Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Lancet Rheumatol. 2023 Jun;5(6):e351-e360. doi: 10.1016/S2665-9913(23)00094-2. Epub 2023 May 4.
Pain is a common and often debilitating symptom for people living with rheumatoid arthritis. Although pain is a generic feature of inflammation and often improves with successful treatment that targets inflammatory pathways, pain experience can persist. Emerging data suggest that the magnitude of pain relief might vary according to the therapeutic target of pharmacological intervention within the inflammatory cascade. Both inflammatory and non-inflammatory causes contribute to the pain experience, which depends on tissue origin, peripheral sensory mechanisms and their transmission, integration, and interpretation within the nervous system. Contemporary neuroimaging is transforming our understanding of these mechanisms and the role of sensory, emotional, and cognitive contributions to the experience of pain. This understanding paves the way for therapeutic approaches that recognise the existence of multiple, cognitively driven, supraspinal mechanisms for pain modulation and could complement pharmacological inflammation suppression. Such approaches include neuropsychological interventions that have the potential to modify human brain cortical structure and reduce suffering that is often associated with pain experience.
疼痛是类风湿关节炎患者常见且常常使人虚弱的症状。尽管疼痛是炎症的一般特征，并且通常随着针对炎症途径的成功治疗而改善，但疼痛体验可能会持续存在。新出现的数据表明，根据炎症级联中药物干预的治疗靶点，缓解疼痛的幅度可能会有所不同。炎症和非炎症原因都会导致疼痛体验，这取决于组织来源、外周感觉机制以及它们在神经系统中的传递、整合和解释。当代神经影像学正在改变我们对这些机制以及感觉、情感和认知对疼痛体验的贡献的理解。这种理解为治疗方法铺平了道路，这些方法认识到存在多种认知驱动的、脊髓以上的疼痛调节机制，并可以补充药物抑制炎症的作用。此类方法包括有潜力改变人类大脑皮质结构并减轻与疼痛体验相关的痛苦的神经心理学干预。
