神经源性疼痛由于神经系统损伤或功能障碍而增加,并且在其他病理性疼痛中最难以治疗。据报道,针灸因其无限的优势而被认为是治疗神经性疼痛的绝佳选择。然而,以往关于针刺对NP镇痛作用的研究比较零散,没有形成一个整体。在这项研究中,我们首先全面回顾了近5年发表的关于针刺治疗NP的相关基础文章,总结了针刺在神经信号方面的镇痛机制,神经免疫串扰,以及代谢和氧化应激调节。针刺抑制上游兴奋系统,通过下调谷氨酸来抑制神经元传递效率,NMDA受体,P2XR,SP,CGRP,脊髓中的其他神经递质和受体,以及等离子体通道,如TRPV1,HCN。它还可以通过上调阿片类肽(β-内啡肽)激活下游疼痛抑制途径,MOR受体,GABA和GABA受体,双向调节5-羟色胺(5-HT)及其受体(上调5-HT1A并下调5-HT7R)并刺激下丘脑食欲调节神经元。此外,针刺可通过抑制JAK2/STAT3、PI3K/mTOR通路,下调小胶质细胞的趋化因子受体CX3CR1,上调星形胶质细胞的腺苷受体A1R,抑制神经胶质的激活和减少TNF-α和其他炎症物质。针刺还通过下调mPFC的GLUT-3来抑制神经元葡萄糖代谢,并促进大脑的代谢改变,从而发挥镇痛作用。总之,外周和中枢水平的神经信号传导和神经免疫串扰的调节以整合的方式介导了针刺对神经病理性疼痛的镇痛作用。这些发现为临床更好地应用针灸治疗神经病理性疼痛提供了可靠的依据。
Neurogenic pain rises because of nervous system damage or dysfunction and is the most difficult to treat among other pathological pains. Acupuncture has been reported as a great treatment option for neurogenic pain owing to its unlimited advantages. However, previous studies on the analgesic effects of acupuncture for NP were scattered and did not form a whole. In this study, we first comprehensively review the relevant basic articles on acupuncture for NP published in the last 5 years and summarize the analgesic mechanisms of acupuncture in terms of nerve signaling, neuro-immune crosstalk, and metabolic and oxidative stress regulation. Acupuncture inhibits the upstream excitatory system and suppresses neuronal transmission efficiency by downregulating glutamate, NMDA receptors, P2XR, SP, CGRP, and other neurotransmitters and receptors in the spinal cord, as well as plasma channels such as TRPV1, HCN. It can also activate the downstream pain inhibitory pathway by upregulating opioid peptide (β-endorphin), MOR receptors, GABA and GABA receptors, bi-directional regulating 5-hydroxytryptamine (5-HT) and its receptors (upregulate 5-HT 1A and downregulate 5-HT7R) and stimulating hypothalamic appetite-modifying neurons. Moreover, neuroinflammation in pain can be inhibited by acupuncture through inhibiting JAK2/STAT3, PI3K/mTOR pathways, down regulating chemokine receptor CX3CR1 on microglia and up regulating adenosine receptor A1Rs on astrocytes, inhibiting the activation of glia and reducing TNF-α and other inflammatory substances. Acupuncture also inhibits neuronal glucose metabolism by downregulating mPFC\'s GLUT-3 and promotes metabolic alterations of the brain, thus exerting an analgesic effect. In conclusion, the regulation of nerve signal transduction and neuroimmune crosstalk at the peripheral and central levels mediates the analgesic effects of acupuncture for neuropathic pain in an integrated manner. These findings provide a reliable basis for better clinical application of acupuncture in the management of neuropathic pain.