Cahana A, Jones D
Programme antalgie postopératoire et interventionnelle, département d'anesthésiologie, hôpitaux universitaires de Genève, Genève, Switzerland.
Ann Fr Anesth Reanim. 2007 Jun;26(6):540-5. doi: 10.1016/j.annfar.2007.03.021. Epub 2007 May 23.
Reviewing the development of nociceptive circuits provides the rationale behind the need to modify and reduce premature painful experiences, especially during the "plastic" neonatal phase. Indeed, if physiological mechanisms of the functional nociceptive system follow a harmonious and predetermined development, it is the individual personal experience, intrinsically random, which will shape the final reactivity of this system and the later painful experience. If pain would not have been the organism's alarm system, we could have simply compared it by analogy to other sensorial systems, which its development depends exclusively on the presence of environmental stimuli. The eyes wait for light, the ears for sound, the skin to be touched, the tongue to taste and the olfactory bulbs to smell. However with pain it is not the quantitative exposure that determines its development, but rather the context-laden aspects of its affliction which in turn create the complex experience and "memory" of pain. Prolonged, but also "unnecessary" exposure to pain transforms it into a futile sensation, which impacts the individual immediately but also resonates into its future. This article reviews recent neurobiological mechanisms (such as neural circuitry, neurotrophins, peripheral and central sensitization, inhibitory pathways) now known to develop during the chronicisation and apprenticing of pain in the growing individual. Its cognizance is vital for a better comprehension of adult pain.
回顾伤害性感受回路的发展历程,有助于理解为何有必要改变并减少过早出现的疼痛体验,尤其是在新生儿这一具有“可塑性”的阶段。事实上,如果功能性伤害感受系统的生理机制遵循和谐且预先确定的发展路径,那么塑造该系统最终反应性及后续疼痛体验的,将是个体内在随机的个人经历。倘若疼痛并非生物体的警报系统,我们或许可以简单地将其与其他感觉系统进行类比,因为其他感觉系统的发育完全依赖于环境刺激的存在。眼睛等待光线,耳朵等待声音,皮肤等待触摸,舌头等待品尝,嗅球等待嗅觉刺激。然而,对于疼痛而言,决定其发展的并非刺激的数量,而是疼痛折磨中与情境相关的方面,这些方面进而塑造了复杂的疼痛体验和“记忆”。长期且“不必要”的疼痛暴露会将其转化为一种徒劳的感觉,这种感觉不仅会立即影响个体,还会在其未来产生回响。本文回顾了目前已知的在成长个体疼痛慢性化和形成过程中发挥作用的神经生物学机制(如神经回路、神经营养因子、外周和中枢敏化、抑制性通路)。了解这些机制对于更好地理解成人疼痛至关重要。