PDF(Pubmed)
Abstract：
Functional pain syndromes, including such common disorders as irritable bowel syndrome (within the field of gastroenterology); chronic pelvic pain (in gynecology); interstitial cystitis/painful bladder syndrome (in urology); fibromyalgia (in rheumatology) and others cross multiple disciplines affecting more than 20% of the population worldwide and are more common in women. Inflammation is not a common pathophysiological pathway for a number of chronic (including functional) diseases. One of the possible explanations for this phenomenon is the neuronal reorganization associated with pain transmission (nociception), but the mechanisms of the crosstalk are unclear. Moreover, clinical presentations of functional syndromes often lack a specific pathology in the affected organ but may respond to a visceral cross-sensitization in which increased nociceptive input from an inflamed organ (i.e., uterus) sensitizes neurons that receive convergent input from an unaffected organ (i.e., colon or bladder). This mini-review focuses on the novel mechanisms for possible therapeutic interventions associated with the visceral pain primarily focusing on visceral nociceptors located within primary afferent neurons of dorsal root ganglia. Since there are observed gender differences in prevalence of functional diseases, it is proposed that estrogen may modulate nociceptor sensitization. Understanding these gender differences and neuronal reorganization associated with visceral pain will be the basis of translational efforts to modulate viscerally mediated mechanisms or functional disorders with ultimate goal to develop new therapies to treat functional disorders.
摘要：
功能性疼痛综合征,包括肠易激综合征（在胃肠病学领域）;慢性盆腔疼痛（在妇科）;间质性膀胱炎/膀胱疼痛综合征（在泌尿外科）;纤维肌痛（在风湿病）和其他跨越多个学科影响全球超过20％的人口，在女性中更为常见。炎症不是许多慢性(包括功能性)疾病的常见病理生理途径。这种现象的可能解释之一是与疼痛传递（伤害感受）相关的神经元重组，但是串扰的机制尚不清楚。此外，功能综合征的临床表现通常在受影响的器官中缺乏特定的病理，但可能对内脏交叉敏感反应，其中炎症器官的伤害性输入增加(即，子宫)敏化从未受影响的器官接收会聚输入的神经元(即，结肠或膀胱)。这篇小型综述着重于与内脏疼痛相关的可能治疗性干预措施的新机制，主要集中在位于背根神经节初级传入神经元内的内脏伤害感受器上。由于功能性疾病的患病率存在性别差异，有人提出雌激素可能调节伤害性感受器的致敏作用。了解这些性别差异和与内脏疼痛相关的神经元重组将是调节内脏介导机制或功能性疾病的转化努力的基础，最终目标是开发治疗功能性疾病的新疗法。
