针刺镇痛陈静.pptVIP

2、经典神经递/调质在针刺镇痛中的作用5-羟色胺（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↓多巴胺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WorldCongressofPain1984,4thWCPWorkshoponacupuncture2010,13thWPCPlenarylectureonacupuncture6000+attendHzHz100HzHighMediumLowEA:FrequencySpecificity2HzEAincreasesEnkrelease2Hz100HzEA15HzControlEnkephalin-irinspinalperfusateDynorphin-irinspinalperfusate0.000.100.200.30BeforeAfterEA***0.000.501.001.502.002.50BeforeAfterEA***2Hz100HzEA15HzControlFrequency-dependentreleaseofneuropeptidesRatExperiment100HzEAincreasesDynreleaseDynorphinAHumanStudy05001000150020001015050500100015002000051015***fmol/mlCSFMek-Arg-PheMEK-Arg-PheDynorphinAAstudyincollaborationwithDr.LarsTerenius2HzEnk100HzDyn**10N=10N=10N=10N=10EAAcceleratesEndogenousOpioidsRelease2Hz100Hz1997???EM?-EPENKDYNANTIBODYNALOXONE197619751979OpioidReceptors0102Acutepain:ClearcutresultsUnanimousconsensusChronicpain:ControversiesexistMoredetailsshouldbeconsideredClinicalApplicationsAcutePain:Post-operativePainSurgicalprocedurePre-emptive30minPost-operative30mineachIntra-operativecontinuousstimulationReductionofanxietyAnestheticsparingReductionofPost-operativepain,nausea.vomitAcupEffect0-30minChronicPainInflammatorypain?Neuropathicpain?Centralpain?Cancerpain?PainofdifferentmechanismsmayrequiredifferenttypesofacupunctureNeiGuan(Pe6)Heku(LI4)2道6道影响针刺镇痛疗效的因素方向角度深度强度频率时程次数针刺?方向：腕踝针疗法有其明确的针刺方向,针尖向腕及踝方向，主治腕踝及以下病症；向肘、膝方向,主治肘膝及以上部位病症。1?深度：有试验以偏头痛为例进行深浅针刺镇痛研究，发现深刺疗效优于常规针刺。2?角度针刺角度不同,其镇痛适应证明显不同。以翳风为例：浅刺法:直刺主要治疗乳突疼痛、面瘫;斜刺主要治疗下颌病变、牙痛,进针后向下颌骨方向斜刺。深