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Vol. 104. Núm. 4.
Páginas 136-140 (Enero 2007)
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Vol. 104. Núm. 4.
Páginas 136-140 (Enero 2007)
DOI: 10.1016/S0304-4858(07)74593-6
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La Sensibilización Central en la fisiopatología del dolor
Central Sensitization in the pathophysiology of pain
Erdiko sentiberatzea minaren patofisiologian
Visitas
...
Jon Jatsu Azkue,1, Vicente Ortiz2, Fernando Torre3, Luciano Aguilera2
1 Departamento de Neurociencias, Facultad de Medicina y Odontología, UPV / EHU. Leioa. Bizkaia. España UE.
2 Servicio de Anestesiología y Reanimación, y Unidad de Tratamiento del Dolor, Hospital de Basurto. Bilbao. Bizkaia. España UE.
3 Servicio de Anestesiología y Reanimación, y Unidad de Tratamiento del Dolor, Hospital de Galdakao-Usansolo. Galdakao. Bizkaia. España UE.
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Resumen

Pruebas clínicas y experimentales han demostrado que un trauma tisular provoca en el Sistema Nervioso Central (SNC) un incremento de la excitabilidad neuronal, conocido como Sensibilización Central (SC), caracterizado por la presencia de dolor espontáneo o persistente, expansión de las áreas afectadas por el dolor, y trastornos sensoriales cualitativos que incluyen alodinia e hiperalgesia. La SC resulta de una serie de alteraciones funcionales y anatómicas en el SNC, algunas de ellas potencialmente irreversibles, las cuales pueden ser responsables, al menos en parte, de la persistencia del dolor tras la resolución de la lesión tisular desencadenante. Un factor clave en todos ellos parece ser la severidad del propio dolor en la fase aguda, con o sin neuropatía concomitante. Más allá del ámbito puramente experimental, la SC constituye un mecanismo relevante en la fisiopatología del dolor en una variedad de situaciones clínicas comunes.

Palabras clave:
dolor neuropático
nocicepción
plasticidad
Summary

Experimental and clinical evidence has shown that tissue injury may lead to Central Sensitization (CS), i.e. a reversible increase in the excitability of central nervous system (CNS) neurones which is characterised by spontaneous or persistent pain, expansion of painful areas, and qualitative sensory disturbances including allodynia and hyperalgesia. CS results from a series of functional and anatomical changes, some of which may be potentially irreversible, that may be at least partially responsible for the persistence of pain once the triggering tissue injury has healed. The severity of acute pain appears to be a key factor therein, irrespective of accompanying neuropathy. Beyond the experimental setting, CS arises as a clinically relevant mechanism in the pathophysiology of pain in a variety of common clinical conditions.

Key words:
neuropathic pain
nociception
plasticity
Laburpena

Esperimentu-arloko eta klinikako froga ugarik jakinarazi dute gorputzeko zauri edo kalte batek Erdiko Sentiberatze (ES) izena hartzen duen kitzikagarritasun-areagotze egoera leheneragarri bat sortzen duela Erdiko Nerbio Sistemako (ENS) neuronetan. Egoera honen ezaugarriak zerak dira, berezko mina edo min iraunkorra, eskualde mingarrien hedapena, eta minaren kalitate-ezaugarrien aldaketak, barne besteak beste alodinia eta hiperalgesia. ENSko neuronetan leheneraezinak ere izan daitezkeen zenbait fisiologi eta anatomi aldaketen ondorioz bilakatzen da ES, eta aldaketok omen dira, zati batez bahintzat, gorputzean hartutako kaltea sendatzearen ondoren minak oraindik ere irautea eragiten dutenak. Egoera hauetan guztietan, minak berak egoera akutuan duen larritasuna omen da gakoetako bat, duela ala ez aldi bereko neuropatia. Esperimentu-arlotik kanpo ere, ES minaren patofisiologiaren mekanismo aipagarri bat da klinikako hainbat egoera arruntetan ere.

Gako hitzak:
min neuropatikoa
nozizepzioa
plastikotasuna
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