Bowsher D
Pain Research Institute, Walton Hospital, Liverpool, UK.
Curr Opin Neurol Neurosurg. 1993 Apr;6(2):257-63.
Neurogenic pain (encompassing all types of neuropathic and central pain) is discussed. Experimental work is presented in a model in which the rat sciatic nerve is loosely ligatured. In painful human neuropathies, tricyclic antidepressants have been found to be effective in proportion to the degree they facilitate monoaminergic activity. Several papers also stress the importance of early treatment with amitriptyline or desipramine, and the ineffectiveness of analgesics, including narcotics. In nociceptive pain, recent findings in humans emphasize the importance of both the retroinsular (SII) and the anterior cingulate cortices in the conscious appreciation of pain. Opioid studies have revealed individual differences in the metabolism of morphine to its 3- and 6-glucuronosides; patients with nociceptive pain who respond poorly to morphine or diamorphine probably have a high 3:6 ratio. It has been pointed out that methadone may be useful in such cases, as it is not broken down to glucuronosides.
本文讨论了神经源性疼痛（包括所有类型的神经性疼痛和中枢性疼痛）。文中展示了在大鼠坐骨神经轻度结扎模型中的实验研究。在疼痛性人类神经病变中，已发现三环类抗抑郁药的有效性与它们促进单胺能活性的程度成正比。几篇论文还强调了早期使用阿米替林或去甲丙咪嗪治疗的重要性，以及包括麻醉药在内的镇痛药的无效性。在伤害性疼痛方面，人类的最新研究结果强调了脑岛后叶（第二躯体感觉区）和前扣带回皮质在疼痛的意识感知中的重要性。阿片类药物研究揭示了吗啡代谢为其3-葡萄糖醛酸苷和6-葡萄糖醛酸苷过程中的个体差异；对吗啡或海洛因反应不佳的伤害性疼痛患者可能具有较高的3:6比率。有人指出，美沙酮在这种情况下可能有用，因为它不会分解为葡萄糖醛酸苷。
