McInnis Peter M, Braund Taylor A, Chua Zhi Kai, Kozlowska Kasia
Department of Psychological Medicine, The Children's Hospital at Westmead, Australia.
Total Brain, Australia.
Clin Child Psychol Psychiatry. 2020 Jan;25(1):78-97. doi: 10.1177/1359104519864994. Epub 2019 Jul 31.
Accumulating evidence indicates that psychological and neurophysiological processes interconnect and interact to activate the body's stress system and to trigger and maintain functional somatic symptoms. This study used the Early Life Stress Questionnaire, Depression Anxiety Stress Scales and biological markers (heart rate, heart rate variability, skin conductance, C-reactive protein (CRP) titre, respiratory rate, and accuracy and reaction time in an emotion-face identification task), to examine childhood adversity, psychological distress and stress-system activation in 35 children and adolescents (23 girls and 12 boys, 9-17 years old) disabled by chronic pain (vs two groups of age- and sex-matched healthy controls). Patients reported more early-life stress ( = 798.5, = .026) and more psychological distress ( = 978, < .001). They showed activation of the autonomic system: elevated heart rate ( = 862.5, = .003), elevated electrodermal activity ( = 804.5, = .024) and lower heart rate variability in the time domain ( = 380.5, = .007) and frequency domain ( = 409.5, = .017). The group showed an upward shift of CRP titres (with 75th and 90th CRP percentiles of 4.5 and 10.5 mg/L, respectively), suggesting the activation of the immune-inflammatory system. Elevated CRP titres were associated with elevated heart rate ( = .028). There were no differences in respiratory rate or in accuracy and reaction time in the emotion-face identification task. The results indicate that interventions for children and adolescents with chronic pain need a multidisciplinary mind-body approach that concurrently addresses psychological distress, physical impairment and stress-system dysregulation.
越来越多的证据表明，心理和神经生理过程相互联系和作用，激活身体的应激系统，并引发和维持功能性躯体症状。本研究使用早期生活应激问卷、抑郁焦虑压力量表和生物标志物（心率、心率变异性、皮肤电传导、C反应蛋白（CRP）滴度、呼吸频率以及情绪面孔识别任务中的准确性和反应时间），对35名因慢性疼痛致残的儿童和青少年（23名女孩和12名男孩，9 - 17岁）进行研究，以考察童年逆境、心理困扰和应激系统激活情况（与两组年龄和性别匹配的健康对照组相比）。患者报告有更多的早期生活应激（ = 798.5， = .026）和更多的心理困扰（ = 978， < .001）。他们表现出自主神经系统的激活：心率升高（ = 862.5， = .003）、皮肤电活动增强（ = 804.5， = .024）以及时域（ = 380.5， = .007）和频域（ = 409.5， = .017）中心率变异性降低。该组显示CRP滴度上升（第75和第90百分位数的CRP分别为4.5和10.5 mg/L），提示免疫炎症系统被激活。CRP滴度升高与心率升高相关（ = .028）。在呼吸频率或情绪面孔识别任务的准确性和反应时间方面没有差异。结果表明，针对患有慢性疼痛的儿童和青少年的干预措施需要一种多学科的身心方法，同时解决心理困扰、身体损伤和应激系统失调问题。
