Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany.
Centre for Clinical Brain Sciences, Western General Hospital, NHS Lothian and University of Edinburgh, Edinburgh, UK.
J Neurol Neurosurg Psychiatry. 2019 May;90(5):608-614. doi: 10.1136/jnnp-2018-318298. Epub 2018 Oct 24.
There have been many articles highlighting differences and similarities between complex regional pain syndrome (CRPS) and functional neurological disorders (FND) but until now the discussions have often been adversarial with an erroneous focus on malingering and a view of FND as 'all in the mind'. However, understanding of the nature, frequency and treatment of FND has changed dramatically in the last 10-15 years. FND is no longer assumed to be only the result of 'conversion' of psychological conflict but is understood as a complex interplay between physiological stimulus, expectation, learning and attention mediated through a Bayesian framework, with biopsychosocial predisposing, triggering and perpetuating inputs. Building on this new 'whole brain' perspective of FND, we reframe the debate about the 'psychological versus physical' basis of CRPS. We recognise how CRPS research may inform mechanistic understanding of FND and conversely, how advances in FND, especially treatment, have implications for improving understanding and management of CRPS.
已经有很多文章强调了复杂性区域疼痛综合征 (CRPS) 和功能性神经障碍 (FND) 之间的差异和相似之处,但到目前为止,这些讨论往往是针锋相对的,错误地关注于装病和将 FND 视为“全在头脑中”。然而,在过去 10-15 年中,对 FND 的性质、频率和治疗的理解发生了巨大变化。现在不再假设 FND 仅仅是心理冲突“转换”的结果,而是理解为一种复杂的生理刺激、预期、学习和注意力之间的相互作用,通过贝叶斯框架介导,具有生物心理社会的易感性、触发和持续作用。基于 FND 的这种新的“全脑”观点,我们重新构建了关于 CRPS“心理与生理”基础的争论。我们认识到 CRPS 研究如何为 FND 的机制理解提供信息,反之,FND 的进展,特别是治疗,如何对改善 CRPS 的理解和管理产生影响。