Clinical psychologic analysis for the pain in patients suffering from pulpal pathosis and responsiveness changes in the tooth pulp-driven neurons in the central nervous system

本研究旨在阐明牙髓病变患者疼痛的生理机制。我们尝试对牙髓疾病患者的疼痛进行临床心理分析和牙髓驱动神经元反应性变化的基础神经生理学调查相结合的研究，并使用日本McGill疼痛问卷对广泛牙髓疾病患者的疼痛描述术语进行测试。采用视觉模拟评分法(VAS)检测疼痛强度。由于没有病例，很难概括牙髓炎特有的疼痛术语。结果表明，急性和慢性病引起的疼痛在描述上有一定差异。尤其是急性炎症患者，常选择情感亚类和评价亚类中的术语。I-…间VAS值差异无统计学意义对中枢神经系统(CNS)中牙髓驱动神经元反应性变化的神经生理学研究表明，三叉神经脊束核(尾侧亚核)、脑干网状结构或丘脑腹后内侧核的神经元可诱发不同类型的中枢敏感化。这些核团含有传递三叉神经信息的中继神经元，包括投射到高级脑区的髓信息，并在处理疼痛的感觉辨别方面和情绪情感方面有密切的联系。这些神经元会通过大脑中的上行/下行控制系统来调整自己的反应能力。这些结果提示，牙源性重度疼痛患者中枢神经系统发生了中枢敏化现象或某些神经可塑性改变。较少

This study was aimed to elucidate the physiological mechanisms of pain observed in the patients with dental pulp pathosis. We have tried to perform the combined study of the clinical psychological analysis for the pain in patients suffering from pulpal pathosis and the basic neurophysiological investigation for the responsiveness changes in tooth pulp-driven neurons.Using the Japanese McGill Pain Questionnaire, the pain description terms were examined in patients suffering from the broad pulpal pathosis. The pain intensity was detected by the visual analog scale (VAS) method. It was difficult to generalize the pain terms specific with pulpitis because of the absence of the cases. It was demonstrated that there were some differences describing the pain caused by the acute and the chronic conditions. Especially, the patients with acute inflammation frequently selected the terms in affective subclass and evaluative subclass. There was no significant differences of the VAS values between i … More n the acute phase patients and in the chronic, eventhough the mean VAS value of the former was larger than the one of the latter.The neurophysiologic investigation for responsiveness changes in the tooth pulp-driven neurons in the central nervous system (CNS) revealed that different types of central sensitization were elicited in neurons in the trigeminal spinal cord nucleus (subnucleus caudalis ), brain stem reticular formation, or ventral posteromedial thalamic nucleus. These nuclei contain relay neurons which transfer the trigeminal information including the pulp one projecting to the higher brain area, and have close relations in processing the sensory-descriminative aspects of pain and the emotional-affective aspects. These neurons would modify their responsiveness with the ascending oan/or descending control system in the brain. These results suggest that the central sensitization phenomena or some neuroplastic changes have occurred in the CNS in patients suffering from severe pain of tooth origin. Less