Giamberardino MA
Pathophysiology of Pain Laboratory, Department of Medicine and Science of Aging, 'G. D'Annunzio' University of Chieti, Chieti, Italy
Eur J Pain. 1999 Jun;3(2):77-92. doi: 10.1053/eujp.1999.0117.
Progress in the field of visceral pain research has been particularly rapid in recent years. Some aspects of the symptom that had previously been neglected for some time have now received a great deal of attention in both clinical and experimental studies. This regards, in particular, phenomena of hyperalgesia: (a) of visceral structures, because of local inflammatory/sensitizing processes (visceral hyperalgesia); (b) of areas of referred pain from viscera (referred somatic hyperalgesia from viscera); and (c) of a visceral structure, because of an algogenic process of another visceral domain (viscero-visceral hyperalgesia). Clinical studies in patients have led to characterisation of subjective and objective symptoms of these phenomena. A number of studies in human volunteers (employing experimental procedures to stimulate and measure pain reactivity in both visceral structures and somatic areas of referral) have further increased the knowledge about modalities of generation of the various forms of hyperalgesia.Animal experiments have improved understanding of pathophysiological mechanisms, mostly those underlying the referred hyperalgesia, with a number of findings supporting the notion of central changes at the basis of the phenomenon. An important aspect of laboratory experiments in recent years has been the setting up of animal models of visceral pain conditions closely mimicking a number of clinical pain states in patients. As a result, the outcome of experimental studies (electrophysiological, pharmacological, etc.) appears more directly applicable to the interpretation of the clinical reality.Finally, in the context of laboratory studies, a novel trend of investigation is represented by genetic experiments, particularly those employing 'knock-out' mice. These experiments, by generating animals lacking specific genes responsible for the production of various receptors implicated in pain transmission, have further contributed to the understanding of the generation of visceral pain symptoms. Although studies in this field are in their early stage, they seem particularly promising for a better understanding of the pathophysiology of visceral pain, and thus the establishment of more satisfying therapies in the future. Copyright 1999 European Federation of Chapters of the International Association for the Study of Pain.
近年来，内脏痛研究领域进展尤为迅速。该症状先前被忽视一段时间的某些方面，如今在临床和实验研究中都受到了大量关注。这尤其涉及痛觉过敏现象：(a) 由于局部炎症/致敏过程导致的内脏结构痛觉过敏（内脏性痛觉过敏）；(b) 内脏牵涉痛区域的痛觉过敏（内脏性牵涉性躯体痛觉过敏）；以及 (c) 由于另一内脏区域的致痛过程导致的某一内脏结构痛觉过敏（内脏-内脏性痛觉过敏）。对患者的临床研究已对这些现象的主观和客观症状进行了特征描述。在人类志愿者中进行的一些研究（采用实验程序刺激并测量内脏结构和牵涉躯体区域的疼痛反应性）进一步增加了对各种形式痛觉过敏产生方式的认识。动物实验增进了对病理生理机制的理解，主要是牵涉性痛觉过敏的潜在机制，许多研究结果支持了该现象基于中枢变化的观点。近年来实验室实验的一个重要方面是建立了紧密模拟患者多种临床疼痛状态的内脏痛动物模型。因此，实验研究（电生理、药理学等）的结果似乎更直接适用于临床实际情况的解释。最后，在实验室研究背景下，一种新的研究趋势以基因实验为代表，尤其是那些使用“基因敲除”小鼠的实验。这些实验通过培育缺乏负责产生参与疼痛传递的各种受体的特定基因的动物，进一步有助于理解内脏痛症状的产生。尽管该领域的研究尚处于早期阶段，但它们似乎对更好地理解内脏痛的病理生理学特别有前景，从而有望在未来建立更令人满意的治疗方法。版权所有 1999 年国际疼痛研究协会欧洲分会联合会。
