Fitzgerald Maria, McKelvey Rebecca
Department of Neuroscience, Physiology & Pharmacology, University College London, London WC1E 6BT, United Kingdom.
Exp Neurol. 2016 Jan;275 Pt 2:296-302. doi: 10.1016/j.expneurol.2015.07.013. Epub 2015 Jul 26.
The effects of peripheral nerve injury on somatosensory processing and pain are highly dependent upon the age at which the damage occurs. Adult nerve injury rapidly triggers neuropathic pain, but this is not so if the same nerve injury is performed in animals below postnatal day (P) 28, consistent with observations in paediatric patients. However, longitudinal studies show that pain hypersensitivity emerges later in life, when the animal reaches adolescence, an observation that could be of clinical importance. Here we discuss the evidence that the central consequences of nerve damage are critically determined by the status of neuroimmune regulation at different ages. In the first postnatal weeks, when spinal somatosensory circuits are undergoing synaptic reorganisation, the 'default' neuroimmune response is skewed in an anti-inflammatory direction, suppressing the excitation of dorsal horn neurons and preventing the onset of neuropathic pain. As animals grow up and the central nervous system matures, the neuroimmune profile shifts in a pro-inflammatory direction, unmasking a 'latent' pain response to an earlier nerve injury. The data predicts that nerve injury in infancy and childhood could go unnoticed at the time, but emerge as clinically 'unexplained' or 'functional' pain in adolescence.
周围神经损伤对躯体感觉处理和疼痛的影响高度依赖于损伤发生时的年龄。成年神经损伤会迅速引发神经性疼痛,但如果在出生后第28天(P28)以下的动物身上进行同样的神经损伤,则情况并非如此,这与儿科患者的观察结果一致。然而,纵向研究表明,当动物进入青春期时,疼痛超敏反应会在生命后期出现,这一观察结果可能具有临床重要性。在这里,我们讨论了神经损伤的中枢后果在不同年龄由神经免疫调节状态关键决定的证据。在出生后的最初几周,当脊髓躯体感觉回路正在进行突触重组时,“默认”的神经免疫反应偏向抗炎方向,抑制背角神经元的兴奋并防止神经性疼痛的发作。随着动物成长和中枢神经系统成熟,神经免疫特征向促炎方向转变,揭示了对早期神经损伤的“潜在”疼痛反应。数据预测,婴儿期和儿童期的神经损伤当时可能未被注意到,但在青春期会表现为临床上“无法解释的”或“功能性的”疼痛。