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临床前关于情感障碍和疼痛的思考:一种广泛交织但经常未被充分探索的关系,具有重大的临床意义。

Preclinical Considerations about Affective Disorders and Pain: A Broadly Intertwined, yet Often Under-Explored, Relationship Having Major Clinical Implications.

机构信息

Department of Research, Faculty of Biology, "Alexandru Ioan Cuza" University, Carol I Avenue, no 11, 700505 Iasi, Romania.

Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", University Street, no 16, 700115 Iasi, Romania.

出版信息

Medicina (Kaunas). 2020 Sep 25;56(10):504. doi: 10.3390/medicina56100504.

Abstract

Pain, a distinctive undesirable experience, encompasses several different and fluctuating presentations across varying mood disorders. Therefore, the present narrative review aimed to shed further light on the matter, accounting for both experimental animal models and clinical observations about major depressive disorder (MDD) pathology. Major databases were inquired from inception until April 2016 for records about MDD and pain. Pain and MDD are tightly associated with each other in a bi-directional fashion. Several cross-sectional and retrospective studies indicated a high presence of pain in the context of mood disorders, including MDD (up to 65%), but also increased prevalence rates in the case of mood disorders documented among people with a primary diagnosis of either psychological or somatic pain (prevalence rates exceeding 45%). The clinical implications of these observations suggest the need to account for mood and pain manifestations as a whole rather than distinct entities in order to deliver more effective interventions. Narrative review, lack of systematic control groups (e.g., people with the primary diagnosis at review, but not the associated comorbidity as a study) to allow reliable comparisons. Prevalence rates and clinical features associated with pain varied across different studies as corresponding operational definitions did. Pain may have a detrimental effect on the course of mood disorders-the opposite holds. Promoting a timely recognition and management of such an often neglected comorbidity would therefore represent a primary goal toward the delivery of effective, multi-disciplinary care.

摘要

疼痛是一种独特的不良体验,在不同的情绪障碍中表现出多种不同且波动的特征。因此,本叙述性综述旨在进一步阐明这一问题,同时考虑到关于重度抑郁症(MDD)病理的实验动物模型和临床观察。从开始到 2016 年 4 月,主要数据库被查询以获取关于 MDD 和疼痛的记录。疼痛和 MDD 以双向的方式紧密相关。几项横断面和回顾性研究表明,在情绪障碍(包括 MDD)中疼痛的发生率很高(高达 65%),但在以心理或躯体疼痛为主要诊断的人群中,情绪障碍的发生率也有所增加(超过 45%)。这些观察结果的临床意义表明,需要将情绪和疼痛表现作为一个整体来考虑,而不是作为不同的实体,以便提供更有效的干预措施。叙述性综述,缺乏系统的对照组(例如,在综述中具有主要诊断的人,但不作为研究的相关合并症),无法进行可靠的比较。不同研究中与疼痛相关的流行率和临床特征因相应的操作性定义而异。疼痛可能对情绪障碍的病程产生不利影响,反之亦然。因此,及时识别和管理这种经常被忽视的合并症将是提供有效、多学科护理的主要目标。

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