Neuropathic Pain
نویسنده
چکیده
What is Neuropathic Pain? A limited understanding of underlying pathophysiology, and recent changes in terminology have led to some confusion. The International Association for the Study of Pain (IASP) defines NP as "pains resulting from disease or damage of the peripheral or central nervous systems, and from dysfunction of the nervous system". Originally, NP was used to describe only pain related to peripheral neuropathies, and central pain (CP) to lesions of the central nervous system associated with pain. Neurogenic pain embraced all causes, both peripheral and central. The addition of a category of "dysfunction" in the definition of NP allows the inclusion of organic pain states which share the clinical features of NP, but which are not initiated by an identifiable lesion of any part of the nervous system. However, this is a contentious issue; some argue that the "dysfunctional" category should be excluded, on the grounds that there is no initiating neural injury. While it is true that including dysfunctional pain causes difficulties in recognising the limits of NP, exclusion of this important type of pain ignores the clinical reality of the existence of similar pain states, one provoked by neurological damage and the other by damage to non-neural tissues. Creation of a separately defined category of dysfunctional pain is acceptable, as long as it is recognised that there may be pathophysiological mechanisms common to both NP and dysfunctional pain. The debate continues, but from a practical point of view, the current approach to treatment is broadly similar for NP and dysfunctional pain. The most important of the dysfunctional pain states is John Scadding is consultant neurologist at the National Hospital for Neurology and Neurosurgery and Whittington Hospital, London, and Honorary Senior Lecturer at the Institute of Neurology. He is also Associate Dean at the Royal Society of Medicine. As a registrar he worked with PD Wall and PK Thomas, and this kindled a clinical and research interest in mechanisms and management of chronic neuropathic pain. Section Review Article
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