0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Pain: Moving from Symptom Control toward Mechanism-Specific Pharmacologic Management

Clifford J. Woolf, MD
[+] Article and Author Information

From Neural Plasticity Research Group, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts.


Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Clifford J. Woolf, MD, Neural Plasticity Research Group, Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School, 149 13th Street, Room 4309, Charlestown, MA 02129; e-mail, cwoolf@partners.org.


Ann Intern Med. 2004;140(6):441-451. doi:10.7326/0003-4819-140-8-200404200-00010
Text Size: A A A

Pain can be essentially divided into 2 broad categories: adaptive and maladaptive. Adaptive pain contributes to survival by protecting the organism from injury or promoting healing when injury has occurred. Maladaptive pain, in contrast, is an expression of the pathologic operation of the nervous system; it is pain as disease.

Topics

pain

First Page Preview

View Large
First page PDF preview

Figures

Grahic Jump Location
Figure 2.
Contributions of primary sensory neurons to pain.

A. The peripheral terminal of a nociceptor sensory neuron. The different transducing receptor and ion channels that respond to thermal, mechanical, and chemical stimuli are shown. B.The mechanism of peripheral sensitization. Inflammatory mediators, such as prostaglandin E2 (PGE2), bradykinin (BK), and nerve growth factor (NGF), activate intracellular kinases in the peripheral terminal that phosphorylate transducer channels to reduce their threshold or sodium channels to increase excitability. C. Transcriptional changes in the dorsal root ganglion. Activity, growth factors, and inflammatory mediators act on sensory neurons to activate intracellular transduction cascades. These cascades control the transcription factors that modulate gene expression, leading to changes in the levels of receptors, ion channels, and other functional proteins. AA = archidonic acid; ASIC = acid-sensing ion channel; ATP = adenosine triphosphate; CaMKIV = camkinase IV; COX-2 = cyclooxygenase-2; ERK = extracellular signal-regulated kinase; EP = prostaglandin E receptor; JNK = jun kinase; mRNA = messenger RNA; PKA = protein kinase A; PKC = protein kinase C; TRP = transient receptor potential receptor.

Grahic Jump Location
Grahic Jump Location
Figure 3.
Contributions of spinal cord dorsal horn neurons to pain.

A. Nociceptive transmission. B. The acute phase of central sensitization. C. The late phase of central sensitization. Some alterations in gene expression are activity-driven and restricted, such as dynorphin, whereas others are widespread and produce diverse changes in function, such as induction of cyclooxygenase-2 (COX-2) in central neurons after peripheral inflammation. D. Disinhibition. AA = arachidonic acid; AMPA = α-amino-3-hydroxy-5-methyl-4-isoxazole propionate; EP = prostaglandin E receptor; IL-1β = interleukin-1β; NK1 = neurokinin 1; NMDA = -methyl- -aspartic acid; PGE2 = prostaglandin E2; TrkB = tyrosine kinase B2.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)