Notícias

Home / Avanços recentes / Notícias

Tamanho da letra
Enviar por e-mail
Central Nervous System

Central Nervous System
Modulation of Spinal Pain:
Pain Sensitization and
Implications for Surgical Selection

David Tauben, MD
Minor and James Medical, PLLC
Seattle, WA

 

Abstract
Central nervous system models of chronic pain now provide many satisfactory explanations for the clinical challenges associated with spinal pain treatment. Recognizing that both nonoperative and surgical failures result in chronic pain conditions that are currently best categorized as neuropathic or central pain, this limited review attempts to demonstrate that newer, more complex and dynamic models of pain neurophysiology are relevant to understanding spine pain problems encountered in clinical practice. Thus, patient selection, particularly avoiding those likely to have unsuccessful outcomes, should be benefited by a deeper appreciation of how the nervous system can become abnormally sensitized, resulting in the pain disorders described clinically as neuropathic and central, where nerves act abnormally even in the absence of active peripheral tissue or nerve injury.

Why is it that technically well-performed spine surgery still fails to cure some patients’ low back pain? How come the targeted low back pain does not resolve after successful anatomic repair? Why are some injuries to the lumbar spine accompanied by abnormally extreme pain sensations, rather than an expected degree of pain commensurate to the degree of peripheral nerve and/or tissue injury?
The cause and resulting symptoms of spinal pain involve much more than just abnormal structural anatomy. Spinal pain results from a disorder of complex cellular, molecular and functional adaptations initiated at the injury site peripheral receptor—the nociceptor, triggering a stimulus that then ascends to the dorsal ganglion neuronal cell body and adjacent dorsal horn palisading interneurons, then on to brainstem medullary structures, finally projecting to widespread regions of the cortical and subcortical central nervous system. Recognition that these more complete system wide mechanisms are involved in patients’ pain sensations and experiences should influence clinical decision-making.
Neuropathic pain describes a painful condition ordinarily initiated by peripheral tissue or nerve injury, where such injury is no longer required to maintain acute or more importantly, chronic allodynia, hyperpathia and paresthesias. Central pain occurs when the abnormally behaving neurons are located within and usually throughout the central nervous system. Both disorders often coexist, and may represent different clinical manifestations of the same spectrum of abnormal neuronal behavior, just differing in their location within the nervous system. The mechanisms that can lead to the development of central nervous system sensitization are particularly relevant to understanding surgical problems often encountered during management of acute and chronic low back pain. Recognizing and treating central nervous system sensitization is a challenge now better understood by integrating recent research on peripheral tissue injury and nerve response to that injury, with newer models of abnormal central nervous system processing in chronic pain disorders.

David Tauben, MD
Minor and James Medical, PLLC
Seattle, WA
November/December, 2005

FONTE: Veja o artigo completo em SPINELINE: Novembro/Dezembro 2005

Rua Padre Rolim, 815, CLÍNICA VÉRTEBRA Medicina e Reabilitação da Coluna. Santa Efigênia - Belo Horizonte - CEP 30130-090
Telefax (31) 3222-7587 / (31) 3245 2122 / (31) 3347 4007 - secretaria@jeffersonleal.com.br - jefferson@jeffersonleal.com.br

Este site segue o Código de Conduta da Health On the Net Foundation

*As informações sobre saúde contidas neste site são fornecidas somente para fins educativos e não pretendem substituir, de forma alguma, as discussões estabelecidas entre o médico e o paciente. O objetivo das informações é fornecer um suplemento para aqueles que desejam compreender melhor sua doença. Antes de fazer qualquer tipo de tratamento, você deve sempre consultar seu médico. É importante que você saiba que os avanços da medicina ocorrem rapidamente e algumas informações descritas aqui podem ter sido já modificadas.