抑郁症疼痛加工的行为特点及神经机制

doi:10.3724/SP.J.1042.2024.01315

摘要/Abstract

摘要： 生理疼痛和心理疼痛是抑郁症常见的两种疼痛类型, 它们的共存给抑郁症的及时诊断、症状缓解和生活质量提升带来了挑战。通过综述文献可发现相比健康被试, 在行为指标方面, 抑郁症在不同类型的生理疼痛上表现出不一致的疼痛敏感性, 在心理疼痛上表现出疼痛阈限更低、持续时间更长和痛苦感更强等特点; 在神经机制方面, 抑郁症患者生理疼痛与心理疼痛的特征模式与健康被试相似。未来研究可以注重探究两种类型疼痛-抑郁共病的特点, 厘清抑郁症疼痛加工的影响因素, 探讨抑郁症的生理疼痛加工和心理疼痛加工的共性和差异性, 阐明抑郁症伴随疼痛的功能性神经学变化, 为更精准的诊断和更有效的治疗提供依据。

关键词: 抑郁症, 生理疼痛, 心理疼痛, 行为特点, 神经机制

Abstract: The coexistence of physical pain and psychological pain, two common types of pain associated with depression, complicates the timely diagnosis of depression, alleviation of symptoms, and improvement of patients’ quality of life. In-depth research into the distinct clinical manifestations and neural mechanisms of these two types of pain is of great significance for the diagnosis of depression and treatment of patients with depression. Numerous studies have found that depression and pain appear to involve many of the same neurotransmitters, immune systems, and neural pathways, which might be the physiological factors leading to their high comorbidity. However, recent research has discovered that the characteristics of brain region activity in patients differ depending on whether pain or depression is the more dominant symptom. From a perspective where depressive symptoms are dominant: (1) What is the relationship between depressive symptoms and pain symptoms? (2) Compared to the healthy subjects, do individuals with depression exhibit any uniqueness in their behavioral performance and brain activity during pain processing? (3) Are there commonalities and specificities in the two types of pain commonly observed in patients with depression—physical pain and psychological pain? If so, what might they be? (4) Is there a difference in brain activity between individuals with depression accompanied by physical pain or psychological pain (with suicidal ideation or behavior) and those without accompanying pain? A review of the literature reveals that, in terms of behavioral indicators, individuals with depression exhibit inconsistent sensitivity to different types of physical pain and characteristics, such as a low pain threshold, long duration, and intense suffering from psychological pain, compared to healthy subjects. With respect to neural mechanisms, the patterns of physical and psychological pain in patients with depression are similar to those of healthy subjects. Specifically, physical pain in depression may involve the participation of somatosensory brain regions such as the anterior and posterior cingulate, while psychological pain in patients with depression might engage the social brain network. It is noteworthy, however, that research on physical pain associated with depression has found that it may be linked to abnormalities in the brain regions and interconnections involved in emotion and pain regulation. That is, non-noxious stimuli could also provoke physical pain in patients with depression, which may differ from the brain regions involved in physical pain among healthy subjects. In the future, (1) To better reveal the relationship between depressive symptoms and pain symptoms, it is necessary to further study the specificity of the comorbidity of pain with depression and depression with pain. This will enhance our understanding of depression and help find targeted interventions for pain dominated by depressive symptoms. (2) To better distinguish the specificities of pain processing in depression compared to the general population, the influencing factors of pain processing in depression need to be clarified, providing evidence for exploring more targeted and effective interventions and treatment plans. (3) Literature shows that currently there is no direct experimental evidence simultaneously addressing physical and psychological pain in patients with depression to reveal the similarities and differences in the neural mechanisms of physical and psychological pain in depression. Therefore, both physical and psychological pains in depression should be examined simultaneously to illuminate the commonalities and distinctions in their processing and to investigate the complex, dynamic interaction between physical and psychological pain in patients with depression, further expanding and deepening our understanding of pain associated with depression. (4) The brain is plastic, and chronic accompanying pain may affect the brain function in patients with depression, posing challenges to clinical diagnosis and treatment. Thus, future research should focus on exploring the functional neuroscientific changes associated with pain in patients with depression.

Key words: depression, physical pain, psychological pain, behavioral characteristics, neural mechanisms

中图分类号:

B845

丁颖, 汪紫滢, 李卫东. (2024). 抑郁症疼痛加工的行为特点及神经机制. 心理科学进展 , 32(8), 1315-1327.

DING Ying, WANG Ziying, LI Weidong. (2024). Behavioral characteristics and neural mechanisms of pain processing in depression. Advances in Psychological Science, 32(8), 1315-1327.

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