Targeting the stress response in pediatric pain: current evidence for psychosocial intervention and avenues for future investigation.
Targeting the stress response in pediatric pain: current evidence for psychosocial intervention and avenues for future investigation.
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DOI：
10.1097/pr9.0000000000000953
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发表时间：
2021-09
期刊：
影响因子：
4.8
通讯作者：
Bosquet Enlow M
中科院分区：
文献类型：
--
作者：
Nelson S;Borsook D;Bosquet Enlow M
以创伤为中心的治疗（例如，以创伤为中心的认知行为治疗，叙事暴露和正念）可能是经历慢性疼痛的青少年的最佳选择，以解决持续压力反应的可能性。青年慢性疼痛的非药物治疗已被确定为一线治疗药物以上。认知行为疗法和基于正念的减压等疗法在减少与儿科慢性疼痛相关的心理相关因素（例如焦虑、抑郁和压力）和社会或行为后遗症（例如身体活动受限和缺乏学校参与）方面表现出良好的疗效。然而，很少有研究检查了这些干预措施的生理作用机制。最近的综述（Cunningham等人，2019）强调需要对儿科疼痛人群的治疗反应进行客观（即生理学）评估。目前的审查增加了这方面的文献，确定生理应激反应作为一个特定的目标，在儿科疼痛的干预措施。研究表明，患有慢性疼痛的青少年报告心理压力、创伤后应激症状和接触不良童年经历（虐待/忽视等）的比例很高。此外，许多研究表明，在青年和成年人中，疼痛处理的神经生物学与压力暴露的神经生物学之间存在很强的相似性。诸如叙事或暴露疗法（例如，以创伤为中心的认知行为疗法）和基于正念或冥想的疗法等干预措施在减轻压力和疼痛对身体的神经生物学影响方面表现出了特别的希望，包括减少非稳态负荷和改变多个大脑区域的连接。然而，迄今为止，还没有研究在儿科疼痛治疗的背景下专门研究这些因素。未来的研究应进一步探索这些结构，以优化这些脆弱人群的预防和治疗。
Trauma-focused therapies (eg, trauma-focused cognitive-behavioral therapy, narrative exposure, and mindfulness) may be optimal for youth experiencing chronic pain to address the potential for an ongoing stress response. Nonpharmacological treatments for chronic pain in youth have been identified as first-line treatments over and above medication. Therapies such as cognitive-behavioral therapy and mindfulness-based stress reduction have shown good efficacy in reducing the psychological correlates (eg, anxiety, depression, and stress) and social or behavioral sequelae (eg, limited physical activity and lack of school engagement) associated with pediatric chronic pain. However, minimal research has examined the physiological mechanism(s) of action for these interventions. A recent review (Cunningham, et al., 2019) emphasized the need for objective (ie, physiological) assessment of treatment response in pediatric pain populations. The current review adds to this literature by identifying the physiological stress response as a particular target of interest in interventions for pediatric pain. Research indicates that youth with chronic pain report high rates of psychological stress, posttraumatic stress symptoms, and exposure to adverse childhood experiences (abuse/neglect, etc). In addition, a host of research has shown strong parallels between the neurobiology of pain processing and the neurobiology of stress exposure in both youth and adults. Interventions such as narrative or exposure therapy (eg, trauma-focused cognitive-behavioral therapy) and mindfulness-based or meditation-based therapies have shown particular promise in alleviating the neurobiological impact that stress and pain can have on the body, including reduction in allostatic load and altered connectivity in multiple brain regions. However, no study to date has specifically looked at these factors in the context of pediatric pain treatment. Future research should further explore these constructs to optimize prevention in and treatment of these vulnerable populations.