Mechanisms of neuropathic pain

• Published in: European neuropsychopharmacology Vol. 22; no. 2; pp. 81 - 91
• Main Authors: Nickel, Florian T, Seifert, Frank, Lanz, Stefan, Maihöfner, Christian
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.02.2012
• Subjects: Central Nervous System Sensitization - physiology; Humans; Internal Medicine; Models, Biological; Neuralgia - diagnosis; Neuralgia - physiopathology; Neuralgia - therapy; Neuropathic pain; Pathophysiology; Psychiatry; Reorganization; Sensitization; Sensory Receptor Cells - physiology; Sympathetically maintained; Symptoms; SCS; AMPA; Reorganization; RVM; spinal cord stimulation; PEPD; mGluR; TRP; transient receptor potential-channel; Sensitization; Pathophysiology; CIP; MAPK; NGF; CRPS; paroxysmal extreme pain disorder; SSRI; nociceptors sensitive to heat, pinch and cold; lysophosphatidic acid; TCA; dorsal root ganglion; LPA; CGRP; Symptoms; long-term potentiation; LTP; HPC-nociceptors; metabotropic G-protein coupled glutamate receptor; voltage-gated sodium channel; Neuropathic pain; mitogen-activated protein kinase; TENS; ASIC; selective serotonin reuptake inhibitor; nerve growth factor; Sympathetically maintained; NMDA; tricyclic antidepressant; TTX; congenital insensitivity to pain; N-methyl-D-aspartate; complex regional pain syndrome; quantitative sensory testing; transcutaneous electrical nerve stimulation; calcitonin gene-related peptide; Na V; periaqueductal grey; QST; PAG; acid sensing ion channel; DRG; α-amino-3-hydroxy-5-methyl-4-isoxazeloproprionic acid; tetrodotoxin; rostral ventral medulla
• ISSN: 0924-977X; 1873-7862
• DOI: 10.1016/j.euroneuro.2011.05.005

Abstract Neuropathic pain is a disease of global burden. Its symptoms include spontaneous and stimulus-evoked painful sensations. Several maladaptive mechanisms underlying these symptoms have been elucidated in recent years: peripheral sensitization of nociception, abnormal excitability of afferent neurons, central sensitization comprising pronociceptive facilitation, disinhibition of nociception and central reorganization processes, and sympathetically maintained pain. This review aims to illustrate these pathophysiological principles, focussing on molecular and neurophysiological findings. Finally therapeutic options based on these findings are discussed.