Pain syndromes and their treatment.

D Bowsher
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Abstract

Neurogenic pain (encompassing all types of neuropathic and central pain) is discussed. Experimental work is presented in a model in which the rat sciatic nerve is loosely ligatured. In painful human neuropathies, tricyclic antidepressants have been found to be effective in proportion to the degree they facilitate monoaminergic activity. Several papers also stress the importance of early treatment with amitriptyline or desipramine, and the ineffectiveness of analgesics, including narcotics. In nociceptive pain, recent findings in humans emphasize the importance of both the retroinsular (SII) and the anterior cingulate cortices in the conscious appreciation of pain. Opioid studies have revealed individual differences in the metabolism of morphine to its 3- and 6-glucuronosides; patients with nociceptive pain who respond poorly to morphine or diamorphine probably have a high 3:6 ratio. It has been pointed out that methadone may be useful in such cases, as it is not broken down to glucuronosides.

疼痛综合征及其治疗。
神经源性疼痛(包括所有类型的神经性和中枢性疼痛)的讨论。实验工作是在大鼠坐骨神经松散结扎模型中进行的。在痛苦的人类神经病变中,三环抗抑郁药已被发现与它们促进单胺能活性的程度成比例。几篇论文也强调了早期使用阿米替林或地西帕明治疗的重要性,以及镇痛药(包括麻醉药)的无效。在痛觉性疼痛中,最近在人类身上的发现强调了岛后皮层(SII)和前扣带皮层在有意识地感知疼痛中的重要性。阿片类药物研究揭示了吗啡对其3-和6-葡萄糖醛酸苷代谢的个体差异;对吗啡或吗啡反应不佳的痛觉性疼痛患者的比例可能高达3:6。有人指出,美沙酮在这种情况下可能是有用的,因为它不会分解成葡萄糖醛酸苷。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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