From the Center for Translational Pain Medicine, Departments of Anesthesiology (R.-R.J., A.N., Y.H., N.T., W.M.) Neurobiology (R.-R.J.) Pharmacology (A.N.), Duke University Medical Center, Durham, North Carolina.
Anesthesiology. 2018 Aug;129(2):343-366. doi: 10.1097/ALN.0000000000002130.
Chronic pain is maintained in part by central sensitization, a phenomenon of synaptic plasticity, and increased neuronal responsiveness in central pain pathways after painful insults. Accumulating evidence suggests that central sensitization is also driven by neuroinflammation in the peripheral and central nervous system. A characteristic feature of neuroinflammation is the activation of glial cells, such as microglia and astrocytes, in the spinal cord and brain, leading to the release of proinflammatory cytokines and chemokines. Recent studies suggest that central cytokines and chemokines are powerful neuromodulators and play a sufficient role in inducing hyperalgesia and allodynia after central nervous system administration. Sustained increase of cytokines and chemokines in the central nervous system also promotes chronic widespread pain that affects multiple body sites. Thus, neuroinflammation drives widespread chronic pain via central sensitization. We also discuss sex-dependent glial/immune signaling in chronic pain and new therapeutic approaches that control neuroinflammation for the resolution of chronic pain.
慢性疼痛部分是由于中枢敏化维持的,这是突触可塑性的一种现象,也是疼痛刺激后中枢疼痛通路中神经元反应性增加的结果。越来越多的证据表明,中枢敏化也受到外周和中枢神经系统神经炎症的驱动。神经炎症的一个特征是脊髓和大脑中的小胶质细胞和星形胶质细胞等神经胶质细胞的激活,导致促炎细胞因子和趋化因子的释放。最近的研究表明,中枢细胞因子和趋化因子是强大的神经调节剂,在中枢神经系统给药后诱导痛觉过敏和感觉异常方面发挥着充分的作用。中枢神经系统中细胞因子和趋化因子的持续增加也会导致影响多个身体部位的广泛慢性疼痛。因此,神经炎症通过中枢敏化导致广泛的慢性疼痛。我们还讨论了慢性疼痛中性别依赖性的神经胶质/免疫信号转导,以及控制神经炎症以解决慢性疼痛的新治疗方法。
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