This chapter focuses on the neurogenic mechanism and neuropeptides in chronic pain. Neuropeptide-mediated cell signalling is complex, and its function is still unknown. Changes in neuropeptide synthesis and release are related to the pain symptoms that follow chronic inflammation and neuropathic injuries. The chapter discusses these specific features of neuropeptide containing afferent neurones and describes some the properties of sensory neurones. The chapter also discusses the neurogenic effects of the neurokinins that are localized in many afferents and that are most extensive studies. The effects of substance P exemplify the diversity of actions that have been described for sensory neuropeptides. In the spinal dorsal horn, substance P induces changes in excitability of afferent nerve terminals, spinal neurones, and glial cells; events associated with the propagation of nociceptive signals and the modulation of acute and chronic pain responses. It is clear that all features of afferent nerve function can be tempered by their chemical environment and involve dynamic interactions between afferent (and sympathetic) fibres and surrounding tissue. This affects neural excitability, but perhaps more significantly over the long term, there are changes in the peptide composition, concentration, and release.
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