Coderre T J, Katz J
Pain Mechanisms Laboratory, Clinical Research Institute of Montreal, Quebec, Canada.
Behav Brain Sci. 1997 Sep;20(3):404-19; discussion 435-513. doi: 10.1017/s0140525x97251484.
This target article examines the clinical and experimental evidence for a role of peripheral and central hyperexcitability in persistent pain in four key areas: cutaneous hyperalgesia, referred pain, neuropathic pain, and postoperative pain. Each suggests that persistent pain depends not only on central sensitization, but also on inputs from damaged peripheral tissue. It is instructive to think of central sensitization as comprised of both an initial central sensitization and an ongoing central sensitization driven by inputs from peripheral sources. Each of these factors, initial sensitization, ongoing central sensitization, and inputs from peripheral sources, contributes to the net activity in dorsal horn neurons and thus influences the expression of persistent pain or hyperalgesia. Since each factor, peripheral inputs and central sensitization (initial or ongoing), can contribute to both the initiation and maintenance of persistent pain, therapies should target both peripheral and central sources of pathology.
皮肤痛觉过敏、牵涉痛、神经性疼痛和术后疼痛。每一项证据都表明，持续性疼痛不仅取决于中枢敏化，还取决于受损外周组织的输入。将中枢敏化视为既包括初始中枢敏化又包括由外周源输入驱动的持续中枢敏化是很有启发性的。这些因素中的每一个，即初始敏化、持续中枢敏化和外周源输入，都有助于背角神经元的净活动，从而影响持续性疼痛或痛觉过敏的表现。由于每个因素，即外周输入和中枢敏化（初始或持续），都可能导致持续性疼痛的起始和维持，因此治疗应针对外周和中枢的病理根源。
