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身体康复医学评论综述

ISSN 打印: 0896-2960
ISSN 在线: 2162-6553

身体康复医学评论综述

DOI: 10.1615/CritRevPhysRehabilMed.2013010295
pages 51-86

Chronic Pain: We Should Not Underestimate the Contribution of Neural Plasticity

Gwyn N. Lewis
Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
David A. Rice
Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand; Waitemata Pain Service, North Shore Hospital, Auckland, New Zealand

ABSTRACT

Disability associated with chronic pain is a prevalent worldwide problem. Much of our understanding of how and why chronic pain develops has been gained through developments in neural imaging and assessment techniques. Such investigations have highlighted the substantial amount of neural plasticity, or neural reorganization, that is possible within the nociceptive system. While this plasticity is often physiologically beneficial and usually reverses over time, persistent plasticity can occur following long-term activation or damage to the nociceptive system. These adaptations are associated with the development and maintenance of chronic pain conditions. This review provides an outline of the nociceptive system and describes the evidence for plasticity of the system at peripheral, spinal, and supraspinal levels. A number of clinical symptoms associated with chronic pain are described, along with the possible neural mechanisms that may contribute to the presentation. Finally, chronic pain management approaches that promote reorganization of the nociceptive system are discussed. These include sensory training, noninvasive brain stimulation, and mechanismbased treatment.