Chronic pain and infection: mechanisms, causes, conditions, treatments, and controversies.
Chronic pain and infection: mechanisms, causes, conditions, treatments, and controversies.
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DOI：
10.1136/bmjmed-2021-000108
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Tontisirin, Nuj
中科院分区：
文献类型：
--
作者：
Cohen, Steven P.;Wang, Eric J.;Doshi, Tina L.;Vase, Lene;Cawcutt, Kelly A.;Tontisirin, Nuj
纵观人类历史，感染一直是发病率和死亡率的主要原因，疼痛是主要的警告信号之一。然而，在相当大比例的病例中，疼痛在急性疾病消退后可持续存在，表现为神经性疼痛、伤害性疼痛（如纤维肌痛、肠易激综合征）或伤害性疼痛。急性感染性疼痛变为慢性的机制是可变的，可以包括免疫现象（例如，旁观者激活，分子模拟），直接微生物入侵，身体或心理触发的中枢致敏，以及治疗并发症。导致慢性疼痛高发病率的微生物包括细菌，如疏螺旋体属和麻风分枝杆菌，以及病毒，如HIV、SARS-CoV-2和疱疹。新出现的证据也支持一部分椎间盘源性腰痛和炎症性肠病患者的感染原因。尽管抗菌治疗可能在治疗涉及活动性感染性炎症过程的慢性疼痛状态中发挥作用，但在自身免疫机制、中枢致敏和不可挽回的组织（例如关节病、血管炎）或神经损伤引起的慢性疼痛状况中使用抗菌治疗可能弊大于利。本文综述了感染和慢性疼痛之间的关系，重点是常见的病毒和细菌的原因。
Throughout human history, infection has been the leading cause of morbidity and mortality, with pain being one of the cardinal warning signs. However, in a substantial percentage of cases, pain can persist after resolution of acute illness, manifesting as neuropathic, nociplastic (eg, fibromyalgia, irritable bowel syndrome), or nociceptive pain. Mechanisms by which acute infectious pain becomes chronic are variable and can include immunological phenomena (eg, bystander activation, molecular mimicry), direct microbe invasion, central sensitization from physical or psychological triggers, and complications from treatment. Microbes resulting in a high incidence of chronic pain include bacteria such as the Borrelia species and Mycobacterium leprae, as well as viruses such as HIV, SARS-CoV-2 and herpeses. Emerging evidence also supports an infectious cause in a subset of patients with discogenic low back pain and inflammatory bowel disease. Although antimicrobial treatment might have a role in treating chronic pain states that involve active infectious inflammatory processes, their use in chronic pain conditions resulting from autoimmune mechanisms, central sensitization and irrevocable tissue (eg, arthropathy, vasculitis) or nerve injury, are likely to cause more harm than benefit. This review focuses on the relation between infection and chronic pain, with an emphasis on common viral and bacterial causes.
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