Department of Rheumatology and Alan Edwards Pain Management Unit, McGill University, Montreal, QC, Canada.
Department of Psychiatry and Behavioral Sciences and Department of Anesthesiology and Critical Care Medicine, Neurology and Physical Medicine and Rehabilitation at Johns Hopkins Hospital, Baltimore, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Lancet. 2021 May 29;397(10289):2098-2110. doi: 10.1016/S0140-6736(21)00392-5.
Nociplastic pain is the semantic term suggested by the international community of pain researchers to describe a third category of pain that is mechanistically distinct from nociceptive pain, which is caused by ongoing inflammation and damage of tissues, and neuropathic pain, which is caused by nerve damage. The mechanisms that underlie this type of pain are not entirely understood, but it is thought that augmented CNS pain and sensory processing and altered pain modulation play prominent roles. The symptoms observed in nociplastic pain include multifocal pain that is more widespread or intense, or both, than would be expected given the amount of identifiable tissue or nerve damage, as well as other CNS-derived symptoms, such as fatigue, sleep, memory, and mood problems. This type of pain can occur in isolation, as often occurs in conditions such as fibromyalgia or tension-type headache, or as part of a mixed-pain state in combination with ongoing nociceptive or neuropathic pain, as might occur in chronic low back pain. It is important to recognise this type of pain, since it will respond to different therapies than nociceptive pain, with a decreased responsiveness to peripherally directed therapies such as anti-inflammatory drugs and opioids, surgery, or injections.
躯体感觉性疼痛是疼痛研究国际共同体提出的语义学术语,用于描述第三种类型的疼痛,这种疼痛在机制上不同于由持续炎症和组织损伤引起的伤害感受性疼痛,也不同于由神经损伤引起的神经性疼痛。这种类型疼痛的潜在机制尚未完全了解,但人们认为增强的中枢神经系统疼痛和感觉处理以及改变的疼痛调节起着突出的作用。躯体感觉性疼痛的症状包括多灶性疼痛,其广泛性或强度比可识别的组织或神经损伤的程度更广泛或更强烈,以及其他源自中枢神经系统的症状,如疲劳、睡眠、记忆和情绪问题。这种类型的疼痛可能单独发生,如在纤维肌痛或紧张性头痛等情况下经常发生,或者与持续的伤害感受性或神经性疼痛结合在一起形成混合性疼痛状态,如慢性腰痛。识别这种类型的疼痛很重要,因为它对疼痛感受性疼痛的治疗反应不同,对针对外周的治疗(如抗炎药和阿片类药物、手术或注射)的反应性降低。
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