Neural mechanisms of pain and alcohol dependence.
Neural mechanisms of pain and alcohol dependence.
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DOI：
10.1016/j.pbb.2013.09.008
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发表时间：
2013-11
期刊：
影响因子：
--
通讯作者：
Regunathan S
中科院分区：
文献类型：
--
作者：
Apkarian AV;Neugebauer V;Koob G;Edwards S;Levine JD;Ferrari L;Egli M;Regunathan S
在许多研究中已经揭示了慢性疼痛状况和酒精依赖之间的关联，在一些人中酒精滥用的发作先于慢性疼痛，而在另一些人中酒精依赖在慢性疼痛发作后出现。酒精依赖和慢性疼痛有着共同的神经回路，这可能导致慢性疼痛状态可能会显著影响酒精使用模式，酒精依赖可能会影响疼痛敏感性。调节药物/酒精成瘾的奖励和情感途径也介导慢性疼痛。例如，大脑学习和大脑奖励回路的疼痛诱发激活可以调节疼痛的皮层处理和由中皮质边缘回路介导的中枢敏化。杏仁核-mPFC相互作用的不平衡和重组可能不仅对持续性疼痛很重要，而且对以情绪情感状态的异常持续性为特征的疾病（如药物和酒精成瘾）也很重要。进一步的研究是必要的，以了解这些神经回路是如何在酗酒和慢性疼痛的共病条件下进行调节。此外，长期饮酒可能会引起疼痛症状，并可能加剧其他来源的慢性疼痛。虽然先前的研究已经确定了神经内分泌应激轴介质在酒精滥用和神经毒性作用中的作用，但这些研究尚未探讨酒精和应激激素的个体影响之间的区别。未来的研究应该探讨酒精和应激轴激素对疼痛的作用机制，这是我们理解酒精滥用和慢性疼痛的神经生物学的一个重要问题。
An association between chronic pain conditions and alcohol dependence has been revealed in numerous studies with episodes of alcohol abuse antedating chronic pain in some people and alcohol dependence emerging after the onset of chronic pain in others. Alcohol dependence and chronic pain share common neural circuits giving rise to the possibility that chronic pain states could significantly affect alcohol use patterns and that alcohol dependence could influence pain sensitivity. The reward and emotional pathways that regulate drug/alcohol addiction also mediate chronic pain. For example, pain-evoked activation of brain learning and brain reward circuitry may modulate cortical processing of pain and central sensitization mediated by mesocorticolimbic circuitry. Imbalance and reorganization of amygdala–mPFC interactions may not only be important for persistent pain, but also for disorders characterized by the abnormal persistence of emotional-affective states such as drug and alcohol addiction. Further studies are necessary to understand how these neural circuits are regulated in comorbid conditions of alcoholism and chronic pain. In addition, long term alcohol use could induce pain symptoms and may exacerbate chronic pain arising from other sources. While prior studies have established a role of neuroendocrine stress axis mediators in alcohol abuse and neurotoxic effects, these studies have not explored the distinction between the individual impact of alcohol and stress hormones. Future studies should explore the mechanisms mediating the contribution of alcohol and stress axis hormones on pain, an important question in our understanding of the neurobiology of alcohol abuse and chronic pain.