Pain and inflammatory bowel disease.
Pain and inflammatory bowel disease.
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DOI：
10.1002/ibd.20848
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发表时间：
2009-05
影响因子：
4.9
通讯作者：
Binion, David G.
中科院分区：
文献类型：
--
作者：
Bielefeldt, Klaus;Davis, Brian;Binion, David G.
腹痛是炎症性肠病（IBD：克罗恩病、溃疡性结肠炎）的常见症状。疼痛可能由不同的机制引起，其中可能包括部分阻塞和肠道扩张以及严重的肠道炎症。大多数患有 IBD 急性发作的患者都会经历疼痛，随着疾病活动性的降低，疼痛通常会得到改善。然而，尽管炎症得到了缓解并实现了临床缓解，但仍有相当大比例的 IBD 患者继续出现疼痛症状。目前的证据表明，感觉通路在炎症过程中变得敏感，导致传入神经元和中枢神经系统疼痛处理的持续变化。这种持续的疼痛不仅仅是感觉输入的简单结果。疼痛处理甚至感觉通路的激活都受到唤醒、情绪和认知因素的调节。考虑到 IBD 患者医源性和基本神经精神合并症（包括焦虑和抑郁）的高患病率，这些中枢调节因素可能对慢性疼痛的临床表现有显着影响。对周围和中枢疼痛机制的进一步了解正在催生新的治疗策略，将疼痛视为生物心理社会问题。因此，可能需要改善潜在的炎症、降低敏感传入通路的兴奋性以及改变情绪和/或认知功能，以更有效地解决困难和致残的疾病表现。
Abdominal pain is a common symptom of inflammatory bowel disease (IBD: Crohn’s disease, ulcerative colitis). Pain may arise from different mechanisms, which can include partial blockage and gut distention as well as severe intestinal inflammation. A majority of patients suffering from acute flares of IBD will experience pain, which will typically improve as disease activity decreases. However, a significant percentage of IBD patients continue experiencing symptoms of pain despite resolving inflammation and achieving what appears to be clinical remission. Current evidence suggests that sensory pathways sensitize during inflammation, leading to persistent changes in afferent neurons and central nervous system pain processing. Such persistent pain is not only a simple result of sensory input. Pain processing and even the activation of sensory pathways is modulated by arousal, emotion, and cognitive factors. Considering the high prevalence of iatrogenic as well as essential neuropsychiatric comorbidities including anxiety and depression in IBD patients, these central modulating factors may significantly contribute to the clinical manifestation of chronic pain. The improved understanding of peripheral and central pain mechanisms is leading to new treatment strategies that view pain as a biopsychosocial problem. Thus, improving the underlying inflammation, decreasing the excitability of sensitized afferent pathways, and altering emotional and/or cognitive functions may be required to more effectively address the difficult and disabling disease manifestations.
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影响因子：
2.2
作者：
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通讯作者：
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DOI：
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影响因子：
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