Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

A Study on Neuropathic Pain:Causes, Grading System, Mechanism-A Review


Affiliations
1 Department of Bio-Engineering, School of Engineering, Vels Institute of Science, Technology and Advanced Studies, India
     

   Subscribe/Renew Journal


Neuropathic pain, the type of pain condition which is caused by the specific nociceptors and is very different from the regular pain. The pain caused is highly intolerable to patients as the pain can be evoked by gentle touch, wind, clothes pressure and puts a great challenge to proceed with day to day activities. The treatments for the neuropathic pain reduces the production of neurotransmitters to some extent which be the cause of intolerable pain, but the faster disease progression is the main concern which can be sorted out by earlier prediction. The efficient grading system is required to differentiate the neuropathic pain condition and to initiate the treatment quickly after the onset of disease. The grading factors give the actual cause, location and the progression of pain. Understanding the mechanism behind the neuropathic pain is very important to carry out the drug formulation, effects of drugs, and distinguishing neuropathic pain from the regular induced pain. It is also required to initiate the treatment shortly after the onset of disease. Here, this review explains about the grading system of neuropathic pain, causes of pain, mechanism and the wide range of drugs involved in the treatment of neuropathic pain.

Keywords

Nociceptors, Neuropathic Pain, Neurotransmitters.
Subscription Login to verify subscription
User
Notifications
Font Size


  • Andersen G, Vestergaard K, Ingeman- Nielsen M, Jensen TS. Incidence of central post-stroke pain. Pain 1995; 61:187–193.
  • Amir R, Kocsis JD, Devor M. Multiple interacting sites of ectopic spike electrogenesis in primary sensory neurons. Journal of Neuroscience. 2005 Mar 9;25(10):2576-85.
  • Abbaszadeh A, Darabi S, Hasanvand A, Amini-Khoyi H, Abbasnezhad A, Choghakhori R, Aaliehpour A. Minocycline through attenuation of oxidative stress and inflammatory response reduces the neuropathic pain in a rat model of chronic constriction injury. Iranian Journal of Basic Medical Sciences. 2018 Feb 1;21(2):138-44.
  • Backonja MM, Galer BS. Pain assessment and evaluation of patients who have neuropathic pain. Neurologic clinics. 1998 Nov 1;16(4):775-89.
  • Backonja MM. Defining neuropathic pain. Anesthesia & Analgesia. 2003 Sep 1;97(3):785-90.
  • Backonja MM. Defining neuropathic pain. Anesthesia & Analgesia. 2003 Sep 1;97(3):785-90.
  • Bouhassira D, Attal N, Fermanian J, et al. Development and validation of the neuropathic pain symptom inventory. Pain 2004; 108:248–257.
  • Bostock H, Campero M, Serra J, Ochoa JL. Temperature-dependent double spikes in C-nociceptors of neuropathic pain patients. Brain. 2005 Jun 9;128(9):2154-63.
  • Bouhassira D, Attal N, Alchaar H, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 2005; 114:29–36.
  • Baron R. Mechanisms of disease: neuropathic pain—a clinical perspective. Nature Reviews Neurology. 2006 Feb;2(2):95.
  • Black JA, Nikolajsen L, Kroner K, Jensen TS, Waxman SG. Multiple sodium channel isoforms and mitogen‐activated protein kinases are present in painful human neuromas. Annals of neurology. 2008 Dec 1;64(6):644-53.
  • Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. The Lancet Neurology. 2010 Aug 1;9(8):807-19.
  • Cervero F, Laird JM. One pain or many pains?. Physiology. 1991 Dec 1;6(6):268-73.
  • Chen L, Huang LY. Protein kinase C reduces Mg2+ block of NMDA-receptor channels as a mechanism of modulation. Nature. 1992 Apr;356(6369):521.
  • Canavero S, Bonicalzi V. Lamotrigine control of central pain. Pain. 1996 Nov 1;68(1):179-81.
  • Carter GT, Galer BS. Advances in the management of neuropathic pain. Physical medicine and rehabilitation clinics of North America. 2001 May;12(2):447-59.
  • Cruccu G, Anand P, Attal N, Garcia‐Larrea L, Haanpää M, Jørum E, Serra J, Jensen TS. EFNS guidelines on neuropathic pain assessment. European journal of neurology. 2004 Mar 1;11(3):153-62.
  • Dray A. Agonists and antagonists of nociception. PROGRESS IN PAIN RESEARCH AND MANAGEMENT. 1997; 8:279-92.
  • Fields HL, Rowbotham M, Baron R. Postherpetic neuralgia: irritable nociceptors and deafferentation. Neurobiology of disease. 1998 Oct 1;5(4):209-27.
  • Dworkin RH. An overview of neuropathic pain: syndromes, symptoms, signs, and several mechanisms. The Clinical journal of pain. 2002 Nov 1;18(6):343-9.
  • Dworkin RH, Backonja M, Rowbotham MC, Allen RR, Argoff CR, Bennett GJ, Bushnell MC, Farrar JT, Galer BS, Haythornthwaite JA, Hewitt DJ. Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Archives of neurology. 2003 Nov 1;60(11):1524-34.
  • Dib-Hajj SD, Black JA, Waxman SG. Voltage-gated sodium channels: therapeutic targets for pain. Pain Medicine. 2009 Oct 1;10(7):1260-9.
  • Flor H, Elbert T, Knecht S, Wienbruch C, Pantev C, Birbaumers N, Larbig W, Taub E. Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature. 1995 Jun;375(6531):482.
  • Gracely RH, Lynch SA, Bennett GJ. Painful neuropathy: altered central processing maintained dynamically by peripheral input. Pain. 1992 Nov 1;51(2):175-94.
  • Gracely RH, Lynch SA, Bennett GJ. Painful neuropathy: altered central processing maintained dynamically by peripheral input. Pain. 1992 Nov 1;51(2):175-94.
  • Harati Y, Gooch C, Swenson M, Edelman S, Greene D, Raskin P, Donofrio P, Cornblath D, Sachdeo R, Siu CO, Kamin M. Double‐blind randomized trial of tramadol for the treatment of the pain of diabetic neuropathy. Neurology. 1998 Jun 1;50(6):1842-6.
  • Hansson PT, Lacerenza M, Marchettini P. Aspects of clinical and experimental neuropathic pain: the clinical perspective. Progress in Pain Research and Management. 2001; 21:1-8.
  • Hansson P. Neuropathic pain: clinical characteristics and diagnostic workup. European Journal of Pain. 2002 Jan 1;6(SA):47-50.
  • Hains BC, Waxman SG. Sodium channel expression and the molecular pathophysiology of pain after SCI. Progress in brain research. 2007 Jan 1; 161:195-203.
  • Jensen TS, Sindrup SH, Bach FW. Test the classification of pain: reply to Mitchell Max. Pain. 2002;96(3):407-8.
  • Jensen TS, Gottrup H. Assessment of neuropathic pain. In: Jensen TS, Wilson PR, Rice ASC, eds. Clinical pain management: chronic pain. London: Arnold,2003;113–124.
  • Kastrup J, Petersen P, Dejgård A, Angelo HR, Hilsted J. Intravenous lidocaine infusion—a new treatment of chronic painful diabetic neuropathy?. Pain. 1987 Jan 1;28(1):69-75.
  • Koltzenburg M, Torebjörk HE, Wahren LK. Nociceptor modulated central sensitization causes mechanical hyperalgesia in acute chemogenic and chronic neuropathic pain. Brain. 1994 Jun 1;117(3):579-91.
  • Krause SJ, Backonja MM. Development of a neuropathic pain questionnaire. The Clinical journal of pain. 2003 Sep 1;19(5):306-14.
  • Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgicaL pain: risk factors and prevention. Lancet 2006;367:1618–1625.
  • Lai J, Hunter JC, Porreca F. The role of voltage-gated sodium channels in neuropathic pain. Current opinion in neurobiology. 2003 Jun 1;13(3):291-7.
  • McLachlan EM, Jänig W, Devor M, Michaelis M. Peripheral nerve injury triggers noradrenergic sprouting within dorsal ischolar_main ganglia. Nature. 1993 Jun;363(6429):543.
  • Merskey H. Classification of chronic pain. Description of chronic pain syndromes and definitions of pain terms. 1994:1-213.
  • Mannion RJ, Doubell TP, Coggeshall RE, Woolf CJ. Collateral sprouting of uninjured primary afferent A-fibers into the superficial dorsal horn of the adult rat spinal cord after topical capsaicin treatment to the sciatic nerve. Journal of Neuroscience. 1996 Aug 15;16(16):5189-95.
  • Miki K, Fukuoka T, Tokunaga A, Noguchi K. Calcitonin gene-related peptide increase in the rat spinal dorsal horn and dorsal column nucleus following peripheral nerve injury: up-regulation in a subpopulation of primary afferent sensory neurons. Neuroscience. 1997 Nov 12;82(4):1243-52.
  • Moore KA, Kohno T, Karchewski LA, Scholz J, Baba H, Woolf CJ. Partial peripheral nerve injury promotes a selective loss of GABAergic inhibition in the superficial dorsal horn of the spinal cord. Journal of Neuroscience. 2002 Aug 1;22(15):6724-31.
  • Marchettini P. The burning case of neuropathic pain wording. Pain 2005;114: 313–314.
  • Nyström B, Hagbarth KE. Microelectrode recordings from transected nerves in amputees with phantom limb pain. Neuroscience letters. 1981 Dec 11;27(2):211-6.
  • Nelson KA, Park KM, Robinovitz E, Tsigos C, Max MB. High‐dose oral dextromethorphan versus placebo in painful diabetic neuropathy and postherpetic neuralgia. Neurology. 1997 May 1;48(5):1212-8.
  • Nelson KA, Park KM, Robinovitz E, Tsigos C, Max MB. High‐dose oral dextromethorphan versus placebo in painful diabetic neuropathy and postherpetic neuralgia. Neurology. 1997 May 1;48(5):1212-8.
  • Novakovic SD, Tzoumaka E, McGivern JG, Haraguchi M, Sangameswaran L, Gogas KR, Eglen RM, Hunter JC. Distribution of the tetrodotoxin-resistant sodium channel PN3 in rat sensory neurons in normal and neuropathic conditions. Journal of Neuroscience. 1998 Mar 15;18(6):2174-87.
  • Norrbrink C, Lundeberg T. Tramadol in neuropathic pain after spinal cord injury: a randomized, double-blind, placebo-controlled trial. The Clinical journal of pain. 2009 Mar 1;25(3):177-84.
  • Ochoa JL, Yarnitsky D. Mechanical hyperalgesias in neuropathic pain patients: dynamic and static subtypes. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society. 1993 May;33(5):465-72.
  • Ørstavik K, Namer B, Schmidt R, Schmelz M, Hilliges M, Weidner C, Carr RW, Handwerker H, Jørum E, Torebjörk HE. Abnormal function of C-fibers in patients with diabetic neuropathy. Journal of Neuroscience. 2006 Nov 1;26(44):11287-94.
  • O'Connor AB, Dworkin RH. Treatment of neuropathic pain: an overview of recent guidelines. The American journal of medicine. 2009 Oct 1;122(10):S22-32.
  • Ørstavik K, Jørum E. Microneurographic findings of relevance to pain in patients with erythromelalgia and patients with diabetic neuropathy. Neuroscience letters. 2010 Feb 19;470(3):180-4.
  • Petersen KL, Rice FL, Suess F, Berro M, Rowbotham MC. Relief of post-herpetic neuralgia by surgical removal of painful skin. Pain. 2002 Jul 1;98(1-2):119-26.
  • Rowbotham MC, Reisner-Keller LA, Fields HL. Both intravenous lidocaine and morphine reduce the pain of postherpetic neuralgia. Neurology. 1991 Jul 1;41(7):1024-.
  • Rowbotham MC, Petersen KL, Fields HL. Is postherpetic neuralgia more than one disorder?. InPain Forum 1998 Dec 1 (Vol. 7, No. 4, pp. 231-237). Churchill Livingstone.
  • Sugimoto T, Bennett GJ, Kajander KC. Transsynaptic degeneration in the superficial dorsal horn after sciatic nerve injury: effects of a chronic constriction injury, transection, and strychnine. Pain. 1990 Aug 1;42(2):205-13.
  • Sindrup SH, Jensen TS. Efficacy of pharmacological treatments of neuropathic pain: an update and effect related to mechanism of drug action. PAIN®. 1999 Dec 1;83(3):389-400.
  • Scholz J, Broom DC, Youn DH, Mills CD, Kohno T, Suter MR, Moore KA, Decosterd I, Coggeshall RE, Woolf CJ. Blocking caspase activity prevents transsynaptic neuronal apoptosis and the loss of inhibition in lamina II of the dorsal horn after peripheral nerve injury. Journal of Neuroscience. 2005 Aug 10;25(32):7317-23.
  • Sun Q, Tu H, Xing GG, Han JS, Wan Y. Ectopic discharges from injured nerve fibers are highly correlated with tactile allodynia only in early, but not late, stage in rats with spinal nerve ligation. Experimental neurology. 2005 Jan 1;191(1):128-36.
  • Siqueira SR, Alves B, Malpartida HM, Teixeira MJ, Siqueira JT. Abnormal expression of voltage-gated sodium channels Nav1. 7, Nav1. 3 and Nav1. 8 in trigeminal neuralgia. Neuroscience. 2009 Dec 1;164(2):573-7.
  • Treede RD, Davis KD, Campbell JN, Raja SN. The plasticity of cutaneous hyperalgesia during sympathetic ganglion blockade in patients with neuropathic pain. Brain. 1992 Apr 1;115(2):607-21.
  • Treede RD, Meyer RA, Raja SN, Campbell JN. Peripheral and central mechanisms of cutaneous hyperalgesia. Progress in neurobiology. 1992 Apr 1;38(4):397-421.
  • Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra J. Neuropathic pain redefinition and a grading system for clinical and research purposes. Neurology. 2008 Apr 29;70(18):1630-5.
  • Ultenius C, Linderoth B, Meyerson BA, Wallin J. Spinal NMDA receptor phosphorylation correlates with the presence of neuropathic signs following peripheral nerve injury in the rat. Neuroscience letters. 2006 May 15;399(1-2):85-90.
  • Woolf CJ. Evidence for a central component of post-injury pain hypersensitivity. Nature. 1983 Dec;306(5944):686.
  • Watson CP, Evans RJ. The postmastectomy pain syndrome and topical capsaicin: a randomized trial. Pain. 1992 Dec 1;51(3):375-9.
  • Woolf CJ, Shortland P, Coggeshall RE. Peripheral nerve injury triggers central sprouting of myelinated afferents. Nature. 1992 Jan;355(6355):75.
  • Woolf CJ, Mannion RJ. Neuropathic pain: aetiology, symptoms, mechanisms, and management. The lancet. 1999 Jun 5;353(9168):1959-64.
  • Woolf CJ, Doubell TP. The pathophysiology of chronic pain—increased sensitivity to low threshold Aβ-fibre inputs. Current opinion in neurobiology. 1994 Aug 1;4(4):525-34.
  • Wu G, Ringkamp M, Murinson BB, Pogatzki EM, Hartke TV, Weerahandi HM, Campbell JN, Griffin JW, Meyer RA. Degeneration of myelinated efferent fibers induces spontaneous activity in uninjured C-fiber afferents. Journal of Neuroscience. 2002 Sep 1;22(17):7746-53.
  • Willis Jr WD, Coggeshall RE. Sensory mechanisms of the spinal cord: Volume 1 primary afferent neurons and the spinal dorsal horn. Springer Science & Business Media; 2012 Dec 6.
  • Amanova E, Abassova G, Kaishibayeva G, Kovalchuk V. Quality of Life of Patients with Neurological Conditions and Neuropathic Pain. Research Journal of Pharmacy and Technology. 2018 Feb 1;11(2):504-8.
  • Purushothaman P, Sha AU, Vetrichelvan T. Formulation development and Evaluation of immediate and sustained release Bilayer Tablets Containing Amitriptyline HCl and Pregabalin for the treatment of Neuropathic Pain. Asian Journal of Pharmacy and Technology. 2017 Sep 27;7(3):127-36.
  • Devi SR, Venkatesan B. Effectiveness of foot reflexology on diabetic peripheral neuropathic pain among patients with diabetes. International Journal of Advances in Nursing Management. 2018 Jun 23;6(2):91-2.

Abstract Views: 402

PDF Views: 1




  • A Study on Neuropathic Pain:Causes, Grading System, Mechanism-A Review

Abstract Views: 402  |  PDF Views: 1

Authors

S. Akilashree
Department of Bio-Engineering, School of Engineering, Vels Institute of Science, Technology and Advanced Studies, India
P. Brindha Devi
Department of Bio-Engineering, School of Engineering, Vels Institute of Science, Technology and Advanced Studies, India

Abstract


Neuropathic pain, the type of pain condition which is caused by the specific nociceptors and is very different from the regular pain. The pain caused is highly intolerable to patients as the pain can be evoked by gentle touch, wind, clothes pressure and puts a great challenge to proceed with day to day activities. The treatments for the neuropathic pain reduces the production of neurotransmitters to some extent which be the cause of intolerable pain, but the faster disease progression is the main concern which can be sorted out by earlier prediction. The efficient grading system is required to differentiate the neuropathic pain condition and to initiate the treatment quickly after the onset of disease. The grading factors give the actual cause, location and the progression of pain. Understanding the mechanism behind the neuropathic pain is very important to carry out the drug formulation, effects of drugs, and distinguishing neuropathic pain from the regular induced pain. It is also required to initiate the treatment shortly after the onset of disease. Here, this review explains about the grading system of neuropathic pain, causes of pain, mechanism and the wide range of drugs involved in the treatment of neuropathic pain.

Keywords


Nociceptors, Neuropathic Pain, Neurotransmitters.

References