When pain gets stuck: the evolution of pain chronification and treatment resistance
| Autor: | Christopher Eccleston, Laura E. Simons, Andrew M. Youssef, Igor Elman, David Borsook |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
media_common.quotation_subject Drug Resistance Vulnerability Disease Article 03 medical and health sciences 0302 clinical medicine Neurobiology Intervention (counseling) Perception medicine Animals Humans Genetic Predisposition to Disease Treatment resistance Illness Behavior media_common Persistent pain Chronic pain Brain medicine.disease Allostatic load 030104 developmental biology Anesthesiology and Pain Medicine Socioeconomic Factors Neurology Neurology (clinical) Chronic Pain Psychology Neuroscience 030217 neurology & neurosurgery |
| Zdroj: | Pain. 159:2421-2436 |
| ISSN: | 1872-6623 0304-3959 |
| DOI: | 10.1097/j.pain.0000000000001401 |
| Popis: | It is well recognized that, despite similar pain characteristics, some people with chronic pain recover, whereas others do not. In this review, we discuss possible contributions and interactions of biological, social, and psychological perturbations that underlie the evolution of treatment-resistant chronic pain. Behavior and brain are intimately implicated in the production and maintenance of perception. Our understandings of potential mechanisms that produce or exacerbate persistent pain remain relatively unclear. We provide an overview of these interactions and how differences in relative contribution of dimensions such as stress, age, genetics, environment, and immune responsivity may produce different risk profiles for disease development, pain severity and chronicity. We propose the concept of ‘stickiness’ as a soubriquet for capturing the multiple influences on the persistence of pain and pain behavior, and their stubborn resistance to therapeutic intervention. We then focus on the neurobiology of reward and aversion to address how alterations in synaptic complexity, neural networks and systems (e.g., opioidergic and dopaminergic) may contribute to pain stickiness. Finally, we propose an integration of the neurobiological with what is known about environmental and social demands on pain behavior and explore treatment approaches based on the nature of the individual’s vulnerability to or protection from allostatic load. |
| Databáze: | OpenAIRE |
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