Rehaklinik Freihof, Zurzach Care Group, Baden 5401, Switzerland.
Department of Rheumatology, University Hospital Lausanne, 1011 Lausanne, Switzerland.
Exp Neurol. 2022 Oct;356:114108. doi: 10.1016/j.expneurol.2022.114108. Epub 2022 May 10.
Chronic pain syndrome is a heterogeneous group of diseases characterized by several pathological mechanisms. One in five adults in Europe may experience chronic pain. In addition to the individual burden, chronic pain has a significant societal impact because of work and school absences, loss of work, early retirement, and high social and healthcare costs. Several anti-inflammatory treatments are available for patients with inflammatory or autoimmune diseases to control their symptoms, including pain. However, patients with degenerative chronic pain conditions, some with 10-fold or more elevated incidence relative to these manageable diseases, have few long-term pharmacological treatment options, limited mainly to non-steroidal anti-inflammatory drugs or opioids. For this review, we performed multiple PubMed searches using keywords such as "pain," "neurogenic inflammation," "NGF," "substance P," "nociception," "BDNF," "inflammation," "CGRP," "osteoarthritis," and "migraine." Many treatments, most with limited scientific evidence of efficacy, are available for the management of chronic pain through a trial-and-error approach. Although basic science and pre-clinical pain research have elucidated many biomolecular mechanisms of pain and identified promising novel targets, little of this work has translated into better clinical management of these conditions. This state-of-the-art review summarizes concepts of chronic pain syndromes and describes potential novel treatment strategies.
慢性疼痛综合征是一组异质性疾病，其特征是存在几种病理机制。欧洲每五个成年人中就有一个可能经历慢性疼痛。除了个人负担外，慢性疼痛还会对社会产生重大影响，因为它会导致缺勤、失业、提前退休以及高额的社会和医疗保健费用。有几种抗炎治疗方法可用于治疗炎症或自身免疫性疾病以控制其症状，包括疼痛。然而，患有退行性慢性疼痛疾病的患者，其发病率比这些可管理疾病高出十倍甚至更多，他们的长期药物治疗选择有限，主要限于非甾体抗炎药或阿片类药物。在本次综述中，我们使用了“疼痛”、“神经源性炎症”、“NGF”、“P 物质”、“伤害感受”、“BDNF”、“炎症”、“CGRP”、“骨关节炎”和“偏头痛”等关键词，在 PubMed 上进行了多次搜索。有许多治疗方法，大多数都缺乏有效的科学证据，通过试错的方法来管理慢性疼痛。尽管基础科学和临床前疼痛研究已经阐明了许多疼痛的生物分子机制，并确定了有前途的新靶点，但这些工作很少能转化为这些疾病的更好的临床管理。本综述总结了慢性疼痛综合征的概念，并描述了潜在的新型治疗策略。
