Letter to the Editor of Pain on Jørum et al: Catecholamine-induced excitation of nociceptors in sympathetically maintained pain; Pain 2007;127:296-301.
Letter to the Editor of Pain on Jørum et al: Catecholamine-induced excitation of nociceptors in sympathetically maintained pain; Pain 2007;127:296-301.
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致《Pain》编辑关于 Järum 等人的信：儿茶酚胺引起交感神经维持疼痛中伤害感受器的兴奋；
DOI：
10.1016/j.pain.2007.06.003
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发表时间：
2007
期刊：
影响因子：
7.4
通讯作者：
Ochoa,JoséL
中科院分区：
文献类型：
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作者：
Ochoa,JoséL
这个病人的医学性质。对于作者来说，这位慢性疼痛患者患有“SMP”，这种情况“首先与CRPS相关”。读者想知道什么样的“CRPS”。有神经病变吗？这是无法解决的，因为临床描述是不完整的。烧灼性疼痛见于腓神经领域，但神经学检查未包括运动系统或反射；运动神经传导正常，肌电图未见肌肉去神经支配的迹象。此外，主观性痛觉过敏的区域在双侧袜子；没有感觉缺陷；感觉神经传导正常（校正左腿温度降低1.5℃），QST主观热阈值非特异性受损。因此，不能以神经病变（或外周炎症）为例。这是单纯的小口径纤维神经病吗？不太可能，因为在急性局部压迫综合征中，原发性神经病变会保留小口径纤维（Ochoa等，1971）。总之，patientÕs症状复合体的原因尚不清楚。因此，他正式符合“CRPS I”，这是一个因不合逻辑而被禁用的概念，特别是在它的标准# 4中，当它指出：“这种诊断被排除在其他条件之外，否则会解释疼痛和功能障碍的程度”（见Ochoa和Verdugo， 2001）。受邀介绍Wilson et al.（2005）编辑的最新一本关于CRPS的书的开明学者写道：“第四个标准说CRPS是一种诊断，只有在另一种诊断无法建立时才能做出。这意味着，如果我们能更好地诊断其他疾病，我们将减少诊断CRPS的频率。这个实体要么有自己的标准，要么没有，只是一个无法得到充分评估和标记的患者的存储库”（Loeser, 2005）。但必须有一个可检验的医学解释patientÕs非特异性症状。除非进行鉴别诊断，否则无法发现（Ochoa, 2006）。作者没有。它甚至可能是一种特征不明确的，以结构为基础的周围神经病变。临床“SMP”。根据浅层标准：“SMP均为可通过交感神经阻滞缓解的疼痛综合征”（Treede et al., 1991），该患者因其疼痛主诉被消除11年
The medical nature of this patient. For the authors, this chronic pain patient has ‘‘SMP’’, a condition which ‘‘is first and foremost associated with CRPS’’. The reader wants to know what kind of ‘‘CRPS’’. Was there nerve pathology? This is impossible to resolve because the clinical description is incomplete. Burning pain was reported in peroneal nerve territories, but neurological examination did not include motor system or reflexes; motor nerve conductions were normal and the electromyogram did not show signs of muscle denervation. Moreover, the area of subjective hyperalgesia was in bilateral stocking; no sensory deficits are described; sensory nerve conduction was normal (correcting for a 1.5 C cooler left leg) and subjective thermal thresholds by QST were non-specifically impaired. Thus, a case cannot be made for neuropathy (nor peripheral inflammation). Could this be a pure small caliber fiber neuropathy? Unlikely because, in acute local compression syndromes, the primary nerve lesion spares small caliber fibers (Ochoa et al., 1971). In sum, the cause of the patientÕs symptom complex is not known. Therefore, he officially fits ‘‘CRPS I’’, a concept disabled by nonsequitur, particularly in its criterion# 4, one that evades refutability principle when it states:‘‘This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction’’(see Ochoa and Verdugo, 2001). The enlightened scholar invited to introduce the latest book on CRPS, edited by Wilson et al.(2005) wrote:‘‘The fourth criterion says that CRPS is a diagnosis that can only be made when another diagnosis cannot be established. This means that if we get better at diagnosing something else, we will reduce the frequency of diagnosing CRPS. Either this entity exists on its own criteria, or it does not and is just a repository for patients who cannot be adequately assessed and labeled’’(Loeser, 2005). But there must exist a testable medical explanation for this patientÕs non-specific symptoms. It will not be found unless differential diagnosis is pursued (Ochoa, 2006). The authors did not. It might even be an ill-characterized, structurally-based peripheral neuropathy. The clinical ‘‘SMP’’. As per the shallow criterion:‘‘SMP are all pain syndromes that can be relieved by sympathetic blockade’’(Treede et al., 1991), this patient qualified as his pain complaint was eliminated for 1 1