Visceral versus Somatic Pain: Similarities and Differences
Visceral versus Somatic Pain: Similarities and Differences
复制标题
DOI：
10.1159/000268115
复制
发表时间：
2009-01-01
影响因子：
2.3
通讯作者：
Cervero, Fernando
中科院分区：
文献类型：
--
作者：
Cervero, Fernando
炎症性肠病和肠易激综合征是以慢性疼痛为特征的病症，其在身体的许多区域产生持续的痛觉过敏状态。很难通过直接从已知的躯体疼痛机制来解释炎症性肠病和肠易激综合征等疾病的疼痛。内脏痛和躯体痛不仅在感觉的心理物理学上，而且在介导感觉过程的神经生物学机制上显示出许多差异。内脏伤害感受器的激活和敏化受到感觉感受器所在微环境的分泌和运动特性的严重影响。在某些情况下，上皮细胞可以在初级感觉神经元的激活中发挥直接作用。上皮的亚临床改变可有助于增强内脏敏感性。内脏兴奋引起的中枢高敏感性也与躯体高敏感性不同。AMPA受体从细胞质迁移到伤害性神经元的膜已被确定为内脏痛通路的敏化机制。最后，功能性疼痛综合征，如肠易激综合征，可以触发或维持激素的变化，特别是那些涉及性激素，如雌激素。版权所有（C）2010 S. Karger AG，巴塞尔
Inflammatory bowel disease and the irritable bowel syndrome are conditions characterized by chronic pain that generates persistent, hyperalgesic states in many regions of the body. It is difficult to explain the pain of conditions such as inflammatory bowel disease and irritable bowel syndrome by extrapolating directly from what is known about the mechanisms of somatic pain. Visceral and somatic pain show many differences not only in the psychophysics of the sensation, but also in the neurobiological mechanisms that mediate the sensory process. The activation and sensitization of visceral nociceptors are heavily influenced by the secretory and motor properties of the microenvironment where the sensory receptors are located. In some cases, epithelial cells can play a direct role in the activation of primary sensory neurons. Subclinical alterations of the epithelium can contribute to enhanced visceral sensitivity. Central hypersensitivity induced by visceral activation also shows differences with its somatic counterpart. Mobilization of AMPA receptors from the cytosol to the membrane of nociceptive neurons has been identified as a mechanism of sensitization of visceral pain pathways. Finally, functional pain syndromes, such as irritable bowel syndrome could be triggered or maintained by hormonal alterations, particularly those involving sex hormones such as estrogen. Copyright (C) 2010 S. Karger AG, Basel