Modern concepts of pain mechanisms

Close metadata

Recommended articles:

Risk factors of chronic postoperative pain in cardiac surgery: mental characteristics and central sensitization. Russian Journal of Pain. 2023;(4):32-38

Features of fibromyalgia in patients with rheumatoid arthritis. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(2):28-36

Central sensitization and comorbid disorders in patients with coronary heart disease. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(6):89-93

Multivalent effect on chronic back pain: results of randomized clinical trials of Dorsumio. Russian Journal of Pain. 2024;(3):63-73

The idea of this article is to focus the pain mechanisms. There are nociception, peripheral sensitization, central sensitization, ectopic neuronal activity, peripheral disinhibition, central disinhibition, and efferent-afferent conduit that are known well. Importantly, any of them can contribute in pain appearance wherein in any combination. To our opinion because the detection of pain mechanism precisely gives the opportunity of treatment of pain based on pathogenesis these representations could be useful for creation of new approaches to management of chronic pain.

Keywords:

pain mechanisms

nociception

peripheral sensitization

central sensitization

ectopic neuronal activity

disinhibition

Authors:

Karelov A.E.

North-Western State Medical University named after I.I. Mechnikov

Scopus AuthorID: 6508037675
ORCID: 0000-0003-4401-1599

Received:

23.06.2020

Accepted:

21.07.2020

List of references:

Zozulya MV, Lenkin AI, Kurapeev IS, Karelov AE, Saiganov SA, Lebedinskii KM. Analgesia after cardiac surgery. Russian Journal of Anaesthesiology and Reanimatology/«Anesteziologiya i reanimatologiya». 2019;5:38-46. (In Russ.). https://doi.org/10.17116/anaesthesiology201905138
Karelov AE, Aleeva RS, Gorohov KA, Patlay IV. Effects of activation or blockade of purine receptors during strong nociceptive stimulation in conscious volunteers. Efferentnaya terapiya. 2010;16(3):86-90. (In Russ.).
Крыжановский Г.Н. Детерминантные структуры в патологии нервной системы: Генераторные механизмы нейропатологических синдромов. М.: Медицина; 1980.
Mazurov VI, Belyaeva IB. The role of IL-6 in the formation of the pathogenetic mechanisms of rheumatoid arthritis. Polyclinica. 2019;3:42-47. (In Russ.).
Mazurov VI, Trofimova AS, Trofimov EA. Risk factors and some aspects of the osteoarthritis pathogenesis. Herald of I.I. Mechnikov North-West State Medical University. 2016;8(2):116-124. (In Russ.).
Ovechkin AM, Bayalieva AZh, Ezhevskaya AA, Eremenko AA, Zabolotskij DV, Zabolotskikh IB, Karelov AE, Koryachkin VA, Spasova AP, Khoronenko VE, Uvarov DN, Ulrikh GE, Shadrin RV. Postoperative analgesia. A.I. Saltanov Herold of Intensive Therapy. 2019;4:9-33. (In Russ.). https://doi.org/10.21320/1818-474X-2019-4-34-46.
Povzun AS, Mazurov VI. Acute articular syndrome. The concept of emergency care in rheumatology. Naučno-praktičeskaâ revmatologiâ. 2018;56(4):456-460. (In Russ.). https://doi.org/10.14412/1995-4484-2018-456-460
Nasonov EL, Lila AM. Rheumatoid arthritis: achievements and unresolved issues. Terapevticheskii arkhiv. 2019;91(5):4-7. (In Russ.). https://doi.org/10.26442/00403660.2019.05.000259
Yachno NN. Neurology of pain. Russian Journal of Pain. 2013;2:3-5. (In Russ.).
Amir R, Kocsis JD, Devor M. Multiple interacting sites of ectopic spike electrogenesis in primary sensory neurons. J Neurosci. 2005;25:2576-2585. https://doi.org/10.1523/JNEUROSCI.4118-04.2005
Balasubramanyan S, Stemkowski PL, Stebbing MJ, Smith PA. Sciatic chronic constriction injury produces cell-type-specific changes in the electrophysiological properties of rat substantia gelatinosa neurons. J Neurophysiol. 2006;96:579-590. https://doi.org/10.1152/jn.00087.2006
Baliki MN, Apkarian AV. Nociception, Pain, Negative Moods, and Behavior Selection. Neuron. 2015;87(3):474‐491. https://doi.org/10.1016/J.NEURON.2015.06.005
Baron R, Maier C, Attal N, Binder A, Bouhassira D, Cruccu G, Finnerup NB, Haanpää M, Hansson P, Hüllemann P, Jensen TS, Freynhagen R, Kennedy JD, Magerl W, Mainka T, Reimer M, Rice AS, Segerdahl M, Serra J, Sindrup S, Sommer C, Tölle T, Vollert J, Treede RD. Peripheral neuropathic pain: a mechanism-related organizing principle based on sensory profiles. Pain. 2017;158(2):261‐272. https://doi.org/10.1097/j.pain.0000000000000753
Binshtok AM, Wang H, Zimmermann K, Amaya F, Vardeh D, Shi L, Brenner GJ, Ji RR, Bean BP, Woolf CJ, Samad TA. Nociceptors are interleukin-1beta sensors. J Neurosci. 2008;28(52):14062-14073. https://doi.org/10.1523/JNEUROSCI.3795-08.2008
Bove GM, Ransil BJ, Lin HC, Leem JG. Inflammation induces ectopic mechanical sensitivity in axons of nociceptors innervating deep tissues. J Neurophysiol. 2003;90:1949-1955. https://doi.org/10.1152/jn.00175.2003
Campbell JN, Raja SN, Meyer RA, Mackinnon SE. Myelinated afferents signal the hyperalgesia associated with nerve injury. Pain. 1988;32:89-94. https://doi.org/10.1016/0304-3959(88)90027-9
Caraceni A, Shkodra M. Cancer Pain Assessment and Classification. Cancers (Basel). 2019;11(4):510-523. https://doi.org/10.3390/cancers11040510
Dellemijn PL, van Duijn H, Vanneste JA. Prolonged treatment with transdermal fentanyl in neuropathic pain. J Pain Symptom Manag. 1998;16:220-229. https://doi.org/10.1016/S0885-3924(98)00070-0
Devor M. Centralization, central sensitization and neuropathic pain. Focus on «sciatic chronic constriction injury produces cell-type-specific changes in the electrophysiological properties of rat substantia gelatinosa neurons». J Neurophysiol. 2006;96:522-523. https://doi.org/10.1152/jn.00365.2006
Devor M. Rethinking the causes of pain in herpes zoster and postherpetic neuralgia: the ectopic pacemaker hypothesis. Pain Rep. 2018;3(6):1-9. https://doi.org/10.1097/PR9.0000000000000702
Fields HL, Rowbotham M, Baron R. Postherpetic neuralgia: irritable nociceptors and deafferentation. Neurobiol Dis. 1998;5:209-227. https://doi.org/10.1006/nbdi.1998.0204
Galer BS, Miller KV, Rowbotham MC. Response to intravenous lidocaine infusion differs based on clinical diagnosis and site of nervous system injury. Neurology. 1993;43:33-1235. https://doi.org/10.1212/WNL.43.6.1233
Hains BC, Waxman SG. Sodium channel expression and the molecular pathophysiology of pain after SCI. Prog Brain Res. 2007;161:195-203. https://doi.org/10.1016/S0079-6123(06)61013-3
Hoffmann T, Sauer SK, Horch RE, Reeh PW. Sensory transduction in peripheral nerve axons elicits ectopic action potentials. J Neurosci. 2008;28(24):6281-6284. https://doi.org/10.1523/JNEUROSCI.1627-08.2008
Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009;10(9):895‐926. https://doi.org/10.1016/j.jpain.2009.06.012
Laupacis A, Sackett DL, Roberts RS. An assessment of clinically useful measures of the consequences of treatment. N Engl J Med. 1988;318(26):1728-1733. https://doi.org/10.1056/NEJM198806303182605
McMahon SB. Mechanisms of sympathetic pain. Br Med Bull. 1991;47(3):584‐600. https://doi.org/10.1093/oxfordjournals.bmb.a072494
Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971‐979. https://doi.org/10.1126/science.150.3699.971
Scholz J, Mannion RJ, Hord DE, Griffin RS, Rawal B, Zheng H, Scoffings D, Phillips A, Guo J, Laing RJC, Abdi S, Decosterd I, Woolf CJ. A novel tool for the assessment of pain: validation in low back pain. PLoS Med. 2009;6(4):1-16. https://doi.org/10.1371/journal.pmed.1000047
Vargas-Schaffer G. Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician. 2010;56(6):514-517.
Woolf CJ. Evidence for a central component of post-injury pain hypersensitivity. Nature. 1983;306:686-688.
Woolf CJ, Bennett GJ, Doherty M, Dubner R, Kidd B, Koltzenburg M, Lipton R, Loeser JD, Payne R, Torebjork E. Towards a mechanism-based classification of pain? Pain. 1998;77(3):227‐229. https://doi.org/10.1016/S0304-3959(98)00099-2
Woolf CJ, Max MB. Mechanism-based pain diagnosis: issues for analgesic drug development. Anesthesiology. 2001;95(1):241‐249.
Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science. 2000;288:1765-1769. https://doi.org/10.1126/science.288.5472.1765
Zhang XH, Li YJ, Hu YS, Tao W, Zheng Z. Dorsal root entry zone coagulation for treatment of deafferentation pain syndromes. Chin Med J (Engl). 2008;121(12):1089‐1092.

Close metadata