Sektion Neurologische Schmerzforschung und -therapie, Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany.
PLoS One. 2011 May 9;6(5):e18018. doi: 10.1371/journal.pone.0018018.
Painful radiculopathies (RAD) and classical neuropathic pain syndromes (painful diabetic polyneuropathy, postherpetic neuralgia) show differences how the patients express their sensory perceptions. Furthermore, several clinical trials with neuropathic pain medications failed in painful radiculopathy. Epidemiological and clinical data of 2094 patients with painful radiculopathy were collected within a cross sectional survey (painDETECT) to describe demographic data and co-morbidities and to detect characteristic sensory abnormalities in patients with RAD and compare them with other neuropathic pain syndromes. Common co-morbidities in neuropathic pain (depression, sleep disturbance, anxiety) do not differ considerably between the three conditions. Compared to other neuropathic pain syndromes touch-evoked allodynia and thermal hyperalgesia are relatively uncommon in RAD. One distinct sensory symptom pattern (sensory profile), i.e., severe painful attacks and pressure induced pain in combination with mild spontaneous pain, mild mechanical allodynia and thermal hyperalgesia, was found to be characteristic for RAD. Despite similarities in sensory symptoms there are two important differences between RAD and other neuropathic pain disorders: (1) The paucity of mechanical allodynia and thermal hyperalgesia might be explained by the fact that the site of the nerve lesion in RAD is often located proximal to the dorsal root ganglion. (2) The distinct sensory profile found in RAD might be explained by compression-induced ectopic discharges from a dorsal root and not necessarily by nerve damage. These differences in pathogenesis might explain why medications effective in DPN and PHN failed to demonstrate efficacy in RAD.
疼痛性根神经病（RAD）和经典的神经病理性疼痛综合征（痛性糖尿病多发性神经病、带状疱疹后神经痛）在患者表达其感觉感知方面表现出差异。此外，几项针对神经病理性疼痛药物的临床试验在疼痛性根神经病中失败了。在一项横断面调查（疼痛 DETECT）中收集了 2094 例疼痛性根神经病患者的流行病学和临床数据，以描述人口统计学数据和合并症，并检测 RAD 患者的特征性感觉异常，并将其与其他神经病理性疼痛综合征进行比较。神经病理性疼痛的常见合并症（抑郁、睡眠障碍、焦虑）在这三种情况下并没有明显的差异。与其他神经病理性疼痛综合征相比，触诱发痛和热痛觉过敏在 RAD 中相对不常见。发现一种独特的感觉症状模式（感觉特征），即严重的疼痛发作和压力引起的疼痛与轻度自发性疼痛、轻度机械性痛觉过敏和热痛觉过敏相结合，是 RAD 的特征。尽管感觉症状相似，但 RAD 和其他神经病理性疼痛障碍之间有两个重要区别：（1）机械性痛觉过敏和热痛觉过敏的缺乏可能是由于 RAD 中神经病变的部位通常位于背根神经节近端。（2）在 RAD 中发现的独特感觉特征可能是由于背根的压迫引起的异位放电引起的，而不一定是由神经损伤引起的。这些发病机制的差异可能解释了为什么在 DPN 和 PHN 中有效的药物在 RAD 中未能显示出疗效。
