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Pathophysiology of Pain

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Chronic Pain Management in General and Hospital Practice

Abstract

Following the definition of pain and a brief summary of the pain pathway, each level is analysed in more detail. The sensation of pain may originate from each level, and modulation takes place at each synaptic interface, with a multitude of chemical mediators involved. The importance of peripheral and central sensitization is stressed. Present knowledge and techniques of investigation of cerebral processing are discussed. Behavioural techniques of pain management are highlighted.

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References

  1. Mersky H, Bogduk N. Classification of chronic pain. Seattle: IASP Press; 1994.

    Google Scholar 

  2. Iggo A. Cutaneous heat and cold receptors with slowly conducting ©afferent fibres. Quart J Exp Physiol. 1959;44:362–70.

    Article  CAS  PubMed  Google Scholar 

  3. Torebjörk HE, Schady W, Ochoa J. Sensory correlates of somatic afferent fibre activation. Hum Neurobiol. 1982;3(1):15–20.

    Google Scholar 

  4. Torebjörk HE, Ochoa J. New method to identify nociceptor units innervating glabrous skin of the human hand. Exp Brain Res. 1990;81(3):509–14.

    Article  PubMed  Google Scholar 

  5. Schaible HG, Grubb BD. Afferent and spinal mechanisms of joint pain. Pain. 1993;55:5–54.

    Article  CAS  PubMed  Google Scholar 

  6. Caterina MJ, Schumacher MA, Makoto T, Rosen TA, Levine DJ, Julius D. The capsaicin receptor: a heat activated ion channel in the pain pathway. Nature. 1997;389:816–24.

    Article  CAS  PubMed  Google Scholar 

  7. Derry S, Wiffen PJ, Kalso EA, Bell RF, Aldington D, Phillips T, Gaskell H, Moore RA. Topical analgesics for acute and chronic pain in adults‐an overview of cochrane reviews. Cochrane Database Syst Rev. 2017;5(3):CD008609.

    Google Scholar 

  8. Zhang JM, An J. Cytokines, inflammation and pain. Intl Anesthesiol Clin. 2007;45(2):27–37.

    Article  CAS  Google Scholar 

  9. Iyengar S, Ossipov MH, Johnson KW. The role of calcitonin-related pain mechanisms including migraine. Pain. 2017;158(4):543–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Hirth M, et al. Nerve growth factor induces sensitization of nociceptors without evidence for increased intra-epidermal nerve fibre density. Pain. 2013;154:2500–11.

    Article  CAS  PubMed  Google Scholar 

  11. Yuan H, Lauritsen CG, Kaiser EA, Silberstein SD. CGRP monoclonal antibodies for migraine. BioDrugs. 2017;31(6):487–501.

    Article  CAS  PubMed  Google Scholar 

  12. Woolf CJ, Allchorne A, Safieh-Garabedian B, Poole S. Cytokines, nerve growth factor and inflammatory hyperalgesia: the contribution of tumor necrosis factor. Br J Pharmacol. 1997;121:417–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Thacker M, Gifford L. Sympathetically maintained pain: myth or reality. 2013. https://giffordsachesandpains.files.wordpress.com/2013/06/04_chapteru.pdf.

    Google Scholar 

  14. Perl ED. Ideas about pain, a historical review. Nat Rev Neurosci. 2007;8:71–80.

    Article  CAS  PubMed  Google Scholar 

  15. Melzack R, Wall P. Pain mechanisms: a new theory. Science. 1965;150(3699):971–9.

    Article  CAS  PubMed  Google Scholar 

  16. Mendell LM. Constructing and deconstructing the gate theory of pain. Pain. 2014;155(2):210–6.

    Article  PubMed  Google Scholar 

  17. Christensen BN, Perl ER. Spinal neurones specifically excited by noxious or thermal stimuli: marginal zone of the dorsal horn. J Neurophysiol. 1970;33:293–307.

    Article  CAS  PubMed  Google Scholar 

  18. Brown AG, Hamann WC, Martin HF 3rd. Effects of activity in non-myelinated afferent fibres on the spinocervical tract. Brain Res. 1975;98(2):243–59.

    Article  CAS  PubMed  Google Scholar 

  19. Sindrup SH, Otto M, Finnerup NB, Jensen TS. Antidepressants in the treatment of neuropathic pain. Basic Clin Pharmacol Toxicol. 2005;96(6):399–409.

    Article  CAS  PubMed  Google Scholar 

  20. Rose MA, Kam PCA. Gabapentin: pharmacology and its use in pain management. Anaesthesia. 2002;57:451–62.

    Article  CAS  PubMed  Google Scholar 

  21. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152:S2–S15.

    Article  PubMed  Google Scholar 

  22. Bannister K, Patel R, Goncalves L, Townson L, Dickenson AH. Diffuse noxious inhibitory controls and nerve injury: restoring an imbalance between descending monoamine inhibitions and facilitations. Pain. 2015;156(9):1803–11.

    Article  CAS  PubMed  Google Scholar 

  23. Hughes J, Smith TW, Kosterlitz HW, Fothergill LA, Morgan BA, Morris HR. Identification of two related pentapeptides from the brain with potent opiate agonist activity. Nature. 1975;258:577–9.

    Article  CAS  PubMed  Google Scholar 

  24. Levine JD, Newton CG, Fields HL. The mechanism of placebo analgesia. Lancet. 1978;312:654–7.

    Article  Google Scholar 

  25. Gruener H, Zeilig G, Laufer Y, Blumen N, Defrin R. Differential pain modulation properties in central neuropathic pain after spinal cord injury. Pain. 2016;157:1415–25.

    Article  PubMed  Google Scholar 

  26. Helyes Z, Tekus V, Szentes N, Pohoczky K, Botz B, et al. Non-inflammatory autoantibody-induced glia activation in a passive transfer complex regional pain syndrome. J Neurochemistry. 2017;142(Suppl. 1):255.

    Google Scholar 

  27. Woodhams SG, Chapman V, Finn DP, Hohmann AG, Neugebauer W. The cannabinoid system and pain. Neuropharmacology. 2017;124:105–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Abrams DI. The therapeutic effect of Cannabis and cannabinoids: An update from the National Academies of Sciences, Engineering and Medicine report. Eur J Intern Med. 2018;49:7–11.

    Article  CAS  PubMed  Google Scholar 

  29. Wager TD, Atlas LY, Lindquist MA, Mathieu R, Choong WW. An fMRI-based neurologic signature of physical pain. N Engl J Med. 2013;368:1388–139.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Guenther K. “It’s all done with mirrors” V.S. Ramachandran and the material culture of phantom limb research. Med Hist. 2016;60:342–58.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kumbhare DA. Evaluation of chronic pain using magnetic resonance (MR), neuroimaging approaches, what the clinician needs to know. Clin J Pain. 2017;33(4):281–90.

    Article  PubMed  Google Scholar 

  32. Pujol J, Martinez-Vilavella G, Llorente-Onaindia J, Harrison BJ, Lopez-Sola M, Lopez-Ruiz M, Bianco-Hinojo L, Benito P, Deus J, Monfort J. Brain imaging of pain sensitization in patients with in patients with knee osteoarthritis. Pain. 2017;158(9):1831–8.

    Article  PubMed  Google Scholar 

  33. Kabat-Zinn J. Mindfulness with Jon Kabat-Zinn. YouTube. 2007. https://www.youtube.com/watch?v=3nwwKbM_vJc.

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Author information

Authors and Affiliations

  1. Guy’s and St Thomas’ Hospital, Pain Management Centre, London, UK

    W. Hamann

Authors
  1. W. Hamann
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Correspondence to W. Hamann .

Editor information

Editors and Affiliations

  1. Pain Control Institute, Shinjyuku, Tokyo, Japan

    Koki Shimoji

  2. Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Antoun Nader

  3. Guy’s and St Thomas’ Hospital, Pain Management Centre, London, UK

    Wolfgang Hamann

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Hamann, W. (2021). Pathophysiology of Pain. In: Shimoji, K., Nader, A., Hamann, W. (eds) Chronic Pain Management in General and Hospital Practice. Springer, Singapore. https://doi.org/10.1007/978-981-15-2933-7_4

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  • DOI: https://doi.org/10.1007/978-981-15-2933-7_4

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-2932-0

  • Online ISBN: 978-981-15-2933-7

  • eBook Packages: MedicineMedicine (R0)

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