Transcript Document

NEUROPATHIC PAIN
Pain arising as a direct consequence of a lesion or disease
affecting the somatosensory system
Neuropathic pain
Pain usually results from activation of nociceptive
afferents by actually or potentially tissue damaging
stimuli. Pain may also arise by activity generated within
the nervous system without adequate stimulation of its
peripheral sensory endings. For this type of pain, the
IASP introduced the term neuropathic pain.
Treede et al. Neurology 2008
Kennedy et al 2007
IN PERIPHERAL PAINFUL NEUROPATHIES THE
CORRELATION BETWEEN SKIN INNERVATION
AND PAIN IS POOR
THE ROLE OF SKIN BIOPSIES IN THE DIAGNOSIS OF PERIPHERAL
PAINFUL NEUROPATHIES
C. Sommer, University of Wuerzburg, Wuerzburg, Germany.
(…) the correlation between measures of skin innervation and functional
data, including pain, is poor, such that additional factors must play a
role.
Some patients with severe burning pain of the extremities have reduced
skin innervation, which is normal in others.
Among the factors that may play a role are central sensory pathways,
local inflammatory cells and mediators, and further variables on the
patient side.
Fields 1987
PAINFUL NEUROPATHIES
Distal axonal damage
POSITIVE
BIOPSY
Death of sensory ganglion
neurons
Proximal axonal damage
NEGATIVE
BIOPSY
No axonal damage