Woolf CJ, Max MB: Mechanism-based pain diagnosis: Issues for analgesic drug development

Harvard University, Cambridge, Massachusetts, United States
Anesthesiology (Impact Factor: 5.88). 08/2001; 95(1):241-9. DOI: 10.1097/00000542-200107000-00034
Source: PubMed
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    • "Clinical pain management should be based on a relational classification system of pain [16]. Recent studies suggest that QST may be useful in differential diagnosis , including detection of hypersensitivity and other pathogenesis of pain [4] [5] [7] [17]. "
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    ABSTRACT: Accurate assessment of pain or sensory function in clinical practice is challenging. Quantitative Sensory Testing (QST) is a standardized approach to measuring pain and sensory thresholds or tolerances as a means of assessing the functionality of neural pathways from the receptors along the afferent fibers to the brains. This paper reviews two simple QST techniques potentially useful to clinical practice: the Cold Stress Test and Ten Test. The background, evidence for clinical measurement properties and feasibility issues are considered. Keywords Quantitative evaluation, sensory test, pain, sensation, threshold
    Physiotherapy Practice and Research 03/2014; 35(1):33-40. DOI:10.3233/PPR-130030
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    • "Finding better preclinical testing methods is critical for more effective development of novel analgesics. Until now, the track record of rational drug development in the field of analgesics [5] has not been very convincing. Most of the new analgesics have originally been developed for other indications, and it has been argued that none of the analgesic drugs in clinical use at present is a result of a truly rational development program. "

    Scandinavian Journal of Pain 10/2013; 4(4):224–225. DOI:10.1016/j.sjpain.2013.07.025
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    • "Peripheral nerve injury may result in neuropathic pain which is characterized by severe persistent pain in the areas innervated by the injured nerve [1], [2], [3], [4], [5]. Following orofacial surgical treatment such as third molar tooth extraction, dental pulpectomy or dental implantation, neuropathic pain sometimes occurs in the orofacial region and is difficult to diagnose and treat, and its underlying mechanisms are unclear [6], [7], [8], [9], [10], [11]. "
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    ABSTRACT: To evaluate the involvement of the mitogen-activated protein kinase (MAPK) cascade in orofacial neuropathic pain mechanisms, this study assessed nocifensive behavior evoked by mechanical or thermal stimulation of the whisker pad skin, phosphorylation of extracellular signal-regulated kinase (ERK) in trigeminal spinal subnucleus caudalis (Vc) neurons, and Vc neuronal responses to mechanical or thermal stimulation of the whisker pad skin in rats with the chronic constriction nerve injury of the infraorbital nerve (ION-CCI). The mechanical and thermal nocifensive behavior was significantly enhanced on the side ipsilateral to the ION-CCI compared to the contralateral whisker pad or sham rats. ION-CCI rats had an increased number of phosphorylated ERK immunoreactive (pERK-IR) cells which also manifested NeuN-IR but not GFAP-IR and Iba1-IR, and were significantly more in ION-CCI rats compared with sham rats following noxious but not non-noxious mechanical stimulation. After intrathecal administration of the MEK1 inhibitor PD98059 in ION-CCI rats, the number of pERK-IR cells after noxious stimulation and the enhanced thermal nocifensive behavior but not the mechanical nocifensive behavior were significantly reduced in ION-CCI rats. The enhanced background activities, afterdischarges and responses of wide dynamic range neurons to noxious mechanical and thermal stimulation in ION-CCI rats were significantly depressed following i.t. administration of PD98059, whereas responses to non-noxious mechanical and thermal stimulation were not altered. The present findings suggest that pERK-IR neurons in the Vc play a pivotal role in the development of thermal hypersensitivity in the face following trigeminal nerve injury.
    PLoS ONE 02/2013; 8(2):e57278. DOI:10.1371/journal.pone.0057278 · 3.23 Impact Factor
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