Spinal cord mechanisms of pain
Spinal cord mechanisms of pain
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DOI：
10.1093/bja/aen088
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发表时间：
2008-07-01
影响因子：
9.8
通讯作者：
Dickenson, A. H.
中科院分区：
文献类型：
--
作者：
D'Mello, R.;Dickenson, A. H.
脊髓是伤害性信息从外周向大脑传递的第一个中继点。感觉信号由外周神经通过初级传入纤维传入脊髓背角，这些传入纤维与脊髓内源性背角神经元发生突触。然后，脊髓投射神经元将这些信息传递到大脑的高级中枢，在那里可以感知到无害和有害的信号。在伤害性传递过程中，脊髓的输出依赖于各种脊髓机制，这些机制可以增加或减少背角神经元的活动。这些机制包括局部兴奋性和抑制性中间神经元，n -甲基- d -天冬氨酸受体激活，以及来自脑干的下行影响，这些影响在本质上可以是抑制性和兴奋性的。在神经损伤或炎症条件下，这些调节脊髓兴奋性的兴奋性和抑制性机制会发生变化，通常导致背神经元对传入传入信号的反应增强，并增加向大脑的输出，这种现象被称为中枢敏化。在这篇综述中，我们考虑了在慢性疼痛状态下脊髓活动可能被改变的方式。此外，我们还讨论了目前用于慢性疼痛治疗的镇痛药所针对的脊柱机制。
The spinal cord is the first relay site in the transmission of nociceptive information from the periphery to the brain. Sensory signals are transmitted from the periphery by primary afferent fibres into the dorsal horn of the spinal cord, where these afferents synapse with intrinsic spinal dorsal horn neurones. Spinal projection neurones then convey this information to higher centres in the brain, where non-noxious and noxious signals can be perceived. During nociceptive transmission, the output of the spinal cord is dependent on various spinal mechanisms which can either increase or decrease the activity of dorsal horn neurones. Such mechanisms include local excitatory and inhibitory interneurones, N-methyl-D-aspartate receptor activation, and descending influences from the brainstem, which can be both inhibitory and excitatory in nature. After nerve injury or conditions of inflammation, shifts can occur in these excitatory and inhibitory mechanisms which modulate spinal excitability, often resulting in the heightened response of dorsal neurones to incoming afferent signals, and increased output to the brain, a phenomenon known as central sensitization. In this review, we consider the ways in which spinal cord activity may be altered in chronic pain states. In addition, we discuss the spinal mechanisms which are targeted by current analgesics used in the management of chronic pain.