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基于神经影像技术认识膝骨关节炎慢性疼痛的复杂性

郭光昕¹, 朱清广^2,3, 陈子颖¹, 顾元嘉¹, 姚斐^1,2, 房敏^1,2,3,*

¹上海中医药大学针灸推拿学院，上海 201203；²上海中医药大学附属岳阳中西医结合医院，上海 200437；³上海市中医药研究院推拿研究所，上海 200437

摘要

膝骨关节炎(knee osteoarthritis, KOA)慢性疼痛极大影响患者的生活质量及功能活动，明确KOA疼痛的机制及不同疗法的镇痛效应是目前研究的重要任务。近年来，神经影像技术在疼痛的基础和临床研究中发挥了重要作用。随着神经影像技术在KOA慢性疼痛研究中的应用和发展，学者们发现KOA的慢性疼痛不仅包含伤害感受性疼痛，也含有神经病理性疼痛成分。参与KOA疼痛的神经病理性疼痛机制复杂，可能是外周或中枢敏化引起的，但在临床诊疗中未引起足够的重视，针对合并神经病理性疼痛KOA的治疗方法也尚未形成共识。因此，本综述基于磁共振成像(magnetic resonance imaging, MRI)、脑电图(electroencephalogram, EEG)、脑磁图(magnetoencephalogram, MEG)、近红外光谱(near-infrared spectroscopy, NIRS)等神经影像技术研究成果，回顾KOA疼痛引起的大脑病理生理学相关区域变化，梳理疼痛评估和预测方面的最新成果，明确KOA不同疗法的脑中枢镇痛机制，希望为KOA疼痛的治疗提供新思路，以利于制定KOA的早、中期合理治疗方案，促进临床镇痛疗效的提高。

关键词： 神经影像技术; 膝骨关节炎; 慢性疼痛; 神经病理性疼痛; 伤害感受性疼痛

分类号：R445;R684.3

Complex mechanisms of chronic pain in knee osteoarthritis identified by neuroimaging technology

GUO Guang-Xin¹, ZHU Qing-Guang^2,3, CHEN Zi-Ying¹, GU Yuan-Jia¹, YAO Fei^1,2, FANG Min^1,2,3,*

¹School of Acupuncture-moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China；²Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China；³Research Institute of Tuina, Shanghai Academy of Traditional Chinese Medicine, Shanghai 200437, China

Abstract

Chronic pain of knee osteoarthritis (KOA) greatly affects the quality of life and functional activities of patients. It is important to clarify the underlying mechanisms of KOA pain and the analgesic effect of different therapies. Neuroimaging technology has been widely used in the basic and clinical research of pain. In the recent years, neuroimaging technology has played an important role in the basic and clinical research of KOA pain. Increasing evidence demonstrates that chronic pain in KOA includes both nociceptive and neuropathic pain. The neuropathic mechanism involved in KOA pain is complex, which may be caused by peripheral or central sensitization. In this paper, we review the regional changes of brain pathophysiology caused by KOA pain based on magnetic resonance imaging (MRI), electroencephalogram (EEG), magnetoencephalogram (MEG), near-infrared spectroscopy (NIRS) and other neuroimaging techniques. We also discuss the central analgesic mechanism of different KOA therapies, with a focus on the latest achievements in the evaluation and prediction of pain. We hope to provide new thoughts for the treatment of KOA pain, especially in the early and middle stages of KOA.

Key words: neuroimaging technology; knee osteoarthritis; chronic pain; neuropathic pain; nociceptive pain

收稿日期：2021-01-15　　录用日期：2021-05-31

通讯作者：房敏　　E-mail: fangmin19650510@163.com

DOI: 10.13294/j.aps.2021.0044

引用本文：

郭光昕, 朱清广, 陈子颖, 顾元嘉, 姚斐, 房敏. 基于神经影像技术认识膝骨关节炎慢性疼痛的复杂性[J]. 生理学报 2021; 73 (3): 423-432.

GUO Guang-Xin, ZHU Qing-Guang, CHEN Zi-Ying, GU Yuan-Jia, YAO Fei, FANG Min. Complex mechanisms of chronic pain in knee osteoarthritis identified by neuroimaging technology. Acta Physiol Sin 2021; 73 (3): 423-432 (in Chinese with English abstract).