Cellular and molecular insights into neuropathy-induced pain hypersensitivity for mechanism-based treatment approaches

Julie V. Berger, Liesbeth Knaepen, Sofie P. M. Janssen, Robby J. P. Jaken, Marco A. E. Marcus, Elbert A. J. Joosten, Ronald Deumens*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

64 Citations (Web of Science)

Abstract

Neuropathic pain is currently being treated by a range of therapeutic interventions that above all act to lower neuronal activity in the somatosensory system (e.g. using local anesthetics, calcium channel blockers, and opioids). The present review highlights novel and often still largely experimental treatment approaches based on insights into pathological mechanisms, which impact on the spinal nociceptive network, thereby opening the 'gate' to higher brain centers involved in the perception of pain. Cellular and molecular mechanisms such as ectopia, sensitization of nociceptors, phenotypic switching, structural plasticity, disinhibition, and neuroinflammation are discussed in relation to their involvement in pain hypersensitivity following either peripheral neuropathies or spinal cord injury. A mechanism-based treatment approach may prove to be successful in effective treatment of neuropathic pain, but requires more detailed insights into the persistence of cellular and molecular pain mechanisms which renders neuropathic pain unremitting. Subsequently, identification of the therapeutic window-of-opportunities for each specific intervention in the particular peripheral and/or central neuropathy is essential for successful clinical trials. Most of the cellular and molecular pain mechanisms described in the present review suggest pharmacological interference for neuropathic pain management. However, also more invasive treatment approaches belong to current and/or future options such as neuromodulatory interventions (including spinal cord stimulation) and cell or gene therapies, respectively.
Original languageEnglish
Pages (from-to)282-310
JournalBrain Research Reviews
Volume67
Issue number1-2
DOIs
Publication statusPublished - 24 Jun 2011

Keywords

  • Neuropathic pain
  • Chronic pain
  • Glia
  • Neuroplasticity
  • Mechanism
  • Nociceptive network
  • Sprouting
  • Inflammation
  • Microglia
  • Astrocyte
  • GABA
  • Disinhibition
  • Ectopic firing
  • PKC
  • Glutamate

Cite this