Spiegel David R, Chatterjee Aparna, McCroskey Aidan L, Ahmadi Tamana, Simmelink Drew, Oldfield Edward C, Pryor Christopher R, Faschan Michael, Raulli Olivia
Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA.
Health Serv Res Manag Epidemiol. 2015 Jan 26;2:2333392814567920. doi: 10.1177/2333392814567920. eCollection 2015 Jan-Dec.
Pain can be broadly divided into 3 classes, including nociceptive or inflammatory pain (protective), neuropathic (pathological, occurring after damage to the nervous system), or centralized (pathological, due to abnormal function but with no damage or inflammation to the nervous system). The latter has been posited to occur when descending analgesic pathways are attenuated and/or glutamatergic transmission is facilitated. Additionally, this "pain prone phenotype" can be associated with early life trauma and a suboptimal response to opiates. This article will review the relationships between centralized pain syndromes (ie, fibromyalgia, chronic low back pain), childhood sexual abuse, and opiate misuse. Finally, treatment implications, potentially effecting primary care physicians, will be discussed.
疼痛大致可分为三类，包括伤害性或炎症性疼痛（保护性）、神经性疼痛（病理性，在神经系统受损后出现）或中枢性疼痛（病理性，由于功能异常但神经系统无损伤或炎症）。后者被认为是在下行镇痛通路减弱和/或谷氨酸能传递增强时发生。此外，这种“疼痛易发表型”可能与早年创伤和对阿片类药物的反应不佳有关。本文将综述中枢性疼痛综合征（即纤维肌痛、慢性下腰痛）、儿童期性虐待和阿片类药物滥用之间的关系。最后，将讨论对初级保健医生可能产生影响的治疗意义。
