关键词：医药；空调疼痛调制；漫伤害抑制控制；子网状核背
摘 要：Conditioning pain modulation (CPM) is one of two dynamic test paradigms which measure an individual's ability to dampen pain centrally. Diffuse noxious inhibitory control (DNIC) is inhibitory pain modulation measured through the ability of a conditioning pain to dampen capacity on a test pain in an anatomically different location from the conditioning pain ("heterotropic pain inhibiting pain", also known as counterirritation). The primary target of DNIC is dorsal horn afferent neuron and wide dynamic range neuron. The critical medullary site for DNIC is the sub-nucleus reticularis dorsalis (SRD), located in the medulla. There is interplay between the SRD and rostral ventromedial medulla (RVM). Activation of the RVM by morphine impairs DNIC. There is also an important interplay between the SRD and the anterior cingulate gyrus. The spino-bulbo-spinal loop of DNIC is dependent upon serotonergic neurotransmission. DNIC can be imaged via EEG and functional MRI as well as measured clinically through CPM. DNIC decreases with age and is less efficient in females. Certain pain processing disorders such as fibromyalgia and irritable bowel syndrome are more frequently associated with impaired DNIC. Duloxetine improves DNIC while morphine impairs DNIC. Clinically testing for DNIC through CPM may allow clinicians to better prescribe analgesics, as recently demonstrated in adaptive designed trials.