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Nociception, Sympathetic Nervous System, and Inflammation

When the Heart and the Skin Speak the Same Language

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Brain and Heart Dynamics

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Abstract

Sympathetically maintained pain syndromes (SMPs) are a heterogeneous group of painful disorders typically worsened by sympathetic activation and improved by sympathetic blockade. From a clinical standpoint, SMPs have long been known, and the first attempt to percutaneously block a sympathetic ganglion to control pain was reported in 1934. Nevertheless, the pathophysiology of these disorders is yet to be fully elucidated. A pathological nociceptive activation/pain processing, autonomic dysregulation, and immune-inflammatory dysfunctions are thought to be the main mechanisms. Of note, similar mechanisms may also be involved in pathological pain perception at the cardiac level, as it likely happens in the cardiac syndrome X. In this chapter, an overview of the molecular mechanisms linking inflammation, sympathetic nervous system (SNS) overactivity, and nociceptive activation at the cutaneous as well as the cardiac level will be provided first. The surgical procedures of sympathetic block/removal used to treat sympathetically mediated cutaneous and cardiac conditions will be then discussed. Finally, a working hypothesis for the emerging clinical issue of post-thoracoscopic sympathectomy neuropathic pain will be provided. Indeed, thousands of people all over the world underwent thoracoscopic sympathectomy (consisting in the surgical removal of the first sympathetic thoracic ganglia) for essential hyperhidrosis, with few or no reported cases of postoperative neuropathic pain. On the contrary, neuropathic pain is being reported with increasing frequency in patients with channelopathies/cardiomyopathies undergoing thoracoscopic sympathectomy for anti-arrhythmic purposes. These patients, particularly those with cardiomyopathies, have exaggerated sympathetic tone and reflexes, combined with neuronal remodeling processes affecting the sympathetic ganglia. Neuropathic pain in this setting might be related to post-denervation supersensitivity, consistently favored by the abovementioned mechanisms.

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Authors and Affiliations

  1. Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy

    Veronica Dusi

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  1. Veronica Dusi
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Correspondence to Veronica Dusi .

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Editors and Affiliations

  1. Dept of Drug Sciences, Pharmacology Sect, University of Pavia, Dept of Drug Sciences, Pharmacology Sect, Pavia, Pavia, Italy

    Stefano Govoni

  2. Dept of Brain and Behavioural Sciences, University of Pavia Dept of Brain and Behavioural Sciences, Pavia, Pavia, Italy

    Pierluigi Politi

  3. Department of Molecular Medicine, University of Pavia, Department of Molecular Medicine, Pavia, Pavia, Italy

    Emilio Vanoli

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  1. Department of Cardiovascular, Neural and Metabolic Sciences,, IRCCS Istituto Auxologico Italiano, Milan, Italy, Italy

    Laura Calvillo

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Dusi, V. (2020). Nociception, Sympathetic Nervous System, and Inflammation. In: Govoni, S., Politi, P., Vanoli, E. (eds) Brain and Heart Dynamics. Springer, Cham. https://doi.org/10.1007/978-3-319-90305-7_63-1

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  • DOI: https://doi.org/10.1007/978-3-319-90305-7_63-1

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