通过脊髓刺激调节疼痛的脊柱机制:一个系统性审查
Jaden Y Fang1, Hideaki Yamamoto2, Adam Romman1
1Anesthesiology, University of Texas Medical Branch, Galveston, USA.
Cureus
|July 10, 2025
概括
脊髓刺激 (SCS) 通过作用于脊髓来缓解慢性疼痛. 它抑制疼痛信号,增强自然疼痛缓解途径,并减少质细胞中的炎症.
科学领域:
- 神经调节是一种神经调节.
- 神经科学是一个神经科学.
- 疼痛管理 疼痛管理
背景情况:
- 脊髓刺激 (SCS) 是慢性神经病痛的关键疗法,但其精确的机制尚未完全理解.
- 了解SCS机制对于优化其在失败的背部手术综合征和复杂的区域性疼痛综合征等疾病中的使用至关重要.
研究的目的:
- 系统地审查临床前动物研究,并对SCS诱导的脊椎止痛机制进行分类.
- 通过翻译性研究为改善SCS治疗提供机制框架.
主要方法:
- 根据PRISMA指南,对40项临床前动物研究进行了系统审查,搜索了PubMed,MEDLINE和Cochrane数据库.
- 研究侧重于SCS对脊髓细胞的影响,不包括大脑结构,并按机制分类:感知传输抑制,下降抑制增强和神经免疫调节.
- 使用SYRCLE工具评估了偏差风险.
主要成果:
- SCS抑制了上升的感知传输 (22 项研究),增强了下降的抑制 (5 项研究),并调节神经免疫通路 (13 项研究).
- 观察到的效应包括增强抑制信号,减少激发性神经递质释放,调节背部角活动,以及下降途径 (血清激素,阿片类,胆固醇) 的激活.
- 神经免疫效应涉及抑制促炎性细胞因子和调节微质和天体细胞活动,通常通过MAPK信号传递.
结论:
- 脊髓神经系统通过集成的脊髓机制提供止痛:神经元抑制,下降调制和质抑制.
- 虽然动物模型提供了洞察力,但直接临床翻译需要在人类生理学中进一步验证.
- 本综述建立了一个框架,以指导未来的研究,以优化SCS治疗.
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