Nociceptive and non-nociceptive rheumatological pain: recent developments in the understanding of pathophysiology and management in rheumatoid arthritis and fibromyalgia

被引:4
作者
Dessein, PH
Shipton, EA
Budd, K
机构
[1] Univ Witwatersrand, Milpark Hosp, Rheumatol Unit, Johannesburg, South Africa
[2] Univ Witwatersrand, CH Baragwanath Hosp, Dept Anaesthesiol, Pain Relief & Res Unit, Johannesburg, South Africa
来源
PAIN REVIEWS | 2000年 / 7卷 / 02期
关键词
D O I
10.1191/096813000678809429
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Musculoskeletal disorders, in which pain is the most prevalent and disabling symptom, constitute the commonest cause of disability in the community. Major progress has recently been made in the elucidation of rheumatic pain processing. Based on this information, we construct a classification of rheumatic pain: nociceptive and non-nociceptive. In the former, pain perception is proportional to inflammation or damage. usually in joint structures. In the latter, peripheral noxious stimulation is minimal or unidentifiable, at least at presentation. A prototype disorder of nociceptive pain is rheumatoid arthritis. Pain genesis in this condition entails both peripheral and central sensitization, and neurogenic inflammation. Antinociceptive mechanisms are activated. A prototype disorder of non-nociceptive pain is fibromyalgia. Despite the absence of obvious peripheral nociceptive stimulation, features in keeping with central sensitization have similarly been documented of late, while antinociceptive mechanisms seem defective. There is compelling evidence that neuroendocrine axes disturbances, particularly hypothalamic-pituitary-adrenal axis hypofunction, may mediate the onset and persistence of both nociceptive and non-nociceptive rheumatic pain. Our classification implies the need for a mechanism-based approach. We substantiate this paradigm by evaluating mechanisms of action of promising therapeutic interventions in rheumatic pain.
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页码:67 / 79
页数:13
相关论文
共 126 条
[1]   Reduced hypothalamic-pituitary and sympathoadrenal responses to hypoglycemia in women with fibromyalgia syndrome [J].
Adler, GK ;
Kinsley, BT ;
Hurwitz, S ;
Mossey, CJ ;
Goldenberg, DL .
AMERICAN JOURNAL OF MEDICINE, 1999, 106 (05) :534-543
[2]   Advances in the treatment of fibromyalgia:: Current status and future directions [J].
Alarcón, GS ;
Bradley, LA .
AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 1998, 315 (06) :397-404
[3]  
AMATRUDA JM, 1995, ENDOCRINOL METAB, P1271
[4]  
[Anonymous], 1996, Arthritis Rheum, V39, P713
[5]  
[Anonymous], ENDOCRINOLOGYAND MET
[6]   Dehydroepiandrosterone replacement in women with adrenal insufficiency [J].
Arlt, W ;
Callies, F ;
van Vlijmen, JC ;
Koehler, I ;
Reincke, M ;
Bidlingmaier, M ;
Huebler, D ;
Oettel, M ;
Ernst, M ;
Schulte, HM ;
Allolio, B .
NEW ENGLAND JOURNAL OF MEDICINE, 1999, 341 (14) :1013-1020
[7]   PSYCHOLOGICAL AND ENDOCRINE ABNORMALITIES IN REFUGEES FROM EAST-GERMANY .1. PROLONGED STRESS, PSYCHOPATHOLOGY, AND HYPOTHALAMIC-PITUITARY-THYROID AXIS ACTIVITY [J].
BAUER, M ;
PRIEBE, S ;
KURTEN, I ;
GRAF, KJ ;
BAUMGARTNER, A .
PSYCHIATRY RESEARCH, 1994, 51 (01) :61-73
[8]   REDUCED HIGH-ENERGY PHOSPHATE LEVELS IN THE PAINFUL MUSCLES OF PATIENTS WITH PRIMARY FIBROMYALGIA [J].
BENGTSSON, A ;
HENRIKSSON, KG ;
LARSSON, J .
ARTHRITIS AND RHEUMATISM, 1986, 29 (07) :817-821
[9]   A randomized, double-blind, placebo-controlled study of growth hormone in the treatment of fibromyalgia [J].
Bennett, RM ;
Clark, SC ;
Walczyk, J .
AMERICAN JOURNAL OF MEDICINE, 1998, 104 (03) :227-231
[10]   Emerging concepts in the neurobiology of chronic pain: Evidence of abnormal sensory processing in fibromyalgia [J].
Bennett, RM .
MAYO CLINIC PROCEEDINGS, 1999, 74 (04) :385-398