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1、神经病理性疼痛的概念与诊断上海交通大学医学院附属仁济医院神经科李焰生疼痛的解剖和生理伤害性感受器温度,机械,化学Aσ和C纤维脊髓后角1,2,5层对侧脊髓丘脑束丘脑VPL核感觉皮质边缘系统脑干导水管周围灰质蓝斑5-HTNA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D
2、workinClinJPain.2002;18:343-349Rajaetal.inWallPD,MelzackR(Eds).Textbookofpain.4thEd.1999.;11-57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）NEUROLOGY2008;70:1630-1635Neuropathicpain：Redef
3、initionandagradingsystemforclinicalandresearchpurposesR.-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,PhDandJ.Serra,MDPainusuallyresultsfromactivationofnociceptiveaff
4、erentsbyactuallyorpotentiallytissue-damagingstimuli.Painmayalsoarisebyactivitygeneratedwithinthenervoussystemwithoutadequatestimulationofitsperipheralsensoryendings.Forthistypeofpain,theInternationalAssociationfortheStudyofPainintroducedthetermneuropathicpain,d
5、efinedas“paininitiatedorcausedbyaprimarylesionordysfunctioninthenervoussystem.”Whilethisdefinitionhasbeenusefulindistinguishingsomecharacteristicsofneuropathicandnociceptivetypesofpain,itlacksdefinedboundaries.Sincethesensitivityofthenociceptivesystemismodulate
6、dbyitsadequateactivation(e.g.,bycentralsensitization),ithasbeendifficulttodistinguishneuropathicdysfunctionfromphysiologicneuroplasticity.Wepresentamoreprecisedefinitiondevelopedbyagroupofexpertsfromtheneurologicandpaincommunity:painarisingasadirectconsequenceo
7、falesionordiseaseaffectingthesomatosensorysystem.Thisreviseddefinitionfitsintothenosologyofneurologicdisorders.Thereferencetothesomatosensorysystemwasderivedfromawiderangeofneuropathicpainconditionsrangingfrompainfulneuropathytocentralpoststrokepain.Becauseofth
8、elackofaspecificdiagnostictoolforneuropathicpain,agradingsystemofdefinite,probable,andpossibleneuropathicpainisproposed.Thegradepossiblecanonlyberegardedasaworkinghypothesis
