Reversal of visceral and cutaneous hyperalgesia by local rectal anesthesia in irritable bowel syndrome (IBS) patients
Reversal of visceral and cutaneous hyperalgesia by local rectal anesthesia in irritable bowel syndrome (IBS) patients
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DOI：
10.1016/s0304-3959(03)00210-0
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发表时间：
2003-09-01
期刊：
影响因子：
7.4
通讯作者：
Price, DD
中科院分区：
文献类型：
--
作者：
Verne, GN;Robinson, ME;Price, DD
肠易激综合征（IBS）是最常见的胃肠道疾病之一，其特征是内脏感觉改变。本研究的目的是确定局部麻醉阻断外周内脏伤害性输入是否能减少IBS患者的内脏和皮肤继发性痛觉过敏。在双盲交叉设计中，10名患有IBS的女性（平均年龄30 ± 10岁）和10名对照受试者（所有女性）（平均年龄29 ± 7岁）在直肠施用利多卡因凝胶或盐水凝胶之前和之后对疼痛强度和直肠扩张（35 mmHg）和足部热刺激（47 ℃）的不愉快进行评级。直肠内利多卡因（300 mg）减少了所有IBS患者报告的直肠和皮肤疼痛。这些效应在统计学上远大于安慰剂，大多数效应在治疗开始后5-15分钟内出现。在对照组中，直肠利多卡因没有减少内脏和皮肤刺激的疼痛报告。本研究的结果支持这样的假设，即局部麻醉阻断直肠/结肠的外周脉冲输入可以减少IBS患者内脏和皮肤的继发性痛觉过敏。结果提供了进一步的证据，内脏痛觉过敏和继发性皮肤痛觉过敏IBS反映了中枢敏化机制，动态维持的紧张性脉冲输入从直肠/结肠。利多卡因凝胶直肠给药也可能是一种安全有效的减轻IBS患者疼痛症状的方法。(C)2003年国际疼痛研究协会。Elsevier B. V.出版，保留所有权利。
Irritable bowel syndrome (IBS) is one of the most common gastrointestinal illnesses and is characterized by altered visceral perception. The aim of the study was to determine if local anesthetic blockade of peripheral visceral nociceptive input reduces both visceral and cutaneous secondary hyperalgesia in IBS patients. Ten women with IBS (mean age 30 +/- 10 years) and ten control subjects (all women) (mean age 29 +/- 7 years) rated pain intensity and unpleasantness to distension of the rectum (35 mmHg) and thermal stimulation (47 degreesC) of the foot before and after rectal administration of either lidocaine jelly or saline jelly in a double blind crossover design. Intrarectal lidocaine (300 mg) reduced reported rectal and Cutaneous pain in all of the IBS patients. The effects were statistically much greater than those of placebo and most of the effects were present within 5-15 min after the onset of the treatment. In the control subjects, rectal lidocaine did not decrease pain report from visceral and Cutaneous stimuli. The results of this study support the hypothesis that local anesthetic blockade of peripheral impulse input from the rectum/colon reduces both visceral and cutaneous Secondary hyperalgesia in IBS patients. The results provide further evidence that visceral hyperalgesia and secondary cutaneous hyperalgesia in IBS reflects central sensitization mechanisms that are dynamically maintained by tonic impulse input from the rectuni/colon. Rectal administration of lidocaine jelly may also be a safe and effective means of reducing pain symptoms in IBS patients. (C) 2003 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.