Neuropathic pain: a maladaptive response of the nervous system to damage

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Annu Rev Neurosci. 2009;32:1-32.

Neuropathic pain: a maladaptive response of the nervous system to damage.

Costigan M, Scholz J, Woolf CJ.

Neural Plasticity Research Group, Department of Anesthesia and Critical Care,

Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

02129, USA.

Neuropathic pain is triggered by lesions to the somatosensory nervous system

that alter its structure and function so that pain occurs spontaneously and

responses to noxious and innocuous stimuli are pathologically amplified.

The pain is an expression of maladaptive plasticity within the nociceptive

system, a series of changes that constitute a neural disease state.

Multiple alterations distributed widely across the nervous system contribute to

complex pain phenotypes. These alterations include ectopic generation of action

potentials, facilitation and disinhibition of synaptic transmission, loss of

synaptic connectivity and formation of new synaptic circuits, and neuroimmune

interactions.

Although neural lesions are necessary, they are not sufficient to generate

neuropathic pain; genetic polymorphisms, gender, and age all influence the risk

of developing persistent pain.

Treatment needs to move from merely suppressing symptoms to a disease-modifying

strategy aimed at both preventing maladaptive plasticity and reducing intrinsic

risk.