Chronic neuropathic, 'phantom' pain comes from affected nerve and spinal cord, not brain

in, it's hard to treat. But if the impact is in the nerve, we have a better idea where to look and it's also easier to target therapy there."

Devor added that the Alberta team "didn't prove that the central nervous system isn't involved, but they have shown that the peripheral nerve probably is highly involved." Devor wrote an editorial in the Journal accompanying the Balasubramanyan et al. paper.

Paradoxes abound: role of inflammation, contrary reactions; Iraq casualties

"The subject gets complicated quickly and is full of paradoxes," Smith said: "For instance, in chronic pain there's often an emotional element. If a patient has post-traumatic stress syndrome, that could make the pain worse because there are overlapping disorders."

The war in Iraq has highlighted the issue of chronic neuropathic pain in amputations (called "phantom limb pain") because the rate of amputations is so high compared to previous wars.

Smith said that another "big issue in chronic pain is that two people can have more or less identical injuries, and one gets chronic pain, but the other doesn't. It may have to do with the immune system and inflammation," he said.

Another paradox, he pointed out, is that "most types of pain are associated with tissue damage and inflammation. Because neuropathic pain can go on for years after initial inflammation has subsided, it is defined as 'noninflammatory pain.' Although this definition is accurate, it may have clouded our thinking as to how neuropathic pain is initiated. Current research suggests that an initial transient inflammatory event may set the whole long term pain sequence into motion," he said.

Classic explanation found lacking, though spinal changes identified

In the current study, researchers constricted the sciatic nerve of young rats, then studied what changes had occurred in the substantia gelatinosa. This translucent area of the spinal cord is involved in t

Contact: Mayer Resnick
American Physiological Society

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