Withey Sarah L, Maguire David R, Kangas Brian D
1Harvard Medical School, McLean Hospital, Belmont, MA USA.
2University of Texas Health Science Center at San Antonio, San Antonio, TX USA.
Perspect Behav Sci. 2020 Jan 3;43(1):39-55. doi: 10.1007/s40614-019-00239-6. eCollection 2020 Mar.
The effective management of pain is a longstanding public health concern. Although opioids have been frontline analgesics for decades, they also have well-known undesirable effects that limit their clinical utility, such as abuse liability and respiratory depression. The failure to develop better analgesics has, in some ways, contributed to the escalating opioid epidemic that has claimed tens of thousands of lives and has cost hundreds of billions of dollars in health-care expenses. A paradigm shift is needed in the pharmacotherapy of pain management that will require extensive efforts throughout biomedical science. The purpose of the present review is to highlight the critical role of the to devise improved translational models of pain for drug development. Despite high heterogeneity of painful conditions that involve cortical-dependent pain processing, current models often feature an overreliance on simple reflex-based measures and an emphasis on the absence, rather than presence, of behavior as evidence of analgesic efficacy. Novel approaches should focus on the restoration of operant and other CNS-mediated behavior under painful conditions.
疼痛的有效管理一直是一个长期的公共卫生问题。尽管几十年来阿片类药物一直是一线镇痛药,但它们也有众所周知的不良作用,限制了其临床应用,如成瘾性和呼吸抑制。未能开发出更好的镇痛药在某种程度上导致了阿片类药物流行的升级,这场流行已夺去数万人的生命,并在医疗费用上花费了数千亿美元。疼痛管理的药物治疗需要范式转变,这将需要整个生物医学领域付出巨大努力。本综述的目的是强调[此处原文缺失相关内容]在设计改进的疼痛转化模型以用于药物开发方面的关键作用。尽管涉及皮层依赖性疼痛处理的疼痛状况具有高度异质性,但当前模型往往过度依赖基于简单反射的测量方法,并强调行为的缺失而非存在作为镇痛效果的证据。新方法应专注于在疼痛状况下恢复操作性及其他中枢神经系统介导的行为。