Nees Frauke, Becker Susanne
Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Neuroscience. 2018 Sep 1;387:72-84. doi: 10.1016/j.neuroscience.2017.08.051. Epub 2017 Sep 7.
In the understanding of chronic pain, hypotheses derived from psychological theories, together with insights from physiological assessments and brain imaging, highlight the importance of mechanistically driven approaches. Physical system changes, for example following injury, can result in alterations of psychological processes and are accompanied by changes in corticolimbic circuits, which have been shown to be essential in emotional learning and memory, as well as reward processing and related behavior. In the present review, we thus highlight the importance of motivational, reward/pain relief, and fear learning processes in the context of chronic pain and discuss the potential of a mechanistic understanding of chronic pain within a clinical perspective, for example for the development of therapeutic strategies. We argue that changes in these mechanisms are not only characteristic for chronic pain, reflecting consequences of the disorder, but are also critically involved in the transition from acute to chronic pain states.
在对慢性疼痛的理解中，源自心理学理论的假说，连同生理评估和脑成像的见解，凸显了机制驱动方法的重要性。例如，身体系统在受伤后发生的变化，会导致心理过程的改变，并伴随着皮质边缘回路的变化，而皮质边缘回路已被证明在情绪学习和记忆、奖励处理及相关行为中至关重要。因此，在本综述中，我们强调了动机、奖励/疼痛缓解和恐惧学习过程在慢性疼痛背景下的重要性，并从临床角度讨论了对慢性疼痛进行机制性理解的潜力，例如用于制定治疗策略。我们认为，这些机制的变化不仅是慢性疼痛的特征，反映了该病症的后果，而且在从急性疼痛状态向慢性疼痛状态的转变中也起着关键作用。
