RT Book, Section
A1 Wainger, Brian J.
A1 Brenner, Gary J.
A2 Longnecker, David E.
A2 Mackey, Sean C.
A2 Newman, Mark F.
A2 Sandberg, Warren S.
A2 Zapol, Warren M.
SR Print(0)
ID 1144136914
T1 Mechanisms of Chronic Pain
T2 Anesthesiology, 3e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071848817
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1144136914
RD 2024/04/19
AB KEY  POINTSUnderstanding  the  mechanisms  underlying  chronic  pain  requires  knowledge  of  the  neuroanatomy,  neurochemistry,  and  neurophysiology  of  nociception  and  central  pain  processing.Generation  of  pain  hypersensitivity  results  from  changes  in  the  function,  chemistry,  and  structure  of  both  the  peripheral  and  central  nervous  systems.Pain  can  be  categorized  into  the  following  broad  etiologic  groups:  nociceptive  pain,  which  is  associated  with  an  ongoing  nociceptive  stimulus  and  reflects  minimal  central  modulation  of  the  painful  stimulus;  inflammatory  pain,  which  describes  pain  due  to  tissue  inflammation;  neuropathic  pain,  which  results  from  injury  of  the  peripheral  or  central  nervous  system;  and  dysfunctional  pain,  which  refers  to  pain  due  to  abnormal  functioning  of  the  nervous  system,  despite  the  absence  of  an  identified  insult.Nociception  serves  a  protective  function  that  is  important  from  an  evolutionary  perspective.  However,  chronic  pain—especially  neuropathic  pain  and  dysfunctional  pain—do  not  serve  such  a  protective  role  and  result  instead  from  a  pathologic  condition  of  the  nervous  system.  In  these  circumstances,  chronic  pain  is  a  disease.As  an  injury  heals,  pain  can  dissipate  with  resolution  of  tissue  injury  and  inflammation;  alternatively,  pain  can  persist  and  become  independent  of  peripheral  stimulation.  The  independence  of  ongoing  stimulus  reflects  the  marked  pathologic  changes  that  persistent  pain  effects  on  the  nervous  system.Different  mechanisms  are  responsible  for  different  types  of  pain,  and  therefore  the  rational  and  successful  treatment  of  pain  requires  diagnostic  and  therapeutic  modalities  that  reflect  the  specific  molecular  mechanisms.