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Is postherpetic neuralgia more than one disorder? 带状疱疹后神经痛不止一种疾病吗?
Pain Forum
Pub Date : 1998-12-01 DOI: 10.1016/S1082-3174(98)70003-0
Michael C. Rowbotham , Karin Lottrup Petersen , Howard L. Fields

Acute herpes zoster is a highly stereotyped condition of viral recrudescence producing inflammation in a dorsal root ganglion, a segmental vesicular rash, and pain. The long-term outcome is unpredictable. Those acute zoster patients that develop postherpetic neuralgia (PHN) fall into three subtypes: (1) an “irritable nociceptor” group with minimal deafferentation and touch-evoked allodynia due to peripheral nociceptor input, (2) a deafferentation group with marked sensory loss and no allodynia, and (3) a deafferentation group with sensory loss and allodynia due to central reorganization. Response to therapy also shows significant inhomogeneity. Some patients obtain nearly complete relief by either topical agents or oral monotherapy with opioids, antidepressants, or anticonvulsants. Other PHN sufferers are refractory to all measures, similar to patients with spinal cord injury and central poststroke pain. Because the clinical picture of PHN falls into distinct patterns based on differing pathophysiology, PHN should be thought of as several disorders, which may respond differently to therapeutic interventions and which may or may not coexist in the same patient.

急性带状疱疹是一种高度定型的疾病，病毒复发产生背根神经节炎症，节段性水疱疹和疼痛。长期的结果是不可预测的。发生带状疱疹后神经痛(PHN)的急性带状疱疹患者可分为三种亚型:(1)“激惹性伤害感受器”组，由于外周伤害感受器输入，有轻微的神经传递障碍和触摸诱发的异常痛觉;(2)神经传递障碍组，有明显的感觉丧失和无异常痛觉;(3)神经传递障碍组，由于中枢重组，有感觉丧失和异常痛觉。对治疗的反应也表现出明显的不均匀性。一些患者通过局部用药或口服阿片类药物、抗抑郁药或抗惊厥药的单药治疗获得几乎完全的缓解。其他PHN患者与脊髓损伤和中枢性中风后疼痛的患者类似，对所有措施都难以治疗。由于PHN的临床表现基于不同的病理生理学而呈现出不同的模式，因此应将PHN视为几种疾病，这些疾病对治疗干预的反应可能不同，并且可能在同一患者中共存，也可能不共存。
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引用次数: 60
Laser-evoked potentials in human pain 人类疼痛的激光诱发电位
Pain Forum
Pub Date : 1998-12-01 DOI: 10.1016/S1082-3174(98)70002-9
Andrew C.N. Chen , Lars Arendt-Nielsen , Leon Plaghki

In Part II, the dynamic topography of laser-evoked brain potentials (LEPs) in human pain is reviewed. The cerebral generators of LEPs, SI, Sil, and midline deep generators, are then systematically examined, and the results of LEPs and positron-emission tomography (PET)/functional magnetic resonance imaging (fMRI) in pain studies are compared. The theoretical ground of functional segregation and integration of pain processing in the brain can be delineated. Four contending issues are raised: (1) which to use: electroencephalography or magnetoencephalography?, (2) what are the reliability and validity of source localization in LEPs?, (3) can neural generators of LEPs contribute to PET/fMRI of human pain?, and (4) is there a “holy grail” of pain in the brain? Future directions needed for developing comprehensive neurophysiology of pain mechanisms using dynamic topography/source modeling of LEPs with PET/fMRI neuroimaging are discussed. It is concluded that full understanding of the cerebral genesis of LEPs requires empirical identification of their cortical/subcortical substrates, as well as theoretical modeling of their modular function during sequential and parallel stages of human pain processing in the brain.

第二部分综述了人类疼痛中激光诱发脑电位(LEPs)的动态形貌。然后系统地检查lep的大脑发生器，SI, Sil和中线深部发生器，并比较lep和正电子发射断层扫描(PET)/功能磁共振成像(fMRI)在疼痛研究中的结果。大脑疼痛处理的功能分离和整合的理论基础可以被描绘出来。提出了四个有争议的问题:(1)使用脑电图还是脑磁图?(2) lep中源定位的信度和效度如何?(3) lep的神经发生器是否与人类疼痛的PET/fMRI有关?(4)大脑中是否存在疼痛的“圣杯”?讨论了利用PET/fMRI神经成像技术对lep进行动态地形/源建模，以发展全面的疼痛机制神经生理学的未来发展方向。因此，要充分理解lep的大脑起源，需要对其皮层/皮层下底物进行经验鉴定，并对其在人类大脑中疼痛处理的顺序和平行阶段的模块功能进行理论建模。
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引用次数: 39
Neuropathic pain 神经性疼痛
Pain Forum
Pub Date : 1998-12-01 DOI: 10.1016/S1082-3174(98)80011-1
David Yarnitsky , Elon Eisenberg
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引用次数: 17
Response to Dr. J. Loeser's letter on back pain in the workplace 对J. Loeser博士关于工作场所背痛的信的回应
Pain Forum
Pub Date : 1998-12-01 DOI: 10.1016/S1082-3174(98)80001-9
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引用次数: 0
Multimodal approaches to laser-evoked potential generators 激光诱发电位发生器的多模态方法
Pain Forum
Pub Date : 1998-12-01 DOI: 10.1016/S1082-3174(98)80008-1
Luis García-Larrea
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引用次数: 23
Raphe magnus serotonergic neurons tonically modulate nociceptive transmission 中缝大鼠血清素能神经元张力调节伤害性传递
Pain Forum
Pub Date : 1998-09-01 DOI: 10.1016/S1082-3174(98)70008-X
Peggy Mason, Keming Gao

Serotonin-containing neurons in the medullary raphe magnus (RM) have long been thought to be important mediators of descending nociceptive inhibition. Although pharmacologic and behavioral studies support this idea, recent physiologic evidence demonstrates that RM serotonergic cells do not respond to antinociceptive stimulation in the periaqueductal gray or analgesic doses of morphine with a change in discharge rate. Instead, serotonergic cell discharge is likely to influence the outcome of modulatory circuits by tonically modulating the effects of other synaptic connections in the dorsal horn. Because serotonergic cells discharge in relation to sleep and wake cycles, RM serotonergic cells are hypothesized to subserve the relative decrease in nociceptive responsiveness observed during waking compared to slow-wave sleep.

中脑大髓中含有5 -羟色胺的神经元一直被认为是下行伤害抑制的重要介质。尽管药理学和行为学研究支持这一观点，但最近的生理学证据表明，RM 5 -羟色胺能细胞对导水管周围灰质的抗痛感刺激或镇痛剂量的吗啡的放电率没有反应。相反，5 -羟色胺能细胞放电可能通过张力性地调节背角中其他突触连接的作用来影响调节回路的结果。由于5 -羟色胺能细胞的放电与睡眠和清醒周期有关，RM 5 -羟色胺能细胞被假设为与慢波睡眠相比，在清醒时观察到的伤害性反应的相对减少。
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引用次数: 32
From Aristotle to AI haig via an interactive continuum 从亚里士多德到人工智能，这是一个互动的连续体
Pain Forum
Pub Date : 1998-09-01 DOI: 10.1016/S1082-3174(98)80043-3
Fernando Cervero
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引用次数: 0
Visceral and somatic pain: The gift that nobody wants and everybody needs 内脏和身体的疼痛:没有人想要，但每个人都需要的礼物
Pain Forum
Pub Date : 1998-09-01 DOI: 10.1016/S1082-3174(98)80041-X
A. Vania Apkarian, Johannes Brüggemann
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引用次数: 0
Visceral pain 发自内心的痛苦
Pain Forum
Pub Date : 1998-09-01 DOI: 10.1016/S1082-3174(98)80044-5
Robert D. Foreman
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引用次数: 1
From Aristotle to AI Haig via an Interactive Continuum 从亚里士多德到AI黑格的互动连续体
Pain Forum
Pub Date : 1998-09-01 DOI: 10.1016/S1082-3174(98)80043-3
F. Cerveró
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引用次数: 0
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