Release date: 2014-11-07
If one day, the scientists who specialize in pain research won the Nobel Prize, it is not surprising! This year's Nobel Prize in Physiology and Medicine was awarded to three scientists who discovered the brain "GPS cells". In recent years, the United States, the European Union and China has also launched brain science programs. The popular candidates for the Nobel Prize in Physiology and Medicine this year include David Julius, an American scientist who discovered multiple pain receptors.
In the future, pain research may also become a comprehensive national research project that countries are competing to launch, just like the brain plan. On the evening of October 23, the two keynote speakers pointed out in the 186th Xinmin Science Cafe that it is gratifying that China's comprehensive diagnosis and treatment of pain has taken the lead in the international arena. If there is a "sick plan" international science competition, China is located in the "leading square". The 186th Xinmin Science Cafe shared a lot of "painful insights" with readers, and also corrected many misunderstandings about the basic physical signs of pain, the fifth human being born.
Pain treatment is system engineering
Ma Ke, chief physician of the Pain Specialist of Xinhua Hospital, told reporters that even in the United States, the "10 years of pain control and research" has already become a motion passed by Congress, but the pain diagnosis and treatment is still fragmented, mostly scattered in various departments. In China, the Department of Pain has been approved by the Ministry of Health as a first-level discipline and diagnosis and treatment project in 2007, and it has been promoted in the country and required to be established in hospitals above the second level. This is a leading practice in the world. At present, in Shanghai, the top three hospitals have been equipped with pain departments, and the range of pain treatment is quite extensive.
Wang Yongxiang, a professor at the School of Pharmacy of Shanghai Jiaotong University, said that according to the definition of the International Pain Research Organization, pain is an unpleasant sensory experience accompanied by actual or potential tissue damage. This feeling is the patient's subjective feeling and can only be made by the patient himself. To describe, "In other words, the pain is determined by the patient, there is no such thing as 'I see you have a little pain". Ma Ke also pointed out that there are still many mysteries about pain that need to be solved, and there are many social, psychological and physiological factors behind the pain. Therefore, the treatment of pain is a comprehensive systematic project, not just doctors and scientists. Things. In the medical field, in addition to the familiar injections, electrical stimulation, morphine pump, ozone injection, freezing or high temperature destruction of local nerves and other new methods, have a good effect on the treatment of pain.
Pain is not tolerable
Wang Yongxiang said that people have a lot of misunderstandings about pain. For example, if you have pain and tolerance, taking analgesics will be addictive; postoperative pain will help the body recover; pain is only a symptom of the disease, and the disease is cured. The pain will disappear. "In fact, these are old concepts. Pain is defined as a disease by modern medicine. Whether it is usual pain, pain associated with other diseases, or postoperative pain, it is necessary to correct the pain of the patient through proper treatment. The pain treatment must be early."
Usually, pain can be divided into two types, nociceptive pain and neuropathic pain. "The former is the acute pain that the human body has recently suffered from external injuries. It is easier to treat. The latter is caused by chronic nerve damage caused by human nerve tissue damage. It not only has a long recovery period, but also has repeated attacks, sometimes it is not easy to locate, and the injury is cured. It may still exist afterwards."
According to the World Health Organization standards, pain can be divided into three phases, mild, moderate and severe. Wang Yongxiang said that in mild cases, non-opioid drugs can be used for control; after entering moderate pain, weak opioid analgesics need to be introduced; in the case of severe pain, strong opioids such as morphine are needed.
“In fact, such a three-step treatment is only effective for 90% of patients with pain. For the remaining 10% of patients, a fourth step treatment is needed, with minimally invasive surgery or drug intervention.†Wang Yongxiang further Explain that smoking opiate addiction makes people talk about morphine, the main ingredient in opium. In fact, morphine is a mainstream strain in the treatment of chronic pain in the world. Reasonable use will not cause addiction and tolerance. "Under the necessity of not using morphine" "I can't withdraw if I use morphine" is wrong. However, in China, the use of morphine is too conservative, with a per capita consumption of only 0.13 mg, ranking 100 in the world.
Chronic pain has new targets
Miraculously, the world not only has analgesic drugs like morphine, but also produces endogenous morphine substances in the human body, such as enkephalin, β-endorphin, strong non-peptide, etc., which can agonize related receptors. It can also produce analgesic effects. Professor Wang Yongxiang's research team has discovered such receptors and analgesic pathways in microglia of the spinal cord, which is expected to be a new potential analgesic target for the treatment of chronic pain.
Wang Yongxiang said that the GLP-1 receptor in the spinal cord can produce an effective analgesic effect in chronic pain. Inflammatory stimuli, peripheral nerve damage, and diabetes all activate microglia in the dorsal horn of the spinal cord, increasing their number and causing pain to the patient. The "small G" "lives" in the small glial cells in the dorsal horn of the spinal cord. "Therefore, GLP-1 receptor is a new target molecule for the treatment of chronic pain, and has good drug-producibility, high efficiency, etc., and long-term administration will not produce tolerance."
Source: Xinmin Science Cafe
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