中枢卒中后疼痛的神经机制与临床管理策略

Neurological mechanisms and clinical management strategies of central post-stroke Pain

中枢性脑卒中后疼痛(central post-storke pain,CPSP)是一种慢性顽固性中枢神经性疼痛综合征,是由中枢神经系统血管病变引起的疼痛,与躯体感觉系统损伤有关,表现为与脑损伤区域相对应的躯体部位的持续或间歇性疼痛,伴有感觉异常。目前,CPSP的发病机制尚不明确,现有研究表明疼痛信号传导通路功能障碍、中枢脱抑制、中枢敏化、神经胶质细胞机制、神经递质失衡、离子通道改变等均与CPSP有关。随着CPSP患病人群的增多,当前治疗和管理面临巨大挑战。常见的管理策略包括药物治疗和非药物治疗,但治疗效果有限。未来研究重点应在多学科综合治疗、功能神经影像学建立预测模型、生物标志物开发、新药物靶点探索以及关注CPSP与焦虑、抑郁和睡眠障碍共患病的基础研究上。本文就CPSP的神经机制与临床管理策略作一综述,以期找到更有效的治疗方法,提升患者的生活质量。

Central post-stroke pain(CPSP)is a chronic refractory central neuropathic pain syndrome caused by cerebrovascular lesions affecting the central nervous system.It is associated with damage to the somatosensory system and manifests as persistent or intermittent pain in body parts corresponding to the area of brain injury,accompanied by sensory abnormalities.The pathophysiology of CPSP remains unclear,but current research suggests dysfunction in pain signal transmission pathways,central disinhibition and sensitization,as well as mechanisms involving neuroglial cells,neurotransmitter imbalance,and ion channel alterations are implicated.With the increasing prevalence of CPSP,effective management poses significant challenges.Common management strategies include pharmacological and non-pharmacological treatments,yet their efficacy remains limited.Future research should focus on multidisciplinary comprehensive therapy,establishment of functional neuroimaging prediction models,biomarker development,exploration of new drug targets,and fundamental studies on CPSP comorbidities such as anxiety,depression,and sleep disorders.This review aims to summarize the neurobiological mechanisms and clinical management strategies of CPSP in pursuit of more effective treatments and improved quality of life for patients.