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盘点:神经性疼痛研究一览

2016-09-26 MedSci MedSci原创

神经性疼痛一直是困扰医学界的难题:发病机理不清楚,阿片类药物治疗效果不佳,患者非常痛苦。近年来随着分子生物学和电生理技术的发展,人们已逐渐深入地认识到神经性疼痛的复杂病理机制,并为治疗提供新的思路和方法。本文梅斯医学小编为您盘点有关神经性疼痛研究进展。【1】治疗神经性疼痛:普瑞巴林是良药根据在线发表于9月9日的《疼痛实践》上的研究结果,不管之前有没有用过加巴喷丁,普瑞巴林对于神经性疼痛的治疗都

神经性疼痛一直是困扰医学界的难题:发病机理不清楚,阿片类药物治疗效果不佳,患者非常痛苦。近年来随着分子生物学和电生理技术的发展,人们已逐渐深入地认识到神经性疼痛的复杂病理机制,并为治疗提供新的思路和方法。本文梅斯医学小编为您盘点有关神经性疼痛研究进展。

【1】治疗神经性疼痛:普瑞巴林是良药

根据在线发表于9月9日的《疼痛实践》上的研究结果,不管之前有没有用过加巴喷丁,普瑞巴林对于神经性疼痛的治疗都是有益的。
 
来自纽约罗彻斯特大学医学院的John D. Markman博士和同事们收集了来自在神经性疼痛患者身上进行的18项有关普瑞巴林的随机、双盲试验。作者们比较了普瑞巴林介导的疼痛改变和疼痛相关的睡眠干预得分、最终患者整体印象变化分数以及不良反应在那些之前接受和未接受加巴喷丁的患者身上的发生情况。
 
研究人员发现,不管在任何时间点使用多大剂量的普瑞巴林,在之前接受和未接受过加巴喷丁的患者群体之间,疼痛缓解以及疼痛相关睡眠干扰的缓解程度并没有差别。并且,在研究结束时,患者整体印象变化分数或者不良反应的发生情况分布在接受和未接受加巴喷丁治疗的患者群中也没有显著性差异。
 
“这些研究发现支持了一个观点,即普瑞巴林也许能成功用于那些患有神经性疼痛同时对加巴喷丁反应较差或不能耐受的患者。”作者们写道。“这些结果强调了根据个体对不同治疗(包括同种机制下的多种试剂的应用)的反应来调整神经性疼痛治疗的重要性。”(文章详见--治疗神经性疼痛:普瑞巴林是良药

【2】Lancet Neurol:反复注射肉毒杆菌毒素可减轻周围神经性疼痛

既往研究数据表明,肉毒杆菌毒素注射对周围神经性疼痛具有镇痛效果,但研究结果的有效性不高且值得怀疑。该研究旨在再次评估使用肉毒杆菌毒素为神经性疼痛患者止痛的安全性和有效性。

方法:该研究为随机、双盲、安慰剂对照试验,实验在法国和巴西共3个临床疼痛中心进行(法国2个,巴西1个)。研究人员选取18-85岁周围神经性疼痛的患者并把他们随机分为2组(1:1)。实验组患者接受两个疗程皮下注射肉毒杆菌毒素(最多300单位),对照组采用安慰剂治疗,共计12周。在实验过程中,所有的研究人员和患者都不知道具体情况(双盲)。研究人员关注的主要结果是患者接受肉毒杆菌毒素与安慰剂治疗后的疗效,并收集患者自从实验开始后24周内每周的疼痛情况。

结果:2010年10月2日-2013年8月2日,研究人员共招募了152名患者参与实验。其中68人被随机分配,每组34人。共66人(男性37人,占56%)参与实验,实验组34人,对照组32人。结果表明,相比对照组而言,24周内,实验组患者的疼痛得到减轻(效应估计值:-0.77, 95%CI:-0.95—-0.59;p<0.0001)。注射时出现的疼痛为唯一不良事件。实验组中有19人(56%)发生,对照组有17人(53%)发生(p=1.0)。 实验组中有10人(29%)、对照组中有11人(34%)自诉剧烈疼痛(p=0.8)。

结论:注射两个疗程A型肉毒杆菌毒素,每1个疗程都包含许多次注射,但这一方法对周围神经性疼痛有持续的镇痛作用。今后的研究中将重点探究触摸痛和热环境等因素对治疗的影响。 (文章详见--Lancet Neurol:反复注射肉毒杆菌毒素可减轻周围神经性疼痛

【3】降低2型糖尿病患者神经性疼痛的新型药物

这项研究由Araim Pharmaceuticals完成,并开发出慢性疾病的创新治疗方法,研究人员还观察到服用ARA290患者的代谢控制得到改善。ARA290是一种肽,被研究人员进行改造以激活机体内的先天修复受体,该受体由Araim科学家发现,只在组织损伤或应激情况下表达。

在最初的研究中,患者每日服用ARA290(一种新型的药物),持续28天,以评价其治疗神经性疼痛的功效(糖尿病患者之间的共同并发症)。当服用ARA290,体内的先天修复受体被激活,并随后关闭炎症,开启人体的自然修复系统。短半衰期的ARA290加上先天修复受体的表达降低,充当双重安全系统以避免潜在的副作用。

临床显著的结果和出色的安全性,支持Araim在2015年开展两个未来的研究。第一,在有中度肾功能损害2型糖尿病患者中开展新陈代谢改善将研究。

第二,1型糖尿病患者的多中心临床实验研究ARA290对神经性疼痛的减少功效。第二阶段的临床试验将在英国进行,患者会每天服用ARA290,持续六个月,以便有充分时间来修复组织。(文章详见--降低2型糖尿病患者神经性疼痛的新型药物

【4】Arthritis Rheum:AS患者背痛为包含有神经性疼痛在内的混合性疼痛

强直性脊柱炎(AS)的病变主要累及中轴脊柱,是引起下腰背痛症状的常见疾病。为明确AS患者的背痛是否含有神经性疼痛并描绘与AS病情相关的脑灰质异常,来自多伦多西部医院西部研究所的Qi Wu博士等人进行了一项研究。研究结果发表于2013年6月的《关节炎与风湿病》(ARTHRITIS & RHEUMATISM)杂志上。研究发现,AS患者的背痛是一种包含有神经性疼痛在内的混合性疼痛。[Arthritis Rheum. 2013 Jun;65(6):1494-503]

该研究纳入了17例AS患者,其背痛症状均由AS病情引起,且均未使用过生物制剂。同时研究还纳入了17例在年龄和性别方面与患者组相匹配的健康受试者。对所有研究对象使用疼痛检测仪(积分≤12表明其存在神经性疼痛的可能性较小)和McGill疼痛调查问卷进行测试。所有研究对象的机械阈值和温度阈值均被测定,其脑灰质通过3T磁共振成像进行评估。

以上的研究结果支持AS患者合并有神经性疼痛。此外,脑灰质及与神经性疼痛相关的神经中枢异常,也与AS患者临床中出现的感觉障碍、情绪障碍、神经性疼痛综合征等临床现象相一致。这些研究结果提示,AS患者的背痛是一种包含有神经性疼痛在内的混合性疼痛。(文章详见--Arthritis Rheum:AS患者背痛为包含有神经性疼痛在内的混合性疼痛

【5】Pain:抗焦虑药治疗神经性疼痛

最近,卡尔加里霍奇基斯脑研究所的一项研究显示,抗焦虑药大麻隆(Nabilone)可以治疗糖尿病周围神经病变或神经性疼痛。在为期12周的有安慰剂对照的临床研究中,研究人员招募了60例糖尿病周围神经病变患者。在研究结束时,服用大麻隆的患者疼痛减少,睡眠和焦虑也得到改善,相比较于安慰剂。

神经科医师和Cory Toth博士说:大麻隆是一个很好的选择,以帮助治疗糖尿病神经性疼痛,该药副作用很少。
在研究中使用的药物通用名称为大麻隆,目前在加拿大用于治疗化疗病人的恶心。这项研究给医生有更多的证据来支持用其处方来治疗糖尿病神经病变疼痛。大麻隆是一种人工合成大麻素,它模拟大麻的一些化学成分。目前已被加拿大卫生部和FDA批准。

2型糖尿病流行率正在迅速增长。最近的研究表明,糖尿病神经病变会导致患者麻木,刺痛,烧灼感和疼痛。大约有一半的糖尿病患者患有糖尿病周围神经病变,服用大麻隆后,患者可以减轻痛苦,这项研究结果发表在十月发行的Pain杂志上。(文章详见--Pain:抗焦虑药治疗神经性疼痛

【6】Neurology:普瑞巴林可有效治疗脊髓损伤所致神经性疼痛

美国学者的一项研究表明,普瑞巴林可有效治疗脊髓损伤所致神经性疼痛,并且耐受性良好。论文于2013年1月23日在线发表于《神经病学》(Neurology)。
  
此项研究共纳入220例脊髓损伤所致慢性神经性疼痛患者,并随机给予为期17周的普瑞巴林(108例)或安慰剂(112例)治疗。依据损伤神经平面相关性对疼痛加以分类。主要转归指标为持续时间校正的疼痛平均改变。关键性次要转归指标包括基线至终点平均疼痛评分变化、终点时平均疼痛评分降低≥30%的患者百分比、终点时患者全面印象变化评分以及疼痛相关性睡眠干扰平均评分变化。
  
结果显示,与安慰剂相比,普瑞巴林治疗可显著改善所有主要转归指标和关键性次要转归标准。显著疼痛改善早在治疗1周时即可出现,并且持续至整个治疗期间。不良事件与普瑞巴林已知安全性特征相一致,并且大部分为轻中度。嗜睡和眩晕为最常见不良反应。(文章详见--Neurology:普瑞巴林可有效治疗脊髓损伤所致神经性疼痛

【7】Neuron:胚胎干细胞用于治疗神经性疼痛

近日,加州大学旧金山分校的科学家们发现使用胚胎干细胞能用来治疗神经性疼痛。加州大学旧金山分校的科学家完成的一项新研究证实:细胞疗法可能有一天被用来治疗一些常见类型的疼痛症状。

研究人员在小鼠身上开展的研究,关注于治疗神经损伤引起的慢性疼痛即所谓的神经性疼痛。

相关研究论文发表在Neuron杂志上,在他们的研究中,科学家们在老鼠大脑中移植不成熟的胚胎神经细胞,在大脑中神经细胞被用来更新特定的功能丧失的神经元。

移植的细胞中有一小部分存活,并发育成成熟的神经细胞。这些神经细胞融入脊髓神经细胞信号交流环路中。
州大学旧金山分校解剖学教研室主任Allan Basbaum博士说:现在我们正在积极开发潜在的治疗方法,尽可能消除神经性疼痛的来源。

虽然受伤后的疼痛和过敏反应通常会得到治愈,但在某些情况下这些症状会长久对身体造成伤害,引发慢性疼痛。引发慢性疼痛的原因很多但基本上是无害的如轻触刺激等。

神经性疼痛是指由中枢或外周神经系统原发性病变或功能障碍而引起的疼痛综合征。可由外伤或/和疾病致末梢神经,高频重复经颅磁刺激(rTMS)可有效治疗神经性疼痛,尤其是三叉神经痛(TGN)和卒中后疼痛(PSP)。(文章详见--Neuron:胚胎干细胞用于治疗神经性疼痛

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  2. 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  3. 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2016, time=2016-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135761, encodeId=adbc135e6154, content=应当认真研究一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd381919282, createdName=1e0a2178m68(暂无匿称), createdTime=Tue Sep 27 10:22:14 CST 2016, time=2016-09-27, status=1, ipAttribution=)]
    2016-09-27 医路开来

    谢谢分享。,,

    0

  4. 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2016, time=2016-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135761, encodeId=adbc135e6154, content=应当认真研究一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd381919282, createdName=1e0a2178m68(暂无匿称), createdTime=Tue Sep 27 10:22:14 CST 2016, time=2016-09-27, status=1, ipAttribution=)]
    2016-09-27 医路开来

    学习啦,,,

    0

  5. 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2016, time=2016-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135761, encodeId=adbc135e6154, content=应当认真研究一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd381919282, createdName=1e0a2178m68(暂无匿称), createdTime=Tue Sep 27 10:22:14 CST 2016, time=2016-09-27, status=1, ipAttribution=)]
    2016-09-27 医路开来

    普瑞巴林可有效治疗脊髓损伤所致神经性疼痛

    0

  6. 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2016, time=2016-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135761, encodeId=adbc135e6154, content=应当认真研究一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd381919282, createdName=1e0a2178m68(暂无匿称), createdTime=Tue Sep 27 10:22:14 CST 2016, time=2016-09-27, status=1, ipAttribution=)]
    2016-09-27 医路开来

    :大麻隆是一个很好的选择,以帮助治疗糖尿病神经性疼痛,该药副作用很少。

    0

  7. 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2016, time=2016-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135761, encodeId=adbc135e6154, content=应当认真研究一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd381919282, createdName=1e0a2178m68(暂无匿称), createdTime=Tue Sep 27 10:22:14 CST 2016, time=2016-09-27, status=1, ipAttribution=)]
    2016-09-27 医路开来

    抗焦虑药治疗神经性疼痛

    0

  8. 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2016, time=2016-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135761, encodeId=adbc135e6154, content=应当认真研究一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd381919282, createdName=1e0a2178m68(暂无匿称), createdTime=Tue Sep 27 10:22:14 CST 2016, time=2016-09-27, status=1, ipAttribution=)]
    2016-09-27 医路开来

    反复注射肉毒杆菌毒素可减轻周围神经性疼痛

    0

  9. 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createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Sep 27 14:27:05 CST 2016, time=2016-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135962, encodeId=55e4135962c2, content=普瑞巴林可有效治疗脊髓损伤所致神经性疼痛, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Sep 27 14:26:44 CST 2016, time=2016-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135961, encodeId=99281359615f, content=:大麻隆是一个很好的选择,以帮助治疗糖尿病神经性疼痛,该药副作用很少。, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Sep 27 14:26:27 CST 2016, time=2016-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135960, encodeId=2001135960f6, content=抗焦虑药治疗神经性疼痛, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Sep 27 14:26:06 CST 2016, time=2016-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135959, 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2016, time=2016-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135761, encodeId=adbc135e6154, content=应当认真研究一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd381919282, createdName=1e0a2178m68(暂无匿称), createdTime=Tue Sep 27 10:22:14 CST 2016, time=2016-09-27, status=1, ipAttribution=)]
    2016-09-27 医路开来

    治疗神经性疼痛:普瑞巴林是良药

    0

  10. 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2016, time=2016-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135761, encodeId=adbc135e6154, content=应当认真研究一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd381919282, createdName=1e0a2178m68(暂无匿称), createdTime=Tue Sep 27 10:22:14 CST 2016, time=2016-09-27, status=1, ipAttribution=)]
    2016-09-27 1e0a2178m68(暂无匿称)

    应当认真研究一下

    0

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