神经病理性疼痛的概念与诊断李焰生.pptxVIP

神经病理性疼痛的概念与诊断李焰生第1页/共37页第2页/共37页第3页/共37页第4页/共37页第5页/共37页疼痛的解剖和生理 脑 干导水管周围灰质 蓝斑 5-HT NA伤害性感受器温度,机械,化学Aσ 和 C纤维 脊髓后角1,2,5层感觉皮质边缘系统丘脑VPL核对侧脊髓丘脑束第6页/共37页参与神经病理性疼痛的神经纤维Aβ 纤维大直径、有髓、快传导纤维机械感受，正常由非伤害性刺激（触觉）激活，感觉异常Aδ 纤维中等直径、有髓、中速传导纤维正常由伤害性刺激（锐痛）激活。C 纤维小直径、无髓、慢传导正常由伤害性刺激激活，负责继发痛。刺痛、持续灼痛神经病理性疼痛的异常感觉可由Aβ、Aδ或C纤维传导Dworkin Clin J Pain. 2002;18:343-349Raja et al. in Wall PD, Melzack R (Eds). Textbook of pain. 4th Ed. 1999.;11-57第7页/共37页神经病理性疼痛的定义IASP 由或认为是由周围或中枢神经系统障碍所导致的疼痛 由神经系统原发性/继发性损害或功能障碍或一过性紊乱所引起或导致的疼痛同义词神经病性痛，神经病变性痛，神经性疼痛，神经源性疼痛，等等不同于神经痛（neuralgia）NEUROLOGY 2008;70:1630-1635Neuropathic pain：Redefinition and a grading system for clinical and research purposes R. -D. Treede, MD, T. S. Jensen, MD, PhD, J. N. Campbell, MD, G. Cruccu, MD, J. O. Dostrovsky, PhD, J. W. Griffin, MD, P. Hansson, MD, DMSc, DDS, R. Hughes, MD, T. Nurmikko, MD, PhD and J. Serra, MD Pain usually results from activation of nociceptive afferents by actually or potentially tissue-damaging stimuli. Pain may also arise by activity generated within the nervous system without adequate stimulation of its peripheral sensory endings. For this type of pain, the International Association for the Study of Pain introduced the term neuropathic pain, defined as “pain initiated or caused by a primary lesion or dysfunction in the nervous system.” While this definition has been useful in distinguishing some characteristics of neuropathic and nociceptive types of pain, it lacks defined boundaries. Since the sensitivity of the nociceptive system is modulated by its adequate activation (e.g., by central sensitization), it has been difficult to distinguish neuropathic dysfunction from physiologic neuroplasticity. We present a more precise definition developed by a group of experts from the neurologic and pain community: pain arising as a direct consequence of a lesion or disease affecting the somatosensory system. This revised definition fits into the nosology of neurologic disorders. The reference to the somatose