Peyron Roland
Service de neurologie, hôpital Nord, CHU de Saint-Etienne, Inserm U1028, CNRL-Lyon, 42277 Saint-Priest-en-Jarez Cedex, France.
Rev Prat. 2013 Jun;63(6):773-8.
Pain is a physiological sensation which aim is to alert for an upcoming danger that may threaten the individual. This system includes peripheral nociceptors that initiate the nociceptive message. Then, the information is conveyed to the brain through the spinothalamic tract that projects to the thalamus, insula, SII and other areas. In clinical situations, a dysfunction of this nociceptive system explains chronic pain that can be simply classified into 3 subtypes according to pathophysiological mechanisms. Case 1: the nociceptive system is functioning normally, and provides (appropriately) a pain message that informs the brain of a local inflammation, or cancer, or infection... This is the situation of chronic pain because of an excess of nociception. Case 2: there is a (past or present) lesion of the nervous system that induces a dysfunction in the pain system. This is the neuropathic pain. Case 3: between the two former cases, there is no evidence for a lesion in the nociceptive system, and there are no evidences for lesion at the peripheral level, but there are evidences of dysregulation(s). These are the cases of dysfunctional pain.
疼痛是一种生理感觉，其目的是对可能威胁个体的即将来临的危险发出警报。该系统包括启动伤害性信息的外周伤害感受器。然后，信息通过投射到丘脑、岛叶、第二躯体感觉区和其他区域的脊髓丘脑束传递到大脑。在临床情况下，这种伤害感受系统的功能障碍解释了慢性疼痛，根据病理生理机制，慢性疼痛可简单分为3种亚型。病例1：伤害感受系统功能正常，并（适当地）传递疼痛信息，告知大脑局部炎症、癌症或感染等情况……这是由于伤害感受过度导致的慢性疼痛情况。病例2：存在（过去或现在的）神经系统损伤，导致疼痛系统功能障碍。这就是神经性疼痛。病例3：在上述两种情况之间，没有证据表明伤害感受系统存在损伤，也没有外周水平损伤的证据，但存在调节异常的证据。这些就是功能障碍性疼痛的病例。
