Finnerup Nanna B
Danish Pain Research Center, Aarhus University Hospital, and the Spinal Cord Unit, Viborg Hospital, Denmark.
Curr Opin Anaesthesiol. 2008 Oct;21(5):586-9. doi: 10.1097/ACO.0b013e32830a4c11.
Central neuropathic pain is an important and disabling but often neglected problem following central nervous system lesions. The present review highlights recent advances in the understanding of the underlying mechanisms and in the diagnosis and treatment of central pain.
Within the past year, the field of central pain has moved toward a more integrative understanding of central pain. The involvement of nonneuronal cells and interaction between multiple areas of the central nervous system has been recognized as important in the underlying mechanisms. The interest for conditions other than spinal cord injury, multiple sclerosis, and stroke has increased, and continued discussions on clear clinical diagnostic criteria are needed. The treatment of central pain is still a great challenge, but recent evidence points to tricyclic antidepressants, gabapentin and pregabalin, and selective serotonin-noradrenaline reuptake inhibitors as first-line drugs in central pain. An increased understanding of the psychosocial aspects of central pain also has implications for the treatment.
Increased insight into the mechanisms of central pain will hopefully lead to increased efforts to study mechanism-based treatment of central pain.
中枢性神经病理性疼痛是中枢神经系统损伤后一个重要且致残但常被忽视的问题。本综述重点介绍了在中枢性疼痛潜在机制、诊断和治疗方面的最新进展。
在过去一年里，中枢性疼痛领域朝着对中枢性疼痛更综合的理解发展。非神经元细胞的参与以及中枢神经系统多个区域之间的相互作用在潜在机制中被认为很重要。除脊髓损伤、多发性硬化症和中风之外的其他病症也受到更多关注，并且仍需就明确的临床诊断标准展开持续讨论。中枢性疼痛的治疗仍是一项巨大挑战，但近期证据表明，三环类抗抑郁药、加巴喷丁和普瑞巴林以及选择性5-羟色胺-去甲肾上腺素再摄取抑制剂是中枢性疼痛的一线用药。对中枢性疼痛心理社会方面认识的增加也对治疗有影响。
对中枢性疼痛机制的深入了解有望促使人们加大对基于机制的中枢性疼痛治疗的研究力度。
