Evidence of involvement of central neural mechanisms in generating fibromyalgia pain.
Evidence of involvement of central neural mechanisms in generating fibromyalgia pain.
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DOI：
10.1007/s11926-002-0038-5
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发表时间：
2002-08-01
影响因子：
5
通讯作者：
Staud, Roland
中科院分区：
文献类型：
--
作者：
Staud, Roland
纤维肌痛综合征（FMS）的特征是广泛的疼痛，疲劳，睡眠异常和痛苦。由于FMS缺乏一致的组织异常的证据，最近的调查集中在中枢神经系统的疼痛机制。最近在FMS患者中描述了第二次疼痛（发条）和中枢致敏的异常时间总和。依赖于中枢疼痛机制的发条和中枢致敏作用发生在长时间的C-伤害感受器输入之后，并且依赖于脊髓背角中伤害感受器特异性神经元和宽动态范围神经元的激活。最近在FMS患者中检测到的其他异常中枢疼痛机制包括弥漫性伤害性抑制控制。这些疼痛抑制机制依赖于脊髓和脊髓上系统，涉及疼痛易化和疼痛抑制途径。脑成像技术，可以检测神经元激活后，伤害性刺激提供了额外的证据异常中枢疼痛机制的FMS。脑图像证实了纤维肌痛患者在实验性疼痛刺激期间报告的疼痛体验增加。此外，纤维肌痛患者的丘脑活动（对疼痛处理有重要作用）减少。然而，纤维肌痛的中枢疼痛机制可能并不完全依赖于神经元激活。神经胶质细胞的激活在慢性疼痛的诱导和维持中起着重要的作用。这些发现可能对未来的研究和纤维肌痛的治疗具有重要意义。
Fibromyalgia syndrome (FMS) is characterized by widespread pain, fatigue, sleep abnormalities, and distress. Because FMS lacks consistent evidence of tissue abnormalities, recent investigations have focused on central nervous system mechanisms of pain. Abnormal temporal summation of second pain (wind-up) and central sensitization have been described recently in patients with FMS. Wind-up and central sensitization, which rely on central pain mechanisms, occur after prolonged C-nociceptor input and depend on activation of nociceptor-specific neurons and wide dynamic range neurons in the dorsal horn of the spinal cord. Other abnormal central pain mechanisms recently detected in patients with FMS include diffuse noxious inhibitory controls. These pain inhibitory mechanisms rely on spinal cord and supraspinal systems involving pain facilitatory and pain inhibitory pathways. Brain-imaging techniques that can detect neuronal activation after nociceptive stimuli have provided additional evidence for abnormal central pain mechanisms in FMS. Brain images have corroborated the augmented reported pain experience of patients with fibromyalgia during experimental pain stimuli. In addition, thalamic activity, which contributes significantly to pain processing, was decreased in fibromyalgia. However, central pain mechanisms of fibromyalgia may not depend exclusively on neuronal activation. Neuroglial activation has been found to play an important role in the induction and maintenance of chronic pain. These findings may have important implications for future research and the treatment of fibromyalgia pain.