Pain is an essential physiological defense against danger, be it external, from the environment, or internal, arising from within the body. The initiation of this acute defensive pain is driven by activation in the periphery of the terminals of high threshold nociceptor sensory neurons by intense or irritant noxious stimuli and comprises both the distinct unpleasant sensation of pain and protective motor responses. Clinical pain, is though, very different from the immediate detection of and reaction to noxious stimuli, it includes ongoing pain and development of pain hypersensitivity in the presence of tissue damage, after nerve injury and in some cases, in the absence of any peripheral pathology. In all these situations, a prominent feature and sometimes prime driver of the pain, is an altered modulation of pain processing within the central nervous system, an amplification consequent on increased excitability and/or reduced inhibition in specific neural networks, which constitute the phenomenon of central sensitization. Recognition of the importance of central sensitization for the maintenance and manifestation of clinical pain states has led to an appreciation that such pain typically is an expression of an altered/disease state of nociceptive circuits in the central nervous system, one triggered but not necessarily sustained by peripheral injury, rather than only a symptom of some ongoing peripheral pathology, and treatment needs to be targeted accordingly.

中文翻译：

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疼痛放大——关于中枢敏化的方式、原因、时间和地点的观点

疼痛是抵御危险的基本生理防御，无论是外部的，来自环境的，还是内部的，来自身体内部。这种急性防御性疼痛的发生是由高阈值伤害感受器感觉神经元末梢周围的强烈或刺激性有害刺激引起的，包括明显的疼痛和保护性运动反应的不愉快感觉。然而，临床疼痛与对有害刺激的立即检测和反应非常不同，它包括在组织损伤、神经损伤后以及在某些情况下，在没有任何外周病理的情况下持续疼痛和疼痛过敏的发展. 在所有这些情况下，一个突出的特征，有时是疼痛的主要驱动因素，是中枢神经系统内疼痛处理的改变调制，是特定神经网络兴奋性增加和/或抑制减少导致的放大，构成中枢敏化现象。认识到中枢敏化对于临床疼痛状态的维持和表现的重要性已经导致人们认识到这种疼痛通常是中枢神经系统中伤害性回路的改变/疾病状态的表现，一种由以下因素触发但不一定持续外周损伤，而不仅仅是一些正在进行的外周病理的症状，治疗需要相应地有针对性。构成中枢敏化现象。认识到中枢敏化对于临床疼痛状态的维持和表现的重要性已经导致人们认识到这种疼痛通常是中枢神经系统中伤害性回路的改变/疾病状态的表现，一种由以下因素触发但不一定持续外周损伤，而不仅仅是一些正在进行的外周病理的症状，治疗需要相应地有针对性。构成中枢敏化现象。认识到中枢敏化对于临床疼痛状态的维持和表现的重要性已经导致人们认识到这种疼痛通常是中枢神经系统中伤害性回路的改变/疾病状态的表现，一种由以下因素触发但不一定持续外周损伤，而不仅仅是一些正在进行的外周病理的症状，治疗需要相应地有针对性。