Dimcevski Georg, Staahl Camilla, Andersen Søren Due, Thorsgaard Niels, Funch-Jensen Peter, Arendt-Nielsen Lars, Drewes Asbjørn Mohr
Department of Medical Gastroenterology, Haukeland University Hospital, Bergen, Norway.
Pancreas. 2007 Jul;35(1):22-9. doi: 10.1097/mpa.0b013e31805c1762.
Comprehensive experimental methods are of major relevance assessing pain mechanisms in patients with chronic pain. Chronic pancreatitis is thought to involve the sensory response in other visceral organs and somatic tissue. We, therefore, aimed at exploring the pain mechanisms in chronic pancreatitis (CP) using a multimodal and multitissue stimulation approach.
Ten patients (mean age, 50 years) with CP and 13 healthy controls (mean age, 35 years) participated. None of the patients took analgesics regularly. All were exposed to multimodal (mechanical, thermal, and electrical) experimental pain in the skin, muscles, and esophagus.
The patients were hyposensitive to mechanical stimulations of the skin (P = 0.001), but there were no differences in the pain to thermal and electrical stimulations. In the muscle and esophagus, no differences in pain thresholds were found. The difference between single and repeated stimulations reflecting the degree of central sensitization was 17% in controls and 36% in patients (P = 0.001). The referred pain area to electrical stimulation was 30.1 cm2 in the patients and 7.7 cm2 for the controls (P = 0.02).
The findings suggest that the balance among central hyperexcitability, neuroplastic changes, and descending pain-modulating pathways may explain the pain response to experimental multimodal stimulations in CP. This will likely also reflect the clinical pain mechanisms and may have important impact in selection of treatment, where drugs with potential effects on these mechanisms should be used.
综合实验方法对于评估慢性疼痛患者的疼痛机制具有重要意义。慢性胰腺炎被认为涉及其他内脏器官和躯体组织的感觉反应。因此，我们旨在采用多模式、多组织刺激方法探索慢性胰腺炎（CP）的疼痛机制。
10例CP患者（平均年龄50岁）和13名健康对照者（平均年龄35岁）参与研究。所有患者均未规律服用镇痛药。所有人均接受皮肤、肌肉和食管的多模式（机械、热和电）实验性疼痛刺激。
患者对皮肤的机械刺激反应迟钝（P = 0.001），但对热刺激和电刺激的疼痛反应无差异。在肌肉和食管方面，疼痛阈值未发现差异。反映中枢敏化程度的单次刺激与重复刺激之间的差异在对照组为17%，在患者组为36%（P = 0.001）。患者对电刺激的牵涉痛面积为30.1平方厘米，对照组为7.7平方厘米（P = 0.02）。
研究结果表明，中枢性过度兴奋、神经可塑性变化和下行性疼痛调节通路之间的平衡可能解释了CP患者对实验性多模式刺激的疼痛反应。这可能也反映了临床疼痛机制，并且可能对治疗选择产生重要影响，即应使用对这些机制有潜在作用的药物。
