扁桃体术后镇痛研究进展

慢性扁桃体炎是耳鼻咽喉科常见疾病之一,扁桃体手术是耳鼻咽喉科的常见手术,术后的疼痛可影响病人的顺利康复。尤其在手术后24h内疼痛最为明显,疼痛严重者不敢进食、睡眠障碍,造成术后康复时间延长。调查资料显示,40％的病人术后疼痛剧烈。扁桃体术后镇痛已为临床医护人员所共识。现对扁桃体术后镇痛进展作一综述。     

腹腔镜手术术后镇痛的研究进展

<正>腹腔镜手术发展迅速,与开腹手术相比,其切口小,疼痛轻,但术后镇痛不应忽视。如术后疼痛治疗不及时而引起慢性痛,影响患者生活质量。阻止中枢敏化的发生和控制术后痛可减少慢性痛的发生率。术后早期疼痛得到控制的患者能积极参加术后康复训练,有助于其术后短期和长期的康复。因此,控制术后急性痛能促进患者的长期康复,而良好的术后镇痛能提高患者的生活质量[1]。近年来,随着对疼痛     

哈慈五行针镇痛作用的临床观察

方法与步骤腰腿痛患者３４例,其中急性腰扭伤１０例,腰背肌筋膜炎５例,纤维组织炎１３例,第三腰椎横突综合症６例。所有病例由我院骨科门诊和康复科诊断,其中男２２例,女１２例,年龄１８～５６岁,平均３２．５岁。病程３～３０天,平均１０天。采用哈慈五行针治疗腰部疼痛点,部分采用阿是穴,每天治疗一次,每次１５分钟,１０次为一个疗程。疗效标准痊愈：腰部疼痛、肿胀等症状消失,活动自如。显效：腰部活动正常,疼痛等症状明显减轻。好转：腰部疼痛等症状减轻,功能有改善。无效：疼痛无缓解,腰部活动困难。结果经一疗程的治…     

主动运动和被动运动的镇痛效果及其镇痛机制

主动运动和被动运动可以有效缓解各种急性疼痛和慢性疼痛,且主动运动诱发的镇痛效果强于运动参数相似的被动运动.文章在讨论运动镇痛机制的基础上,探讨了主、被动运动镇痛效果存在差异的原因.具体来说,通过比较两种运动传导运动信息的下行通路和传导躯体感觉/本体感觉的上行通路,论述了主、被动运动在生理(外周神经系统和中枢神经系统)和心理(情绪和认知)层面上镇痛机制的异同.由于被动运动缺少运动下行控制且肌肉激活程度小,其在外周镇痛物质含量和皮层水平上对疼痛的调控弱于主动运动.此外,被动运动相比主动运动不易诱发积极情绪,较难转移对疼痛的注意力,缺乏身体掌控感并拥有较低的身体归属感,进而导致较弱的镇痛效果.最后,文章指出了目前本领域研究的局限性,并对运动镇痛未来的研究方向和方法提出了建议.     

非侵入性电刺激神经调控技术：镇痛效果与镇痛机制

非侵入性电刺激神经调控技术是一种潜力巨大的非药物镇痛手段,具有经济、易操作、安全性高等优点,已被应用于各类临床疼痛的治疗。然而,目前仍缺乏对不同电刺激神经调控技术镇痛特性的深入理解。本文从镇痛效果和镇痛机制两个方面入手,评述非侵入性外周神经电刺激(经皮神经电刺激、经皮迷走神经电刺激)和中枢神经电刺激(经颅直流电刺激、经颅交流电刺激)在镇痛方面的研究结果,总结各技术在缓解急性疼痛和慢性疼痛中常用的刺激参数和其镇痛效果,探讨可能的镇痛机制。最后,本文对比和总结各技术的镇痛特点,讨论了现有研究的若干局限和未来的研究方向。克服这些局限将促进相关技术的临床应用,最终达到帮助患者缓解疼痛的目的,减轻疼痛对患者、其家庭和整个社会带来的健康和经济负担。     

综述与专论：运动诱发的镇痛效应：脊髓、皮层下和皮层机制

在健康受试者或部分慢性疼痛人群中，一定强度和时长的运动锻炼或针对性的运动疗法，已被广泛验证可以有效提高疼痛阈值并改善疼痛症状。上述运动诱发的镇痛效应（exercise induced hypoalgesia,EIH）被认为与痛觉内源性调控系统在神经系统不同水平上的调控作用紧密联系；合适类型的运动刺激可以在脊髓水平诱发镇痛效应，亦可激活脊髓以上高位中枢神经系统的痛觉内源性调控系统，进而对脊髓水平的伤害性反应进行调控。病理性痛状态下，EIH的产生与运动皮层的激活水平以及痛觉下行抑制作用均有关。研究脊髓、皮层下和皮层水平EIH效应的确切机制，将为非药物运动手段预防疼痛慢性化提供帮助。     

辣椒素的镇痛作用

辣椒素是从辣椒中提取出来的一种具有镇痛作用的物质。通过激活感觉神经纤维上的瞬时感受器电位香草酸受体1(transient receptor potential vanilloid 1,TRPV1),释放并消耗大量神经肽物质,使神经细胞对伤害性刺激产生脱敏化反应,进而发挥持久的镇痛作用而不影响运动功能。因而在难治性疼痛类疾病中,辣椒素具有独特的治疗价值。以辣椒素为主要成分的制剂已经在临床治疗中开展应用。特定位点注射辣椒素或其类似物resiniferatoxin可以减轻癌痛患者的疼痛症状。但由于辣椒素的治疗剂量与毒性剂量存在部分重叠,使得其在临床应用中受到一定程度的限制。不同的给药方式和作用部位所产生的作用效果可能不同。为深入了解辣椒素的镇痛作用及作用机制,充分发挥其治疗价值,现从不同给药途径总结近几年来辣椒素镇痛作用的研究成果。     

前列腺素与针刺镇痛——Ⅰ.阿斯匹林对人体皮肤的电针镇痛的影响

前列腺素(Prostaglandin,简称PG)是广泛存在于动物机体的一族二十碳多不饱和脂肪酸,对多种生理生化过程的调节具有重要意义。就其与疼痛的关系来说,一方面,PG对中枢神经系统有镇静安定作用(Karim,1972;Gilmore and Shaikh,1972)、抗惊厥作用(Dutu and T(?)rker,1969)和明显减低皮层自发电、抑制动物防御反射(Desiraju,1973;Potts et al.,1974)等作用;另一方面,又有报告指出,不同浓度的PG和PG生物合成过程中的脂过氧化物中间产物(Lipoperoxide intermediates)能引起疼痛,特别是类似炎症浓度的PG虽不能致痛,伹却能使痛觉过敏(Ferreira and Vane,1974)。     

经皮神经电刺激的镇痛机制及其临床应用

经皮神经电刺激(transcutaneous electrical nerve stimulation,TENS)是一种非侵入式的通过电流脉冲来激活外周神经纤维的镇痛疗法,具有非药理性、安全无创伤、费用低等多方面优点,已用于临床中多种疼痛的缓解。然而,TENS的临床镇痛效果存在较大的差异,这可能是由于不同刺激参数下的TENS涉及不同的镇痛机制。为推进TENS相关的基础研究与临床应用,本文首先综述了不同类型TENS镇痛的神经生理和生化机制,进而从刺激位置、脉冲参数(电流强度、频率与脉宽)以及使用时长和使用频度等多个方面讨论了影响TENS镇痛效果的因素,并总结了TENS在临床镇痛的相关应用,包括术后痛、慢性腰背痛、分娩痛等情况下的应用。最后,为实现更好的临床镇痛效果,本文提出在TENS相关的临床应用中,应充分考虑到不同刺激参数对TENS镇痛效果的影响以及患者个体间差异所导致的TENS镇痛效果的差别,优化TENS参数设置,建立基于患者疼痛评分与TENS刺激输入之间的动态关系模型,自适应地根据患者实时疼痛评分调整TENS刺激模式。     

哈慈五行针镇痛及抗炎症等的机理探讨

哈慈五行针用负压吸附原理,用２５０mT（毫特拉斯）以上磁针点压在穴位上,使无形的磁力线束穿透人体６～９cm深度（相当于传统毫针深度）,代替毫针对穴位的刺激,不刺破皮肤,安全可靠,是一种无创伤无痛苦的针灸。大量的临床实践证明,五行针对牙、颈、肩、臂、腰、腿等各类疼痛具有显著的疗效。对哈慈五行针镇痛及抗炎症等机理的探讨如下。什么是疼痛疼痛是怎样产生的疼痛是人类共有的个体差异很大的一种主观感觉。它既是一种不愉快的感觉,又是机体不可缺少的一种特殊的保护功能,因而疼痛也是许多疾病的一种症状,在临床诊断和治疗…     

Pain issues in poultry

This review highlights the possible pain experienced by layer and broiler poultry in modern husbandry conditions. Receptors which respond to noxous stimulation (nociceptors) have been identified and physiologically characterised in many different part of the body of the chicken including the beak, mouth, nose, joint capsule and scaly skin. Stimulation of these nociceptors produces cardiovascular and behavioural changes consistent with those seen in mammals and are indicative of pain perception. Physiological and behavioural experiments have identified the problem of acute pain following beak trimming in chicks, shackling, and feather pecking and environmental pollution. Chronic pain is a much greater welfare problem because it can last for long periods of time from weeks to months. Evidence for possible chronic pain is presented from a variety of different conditions including beak trimming in older birds, orthopaedic disease in broiler and bone breakage in laying hens. Experiments on pain in the chicken have not only identified acute and chronically painful conditions but also have provided information on qualitative differences in the pain experienced as well as identifying a cognitive component providing evidence of conscious pain perception.     

Nociceptive processing in the human brain

Since the advent of modern neuroimaging techniques, studies have been carried out to examine nociceptive processing within the human brain non-invasively. Combined with advances in immunohistochemistry, histology and genetics, we have been able to correlate more objective measures of nociceptive processing with the subjective experience that is pain. The result has produced a dramatic shift in our thinking about the neural circuitry involved in nociceptive processing, revealing that pain is much more than a submodality of the sense of touch.     

Biology and therapy of fibromyalgia. Stress, the stress response system, and fibromyalgia

Stress is a state of disharmony, or threatened homeostasis. A stressor could have a psychological origin or a biological origin. Societies have become more intricate with industrialization, and modern individuals try to adapt to the new defiance by forcing their stress response system. The main component of the stress response network is the autonomic nervous system. The present article reviews current knowledge on autonomic dysfunction in fibromyalgia. Sympathetic hyperactivity has been consistently described by diverse groups of investigators. Fibromyalgia is proposed to be a sympathetically maintained neuropathic pain syndrome, and genomic data support this contention. Autonomic dysfunction may also explain other fibromyalgia features not related to pain.     

Expanding use of pulsed electromagnetic field therapies

Various types of magnetic and electromagnetic fields are now in successful use in modern medicine. Electromagnetic therapy carries the promise to heal numerous health problems, even where conventional medicine has failed. Today, magnetotherapy provides a non invasive, safe, and easy method to directly treat the site of injury, the source of pain and inflammation, and a variety of diseases and pathologies. Millions of people worldwide have received help in treatment of the musculoskeletal system, as well as for pain relief. Pulsed electromagnetic fields are one important modality in magnetotherapy. Recent technological innovations, implementing advancements in computer technologies, offer excellent state-of-the-art therapy.     

Inhibiting astrocytic activation: a novel analgesic mechanism of ketamine at the spinal level?

Although ketamine is widely used as an analgesic agent and has an anti-allodynic effect on neuropathic pain, the underlying analgesic mechanisms are not fully explained by the modern 'neuronal-based' theories. As emerging studies have focused on the critical role of spinal astrocytes in the pathological pain states, we have hypothesized that there exist some 'astrocytes-related' mechanisms in the analgesic function of ketamine. In the present study, using the spinal nerve ligation (SNL) pain model, we investigated the anti-nociceptive effects of intraperitoneal or intrathecal ketamine on SNL-induced neuropathic pain response, meanwhile, we investigated the astrocytic activation after ketamine administration on SNL rats. Behavioral data showed that either intraperitoneal or intrathecal ketamine inhibited SNL-induced allodynia, however, immunohistochemistry showed that SNL induced astrocytic activation was suppressed by intrathecal but not intraperitoneal ketamine. Using quantitative Western blot analysis, our report showed that intrathecal ketamine down-regulated glial fibrillary acidic protein expression, suggesting inhibition of SNL-induced astrocytic activation, which wasn't influenced by intraperitoneal administration. We conclude that intraperitoneal ketamine could alleviate SNL-induced neuropathic pain via the classical 'neuronal-based' mechanisms, but in addition, 'astrocytes-related' mechanisms were also important underlying the anti-allodynic effect of intrathecal ketamine.     

Cannabis, pain, and sleep: lessons from therapeutic clinical trials of Sativex, a cannabis-based medicine

Cannabis sativa L. has been utilized for treatment of pain and sleep disorders since ancient times. This review examines modern studies on effects of Delta9-tetrahydrocannabinol (THC) and cannabidiol (CBD) on sleep. It goes on to report new information on the effects on sleep in the context of medical treatment of neuropathic pain and symptoms of multiple sclerosis, employing standardized oromucosal cannabis-based medicines containing primarily THC, CBD, or a 1 : 1 combination of the two (Sativex). Sleep-laboratory results indicate a mild activating effect of CBD, and slight residual sedation with THC-predominant extracts. Experience to date with Sativex in numerous Phase I-III studies in 2000 subjects with 1000 patient years of exposure demonstrate marked improvement in subjective sleep parameters in patients with a wide variety of pain conditions including multiple sclerosis, peripheral neuropathic pain, intractable cancer pain, and rheumatoid arthritis, with an acceptable adverse event profile. No tolerance to the benefit of Sativex on pain or sleep, nor need for dosage increases have been noted in safety extension studies of up to four years, wherein 40-50% of subjects attained good or very good sleep quality, a key source of disability in chronic pain syndromes that may contribute to patients' quality of life.     

The pharmacological control of musculoskeletal pain

The modern therapy of the pain of inflammatory rheumatic disease and osteoarthritis is based on several advances in molecular biology, which are reviewed in this paper. Inhibition of the ubiquitous enzyme cyclooxygenase by the nonsteroidal anti-inflammatory drugs including the salicylates prevents the production of endoperoxides, which are pro-inflammatory, and prostaglandins E2 and I2, which sensitize peripheral pain receptors. In addition, a fundamental understanding of neural tracts that inhibit the pain signal has introduced the concept of giving low dose tricyclic antidepressants for chronic pain to block the re-uptake of serotonin from the neural cleft of synapses. This amplifies the effect of serotonin and catecholamines, which are neurotransmitters for these inhibitory tracts.     

解构“环境工程微生物学”教学改革：痛点、创新路径和实施策略

本文针对00后大学生的特点,通过实践探索发现了四大教学痛点。根据这些教学痛点,提出了将专业主题和时代认知融入翻转课堂的教学目标和四项教学改革举措。通过整合教学内容形成专业主题、将专业主题与时代热点融合、优化课堂翻转教学过程、创新全过程全方位考核四项教学改革举措,实现了课程专业主题的深入教学和学生情感认知的清晰培养。这种独特的教学模式能够激发学生对专业的热情,并提高他们的参与感和学习效果。     

On the mathematical modelling of pain

In this review a case is presented for the use of mathematical modelling in the study of pain. The philosophy of mathematical modelling is outlined and a recommendation is made for the use of modern nonlinear techniques and computational neuroscience in the modelling of pain. Classic and more recent examples of modelling in neurobiology in general and pain in particular, at three different levels—molecular, cellular and neural networks—are described and evaluated. Directions for further progress are indicated, particularly in plasticity and in modelling brain mechanisms. Major advantages of mathematical modelling are that it can handle extremely complex theories and it is non-invasive, and so is particularly valuable in the investigation of chronic pain. Special issue dedicated to Dr. Herman Bachelard     

Glutamate transporter: an unexpected target for some antibiotics

Molecular pain is a relatively new and rapidly expanding research field that represents an advanced step from conventional pain research. Molecular pain research addresses physiological and pathological pain at the cellular, subcellular and molecular levels. These studies integrate pain research with molecular biology, genomics, proteomics, modern electrophysiology and neurobiology. The field of molecular pain research has been rapidly expanding in the recent years, and has great promise for the identification of highly specific and effective targets for the treatment of intractable pain. Although several existing journals publish articles on classical pain research, none are specifically dedicated to molecular pain research. Therefore, a new journal focused on molecular pain research is needed. Molecular Pain, an Open Access, peer-reviewed, online journal, will provide a forum for molecular pain scientists to communicate their research findings in a targeted manner to others in this important and growing field.