牵涉痛:特征、可能机制及临床处理

Referred pain: characteristics, possible mechanisms, and clinical management.

作者信息

Jin Qianjun, Chang Yuxin, Lu Chenmiao, Chen Lunhao, Wang Yue

机构信息

Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.

出版信息

Front Neurol. 2023 Jun 28;14:1104817. doi: 10.3389/fneur.2023.1104817. eCollection 2023.

Abstract

PURPOSE OF THIS REVIEW

Referred pain is a common but less understood symptom that originates from somatic tissues. A comprehensive recognition of referred pain is important for clinicians when dealing with it. The purpose of this study is to summarize the current understanding of referred pain, including its pathogenesis, characteristics, diagnosis, and treatment.

RECENT FINDINGS

Referred pain arises not only from pathologies primarily involving local tissue but also from lesions in distant structures. Central sensitization of convergent neurons and peripheral reflexes of dichotomizing afferent fibers are two theories proposed to explain the pathological mechanism of referred pain. Because syndromes related to referred pain of different origins overlap each other, it is challenging to define referred pain and identify its originating lesions. Although various approaches have been used in the diagnosis and treatment of referred pain, including conservative treatment, blockade, radiofrequency, and surgery, management of referred pain remains a clinical challenge.

SUMMARY

Unlike radicular pain and neuropathic pain, referred pain is a less studied area, despite being common in clinics. Referred pain can derive from various spinal structures, and blockage helps identify the primary pathology. Due to the heterogeneity of referred pain, treatment outcomes remain uncertain. Further studies are needed to improve our understanding of referred pain.

摘要

本综述的目的

牵涉痛是一种常见但了解较少的源自躯体组织的症状。全面认识牵涉痛对临床医生处理该症状很重要。本研究的目的是总结目前对牵涉痛的认识,包括其发病机制、特点、诊断和治疗。

最新发现

牵涉痛不仅源于主要累及局部组织的病变,也源于远处结构的损伤。会聚神经元的中枢敏化和分支传入纤维的外周反射是为解释牵涉痛的病理机制而提出的两种理论。由于不同起源的牵涉痛相关综合征相互重叠,定义牵涉痛并确定其原发损伤具有挑战性。尽管在牵涉痛的诊断和治疗中使用了各种方法,包括保守治疗、阻滞、射频和手术,但牵涉痛的管理仍然是一项临床挑战。

总结

与根性痛和神经性疼痛不同,牵涉痛尽管在临床上很常见,但却是一个研究较少的领域。牵涉痛可源自各种脊柱结构,阻滞有助于确定原发病理。由于牵涉痛的异质性,治疗结果仍不确定。需要进一步研究以增进我们对牵涉痛的理解。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd47/10338069/565987617610/fneur-14-1104817-g001.jpg

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