Paediatric chronic pain as a catalyst for toxic stress.
Paediatric chronic pain as a catalyst for toxic stress.
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DOI：
10.1016/s2352-4642(22)00187-0
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发表时间：
2022-10
影响因子：
36.4
通讯作者：
Noel, Melanie
中科院分区：
文献类型：
--
作者：
Nelson, Sarah;Miller, Jillian Vinall;Timmers, Inge;Simons, Laura E.;Meldrum, Keith;Noel, Melanie
毒性压力，定义为在缺乏保护性关系的情况下无法忍受的、持久的、严重的压力，被认为是年轻人“生理上最具威胁性的压力体验”，与积极压力（即，生理压力反应的轻微升高）或可容忍压力（即，严重但暂时的压力反应升高被保护性关系减轻）形成对比。大量研究表明，儿童期（≤18岁）的毒性应激是终生健康相关后果的重要预测因子。毒性压力的来源包括不良的童年经历（如虐待或忽视）、低社会经济地位以及种族或民族歧视。对于毒性应激，生理应激反应的长期激活，加上应对资源和保护关系的不足，导致无法恢复体内平衡，导致大脑和神经系统的长期改变。成年期许多健康问题的起因可以通过增加对儿童期有毒压力的关注而得到改善。2然而，迄今为止关于慢性健康问题与毒性应激之间关系的研究，无论是线性的还是双向的，尚未扩展到儿科人群的慢性疼痛（即持续≥3个月的疼痛）。在这篇评论中，我们详细阐述了缺乏保护性关系的人际和社会因素——毒性压力的关键催化剂——如何在青年中表现出来，反过来，慢性疼痛生活的独特方面会加剧毒性压力。将有毒压力的概念应用于儿科慢性疼痛可以重新定义和验证如何维持疼痛-最明显的是通过与个人因素相结合的人际和社会风险，特别是对于包括种族和少数民族在内的边缘化个体。
Toxic stress, defined as intolerable, lasting, severe stress in the absence of protective relation ships, has been proposed to be “the most physiological threatening kind of stressful experience” for youth, in contrast with positive (ie, mild elevations in the physiological stress response) or tolerable (ie, serious but temporary stress response elevations mitigated by protective relationships) stress. 1 Abundant research has revealed that toxic stress in childhood (≤ 18 years of age) is a significant predictor of lifelong healthrelated consequences. 1 Sources of toxic stress can include adverse childhood experiences (eg, abuse or neglect), low socioeconomic status, and racial or ethnic discrimination. 1 With toxic stress, prolonged activation of the physiological stress response, combined with inadequate coping resources and protective relationships, results in an inability to restore homoeostasis, leading to long-lasting alterations to the brain and nervous system. 2 The cause of many health issues in adulthood could potentially be ameliorated by increased attention to toxic stress in childhood. 2 However, research to date on the relationship between chronic health issues and toxic stress, whether linear or bidirectional, has not been extended to chronic pain (ie, pain lasting≥ 3 months) in the paediatric population. 3 In this Comment, we elaborate on how interpersonal and societal factors in the absence of protective relationships—a key catalyst for toxic stress—can manifest in youth, and, in turn, toxic stress can be fuelled by unique aspects of living with chronic pain. Applying the concept of toxic stress to paediatric chronic pain could serve to reconceptualise and vali date how pain can be maintained—most notably through interpersonal and societal risk in conjunction with individual factors, particularly for marginalised individuals including racial and ethnic minorities.