El origen bioquímico del dolor - proponiendo una nueva ley de dolor: el origen de todo dolor es la inflamación y la respuesta inflamatoria. Parte 1 de 3 - una unificación de la derecho de dolor. |
The biochemical origin of pain--proposing a new law of pain: the origin of all pain is inflammation and the inflammatory response. Part 1 of 3- a unifying law of pain.
Omoigui S.
Division of Inflammation and Pain Research, L.A Pain Clinic, 4019 W. Rosecrans Avenue, Los Angeles, CA 90250, USA. medicinechief@aol.com
Med Hypotheses. 2007;69(1):70-82. Epub 2007 Jan 19.
Abstract
We are proposing a unifying theory or law of pain, which states: the origin of all pain is inflammation and the inflammatory response. The biochemical mediators of inflammation include cytokines, neuropeptides, growth factors and neurotransmitters. Irrespective of the type of pain whether it is acute or chronic pain, peripheral or central pain, nociceptive or neuropathic pain, the underlying origin is inflammation and the inflammatory response. Activation of pain receptors, transmission and modulation of pain signals, neuro plasticity and central sensitization are all one continuum of inflammation and the inflammatory response. Irrespective of the characteristic of the pain, whether it is sharp, dull, aching, burning, stabbing, numbing or tingling, all pain arise from inflammation and the inflammatory response. We are proposing a re-classification and treatment of pain syndromes based upon their inflammatory profile. Treatment of pain syndromes should be based on these principles: 1. Determination of the inflammatory profile of the pain syndrome; 2. Inhibition or suppression of production of the appropriate inflammatory mediators, e.g. with inflammatory mediator blockers or surgical intervention where appropriate; 3. Inhibition or suppression of neuronal afferent and efferent (motor) transmission, e.g. with anti-seizure drugs or local anesthetic blocks; 4. Modulation of neuronal transmission, e.g. with opioid medication. At the L.A. Pain Clinic, we have successfully treated a variety of pain syndromes by utilizing these principles. This theory of the biochemical origin of pain is compatible with, inclusive of, and unifies existing theories and knowledge of the mechanism of pain including the gate control theory, and theories of pre-emptive analgesia, windup and central sensitization.
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| El origen bioquímico del dolor: el origen de todos los dolores es la inflamación y la respuesta inflamatoria. Parte 2 de 3- perfil inflamatorio de los síndromes dolorosos. |
The biochemical origin of pain: the origin of all pain is inflammation and the inflammatory response. Part 2 of 3 - inflammatory profile of pain syndromes.
Omoigui S.
Division of Inflammation and Pain Research, L.A Pain Clinic, 4019 W. Rosecrans Avenue, Los Angeles, CA 90250, United States.medicinechief@aol.com
Med Hypotheses. 2007;69(6):1169-78. Epub 2007 Aug 28. Abstract
Every pain syndrome has an inflammatory profile consisting of the inflammatory mediators that are present in the pain syndrome. The inflammatory profile may have variations from one person to another and may have variations in the same person at different times. The key to treatment of Pain Syndromes is an understanding of their inflammatory profile. Pain syndromes may be treated medically or surgically. The goal should be inhibition or suppression of production of the inflammatory mediators and inhibition, suppression or modulation of neuronal afferent and efferent (motor) transmission. A successful outcome is one that results in less inflammation and thus less pain. We hereby briefly describe the inflammatory profile for several pain syndromes including arthritis, back pain, neck pain, fibromyalgia, interstitial cystitis, migraine, neuropathic pain, complex regional pain syndrome/reflex sympathetic dystrophy (CRPS/RSD), bursitis, shoulder pain and vulvodynia. These profiles are derived from basic science and clinical research performed in the past by numerous investigators and serve as a foundation to be built upon by other researchers and will be updated in the future by new technologies such as magnetic resonance spectroscopy. Our unifying theory or law of pain states: the origin of all pain is inflammation and the inflammatory response. The biochemical mediators of inflammation include cytokines, neuropeptides, growth factors and neurotransmitters. Irrespective of the type of pain whether it is acute or chronic pain, peripheral or central pain, nociceptive or neuropathic pain, the underlying origin is inflammation and the inflammatory response. Activation of pain receptors, transmission and modulation of pain signals, neuro plasticity and central sensitization are all one continuum of inflammation and the inflammatory response. Irrespective of the characteristic of the pain, whether it is sharp, dull, aching, burning, stabbing, numbing or tingling, all pain arise from inflammation and the inflammatory response. We are proposing a re-classification and treatment of pain syndromes based upon their inflammatory profile.
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| Dolor Mixto. Cambiando Paradigmas |
Dr. Uriah Guevara-López
Anestesia en México, Vol.17, Suplemento 1, 2005;12-20.
En la lumbocitalgia operan diferentes mecanismos fisiopatológicos, cuyos componentes nociceptivo y neuropático pueden diferenciarse. El dolor nociceptivo ha sido descrito ampliamente como resultado de diversas afecciones del sistema músculo esquelético de diversa naturaleza (inflamatorios o degenerativos). El neuropático puede ser provocado por la formación de brotes nociceptivos dentro del disco degenerado (neuropático local), por la presión mecánica de la raíz nerviosa (dolor de raíz nerviosa mecánica), o por la acción de los mediadores inflamatorios liberados por el núcleo pulposo sobre la raíz nerviosa, aún en ausencia de presión mecánica. La suma de dos o más de estos componentes da como resultado síndromes dolorosos complejos denominados mixtos. En el caso de la lumbociatalgia, no se conoce aún la incidencia de cada componente, así como las herramientas de diagnóstico válidas para identificarlo. En cuanto a las estrategias terapéuticas-analgésicas se basan en analgésicos no opiáceos que alivian el dolor nociceptivo solamente. Para el dolor neuropático, se han propuesto diversos enfoques terapéuticos con diverso grado de eficacia como los antidepresivos tricíclicos y anticonvulsivantes. Por lo que, la combinación de dichos fármacos pudieran ser de utilidad en pacientes con esta patología.
Palabras clave: Dolor nociceptivo, Dolor neuropático, Dolor Mixto, Lumbociatalgia
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