<綜説>最終講義内在性抗疼痛機構と内在性抗脳虚血機構

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It is well known that there are descending pain inhibitory systems since Reynold's pioneering work in 1969,and even segmental pain inhibitory mechanisms since the hypothesis advocated by Melzack and Wall in 1965. Thus, it might be ideal to activate these pain inhibitory mechanisms in clinical practice without or minimally using the analgesic or narcotic drugs. Although several measures were found to be effective for activation of these mechanisms in experimental studies, there have been no definite way in clinical practice of alleviating chronic pain by provoking these mechanisms. Sheally et al. reported spinal cord dorsal column stimulation with surgically implanted electrodes to be effective for treating chronic pain patients in 1970. On the other hand, we found that percutaneous epidural stimulation of spinal dorsal column ameliorated chronic pain in 1971. Since these studies, numbers of patients with chronic pain have been treated successfully by electrical stimulation of the dorsal column of spinal cord with implanted epidural electrodes at our clinic as well as other institutes. However, the detailed mechanism by which this stimulation produced analgesic effect is still unknown. We presumed that there might be an endogenous anti-ischemic mechanism in analogy with anti-pain system, and tested it in the ischemic model of mice. We found in 1986 that prior micro-injury in the brain significantly protected the death caused by following brain ischemia. The other goup also found in the same year that prior short period of myocardial ischemia protected the following ischemic heart failure. Since these two studies, several investigators confirmed this phenomenon in brain, heart and other organs, which is now called preconditioning. This ischemic precondioning phenomenon is already applied clinically during heart surgery. The background mechanism producing this phenomenon is left to be answered. Activation of this endogenous mechanism by a substance or some measure if found might be beneficial for the treatment or prevention of brain ischemia.
新潟大学の論文
2002-04-10

<綜説>最終講義内在性抗疼痛機構と内在性抗脳虚血機構

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