[Pathophysiology of chronic pain. Classification of three subtypes of pain].
Service
de neurologie, hôpital Nord, CHU de Saint-Etienne, Inserm U1028,
CNRL-Lyon, 42277 Saint-Priest-en-Jarez Cedex, France.
roland.peyron@univ-st-etienne.fr
roland.peyron@univ-st-etienne.fr
Pain
is a physiological sensation which aim is to alert for an upcoming
danger that may threaten the individual.
This system includes peripheral nociceptors that initiate the
nociceptive message.
Then, the information is conveyed to the brain through the spinothalamic
tract that projects to the thalamus, insula, SII and other areas.
In clinical situations, a dysfunction of this nociceptive system
explains chronic pain
that can be simply classified into 3 subtypes according to
pathophysiological mechanisms.
Case 1: the nociceptive system is functioning normally, and provides
(appropriately) a pain message that informs the brain of a local
inflammation, or cancer, or infection...
This is the situation of chronic pain because of an excess of nociception.
Case 2: there is a (past or present) lesion of the nervous system that
induces a dysfunction in the pain system.
This is the neuropathic pain.
Case 3: between the two former cases, there is no evidence for a lesion in the nociceptive system, and there are no evidences for lesion at the peripheral level, but there are evidences of dysregulation(s). These are the cases of dysfunctional pain.
Case 3: between the two former cases, there is no evidence for a lesion in the nociceptive system, and there are no evidences for lesion at the peripheral level, but there are evidences of dysregulation(s). These are the cases of dysfunctional pain.
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