神经病性疼痛和辅助镇痛剂的意义.pptVIP

神经病性疼痛和辅助镇痛剂的意义Neuropathic pain and the meaning of adjuvant analgesics Dr. Z. Zylicz Hospice in the Weald Pembury, Tunbridge Wells Kent, UK “自然”疼痛的两种类型 适应性疼痛 - “正常”的疼痛， 疼痛有助于维护躯体的整合（自闭，总是准备，“急性疼痛”大部分与A - δ纤维相关） 疼痛促进康复：“不要移动你断了的腿”，炎性疼痛，“慢性疼痛”大部分与C纤维有关 Two types of “natural” pain Adaptation pain – “normal pain”, The pain helps to preserve body’s integrity (withdrawal, always ready, “fast pain” mostly A delta fibres） The pain promotes recovery: “do not move your broken leg”, inflammatory pain, “slow pain” mostly C fibres 感受伤害性的疼痛Nociceptive pain 炎性疼痛Inflammatory pain “病理性疼痛” 与适应性无关 “病理性疼痛”，“没有目的的疼痛” 常常是神经病性源性 对经典镇痛剂没有或部分敏感 对辅助镇痛剂常常敏感 “pathologic pain” has nothing to do with adaptation “pathologic pain”, “pain without purpose” frequently of neuropathic origin, not or only partially sensitive to classical analgesics frequently sensitive to adjuvant analgesics 神经病性疼痛Neuropathic pain 神经病性疼痛的2种类型Two types of neuropathic pain Neurogenic pain 神经源性疼痛 pressure on the nerve 神经受压迫 peripheral sensitization 外周神经敏化 Reversible可逆转性 distal to the damage 末稍损伤 partially sensitive to analgesics 对镇痛剂部分敏感 responds to local anaethetics 对局部麻醉剂有反应 nerve entrapment 神经的压迫性损害 True neuropathic pain 真性神经病性疼痛 damage irreversible 不可逆损伤 central sensitization (spinal cord, brain) 中枢神经敏化（脊索，脑） classical analgesics and anesthetics frequently ineffective普通镇痛剂和麻醉剂常常无效 adjuvant analgesics like TCA are effective 辅助镇痛剂有效，如TCA类 nerve section 神经切除 “辅助性镇痛剂…” 所有的药物，包括尚未被许可用于治疗疼痛，但对于改善镇痛质量有用的药物。这些药物可能有经典镇痛剂的内在镇痛活性或潜在活性，或减低经典镇痛剂的毒性作用。 “Adjuvant analgesics…” All drugs, not licensed as such for the treatment of pain, but useful to improve the quality of analgesia. They may have an intrinsic analgesic activity or may potentiate the activity of classical analgesics or diminish their toxic effects. 我们将讨论哪些药物？About which drugs we are talking about? Antidepressants 抗抑郁剂 Anxiolytics 抗焦虑剂 Anticonvulsants 抗惊厥药物 NMDA inhibitors