Bułdyś Kacper, Górnicki Tomasz, Kałka Dariusz, Szuster Ewa, Biernikiewicz Małgorzata, Markuszewski Leszek, Sobieszczańska Małgorzata
Faculty of Medical Sciences and Health Sciences, Kazimierz Pulaski University of Technology and Humanities in Radom, 26-600 Radom, Poland.
Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland.
Healthcare (Basel). 2023 Jun 17;11(12):1794. doi: 10.3390/healthcare11121794.
Nociplastic pain is a recently distinguished type of pain, distinct from neuropathic and nociceptive pain, and is well described in the literature. It is often mistaken for central sensitization. Pathophysiology has not been clearly established with regard to alteration of the concentration of spinal fluid elements, the structure of the white and gray matter of the brain, and psychological aspects. Many different diagnostic tools, i.e., the painDETECT and Douleur Neuropathique 4 questionnaires, have been developed to diagnose neuropathic pain, but they can also be applied for nociplastic pain; however, more standardized instruments are still needed in order to assess its occurrence and clinical presentation. Numerous studies have shown that nociplastic pain is present in many different diseases such as fibromyalgia, complex regional pain syndrome type 1, and irritable bowel syndrome. Current pharmacological and nonpharmacological treatments for nociceptive and neuropathic pain are not entirely suitable for treating nociplastic pain. There is an ongoing effort to establish the most efficient way to manage it. The significance of this field has led to several clinical trials being carried out in a short time. The aim of this narrative review was to discuss the currently available evidence on pathophysiology, associated diseases, treatment possibilities, and clinical trials. It is important that physicians widely discuss and acknowledge this relatively new concept in order to provide optimized pain control for patients.
伤害性感受性疼痛是一种最近才被区分出来的疼痛类型,有别于神经性疼痛和伤害感受性疼痛,并且在文献中有详尽描述。它常被误诊为中枢敏化。关于脑脊液成分浓度的改变、脑白质和灰质的结构以及心理方面,其病理生理学尚未明确确立。已开发出许多不同的诊断工具,如疼痛DETECT问卷和神经病理性疼痛4问卷,用于诊断神经性疼痛,但它们也可用于诊断伤害性感受性疼痛;然而,仍需要更标准化的工具来评估其发生情况和临床表现。大量研究表明,伤害性感受性疼痛存在于许多不同疾病中,如纤维肌痛、1型复杂性区域疼痛综合征和肠易激综合征。目前用于伤害感受性疼痛和神经性疼痛的药物及非药物治疗并不完全适用于治疗伤害性感受性疼痛。人们正在不断努力寻找最有效的治疗方法。该领域的重要性促使在短时间内开展了多项临床试验。本叙述性综述的目的是讨论目前关于病理生理学、相关疾病、治疗可能性和临床试验的现有证据。医生广泛讨论并认可这一相对较新的概念,以便为患者提供优化的疼痛控制,这一点很重要。
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