慢性疼痛合并认知障碍相关机制研究进展

Progress on the Mechanism of Comorbidity between Chronic Pain and Cognitive Impairment

摘要:

慢性疼痛是指持续超过3个月的疼痛，常合并认知障碍。50%的慢性疼痛患者存在认知障碍现象，严重影响患者的生活质量。慢性疼痛合并认知障碍的可能机制包括慢性疼痛挤占脑内“认知脑区资源”导致认知障碍的发生；慢性疼痛引发蓝斑-去甲肾上腺素能系统功能障碍导致认知行为异常；慢性疼痛引起脑内促炎细胞因子的过度产生与小胶质细胞促炎表型转变，通过中枢神经炎症反应引起认知障碍。针对以上机制，通过认知行为疗法恢复“认知资源”以及使神经炎症正常化近年来已成为治疗慢性疼痛合并认知障碍的潜在靶点。本文旨在总结慢性疼痛合并认知障碍的相关机制，在为开发相关治疗药物靶点、更新镇痛与改善认知的策略提供相关机制的理论依据。

Abstract:

Chronic pain refers to pain that lasts for more than 3 months and is often associated with cognitive impairment. 50% of patients with chronic pain have cognitive impairment, which seriously affects the quality of life of patients. The possible mechanisms of chronic pain combined with cognitive impairment include the occurrence of cognitive impairment caused by chronic pain occupying the "cognitive brain region resources" in the brain; chronic pain triggering dysfunction of the locus coeruleus-noradrenergic system, resulting in abnormal cognitive behavior; and chronic pain causing excessive production of pro-inflammatory cytokines in the brain and a transformation of the pro-inflammatory phenotype of microglia, causing cognitive impairment through central neuroinflammation. Against the above mechanisms, restoring "cognitive resources" through cognitive behavioral therapy and normalizing neuroinflammation have become potential targets for the treatment of chronic pain combined with cognitive impairment in recent years. This article aims to summarize the related mechanisms of chronic pain combined with cognitive impairment, providing a theoretical basis for the development of related therapeutic drug targets and the update of strategies for analgesia and improvement of cognition.