Continuum (Minneap Minn). 2024 Oct 1;30(5):1381-1396. doi: 10.1212/CON.0000000000001490.
This article provides an approach to the assessment, diagnosis, and treatment of central neuropathic pain.
Recent studies of the pathophysiology of central neuropathic pain, including evidence of changes in the expression of voltage-gated sodium channels and N-methyl-d-aspartate (NMDA) receptors, may provide the basis for new therapies. Other areas of current research include the role of cannabinoid-receptor activity and microglial cell activation in various animal models of central neuropathic pain. New observations regarding changes in primary afferent neuronal activity in central neuropathic pain and the preliminary observation that peripheral nerve blocks may relieve pain due to central neuropathic etiologies provide new insights into both the mechanism and treatment of central neuropathic pain.
In the patient populations treated by neurologists, central neuropathic pain develops most frequently following spinal cord injury, multiple sclerosis, or stroke. A multimodal, individualized approach to the management of central neuropathic pain is necessary to optimize pain relief and may require multiple treatment trials to achieve the best outcome.
本文提供了一种评估、诊断和治疗中枢神经性疼痛的方法。
中枢神经性疼痛病理生理学的近期研究，包括电压门控钠离子通道和 N-甲基-D-天冬氨酸（NMDA）受体表达变化的证据，可能为新疗法提供基础。目前研究的其他领域包括大麻素受体活性和小胶质细胞激活在各种中枢神经性疼痛动物模型中的作用。关于中枢神经性疼痛中初级传入神经元活动变化的新观察结果，以及外周神经阻滞可能缓解中枢神经性病因引起的疼痛的初步观察结果，为中枢神经性疼痛的机制和治疗提供了新的见解。
在神经病学家治疗的患者群体中，脊髓损伤、多发性硬化或中风后最常发生中枢神经性疼痛。需要采用多模式、个体化的方法来管理中枢神经性疼痛，以优化疼痛缓解效果，并且可能需要多次治疗试验才能达到最佳效果。
