Extending the Therapeutic Scope for the Treatment of Neuropathic Pain with Topical Analgesics

D. Kopsky
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引用次数: 3

Abstract

Neuropathic pain is defined as "pain arising as a direct consequence of a lesion or disease affecting the somatosensory system” [1]. Peripheral nerve damage causes the release of pro-inflammatory mediators (including interleukin-1β, tumor necrosis factor-α, bradykinin, substance P, calcitonin gene-related peptide, nerve growth factor, and prostaglandins) contributing to the ‘inflammatory soup’[2] The inflammatory response has adaptive functions enabling nerve repair [2]. On the other hand, these mediators have the undesired effect of sensitizing and stimulating nociceptors, leading to neuropathic pain [2]. The intensity of neuropathic pain progressively increases throughout the day [3]. This circadian cycle of neuropathic pain might be due to fluctuation of neurotransmitters and endocrine hormones, as well as repeated somatic stimulation and physical activity [3]. Allodynia (a potential characteristic of neuropathic pain) can exhibit temporal summation [3]. The fact that neuropathic pain often restricts walking and mobility, implies that physical activity evokes or exacerbates neuropathic pain [3]. Thus sensitization and stimulation of the peripheral nerve seem to play an important role in the aggravation throughout the day.
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扩大局部镇痛药治疗神经性疼痛的治疗范围
神经性疼痛被定义为“由影响体感觉系统的病变或疾病直接引起的疼痛”[1]。周围神经损伤导致促炎介质(包括白细胞介素-1β、肿瘤坏死因子-α、缓激肽、P物质、降钙素基因相关肽、神经生长因子和前列腺素)的释放,形成“炎症汤”[2]。炎症反应具有适应性功能,可促进神经修复[2]。另一方面,这些介质具有致敏和刺激伤害感受器的不良作用,导致神经性疼痛[2]。神经性疼痛的强度在一天中逐渐增加[3]。神经性疼痛的这种昼夜周期可能是由于神经递质和内分泌激素的波动,以及反复的躯体刺激和身体活动[3]。异常性疼痛(神经性疼痛的潜在特征)可表现为时间累加[3]。神经性疼痛常常限制行走和活动,这意味着身体活动会引起或加剧神经性疼痛[3]。因此,周围神经的敏感化和刺激似乎在全天的加重中起着重要作用。
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