Fregni Felipe, Pascual-Leone Alvaro, Freedman Steven D
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Pancreatology. 2007;7(5-6):411-22. doi: 10.1159/000108958. Epub 2007 Sep 25.
Pain in chronic pancreatitis is frequently refractory to medical and even surgical treatment. This refractoriness leads us to believe that a pancreas-independent, brain-mediated mechanism must be responsible. If so, several scenarios are worth considering. First, chronic pain could be the consequence of undesirable neuroplastic changes, by which pathology becomes established and causes disability. Alternatively, pain may be linked to the salutogenic (from salutogenesis, the Latin word for health and well-being) central nervous system response (we defined 'salutogenic response' as the specific modulation of the immune system induced by brain activity changes) to promote healing of the injured viscera. If so, chronic pain could index the ongoing nervous system attempt to promote healing. In this review, we discuss (1) the mechanisms of pain in chronic pancreatitis; (2) potential brain-related salutogenic mechanisms, and (3) the potential relationship of these two factors to the disease status. Furthermore, we consider these aspects in light of a new approach to treat visceral pain: transcranial magnetic stimulation, a noninvasive method of brain stimulation.
慢性胰腺炎的疼痛往往对药物治疗甚至手术治疗都难以奏效。这种难治性让我们相信，一定存在一种不依赖胰腺、由大脑介导的机制在起作用。如果是这样，有几种情况值得考虑。首先，慢性疼痛可能是不良神经可塑性变化的结果，病理状态借此形成并导致功能障碍。或者，疼痛可能与促健康的（源自“促健康”一词，在拉丁语中表示健康和幸福）中枢神经系统反应有关（我们将“促健康反应”定义为由大脑活动变化引起的免疫系统的特定调节），以促进受损内脏的愈合。如果是这样，慢性疼痛可能表明神经系统正在尝试促进愈合。在这篇综述中，我们讨论了：（1）慢性胰腺炎疼痛的机制；（2）潜在的与大脑相关的促健康机制；（3）这两个因素与疾病状态之间的潜在关系。此外，我们根据一种治疗内脏疼痛的新方法——经颅磁刺激（一种非侵入性的脑刺激方法）来探讨这些方面。
