Department of Anatomy and Cell Biology, Indiana University School of Medicine, Ft. Wayne, Indiana.
Clin Anat. 2014 Apr;27(3):451-4. doi: 10.1002/ca.22120. Epub 2012 Jun 21.
The anatomical understanding of the pain generators in osteoarthritis (OA) is incomplete and the teaching about these pain generators in medical school anatomy/histology courses is minimal. This review covers the nociceptive innervation of synovial joints for the purposes of teaching. Studies that discuss the presence of neuropeptides involved in pain, such as Substance P (SP) and calcitonin-gene-related peptide, are the focus of this review. Nociceptive free-nerve endings and SP staining nerves are found in the accessory ligaments, synovium, subchondral bone, menisci, and periosteum. The vasculature may also play a role in pain generation through vasospasm or ischemia, but this has yet to be proven. Joint denervation may relieve joint pain showing that it is indeed articular nerves that are carrying pain impulses but denervation does not identify the precise source of the pain. It remains unclear which of the anatomical loci of pain generation are primary in OA and if sources of pain vary in different patients and in different joints.
骨关节炎（OA）中疼痛产生器的解剖学理解不完整，医学院解剖学/组织学课程对此类疼痛产生器的教学也很少。本综述涵盖了为教学目的而对滑膜关节的伤害感受性神经支配的研究。本综述的重点是讨论涉及疼痛的神经肽的存在，如 P 物质（SP）和降钙素基因相关肽。伤害性游离神经末梢和 SP 染色神经存在于副韧带、滑膜、软骨下骨、半月板和骨膜中。血管系统也可能通过血管痉挛或缺血在疼痛产生中发挥作用，但这尚未得到证实。关节去神经支配可能会缓解关节疼痛，这表明确实是关节神经传递疼痛冲动，但去神经支配并不能确定疼痛的确切来源。OA 中疼痛产生的解剖学部位中哪些是主要的，以及不同患者和不同关节的疼痛来源是否不同，这些仍不清楚。
