Central Nervous System Targets: Supraspinal Mechanisms of Analgesia.
Central Nervous System Targets: Supraspinal Mechanisms of Analgesia.
复制标题
中枢神经系统靶标：镇痛的上脊髓机制。
DOI：
10.1007/s13311-020-00887-6
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发表时间：
2020-07
期刊：
影响因子：
--
通讯作者：
Dickenson AH
中科院分区：
文献类型：
--
作者：
Bannister K;Dickenson AH
虽然剧烈的痛感是保护性的，表明存在实际的或潜在的身体伤害，但其持续时间是令人不快的。当疼痛变得慢性时，它在进化上的优势是有限的。尽管急性和慢性疼痛的性质不同，但一个共同的主题是患者寻求疼痛缓解。药物治疗从牙痛到术后疼痛等各种疼痛类型的可能性反映了止痛“止痛”疗法可以减轻、消除或预防疼痛的不同机制(S)。全身应用一种能够跨越血脑屏障的止痛药，可以通过与中枢神经系统不同部位的靶点相互作用来调节疼痛。所谓的脊椎上活动机制表明操纵了大脑定义的回路。临床前研究表明，根据靶向的大脑回路，可以观察到不同的治疗止痛效果，这些效果与对疼痛的感觉和/或情感性质的影响有关。在许多情况下，这转化为诊所。无论大脑回路如何，大脑处理的调制往往直接影响伤害性信息传递的多个方面，包括脊髓神经元信号。在考虑脊髓上的镇痛机制和随后的疼痛缓解时，必须考虑非脑介导的作用；因此，本文就阿片能、抗惊厥和抗抑郁药物的棘上介导的镇痛作用进行了讨论。目前使用的镇痛剂的不良治疗结果和/或副作用持续存在，突显了开发新的治疗药物或更精确地使用现有药物的必要性。充分揭示伤害性感受的复杂生物学，以及目前使用的止痛机制(S)和作用部位(S)，将加速这一过程。
While the acute sensation of pain is protective, signaling the presence of actual or potential bodily harm, its persistence is unpleasant. When pain becomes chronic, it has limited evolutionarily advantage. Despite the differing nature of acute and chronic pain, a common theme is that sufferers seek pain relief. The possibility to medicate pain types as varied as a toothache or postsurgical pain reflects the diverse range of mechanism(s) by which pain-relieving “analgesic” therapies may reduce, eliminate, or prevent pain. Systemic application of an analgesic able to cross the blood–brain barrier can result in pain modulation via interaction with targets at different sites in the central nervous system. A so-called supraspinal mechanism of action indicates manipulation of a brain-defined circuitry. Pre-clinical studies demonstrate that, according to the brain circuitry targeted, varying therapeutic pain-relieving effects may be observed that relate to an impact on, for example, sensory and/or affective qualities of pain. In many cases, this translates to the clinic. Regardless of the brain circuitry manipulated, modulation of brain processing often directly impacts multiple aspects of nociceptive transmission, including spinal neuronal signaling. Consideration of supraspinal mechanisms of analgesia and ensuing pain relief must take into account nonbrain-mediated effects; therefore, in this review, the supraspinally mediated analgesic actions of opioidergic, anti-convulsant, and anti-depressant drugs are discussed. The persistence of poor treatment outcomes and/or side effect profiles of currently used analgesics highlight the need for the development of novel therapeutics or more precise use of available agents. Fully uncovering the complex biology of nociception, as well as currently used analgesic mechanism(s) and site(s) of action, will expedite this process.
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影响因子：
7.4
作者：
Bee, Lucy A.;Bannister, Kirsty;Dickenson, Anthony H.
通讯作者：
Dickenson, Anthony H.
影响因子：
7.4
作者：
Gruener, Hila;Zeilig, Gabi;Defrin, Ruth
通讯作者：
Defrin, Ruth
影响因子：
2.9
作者：
Bianchi, M;Panerai, AE
通讯作者：
Panerai, AE
DOI：
10.1097/spc.0000000000000207
发表时间：
2016-06
影响因子：
2.1
作者：
Bannister K;Dickenson AH
通讯作者：
Dickenson AH
影响因子：
8.8
作者：
Bannister K;Sikandar S;Bauer CS;Dolphin AC;Porreca F;Dickenson AH
通讯作者：
Dickenson AH