Cahana A, Forster A
Programme d'Antalgie Interventionnelle, Service d'Anesthésiologie Département APSIC, Hôpitaux Universitaires de Genève, Suisse. alex.cahanacuge.ch
Rev Stomatol Chir Maxillofac. 2006 Jun;107(3):156-60. doi: 10.1016/s0035-1768(06)77011-5.
Pain is a complex, multidimensional experience encompassing sensory-discriminative, cognitive, emotional and motivational dimensions. These dimensions in the orofacial region have particular expression since the face and mouth have special biological, emotional and psychological meaning to each individual. Orofacial pain is frequent. Epidemiological studies reveal a high prevalence of severe pain in syndromes such as temporomandibular disorders (TMD), burning mouth syndrome and toothaches, as well as an important role of psychosocial influences, contributing to the persistence of these syndromes. Many of the difficulties experienced by clinicians with the diagnosis and management of acute and chronic orofacial pain stem from a lack of recognition and understanding of these complex conditions, the various intricate bio-psycho-social interactions and the neurobiology behind the chronicisation of acute pain. This text strives to review the important advances and insights into the peripheral processes by which noxious stimuli activates or modulates nociceptive afferent input into the brainstem, the neural pathways in the brainstem and higher levels of the trigeminal (V) somatosensory system and the mechanisms involved in the plasticity of nociceptive transmission. We shall link this knowledge to clinical correlates and suggest a therapeutic approach in acute orofacial pain, in the attempt to avoid the development of chronic pain.
疼痛是一种复杂的多维度体验，涵盖感觉辨别、认知、情感和动机等维度。这些维度在口面部区域有特殊表现，因为面部和口腔对每个人都具有特殊的生物学、情感和心理意义。口面部疼痛很常见。流行病学研究表明，颞下颌关节紊乱症（TMD）、灼口综合征和牙痛等综合征中严重疼痛的患病率很高，并且社会心理影响在这些综合征的持续存在中起着重要作用。临床医生在诊断和管理急性和慢性口面部疼痛时遇到的许多困难，源于对这些复杂病症、各种错综复杂的生物 - 心理 - 社会相互作用以及急性疼痛慢性化背后的神经生物学缺乏认识和理解。本文旨在综述有害刺激激活或调节伤害性传入输入到脑干的外周过程、脑干和三叉神经（V）体感系统更高水平的神经通路以及伤害性传递可塑性所涉及机制的重要进展和见解。我们将把这些知识与临床关联联系起来，并提出急性口面部疼痛的治疗方法，以试图避免慢性疼痛的发生。
