Gennari C
Institute of Internal Medicine, University of Siena, Siena, Italy.
Bone. 2002 May;30(5 Suppl):67S-70S. doi: 10.1016/s8756-3282(02)00713-5.
Bone pain is the most common symptom in osteoporotic patients. To date, there is mounting evidence that calcitonin significantly reduces bone pain in osteoporosis, and that the analgesic effect can be evident as soon as the second week of treatment. The limitations to the use of calcitonin, which are parenteral administration and side effects, can now be overcome by the availability of the nasal spray preparation. At present, controlled studies have demonstrated the analgesic activity of calcitonin given by nasal spray in patients with vertebral crush fractures and bone pain. The mechanism for the analgesic effect of calcitonin is yet to be clarified. In humans, similarities between calcitonin and morphine-induced analgesia, and reports of calcitonin-induced elevation of plasma beta-endorphin levels, suggest the possible involvement of the endogenous opiate system in mediating the analgesic action of calcitonin. However, the demonstration of calcitonin binding sites in areas of the brain involved in pain perception and a series of animal studies have raised the possibility that calcitonin may directly modulate nociception in the central nervous system. In support of this hypothesis are some observations of an analgesic effect obtained by direct epidural or subaracnoidal injection of calcitonin in humans.
骨痛是骨质疏松症患者最常见的症状。迄今为止，越来越多的证据表明，降钙素能显著减轻骨质疏松症患者的骨痛，且在治疗的第二周止痛效果就可能明显显现。降钙素使用方面的局限，即需要肠胃外给药和存在副作用，如今可通过鼻喷雾剂制剂的出现而克服。目前，对照研究已证实，鼻用喷雾剂降钙素对椎体压缩性骨折和骨痛患者具有止痛活性。降钙素的止痛作用机制尚待阐明。在人类中，降钙素与吗啡诱导的镇痛作用存在相似性，而且有报道称降钙素可使血浆β-内啡肽水平升高，这表明内源性阿片系统可能参与介导降钙素的止痛作用。然而，在参与痛觉感知的脑区发现降钙素结合位点以及一系列动物研究，都提示降钙素可能直接调节中枢神经系统的伤害感受。在人体中直接硬膜外或蛛网膜下腔注射降钙素可产生止痛效果的一些观察结果支持了这一假说。
