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/ www.els.net / 2001 2

 . . erentiation FF
motoric. somatosensory
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ects E FF .
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/ www.els.net / 2001 3ENCYCLOPEDIA

NMDA postsynaptic .
) .(1991 hyperexcitability
ammatory FL ) dextromethor- MK-801( NMDA

E ects FF E FF
forpainprocessing.Theseagentsalsosynergizewithspinal
Metabotropic EAA .
C (PKC). G
)) metabotropic 1 (mGluR1 (
E FF ECT P nocifensive.
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III-V
neurons.Thereareseveralactionssubsequenttobindingat theNK1receptor
summate. ) (tensof includingadelayed
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PKC-G NK1 .
). .. Mantyh 1997 1997 (Malmberg
FF UnlikesubstancePandtheEAAs whicharesynthesized

theinhibitoryneurotransmittersarefoundonlyinintrinsic. interneurons

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) (enkephalin dynorphin interneurons .
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enkephalin enkephalin
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metabolicproductofATP . ATP
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.

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localpH) andsuperoxidefreeradicals aswellasserotonin(
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ammation resultinginactivationor. ectsonnociceptors FF
E FF . FL
FF bres
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/ www.els.net / 2001 4
.
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itisnormally.In FL ) (
. ammatoryhyperalgesiaisinvolvedinthe
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ectiveness E . FL exion
) ) FL ammatory (NSAIDs FF
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hyperresponsive. postsynaptic

mechanoreceptive bres
.
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FF PKC.
.
thatreceiveconvergentcutaneousandvisceral
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)( .
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FL ammation Thetimerequiredforhealingfollowingtraumaticinjuryor
.

.
ects FF E
. withorganiccausesofpain.Severalinhibitorymechanisms
(egrubbing A- )''( C
) counterirritation ( ) andbyAdnociceptoractivity
nitivelyduringa . whichcanbeshownde
) (Melzack 1965 ects FF E
.
underly.
) (TENS
) ( thermosensory .
E FF . C-
FF E . ammation FL
.

thermosensory cooling-
) ( )(
.
.bres ) spinothalamic (1996

( ) (bymaintainedpressure blockofperipheralnerveA
) ) bres
(.
numbed thermoregula-
.
- .
stimulationoftheperiaqueductalgreycanalleviate kindsofchronicpain
andstimulationinthehypothalamus
) P( peptidergic.
rostroventral
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dorsalhorn 1978) . Thesecells
a2 .

/ www.els.net / 2001 5ENCYCLOPEDIA
. .
bulbospinal E ects FF
preganglionic
stimulation- .
. controlsystems
)' Theseendogenous
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antianalgesia
.
E ects FF
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. ectively
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lamines catecho-
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. paraventricular
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( ammatory proin FL .
FF bres Fi E ects FF ) TNF
.
proin FL -
. ammatory

 )
(
metaboreception. FF erents
.
thegeneralhealthofthebody aswellasbyhormonelevels
) (1998 .
emotionalstatus previousexperienceand
ects E FF .
caninhibitimmune onhealth.Pain likestressandsurgery
. * * * *
.
. kill.Managementofpatientswithchronic intractablepain

FF erents epineurium
injurytothenervoussystemcancausepathologicalpainby .
) (egincarpaltunnelsyndrome .
)(( ortopathogenic
FF caninitiatecellular )neuralgiaorrheumatoidin FL ammation
MICAL anato- bres
FF bres gangliosides .
(C3a) ofCnociceptors ) (TNFa
)( . lignocaine ) maycauseactivation (1997
gabapen- .
.
canbetreatede evulsion erentation FF DEA
ectivelybyalesionofthedorsalrootentry FF
" FL .
FF bres causalgia
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.

/ www.els.net / 2001 6
.
) aninfarctinthecaudalmedullaproduceslossof (
.
) (
parietoinsular
.
)( . ) (
.

 E FFI cacious ( ) ( buttricyclic

1998).

. oracetylsalicylicacid wasoriginallyderivedfrom
cyclooxygenases (COXs)
) ( .

.
FL amma-
. FL ammation FL
NSAID
FF ECT E Corticoster- . Oid ects E FF
COX-1 NSAID ammatory. proin FL COX
whichproducedi FF )( COX-2 )(
. COX-1 FF erentprostaglandinsandarelocalizedin
.
sensitiza- ammation FL COX-2
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. ects FF E . NSAID E ects FF
prostaglandinsarereleasedinthespinalcord
FF E FF

NSAIDs .
eliminat- ammation FL
. NSAID ) ( antidromically bres
ects E FF

). synergize (1997
morphineandalsopeptideswithsimilaractions arepotent
ammatory FL FF .
. FF ecting FF bres Fi
) ( FF erents
G ( postsynapticinhibitionofnociceptivedorsalhorncells
NSAID ).
) K (M D paintransmissionarereducedbyopiates.Allthreetypesof
) ( ) (
. E FF
FF bres
.
dala amyg-. M- periaqueductal
nergic noradre- bres
producedanalgesia.Anotherantinociceptivepathwaythat
B- stimulation-
ects E FF .

 synergize.
underprescribed
1 basedonstudiesshowingthat nowstronglyrecommended
. ) (

exampleinbedsidepumpsforpatient-controlledanalgesia.

.
beha-

/ www.els.net / 2001 7ENCYCLOPEDIA
vioural
FF ering.
neurochemicals

.

erating Accel- .

whichcausesenormouscoststooursocietyincare andlost E FF ORT
.

: . ISMS ) HL (1978 Basbaum AI

MA Tominaga M (1997) . MJ . Caterina 462-451 :4
: aheat-activatedionchannelinthepainpathway.Nature389: 816-824.
. MC (1996) :384 EM AD
: ) LR (1998 .260-258 SF
. . 107-83 :105
Basbaum AI (1997) acutepain C Tonegawa S Malmberg AB
. Mantyh PW micelacking painin reducedneuropathic PKCgamma. 283-279 :278
(1997) . P SD
. P. 279-275 :278
CA : . .979-971 :150 ) PD (1965 Melzack R
GH . Rainville P : Ediziona : . )(1998
FF ) MC (1997 B DD
Sieghart W RC C AJ . .971-968 :277 somatosen-
. (1996) Colocalization
) MJ (1997 MA SL CW .982-974 :16
CJ opioidsinhibitGABA-mediatedneurotransmission.Nature390: 611- 614.
-D- N ) SWN (1991
WH . . .299-293 :44
FF bres ) Sorkin LS (1997 AL
. GD2. 151-145 :69 ganglioside


. : ) Cervero F (1996 C
) Ollat H (EDS) (1995 JM Guilbaud G .
). PerlER (1984 . : ) HL (1987 Libbey Eurotext. . :
. :- )( 1 . andnociception.
). DD (1988 .975-915 : III
) Melzack R (EDS PD . : .
)) (1992( WD . :- . )(1994
C Zapol WM (1998) . . Yaksh TL . :
. : Lippincott- : .

/ www.els.net / 2001 8