Peripheral and central hyperexcitability: differential signs and symptoms in persistent pain

• Published in: The Behavioral and brain sciences Vol. 20; no. 3; p. 404
• Main Authors: Coderre, T J, Katz, J
• Format: Journal Article
• Language: English
• Published: England 01.09.1997
• Subjects: Anesthetics, Local - pharmacology; Anesthetics, Local - therapeutic use; Animals; Central Nervous System - drug effects; Central Nervous System - physiology; Diagnosis, Differential; Humans; Hyperalgesia - etiology; Nerve Block; Neuronal Plasticity - drug effects; Neuronal Plasticity - physiology; Neurons, Afferent - drug effects; Nociceptors - drug effects; Nociceptors - physiology; Pain - diagnosis; Pain - drug therapy; Pain - etiology; Pain Measurement; Peripheral Nervous System - drug effects; Peripheral Nervous System - physiology; Sensation - drug effects; Sensation - physiology; Time Factors; Wounds and Injuries - complications; Wounds and Injuries - drug therapy
• ISSN: 0140-525X
• DOI: 10.1017/s0140525x97251484

This target article examines the clinical and experimental evidence for a role of peripheral and central hyperexcitability in persistent pain in four key areas: cutaneous hyperalgesia, referred pain, neuropathic pain, and postoperative pain. Each suggests that persistent pain depends not only on central sensitization, but also on inputs from damaged peripheral tissue. It is instructive to think of central sensitization as comprised of both an initial central sensitization and an ongoing central sensitization driven by inputs from peripheral sources. Each of these factors, initial sensitization, ongoing central sensitization, and inputs from peripheral sources, contributes to the net activity in dorsal horn neurons and thus influences the expression of persistent pain or hyperalgesia. Since each factor, peripheral inputs and central sensitization (initial or ongoing), can contribute to both the initiation and maintenance of persistent pain, therapies should target both peripheral and central sources of pathology.