The Miami Project to Cure Paralysis, University of Miami, 1095 NW 14th Terrace, Miami, FL, 33136, USA.
Department of Neurological Surgery, University of Miami, 1095 NW 14th Terrace, Miami, FL, 33136, USA.
Drugs. 2017 Jun;77(9):967-984. doi: 10.1007/s40265-017-0747-8.
Chronic neuropathic pain is a complicated condition after a spinal cord injury (SCI) that often has a lifelong and significant negative impact on life after the injury; therefore, improved pain management is considered a significant and unmet need. Neuropathic pain mechanisms are heterogeneous and the difficulty in determining their individual contribution to specific pain types may contribute to poor treatment outcomes in this population. Thus, identifying human neuropathic pain phenotypes based on pain symptoms, somatosensory changes, or cognitive and psychosocial factors that reflect specific spinal cord or brain mechanisms of neuropathic pain is an important goal. Once a pain phenotype can be reliably replicated, its relationship with biomarkers and clinical treatment outcomes can be analyzed, and thereby facilitate translational research and further the mechanistic understanding of individual differences in the pain experience and in clinical trial outcomes. The present article will discuss clinical aspects of SCI-related neuropathic pain, neuropathic pain phenotypes, pain mechanisms, potential biomarkers and pharmacological interventions, and progress regarding how defining neuropathic pain phenotypes may lead to more targeted treatments for these difficult pain conditions.
慢性神经性疼痛是脊髓损伤(SCI)后的一种复杂情况,它经常对损伤后的生活产生终身的重大负面影响;因此,改善疼痛管理被认为是一种重要的、未满足的需求。神经性疼痛的机制具有异质性,确定其对特定疼痛类型的个体贡献的困难可能导致该人群的治疗效果不佳。因此,基于疼痛症状、体感变化或反映特定脊髓或大脑神经性疼痛机制的认知和心理社会因素,确定人类神经性疼痛表型是一个重要目标。一旦能够可靠地复制疼痛表型,就可以分析其与生物标志物和临床治疗结果的关系,从而促进转化研究,并进一步深入了解疼痛体验和临床试验结果中的个体差异的机制。本文将讨论与 SCI 相关的神经性疼痛的临床方面、神经性疼痛表型、疼痛机制、潜在的生物标志物和药物干预措施,以及确定神经性疼痛表型如何可能为这些困难的疼痛状况提供更有针对性的治疗方法方面的进展。