抗焦虑药物在骨关节疼痛中的机制研究 与临床应用
Mechanism Research and Clinical Application of Anti-Anxiety Drugs in Bone and Joint Pain
DOI: 10.12677/acm.2026.1662439, PDF,   
作者: 王星宇：安徽中医药大学第一附属医院骨伤一科，安徽 合肥；张 乐*：安徽中医药大学第一附属医院骨伤三科，安徽 合肥
关键词: 抗焦虑；骨关节疼痛；机制；临床应用；Anti-Anxiety； Bone and Joint Pain； Mechanism； Clinical Application
摘要: 骨关节疼痛作为临床常见的慢性疼痛类型，其病理机制复杂，不仅涉及外周组织损伤，更与中枢神经系统的敏化及情绪调节障碍密切相关。传统镇痛药物如非甾体抗炎药在慢性骨关节疼痛管理中常疗效欠佳，且伴随安全性问题。近年来，抗焦虑药物在慢性疼痛管理中的应用日益受到重视。本文综述了抗焦虑药物缓解骨关节疼痛的神经生物学基础，重点探讨了其通过调节中枢下行疼痛抑制通路、改善中枢敏化与神经可塑性、抑制神经炎症等机制发挥镇痛作用。此外，本文深入分析了不同类别抗焦虑药物干预骨关节疼痛的应用现状。
Abstract: Bone and joint pain is a common type of chronic pain in clinical practice. Its pathological mechanism is complex, not only involving peripheral tissue damage, but also closely related to the sensitization of the central nervous system and emotional regulation disorders. Traditional analgesic drugs such as non-steroidal anti-inflammatory drugs are often ineffective in the management of chronic bone and joint pain, and are accompanied by safety problems. In recent years, the application of anti-anxiety drugs in chronic pain management has received increasing attention. This article reviews the neurobiological basis of anti-anxiety drugs in relieving bone and joint pain and focuses on its analgesic effect by regulating the central descending pain inhibition pathway, improving central sensitization and neuroplasticity and inhibiting neuroinflammation. In addition, this paper deeply analyzed the application status of different types of anti-anxiety drugs in the intervention of bone and joint pain.
文章引用：王星宇, 张乐. 抗焦虑药物在骨关节疼痛中的机制研究 与临床应用[J]. 临床医学进展, 2026, 16(6): 2185-2191. https://doi.org/10.12677/acm.2026.1662439

参考文献

[1] 陈兴超, 高振华, 徐生刚, 邹永刚, 钱军, 魏建仝. 1990-2021年全球和中国及不同社会人口学指数地区骨关节炎疾病负担趋势分析[J]. 中国全科医学, 2025, 28(17): 2172-2178.
[2] 宋雨晴, 宋涛, 董道松, 万成福. 慢性疼痛患者的焦虑、抑郁现状分析[J]. 神经疾病与精神卫生, 2024, 24(9): 665-670.
[3] 林丽芬, 陈沭, 卢燕辉, 刘岳金, 潘海山, 沈赟. 某院2020-2022年门诊药房非甾体抗炎药的用药分析[J]. 中国药物评价, 2024, 41(4): 327-330.
[4] 高艳丽, 于玲玲, 冯东亮, 崔冰. 护理专案改善活动对阿片类药物治疗膝骨关节炎患者不良反应、负性情绪和镇痛效果的影响[J]. 中国药物滥用防治杂志, 2024, 30(4): 626-629.
[5] Xiong, S., Li, T., Chen, Z., Ma, Z., Lin, L., Shi, G., et al. (2026) Best1-Mediated Tonic Excitation Facilitates Anxiety-Like Behaviors in a Mouse Model of Chronic Neuropathic Pain. Cell Reports, 45, Article 117229. [Google Scholar] [CrossRef] 
[6] Zhuo, M. (2016) Neural Mechanisms Underlying Anxiety-Chronic Pain Interactions. Trends in Neurosciences, 39, 136-145. [Google Scholar] [CrossRef] [PubMed]
[7] Thompson, J.M. and Neugebauer, V. (2019) Cortico-Limbic Pain Mechanisms. Neuroscience Letters, 702, 15-23. [Google Scholar] [CrossRef] [PubMed]
[8] Wang, D., Pan, X., Zhou, Y., Wu, Z., Ren, K., Liu, H., et al. (2023) Lateral Septum-Lateral Hypothalamus Circuit Dysfunction in Comorbid Pain and Anxiety. Molecular Psychiatry, 28, 1090-1100. [Google Scholar] [CrossRef] [PubMed]
[9] Ferrari, L.F., Pei, J., Zickella, M., Rey, C., Zickella, J., Ramirez, A., et al. (2021) D2 Receptors in the Periaqueductal Gray/Dorsal Raphe Modulate Peripheral Inflammatory Hyperalgesia via the Rostral Ventral Medulla. Neuroscience, 463, 159-173. [Google Scholar] [CrossRef] [PubMed]
[10] Chen, T., Wang, J., Wang, Y. and Chu, Y. (2022) Current Understanding of the Neural Circuitry in the Comorbidity of Chronic Pain and Anxiety. Neural Plasticity, 2022, 1-13. [Google Scholar] [CrossRef] [PubMed]
[11] Havelin, J. and King, T. (2018) Mechanisms Underlying Bone and Joint Pain. Current Osteoporosis Reports, 16, 763-771. [Google Scholar] [CrossRef] [PubMed]
[12] Previtali, D., Bordoni, V., Filardo, G., Marchettini, P., Guerra, E. and Candrian, C. (2021) High Rate of Pain Sensitization in Musculoskeletal Shoulder Diseases: A Systematic Review and Meta-Analysis. The Clinical Journal of Pain, 37, 237-248. [Google Scholar] [CrossRef] [PubMed]
[13] Shyu, B.C., He, A.B., Yu, Y.H. and Huang, A.C.W. (2021) Tricyclic Antidepressants and Selective Serotonin Reuptake Inhibitors but Not Anticonvulsants Ameliorate Pain, Anxiety, and Depression Symptoms in an Animal Model of Central Post-Stroke Pain. Molecular Pain, 17, Article 794264631. [Google Scholar] [CrossRef] [PubMed]
[14] Bharti, V., Tan, H., Deol, J., Wu, Z. and Wang, J. (2020) Upregulation of Antioxidant Thioredoxin by Antidepressants Fluoxetine and Venlafaxine. Psychopharmacology, 237, 127-136. [Google Scholar] [CrossRef] [PubMed]
[15] Verma, V., Singh, N. and Jaggi, A. (2014) Pregabalin in Neuropathic Pain: Evidences and Possible Mechanisms. Current Neuropharmacology, 12, 44-56. [Google Scholar] [CrossRef] [PubMed]
[16] Ferreira, G.E., McLachlan, A.J., Lin, C.C., Zadro, J.R., Abdel-Shaheed, C., O’Keeffe, M., et al. (2021) Efficacy and Safety of Antidepressants for the Treatment of Back Pain and Osteoarthritis: Systematic Review and Meta-Analysis. British Medical Journal, 372, m4825. [Google Scholar] [CrossRef] [PubMed]
[17] Robinson, C., Dalal, S., Chitneni, A., Patil, A., A. Berger, A., Mahmood, S., et al. (2022) A Look at Commonly Utilized Serotonin Noradrenaline Reuptake Inhibitors (SNRIs) in Chronic Pain. Health Psychology Research, 10, Article 32309. [Google Scholar] [CrossRef] [PubMed]
[18] 张霞, 刘士丽, 王翠芹. 选择性5-Ht再摄取抑制剂与5-Ht、Ne再摄取双重抑制剂治疗围绝经期情绪障碍疗效[J]. 中国健康心理学杂志, 2014, 22(12): 1777-1779.
[19] Almeida, O.P., Page, A., Sanfilippo, F.M. and Etherton-Beer, C. (2024) Prospective Association between the Dispensing of Antidepressants and of Medications to Treat Osteoporosis in Older Age. The American Journal of Geriatric Psychiatry, 32, 349-357. [Google Scholar] [CrossRef] [PubMed]
[20] Chou, R., Deyo, R., Friedly, J., Skelly, A., Weimer, M., Fu, R., et al. (2017) Systemic Pharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Annals of Internal Medicine, 166, 480-492. [Google Scholar] [CrossRef] [PubMed]
[21] Tóth, V., Molnár, B. and Gazdag, G. (2020) Survey of Anxiolytic Drug Dependence in Patients Treated in Psychiatric and Addiction Rehabilitation Wards. Orvosi Hetilap, 161, 594-600.
[22] Muraoka, H. and Inada, K. (2023) Anxiolytics: Appropriate Use of Benzodiazepine Receptor Agonists. Brain Nerve, 75, 585-590.
[23] Aydın, Ş., Kılıç, T.C., Çivgin, M.E., Yazıcı, Z.G., et al. (2023) The Investigation of Antidepressant and Anxiolytic Effects of Pregabalin and Its Mechanisms of Action in Rats. Ağrı—The Journal of The Turkish Society of Algology, 35, 236-243. [Google Scholar] [CrossRef] [PubMed]
[24] 杨乃艳, 李顺华. 丁螺环酮联合帕罗西汀治疗焦虑症的有效性研究[J]. 哈尔滨医药, 2020, 40(2): 134-135.
[25] 聂智勇, 鲁玉荣. 丁螺环酮与帕罗西汀联合治疗焦虑症的临床效果观察及对患者精神状态的影响[J]. 中国社区医师, 2021, 37(26): 41-42.
[26] Dowell, D., Ragan, K.R., Jones, C.M., Baldwin, G.T. and Chou, R. (2022) CDC Clinical Practice Guideline for Prescribing Opioids for Pain—United States, 2022. MMWR Recommendations and Reports, 71, 1-95. [Google Scholar] [CrossRef] [PubMed]
[27] Sanabria-Mazo, J.P., Colomer-Carbonell, A., Fernández-Vázquez, Ó., Noboa-Rocamora, G., Cardona-Ros, G., McCracken, L.M., et al. (2023) A Systematic Review of Cognitive Behavioral Therapy-Based Interventions for Comorbid Chronic Pain and Clinically Relevant Psychological Distress. Frontiers in Psychology, 14, Article 1200685. [Google Scholar] [CrossRef] [PubMed]
[28] National Institute for Health and Care Excellence (2021) Chronic Pain (Primary and Secondary) in over 16s: Assessment of All Chronic Pain and Management of Chronic Primary Pain: NICE Guideline NG193.
[29] Anheyer, D., Haller, H., Barth, J., Lauche, R., Dobos, G. and Cramer, H. (2017) Mindfulness-Based Stress Reduction for Treating Low Back Pain: A Systematic Review and Meta-Analysis. Annals of Internal Medicine, 166, 799-807. [Google Scholar] [CrossRef] [PubMed]
[30] National Institute for Health and Care Excellence (2022) Osteoarthritis in over 16s: Diagnosis and Management: NICE Guideline NG226.

为你推荐