Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel , Brussels , Belgium.
Chronic pain rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels , Brussels , Belgium.
Expert Opin Pharmacother. 2019 Nov;20(16):1961-1970. doi: 10.1080/14656566.2019.1647166. Epub 2019 Jul 29.
: Given our improved understanding of the role of central sensitization (CS) in many patients with chronic pain, it seems rational to account for CS during treatment. : First, the treatment rationale based on the complex mechanisms underlying CS in patients having chronic pain is presented. Second, emphasis is given to explaining the concept of CS when providing treatment, as well as why patients and clinicians should focus on long-term rather than short-term treatment effects. Third, possible pharmacological and non-pharmacological treatment options are discussed. : Centrally acting drugs such as tricyclic compounds, serotonin-norepinephrine reuptake inhibitors, and αδ ligands each target mechanisms that are often dysfunctional in patients having chronic pain and CS, but decades of clinical practice and clinical trials have not resulted in satisfactory outcomes. This comes as no surprise; CS comprises complex psycho-neuro-immunological interactions, while each of the tested drugs targets one or two of those mechanisms from a purely biomedical viewpoint. Clinicians willing to take CS into account should design an individually tailored multimodal treatment plan comprising pain neuroscience education, cognition-targeted exercise therapy, sleep management, stress management, and/or dietary intervention.
鉴于我们对中枢敏化（CS）在许多慢性疼痛患者中的作用有了更好的理解，在治疗中考虑 CS 似乎是合理的。首先，提出了基于慢性疼痛患者 CS 背后复杂机制的治疗原理。其次，强调了在提供治疗时解释 CS 概念的重要性，以及为什么患者和临床医生应该关注长期而非短期的治疗效果。第三，讨论了可能的药物和非药物治疗选择。中枢作用药物，如三环化合物、5-羟色胺-去甲肾上腺素再摄取抑制剂和αδ配体，每种药物都针对慢性疼痛和 CS 患者中经常出现功能障碍的机制，但几十年的临床实践和临床试验并未带来满意的结果。这并不奇怪；CS 包括复杂的心理神经免疫相互作用，而每个经过测试的药物都从纯粹的生物医学角度针对其中一种或两种机制。愿意考虑 CS 的临床医生应该设计一个个体化的多模式治疗计划，包括疼痛神经科学教育、针对认知的运动疗法、睡眠管理、压力管理和/或饮食干预。
