Importance of Non-pharmacological Approaches for Treating Irritable Bowel Syndrome: Mechanisms and Clinical Relevance.
Importance of Non-pharmacological Approaches for Treating Irritable Bowel Syndrome: Mechanisms and Clinical Relevance.
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DOI：
10.3389/fpain.2020.609292
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Greenwood-Van Meerveld B
中科院分区：
文献类型：
--
作者：
Orock A;Yuan T;Greenwood-Van Meerveld B
慢性内脏疼痛是一种主要的未得到满足的临床需求，疼痛的严重程度从轻微到严重不等，以至阻止个人参与日常活动，并对其生活质量造成不利影响。虽然慢性内脏疼痛可以是多因素的，许多不同的生物和心理系统导致了症状的发生和严重程度，但内脏疼痛的主要触发因素之一是暴露在情绪和身体压力之下。慢性内脏疼痛因压力而加剧，是肠易激综合征(IBS)等功能性胃肠疾病的一个显著特征。目前对慢性内脏疼痛患者的药物干预通常缺乏疗效，许多都充满了不想要的副作用。认知行为疗法(CBT)作为一种心理疗法，在改善应激诱导的慢性内脏疼痛方面显示出有效性；然而，CBT背后的分子机制仍不完全清楚。使用环境浓缩(EE)作为CBT的动物模型替代品的应激性内脏疼痛实验模型的临床前研究正在揭示环境信号可以导致基因表达和行为的长期变化的机制。有证据表明EE信号与应激和伤害性信号相互作用。该综述将(1)对导致IBS慢性疼痛的行为和分子变化进行批判性评价，(2)总结用于治疗IBS患者的药理学和非药理学方法，(3)为CBT改善应激性内脏疼痛的潜在机制提供实验证据。
Chronic visceral pain represents a major unmet clinical need with the severity of pain ranging from mild to so severe as to prevent individuals from participating in day-to-day activities and detrimentally affecting their quality of life. Although chronic visceral pain can be multifactorial with many different biological and psychological systems contributing to the onset and severity of symptoms, one of the major triggers for visceral pain is the exposure to emotional and physical stress. Chronic visceral pain that is worsened by stress is a hallmark feature of functional gastrointestinal disorders such as irritable bowel syndrome (IBS). Current pharmacological interventions for patients with chronic visceral pain generally lack efficacy and many are fraught with unwanted side effects. Cognitive behavioral therapy (CBT) has emerged as a psychotherapy that shows efficacy at ameliorating stress-induced chronic visceral pain; however, the molecular mechanisms underlying CBT remain incompletely understood. Preclinical studies in experimental models of stress-induced visceral pain employing environmental enrichment (EE) as an animal model surrogate for CBT are unraveling the mechanism by which environmental signals can lead to long-lasting changes in gene expression and behavior. Evidence suggests that EE signaling interacts with stress and nociceptive signaling. This review will (1) critically evaluate the behavioral and molecular changes that lead to chronic pain in IBS, (2) summarize the pharmacological and non-pharmacological approaches used to treat IBS patients, and (3) provide experimental evidence supporting the potential mechanisms by which CBT ameliorates stress-induced visceral pain.
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