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Nociception—the ability to feel pain—is essential for an organism’s survival and overall well-being. Noxious stimuli such as piercing pain from a sharp object, heat from an open flame, or contact with corrosive chemicals are first detected by sensory receptors, called nociceptors, located on nerve endings. Nociceptors express ion channels that convert noxious stimuli into electrical signals. When these signals reach the brain via sensory neurons, they are perceived as pain.
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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Pain serves as a critical warning signal that alerts the body to potential or actual harm. When mechanical pressure on the skin is intense, such as from a sharp pinch, the sensation transitions from touch to pain. Similarly, extreme temperatures, like a hot pot handle, convert the sensation of heat into pain. Pain can also result from overstimulation of other senses, such as blinding light, loud noise, or the intense heat from habañero peppers. This ability to sense pain is essential for...
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Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
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Bones are dynamic organs that require a rich supply of oxygen and nutrients. Around 5% to 10% of the cardiac output supplies blood to the bones. A typical long bone has three main sources: the nutrient artery, the metaphyseal and epiphyseal arteries, and the periosteal arteries.
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Central neuropathic pain.

Jan Rosner1,2,3, Daniel C de Andrade4, Karen D Davis5,6

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Central neuropathic pain, often following brain or spinal cord injury, involves complex nervous system changes. Understanding these mechanisms is key to developing better treatments beyond current medications and therapies.

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Area of Science:

  • Neurology
  • Pain Medicine
  • Neuroscience

Background:

  • Central neuropathic pain (CNP) originates from damage to the central nervous system (CNS), including brain injury, spinal cord injury, stroke, and multiple sclerosis.
  • While incidence varies, central post-stroke pain is the most common form globally, with spinal cord injury patients facing the highest risk.
  • Pathophysiology is complex, involving maladaptive plasticity, neuronal hyperexcitability, and neuro-immune interactions within pain pathways.

Purpose of the Study:

  • To review the current understanding of central neuropathic pain mechanisms.
  • To outline current and potential therapeutic strategies for managing CNP.
  • To emphasize the role of clinical assessment and advanced techniques in CNP research and patient care.

Main Methods:

  • Literature review of existing research on CNP.
  • Analysis of current pharmacological and non-pharmacological treatment options.
  • Discussion of the role of neurophysiological and neuroimaging techniques.

Main Results:

  • CNP mechanisms involve intricate interactions within spinal and brain circuits, leading to neuronal hyperexcitability.
  • Antidepressants and gabapentinoids are first-line pharmacological treatments.
  • Non-pharmacological approaches include self-management, exercise, and neuromodulation.

Conclusions:

  • Modulating neuronal activity, neuro-immune interactions, and brain connectivity are promising therapeutic avenues.
  • Comprehensive clinical evaluation is crucial for CNP classification and patient stratification.
  • Neuroimaging and neurophysiology offer potential for mechanistic insights and predictive biomarkers for treatment response.