Nerve injury and neuropathic pain - A question of age.
Nerve injury and neuropathic pain - A question of age.
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DOI：
10.1016/j.expneurol.2015.07.013
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发表时间：
2016-01
影响因子：
5.3
通讯作者：
McKelvey R
中科院分区：
文献类型：
--
作者：
Fitzgerald M;McKelvey R
周围神经损伤对体感觉加工和疼痛的影响高度依赖于损伤发生的年龄。成人神经损伤迅速引发神经性疼痛，但如果同样的神经损伤发生在出生后28天(P)以下的动物身上，则不会出现这种情况，这与儿科患者的观察结果一致。然而，纵向研究表明，当动物进入青春期时，疼痛超敏反应会在生命的后期出现，这一观察结果可能具有临床重要性。在这里，我们讨论的证据表明，神经损伤的主要后果是由不同年龄的神经免疫调节状态决定的。在出生后的最初几周，当脊髓体感回路正在经历突触重组时，“默认”的神经免疫反应向抗炎方向倾斜，抑制背角神经元的兴奋，防止神经性疼痛的发生。随着动物的成长和中枢神经系统的成熟，神经免疫图谱向促炎方向转变，揭示了早期神经损伤的“潜在”疼痛反应。数据预测，婴儿期和儿童期的神经损伤在当时可能不会被注意到，但在青春期会出现临床“无法解释的”或“功能性”疼痛。
The effects of peripheral nerve injury on somatosensory processing and pain are highly dependent upon the age at which the damage occurs. Adult nerve injury rapidly triggers neuropathic pain, but this is not so if the same nerve injury is performed in animals below postnatal day (P) 28, consistent with observations in paediatric patients. However, longitudinal studies show that pain hypersensitivity emerges later in life, when the animal reaches adolescence, an observation that could be of clinical importance. Here we discuss the evidence that the central consequences of nerve damage are critically determined by the status of neuroimmune regulation at different ages. In the first postnatal weeks, when spinal somatosensory circuits are undergoing synaptic reorganisation, the ‘default’ neuroimmune response is skewed in an anti-inflammatory direction, suppressing the excitation of dorsal horn neurons and preventing the onset of neuropathic pain. As animals grow up and the central nervous system matures, the neuroimmune profile shifts in a pro-inflammatory direction, unmasking a ‘latent’ pain response to an earlier nerve injury. The data predicts that nerve injury in infancy and childhood could go unnoticed at the time, but emerge as clinically ‘unexplained’ or ‘functional’ pain in adolescence.