慢性疼痛与负性情绪的神经交互机制及综合干预策略研究进展  

The Research Progress on the Neural Interaction Mechanisms and Integrated Intervention Strategies of Chronic Pain and Negative Emotions

作　　者：王笑珂 舒晴 WANG Xiaoke;SHU Qing(College of Sports Medicine,Wuhan Sports University,Wuhan 430079,China;Department of Rehabilitation Medicine,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉体育学院运动医学院,湖北武汉430079 [2]武汉大学中南医院康复医学科,湖北武汉430071

出　　处：《中山大学学报(医学科学版)》2025年第2期197-209,共13页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：湖北省自然科学基金(2022CFB192);武汉大学中南医院创新培育基金(CXPY2022041)。

摘　　要：慢性疼痛患者普遍伴随不同程度的负性情绪,如焦虑、抑郁等,而这些负性情绪的持续存在可能会进一步加重慢性疼痛。在治疗慢性疼痛时,改善疼痛或负性情绪中的任何一个方面,另一症状也会有所缓解。慢性疼痛和负性情绪所涉及的脑区部分重叠,且具有相似的神经生理机制,这可能是二者相互作用的重要原因之一。多个脑区在疼痛相关的情感、认知和动机处理中发挥协同作用,特别是大脑皮层-边缘系统中的杏仁核、前额叶皮层、伏隔核以及腹侧被盖区等脑区,对情感信息的识别与处理至关重要。目前,慢性疼痛的临床治疗仍面临诸多挑战,尤其是现有药物治疗的局限性。因此,负性情绪的良性调节作为重要的干预靶点之一,在慢性疼痛的治疗中占据了重要地位。本文在总结慢性疼痛产生负性情绪的神经机制基础上,归纳整理了目前针对慢性疼痛相关负性情绪的多种治疗方案,包括药物治疗、无创神经调控、心理治疗、中医针灸治疗等。这些方案的综合应用不仅有助于缓解患者的负性情绪,还能为未来的研究提供更加精准的治疗靶点和更为有效的策略。本文旨在加深初学者对慢性疼痛病理生理学背景的理解,并为临床实践和研究提供参考。Chronic pain patients often experience varying degrees of negative emotions,such as anxiety and depression,and the persistent presence of these negative emotions may further exacerbate chronic pain.When treating chronic pain,improving either aspect of pain or negative emotions,the other symptom will also be alleviated.The brain regions involved in chronic pain and negative emotions partially overlap and share similar neurophysiological mechanisms,which may be one of the important reasons for their interaction.Multiple brain regions play synergistic roles in pain-related emotional,cognitive,and motivational processing,especially brain regions such as the amygdala,prefrontal cortex,nucleus accumbens,and ventral tegmental area in the cerebral cortex-limbic system,which are critical for the recognition and processing of emotional information.Currently,the clinical treatment of chronic pain remains challenging,especially the limitations of existing pharmacologic treatments.Therefore,benign regulation of negative emotions occupies an important place in the treatment of chronic pain as one of the important intervention targets.In this paper,on the basis of summarizing the neural mechanisms that generate negative emotions in chronic pain,a variety of current therapeutic options for chronic pain related negative emotions are summarize and organized,including pharmacotherapy,non-invasive neuromodulation,psychotherapy,and acupuncture.The combined application of these options not only helps to alleviate patients'negative emotions,but also provides more precise therapeutic targets and more effective strategies for future research.The aim of this article is to deepen beginners'understanding of the background of chronic pain pathophysiology and to provide a reference for clinical practice and research.

关 键 词：慢性疼痛 负性情绪 药物治疗 无创神经调控 心理疗法 中医针灸 

分 类 号：R493[医药卫生—康复医学]