NEUROPATHIC PAIN: POSSIBLE STRATEGIES FOR PATHOPHYSIOLOGY AND MANAGEMENT

Abstract

Pain is an unpleasant sensation that has both physical and emotional components. The physical part of pain results from nerve stimulation. Pain is mediated by specific nerve fibers that carry the pain impulses to the brain where their conscious appreciation may be modified by many factors. Neuropathic pain results from damage to or dysfunction of the peripheral or central nervous system, rather than stimulation of pain receptors. Chronic pain results from injury to the nervous system. The injury can be to the central nervous system or the peripheral nervous system. There are various factors (chemical excitation of nonnociceptors, recruitment of nerve outside of site of injury, excitotonicity, sodium channel, ectopic discharge, central sensitization and sympathic over stimulation) involve in the pathophysiology of neuropathic pain. In recent years, it is increasingly recognized that non-neuronal cells such as immune cells (macrophages, lymphocytes) and glial cells in the PNS (schwann cells and satellite cells) and in CNS (astrocytes and microglia) also play a critical role in chronic pain processing. Symptoms of neuropathic pain are mainly associated with numbness, burning, tingling, dysesthesia, hypergesia, allodynia. The concomitant symptoms are includes disturbance of sleep, mood, sex life and recreation. One of the more invasive but effective treatments for chronic neuropathic pain is neurostimulation. The treatment is based on creating paresthesias due to electrical stimulation in the affected and painful area