Petersen Kristian K, McPhee Megan E, Hoegh Morten S, Graven-Nielsen Thomas
Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
Curr Opin Support Palliat Care. 2019 Jun;13(2):99-106. doi: 10.1097/SPC.0000000000000419.
The purpose of this review is to summarize recent findings on conditioned pain modulation (CPM) in humans with a focus on methodology, factors modulating CPM, and the potential for CPM as a clinical marker for pain progression.
CPM can be evoked by combining different stimulus modalities with good reliability; sequential CPM effects are stable over time with limited carryover effects. Optimism and pain catastrophizing might influence pain inhibition. Further, studies suggest that the CPM effect can be improved by gabapentinoids, transcranial direct current stimulation to cortical structures, and exercise and that long-term opioid use might impair CPM in patients with chronic pain. Clinical evidence suggests that preoperative impaired CPM may predict more severe chronic postoperative pain. The effect of pain duration on CPM impairment has been challenged by recent studies.
As CPM methodology is optimized, studies are revealing factors that can modulate descending pain inhibitory pathways. Understanding underlying mechanisms of CPM will improve the utility of CPM in a clinical setting and potentially lead to personalized treatments for chronic pain patients.
本综述旨在总结人类条件性疼痛调制（CPM）的最新研究成果，重点关注方法学、调节CPM的因素以及CPM作为疼痛进展临床标志物的潜力。
通过结合不同的刺激方式能够可靠地诱发CPM；序贯CPM效应随时间稳定，且遗留效应有限。乐观情绪和疼痛灾难化思维可能会影响疼痛抑制。此外，研究表明加巴喷丁类药物、经颅直流电刺激皮质结构以及运动可以改善CPM效应，而长期使用阿片类药物可能会损害慢性疼痛患者的CPM。临床证据表明，术前CPM受损可能预示着更严重的慢性术后疼痛。近期研究对疼痛持续时间对CPM损害的影响提出了挑战。
随着CPM方法学的优化，研究正在揭示能够调节下行性疼痛抑制通路的因素。了解CPM的潜在机制将提高CPM在临床环境中的实用性，并有可能为慢性疼痛患者带来个性化治疗。
