Med Hypotheses. 2012 Jan;78(1):79-85. doi: 10.1016/j.mehy.2011.09.045. Epub 2011 Oct 21.
The neuroscientific understanding of chronic pain presented evolved through the integration of clinical, research and theoretical conceptualizations associated with chronic idiopathic orofacial pain after posing the following three questions: (1) What if chronic idiopathic orofacial pain was viewed from a neuroscientific perspective as part of a global syndrome rather than a site-specific anatomo-physiological perspective? (2) What if it was assumed that rather than serving no useful purpose chronic idiopathic orofacial pain served a useful purpose? (3) Would current knowledge be sufficient to explain chronic idiopathic orofacial pain? The understanding defines chronic pain as being a centrally perceived event expressing the continual or episodic persistence of a level of peripheral and/or central neural activity above the pain threshold of a sensitized nervous system that is sufficient to maintain the sensitization. This ongoing neural activity may be associated with or independent of the neural activity that initiated the sensitization. In effect the nervous system is "bruised" and the "bruising" is being maintained (prodded) by the total neural activity of the system irrespective of its origin; the normal protective healing function of the nervous system, pain, continues its warning when the activity of the system activates the switch that is the pain threshold. The common clinical history of initial trauma and ongoing stress suggests that chronic pain might be thought of as an expression of post-traumatic stress. Treatment based on the presented understanding would aim to reduce and maintain total neural activity below the pain threshold level and ideally down to where the sensitization can be reduced or even resolved by neuroplastic processes, the level rather than the origin of neural activity being relevant to the pain mitigation. A review of chronic pain in the light of this understanding will provide the opportunity to formulate, test and refine new and existing strategies for its prevention and treatment, thereby offering hope to the millions of sufferers worldwide.
从神经科学角度理解慢性疼痛是通过整合与慢性特发性或面部疼痛相关的临床、研究和理论概念而发展起来的，这些概念提出了以下三个问题：（1）如果将慢性特发性或面部疼痛视为全身性综合征的一部分，而不是特定部位的解剖生理观点，会怎样？（2）如果假设慢性特发性或面部疼痛并非毫无用处，而是有一定用处，会怎样？（3）当前的知识是否足以解释慢性特发性或面部疼痛？这种理解将慢性疼痛定义为一种中枢感知事件，表现为外周和/或中枢神经活动持续或间歇性地高于敏化神经系统的疼痛阈值，足以维持敏化。这种持续的神经活动可能与引发敏化的神经活动有关，也可能无关。实际上，神经系统“受伤”了，而这种“受伤”是由系统的总神经活动维持的（刺激），而不管其起源如何；神经系统的正常保护愈合功能，即疼痛，会继续发出警告，当系统的活动激活疼痛阈值的开关时。初始创伤和持续压力的常见临床病史表明，慢性疼痛可能被视为创伤后应激的一种表现。基于所提出的理解的治疗方法将旨在降低和维持总神经活动低于疼痛阈值水平，理想情况下降至敏化可以通过神经可塑性过程降低甚至解决的水平，而不是神经活动的起源与疼痛缓解相关。从这一理解出发对慢性疼痛进行审查，将有机会制定、测试和完善预防和治疗慢性疼痛的新策略和现有策略，从而为全世界数以百万计的疼痛患者带来希望。
