神经病理性疼痛患者疼痛灾难化的研究进展

Progress on pain catastrophizing in patients with neuropathic pain

摘要:

神经病理性疼痛是一种顽固且治疗困难的慢性疼痛，尽管目前存在多种治疗手段，但患者疼痛缓解往往仍不充分。疼痛灾难化是一种对实际或潜在疼痛的负面想法，通过生理-心理-社会多重机制调控疼痛体验，参与了神经病理性疼痛的发生发展，是神经病理性疼痛慢性化的重要危险因素，也是目前疼痛认知领域研究的热点。作为神经病理性疼痛的潜在产生者和维持者，早期高水平的疼痛灾难化预示着治疗效果不佳，因此在神经病理性疼痛的治疗和管理中，识别和干预疼痛灾难化尤为重要，但临床实践中却没有得到应有的关注。本文旨在对疼痛灾难化的定义和评估、神经病理性疼痛患者疼痛灾难化的相关机制、疼痛灾难化对神经病理性疼痛的负面影响以及对神经病理性疼痛患者疼痛灾难化的干预措施等作一综述，探讨改善疼痛灾难化在神经病理性疼痛预后中的益处，为神经病理性疼痛的临床研究及治疗提供思路。

Abstract:

Neuropathic pain，as a kind of chronic pain that is intractable and difficult to treat. Despite there are many treatments, neuropathic pain often fails to adequately alleviate. Pain catastrophizing is a negative thought process regarding actual or potential pain, which regulates the pain experience through multiple physiological-psychological-social mechanisms. It is involved in the onset and development of neuropathic pain. At the same time, it is a current research hotspot in the field of pain cognition. As a potential generator and maintainer of neuropathic pain, early high-level pain catastrophizing indicates poor treatment outcomes. The identification and intervention of pain catastrophizing is particularly important in the treatment and management of neuropathic pain, but it has not been paid attention in clinical practice. The aim of this article is to review the assessment, underlying mechanisms, practical implications and treatment strategies of pain catastrophizing in patients with neuropathic pain, to explore the benefits of improving pain catastrophizing in the prognosis of neuropathic pain, and to provide insights for clinical research and treatment of neuropathic pain.