Neuropathic pain mechanisms and potential future pharmacotherapeutic strategies

Abstract

Although a relatively recent explosion of basic science efforts have rocketed the field of pain medicine forward, much work still needs to be done “at the bench.” As far as clinical pain medicine is concerned, it too has made major strides but remains in a relative infancy period.The simplistic conventional assumptions and models used in clinical pain medicine have been only partially helpful in developing new, effective strategies for treating chronic pain. Collaborative multidisciplinary efforts blending basic and clinical science, formulating a combined appreciation of peripheral, spinal, and supratentorial phenomena, may lead to further advancements in the field of pain medicine. Our ability to determine which sensory afferents are activated and the duration and intensity of the activation, as well as to better objectively assess individual patients’: physiology (eg, altered circuitry, neurotransmitter changes, and neuronal phenotypic changes) will hopefully lead to specifically tailored patient therapeutic options that will optimize patient care. There does not seem to be one final common pathway of pain; rather signals can be modulated or relayed to the brain at many levels of neural transmission.Apparently a multitude of changes occur in the periphery, spinal cord, brain stem, and brain of patients with chronic pain.Altered brain activity and perceptions that may be crucial to various chronic pain states are only beginning to be appreciated.