Maldynia: Pathophysiology and Management of Neuropathic and Maladaptive Pain—A Report of the AMA Council on Science and Public Health

Dickinson, Barry D.; Head, C. Alvin; Gitlow, Stanley E.; Osbahr, Albert J.

doi:10.1111/j.1526-4637.2010.00986.x

Cited by 49 publications

(37 citation statements)

References 167 publications

(199 reference statements)

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“…This is followed by a process called deafferentation and the proximal portion of the severed nerve sprouts to form neuromas [18]. There is an increased accumulation of molecules enhancing the expression of sodium channels in these neuromas that results in hype-excitability and spontaneous discharges [19]. This abnormal peripheral activity is thought to be a potential source of the stump pain, including phantom pain [18].…”

Section: Mechanismsmentioning

confidence: 99%

“…Some neurons in the areas of spinal cord that are not responsible for pain transmission also sprout into the Lamina II of the dorsal horn of the spinal cord which is the area involved in the transmission of nociceptive afferent inputs [18, 19]. This is followed by increased neuronal activity, expansion of the neuronal receptive field, and hyperexcitability of other regions.…”

Section: Mechanismsmentioning

confidence: 99%

See 1 more Smart Citation

Phantom Limb Pain: Mechanisms and Treatment Approaches

Subedi

Grossberg

2011

Pain Research and Treatment

143

131

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The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. More recently, the role of mirror neurons in the brain has been proposed in the generation of phantom pain. A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary measures. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain.

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Section: Mechanismsmentioning

confidence: 99%

Section: Mechanismsmentioning

confidence: 99%

Phantom Limb Pain: Mechanisms and Treatment Approaches

Subedi

Grossberg

2011

Pain Research and Treatment

143

131

View full text Add to dashboard Cite

show abstract

“…Moreover, it is often stated that chronic pain is pain that extends beyond the expected period of healing, and that the pain is without purpose and a disease in its own right [173]. In this context, some authors use concepts like pathological pain, or maladaptive pain, or maldynia (Greek for "bad pain") [71,96]. It is sometimes stated that the vital importance of acute pain might be an important background to why pain can become chronic.…”

Section: Some Basic Definitionsmentioning

confidence: 99%

The Cerebrospinal Fluid in Severe Pain Conditions : Clinical, Pharmacological and Proteomic Aspects

Bäckryd¹

2015

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The treatment of both cancer pain and non-cancer chronic pain is still suboptimal. The overall aim of this PhD thesis was to conduct translational pain research at the interface between clinical pain medicine and the field of human proteomics, using the practice of intrathecal analgesia at our institution as a starting point. Hence, the cerebrospinal fluid (CSF) is at the centre of the present dissertation, both as a target for infusing analgesics (Papers I and II – clinical and pharmacological aspects) and as an important biofluid for human biomarker studies (Papers III and IV – proteomic aspects). In Paper I, 28 cases of intrathecal analgesia in cancer patients were prospectively followed. Movement-evoked breakthrough pain remained a major clinical problem throughout the study month despite otherwise successful intrathecal analgesia (defined as good control of spontaneous resting pain paralleled by a marked decrease of concomitant systemic opioid doses). This study therefore illustrates the importance of considering not only spontaneous resting pain but also movement-evoked breakthrough pain. In Paper II, an expert-based algorithm for trialing the intrathecal analgesic ziconotide by bolus injections was evaluated in an open-label study of 23 patients with chronic neuropathic pain. We found few responders (13%) according to the strict criteria of the algorithm, but ziconotide bolus injection trialing seems feasible. The predictive power of ziconotide bolus trialing remains unclear, and the pharmacological profile of ziconotide (with very slow tissue penetration due to high hydrophilicity) calls the rationale for ziconotide bolus trialing into question. In Paper III, we found low levels of beta-endorphin in the CSF of chronic neuropathic pain patients (n=15) compared to healthy controls (n=19). We speculate that this might indicate dysfunctional top-down control of nociception. Substance P levels in the CSF did not differ by univariate statistics. In Paper IV, the CSF proteome of 11 patients with chronic neuropathic pain and 11 healthy controls was exploratively studied, combining gel-based proteomics with multivariate data analysis. After eliminating four proteins associated with age, 32 proteins were found to highly discriminate between groups. Among these, the seven proteins having the highest discriminatory power between patients and controls were: one isoform of angiotensinogen, two isoforms of alpha-1-antitrypsin, three isoforms of haptoglobin, and one isoform of pigment epithelium-derived factor. In conclusion, this PhD thesis demonstrates the fruitfulness of studying the CSF, both as a target for infusing analgesics and as a potential mirror of the neurobiological processes involved in pathological pain conditions. The thesis points to the need for more research into the mechanisms of different pain conditions, in order to hopefully achieve the vision of mechanism-based pain diagnoses

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“…In addition, there is a growing consensus that multiple chemical sensitivity, post traumatic stress disorder, depression, primary dysmenorrhea, irritable bowel syndrome, periodic limb movement disorder and restless leg syndrome are strong candidates for inclusion as central sensitization syndromes. [2,17,19] Figure 2. …”

Section: What Are Central Sensitization Syndromes (Css)mentioning

confidence: 99%

“…The pathways are few, and have fairly specific therapeutic protocols associated with them. [2,5,7,8,[13][14][15]17,19,20,32] There are two distinctly different approaches to CSS therapy. The first, and historically more common, is to address the effects of CS after it has occurred.…”

Section: Therapymentioning

confidence: 99%

Central Sensitization: Clinical Implications for Chronic Head and Neck Pain

Roberts¹

2012

CMD

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Chronic clinical pain associated with CS, is a potentially progressive, devastating, multimodal disease with a significant worldwide economic and social burden. Effective intervention is dependent upon recognizing the fundamental differences in acute and chronic pain, the effects on and by the neuromatrix upon the biopsychosocial health of the individual patient, and integrating that knowledge into a comprehensive multidisciplinary therapeutic plan.

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Maldynia: Pathophysiology and Management of Neuropathic and Maladaptive Pain—A Report of the AMA Council on Science and Public Health

Cited by 49 publications

References 167 publications

Phantom Limb Pain: Mechanisms and Treatment Approaches

Phantom Limb Pain: Mechanisms and Treatment Approaches

The Cerebrospinal Fluid in Severe Pain Conditions : Clinical, Pharmacological and Proteomic Aspects

Central Sensitization: Clinical Implications for Chronic Head and Neck Pain

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