Nijs Jo, Malfliet Anneleen, Ickmans Kelly, Baert Isabel, Meeus Mira
Pain in Motion Research Group , Brussels , Belgium.
Expert Opin Pharmacother. 2014 Aug;15(12):1671-83. doi: 10.1517/14656566.2014.925446. Epub 2014 Jun 15.
Central sensitization (CS) is present in a variety of chronic pain disorders, including whiplash, temporomandibular disorders, low back pain, osteoarthritis, fibromyalgia, headache, lateral epicondylalgia among others. In spite of our increased understanding of the mechanisms involved in CS pain, its treatment remains a challenging issue.
An overview of the treatment options we have for desensitising the CNS in patients with CS pain is provided. These include strategies for eliminating peripheral sources of nociception, as well as pharmacotherapy and conservative interventions that primarily address top-down (i.e., brain-orchestrated) mechanisms.
A combination of different strategies, each targeting a different 'desensitizing' mechanism, might prove superior over monotherapies. Such combined therapy may include both bottom-up and top-down (e.g., opioids, combined μ-opioid receptor agonist and noradrenaline reuptake inhibitor drugs) strategies. Topically applied analgesic therapies have strong potential for (temporally) decreasing peripheral nociceptive input (bottom-up approach). Targeting metabolic (e.g., ketogenic diets) and neurotrophic factors (e.g., decreasing brain-derived neurotrophic factor) are promising new avenues for diminishing hyperexcitability of the CNS in central sensitization pain patients. Addressing conservative treatments, pain neuroscience education, cognitive behavioural therapy and exercise therapy are promising treatments for CS pain.
中枢敏化（CS）存在于多种慢性疼痛疾病中，包括鞭打损伤、颞下颌关节紊乱、腰痛、骨关节炎、纤维肌痛、头痛、外侧上髁炎等。尽管我们对CS疼痛所涉及的机制有了更多了解，但其治疗仍然是一个具有挑战性的问题。
本文概述了我们针对CS疼痛患者使中枢神经系统脱敏的治疗选择。这些包括消除伤害性感受外周来源的策略，以及主要针对自上而下（即大脑协调）机制的药物治疗和保守干预措施。
不同策略的组合，每种策略针对不同的“脱敏”机制，可能比单一疗法更具优势。这种联合治疗可能包括自下而上和自上而下（例如阿片类药物、μ-阿片受体激动剂和去甲肾上腺素再摄取抑制剂联合药物）策略。局部应用的镇痛疗法在（暂时）减少外周伤害性输入（自下而上方法）方面具有很大潜力。针对代谢（如生酮饮食）和神经营养因子（如减少脑源性神经营养因子）是减少中枢敏化疼痛患者中枢神经系统过度兴奋性的有前景的新途径。在保守治疗方面，疼痛神经科学教育、认知行为疗法和运动疗法是治疗CS疼痛的有前景的方法。
