Chronic Pain and Chronic Stress: Two Sides of the Same Coin?
Chronic Pain and Chronic Stress: Two Sides of the Same Coin?
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DOI：
10.1177/2470547017704763
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发表时间：
2017-03
期刊：
影响因子：
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通讯作者：
Geha P
中科院分区：
文献类型：
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作者：
Abdallah CG;Geha P
疼痛和压力在概念上和生理上有很大的重叠。这两种现象都挑战了身体的稳态，并需要做出决策来帮助动物适应环境。此外，慢性压力和慢性疼痛有一个共同的行为模式，即无法消除负面记忆。然而，他们也有差异，例如创伤后应激障碍，抑郁症和慢性疼痛的最终脑内表型似乎在这三种情况下是不同的，下丘脑-垂体-肾上腺轴在疼痛生理学中的作用仍然不清楚。压力或疼痛的持续存在是适应不良的，可能导致健康受损。在这篇简短的综述中，我们强调了慢性压力和慢性疼痛之间的共性和差异，同时特别关注边缘系统的核心作用。我们评估目前在该领域的尝试，概念化和理解慢性疼痛，从压力文献中获得的知识的背景下。大脑边缘系统包括海马体、杏仁核和腹内侧前额叶皮层在学习中起着关键作用。这些大脑区域将传入的伤害性或压力信号与内部状态整合在一起，并产生决策所需的学习信号。因此，在慢性疼痛、抑郁和创伤后应激障碍等疾病中观察到这种学习回路的生理和结构重塑，并且这种重塑也与这些疾病的发病风险有关。
Pain and stress share significant conceptual and physiological overlaps. Both phenomena challenge the body’s homeostasis and necessitate decision-making to help animals adapt to their environment. In addition, chronic stress and chronic pain share a common behavioral model of failure to extinguish negative memories. Yet, they also have discrepancies such that the final brain endophenotype of posttraumatic stress disorder, depression, and chronic pain appears to be different among the three conditions, and the role of the hypothalamic-pituitary-adrenal axis remains unclear in the physiology of pain. Persistence of either stress or pain is maladaptive and could lead to compromised well-being. In this brief review, we highlight the commonalities and differences between chronic stress and chronic pain, while focusing particularly on the central role of the limbic brain. We assess the current attempts in the field to conceptualize and understand chronic pain, within the context of knowledge gained from the stress literature. The limbic brain—including hippocampus, amygdala, and ventromedial prefrontal cortex—plays a critical role in learning. These brain areas integrate incoming nociceptive or stress signals with internal state, and generate learning signals necessary for decision-making. Therefore, the physiological and structural remodeling of this learning circuitry is observed in conditions such as chronic pain, depression, and posttraumatic stress disorder, and is also linked to the risk of onset of these conditions.