Cervero F
Department of Physiology and Pharmacology, University of Alcalá de Henares, Madrid, Spain.
Ann Med. 1995 Apr;27(2):235-9. doi: 10.3109/07853899509031965.
This paper describes the responses of peripheral and central visceral nociceptive systems to acute injury and discusses these observations in relation to the concept of 'pre-emptive analgesia'. Visceral nociceptors are known to respond to injury but are also known to become sensitized to non-noxious stimuli during the inflammatory process that follows intense noxious stimulation. The afferent barrages triggered in visceral nociceptors by the acute injury and the enhanced responses evoked in sensitized nociceptors during the repair process can, in turn, increase the excitability of central nociceptive systems. The maintenance of central hypersensitivity is, however, dependant on the continuing presence of afferent volleys from sensitized nociceptors because the central changes cannot be sustained in the absence of a peripheral drive. Therefore it is proposed that the concept of 'pre-emptive analgesia', as such, has no neurophysiological basis. Any analgesic procedure aimed at reducing postoperative pain must not only prevent the arrival in the CNS of the initial afferent barrage evoked in nociceptive endings but also reduce or eliminate the persistent discharges of sensitized nociceptors during the inflammatory repair process that are critically important for the maintenance of the central pain state.
本文描述了外周和中枢内脏伤害感受系统对急性损伤的反应，并结合“超前镇痛”的概念对这些观察结果进行了讨论。已知内脏伤害感受器对损伤有反应，但也已知在强烈的伤害性刺激后的炎症过程中，它们会对非伤害性刺激变得敏感。急性损伤在内脏伤害感受器中引发的传入冲动，以及修复过程中敏感化的伤害感受器所引发的增强反应，反过来又会增加中枢伤害感受系统的兴奋性。然而，中枢超敏反应的维持依赖于来自敏感化伤害感受器的传入冲动的持续存在，因为在没有外周驱动的情况下，中枢变化无法持续。因此，有人提出，“超前镇痛”的概念本身没有神经生理学基础。任何旨在减轻术后疼痛的镇痛程序不仅必须防止伤害性末梢引发的初始传入冲动到达中枢神经系统，还必须减少或消除炎症修复过程中敏感化伤害感受器的持续放电，而这些放电对于维持中枢疼痛状态至关重要。
