Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, 850 Boylston Street, Suite 302, Chestnut Hill, MA 02467, USA.
Nat Rev Rheumatol. 2011 Apr;7(4):216-24. doi: 10.1038/nrrheum.2011.2. Epub 2011 Feb 1.
Persistent and disabling pain is the hallmark of osteoarthritis, rheumatoid arthritis, fibromyalgia, and various other rheumatologic conditions. However, disease severity (as measured by 'objective' indices such as those that employ radiography or serology) is only marginally related to patients' reports of pain severity, and pain-related presentation can differ widely between individuals with ostensibly similar conditions (for example, grade 4 osteoarthritis of the knee). Increasing evidence in support of the biopsychosocial model of pain suggests that cognitive and emotional processes are crucial contributors to inter-individual differences in the perception and impact of pain. This Review describes the growing body of literature relating depression and catastrophizing to the experience of pain and pain-related sequelae across a number of rheumatic diseases. Depression and catastrophizing are consistently associated with the reported severity of pain, sensitivity to pain, physical disability, poor treatment outcomes, and inflammatory disease activity, and potentially with early mortality. A variety of pathways, from cognitive to behavioral to neurophysiological, seem to mediate these deleterious effects. Collectively, depression and catastrophizing are critically important variables in understanding the experience of pain in patients with rheumatologic disorders. Pain, depression, and catastrophizing might all be uniquely important therapeutic targets in the multimodal management of a range of such conditions.
持续性和致残性疼痛是骨关节炎、类风湿关节炎、纤维肌痛症和各种其他风湿病的特征。然而，疾病严重程度（通过放射学或血清学等“客观”指标来衡量）与患者报告的疼痛严重程度只有轻微的相关性，而且具有明显相似疾病的个体之间的疼痛相关表现可能存在很大差异（例如，膝关节 4 级骨关节炎）。越来越多的证据支持疼痛的生物心理社会模型表明，认知和情绪过程是个体间对疼痛的感知和影响差异的重要因素。本综述描述了越来越多的文献，这些文献将抑郁和灾难化与多种风湿病中的疼痛体验和疼痛相关后果联系起来。抑郁和灾难化与报告的疼痛严重程度、对疼痛的敏感性、身体残疾、治疗效果不佳以及炎症性疾病活动度始终相关，并且可能与早期死亡率相关。从认知到行为到神经生理学的各种途径似乎介导了这些有害影响。总之，抑郁和灾难化是理解风湿病患者疼痛体验的重要变量。在多种情况下的综合治疗中，疼痛、抑郁和灾难化可能都是独特的重要治疗靶点。
