Viscerosomatic facilitation in a subset of IBS patients, an effect mediated by N-methyl-D-aspartate receptors.
Viscerosomatic facilitation in a subset of IBS patients, an effect mediated by N-methyl-D-aspartate receptors.
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DOI：
10.1016/j.jpain.2012.06.002
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发表时间：
2012-09
期刊：
影响因子：
4
通讯作者：
Zhou, QiQi
中科院分区：
文献类型：
--
作者：
Verne, G. Nicholas;Price, Donald D.;Callam, Christopher S.;Zhang, Buyi;Peck, Josh;Zhou, QiQi
关键词：
肠易激综合征（IBS）是一种常见的胃肠道疾病，其疼痛和过敏的病理生理机制尚不完全清楚。肠易激综合征患者经常抱怨疼痛的身体部位不同的肠道，这表明参与中枢痛觉过敏机制。我们测试了紧张性外周脉冲输入的作用，通过使用重复的热刺激的腿和重复的刺激直肠。确定伤害性热/内脏重复刺激后热/内脏疼痛敏感性的变化。IBS患者的一个子集在重复热/直肠刺激后分别表现出增强的直肠/热疼痛敏感性。IBS患者随后在一项随机、双盲、交叉试验中接受60 mg美沙芬和安慰剂（苯那君）。结果显示：（1）在一系列重复的伤害性刺激后，一部分IBS患者具有增加的内脏/皮肤超敏性。（2）这种增加的疼痛敏感性被给予右美沙芬阻断。这是第一个人类研究表明，重复刺激增强了双向机制的继发性痛觉过敏，由于内脏促进IBS患者。这些独特的发现阐明了IBS患者的躯体超敏反应机制，并支持异常NMDA受体机制的病因学基础，这些机制可能是IBS未来治疗的目标。
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder in which the pathophysiological mechanisms of the pain and hypersensitivity are incompletely understood. IBS patients frequently complain of pain in body regions somatotopically distinct from the gut, suggesting involvement of central hyperalgesic mechanisms. We tested the role of tonic peripheral impulse input by using both repetitive thermal stimuli to the leg and repetitive stimuli to the rectum. Changes in thermal/visceral pain sensitivity after nociceptive thermal/visceral repetitive stimulation were determined. A subset of IBS patients showed enhanced rectal/thermal pain sensitivity after repetitive thermal/rectal stimulation respectively. IBS patients then received 60 mg dextromethorphan and placebo (Benadryl) in a randomized, double-blind, crossover trial. The results showed: (1) a subset of IBS patients had increased visceral/cutaneous hypersensitivity following a series of repetitive nociceptive stimuli (2) This increased pain sensitivity was blocked by administration of dextromethorphan. This is the first human study that indicates repetitive stimulation enhances a bidirectional mechanism of secondary hyperalgesia due to viscerosomatic facilitation in IBS patients. These unique findings elucidate mechanisms of somatic hypersensitivity in IBS patients and support an etiologic basis for abnormal NMDA receptor mechanisms that may be the target of future therapies for IBS.
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影响因子：
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