Preventing Chronic Pain following Acute Pain: Risk Factors, Preventive Strategies, and their Efficacy.
Preventing Chronic Pain following Acute Pain: Risk Factors, Preventive Strategies, and their Efficacy.
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DOI：
10.1016/j.eujps.2011.08.013
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发表时间：
2011-11-11
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在美国，慢性疼痛是导致残疾的主要原因。从急性疼痛到持续性疼痛的转变被认为是由适应不良的神经再生机制引起的，这些机制涉及三个相互交织的过程，即外周敏化、中枢敏化和下行调节。旨在预防持续性疼痛的战略可能针对这些过程。研究预防策略的模型包括持续性手术后疼痛(PPP)、持续性创伤后疼痛(PTP)和带状疱疹后神经痛(PHN)。这样的实体允许更明确的组织损伤的急性发作，之后更容易检查长期影响的研究。在这篇综述中，我们使用这些模型研究了慢性疼痛预防的病理生理学、流行病学、危险因素和治疗策略。描述了药理学和干预性方法，以及对即将到来的预防策略的讨论。
Chronic pain is the leading cause of disability in the United States. The transition from acute to persistent pain is thought to arise from maladaptive neuroplastic mechanisms involving three intertwined processes, peripheral sensitization, central sensitization, and descending modulation. Strategies aimed at preventing persistent pain may target such processes. Models for studying preventive strategies include persistent post-surgical pain (PPP), persistent post-trauma pain (PTP) and post-herpetic neuralgia (PHN). Such entities allow a more defined acute onset of tissue injury after which study of the long-term effects is more easily examined. In this review, we examine the pathophysiology, epidemiology, risk factors, and treatment strategies for the prevention of chronic pain using these models. Both pharmacological and interventional approaches are described, as well as a discussion of preventive strategies on the horizon.