Taira T, Kawamura H, Tanikawa T, Iseki H, Kawabatake H, Takakura K
Tokyo Women's Medical College, Japan.
Stereotact Funct Neurosurg. 1995;65(1-4):101-5. doi: 10.1159/000098905.
Baclofen, an agonist of the gamma-aminobutyric acid (GABA) receptor, has antinociceptive effects, and its intrathecal administration reduces allodynic responses in animal models of neurogenic central pain. Such experimental studies lead to the hypothesis that neurogenic pain may be induced in part by functional abnormalities in spinal GABAergic systems. However, whether a GABAergic system is actually involved in human central pain is unknown. The authors investigated the effect of an intrathecal bolus injection of baclofen in 14 patients with central pain due to a stroke or spinal cord injury. Nine reported substantial pain relief they had never experienced previously. The effect appeared 1-2 h after the injection and persisted for 10-24 h. Allodynia and hyperalgesia, if present, were relieved as well. Pinprick and light touch sensations did not change in nonaffected regions. The results indicate that dysfunction of spinal GABAergic systems plays a role in the clinical expression of central pain. In clinical situations, continuous intrathecal infusion of baclofen seems feasible for relief of central pain.
巴氯芬是γ-氨基丁酸（GABA）受体激动剂，具有抗伤害感受作用，鞘内注射巴氯芬可减轻神经源性中枢性疼痛动物模型中的异常性疼痛反应。此类实验研究提出了一个假说，即神经源性疼痛可能部分由脊髓GABA能系统的功能异常所致。然而，GABA能系统是否实际参与人类中枢性疼痛尚不清楚。作者对14例因中风或脊髓损伤导致中枢性疼痛的患者进行了鞘内推注巴氯芬的研究。9例患者报告疼痛大幅缓解，这是他们之前从未经历过的。注射后1 - 2小时出现效果，并持续10 - 24小时。如有异常性疼痛和痛觉过敏也得到缓解。在未受影响区域，针刺觉和轻触觉未发生改变。结果表明，脊髓GABA能系统功能障碍在中枢性疼痛的临床症状表现中起作用。在临床情况下，持续鞘内输注巴氯芬似乎对缓解中枢性疼痛可行。
