What do monoamines do in pain modulation?
What do monoamines do in pain modulation?
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DOI：
10.1097/spc.0000000000000207
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发表时间：
2016-06
影响因子：
2.1
通讯作者：
Dickenson AH
中科院分区：
文献类型：
--
作者：
Bannister K;Dickenson AH
在这里，我们给出了一个局部概述的方式，大脑处理可以改变通过下行控制通路的脊髓疼痛传输，以及这些如何改变疼痛状态。我们联系临床前的发现所涉及的递质系统，并讨论如何单胺类，去甲肾上腺素（NA），5-羟色胺（5-HT）和多巴胺，可以通过抑制和兴奋途径相互作用。下行通路控制感觉事件，并且根据被激活的受体，脊髓背角中的神经递质NA和5-HT的作用主要涉及伤害感受或抗伤害感受。下行控制的抑制影响中枢疼痛处理。神经损伤后，NA介导的脊髓兴奋性控制丧失，而其恢复降低神经性超敏反应。5-HT的故事仍然更加复杂，因为它可以作用于无数的受体;然而，最新的研究结果支持促进作用可能超过抑制作用。单胺能系统可以在临床上发挥很大的作用，从而改善治疗效果，并且是抗癫痫药物在疼痛中发挥作用的基础。展望未来，通过监测一种抑制性下降控制的形式来预测治疗反应将是可能的，以优化疼痛缓解。
Here we give a topical overview of the ways in which brain processing can alter spinal pain transmission through descending control pathways, and how these change in pain states. We link preclinical findings on the transmitter systems involved and discuss how the monoamines, noradrenaline (NA), 5-hydroxytryptamine (5-HT) and dopamine, can interact through inhibitory and excitatory pathways. Descending pathways control sensory events and the actions of the neurotransmitters NA and 5-HT in the dorsal horn of the spinal cord are chiefly implicated in nociception or anti-nociception according to the receptor that is activated. Abnormalities in descending controls effect central pain processing. Following nerve injury a NA-mediated control of spinal excitability is lost while its restoration reduces neuropathic hypersensitivity. The story with 5-HT remains more complex due to the myriad of receptors that it can act upon; however the most recent findings support that facilitations may dominate over inhibitions. The monoaminergic system can be manipulated to great effect in the clinic resulting in improved treatment outcomes and is the basis for the actions of the anti-depressant drugs in pain. Looking to the future, prediction of treatment responses will possible by monitoring a form of inhibitory descending control for optimised pain-relief.