Surgically induced neuropathic pain: understanding the perioperative process.
Surgically induced neuropathic pain: understanding the perioperative process.
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DOI：
10.1097/sla.0b013e3182701a7b
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发表时间：
2013-03
影响因子：
9
通讯作者：
Burke DW
中科院分区：
文献类型：
--
作者：
Borsook D;Kussman BD;George E;Becerra LR;Burke DW
神经损伤发生在手术过程中。因此，大量（10-40%）患者经历称为手术诱导的神经性疼痛（SNPP）的慢性神经性疼痛。初始手术和神经损伤引发了一系列事件，包括疼痛和炎症反应，导致“外周”和“中枢致敏”，后者是由伤害感受器的神经活动的反复干扰引起的。在受影响的患者中，这些初始事件在外周（PNS）和中枢神经（CNS）系统中产生化学，结构和功能变化。受损神经的适应不良变化导致神经病状态的外周表现-异常性疼痛、感觉丧失、刺痛等，在手术损伤的影响消失后很久才会出现。发生的CNS表现被称为“疼痛集中”，并影响感觉、情绪和其他（例如，认知）系统以及促成慢性疼痛综合征的某些表现（例如，抑郁症）。目前还没有围手术期疼痛的客观指标。因此，间歇性疼痛或持续性疼痛可能发生在手术期间和手术后。新技术包括直接测量伤害感受的特定脑功能和对患者术前评估的新见解，包括遗传易感性，似乎提供了减少SNPP负担的初步机会，直到发现预防或治疗疼痛的高疗效和低副作用的治疗方法。
Nerve damage takes place during surgery. As a consequence, significant numbers (10–40%) of patients experience chronic neuropathic pain termed surgically induced neuropathic pain (SNPP). The initiating surgery and nerve damage set off a cascade of events that includes both pain and an inflammatory response, resulting in ‘peripheral’ and ‘central sensitization’, with the latter resulting from repeated barrages of neural activity from nociceptors. In affected patients these initial events produce chemical, structural and functional changes in the peripheral (PNS) and central nervous (CNS) systems. The maladaptive changes in damaged nerves lead to peripheral manifestations of the neuropathic state – allodynia, sensory loss, shooting pains etc., that can manifest long after the effects of the surgical injury have resolved. The CNS manifestations that occur are termed ‘centralization of pain’ and affect sensory, emotional and other (e.g., cognitive) systems as well as contributing to some of the manifestations of the chronic pain syndrome (e.g., depression). Currently there are no objective measures of pain in the peri-operative period. As such intermittent pain or continuous may take place during and after surgery. New technologies including direct measures of specific brain function of nociception and new insights into preoperative evaluation of patients including genetic predisposition appear to provide initial opportunities for decreasing the burden of SNPP until treatments with high efficacy and low side effects that either prevent or treat pain are discovered.