IRCCS Santa Lucia Foundation, Rome, Italy.
Surg Oncol. 2010 Sep;19(3):160-6. doi: 10.1016/j.suronc.2009.11.006. Epub 2009 Dec 6.
Patients with cancer are burdened with pain, ranging in prevalence from 14 to 100% in this population, and with comorbid behavioural symptoms such as depression and cognitive decline. However, the complex relationships between cancer pain, depression and cognitive decline, as well as their causes, still need to be clarified. Here, the existing literature on pain and its relationships with depression and cognitive decline in adult patients with cancer is reviewed, in order to understand the impact of pain on these interrelated symptoms, and the importance of its correct assessment and management. From the literature, it emerges that pain in cancer patients has a multidimensional phenomenology, which is the final product of a complex process involving emotional, cognitive, and sensory components. There is a substantial agreement that cancer patients with pain are at higher risk of having depression and cognitive decline. However, it is still controversial if these symptoms may fit into the same cluster, due to the paucity of studies exploring the simultaneous impact of pain on the psychological and cognitive well-being of patients with cancer, which would be consequential on their treatment and management. Finally, recent advances in immunology/oncology have provided novel insights into the pathophysiologic mechanisms supposedly underlying pain-related symptoms. Particularly, immune dysfunction may represent a common pathogenic ground of pain, depression and cognitive decline in cancer patients. In clinical practice, an appropriate assessment of pain should take into account the relationships with depression and cognitive decline, in order to develop more personalised and effective therapies for its management.
癌症患者承受着疼痛的负担，在这一人群中，疼痛的患病率从 14%到 100%不等，并且伴有抑郁和认知能力下降等共病行为症状。然而，癌症疼痛、抑郁和认知能力下降之间的复杂关系及其原因仍需阐明。在这里，我们回顾了成人癌症患者疼痛及其与抑郁和认知能力下降关系的现有文献，以了解疼痛对这些相互关联症状的影响，以及正确评估和管理疼痛的重要性。从文献中可以看出，癌症患者的疼痛具有多维现象学，它是一个涉及情感、认知和感觉成分的复杂过程的最终产物。大量研究表明，有疼痛的癌症患者患抑郁和认知能力下降的风险更高。然而，由于缺乏研究探索疼痛对癌症患者心理和认知健康的同时影响，这些症状是否可能属于同一类别仍存在争议，而这对他们的治疗和管理具有重要意义。最后，免疫学/肿瘤学的最新进展为疼痛相关症状的病理生理机制提供了新的见解。特别是，免疫功能障碍可能代表癌症患者疼痛、抑郁和认知能力下降的共同发病基础。在临床实践中，对疼痛的适当评估应考虑到与抑郁和认知能力下降的关系，以便为疼痛管理制定更个性化和有效的治疗方法。
