疼痛之診斷、評估與治療

Diagnosis, Assessments, and Therapy of Pain

疼痛是第五生命徵象，顯示其在臨床實務上的重要性。雖然疼痛是一種令人不舒服的感覺，但在生物演化上與日常功能，是一種重要保護性感覺，可以防止對身體造成有害刺激或傷害。相反的，神經性疼痛是因為神經系統功能障礙所引起的，並沒有真正的組織損傷。傳統上，疼痛的評估取決於患者提供的主觀描述、以及口頭評定量表或視覺模擬量表，因此，疼痛及其病理生理學的準確評估和診斷，一直都是臨床醫師面臨的挑戰，更不用說治療。在過去10年中，在理解神經性疼痛的機制、和應用生物技術的進步與神經影像，來強化對於神經性疼痛的診斷和評估，有重大的進展。這一專輯全面性地闡述神經性疼痛的評估，包括應用神經影像來了解神經損傷後大腦的可塑性變化。除了由糖尿病、自身免疫性疾病和化療引起的神經病變引起的常見神經病變痛以外，小纖維神經病變是一種重要的疾病症候群，其特徵是周邊神經退化和疼痛，對這一疾病詳細描述。近10年來，神經系統疼痛疾病的治療有了長足的進步，包括降鈣素相關肽肽單株抗體於偏頭痛的治療應用、局部疼痛的介入治療、非侵襲性腦刺激等，如穿顱磁刺激和穿顱直流電刺激治療全身性神經性疼痛等。隨著這些評估、診斷和新治療策略的應用，神經性疼痛的已進入精準醫學的新時代。

Pain is the fifth vital sign, suggesting its importance in clinical practice. Although pain is a disturbing feeling, it is a protective sensation to prevent a harmful stimulus or injury to the body. Neuropathic pain, in contrast, arises from dysfunctions of the nervous system without a real tissue injury. Traditionally, the evaluation of pain depends on subjective description offered by patients together with verbal rating scale or visual analogue scale. Thus accurate assessment and diagnosis of pain and its pathophysiology has been a challenge for clinicians, let alone therapies. During the past decade, there has been tremendous progress in understanding the mechanisms of neuropathic pain and taking advantage of biotechnological advancements to enhance the diagnosis and assessments of neuropathic pain. This series provides a comprehensive overview in the context of assessment of neuropathic pain including the application of neuroimages to decipher the reorganization of the brain after nerve injury. In addition to common neuropathies due to diabetes, autoimmune disease, and chemotherapy-induced neuropathy, small fiber neuropathy emerges as an important disease entity characterized with peripheral nerve degeneration and pain which will be described in detail. Over the past 10 years, there has been improvement in the therapy of pain disorders in the nervous systems, such as the application of monoclonal antibody against calcitonin related peptide (CGRP), interventional therapy for localized pain, and non-invasive brain stimulation, such as transcranial magnetic stimulation and transcranial direct current stimulation for generalized neuropathic pain. With applications of these assessments, diagnostic procedures, and new therapeutic strategies, the management of neuropathic pain has been entering a new era of precision medicine.