Pain in Neurological Disease
John W. Scadding, Nicholas A. Losseff in Clinical Neurology, 2011
Evoked, stimulus-dependent pains include allodynia, hyperalgesia and hyperpathia, to mechanical, thermal or chemical stimulation. Allodynia is pain resulting from a stimulus that does not normally provoke a painful sensation.Hyperalgesia is an increased response to a stimulus that is normally painful. In hyperalgesia, normally noxious stimuli are often associated with a lowering of the pain threshold, together with an exaggerated perception of pain. In clinical practice, the term ‘hyperalgesia’ tends to be loosely used to describe abnormally painful responses to stimuli that are normally not painful, so that strictly speaking, these fall into the category of allodynia rather than hyperalgesia.
Is Fibromyalgia a Central Pain State?
Robert M. Bennett in The Clinical Neurobiology of Fibromyalgia and Myofascial Pain, 2020
symptom-chronic multifocal pain-and one sign-generalized allodynia/ hyperalgesia (1). The patient who is diagnosed with FMS, however, is polysymptomatic. Besides pain there is fatigue, sleep disturbance, psychological distress, impaired muscle function, and symptoms that are usually regarded as stress-related. Fibromyalgia is an illness, a syndrome, that effects three systems that regulate our well being: the nociceptive system, the stress-regulating system, and the immune system. These systems interact with each other, making it difficult to determine which of them is primarily affected in an individual patient. Psychological factors, personality traits, and social circumstances play a role for the total clinical picture. Fibromyalgia is indeed a biopsychosocial syndrome. The biological part concerns mainly pain and allodynia/hyper-algesia as well as biological changes related to continuous physical and emotional stress. This article will deal only with pain and allodynia. Allodynia is pain elicited by normally nonpainful stimuli. Hyperalgesia is increased pain intensity and prolonged pain duration evoked by stimuli that normally are painful.
Herpes Zoster
Thomas T. Yoshikawa, Shobita Rajagopalan in Antibiotic Therapy for Geriatric Patients, 2005
The most common and feared complication of HZ is postherpetic neuralgia (PHN) (5). PHN is defined as pain 90-120 days after rash onset. The pathogenesis of PHN includes ectopic discharge from damaged peripheral, primary afferent nerves; decreased inhibition of neuronal activity in central structures; and central sensitization such that normal sensory input is amplified and perceived as painful. Older age is the most powerful predictor of PHN but greater acute pain severity, prodromal pain, and greater rash severity are also important risk factors. The patient with PHN may suffer from non-stimulus-evoked constant burning or aching pain, non-stimulus-evoked intermittent stabbing or shooting pain, and/or stimulus-evoked pain, the worst of which is allodynia. Allodynia is pain after a nonnoxious stimulus such that severe pain may be induced by the lightest touch of clothing or the wind. These subtypes of pain may produce disordered sleep, depression, anorexia, weight loss, chronic fatigue, and social isolation. Furthermore, PHN can impair basic and instrumental activities of daily living, depending on the severity and location of the pain.
Utility of lidocaine as a topical analgesic and improvements in patch delivery systems
Published in Postgraduate Medicine, 2020
Neuropathic pain (NP) is a pathological process in the peripheral or central nervous system (CNS) defined by International Association for the Study of Pain (IASP) as pain caused by a lesion or disease of the somatosensory nervous system [12]. While many NP conditions are initiated by damage to the peripheral nervous system, their chronicity appears to rely on maladaptive processes within the CNS. Neuronal hyperexcitability and central sensitization lead to altered pain processing so that pain occurs spontaneously, and responses to noxious and innocuous stimuli are pathologically amplified [13]. The resulting symptoms include allodynia (pain which results from a stimulus that normally would not induce pain) and hyperalgesia. Patients experience paroxysms of burning, shooting, electrical sensations, as well as painful and non-painful numbness [14]. Examples of NP include postherpetic neuralgia (PHN), diabetic peripheral neuropathy (DPN), carpal tunnel syndrome, complex regional pain syndrome, and post-traumatic/post-surgical pain [15]. Pharmacologic treatments options for NP include antidepressants, anticonvulsants, topical local anesthetics and opioids [16,17].
Andrographolide relieved pathological pain generated by spared nerve injury model in mice
Published in Pharmaceutical Biology, 2018
Huang-Chi Wang, Hsin-Sheng Tsay, Hui-Nung Shih, Yi-An Chen, Kai-Ming Chang, Dinesh Chandra Agrawal, Siendong Huang, Yi-Lo Lin, Meng-Jen Lee
Allodynia is a pain due to a stimulus (touch or temperature) which does not normally provoke pain. In the spinal cord, the allodynia could be triggered by an autocrine loop mediated by MAPK/nuclear factor kappa-B (NF-κB) pathway which is initiated by pro-inflammatory cytokines (Stellwagen et al. 2005). We used von Frey test to measure the mechanical allodynia behaviour in the spared nerve injury model. Glial fibrillary acidic protein (GFAP) is an astrocyte marker, and upregulation of Glial fibrillary acidic protein immunorectivity (GFAP IR) is an indication of astrocytic responses. Secretion of pro-inflammatory cytokines is a major regulator of central pain sensitization that is of the glial source (Watkins et al. 2001). The expression of pro-inflammatory cytokine, interleukin-1 (IL-1), as well as GFAP as markers for astrocytic activities was tested in the spinal cord to verify if the behaviour was associated with changes in glia activities. These tests examine whether Andro could alleviate allodynia behaviour and establish the correlation of this Andro action to central nervous system (CNS) inflammatory signalling pathways.
Factors determining the response to treatment in patients with vestibular migraine
Published in Neurological Research, 2022
Ayşın Kısabay Ak, Neşe Çelebisoy, Hüseyin Nezih Özdemir, Figen Gökçay, Gülsüm Saruhan Durmaz, Dilek Top Kartı, Hülya Ertaşoğlu Toydemir, Vildan Yayla, Ayşe İlksen Çolpak Işıkay, İrem Erkent, Pınar Özçelik, Gülden Akdal, Ceyla Ataç, Şebnem Bıçakcı, Eylem Ozaydın-Göksu, Feray Güleç Uyaroğlu
Cutaneous allodynia is a common feature accompanying migraine attacks characterized by pain perception in response to non-noxious stimuli to the normal skin. Its prevalence in migraine patients has been reported to change from 50–80% [34]. It reflects sensitization of second- and third-order trigeminovascular neurons, in the trigeminal nucleus caudalis, and predicts a poor response to attack treatment [35]. Female gender, high body mass index, long history of migraine, high frequency of attacks and comorbidity with depression and anxiety have been found to be associated with the presence of allodynia [36–39]. It is also accepted as a predictor of migraine chronification [40]. The mean age of our patients was 42.2 years, and the mean age at the onset of migraine attacks was 24.5 years. In addition to being female, long history of migraine in our patients seems to be associated with the development of cutaneous allodynia and cutaneous allodynia was related to reduced response to prophylactic treatment. Response to treatment was poor in our patients on amitriptyline and defining allodynia. However, again, comorbid anxiety/depression was an additional risk factor in these patients.
Related Knowledge Centers
- Complex Regional Pain Syndrome
- Hyperalgesia
- Postherpetic Neuralgia
- Sunburn
- Stem Cell
- Pain
- Stimulus
- Peripheral Neuropathy
- Fibromyalgia
- Migraine