Cahill Catherine M, Taylor Anna Mw
Department of Anesthesiology and Perioperative Care, University of California, Irvine 837 Health Sciences Road, Irvine, CA 90095, USA.
Department of Biomedical and Molecular Sciences, Queen's University, 5117 Botterell Hall, Kingston, Ontario K7L 3N6, Canada.
Curr Opin Behav Sci. 2017 Feb;13:171-177. doi: 10.1016/j.cobeha.2016.12.003. Epub 2017 Jan 6.
Chronic pain is a disease that encompasses both sensory and emotional elements. Opioids are highly effective analgesics because they target both of these elements, by inhibiting pain pathways and alleviating negative affect (including depression) by engaging reward or hedonic pathways. Unfortunately, chronic opioid use is limited by the development of unwanted side effects, such as tolerance, hyperalgesia, and abuse liability. Thus, the challenge of providing effective pain treatment while minimizing these unwanted side effects is an ongoing issue with significant clinical and societal impact. In this review, we posit that neuroinflammation within the central nervous system is a shared phenomenon between chronic pain and opioids that contributes to pain sensitization and negative affect. The implications for pain progression, addiction liability, and alternative treatment strategies are discussed.
慢性疼痛是一种包含感觉和情感因素的疾病。阿片类药物是高效镇痛药,因为它们通过抑制疼痛通路并通过激活奖赏或享乐通路减轻负面影响(包括抑郁)来针对这两个因素。不幸的是,长期使用阿片类药物受到诸如耐受性、痛觉过敏和滥用倾向等不良副作用的限制。因此,在尽量减少这些不良副作用的同时提供有效的疼痛治疗这一挑战是一个持续存在的问题,具有重大的临床和社会影响。在本综述中,我们认为中枢神经系统内的神经炎症是慢性疼痛和阿片类药物之间的一个共同现象,它会导致疼痛敏化和负面影响。文中讨论了对疼痛进展、成瘾倾向和替代治疗策略的影响。