The Multiplicities of Pain – Etiologies, Pathways, Mechanisms, and Treatment Multiple types of pain etiologies
– Nociceptive, inflammatory/joint-related, non-inflammatory/non joint-related, neuropathic
Multiple pain pathways
– Multiple ascending and descending pain pathways (excitatory/inhibitory)
Multiple pathological pain mechanisms
– Peripheral nervous system input: peripheral sensitization, ectopic discharge – Central nervous system processing: central sensitization, structural reorganization, decreases inhibition
Multiple treatments
– Goal is to reduce excitability and/or increase inhibition – Multiple classes of medications can be used Woolf CJ. Ann Intern Med. 2004;140(6):441-451.