#acl +All:read #format wiki #language ko #pragma description 통증; = 통증(Pain) & 통각(Nociception) = <> == 말초 통각신경 == [[DOI:10.1038/nrn2042|{{https://media.nature.com/lw926/nature-assets/nrn/journal/v8/n1/images/nrn2042-f1.jpg|Nociception Theory|}}]] === 통각신경 (Nociceptors) === 1. Thermal Nociceptors: Aδ fiber, > 45°C or < 5°C 1. Mechanical Nociceptors: Aδ fiber, 기계적 자극 1. Polymodal Nociceptors: C fiber, 기계,화학,온도자극 1. Silent Nociceptors: 내장기관. 이차통증과민화, 중추감각 [[DOI:10.1038/nrn2042|{{https://media.nature.com/lw926/nature-assets/nrn/journal/v8/n1/images/nrn2042-f2.jpg|그림 24-1|}}]] === Nociceptive Receptors === {{https://upload.wikimedia.org/wikipedia/commons/4/46/Open_hand.jpg||height=75}} Distal End (Peripheral Terminal){{attachment:../../Neuroscience/SensorySystem/pseudounipolar.png|Pseudounipolar neuron|height=75}} [[DOI:10.1016/j.cell.2009.09.028|{{https://ars.els-cdn.com/content/image/1-s2.0-S0092867409012434-gr3_lrg.jpg||width=600}}]] ==== TRP channels ==== [[doi:10.1038/39807|The capsaicin receptor: a heat-activated ion channel in the pain pathway. Nature 1997.]] [[DOI:10.1016/S0959-4388(03)00101-6|{{https://ars.els-cdn.com/content/image/1-s2.0-S0959438803001016-gr1.jpg|그림 24-2|}}]] ==== Inflammatory mediator receptors ==== [[DOI:10.1016/j.cell.2009.09.028|{{https://ars.els-cdn.com/content/image/1-s2.0-S0092867409012434-gr4_lrg.jpg||width=600}}]] [[WikiPedia:Cyclooxygenase|{{https://cdn1.medicalnewstoday.com/content/images/articles/161/161255/aspirin.jpg||height=100}}]] [[https://www.medicinenet.com/cox-2_inhibitors/article.htm#what_are_the_side_effects_of_cox-2_inhibitors_and/or_nsaids?|{{https://www.evopharmacy.com/prod_images_blowup/celebrex_pack.jpg||height=100}}]] ==== Receptor Sensitization ==== [[DOI:10.1016/j.cell.2006.02.023|{{https://ars.els-cdn.com/content/image/1-s2.0-S0092867406002406-gr8.jpg|그림 24-2|}}]] == Spinal Dorsal Horn == {{attachment:../../Neuroscience/SensorySystem/pseudounipolar.png|Pseudounipolar neuron|height=75}} Proximal End (Central Terminal) {{https://upload.wikimedia.org/wikipedia/en/thumb/c/cd/Grey_and_white_matter_in_the_spinal_cord.gif/320px-Grey_and_white_matter_in_the_spinal_cord.gif||height=75}} [[doi:10.1038/nrn2947|{{https://media.nature.com/lw926/nature-assets/nrn/journal/v11/n12/images/nrn2947-f1.jpg|그림 24-3|}}]] [[DOI:10.1016/j.cell.2009.09.028|{{https://ars.els-cdn.com/content/image/1-s2.0-S0092867409012434-gr1_lrg.jpg||width=600}}]] === Referred Pain === {{https://upload.wikimedia.org/wikipedia/commons/a/a4/1506_Referred_Pain_Chart.jpg|그림 24-4|width=600}} === Dorsal Horn Synapses === [[doi:10.1016/j.jpain.2009.06.012|{{https://ars.els-cdn.com/content/image/1-s2.0-S1526590009006099-gr4.jpg}}]] 척수후각 내 TRPV1!! 거기서 뭐 해?? {{attachment:centralTRPV1.png||width=400}} * Pre-synaptic TRPV1 function proposed in [[doi:10.1523/JNEUROSCI.5030-08.2009|J.Neurosci 2009]] * Post-synaptic TRPV1 function proposed in [[DOI:10.1016/j.neuron.2012.02.039|Neuron 2012]] === Second-order Neurons (Interneurons & Projection Neurons) === [[doi:10.1038/nrn2947|{{https://media.nature.com/lw926/nature-assets/nrn/journal/v11/n12/images/nrn2947-f4.jpg|그림 24-5|}}]] == 통각과민 == || Physiologic Nociception || Inflammatory Pain || || [[doi:10.1038/nrn1700|{{https://media.nature.com/lw926/nature-assets/nrn/journal/v6/n7/images/nrn1700-f1.gif}}]] || [[doi:10.1038/nrn1700|{{https://media.nature.com/lw926/nature-assets/nrn/journal/v6/n7/images/nrn1700-f2.gif}}]] || ||<-2>Neuropathic Pain [[doi:10.1038/nrn1700|{{https://media.nature.com/lw926/nature-assets/nrn/journal/v6/n7/images/nrn1700-f3.gif}}]] || [[DOI:10.1016/j.cell.2009.09.028|{{https://ars.els-cdn.com/content/image/1-s2.0-S0092867409012434-gr5_lrg.jpg}}]] [[doi:10.1016/j.jpain.2009.06.012|{{https://ars.els-cdn.com/content/image/1-s2.0-S1526590009006099-gr9.jpg}}]] == 통각 전도로 == === Dorsal Column System & Spinothalamic Tract === {{https://upload.wikimedia.org/wikipedia/commons/thumb/e/ee/1417_Ascending_Pathways_of_Spinal_Cord.jpg/1000px-1417_Ascending_Pathways_of_Spinal_Cord.jpg}} === 시상 === {{https://upload.wikimedia.org/wikipedia/commons/thumb/6/62/Signaling_spinal_cord.png/1280px-Signaling_spinal_cord.png}} {{http://humanphysiology.academy/Neurosciences%202015/Images/3/thalconn%20www.glittra.JPG||width=600}} === 피질 === 통증의 정의 from [[https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698&navItemNumber=576#Pain|International Association for the Study of Pain]]: * An unpleasant sensory and emotional experience * associated with actual or potential tissue damage, * or described in terms of such damage. Cingulate cortex, Insular cortex are active during pain perception. * [[http://a.co/8WH7QGl|the Pain Chronicles]] by Melanie Thernstrom === 내인성 통증조절 기전 === [[DOI:10.1016/j.cell.2009.09.028|{{https://ars.els-cdn.com/content/image/1-s2.0-S0092867409012434-gr2_lrg.jpg||width=500}}]] || 전구체 || Peptide || Receptor || ||<|3> POMC || β-endorphin || μ/δ || || Endomorphin-1 || μ || || Endomorphin-2 || μ || ||<|2> Proenkyphalin || Met-enkephalin || δ || || Leu-enkephalin || δ || ||<|2> Prodynorphin || Dynorphin A || κ || || Dynorphin B || κ || || Pro-orphanin FQ || Orphanin FQ || Orphan receptor || === 진통제 === {{http://www.joacp.org/articles/2016/32/2/images/JAnaesthClinPharmacol_2016_32_2_160_182085_f1.jpg}} <>