Chronic pain, chronic stress and substance use: overlapping mechanisms and implications.
Chronic pain, chronic stress and substance use: overlapping mechanisms and implications.
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DOI：
10.3389/fpain.2023.1145934
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发表时间：
2023
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影响因子：
--
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中科院分区：
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--
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慢性疼痛是美国成年人寻求医疗护理的最常见原因之一。尽管慢性疼痛对个人的身体、情感和财务健康有重大影响，但慢性疼痛的生物学基础仍然不完全清楚。这种对个人健康的有害影响也表现在慢性压力与慢性疼痛的大量共同发生。然而，慢性压力和逆境以及相关的酒精和药物滥用是否会增加患慢性疼痛的风险，如果是这样，重叠的心理生物学过程是什么，目前还不清楚。患有慢性疼痛的人可以通过处方阿片类药物以及非处方大麻、酒精和其他药物来减轻疼痛，这些物质的使用已显著增加。药物滥用也会增加慢性压力。因此，鉴于证据表明慢性应激和慢性疼痛之间存在很强的相关性，我们的目标是审查和确定重叠的因素和过程。我们首先探讨两种情况的共同易感因素和心理特征。接下来是检查疼痛和压力的重叠神经回路，以追踪慢性疼痛发展的共同病理生理过程及其与物质使用的联系。基于先前的文献和我们自己的发现，我们提出腹内侧前额叶皮质功能障碍的关键作用，这是一个与疼痛和压力调节相关的重叠大脑区域，也受物质使用的影响，是发展为慢性疼痛风险的关键。最后，我们确定需要进一步研究探索内侧前额叶回路在慢性疼痛病理中的作用。至关重要的是，为了减轻慢性疼痛的巨大负担而不加剧共同发生的药物滥用危机，我们强调需要找到更好的方法来治疗和预防慢性疼痛。
Chronic pain is among the most common reasons adults in the U.S. seek medical care. Despite chronic pain's substantial impact on individuals' physical, emotional, and financial wellness, the biologic underpinnings of chronic pain remain incompletely understood. Such deleterious impact on an individuals' wellness is also manifested in the substantial co-occurrence of chronic stress with chronic pain. However, whether chronic stress and adversity and related alcohol and substance misuse increases risk of developing chronic pain, and, if so, what the overlapping psychobiological processes are, is not well understood. Individuals suffering with chronic pain find alleviation through prescription opioids as well as non-prescribed cannabis, alcohol, and other drugs to control pain, and use of these substances have grown significantly. Substance misuse also increases experience of chronic stress. Thus, given the evidence showing a strong correlation between chronic stress and chronic pain, we aim to review and identify overlapping factors and processes. We first explore the predisposing factors and psychologic features common to both conditions. This is followed by examining the overlapping neural circuitry of pain and stress in order to trace a common pathophysiologic processes for the development of chronic pain and its link to substance use. Based on the previous literature and our own findings, we propose a critical role for ventromedial prefrontal cortex dysfunction, an overlapping brain area associated with the regulation of both pain and stress that is also affected by substance use, as key in the risk of developing chronic pain. Finally, we identify the need for future research in exploring the role of medial prefrontal circuits in chronic pain pathology. Critically, in order to alleviate the enormous burden of chronic pain without exacerbating the co-occurring substance misuse crisis, we emphasize the need to find better approaches to treat and prevent chronic pain.
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