Chichorro Juliana Geremias, Porreca Frank, Sessle Barry
1 Departamento de Farmacologia, Universidade Federal do Parana - UFPR Setor de Ciências Biológicas, Curitiba, PR, Brasil.
2 Department of Pharmacology, University of Arizona, Tucson, AZ, USA.
Cephalalgia. 2017 Jun;37(7):613-626. doi: 10.1177/0333102417704187. Epub 2017 Apr 25.
Aim To provide an overview of mechanisms underlying craniofacial pain; to highlight peripheral and central adaptations that may promote chronification of pain in craniofacial pain states such as migraine and temporomandibular disorders (TMD). Background Pain is a common symptom associated with disorders involving craniofacial tissues including the teeth and their supporting structures, the temporomandibular joint and the muscles of the head. Most acute painful craniofacial conditions are easily recognized and well managed, but others, especially those that are chronic (e.g., migraine, TMD and trigeminal neuropathies), present clinical challenges. Preclinical studies have provided substantial information about the anatomical and physiological mechanisms related to the initiation and modulation of nociceptive signals in the trigeminal system. While knowledge of the mechanisms underlying chronic craniofacial pain remains limited, both clinical and preclinical investigations suggest that changes in afferent inputs to the brain as well as in brain structure and modulatory pathways occur in chronic pain. Collectively, these changes result in amplification of nociception that promotes and sustains craniofacial chronic pain states. Conclusions The increased understanding gained of the physiological and pathological processing of nociception in the trigeminal system has provided new perspectives for the mechanistic understanding of acute craniofacial pain conditions and the peripheral and central adaptations that are related to pain chronification. Such knowledge may contribute to improvements in currently available treatments as well as to the development of novel analgesic therapies.
目的 概述颅面部疼痛的潜在机制；强调在偏头痛和颞下颌关节紊乱病（TMD）等颅面部疼痛状态下可能促进疼痛慢性化的外周和中枢适应性变化。背景 疼痛是与涉及颅面部组织（包括牙齿及其支持结构、颞下颌关节和头部肌肉）的疾病相关的常见症状。大多数急性颅面部疼痛情况易于识别且管理良好，但其他情况，尤其是慢性疼痛（如偏头痛、TMD和三叉神经病变），则带来临床挑战。临床前研究已经提供了大量关于三叉神经系统中伤害性信号起始和调节相关的解剖学和生理学机制的信息。虽然慢性颅面部疼痛的潜在机制的知识仍然有限，但临床和临床前研究均表明，慢性疼痛中大脑的传入输入以及大脑结构和调节通路会发生变化。总体而言，这些变化导致伤害感受的放大，从而促进和维持颅面部慢性疼痛状态。结论 对三叉神经系统中伤害感受的生理和病理过程的深入理解，为急性颅面部疼痛情况以及与疼痛慢性化相关的外周和中枢适应性变化的机制理解提供了新的视角。这些知识可能有助于改进现有治疗方法以及开发新的镇痛疗法。
