Developmental Neuroscience Division, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Dr, Unit 40, New York, NY 10032, USA.
Psychosom Med. 2012 Sep;74(7):717-27. doi: 10.1097/PSY.0b013e3182688e8b. Epub 2012 Aug 28.
Somatoform pain is a highly prevalent, debilitating condition and a tremendous public health problem. Effective treatments for somatoform pain are urgently needed. The etiology of this condition is, however, still unknown. On the basis of a review of recent basic and clinical research, we propose one potential mechanism of symptom formation in somatoform pain and a developmental theory of its pathogenesis. Emerging evidence from animal and human studies in developmental neurobiology, cognitive-affective neuroscience, psychoneuroimmunology, genetics, and epigenetics, as well as that from clinical and treatment studies on somatoform pain, points to the existence of a shared neural system that underlies physical and social pain. Research findings also show that nonoptimal early experiences interact with genetic predispositions to influence the development of this shared system and the ability to regulate it effectively. Interpersonal affect regulation between infant and caregiver is crucial for the optimal development of these brain circuits. The aberrant development of this shared neural system during infancy, childhood, and adolescence may therefore ultimately lead to an increased sensitivity to physical and social pain and to problems with their regulation in adulthood. The authors critically review translational research findings that support this theory and discuss its clinical and research implications. Specifically, the proposed theory and research review suggest that psychotherapeutic and/or pharmacological interventions that foster the development of affect regulation capacities in an interpersonal context will also serve to more effectively modulate aberrantly activated neural pain circuits and thus be of particular benefit for the treatment of somatoform pain.
躯体形式疼痛是一种高发、致残的疾病，也是一个巨大的公共卫生问题。迫切需要有效的躯体形式疼痛治疗方法。然而，这种疾病的病因仍然未知。基于对最近基础和临床研究的回顾，我们提出了躯体形式疼痛症状形成的一个潜在机制和发病机制的发展理论。来自发育神经生物学、认知情感神经科学、心理神经免疫学、遗传学和表观遗传学的动物和人类研究，以及躯体形式疼痛的临床和治疗研究的新兴证据表明，存在一个潜在的共同神经系统，为身体和社会疼痛提供了基础。研究结果还表明，非最佳的早期经历与遗传易感性相互作用，影响共同系统的发育和有效调节它的能力。婴儿和照顾者之间的人际情感调节对这些大脑回路的最佳发育至关重要。因此，在婴儿期、儿童期和青春期，这个共同神经系统的异常发育可能最终导致对身体和社会疼痛的敏感性增加，以及成年后调节这些疼痛的问题。作者批判性地回顾了支持这一理论的转化研究结果，并讨论了其临床和研究意义。具体来说，提出的理论和研究综述表明，促进人际环境中情感调节能力发展的心理治疗和/或药物干预也将有助于更有效地调节异常激活的神经疼痛回路，因此对躯体形式疼痛的治疗特别有益。
