The relationship of pain, allodynia and thermal sensation in post-herpetic neuralgia
The relationship of pain, allodynia and thermal sensation in post-herpetic neuralgia
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DOI：
10.1093/brain/119.2.347
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发表时间：
1996-04-01
期刊：
影响因子：
14.5
通讯作者：
Fields, HL
中科院分区：
文献类型：
--
作者：
Rowbotham, MC;Fields, HL
在带状疱疹后神经痛综合征(PHN)中，感觉障碍的性质及其与疼痛的严重程度和原因的关系是有争议的。为了解决这些问题，在35名确诊为PHN的受试者中，在不同的会话中进行了四次感觉图和定量热感觉测试。所有受试者都有影响躯干或四肢的疼痛和刷牙引起的痛觉异常。每次治疗包括对持续疼痛的分级，绘制任何感觉障碍区域和最大疼痛区域的地图，对最持续疼痛区域内的痛觉异常严重程度进行分级，以及对疼痛和对侧未受影响的镜像皮肤的热感觉进行定量测试。痛觉异常的严重程度与报告的持续疼痛严重程度呈正相关。作为一个群体，受试者在PHN皮肤中对热刺激的感觉与未受影响的镜像皮肤相比存在感觉缺陷。然而，热痛感觉缺陷的程度与疼痛强度和痛觉异常的严重程度呈负相关。事实上，12名受试者在他们最痛的区域有热痛觉过敏。与23例热痛觉减退受试者相比，12例热痛觉过敏受试者的疼痛程度显著高于热痛觉过敏受试者，感觉丧失程度较轻，但对于无害的温热、降温和冷痛等热疗方式，其疼痛程度仍与疼痛严重程度呈负相关。这意味着周围神经功能丧失与自发性或诱发性疼痛之间没有简单的关系。相反，在他们的最大疼痛区域的几种感觉模式的保存表明，在一些PHN患者中，与他们的外周和中央靶点保持联系的初级传入伤害性感受器的活动对持续的疼痛有显著的贡献。虽然其他机制也可能导致疼痛，但PHN对局部麻醉剂、辣椒素和非类固醇消炎药等外用药物的反应性支持这种疼痛产生机制。
In the syndrome of post-herpetic neuralgia (PHN), the nature of the sensory disturbance and its relationship both to the severity and cause of the pain is controversial. To address these issues, sensory mapping and quantitative thermal sensory testing was carried out four times in separate sessions on 35 subjects with established PHN. All subjects had pain affecting the torso or extremities and brush-evoked allodynia. Each session included rating of ongoing pain, mapping of the area of any sensory disturbance and the area of greatest pain, grading of allodynia severity within the area of greatest ongoing pain, and quantitative testing of thermal sensation in both the painful and the contralateral unaffected mirror-image skin. The severity of allodynia was positively correlated with reported ongoing pain severity. As a group, subjects had a sensory deficit to thermal stimuli in PHN skin compared with unaffected mirror-image skin. However the magnitude of the heat pain sensory deficit was inversely correlated with both pain intensity and severity of allodynia. In fact, 12 subjects had heat hyperalgesia in their region of maximum pain. Compared with the 23 subjects with heat hypoalgesia, the group of 12 heat hyperalgesic subjects had significantly higher pain ratings and allodynia severity Sensory loss was less strongly, but still inversely related to pain severity for the thermal modalities of innocuous warming, cooling and cold pain. This implies that there is no simple relationship between loss of peripheral nerve function and spontaneous or evoked pain. Rather, the preservation of several sensory modalities in their area of maximal pain suggests that in some PHN patients, activity in primary afferent nociceptors that remain connected to both their peripheral and central targets contributes significantly to ongoing pain. Although other mechanisms are likely to contribute to the pain, the demonstrated responsivity of PHN to topical agents including local anaesthetics, capsaicin, and non-steroidal anti-inflammatory drugs, supports this proposed mechanism of pain generation.