Background
fatigue, anxiety, depression, pain, cough, psychiatric, chronic pain
ADVERSE REACTIONS, DISORDERS, CHRONIC PAIN, PATHOLOGY, COMPLICATIONS
Refractory cough is a chronic cough with unclear diagnosis or with a definite diagnosis but poor curative effect. The diagnosis and treatment process recommended by the existing cough guidelines requires that on the basis of careful medical history inquiry and physical examination, necessary auxiliary examinations be selected to identify the cause of chronic cough, and the treatment response to the cause should be determined to confirm or exclude the diagnosis. Sometimes, even after a comprehensive auxiliary examination, the cause of cough cannot be identified, or although the cause can be identified, there is no effective treatment or no good treatment response, resulting in stubborn or persistent cough symptoms. All of the above are refractory coughs [The cough sensitivity of patients with chronic cough is significantly higher than that of normal people, and it has obvious homology with the basic neurobiological mechanism and pathology of chronic pain [As a selective 5-hydroxytryptamine (5-HT) and norepinephrine (NE) reuptake inhibitor, duloxetine is a strong neuronal 5-HT and NE reuptake inhibitor that has a relatively weak inhibitory effect on dopamine reuptake. It is well tolerated, has few adverse reactions, and has been widely used in pain treatment [In addition to possibly improving cough symptoms, the antidepressant effects of 5-HT and NE reuptake inhibitors may also play a role in the treatment of refractory cough. Psychological symptoms are interrelated with cough severity and quality of life. Chronic cough seriously affects the quality of life of patients, causing fatigue, sleep deprivation, and social withdrawal, leading to increased complications of psychiatric disorders such as anxiety and depression. These psychological problems may affect their perception of symptoms and are associated with decreased treatment adherence and slower response to treatment. French et al. found that symptoms of depression, anxiety, and stress also gradually improved when cough symptoms were relieved. They believed that psychological factors, symptom experience, and daily functions interacted and influenced each other, so the authors proposed that intervention on the psychological state may also help improve somatic symptoms and quality of life [