文档介绍:针 刺 镇 痛
陈 静
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◇痛觉
痛觉的定义、特点
疼痛的机制学说
疼痛的传递
◇针刺镇痛
针刺镇痛的定义、优缺点
针刺镇痛的机理
影响针刺镇痛疗效的因素
针
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2、经典神经递/调质在针刺镇痛中的作用
5-羟色***
(5-HT)
中枢5-HT参与镇痛;外周5-HT参与致痛
针刺时,脑内5-HT↑,外周的↓
去甲肾上腺素
(NE)
激活脑内NE能上行投射系统,对抗针刺镇痛;激活低位脑干发出的NE能下行投射系统加强针刺镇痛
针刺时,针刺镇痛的同时伴有脑内上行通路NE的↓
多巴***
参与针刺镇痛主要与其兴奋的受体类型密切相关
兴奋D2受体:有针刺镇痛作用并增强
乙酰胆碱
(Ach)
外周和中枢Ach系统被激活时增加针刺镇痛效应
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World Congress of Pain
1984, 4th WCP Workshop on acupuncture
2010, 13th WPC Plenary lecture on acupuncture 6000+ attend
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1-2 Hz
15 Hz
100 Hz
EA: Frequency Specificity
Low
Medium
High
8
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2Hz EA increases Enk release
2Hz
100Hz
EA
15Hz
Control
Enkephalin-ir
in spinal perfusate
Dynorphin-ir
in spinal perfusate
Before
After EA
*
*
*
Before
After EA
*
*
*
2Hz
100Hz
EA
15Hz
Control
Frequency-dependent release of neuropeptides Rat Experiment
100Hz EA increases Dyn release
9
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0
500
1000
1500
2000
10
15
0
5
0
500
1000
1500
2000
0
5
10
15
*
**
fmol / ml CSF
Mek-Arg-Phe
Dynorphin A
MEK-Arg-Phe
Dynorphin A
A study in collaboration with Dr. Lars Terenius
2Hz Enk
100Hz Dyn
Human Study
*
*
10
N=10
N=10
N=10
N=10
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2 Hz
100 Hz
1997
EM
-EP
ENK
DYN
ANTIBODY
NALOXONE
1976
1975
1979
Opioid Receptors
EA Accelerates Endogenous Opioids Release
11
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Acute pain:
Clearcut results
Unanimous consensus
Chronic pain:
Controversies exist
More details should be considered
Clinical Applications
16
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Surgical procedure
Pre-emptive 30 min
Post-operative 30 min each
Intra-operative continuous st