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[慢性疼痛与创伤性生活事件之间的双向关系:机制与治疗意义]

[The Bidirectional relationship between chronic pain and traumatic life events : Mechanisms and therapeutic implications].

作者信息

Hermes Michelle, Wieland Sebastian, Tesarz Jonas

机构信息

Abteilung für Allgemeine Innere Medizin und Psychosomatik, Universitätsklinikum Heidelberg, Universität Heidelberg, Heidelberg, Deutschland.

DZPG (Deutsches Zentrum für Psychische Gesundheit - Standort Heidelberg/Mannheim/Ulm), .

出版信息

Schmerz. 2025 May 22. doi: 10.1007/s00482-025-00883-9.

Abstract

There is a close bidirectional relationship between chronic pain and psychological trauma disorders, which frequently results in more intense suffering and greater impairment for those affected. This article elucidates the intricate interrelationships between chronic pain, early childhood stress, and traumatic experiences as well as the underlying neurobiological, neuroimmunological and psychosocial mechanisms. Early childhood trauma, such as abuse or neglect, has a significant impact on individuals during particularly vulnerable phases of development, leading to long-lasting changes at various levels. The influence of trauma on pain perception is twofold: it increases the prevalence of chronic pain and intensifies pain and suffering. Therapeutically, interventions that target the hyperactive threat system and strengthen the hypoactive soothing system are essential. The article discusses evidence-based models of pain-trauma interaction and presents therapeutic approaches such as Eye Movement Desensitization Reprocessing (EMDR), Emotional Awareness and Expression Therapy (EAET), and psychodynamic interventions that are promising in the treatment of trauma-associated chronic pain.

摘要

慢性疼痛与心理创伤障碍之间存在密切的双向关系,这常常给受影响者带来更强烈的痛苦和更大的损害。本文阐述了慢性疼痛、童年早期压力和创伤经历之间错综复杂的相互关系,以及潜在的神经生物学、神经免疫学和社会心理机制。童年早期创伤,如虐待或忽视,在个体发育的特别脆弱阶段对其产生重大影响,导致各个层面的长期变化。创伤对疼痛感知的影响是双重的:它增加了慢性疼痛的患病率,并加剧了疼痛和痛苦。在治疗方面,针对过度活跃的威胁系统并加强反应不足的舒缓系统的干预措施至关重要。本文讨论了基于证据的疼痛-创伤相互作用模型,并介绍了诸如眼动脱敏再处理疗法(EMDR)、情绪觉察与表达疗法(EAET)以及在治疗与创伤相关的慢性疼痛方面前景良好的心理动力学干预等治疗方法。

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