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Pain mechanisms in neuropathy

J L Ochoa1

  • 1Good Samaritan Hospital and Medical Center, Portland, Oregon.

Current Opinion in Neurology
|October 1, 1994
PubMed
Summary

Current understanding of neuropathic pain is fragmented. This review prioritizes human studies to explore pain mechanisms and questions animal model extrapolations, emphasizing psychogenic pseudoneuropathy.

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Area of Science:

  • Neuroscience
  • Pain Medicine
  • Clinical Psychology

Background:

  • Current scientific opinion on neuropathic pain is characterized by significant division and lack of consensus.
  • Existing hypotheses and underlying mechanisms require a comprehensive summary and critical interpretation.

Purpose of the Study:

  • To summarize principal hypotheses regarding neuropathic pain.
  • To interpret the basic underlying mechanisms of neuropathic pain.
  • To critically evaluate the extrapolation of animal experimental data to human clinical reality.

Main Methods:

  • Prioritization of evidence from rigorous neurophysiological and psychophysical studies in human volunteers and patients.
  • Critical analysis of existing hypotheses and mechanisms.
  • Review of clinical prevalence and scientific appreciation of psychogenic pseudoneuropathy.

Main Results:

  • Highlights the questionable nature of excessive extrapolation from animal experiments to human clinical reality regarding "centralization" of neuropathic pain mechanisms.
  • Underscores the clinical prevalence and underappreciation of psychogenic pseudoneuropathy by basic scientists and the reflex sympathetic dystrophy establishment.

Conclusions:

  • The current understanding of neuropathic pain is chaotic and requires a more human-centric evidence base.
  • Mechanisms such as "centralization" need re-evaluation due to over-reliance on animal models.
  • Psychogenic pseudoneuropathy represents a significant, yet overlooked, clinical entity in pain research.

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