Department of Psychology, Division of Medical-Clinical Psychology, The University of Alabama at Birmingham, Birmingham, AL, USA.
NeuroRehabilitation. 2013;33(2):343-66. doi: 10.3233/NRE-130965.
The pervasive disease of chronic pain is a common challenge for the clinical rehabilitation professional. Concurrent with physical and emotional symptoms, pain-related cognitive impairment has been reported. Although opioid analgesics are frequently prescribed, concern exists that opioids possess adverse cognitive effects of their own.
To review the neuropsychological and neuroanatomical sequelae of chronic non-malignant pain and opioid therapy, to clarify roles and benefits of neuropsychological assessment in a chronic pain population, and to provide recommendations for clinical practice and future research.
This non-systematic review sought to provide a comprehensive synthesis of relevant neurobiology, neuroimaging, neuropsychological, and rehabilitation research literatures. We included citations from seminal and current texts as well as relevant original and review articles from 1980-2012 in PubMed and PubMedCentral online research databases.
DISCUSSION AND SUMMARY/CONCLUSIONS: To date, evidence from opioid studies suggests only mild deficits in specific cognitive domains (e.g., memory, attention/concentration) and only under specific conditions (e.g., dose escalations). Additionally, neuroimaging and neuropsychological evidence suggests that pain itself results in cognitive sequelae. Methodological improvements in future research will allow for better delineation of the contributing effects of pain and opioids, with an overall goal of improving evidence-based clinical treatment recommendations.
慢性疼痛是一种普遍存在的疾病，对临床康复专业人员来说是一个常见的挑战。除了身体和情绪症状外，还报告了与疼痛相关的认知障碍。尽管经常开阿片类镇痛药，但人们担心阿片类药物本身会产生不良的认知影响。
综述慢性非恶性疼痛和阿片类药物治疗的神经心理学和神经解剖学后果，阐明神经心理学评估在慢性疼痛人群中的作用和益处，并为临床实践和未来研究提供建议。
本非系统性综述旨在对相关神经生物学、神经影像学、神经心理学和康复研究文献进行全面综合。我们从 1980 年至 2012 年在 PubMed 和 PubMedCentral 在线研究数据库中包括了来自开创性和当前文本以及相关原始和综述文章的引用。
讨论和总结/结论：迄今为止，阿片类药物研究的证据仅表明在特定认知领域（例如记忆、注意力/集中力）存在轻度缺陷，并且仅在特定条件下（例如剂量增加）存在。此外，神经影像学和神经心理学证据表明疼痛本身会导致认知后果。未来研究中的方法学改进将能够更好地区分疼痛和阿片类药物的影响，总体目标是改善基于证据的临床治疗建议。
