Plasticity: Implications for opioid and other pharmacological interventions in specific pain states
Plasticity: Implications for opioid and other pharmacological interventions in specific pain states
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DOI：
10.1017/s0140525x97271487
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发表时间：
1997-09
影响因子：
29.3
通讯作者：
Zsuzsanna Wiesenfeld-Hallin;Håkan Aldskogius;Gunnar Grant;J. Hao;Tomas Hökfelt;X.-J. Xu
中科院分区：
文献类型：
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作者：
Zsuzsanna Wiesenfeld-Hallin;Håkan Aldskogius;Gunnar Grant;J. Hao;Tomas Hökfelt;X.-J. Xu
阿片类药物在正常情况下的脊柱作用机制已经相当清楚。阿片类药物的脊髓效应可以增强或减弱，这取决于病理和其他节段性和非节段性通路的活性。这种可塑性将被认为与使用阿片类药物控制不同的疼痛状态有关。关于阿片样物质在椎管上作用的复杂和矛盾的发现可以解释为使用多种递质和受体到达不同脊柱靶点的异质性下行通路-因此阿片样物质可以增加和减少下行通路的活性。这些通路可能表现出相当大的可塑性。越来越多的证据表明，δ阿片受体激动剂具有替代吗啡作为主要镇痛药的潜力，而且副作用更小。基于防止诱发阿片类药物控制的一些负面可塑性影响和疼痛的有害影响的先发制人镇痛的概念是合理的，但在临床环境中进行实验验证是困难的。例如，抑制系统的延迟代偿上调，特别是在炎症中，可能会对抗持续的疼痛输入。阿片类药物联合治疗可能对许多疼痛状态有益，其中负面影响被阻断或抑制性控制得到加强。最后，这些系统的发育方面的讨论与治疗疼痛的幼儿，在脊髓抑制系统是不成熟的。
The spinal mechanisms of action of opioids under normal conditions are reasonably well understood. The spinal effects of opioids can be enhanced or reduced depending on pathology and activity in other segmental and nonsegmental pathways. This plasticity will be considered in relation to the control of different pain states using opioids. The complex and contradictory findings on the supraspinal actions of opioids are explicable in terms of heterogeneous descending pathways to different spinal targets using multiple transmitters and receptors – therefore opioids can both increase and decrease activity in descending pathways. These pathways could exhibit considerable plasticity. There is increasing evidence that delta opioid receptor agonists have the potential to replace morphine as major analgesics with reduced side-effect profiles. The concept of preemptive analgesia, based on preventing the induction of some of the negative plastic influences on opioid controls and the detrimental effects of pain, is sound, but experimental verification in the clinical setting is difficult. For example, a delayed compensatory upregulation of inhibitory systems, particularly in inflammation, may counter persistent painful inputs. Combination therapy with opioids may be beneficial in many pain states where either negative influences are blocked or inhibitory controls are enhanced. Finally, developmental aspects of these systems are discussed in connection with the treatment of pain in young children, where inhibitory systems in the spinal cord are immature.