Neuroplasticity and pain: Understanding the neurobiology to help our patients in pain

Chair: Elon Eisenberg, Israel

Speaker: Kristy Bannister, United Kingdom

A myriad of complex processes marry to drive pain perception in health and chronicity. Here a brief overview of the peripheral and central nervous system circuitry that drives the full pain experience is given, as the process of nociception is discussed. Through consideration of transduction, transmission, modulation and perception processes, one can begin to piece together the nervous system plasticity (adaptive and maladaptive) that governs specific chronic pain states.

In health following a noxious insult at the periphery for example, the transduced pain signal is transmitted to the dorsal horn of the spinal cord along primary afferent fibres with ensuing projections to the cortex (somatosensory and frontal) and limbic brain. Following, descending modulatory controls project to the dorsal horn of the spinal cord where they regulate spinal nociceptive processing and the final percept of pain. In total, the multi-dimensional nature of pain comprises sensory discriminative and affective motivational elements resulting in an individualised and unique experience.

The process of peripheral and central sensitization forms an integral part of the normal healing process but pain can persist leading to neuroadaptive alterations that cannot be sufficiently and/or successfully analgesically targeted. Here the context of dysfunctionality in terms of neuropathic pain is discussed by way of highlighting some of the underlying mechanisms that generate abnormal peripheral and central processing in a chronic pain state.

Q&A