阿片类药物诱发痛觉过敏与术后慢性疼痛的研究进展

The mechanisms underlying opioid-induced hyperalgesia and chronic postoperative pain

背景 阿片类药物诱发的痛觉过敏(opioid induced hyperalgesia, OIH)和术后慢性疼痛(chronic post-surgical pain, CPSP)发生机制均不明确.现有研究发现,OIH和CPSP的发生、发展有一定关系. 目的 探讨OIH的机制、预防、治疗以及与CPSP之间的关系. 内容 OIH是神经系统敏化的结果,其产生机制很复杂,可能与中枢谷氨酸能系统的激活、内源性神经肽的产生与释放、下行易化系统及遗传因素等有关.OIH预防和治疗的基础在于其机制的研究.CPSP发生的神经病理学基础是外周和中枢敏化,因而OIH可能是CPSP发生、发展的潜在危险因素. 趋向 OIH和CPSP的关系还需要进一步的深入研究.

Background The mechanisms underlying opioid induced hyperalgesia (OIH)and chronic post-surgical pain (CPSP)remain unclear.Accumulating evidence supports that OIH and CPSP may share common neural circuit bases.Objective This review discusses the relationship between OIH and CPSP in terms of the mechanisms underlying their development and the therapeutic strategies of these two diseases.Content The development of OIH involves the sensitization of the nervous system, which may be relevant to the hyperactivity of glutaminergic neurons,enhanced release of some endogenous neuropeptides, mobilization of the descending facilitation pathway of pain transduction,and genetic factors,as well Inhibiting glutamate receptors and reducing the release of neurotransmitters are major therapeutic strategies for OIH.Central sensitization is also a major pathophysiological feature of CPSP following nerve injury.Although treatment of OIH relieves acute pain and reduces prevalence of CPSP,but the relationship between OIH and CPSP is not well-understood.Trend Further studies are required to reveal the relationship between the OIH and CPSP.