Pathological C-fibres in patients with a chronic painful condition
Pathological C-fibres in patients with a chronic painful condition
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DOI：
10.1093/brain/awg060
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发表时间：
2003-03-01
期刊：
影响因子：
14.5
通讯作者：
Torebjörk, E
中科院分区：
文献类型：
--
作者：
Orstavik, K;Weidner, C;Torebjörk, E
关于C-传入纤维对人类慢性疼痛状况的贡献知之甚少。我们试图研究C-纤维在红斑性肢痛症疼痛和痛觉过敏的病理生理学中的作用，作为慢性疼痛的模型疾病。红斑性肢痛症是一种以疼痛、发红和发热的四肢为特征的疾病，患者经常报告行走时有压痛。我们从患这种疾病的患者腓神经皮束中的单个C纤维进行了显微神经摄影记录。所有患者都有一个疼痛发作最近和心理物理异常性疼痛和点状痛觉过敏的迹象被found. We获得了录音，从总共103个C-纤维，发现显着降低传导速度和增加活动依赖性减慢传入C-纤维的传导速度的患者与健康对照组相比。此外，几个单位的机械不敏感的纤维的生物物理特性是病理性的，自发活动或敏感的机械刺激。由于这些纤维也介导轴突反射耀斑，它们的过度兴奋不仅可以解释持续的疼痛和压痛，还可以解释这种疼痛综合征中的发红和变暖。在这些患者的C纤维中发现的导电特性的变化可能是小纤维神经病的第一个迹象。这是第一次对患者的单个C纤维进行系统研究，它显示了机械不敏感纤维对慢性疼痛的积极贡献。
Little is known about the contribution of C-afferent fibres to chronic painful conditions in humans. We sought to investigate the role of C-fibres in the pathophysiology of pain and hyperalgesia in erythromelalgia as a model disease for chronic pain. Erythromelalgia is a condition characterized by painful, red and hot extremities, and patients often report tenderness on walking. We made microneurographic recordings from single C-fibres in cutaneous fascicles of the peroneal nerve in patients suffering from this disease. All patients had had a pain attack recently and psychophysical signs of allodynia and punctate hyperalgesia were found. We obtained recordings from a total of 103 C-fibres and found significantly lower conduction velocities and increased activity-dependent slowing of the conduction velocity of afferent C-fibres in the patients compared with healthy controls. Furthermore, several units with biophysical properties of mechano-insensitive fibres were pathological, being spontaneously active or sensitized to mechanical stimuli. Since these fibres also mediate the axon reflex flare, their hyperexcitability might account not only for ongoing pain and tenderness but also for redness and warming in this pain syndrome. The changes in conductive properties found in the C-fibres of these patients could be the first signs of a small-fibre neuropathy. This is the first systematic study of single C-fibres in patients and it shows an active contribution of mechano-insensitive fibres to chronic pain.