Artesis University College Antwerp, Antwerp, Belgium.
Expert Opin Pharmacother. 2011 May;12(7):1087-98. doi: 10.1517/14656566.2011.547475. Epub 2011 Jan 22.
Central sensitization accounts for chronic 'unexplained' pain in a wide variety of disorders, including chronic whiplash-associated disorders, temporomandibular disorders, chronic low back pain, osteoarthritis, fibromyalgia, chronic fatigue syndrome and chronic tension-type headache among others. Given the increasing evidence supporting the clinical significance of central sensitization in those with unexplained chronic pain, the awareness is growing that central sensitization should be a treatment target in these patients.
This article provides an overview of the treatment options available for desensitizing the CNS in patients with chronic pain due to central sensitization. It focuses on those strategies that specifically target pathophysiological mechanisms known to be involved in central sensitization. In addition, pharmacological options, rehabilitation and neurotechnology options are discussed.
Acetaminophen, serotonin-reuptake inhibitor drugs, selective and balanced serototin and norepinephrine-reuptake inhibitor drugs, the serotonin precursor tryptophan, opioids, N-methyl-d-aspartate (NMDA)-receptor antagonists, calcium-channel alpha(2)delta (a2δ) ligands, transcranial magnetic stimulation, transcutaneous electric nerve stimulation (TENS), manual therapy and stress management each target central pain processing mechanisms in animals that - theoretically - desensitize the CNS in humans. To provide a comprehensive treatment for 'unexplained' chronic pain disorders characterized by central sensitization, it is advocated to combine the best evidence available with treatment modalities known to target central sensitization.
中枢敏化解释了多种疾病中的慢性“不明原因”疼痛，包括慢性挥鞭样损伤相关疾病、颞下颌关节紊乱、慢性下背痛、骨关节炎、纤维肌痛、慢性疲劳综合征和慢性紧张型头痛等。鉴于越来越多的证据支持中枢敏化在不明原因慢性疼痛患者中的临床意义，人们越来越意识到中枢敏化应该成为这些患者的治疗目标。
本文概述了针对中枢敏化引起的慢性疼痛患者中枢神经系统脱敏的可用治疗选择。它侧重于那些专门针对已知与中枢敏化相关的病理生理机制的策略。此外，还讨论了药理学选择、康复和神经技术选择。
对乙酰氨基酚、5-羟色胺再摄取抑制剂药物、选择性和平衡的 5-羟色胺和去甲肾上腺素再摄取抑制剂药物、5-羟色胺前体色氨酸、阿片类药物、N-甲基-D-天冬氨酸（NMDA）-受体拮抗剂、钙通道α2δ（a2δ）配体、经颅磁刺激、经皮神经电刺激（TENS）、手法治疗和压力管理，在动物中针对中枢疼痛处理机制，这些机制理论上可使人类中枢神经系统脱敏。为了为以中枢敏化为特征的“不明原因”慢性疼痛疾病提供全面的治疗，提倡将针对中枢敏化的已知治疗模式与现有的最佳证据相结合。
