微小RNA在病理性疼痛中的作用

背景 微小RNA(microRNAs,miRNAs)是目前研究最为广泛的一类内源性非编码小分子RNA,长度范围在16～29个核苷酸之间,通过转录后调节机制调节基因的表达.最近研究发现miRNAs在不同的病理性疼痛模型中均有不同程度的表达,可能参与慢性疼痛以及急性伤害性刺激伤害感受过程的基因调节机制,调控几种与疼痛相关转录物的表达. 目的 对miRNAs在病理性疼痛中作用的研究有助于我们更清楚地了解病理性疼痛的产生和维持分子学机制,为疼痛治疗提供了新的方向. 内容 主要介绍miRNAs在炎症性痛、神经病理性痛以及疼痛相关性疾病中的表达情况,以及miRNAs在慢性病理性疼痛中的可能作用. 趋势 鉴于miRNAs在病理性疼痛的产生中具有重要作用,miRNAs将有可能作为治疗疼痛性疾病的一种新型的研究工具、生物标记和潜在的药物治疗靶点.     

CaMKⅡ信号转导通路在病理性疼痛中的研究进展

背景钙／钙调素依赖性蛋白激酶II（Ca2/almodulin—dependent protein kinaseⅡ,CaMKⅡ）是一种多功能的丝氨酸苏氨酸蛋白激酶,广泛分布在周围和中枢神经系统。目的有研究表明CaMKⅡ在感觉信息特别是伤害性信息的传人与整合中具有重要作用,为此现作一综述。内容此文阐述了背根神经节（dorsal root ganglion,DRG）、脊髓背角（Spinal dorsalhom,SDH）及脊髓上水平的、CaMK11在病理性疼痛的作用及其调节因素的研究进展。趋势CaMKⅡ可能为阐明疼痛机制提供依据,为临床治疗疼痛提供方向和思路。     

Postoperative pain therapy in Germany

OBJECTIVE: A survey was performed to obtain information on the organization and practice of postoperative pain management. METHODS: A questionnaire was mailed to 773 directors of German departments of anesthesiology. RESULTS: A total of 446 replies (57.7%) could be analyzed. Of the departments, 161 (36.1%) had established an acute pain service (APS), more often in hospitals > or = 1000 beds (63%) than in hospitals with 400-999 beds (40%) and hospitals with < 400 beds (27%). Epidural analgesia was practiced in 97% of the departments, however, it was the analgesic technique of choice for larger abdominal surgery or amputation of the lower limb only in 60.8% and 45.5% of the departments, respectively. Departments with APS provided epidural analgesia more often on general wards than departments without APS (88.2% vs. 68.4%, p < 0.01). Technically more challenging methods (e.g. catheters for regional anesthesia, PCA, PCEA) were more often provided in hospitals running an APS (p < 0.001). CONCLUSIONS: The number of departments with APS has increased over the last 10 years. Future decisions on reimbursement should consider this extensive service.     

Acute pain therapy in children

Acute pain therapy in children can be achieved by numerous modalities: non-medicamentous supportive measures, regional and local anesthesia, systemic opioids, non-opioids and co-analgesics. The multimodal approach for prevention and therapy of acute pain in children helps minimizing side effects. A well-organized pediatric pain service based on transparent standard operating procedures seems to be essential for the successful treatment of pain in children.     

脊髓胶质细胞活化与病理性疼痛调节

背景 研究表明脊髓胶质细胞(星形胶质细胞和小胶质细胞)在各种病理性疼痛模型中活化,并且活化的胶质细胞在各种病理性疼痛的发生和发展中具有重要作用.目的 探讨脊髓胶质细胞在病理性疼痛调节中的作用.内容 从脊髓胶质细胞活化参与病理性疼痛调节的生理基础,脊髓胶质细胞活化及其检测,脊髓胶质细胞活化与病理性疼痛和脊髓胶质细胞参与病...     

脊髓胶质细胞活化与病理性疼痛调节

背景 研究表明脊髓胶质细胞(星形胶质细胞和小胶质细胞)在各种病理性疼痛模型中活化,并且活化的胶质细胞在各种病理性疼痛的发生和发展中具有重要作用.目的 探讨脊髓胶质细胞在病理性疼痛调节中的作用.内容 从脊髓胶质细胞活化参与病理性疼痛调节的生理基础,脊髓胶质细胞活化及其检测,脊髓胶质细胞活化与病理性疼痛和脊髓胶质细胞参与病理性疼痛的调节机制等几方面就与此有关的研究进展进行了综述.趋向 胶质细胞将继续引起疼痛研究者的关注,因为它为临床病理性疼痛的治疗提供了新的靶点.     

p38丝裂原活化蛋白激酶与病理性疼痛

病理性疼痛病理机制复杂,临床常用的药物治疗效果差。p38丝裂原活化蛋白激酶可通过多种方式影响疼痛的形成与维持。动物试验及部分临床研究初步表明,p38MAPK特异性的抑制剂用于治疗病理性疼痛可能具有良好的应用前景。     

Transdermal fentanyl against postoperative pain

60 patients (ASA class I-II) undergoing knee arthrotomy received in a double blind fashion, a transdermal drug delivery system, containing either fentanyl (delivery rate of 75 micrograms/hour)--Fentanyl TTS--or placebo. The system remained in place for 24 hours. Even when piritramid was added as escape analgesia, all respiratory and hemodynamic parameters, as well as blood gas analysis showed no statistical significant difference between both groups (fentanyl or placebo). One patient had evidence of a beginning respiratory depression, but no specific therapy was needed. No significant side effects were seen. Concerning escape medication, a highly statistically significant difference in favour of Fentanyl TTS was found (p less than 0.001).     

New aspects in postoperative pain therapy

This review summarizes and critically appraises important and clinically relevant publications dealing with postoperative pain therapy. Several consequences can be drawn from these studies: i) women anticipate postoperative pain more realistically and it occurs more often than in man; however, pain intensity and analgesic consumption are not different; ii) placebos elicit psychological phenomena (e. g. expectation) that trigger neurobiological processes (e. g. activation of endogenous opioid system); iii) COX-2 inhibitors increase the risk for thromboembolic complications (e. g. myocardial infarction, apoplex, pulmonary embolism) and perioperative mortality in patients undergoing aortocoronary bypass surgery; iv) NSAID as supplement to postoperative PCIA with opioids reduce the risk for PONV and sedation; v) preoperative administration of gabapentin reduces preoperative anxiety and postoperative pain; vi) epidural catheters situated at the site of major spinal surgery are promising approach to provide efficient postoperative analgesia; vii) in the literature contradictory results have been reported regarding the effect of perioperative acupuncture on intra- and postoperative consumption of anesthetics or analgesics; acupuncture appears to decrease the incidence of PONV, but no reduction in the postoperative use of antiemetic agents has not been shown yet; viii) laparoscopic versus open colectomy in patients with colon carcinoma results in prolongation of surgery, reduction of postoperative pain and analgesics, earlier mobilization and a reduced hospital stay, if conventional systemic opioid-based pain therapy was used postoperatively.     

Opioid therapy in chronic non-malignant pain

In long-term treatment opioids seem to have only minimal side-effects compared with other analgesics and co-analgesics.Nevertheless, some risks have to be considered. While immunosuppression, neurotoxicity, teratogenity, tolerance and addiction are clinically not relevant or very rare, cognitive impairment, sedation and obstipation may have a clinical impact.However, these symptoms can usually be managed by adjuvant medication and patient education.Treatment of non-malignant pain with opioids can only be considered on an individual basis. Scientific evidence for general treatment with opioids, treatment of specific pain syndromes or treatment with certain opioids is not available. In conclusion, only recommendations regarding opioid treatment for certain chronic pain syndromes can be made. In only a minority of patients can a long-term analgesic effect be expected.Therefore, careful evaluation of alternative options of pain management is necessary before opioid therapy is started.With standardized documentation responders may be distinguished from non-responders.For clinical practice of long-term opioid therapy in non-malignant pain a specialized knowledge in pain management is a prerequisite.Future studies with more sophisticated methodology will be necessary to advocate more precise guidelines.However, the therapeutic recommendations from the DGSS consensus conference allow a safer,well structured and validated use of opioids for chronic non-malignant pain.     

Combination analgesic-antispasmodic therapy in postoperative pain

Pain and muscle spasms are causes of postoperative complaints and complications following spinal surgery. The traditional medical management makes use of narcotic analgesics. The antispasmodics, diazepam and baclofen, might also be effective in pain control. A randomized prospective study of 50 consecutive patients was conducted comparing a regimen of a narcotic analgesic (meperidine hydrochloride) and the two antispasmodic agents versus the narcotic alone with the hope of reducing the requirement, postoperatively, of the narcotic and also the subjective assessments of pain and/or spasm. The results demonstrate the efficacy of the regimen in relieving postoperative spasm. The percentage of patients requiring narcotics and the assessed pain severity were essentially uniform between the groups. Whereas postoperative spasm was a common lament, it did not represent a significant element of postoperative pain when judged by these criteria.     

New insights in postoperative pain therapy

In this review, novel clinical studies on postoperative pain therapy are summarized. Based on these studies, several conclusions can be drawn: i) following tonsillectomy, postoperative therapy with NSAIDs leads to a significant increase in the number of reoperations; thus NSAIDs should be used with caution; ii) COX-2 inhibitors in combination with intravenous opioids improve recovery and functional outcome after knee replacement surgery; iii) the combination therapy of different non-opioid analgesics has no proven clinical efficacy and should not be used routinely; iv) patients' age is not a determinant in postoperative opioid titration after surgery; in contrast, it does predict opioid consumption during the first postoperative day; v) morphine and piritramide have identical analgesic efficacy and induce nausea and vomiting with the incidence; opioid selection can, thus, be based on economic considerations and vi) if tramadol is ineffective in postoperative pain therapy, this might be caused by an allelic variant of one of the cytochrome P450 enzymes (CYP2D6); these patients should be treated with a different opioid.     

New developments in cancer pain therapy

This review will summarize some of the potentially useful new drugs and therapies, which have already been applied in clinical practice or will potentially become available for cancer pain management in the near future. Included will be an introduction to drugs, which effectively relieve the breakthrough pain, a group of new sustained release long-acting opioids, Cyclooxygenase-2 (COX-2) selective nonsteroidal anti-inflammatory drug (NSAIDs), alpha-2 agonists, ion channel blockers, N-methyl-D-aspartate (NMDA) receptor antagonists, and new delivery systems.