Spinal cord mechanisms of chronic pain and clinical implications.
Chronic pain is a prevalent and challenging problem for most medical practitioners. Because of the complex pathologic mechanisms involved in chronic pain, optimal treatment is still under development. The spinal cord is an important gateway for peripheral pain signals transmitted to the brain. In chronic pain states, painful stimuli trigger afferent fibers in the dorsal horn to release neuropeptides and neurotransmitters. These events induce multiple inflammatory and neuropathic processes in the spinal cord dorsal horn, and trigger modification and plasticity of local neural circuits. As a result, ongoing noxious signals to the brain are amplified and prolonged, a phenomenon known as central sensitization. In this review, the molecular events associated with central sensitization, as well as their clinical implications, are discussed.
Thomas Cheng
Hsinlin
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Department of Neurology, University of Michigan, 109 Zina Pitcher Place, 5015 BSRB, Ann Arbor, MI 48109, USA. chengt@umich.edu
D000344:Afferent Pathways / Q000503:physiopathology; D000818:Animals; D002908:Chronic Disease; D006801:Humans; D009437:Neuralgia / Q000503:physiopathology*; D013116:Spinal Cord / Q000503:physiopathology*
J Pharmacol Exp Ther. 1999 May;289(2):1048-53
10215686
Trends Mol Med. 2009 Aug;15(8):369-79
19665431
Brain Res Rev. 2009 Apr;60(1):135-48
19150373
J Neuropathol Exp Neurol. 2009 Nov;68(11):1229-43
19816194
Neuroscience. 2008 Aug 26;155(3):948-58
18621103
Trends Neurosci. 2007 Aug;30(8):407-16
17629578
J Neurosci. 2008 Nov 26;28(48):12775-87
19036970
Brain Behav Immun. 2010 May;24(4):569-76
20035858
Expert Opin Drug Saf. 2009 Jan;8(1):89-109
19236221
J Pharmacol Exp Ther. 2010 Feb;332(2):446-54
19923440
Anesth Analg. 2009 Apr;108(4):1311-9
19299805
Gene Ther. 2009 Apr;16(4):455-60
19242524
Exp Brain Res. 2002 Aug;145(4):448-56
12172656
Trends Neurosci. 2010 Jan;33(1):48-57
19914722
J Pain. 2009 Sep;10(9):895-926
19712899
J Chem Neuroanat. 1998 Dec;16(1):57-72
9924973
Neuron. 2005 Sep 15;47(6):787-93
16157274
Prog Neurobiol. 2003 Aug;70(5):387-407
14511698
J Comp Neurol. 1998 Apr 6;393(2):135-44
9548693
Mol Cell Neurosci. 2002 Dec;21(4):684-95
12504600
Exp Physiol. 2002 Mar;87(2):245-9
11856970
Mol Neurobiol. 2009 Dec;40(3):260-88
19876771
Pain. 2008 Aug 15;138(1):98-110
18158214
Pain Med. 2008 Mar;9(2):253-7
18298710
J Neurosci. 2005 Apr 13;25(15):3900-7
15829642
Anesthesiology. 2002 May;96(5):1053-61
11981142
J Neurosci. 2008 Jul 9;28(28):7084-90
18614677
Mol Cell Neurosci. 2001 Jun;17(6):1025-33
11414791
Pharmacol Ther. 1996;69(3):173-98
8783370
Trends Neurosci. 2002 Nov;25(11):578-88
12392933
Anesthesiology. 2010 Jan;112(1):138-43
20032703
Schmerz. 2003 Dec;17(6):437-40
14648317
Acta Neurol Belg. 2009 Dec;109(4):252-61
20120204
J Pharmacol Exp Ther. 2009 Sep;330(3):834-43
19515968
Anesthesiology. 2000 Feb;92(2):485-92
10691236
J Physiol. 2004 Oct 1;560(Pt 1):249-66
15284347
Curr Pain Headache Rep. 2009 Jun;13(3):208-14
19457281
J Biol Chem. 1992 Jul 5;267(19):13361-8
1320017
Curr Opin Neurobiol. 2005 Jun;15(3):282-8
15919192
Curr Pharm Des. 2007;13(15):1597-605
17504152
Clin J Pain. 2008 Feb;24(2):142-54
18209521
Spine (Phila Pa 1976). 2007 Mar 15;32(6):635-42
17413467
Brain Res Brain Res Rev. 2002 Oct;40(1-3):215-22
12589919
Pain. 2003 Sep;105(1-2):133-41
14499429
Pharmacol Ther. 2010 Apr;126(1):56-68
20117131
Curr Opin Pharmacol. 2007 Feb;7(1):39-47
17088105
Mediators Inflamm. 2009;2009:979258
19884985