淺談疼痛概念與疼痛分類的演進

A Brief Discussion on the Concept of Pain and the Evolution of Pain Classification

西方醫學起源於2500年前的古希臘，醫學之父希波克拉底引領之後無數醫界菁英，以系統性與科學化的方法，投入基礎研究與臨床應用，解開人體的奧秘以及治療人類的疾病。但對於促使病人就醫最主要的原因－疼痛，人類卻在300年前才開始起步。所幸的是人類科技進展飛速，最近這100年累積的研究成果，遠遠超過之前2000多年的總和，科學家對疼痛機制的理解，已經慢慢追上醫學其他領域；但在臨床醫學領域，除了少數引領疼痛研究的加拿大與美國大學醫學院，為疼痛醫學設立專門學程，其他絕大部份的大學，都將疼痛知識的傳授，散置在各科不起眼的角落，而且很多都是過時、甚至是錯誤的概念。這篇論文簡短介紹世界疼痛學會關於疼痛分類的演進，將臨床常見的疼痛，分為造成身體組織受傷引起的感覺接受性疼痛（nociceptive pain），因為傳導感覺訊號的神經通路受傷或病變造成的神經病態性疼痛（neuropathic pain），以及因為長期處於上述2種疼痛狀態後，整個神經系統改變結構與運作模式，而導致的傷害可塑性疼痛（nociplastic pain）。

Western medicine originated in ancient Greece 2,500 years ago. Following the leadership of Hippocrates, the ''Father of Medicine,'' countless medical pioneers have devoted themselves to basic research and clinical applications using systematic and scientific methods, uncovering the mysteries of the human body and developing treatments for various diseases. However, when it comes to pain—the primary reason patients seek medical attention—humanity only began to make significant progress 300 years ago. Fortunately, with rapid advancements in technology, research accumulated over the past century far exceeds the total progress made in the previous two millennia. Scientists' understanding of pain mechanisms has gradually caught up with other medical fields. However, in clinical medicine, apart from a few leading institutions in Canada and the United States that have established dedicated pain medicine programs, most universities scatter pain-related education across different disciplines, often in obscure corners. Worse yet, much of this knowledge is outdated or even incorrect. This paper provides a brief overview of the evolution of pain classification by the International Association for the Study of Pain (IASP). It categorizes common clinical pain into three types: nociceptive pain, which arises from tissue injury; neuropathic pain, which results from damage or disease affecting the nervous pathways that transmit sensory signals; and nociplastic pain, which develops when prolonged exposure to the first two types of pain leads to structural and functional changes in the nervous system.