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Mechanisms of Disease: mechanism-based classification of neuropathic pain—a critical analysis

Nature Clinical Practice Neurology volume 2, pages 107–115 (2006)Cite this article

Abstract

Classification of neuropathic pain according to etiology or localization has clear limitations. The discovery of specific molecular and cellular events following experimental nerve injury has raised the possibility of classifying neuropathic pain on the basis of the underlying neurobiological mechanisms. Application of this approach in the clinic is problematic, however, owing to a lack of precise tools to assess symptoms and signs, and difficulties in correlating symptoms and signs with mechanisms. Development and validation of diagnostic methods to identify mechanisms, together with pharmacological agents that specifically target these mechanisms, seems to be the most logical and rational way of improving neuropathic pain treatment.

Key Points

  • Classification of neuropathic pain on the basis of disease or location has considerable shortcomings, and an approach based on disease mechanisms might provide a viable alternative

  • To develop an effective mechanism-based classification, we need to be able to relate symptoms and signs to mechanisms, and to identify specific treatments for specific mechanisms

  • One mechanism might give rise to different symptoms and signs; for example, upregulation of sodium channels in C-fibers increases fiber activity, resulting in burning pain, paroxysms and dynamic mechanical allodynia

  • Similarly, one symptom or sign can be caused by several initiating mechanisms; for example, cold allodynia can be attributed to different mechanisms in peripheral and central neuropathic pain

  • It is becoming clear that we have not yet obtained a viable mechanism-based classification for neuropathic pain, and more-rigorous studies are required to test this approach

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Figure 1: Cascade of events following peripheral and central nervous system lesion resulting in central sensitization.

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Authors and Affiliations

  1. Danish Pain Research Center,

    Nanna B Finnerup & Troels S Jensen

  2. Aarhus University Hospital, Aarhus, Denmark

    Nanna B Finnerup & Troels S Jensen

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  1. Nanna B Finnerup
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  2. Troels S Jensen
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Correspondence to Nanna B Finnerup.

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Finnerup, N., Jensen, T. Mechanisms of Disease: mechanism-based classification of neuropathic pain—a critical analysis. Nat Rev Neurol 2, 107–115 (2006). https://doi.org/10.1038/ncpneuro0118

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