Activation of nociceptors is not necessary to cause the sensation of pain. There are four main classes: • peripheral focal and multifocal nerve lesions • traumatic,
ischemic or
inflammatory • peripheral generalized
polyneuropathies • toxic,
metabolic,
hereditary or inflammatory •
CNS lesions •
stroke,
multiple sclerosis, spinal cord injury • complex neuropathic disorders •
complex regional pain syndromes [CRPSs] Irregular grouping of these channels in sites of the abnormal activity may be responsible for lowering the activation threshold, thus leading to
hyperactivity. This event is called 'windup' and relies on a
frequency greater or equal to 0.33
Hz of the stimulus. Windup is associated with
chronic pain and central sensitization. This minimum frequency was determined experimentally by comparing healthy patient
fMRI's when subjected to varying frequencies of heat pulses. The fMRI maps show common areas activated by the TSSP responses which include contralateral thalamus (THAL), S1, bilateral S2, anterior and posterior insula (INS), mid-anterior
cingulate cortex (ACC), and supplemental motor areas (SMA). TSSP events are also associated with other regions of the brain that process functions such as somatosensory processing, pain perception and modulation,
cognition, pre-motor activity in the cortex.
Treatment Currently, the availability of drugs proven to treat neuropathic pain is limited and varies widely from patient to patient. Many developed drugs have either been discovered by accident or by observation. Some past treatments include
opiates like
poppy extract, non-steroidal anti-inflammatory drugs like
salicylic acid, and local anesthetics like
cocaine. Other recent treatments consist of
antidepressants and
anticonvulsants, although no substantial research on the actual mechanism of these treatments has been performed. However, patients respond to these treatments differently, possibly because of gender differences or
genetic backgrounds. Therefore, researchers have come to realize that no one drug or one class of drugs will reduce all pain. Research is now focusing on the underlying mechanisms involved in pain perception and how it can go wrong in order to develop an appropriate drug for patients afflicted with neuropathic pain. ==Microneurography==