脊髓损伤后神经病理性疼痛的病理生理机制研究进展

Pathophysiological mechanisms of neuropathic pain following spinal cord injury:a review

神经病理性疼痛(NP)是脊髓损伤后产生的一种常见并发症,其发生率为38%~70%。脊髓损伤后NP通常由于躯体感觉神经受损而表现为灼热、电击痛、刺痛、挤压痛等症状,对患者的生理和心理造成极大负面影响。脊髓损伤后,神经胶质细胞被激活并引发炎症级联反应,导致多种炎症介质的释放并改变神经元功能,从而增加神经元异常兴奋性,促进疼痛信号传递。此外,脊髓损伤可干扰神经递质及神经营养因子的释放、改变离子通道活性,从而破坏正常的疼痛调节机制,进一步增加疼痛感知。这些机制共同作用,导致脊髓损伤后NP的发生和持续。但目前NP的确切发病机制尚未完全阐明,使其治疗效果也存在不确定性,临床治疗困难。深入理解脊髓损伤后NP的潜在病理生理机制对其治疗具有重要意义。为此,笔者就脊髓损伤后NP的特征和病理生理机制的研究进展进行综述,为进一步研究和开发更有效的靶向治疗方法及管理策略提供参考。

Neuropathic pain(NP)is a common complication following spinal cord injury,with an incidence rate ranging from 38%to 70%.NP typically presents as sensation of burning,electric shocks,tingling or squeezing pain resulting from somatosensory nerve damage,which exerts a negative impact on patients′physical and psychological well-being.After spinal cord injury,glial cells are activated to induce inflammatory cascade.Accordingly,various inflammatory mediators that may disrupt the neuronal function are released to promote abnormally increased neuronal excitability and pain signal transduction.Additionally,spinal cord injury can disrupt the release of neurotransmitters and neurotrophic factors,alter ion channel activity,and thereby impair the normal pain regulatory mechanisms and further increase pain perception.The interaction of these mechanisms contributes to the occurrence and persistence of NP after spinal cord injury.However,the precise pathogenesis of NP remains incompletely elucidated,making its therapeutic efficacy uncertain and clinical management difficult.It is of great significance to thoroughly understand the underlying pathophysiological mechanisms of NP following spinal cord injury for its treatment.For this reason,the authors reviewed the research progress on the characteristics and pathophysiological mechanisms of NP following spinal cord injury,aiming to serve as a reference for further research and development of more effective targeted therapies and management strategies.