Pain mechanisms and management: A central perspective

Although pain is always intense and unpleasant, the capacity to experience this sensation is, under normal circumstances, fundamental to the preservat ion of bodily integrity. Clinically, however, after injury to peripheral ti ssue or directly to the nervous system, spontaneous and evoked pain manifes t that serve no physiologic function, cue crippling to patients, and are di fficult to treat. Here, we review the specific role of the dorsal horn of t he spinal cord in the mechanisms of nociceptive protective pain and the spi nal plasticity that occurs after nerve and tissue injury. This spinal neuro nal plasticity is shown to be a key contributor to pathologic pain hypersen sitivity. The potential for the molecular mechanisms responsible for the sp inal plasticity in revealing new targets for future treatment is also discu ssed.