最新(中德康复技术培训课件)25.06 康复技术培训 转化医学-药学医学精品资料.ppt

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1、最新(中德康复技术培训课件)25.06康复技术培训转化医学-药学医学精品资料ContentChronicpainsyndromes:epidemiologyandcharacteristics慢性疼痛特征Mechanismsofpainchronification(Fibromyalgiaasmodelofchronicpain)疼痛的慢性损伤肌肉纤维疼痛◦Neuroplasticity神经重塑◦Painmediators疼痛因子ConclusionandFutureDirection讨论及未来展

2、望Chronicpain(characteristicsandepidemiology)Paininmusculoskeletalsystemisveryfrequentsymptom:肌肉骨骼系统疼痛为主◦withtissuedamage:e.g.Osteoarthritis,discherniation实质性损伤◦without(specific)tissuedamage:jointdysfunction,irritationcausedbyoverstrain,musclehypertensi

3、onandothersManyofthesesyndromearenotverysevere(ordangerous)andselflimitingbutinsomecasestheycanbecomechronicTheimpactofmusculoskeletalpainonqualityoflife,andhealthexpensesisveryhighImportantquestion:howtoprevent(andtreat)chronicpainsyndromes无特殊性损伤关节功能丧

4、失其中一些并不危险，并且有自身受限，但某些情况下会变成慢性重要问题-如何预防并治疗转化成慢性疼痛MechanismsofpainchronificationMay,Pain2008;137:7–15DifferentlevelofplasticityinchronicpainNeuroplasticity:AlterationFunction功能Structure结构Chemicalprofile化学指标Centralsensitization(CoghillRC2005)中枢patientwith

5、chronicpain慢性疼痛normalsubject正常人Centralsensitization:functionalimagingGuedjetal.:JNuclMed2008;49:1798–1803May,2008May,2011.TheNeuroscientistChemicalprofile(painmediators)化学剖面（疼痛因子）Painmediators:BrainDerivedNeurotropicFactor,BDNF脑源性神经营养因子CorrelationofBDN

6、FandageinHealthyControlsandFMSpatientsPainmediators:BrainDerivedNeurotropicFactor,BDNFNugrahaetal.2013:NeurochemIntNugrahaetal.2012RheumatolIntPainmediators:BrainDerivedNeurotropicFactor,BDNF(ntotal=39;HADS-Dscore<8:n=21;8–10:n=10;>10:n=8;Dataareshowni

7、nmean±SEM;TheJocnkheere–Terpstratest:p<0.05)(ntotal=39;HADS-Ascore<8:n=9;8–10:n=12;>10:n=18;Dataareshowninmean±SEM;TheJocnkheere–Terpstratest:p>0.05).LevelofserumBDNFinFMSpatientsbasedondepressionscoregroupLevelofserumBDNFinFMSpatientsbasedonanxietysco

8、regroupCorrelation:R=0.434;p=0.006PainMediators:CD3+CD56+NKTCells:FMSanddepression%CD3+CD56+NKTCellsHADS-DScoreR=-0.297;p=0.03ANOVA:p=0.02Post-hoc:Bonferronitest:HADS-D<8and>10(p=0.018)CorrelationNugrahaetal.2013ClinExpRheumPainmediator