Ağrı ve Bellek

Year 2023, Issue: 19, 290 - 301, 29.04.2023

Beyza Aslı BİLSEL Ebru DURUSOY Rıfat MUTUŞ

https://doi.org/10.38079/igusabder.1253543

Abstract

Öz
Ağrıya bağlı olası psikolojik ve bilişsel bozuklukların insan üzerinde etkileri olduğu giderek daha fazla kabul görmektedir. Ağrı, duyusal/ayırt edici bir uyarıdır ve organizmanın tehlikeden korunma, iyileşme vb. için gerekli eylemleri teşvik edebilmektedir. Aynı zamanda motivasyonel ve duygusal bileşenleri de olan çok boyutlu bir uyarandır. Zararlı bir uyarana verilen yanıtta öğrenme deneyimi sağlayan bilişsel/değerlendirme boyutu yer alır. Öğrenilen ağrı deneyimleri, gelecekteki ağrı deneyimlerinin algılanmasını da etkileyebilmektedir. Ağrı yolları bilişsel, duygusal ve davranışsal etkileri olan kompleks bir duyusal sistemi temsil eder. Yaygın nörotransmitterler ve nöral plastisitenin benzer mekanizmaları (örneğin, merkezi sensitizasyon, uzun süreli güçlenme (long term potentiation), kronik ağrı ve hafıza arasında mekanik bir örtüşme olduğunu düşündürür. Bu anatomik ve mekanik bağıntılar, kronik ağrı ve hafızanın çeşitli seviyelerde yakından etkileşime girdiğini gösterir. Nörogörüntüleme çalışmaları, beyin aktivitesinin uzaysal-zamansal yeniden düzenlenmesinin, ağrının temsilinin yavaş yavaş duyusal yapılardan duygusal ve limbik yapılara kaydığı kronik ağrıya geçişe eşlik ettiğini ileri sürmektedir. Ayrıca bu çalışmalar ağrıya ilişkin psikolojik ve sosyal faktörlerin, bireyin sağlığını, bilişsel durumunu etkilediğini de göstermektedir. Çok boyutlu bir deneyim olan ağrının temel sinirbilim süreçlerinin yanı sıra psikososyal faktörlerinin de incelenerek ağrıya dair biyopsikososyal değerlendirme ve tedavi yöntemlerinin uygulanması ve araştırılması önem arz etmektedir. Bu derlemede bellek süreçleri ile ilişkili olarak ağrıya dair genel bir bakış açısı oluşturmak hedeflenmiştir.

Keywords

Kronik ağrı, bellek, biyopsikososyal yaklaşım, nöroplastisite

Pain and Memory

Abstract

It is increasingly accepted that potential psychological and cognitive disorders related to pain have effects on human health. Pain is a sensory/differential stimulus and can encourage the organism’s need for protection from danger, recovery. It is a multidimensional stimulus that also has motivational and emotional components. Pain pathways represent a complex sensory system with cognitive, emotional and behavioral implications. Common neurotransmitters and similar mechanisms of neural plasticity (e.g., central sensitization, long-term potentiation) suggest a mechanistic overlap between chronic pain and memory. These anatomical and mechanical correlations suggest that chronic pain and memory interact closely at various levels. Neuroimaging studies suggest that spatio-temporal reorganization of brain activity accompanies the transition to chronic pain, in which the representation of pain gradually shifts from sensory structures to emotional and limbic structures. Furthermore, these studies show that psychological and social factors related to pain affect the health and cognitive status of the individual. In addition to the basic neuroscience processes of pain, which is a multidimensional experience, psychosocial factors should also be examined. Biopsychosocial assessment and treatment methods for pain should be applied. In this review, it is aimed to create a general perspective on the connection between pain and memory processes.

Keywords

Chronic pain, memory, biopsychosocial approach, neuroplasticity

References

• Allen HN, Bobnar HJ, Kolber BJ. Left and right hemispheric lateralization of the amygdala in pain. Progress in Neurobiology. 2021;196:101891.
• Merskey H, Bogduk N. Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes And Definitions of Pain Terms. 2nd edition. Seattle, WA: IASP Pres; 1994.
• Khera T, Rangasamy V. Cognition and pain: a review. Front Psychol. 2021; 12: 673962.
• Sauver JLS, Warner DO, Yawn BP, et al. Why patients visit their doctors: Assessing the most prevalent conditions in a defined American population. Paper presented at: Mayo Clinic Proceedings. 2013;88(1): 56-67.
• Nadar MS, Jasem Z, Manee FS. The cognitive functions in adults with chronic pain: A comparative study. Pain Research and Management. 2016;2016.
• Bussone G, Grazzi L, Panerai AE. Pain, emotion, headache. Headache: The Journal of Head and Face Pain. 2012;52:98-101.
• Moriarty O, McGuire BE, Finn DP. The effect of pain on cognitive function: A review of clinical and preclinical research. Progress in Neurobiology. 2011;93(3):385-404.
• Sueki DG, Dunleavy K, Puentedura EJ, Heard L, Van Der Heide P, Cheng MS. The differing effects of nociception and pain memory on pain thresholds in participants with and without a history of injury: A pretest-posttest quasi experimental study. Journal of Behavioral and Brain Science. 2022;12(8):359-379.
• McCarberg B, Peppin J. Pain pathways and nervous system plasticity: Learning and memory in pain. Pain Medicine. 2019;20(12):2421-2437.
• Mazza S, Frot M, Rey AE. A comprehensive literature review of chronic pain and memory. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2018;87:183-192.
• Walankar PP, Panhale VP, Patil MM. Psychosocial factors, disability and quality of life in chronic shoulder pain patients with central sensitization. Health Psychology Research. 2020;8(2):79-83.
• Planchuelo-Gómez Á, García-Azorín D, Guerrero ÁL, Rodríguez M, Aja-Fernández S, de Luis-García R. Gray matter structural alterations in chronic and episodic migraine: a morphometric magnetic resonance imaging study. Pain Medicine. 2020;21(11):2997-3011.
• Lai KL, Niddam DM, Fuh JL, Chen WT, Wu JC, Wang SJ. Cortical morphological changes in chronic migraine in a Taiwanese cohort: Surface-and voxel-based analyses. Cephalalgia. 2020;40(6):575-585.
• Aydın O. Ağrı ve ağrı mekanizmalarına güncel bakış. ADÜ Tıp Fakültesi Dergisi. 2002;3(2):37-48.
• Pask S, Dell'Olio M, Murtagh FE, Boland JW. The effects of opioids on cognition in older adults with cancer and chronic noncancer pain: A systematic review. Journal of Pain and Symptom Management. 2020;59(4):871-893. e871.
• Nijs J, Lahousse A, Kapreli E, et al. Nociplastic pain criteria or recognition of central sensitization? Pain phenotyping in the past, present and future. Journal of Clinical Medicine. 2021;10(15):3203-16.
• Yong RJ, Mullins PM, Bhattacharyya N. Prevalence of chronic pain among adults in the United States. Pain. 2022;163(2):e328-e332.
• Sim L, Harbeck Weber C, Harrison T, Peterson C. Central sensitization in chronic pain and eating disorders: A potential shared pathogenesis. Journal of Clinical Psychology in Medical Settings. 2021;28:40-52.
• Castel A, Cascón‐Pereira R, Boada S. Memory complaints and cognitive performance in fibromyalgia and chronic pain: The key role of depression. Scandinavian Journal of Psychology. 2021;62(3):328-338.
• Kazim MA, Strahl A, Moritz S, Arlt S, Niemeier A. Chronic pain in osteoarthritis of the hip is associated with selective cognitive impairment. Archives of Orthopaedic and Trauma Surgery. 2022:1-9.
• Nijs J, George SZ, Clauw DJ, et al. Central sensitisation in chronic pain conditions: Latest discoveries and their potential for precision medicine. The Lancet Rheumatology. 2021;3(5):e383-e392.
• Raja SN, Carr DB, Cohen M, et al. The revised IASP definition of pain: Concepts, challenges, and compromises. Pain. 2020;161(9):1976-82.
• Jassar H, Nascimento TD, Kaciroti N, et al. Impact of chronic migraine attacks and their severity on the endogenous μ-opioid neurotransmission in the limbic system. NeuroImage: Clinical. 2019;23:101905.
• Vallence A-M, Smith A, Tabor A, Rolan PE, Ridding MC. Chronic tension-type headache is associated with impaired motor learning. Cephalalgia. 2013;33(12):1048-1054.
• Ray AL. Neuroplasticity, sensitization, and pain. Comprehensive Treatment of Chronic Pain by Medical, Interventional, and Integrative Approaches: The American Academy Of Pain Medicine Textbook on Patient Management. 2013:759-768.
• Nijs J, Malfliet A, Ickmans K, Baert I, Meeus M. Treatment of central sensitization in patients with ‘unexplained’chronic pain: An update. Expert Opinion on Pharmacotherapy. 2014;15(12):1671-1683.
• Wildes M, Bigand TL, Layton ME, Wilson M. Cannabis use and cognition in adults prescribed opioids for persistent pain. Pain Management Nursing. 2020;21(1):94-99.
• Bendelow G. Chronic pain patients and the biomedical model of pain. AMA Journal of Ethics. 2013;15(5):455-459.
• George E, Engel L. The clinical application of the biopsychosocial model. American Journal of Psychiatry. 1980;137(5):535-544.
• Melchert TP. Foundations of professional psychology: The end of theoretical orientations and the emergence of the biopsychosocial approach. Elsevier; 2011.
• Miaskowski C, Blyth F, Nicosia F, et al. A biopsychosocial model of chronic pain for older adults. Pain Medicine. 2020;21(9):1793-1805.
• Cheatle MD. Biopsychosocial approach to assessing and managing patients with chronic pain. Medical Clinics. 2016;100(1):43-53.
• Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. The Lancet. 2021;397(10289):2082-2097.
• Seth B, de Gray L. Genesis of chronic pain. Anaesthesia & Intensive Care Medicine. 2016;17(9):431-435.
• Datzman JN. Pain, Attention, and Memory in the Biopsychosocial Model, Stephen F. Austin State University; 2015.
• Mescouto K, Olson RE, Hodges PW, Setchell J. A critical review of the biopsychosocial model of low back pain care: Time for a new approach? Disability and Rehabilitation. 2022;44(13):3270-3284.