Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, 149 Dalian Street, Zunyi, 56300, Guizhou, China.
Guizhou Key Lab of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, 149 Dalian Street, Zunyi, 56300, Guizhou, China.
J Neuroinflammation. 2019 Nov 6;16(1):204. doi: 10.1186/s12974-019-1608-z.
Chronic pain often occurs in the elderly, particularly in the patients with neurodegenerative disorders such as Alzheimer's disease (AD). Although studies indicate that chronic pain correlates with cognitive decline, it is unclear whether chronic pain accelerates AD pathogenesis. In this review, we provide evidence that supports a link between chronic pain and AD and discuss potential mechanisms underlying this connection based on currently available literature from human and animal studies. Specifically, we describe two intertwined processes, locus coeruleus noradrenergic system dysfunction and neuroinflammation resulting from microglial pro-inflammatory activation in brain areas mediating the affective component of pain and cognition that have been found to influence both chronic pain and AD. These represent a pathological overlap that likely leads chronic pain to accelerate AD pathogenesis. Further, we discuss potential therapeutic interventions targeting noradrenergic dysfunction and microglial activation that may improve patient outcomes for those with chronic pain and AD.
慢性疼痛常在老年人中出现，尤其是在阿尔茨海默病（AD）等神经退行性疾病患者中。虽然研究表明慢性疼痛与认知能力下降相关，但尚不清楚慢性疼痛是否会加速 AD 的发病机制。在本综述中，我们提供了支持慢性疼痛与 AD 之间存在关联的证据，并根据来自人类和动物研究的现有文献，讨论了这种联系的潜在机制。具体来说，我们描述了两个相互交织的过程，即蓝斑去甲肾上腺素能系统功能障碍和小胶质细胞促炎激活导致的神经炎症，这些过程发生在介导疼痛和认知的情感成分的大脑区域中，已发现这两个过程会同时影响慢性疼痛和 AD。这些代表了可能导致慢性疼痛加速 AD 发病机制的病理性重叠。此外，我们还讨论了针对去甲肾上腺素能功能障碍和小胶质细胞激活的潜在治疗干预措施，这些措施可能会改善患有慢性疼痛和 AD 的患者的预后。
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