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Neural Basis of Pain in Herpes Zoster and Postherpetic Neuralgia: The Ectopic Pacemaker Hypothesis

  • Marshall DevorEmail author
Chapter

Abstract

Pain in herpes zoster and postherpetic neuralgia is classically ascribed to irritable, inflammation-sensitized nociceptors in the cutaneous rash and to spinal cord deafferentation. After considering weaknesses in the evidence base underlying this view an alternative explanation is offered, based on hyperexcitability at ectopic pacemaker sites in affected primary sensory neurons, and central sensitization induced and maintained by the ectopic activity.

Notes

Acknowledgments

I wish to thank the following individuals for their helpful responses to queries about unpublished observations concerning herpes zoster and postherpetic neuralgia, and for their guidance on published material: Ralf Baron, Shane Brogan, Perry Fine, Ron Goldstein, Michaela Kress, John Loeser, Florella Magora, Christof Maier, Turo Nurmikko, Anne Louise Oaklander, Gabor Racz, Srinivasa Raja, Zvi Harry Rappaport, Andrew Rice, Michael Rowbotham, Ze’ev Seltzer, Jordi Serra, Claudia Sommer, Maarten van Kleef, and Bart van Wijck. A special note of thanks is due to Peter Watson for his feedback on numerous factual and conceptual issues related to the text. The authors’ research on neuropathic pain mechanisms is funded by the Israel Science Foundation, the Seymour and Cecile Alpert Chair in Pain Research, and the Hebrew University Center for Research on Pain.

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of Cell and Developmental BiologyInstitute of Life Sciences and Center for Research on Pain, The Hebrew University of JerusalemJerusalemIsrael

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