Section of Human Anatomy, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
Villa Germana Clinica Ruesch, 80122 Naples, Italy.
Int J Environ Res Public Health. 2022 Jun 27;19(13):7872. doi: 10.3390/ijerph19137872.
Nociplastic pain has been introduced by the IASP as a third category of pain, distinct from nociceptive and neuropathic pain. Pathogenetically, it is considered to be a continuum of these two types of pain after becoming chronic. Repetitive peripheral painful stimulation causes a central sensitization with hypersensitivity of the corresponding spinal metamer or brain region. Therefore, signs of altered nociception, such as allodynia, may be found on the tissues of the related dermatome, myotome and sclerotome, and characterize nociplastic pain. This kind of pain was found in over 20% of people with multiple sclerosis (pwMS), a demyelinating autoimmune disease that affects the central nervous system. Nociplastic pain may be an amplifier of spasticity, the main pyramidal symptom that affects about 80% of pwMS. This article details the case of a 36-year-old woman with multiple sclerosis who was affected by spasticity and non-specific pain of the lower limbs, disabling on walking. Previous analgesic and muscle relaxant treatment had no benefits. The diagnosis of nociplastic pain on the cutaneous tissue of the anterolateral region of the left thigh and its treatment with intradermal normal saline injection on the painful skin area showed immediate and lasting effects on pain and spasticity, improving significantly the patient's balance and walking, as assessed by a 3D motion analysis and rating scales.
神经病理性疼痛已被国际疼痛研究协会（IASP）定义为第三类疼痛，与伤害性疼痛和神经性疼痛不同。从发病机制上讲，它被认为是这两种类型疼痛在慢性化后连续的一个过程。重复的外周疼痛刺激会导致中枢敏化，相应的脊髓节段或脑区出现超敏反应。因此，可能会在相关皮节、肌节和脊柱节段的组织上发现改变的伤害感受迹象，如痛觉过敏，这些都是神经病理性疼痛的特征。这种疼痛在超过 20%的多发性硬化症（pwMS）患者中存在，多发性硬化症是一种影响中枢神经系统的脱髓鞘自身免疫性疾病。神经病理性疼痛可能是痉挛的放大器，痉挛是影响约 80% pwMS 的主要锥体症状。本文详细介绍了一名 36 岁女性多发性硬化症患者的病例，她受到痉挛和下肢非特异性疼痛的影响，行走困难。先前的镇痛和肌肉松弛治疗没有效果。在左大腿前外侧皮肤区域的疼痛皮肤区域内进行皮内生理盐水注射治疗神经病理性疼痛的诊断和治疗，立即并持久地缓解了疼痛和痉挛，通过三维运动分析和评分量表显著改善了患者的平衡和行走能力。
