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

he processing of unpleasant sensations that can be perceived as painful. According to Devor, much has been made of the theory that neuropathic pain actually "imprints" changes in the spinal column that are responsible for the long-lived chronic pain.

What Balasubramanyan et al. found, however, didn't quite match what they, or others, might have expected. According to their discussion section: "Given the increase in the excitability of dorsal horn neurons that follows peripheral nerve injury in vivo, and the presence of mechanical hypersensitivity (heightened pain responses) in our experimental animals, the observed changes in the properties of substantia gelatinosa neurons at first seem relatively modest." For example, CCI [chronic constriction injury] did not promote the generation of spontaneous action potentials in substantia gelatinosa neurons.

They conclude that CCI indeed produced a certain level of bona fide "centralization" in that it "alters the intrinsic properties of the dorsal horn by exerting both pre- and postsynaptic effects on excitatory synaptic transmission and by attenuating inhibitory transmission." However, the "relative contribution of intrinsic, peripheral and descending mechanisms to nerve injury-induced 'central hypersensitivity' is yet to be determined."

New directions in treating pain

In addition to further studies designed to identify more precisely what changes occur in neuropathic and chronic pain scenarios, Smith said there is still much to be done in determining how to treat such pain, whatever the mechanisms.

For instance, it may be most appropriate to target the initial injury that precipitates the enduring neuropathic pain. In fact, this is already done by the use of pre-emptive anesthesia during surgery. The surgeon uses a local anesthetic to deaden the nerves as well as a general anesthetic to immobilize the patent for surgery. Such procedures should be encouraged, Smith said. Ano

Contact: Mayer Resnick
American Physiological Society

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