认知行为疗法和虚拟现实疗法干预神经性疼痛的作用及机制  

The Effects and Mechanisms of Cognitive-behavioral Therapy and Virtual Reality Intervention on Neuropathic Pain

作　　者：阮婷婷 翁明奇 吴璨 鲍晓明[3] 牛艳芳 徐淑君[1] RUAN Ting-Ting;WENG Ming-Qi;WU Can;BAO Xiao-Ming;NIU Yan-Fang;XU Shu-Jun(Zhejiang Provincial Key Laboratory of Pathophysiology,Health Science Center,Ningbo University,Ningbo 315211,China;Hengjie Township Hospital in Haishu District of Ningbo City,Ningbo 315181,China;Department of Cardiology,Ningbo No.2 Hospital,Ningbo 315010,China;Department of Neurology,The First Affiliated Hospital of Ningbo University,Ningbo 315020,China)

机构地区：[1]宁波大学医学部,浙江省病理生理学重点实验室,宁波315211 [2]宁波市海曙区横街镇卫生院,宁波315181 [3]宁波市第二医院心内科,宁波315010 [4]宁波大学附属第一医院神经内科,宁波315020

出　　处：《生物化学与生物物理进展》2023年第10期2396-2405,共10页Progress In Biochemistry and Biophysics

基　　金：浙江省自然科学基金(LY23H090005);宁波市重点研发计划(2023Z173,2022Z147);宁波市自然科学基金(2022J118,2022J250,2021J250);宁波大学王宽诚幸福基金资助项目。

摘　　要：神经性疼痛(neuropathic pain,NP)是由外周或中枢躯体感觉系统的损伤或疾病导致的疼痛。药物治疗在镇痛中占据重要地位,但是过量药物治疗往往会引起严重的副作用,或在可耐受剂量下仅提供了部分的疼痛缓解。认知行为疗法(cognitive-behavioral therapy,CBT)和虚拟现实(virtual reality,VR)干预作为新的、非侵入性的,以及更为安全的疼痛替代治疗方法引起了广泛的关注。CBT和VR疗法可通过转移注意力、改变神经可塑性和神经环路,以及调节促炎和抗炎因子水平缓解神经性疼痛。本文旨在对神经性疼痛的发病机制以及CBT和VR疗法的镇痛效果和机制做出解析,从而为神经性疼痛的治疗干预提供重要的理论指导。Neuropathic pain(NP)is caused by lesion or disease of peripheral or central somatosensory system,accompanied by a certain degree of functional loss and cognitive impairment.Multiple mechanisms are involved in the occurrence and development of neuropathic pain.Abnormalities in voltage-gated sodium and calcium ion channels,imbalanced expression of pro-inflammatory and anti-inflammatory cytokines,changes in neural plasticity and neural circuits,epigenetic regulation and so on lead to abnormal activity of nerve fibers,peripheral and central sensitization which will result in pain.Pharmacological treatments make vital contributions to analgesia,but excessive pharmacological treatments often cause serious side effects,or only provide partial pain relief at tolerable doses.Cognitive-behavioral therapy(CBT)and virtual reality(VR)intervention,as new,noninvasive and safer alternative therapies for pain,have attracted extensive attention.Cognitive-behavioral therapy can relieve chronic pain and improve related psychological complications by learning various self-management skills to establish a correct cognition of pain and reducing pain perception through relaxation training or attention transfer training.By enhancing the feedback to the patient’s vision,hearing and touch,VR enables the patient to completely immerse in the virtual three-dimensional space,which helps to reduce the patient's anxiety,pressure,fear and pain,so as to help the patient recover.In addition,there is a correlation between the immersion degree of VR and the analgesic effect.In future research,more personalized treatment schemes can be provided based on VR to achieve better immersion effect and maximum pain relief,promote the recovery of body function,and improve the quality of life of patients.CBT and VR therapy can alleviate neuropathic pain by diverting attention,altering neuroplasticity and neural circuits,and regulating the expression of pro-inflammatory and antiinflammatory cytokines.Neuropathic pain is often accompanied by other physical dysf

关 键 词：认知行为疗法 虚拟现实 神经性疼痛 神经可塑性 炎症因子 

分 类 号：R74[医药卫生—神经病学与精神病学] R338[医药卫生—临床医学]