Argoff Charles E
Cohn Pain Management Center, North Shore University Hospital, New York University School of Medicine, Bethpage, New York 11714, USA.
Clin J Pain. 2002 Nov-Dec;18(6 Suppl):S177-81. doi: 10.1097/00002508-200211001-00010.
Understanding the pathophysiology of a pain syndrome is helpful in selecting appropriate treatment strategies. Nociceptive pain is related to damage to tissues due to thermal, chemical, mechanical, or other types of irritants. Neuropathic pain results from injury to the peripheral or central nervous system. Common examples of neuropathic pain include postherpetic neuralgia, diabetic neuropathy, complex regional pain syndrome, and pain associated with spinal cord injuries. Nociceptive pain may have similar clinical characteristics to neuropathic pain. It is also possible for acute nociceptive pain to become neuropathic in nature, as with myofascial pain syndrome. A clear benefit of botulinum toxin therapy for treatment of neuropathic pain disorders is that it often relieves pain symptoms. Although the precise mechanism of pain relief is not completely understood, the injection of botulinum toxin may reduce various substances that sensitize nociceptors. As a result, botulinum toxin types A and B are now being actively studied in nociceptive and neuropathic pain disorders to better define their roles as analgesics.
了解疼痛综合征的病理生理学有助于选择合适的治疗策略。伤害性疼痛与热、化学、机械或其他类型的刺激物对组织造成的损伤有关。神经性疼痛源于外周或中枢神经系统的损伤。神经性疼痛的常见例子包括带状疱疹后神经痛、糖尿病性神经病变、复杂性区域疼痛综合征以及与脊髓损伤相关的疼痛。伤害性疼痛可能具有与神经性疼痛相似的临床特征。急性伤害性疼痛也有可能转变为神经性疼痛，如肌筋膜疼痛综合征。肉毒毒素疗法治疗神经性疼痛疾病的一个明显益处是它通常能缓解疼痛症状。尽管疼痛缓解的确切机制尚未完全明确，但注射肉毒毒素可能会减少各种使伤害感受器敏感化的物质。因此，目前正在对A型和B型肉毒毒素在伤害性和神经性疼痛疾病中的应用进行积极研究，以更好地明确它们作为镇痛药的作用。
