■伤害性疼痛(NP),与伤害性和神经性疼痛一起被归类为第三种类型的疼痛,是通过中枢致敏作用放大伤害性刺激引起的慢性疼痛,尽管没有组织损伤,感觉神经损伤,或疾病。NP的一个重要临床特征是它不仅与疼痛有关,而且与对声音和光的感觉过敏以及认知功能障碍有关。包括情绪和注意力障碍。最近的研究表明,抑郁症和发育障碍,如注意缺陷多动障碍(ADHD)和自闭症谱系障碍(ASD),与NP在高频共存。此外,NP患者的认知障碍可能与这些精神病合并症相关.然而,根据我们的知识,没有关于(1)成人ADHD/ASD患者腹部NP的多维评估和诊断细节;(2)当ADHD和抑郁症与NP共存时,ADHD药物和抗抑郁药的给药方式;(3)中枢致敏,大脑功能,NP和家庭关系问题被ADHD和抑郁症的治疗改变。
■这里,我们介绍了一名51岁的腹部NP女性。她出现了严重的右下腹痛,并接受了彻底的体检;然而,物理,医疗原因仍然未知,使治疗具有挑战性。此外,当她开始抱怨失眠和焦虑时,她请假了。她被转介到我们的疼痛中心,抑郁症的诊断,多动症,ASD被证实,并开始使用ADHD药物治疗。虽然单独使用ADHD药物并不能产生足够的改善,哌醋甲酯和抗抑郁药文拉法辛的组合最终导致腹部NP的改善,抑郁症,ADHD症状,中央敏化,和家庭关系问题。治疗期间,前扣带回的脑血流,前额叶,顶骨皮质也有所改善。
■在治疗NP时,共病抑郁症的治疗很重要,文拉法辛可能有效,特别是在多动症/ASD合并症的情况下。腹部NP患者需要筛查发育障碍和抑郁症。
UNASSIGNED: Nociplastic pain (NP), classified as a third type of pain alongside nociceptive and neuropathic pain, is chronic pain arising from the amplification of nociceptive stimuli through central sensitization, despite the absence of tissue damage, sensory nerve damage, or disease. An important clinical feature of NP is that it is not only associated with pain but also with sensory hypersensitivity to sound and light and cognitive dysfunction, including mood and attention disorders. Recent studies have suggested that depression and developmental disorders, such as attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), coexist with NP at high frequency. Additionally, cognitive impairment in individuals with NP may be associated with these psychiatric comorbidities. However, to our knowledge, there are no reports on (1) multidimensional evaluation and diagnostic details of abdominal NP in adults with ADHD/ASD; (2) how ADHD drugs and antidepressants are administered when ADHD and depression coexist with NP; and (3) how central sensitization, brain function, and family relationship problems underlying NP are altered by treatments of ADHD and depression.
UNASSIGNED: Herein, we present the case of a 51-year-old woman with abdominal NP. She developed severe right lower abdominal pain and underwent a thorough medical examination; however, the physical, medical cause remained unknown, making treatment challenging. Additionally, she took time off work as she began to complain of insomnia and anxiety. She was referred to our pain center, where a diagnosis of depression, ADHD, and ASD was confirmed, and treatment with ADHD medication was initiated. While ADHD medications alone did not yield sufficient improvement, a combination of methylphenidate and the antidepressant venlafaxine eventually led to improvements in abdominal NP, depression, ADHD symptoms, central sensitization, and family relationship issues. During treatment, cerebral blood flow in the anterior cingulate, prefrontal, and parietal cortices also improved.
UNASSIGNED: The treatment of comorbid depression is important while treating NP, and venlafaxine may be effective, especially in cases of comorbid ADHD/ASD. Screening for developmental disorders and depression is required in patients with abdominal NP.