Neurogenic painful inflammation

Neurogenic inflammation results from the release of neuropeptides from peripheral nerve terminals. This secretion can be induced by two mechanisms: activation of afferent sensory nerves (e.g. by disease processes or experimentally by electrical stimulation) or activation of receptors expressed on peripheral nerve terminals. While the role of these mechanisms in the regulation of inflammation is well described, its significance for the generation of pain is much less clear and will be examined in this review.

Activation of two receptors on peripheral sensory neurons (i.e. transient receptor potential vanilloid-1 channel and proteinase activated receptor-2) has been shown to induce neurogenic inflammation. Interference with this activation can ameliorate pain, but it remains uncertain whether this effect is indeed mediated by blockage of neurogenic inflammation. Two human diseases (complex regional pain syndrome and migraine) are believed to result from aberrant neuronal activation. In complex regional pain syndrome, studies in human patients and in a recently established animal model do not support a role for neurogenic inflammation in pain. In migraine, antagonists to the receptor for calcitonin gene related peptide ameliorated headache and could be the first conclusive evidence for the role of neurogenic inflammation in the generation of pain. Lastly, spinal mechanisms also appear to regulate immune cell recruitment to a peripheral site and seem to interfere with antinociception.

While considerable experimental and clinical evidence supports the existence of neurogenic inflammation, it is less clear whether this process plays an important role in the generation of pain.