Cross S A
Department of Neurology, Mayo Clinic Rochester, Minnesota 55905.
Mayo Clin Proc. 1994 Apr;69(4):375-83. doi: 10.1016/s0025-6196(12)62225-3.
To review the pain pathways in the central and peripheral nervous system and the actions of drugs used to treat pain.
An overview of pain pathways is presented, beginning in the periphery and progressing centrally, and the ascending and descending pathways are described in detail.
The nociceptive pathway, consisting of the classic three-neuron chain, is now understood to be a dual system at each level, and the sensation of pain is thought to arrive in the central nervous system with the discriminative component of pain ("first pain") carried separately from the affective-motivational component of pain ("second pain"). In addition to spinal control mechanisms of nociceptive transmission, descending pathways that originate in three major areas--the cortex, thalamus, and brain stem--can modify functions at the spinal level. At every level of the nervous system, a close relationship prevails between somatic pain pathways and visceral pathways. This relationship likely accounts for the transmission of visceral pain and also for autonomic responses to somatic pain and somatic responses to visceral pain.
By understanding the pathways of pain and the transmitters involved, prevention and treatment of pain will be improved.
回顾中枢和外周神经系统中的疼痛通路以及用于治疗疼痛的药物的作用。
对疼痛通路进行概述，从外周开始并向中枢推进，详细描述上行和下行通路。
由经典的三神经元链组成的伤害性感受通路现在被认为在每个层面都是一个双重系统，并且疼痛感觉被认为是通过疼痛的辨别成分（“第一痛”）与疼痛的情感 - 动机成分（“第二痛”）分开传递到中枢神经系统的。除了伤害性感受传递的脊髓控制机制外，起源于三个主要区域——皮层、丘脑和脑干——的下行通路可以在脊髓水平改变功能。在神经系统的每个层面，躯体疼痛通路和内脏通路之间都存在密切关系。这种关系可能解释了内脏痛的传递，也解释了对躯体疼痛的自主反应以及对内脏疼痛的躯体反应。
通过了解疼痛通路和相关递质，疼痛的预防和治疗将得到改善。
