Peripheral Mechanisms of Ischemic Myalgia.
Peripheral Mechanisms of Ischemic Myalgia.
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DOI：
10.3389/fncel.2017.00419
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发表时间：
2017
影响因子：
5.3
通讯作者：
Jankowski MP
中科院分区：
文献类型：
--
作者：
Queme LF;Ross JL;Jankowski MP
由于缺血引起的肌肉骨骼疼痛存在于多种临床病症中，包括外周血管疾病（PVD）、镰状细胞病（SCD）、复杂性区域疼痛综合征（CRPS），甚至纤维肌痛（FM）。与深部组织缺血相关的临床特征是独特的，因为尽管疼痛的主观描述与其他形式的肌痛相同，但缺血性肌肉疼痛患者对传统镇痛治疗的反应往往很差。此外，这些患者还表现出对肌肉收缩的心血管反应增加，这通常导致运动不耐受或潜在心血管疾病的恶化。这表明，肌痛发展的机制和缺血条件下心血管功能改变的作用可能与其他肌肉损伤/疾病不同。人们普遍认为，第III组和第IV组肌肉传入神经在缺血性疼痛的发生中起着重要作用。这些相同的肌肉传入也形成运动加压反射（EPR）的感觉成分，这是肌肉收缩后经历的心率和血压（BP）的增加。研究表明，缺血后的传入敏化依赖于外周感觉神经元个体群体中嘌呤能（P2 X和P2 Y）受体、瞬时受体电位（TRP）通道和酸敏感离子通道（ASIC）之间的相互作用。通过这些受体机制的初级传入功能的特定改变与疼痛相关行为的增加和EPR的改变相关。最近的证据表明，在缺血条件下，肌肉内的因素，包括生长因子和细胞因子的上调，和微血管的变化可能与这些不同的受体分子在背根神经节（DRG），反过来调节疼痛和交感神经反射的过度表达。在这篇综述文章中，我们将讨论参与缺血性肌痛的发展和初级感觉神经元在EPR调制中发挥的作用的外周机制。
Musculoskeletal pain due to ischemia is present in a variety of clinical conditions including peripheral vascular disease (PVD), sickle cell disease (SCD), complex regional pain syndrome (CRPS), and even fibromyalgia (FM). The clinical features associated with deep tissue ischemia are unique because although the subjective description of pain is common to other forms of myalgia, patients with ischemic muscle pain often respond poorly to conventional analgesic therapies. Moreover, these patients also display increased cardiovascular responses to muscle contraction, which often leads to exercise intolerance or exacerbation of underlying cardiovascular conditions. This suggests that the mechanisms of myalgia development and the role of altered cardiovascular function under conditions of ischemia may be distinct compared to other injuries/diseases of the muscles. It is widely accepted that group III and IV muscle afferents play an important role in the development of pain due to ischemia. These same muscle afferents also form the sensory component of the exercise pressor reflex (EPR), which is the increase in heart rate and blood pressure (BP) experienced after muscle contraction. Studies suggest that afferent sensitization after ischemia depends on interactions between purinergic (P2X and P2Y) receptors, transient receptor potential (TRP) channels, and acid sensing ion channels (ASICs) in individual populations of peripheral sensory neurons. Specific alterations in primary afferent function through these receptor mechanisms correlate with increased pain related behaviors and altered EPRs. Recent evidence suggests that factors within the muscles during ischemic conditions including upregulation of growth factors and cytokines, and microvascular changes may be linked to the overexpression of these different receptor molecules in the dorsal root ganglia (DRG) that in turn modulate pain and sympathetic reflexes. In this review article, we will discuss the peripheral mechanisms involved in the development of ischemic myalgia and the role that primary sensory neurons play in EPR modulation.
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期刊：
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影响因子：
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作者：
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