【作者】 李骏； 桑康宁； 辛宇时； 胡淑楠； 马柯； 董晓蔚；

【Author】 Jun Li;Kangning Sang;Yushi Xin;Shunan Hu;Ke Ma;Xiaowei Dong;School of Psychology and Cognitive Science, East China Normal University;Department of Anesthesiology and Critical Care Medicine, Xin Hua Hospital,Shanghai Jiaotong University School of Medicine;Institute of Brain and Cognitive Science, New York University Shanghai;

【机构】 华东师范大学心理与认知科学学院； 上海交通大学新华医院麻醉科； 上海纽约大学脑与认知科学研究所；

【摘要】 慢性疼痛患者不但长期被难以忍受的持续性疼痛所折磨,还往往伴随着认知功能损伤和情绪障碍。最近一项临床调查的数据显示,情绪障碍是与慢性疼痛相关的第二种最常见的疾患。此外,具有较高情绪困扰的慢性疼痛患者往往伴有认知功能障碍,如在学习与记忆、注意力和执行功能等方面的障碍。这些现象表明在情绪障碍和认知障碍之间似乎存在一种关联。我们近年来的研究表明,情绪障碍在慢性疼痛引起的认知障碍中起着重要作用。功能磁共振成像数据和事件相关电位分析表明,在爱荷华赌博任务(情绪决策任务)中,病人的不佳表现与情绪反应增强有关。因此,我们假设慢性疼痛患者的情绪失调可能是导致决策障碍的重要原因之一。情绪障碍的有效治疗对改善病人的生活质量十分重要。音乐干预在临床上常被用作缓解疼痛和焦虑的辅助疗法,但对于其治疗机制目前尚没有详细的研究。我们利用坐骨神经选择性损伤(Spared nerve injury,SNI)的大鼠神经病理性疼痛模型,探讨了音乐抗焦虑作用的神经机制。我们发现,大鼠在接受SNI神经损伤手术后的两个月里,出现明显的焦虑样行为。这些大鼠在听古典音乐(莫扎特的奏鸣曲K.448和贝多芬的献给爱丽丝)2周后,其焦虑样行为得到了有效的预防或缓解。音乐的抗焦虑作用达到了与常用抗焦虑药物西酞普兰相类似的疗效。进一步的实验发现,音乐环境可能是通过抑制慢性疼痛导致的前额叶皮层的5-羟色胺转运体表达上升,以及抑制内侧前额叶皮层和腹侧海马θ段异常活动来实现其抗焦虑作用的。综上所述,我们的研究表明情绪障碍对慢性疼痛患者的认知障碍起了很大作用。音乐治疗是干预情绪障碍的有效手段。更多还原

【Abstract】 Patients with chronic pain not only suffer recurrent pain but also have an increased prevalence of certain cognitive impairment and affective or mood disturbances. The data from a recent clinical survey indicated that mood disorder was the second most prevalent disorder associated with chronic pain(Brünahl et al., J Psychosom Res., 98:19-26, 2017). Furthermore, chronic pain patients with higher emotional distress have displayed impairment in cognitive functions, such as learning and memory, attention, and executive functioning. It seems there is a link between emotional disorders and cognitive impairment. Our recent study indicated that the affective disorders played an important role in the cognitive impairment in chronic pain conditions. Both the f MRI data and the ERP analysis suggested that the poor performance of patients in the Iowa Gambling task, an emotional decision-making task, was associated with elevated emotional responses. Thus, we hypothesize that the affective dysregulation in chronic pain patients may contribute to the impairment of decision-making. Given the importance of treatment of emotional disorders, a clear need exists to complement existing medical treatments with nonmedical interventions. Music has been used as an adjuvant therapy to relieve pain and anxiety with variable effectiveness in clinic. It’s safer and much less expensive than drug treatment. However, the lack of understanding of the underlying mechanisms hampered the promotion of its application. We have recently completed a study investigating neural mechanism underlying the effects of selected pieces of classical music in alleviating anxiety-like behaviors associated with chronic pain. In our study, we explored the neural mechanism of anxiolytic effects of music using a rat model of neuropathic pain, in which anxiety-like behaviors became apparent two months following nerve injury surgery. We found that 2-week exposure of the classical music(Mozart Sonata K.448 and Beethoven’s fur Elise), but not white noise, effectively prevented/alleviated anxiety-like behaviors, an action as efficacious as sub-chronic(15 days) treatment with an anti-anxiety drug, citalopram(10 mg/kg, i.p.). Moreover, our study revealed that the music exerts its anxiolytic effect by modulating the chronic pain-induced plasticity changes in serotonin neurotransmission and the abnormal activity of theta oscillation in medial prefrontal cortex.In summary, our study demonstrated the contribution of affective disorders to the cognitive impairment in patients with chronic pain. The music-based therapy may provide an effective intervention for affective disorders.更多还原