Department of Life Science, Atlantic Technological University, F91 YW50 Sligo, Ireland.
Centre for Precision Engineering, Materials and Manufacturing Research (PEM), Atlantic Technological University, F91 YW50 Sligo, Ireland.
Int J Mol Sci. 2022 Aug 2;23(15):8574. doi: 10.3390/ijms23158574.
Functional somatic syndromes are increasingly diagnosed in chronically ill patients presenting with an array of symptoms not attributed to physical ailments. Conditions such as chronic fatigue syndrome, fibromyalgia syndrome, or irritable bowel syndrome are common disorders that belong in this broad category. Such syndromes are characterised by the presence of one or multiple chronic symptoms including widespread musculoskeletal pain, fatigue, sleep disorders, and abdominal pain, amongst other issues. Symptoms are believed to relate to a complex interaction of biological and psychosocial factors, where a definite aetiology has not been established. Theories suggest causative pathways between the immune and nervous systems of affected individuals with several risk factors identified in patients presenting with one or more functional syndromes. Risk factors including stress and childhood trauma are now recognised as important contributors to chronic pain conditions. Emotional, physical, and sexual abuse during childhood is considered a severe stressor having a high prevalence in functional somatic syndrome suffers. Such trauma permanently alters the biological stress response of the suffers leading to neuroexcitatory and other nerve issues associated with chronic pain in adults. Traumatic and chronic stress results in epigenetic changes in stress response genes, which ultimately leads to dysregulation of the hypothalamic-pituitary axis, the autonomic nervous system, and the immune system manifesting in a broad array of symptoms. Importantly, these systems are known to be dysregulated in patients suffering from functional somatic syndrome. Functional somatic syndromes are also highly prevalent co-morbidities of psychiatric conditions, mood disorders, and anxiety. Consequently, this review aims to provide insight into the role of the nervous system and immune system in chronic pain disorders associated with the musculoskeletal system, and central and peripheral nervous systems.
功能性躯体综合征在患有多种非躯体疾病相关症状的慢性疾病患者中越来越多地被诊断出来。慢性疲劳综合征、纤维肌痛综合征或肠易激综合征等疾病是常见的属于这一广泛类别的疾病。这些综合征的特征是存在一种或多种慢性症状，包括广泛的肌肉骨骼疼痛、疲劳、睡眠障碍和腹痛等问题。人们认为这些症状与生物和心理社会因素的复杂相互作用有关，而尚未确定明确的病因。该理论提出了受影响个体的免疫系统和神经系统之间的因果关系途径，在出现一种或多种功能性综合征的患者中确定了几个风险因素。风险因素包括压力和儿童创伤，这些现在被认为是慢性疼痛疾病的重要诱因。儿童期的情感、身体和性虐待被认为是严重的应激源，在功能性躯体综合征患者中普遍存在。这种创伤会永久性改变患者的生物应激反应，导致与成人慢性疼痛相关的神经兴奋和其他神经问题。创伤和慢性应激会导致应激反应基因的表观遗传变化，最终导致下丘脑-垂体轴、自主神经系统和免疫系统失调，表现为广泛的症状。重要的是，这些系统在患有功能性躯体综合征的患者中已知存在失调。功能性躯体综合征也是精神疾病、情绪障碍和焦虑症的高发合并症。因此，本综述旨在深入了解与骨骼肌肉系统以及中枢和外周神经系统相关的慢性疼痛障碍中神经系统和免疫系统的作用。
