Central sensitization: uncovering the relation between pain and plasticity.

摘要

Noxious skin stimuli which are sufficiently intense to produce tissue injury, characteristically generate prolonged poststimulus sensory disturbances that include continuing pain, an increased sensitivity to noxious stimuli and pain following innocuous stimuli. This could result from either a reduction in the thresholds of skin nociceptors (sensitization) or an increase in the excitability of the central nervous system so that normal inputs now evoke exaggerated responses. Because sensi- tization of peripheral receptors occurs following injury, a peripheral mechanism is widely held to be responsible for postinjury hypersensitivity. To investigate this I have now developed an animal model where changes occur in the threshold and responsiveness of the flexor reflex following peripheral injury that are analogous to the sensory changes found in man. Electrophysiological analysis of the injury-induced increase in excitability of the flexion reflex shows that it in part arises from changes in the activity ofthe spinal cord. The long-term consequences of noxious stimuli result, therefore, from central as well as from peripheral changes.