TY - CHAP M1 - Book, Section TI - Chapter 89. Mechanisms of Chronic Pain A1 - Wainger, Brian J. A1 - Brenner, Gary J. A2 - Longnecker, David E. A2 - Brown, David L. A2 - Newman, Mark F. A2 - Zapol, Warren M. PY - 2012 T2 - Anesthesiology, 2e AB - Understanding 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 is associated with an ongoing nociceptive stimulus and reflects minimal central modulation of the painful stimulus; inflammatory pain describes pain due to tissue inflammation; neuropathic pain results from injury of the peripheral or central nervous system; dysfunctional pain 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. SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/03/29 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=56657043 ER -