础与临床合作研究提升计划培育专项资助项目(2022sfy009)