![Page 1: NOCICEPTIVE PAIN ( 組織傷害性疼痛 ) COX-II 有效. Sharpening- 尖銳痛 Prickling- 酥麻痛 Scrawling- 蟻爬感 Lightening- 閃電痛 Tingling- 墊墊的痛 Burning- 燒灼感](https://reader033.vdocuments.net/reader033/viewer/2022061506/56649ea95503460f94badd41/html5/thumbnails/1.jpg)
NOCICEPTIVE PAINNOCICEPTIVE PAIN ( 組織傷害性疼痛 )
COX-II 有效
![Page 2: NOCICEPTIVE PAIN ( 組織傷害性疼痛 ) COX-II 有效. Sharpening- 尖銳痛 Prickling- 酥麻痛 Scrawling- 蟻爬感 Lightening- 閃電痛 Tingling- 墊墊的痛 Burning- 燒灼感](https://reader033.vdocuments.net/reader033/viewer/2022061506/56649ea95503460f94badd41/html5/thumbnails/2.jpg)
Sharpening- 尖銳痛Prickling- 酥麻痛 Scrawling- 蟻爬感Lightening- 閃電痛 Tingling- 墊墊的痛Burning- 燒灼感…………
![Page 3: NOCICEPTIVE PAIN ( 組織傷害性疼痛 ) COX-II 有效. Sharpening- 尖銳痛 Prickling- 酥麻痛 Scrawling- 蟻爬感 Lightening- 閃電痛 Tingling- 墊墊的痛 Burning- 燒灼感](https://reader033.vdocuments.net/reader033/viewer/2022061506/56649ea95503460f94badd41/html5/thumbnails/3.jpg)
1. Diabetic peripheral neuropathic pain ( DPNP) 糖尿病末梢神經疼痛
2. Post-herpetic neuralgia (PHN)疱疹後神經痛
Neuropathic pain
神經性疼痛
COX-II 無效
![Page 4: NOCICEPTIVE PAIN ( 組織傷害性疼痛 ) COX-II 有效. Sharpening- 尖銳痛 Prickling- 酥麻痛 Scrawling- 蟻爬感 Lightening- 閃電痛 Tingling- 墊墊的痛 Burning- 燒灼感](https://reader033.vdocuments.net/reader033/viewer/2022061506/56649ea95503460f94badd41/html5/thumbnails/4.jpg)
Pain Type-分成兩大類
急性疼痛 慢性疼痛
![Page 5: NOCICEPTIVE PAIN ( 組織傷害性疼痛 ) COX-II 有效. Sharpening- 尖銳痛 Prickling- 酥麻痛 Scrawling- 蟻爬感 Lightening- 閃電痛 Tingling- 墊墊的痛 Burning- 燒灼感](https://reader033.vdocuments.net/reader033/viewer/2022061506/56649ea95503460f94badd41/html5/thumbnails/5.jpg)
第三類第三類 ::合併組織傷害合併組織傷害 ++ 神經性疼痛神經性疼痛
1. 急性椎間盤突出 ~~
2. 癌症侵襲合併壓迫 ~~ ~~(NSAID 會有部分療效 )~~~
![Page 6: NOCICEPTIVE PAIN ( 組織傷害性疼痛 ) COX-II 有效. Sharpening- 尖銳痛 Prickling- 酥麻痛 Scrawling- 蟻爬感 Lightening- 閃電痛 Tingling- 墊墊的痛 Burning- 燒灼感](https://reader033.vdocuments.net/reader033/viewer/2022061506/56649ea95503460f94badd41/html5/thumbnails/6.jpg)
疼痛定義
• 痛覺異常 (Dysesthesia). • 感覺異常 (Paresthesia). • 觸痛症 (Allodynia).• 痛覺敏感 (Hyperalgesia).• 感覺過敏 (Hyperesthesia) .• 過度疼痛 (Hyperpathia).• 神經痛 (Neuralgia).• 神經炎 (Neuritis).• 神經燒灼痛 (Causalgia).
![Page 7: NOCICEPTIVE PAIN ( 組織傷害性疼痛 ) COX-II 有效. Sharpening- 尖銳痛 Prickling- 酥麻痛 Scrawling- 蟻爬感 Lightening- 閃電痛 Tingling- 墊墊的痛 Burning- 燒灼感](https://reader033.vdocuments.net/reader033/viewer/2022061506/56649ea95503460f94badd41/html5/thumbnails/7.jpg)
痛覺敏感 vs 觸痛症 Hyperalgesia vs. Allodynia
Martin, 1998.
![Page 8: NOCICEPTIVE PAIN ( 組織傷害性疼痛 ) COX-II 有效. Sharpening- 尖銳痛 Prickling- 酥麻痛 Scrawling- 蟻爬感 Lightening- 閃電痛 Tingling- 墊墊的痛 Burning- 燒灼感](https://reader033.vdocuments.net/reader033/viewer/2022061506/56649ea95503460f94badd41/html5/thumbnails/8.jpg)
Current Prescription Medication Use Among Patients Treated for Neuropathic Pain
Anticonvulsants 13%
Antidepressants/ mood stab. 4%
Opioids 4%
NSAIDs (include COX-2) 41%
Non-narcotic analgesics 21%
Tranquilizers 9%
Local anesthetics 6%
All other 2%
Medications with established efficacy represent a small proportion of prescriptions.
IMS global prescription data 4Q 2003 (n=143 million prescriptions).
![Page 9: NOCICEPTIVE PAIN ( 組織傷害性疼痛 ) COX-II 有效. Sharpening- 尖銳痛 Prickling- 酥麻痛 Scrawling- 蟻爬感 Lightening- 閃電痛 Tingling- 墊墊的痛 Burning- 燒灼感](https://reader033.vdocuments.net/reader033/viewer/2022061506/56649ea95503460f94badd41/html5/thumbnails/9.jpg)
![Page 10: NOCICEPTIVE PAIN ( 組織傷害性疼痛 ) COX-II 有效. Sharpening- 尖銳痛 Prickling- 酥麻痛 Scrawling- 蟻爬感 Lightening- 閃電痛 Tingling- 墊墊的痛 Burning- 燒灼感](https://reader033.vdocuments.net/reader033/viewer/2022061506/56649ea95503460f94badd41/html5/thumbnails/10.jpg)
疼痛路徑周邊敏感器 - 脊椎轉運站 - 中樞大腦站
Peripheral receptor
Spino-thalamic tract
Thalamic projection-->Cortex (Parietal lobe)
Pain
(small fiberfree ending)
![Page 11: NOCICEPTIVE PAIN ( 組織傷害性疼痛 ) COX-II 有效. Sharpening- 尖銳痛 Prickling- 酥麻痛 Scrawling- 蟻爬感 Lightening- 閃電痛 Tingling- 墊墊的痛 Burning- 燒灼感](https://reader033.vdocuments.net/reader033/viewer/2022061506/56649ea95503460f94badd41/html5/thumbnails/11.jpg)
五大疼痛機轉 --( 決定如何用藥 )
• 週邊敏感化(Peripheral sensitization )---NASID effective
• 異位放電(Ectopic discharges)---AEDs
• 中樞激活敏感(Central sensitization)---AEDs/Opioids
• 中樞重入(Central reorganization)---GABA/AEDs/Opioid
• 抑制消失(‘Loss of inhibitory controls)—TCAs
Attal, 1999; Woolf, 1999.
![Page 12: NOCICEPTIVE PAIN ( 組織傷害性疼痛 ) COX-II 有效. Sharpening- 尖銳痛 Prickling- 酥麻痛 Scrawling- 蟻爬感 Lightening- 閃電痛 Tingling- 墊墊的痛 Burning- 燒灼感](https://reader033.vdocuments.net/reader033/viewer/2022061506/56649ea95503460f94badd41/html5/thumbnails/12.jpg)
(I) Peripheral Sensitization
Noxious swelling/ damage
Descending Pathway
PeripheralNerve
Dorsal RootGanglion
C-Fiber
A-beta Fiber
A-delta Fiber
AscendingPathways
Dorsal Horn
Brain
Spinal Cord
Adapted with permission from WebMD Scientific American® Medicine.10
PGE2, (OA or RA pain)
Substance P,Glutamate. (Neuropathic pain)
CGRP, Serotonin (Migraine)
Non-epinephrine..(anxious pain)
N Free-ending
![Page 13: NOCICEPTIVE PAIN ( 組織傷害性疼痛 ) COX-II 有效. Sharpening- 尖銳痛 Prickling- 酥麻痛 Scrawling- 蟻爬感 Lightening- 閃電痛 Tingling- 墊墊的痛 Burning- 燒灼感](https://reader033.vdocuments.net/reader033/viewer/2022061506/56649ea95503460f94badd41/html5/thumbnails/13.jpg)
(2) Ectopic impulses(Na-K pumping imbalance)
![Page 14: NOCICEPTIVE PAIN ( 組織傷害性疼痛 ) COX-II 有效. Sharpening- 尖銳痛 Prickling- 酥麻痛 Scrawling- 蟻爬感 Lightening- 閃電痛 Tingling- 墊墊的痛 Burning- 燒灼感](https://reader033.vdocuments.net/reader033/viewer/2022061506/56649ea95503460f94badd41/html5/thumbnails/14.jpg)
(3) Central Sensitization(NMDA)
AMPA = -amino-3-hydroxy-5-methyl-4-isoazolepropionic acid; Mg+2 = magnesium ions; NK-1 = neurokinin-1 receptor; NMDA = N-methyl D-aspartate. Mannion RJ, Woolf CJ. Clin J Pain 2000 (in press).
Normal resting potential
Mg plug
![Page 15: NOCICEPTIVE PAIN ( 組織傷害性疼痛 ) COX-II 有效. Sharpening- 尖銳痛 Prickling- 酥麻痛 Scrawling- 蟻爬感 Lightening- 閃電痛 Tingling- 墊墊的痛 Burning- 燒灼感](https://reader033.vdocuments.net/reader033/viewer/2022061506/56649ea95503460f94badd41/html5/thumbnails/15.jpg)
AMPA = -amino-3-hydroxy-5-methyl-4-isoazolepropionic acid; Ca+2 = calcium ions; L-Arg = L-arginine; NK-1 = neurokinin-1 receptor; NMDA = N-methyl D-aspartate; NO = nitric oxide; NOS = nitric oxide synthase. Mannion RJ, Woolf CJ. Clin J Pain 2000 (in press).
(3) Central Sensitization
Ca++
Noxious stimulation
Mg unplug
{Glutamate-AMPA}------ {substance P- Neurokinin}