CONTROLLING PAIN: Understanding chronic pain

April 2004 
Volume 34  Number 4
Pages 22 - 23
  PDF Version Available!


  • Getting nervy

  • What goes up must come down

  • Mechanisms of sensitization



  • Figure. No caption a...

    QUESTION: What causes chronic pain, and why do some drugs work better than others for managing it?

    ANSWER: Unlike acute pain, which warns of actual or potential tissue damage, chronic pain serves no useful purpose. Pain scientists still aren't sure why chronic pain develops, but they do know that the longer pain stimuli act on the central nervous system (CNS), the more likely chronic pain is to develop.

    Early recognition and treatment of a patient's acute pain helps prevent sensitization of the CNS, which can lead to chronic pain. But if your patient is already experiencing chronic pain, focus your assessment and treatment on possible underlying causes of pain and symptom management. Research indicates that chronic pain is best treated using a multidisciplinary approach.

    To understand why and how certain drugs work for chronic pain, let's look at central sensitization, the mechanism by which acute pain turns chronic.

    Getting nervy

    When peripheral tissue is injured or inflamed, the intense, repeated, or prolonged stimuli lead to sensitization —a lowering of the threshold required to activate peripheral nerve fibers (see Mechanisms of Sensitization ). Once tissue is sensitized, even harmless stimuli can trigger pain sensations.

    Drugs such as nonsteroidal anti-inflammatory drugs inhibit cyclooxygenase and block prostaglandins, disrupting the inflammatory process. Local anesthetics block pain sensation by disrupting the transmission of pain signals in peripheral nerve fibers.

    Other drugs that ease chronic pain work by interrupting pain transmission at the dorsal root ganglia, where peripheral nerves originate. Peripheral nerve fibers enter the spinal cord ...

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