Nikolajsen Lone, Hansen Carsten L, Nielsen Jesper, Keller Johnny, Arendt-Nielsen Lars, Jensen Troels S
Department of Neurology and Danish Pain Research Center, Aarhus, Denmark Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark Department of Laboratory for Experimental Pain Research, Aalborg University, Aalborg, Denmark.
Pain. 1996 Sep;67(1):69-77. doi: 10.1016/0304-3959(96)03080-1.
Hyperactivity of N-methyl D-aspartate (NMDA) receptors may be one of the factors in the maintenance of persistent stump and phantom limb pain. Ketamine (bolus at 0.1 mg/kg/5 min followed by an infusion of 7 micrograms/kg/min) was administered intravenously to 11 patients with established stump and phantom limb pain in a double-blind saline-controlled study. All 11 patients responded with a decrease in the rating of stump and phantom limb pain assessed by visual analogue scale (VAS) and McGill Pain Questionnaire (MPQ). Ketamine increased pressure-pain thresholds significantly. Wind-up like pain (pain evoked by repeatedly tapping the dysaesthetic skin area) was reduced significantly by ketamine. In contrast, no effect was seen on pain evoked by repeated thermal stimuli. Side effects were observed in nine patients. The results support the notion that stump and phantom pain are generated by activity in afferent fibres activated by mechanical but not by thermal stimuli and that the NMDA receptor is involved in the maintenance of postamputation pain states. NMDA receptor antagonists may have a potential in the treatment of stump and phantom limb pain.
N-甲基-D-天冬氨酸（NMDA）受体功能亢进可能是导致残肢痛和幻肢痛持续存在的因素之一。在一项双盲、生理盐水对照研究中，对11例确诊为残肢痛和幻肢痛的患者静脉注射氯胺酮（先以0.1mg/kg的剂量静脉推注5分钟，随后以7μg/kg/min的速度持续静脉滴注）。所有11例患者的残肢痛和幻肢痛视觉模拟评分（VAS）及麦吉尔疼痛问卷（MPQ）评分均下降。氯胺酮显著提高了压力痛阈值。氯胺酮还显著减轻了“发条样疼痛”（反复轻敲感觉异常的皮肤区域所诱发的疼痛）。相比之下，氯胺酮对反复热刺激诱发的疼痛没有影响。9例患者出现了副作用。这些结果支持以下观点：残肢痛和幻肢痛是由机械刺激而非热刺激激活的传入纤维的活动所产生，且NMDA受体参与了截肢后疼痛状态的维持。NMDA受体拮抗剂在治疗残肢痛和幻肢痛方面可能具有潜力。
