Table Of ContentPathophysiology of Pain Perception
PlenumSeriesin Rehabilitationand Health
SERIESEDITIORS
MichaelFeuerstein
UniformedServicesUniversity0/theHealthSciences(USUHS)
Bethesda,Maryland
and
AnthonyJ.Goreczny
ChathamCollege
Pittsburgh,Pennsylvania
PATHOPHYSIOLOGYOFPAIN PERCEPTION
Stefan Lautenbacher,RogcrFillingim
SOURCEBOOKOFREHABILITATIONANDMENTALHEALTHPRACTICE
DavidP.Moxley,JohnR.Finch
SOCIALRELATIONSANDCHRONICPAIN
RanjanRoy
ENABLINGENVIRONMENTS
EdwardSteinfeld, G.ScottDanford
or
SOURCEBOOK OCCUPATIONALREHABILITATION
PhyllisM.King
INTERACTIVESTAFFTRAINING
PatrickW.Corrigan,StanleyG.McCracken
HANDBOOKOFHEALTHANDREHABILITATIONPSYCHOLOGY
AnthonyJ.Goreczny
AContinuationOrderPlanisavailableforthisseries.Acontinuationorderwillbringdeliveryofeachnewvolume
immediatelyuponpublication.Volumesarebilledonlyuponactualshipment.Forfurtherinformationpleasecontact
thepublisher.
Pathophysiology of Pain
Perception
Editedby
Stefan Lautenbacher
UniversitJ of Bamberg
Bamberg, Germany
and
RogerB.Fillingim
University ofF lorida College of Dentistry and Cainesville VA Medical Center
Gainesville, Florida
Springer Science+Business Media, LLC
Library of Congress Cataloging-in-Publication Data
Patbophysiology of pain perception / edited by Stefan Lautenbacher and Roger B. Fillingim.
p. ; cm.-(Plenum series in rehabilitation and healtb)
Includes bibliograprucal references and index.
ISBN 978-1-4613-4780-4 ISBN 978-1-4419-9068-6 (eBook)
DOI 10.1007/978-1-4419-9068-6
1. Pain-Pathophysiology. 2. Pain perception. 1. Lautenbacher, Stefan, 1956--II. Fillingim,
Roger B., 1962-III. Series.
[DNLM: 1. Pain-physiopatbology. 2. Pain Threshold. WL 704 P297 2004J
RB127.P372oo4
616' .04 72-dc22
2003068656
ISBN 978-1-4613-4780-4
© 2004 by Springer Science+Business Media New York
Originally published by Kluwer Academic/Plenum Publishers, New York in 2004
Softcover reprint ofthe hardcover 1s t edition 2004
10 9 8 7 6 5 4 3 2 1
A CI.P. record for trus book is available from tbe Library of Congress.
Ali rights reserved
No part of this work may be reproduced, stored in a retrieval system, or transmitted in any form or by any means,
electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from tbe
Publisher, with tbe exception of any matetial supplied specifically for the purpose of being emered and executed on a
computer system, for exclusive use by tbe purchaser of tbe work.
Contributors
Lars Arendt-Nielsen, Center for Sensory-Motor Interaction,Aalbord University,Aalborg,
Denmark
David Bowsher, The Pain Research Institute, ClinicalSciences Centre, UniversityHospital
Aintree,Liverpool,UnitedKingdom
ChristinaR.Covelli,UniversityofFlorida,CollegeofMedicine,Gainesville,Florida
Roger B.Fillingim,UniversityofFlorida,CollegeofDentistryandGainesvilleVAMedical
Center,Gainesville,Florida
JoanneM. Gillespie,UniversityofWestern Onrario,London,Ontario,Canada
ThomasGraven-Nielsen,CenterforSensory-MotorInteraction,AalborgUniversity,Aalborg,
Denmark
EleniG. Hapidou,PainManagementCenter,Hamilton HealthSciences,Hamilton,Ontario,
Canada
EvaKosek,DepartmentofRehabiliationMedicine,KarolinskaHospital,Stockholm,Sweden
StefanLautenbacher,PhysiologicalPsychology,UniversityofBamberg,Bamberg,Germany
MadelonL. Peters,DepartmentMcdischeUniversityofMaastricht,Maastricht,Netherlands
AnkePielsticker,PsychosomaticHospital,Windach,Germany
Donald D. Price, Department of Oral and Maxillofacial Surgery,University of Florida,
Gainesville,Florida
Gary B. Rollman, Department of Psychology, University of Western Ontario, London,
Ontario,Canada
KarstenSchepelmann,DepartmentofNeurology,UniversityofMarburg,Marburg,Germany
JuliaSpernal,DepartmentofPsychiatry,UniversityofMarburg,Marburg,Germany
PeterSvensson,CenterforSensory-MotorInteraction,AalborgUniversity,Aalborg,Denmark
G.NicholasVerne, UniversityofFlorida,CollegeofMedicine,Gainesville,Florida
ManfredZimmermann,NeuroscienceandPainResearch Institute,Heidelberg,Germany
v
Preface
Readershaveaccess to legionsofbooksdealingwith themolecular,genetic,neurochemical,
neurophysiological,neuroanatomical,neuroradiologicaland psychologicalaspectsofpain as
wellaswith theclinicalapproaches to pain from various medicaldisciplines.Whythen isit
necessarytopublishabook on thepathophysiologyofpainperception?
Paincanresulteitherfromnoxiousevents due to lesions,injuries,diseases,etc.,or from
disturbancesinthesystemtransducing,transforming,and processingthepotentialpainsignal
or from an interaction of both. Under certain pathological conditions, the pain-processing
system, which includes both physiologicaland psychologicalcomponents,can produce the
experience ofpain in the absence ofanyperipheral noxiousevent.This book primarilyex
amines these pathologicalalterations in the pain-signalling system, and the authors provide
informationon thefunctioningofthepain-processingsystem undernormalandpathological
conditions.
The understanding of pain perception is essential for optimaldiagnosis and treatment
ofacuteand chronic pain.Considerable evidence nowindicates that alterationsin pain per
ception are characteristic ofmanyclinicalpain states.Whether disturbed pain perception is
atrulyetiologicalor onlyamaintaining factor-c-or even a mere epiphenomenon ofchronic
functional pain-isreviewedindetailbyL.Arendt-Nielsen,C.R.Covelli,R.B.Fillingim,].M.
Gillespie,T.Graven-Nielsen,E.Kosek,S.Lautenbacher,M.Peters,A.Pielsticker,DO. Price,
G.B.Rollman,P.Svensson andG.N.Verne for headache,backpain,fibromyalgia,myofascial
pain,temporomandibularpaindisorder,irritablebowelsyndromeandmenstrualcycle-related
paindisorders.
However,changesinthepainsystemandtheresultingalterations ofpainperception do
notnecessarilylead topain.Eventheoppositemayoccurinregionalorgeneralized formsof
hypoalgesia,whichmaypredisposeanindividualto frequentinjuriesandillnessesaswellasto
anengagement in hazardousbehaviours.Increased and decreased painsensitivitymayresult
from ahugenumberofpathologicalconditionsintheperipheralandcentralnervous system
reviewedby0.Bowsherand K.Schepelmannorfrom manypsychiatricdisordersscreenedby
S.Lautenbacherand].Spernalforthatpurpose.
Elevated blood pressure is almost inevitablyassociated with areduction ofpain sensi
tivity acutelyas part ofthe reaction to stress but also in its chronic form as hypertension.
A reduced painsensitivityresulting from thisor from otherpathophysiologicalmechanisms
is definitely a cardiovascular risk factor, e.g. in the form of "silent" myocardial infarcts.
vii
viii Preface
Figure1.TheideaofDescartes(1644)aboutthepathwayofpain.
Accordingly,cardiovascular diseases are ofinterest and considered for the present book by
R.B.Fillingim.
Whetherpregnantwomenarenaturallyprepared fortheachesofdeliverybyareduction
ofpain sensitivity,isan interesting question up to now not fullyanswered.The most recent
findingson thistopicarereported byE.Hapidou.
Pathophysiologicalchangesinthepainsystemandassociatedchangesinpainperception
cannot be understood unless the functioning ofthe pain system under normal conditions
is known. M. Zimmermann educates the reader regarding which structural and functional
componentsofthe painsystemhavetobe considered;i.e,what formsthephysiologicalbasis
ofpainperception.L.Arendt-NielsenandS.Lautenbacherfollowthistopicbyexplainingthe
psychophysicsofpainperceptionandthemethodsforassessmentofpainperception.Whereas
thesechaptersofthebookaremeanttopreparethereadertounderstand thecontributionsthat
follow,R.B.Fillingimtriestosummarizethepresent dataand thefuturevalueofQuantitative
SensoryTesting,whichistheexperimentalapproachmostfrequentlyusedfortheassessment
ofpainperception.
Weletthereaderdecidehowsubstantialthescientificprogressintheunderstandingofpain
perceptionpresentedherehasbecomecomparedtothedaysofDescartes,whowasamongthe
firsttoaddressthepainsysteminasystemicallyconceptualisedfashion(seeFigure1).Itishoped
thattheinformationpresentedinthisvolumewillproveusefulbothinsummarizingourcurrent
understandingofpainperception undernormalandpathologicalconditionsandinstimulating
additional researchthatmayultimatelyenhanceclinicalpainassessmentandtreatment.
Preface ix
REFERENCES
Descartes,R.(1644).L'homme.TranslatedI!JM.Foster,LeauresonthehistoryoJpl!]fiologydllringthe16th,17thand18thetntllry.
CambridgesUniversitypress.
Contents
1. BasicPhysiologyofPainPerception....................................................... 1
ManfredZimmerman
IntroductiontoNociception,Acuteand Chronic Pain 1
AnimalStudieson NociceptionandPain .............................................. 2
ThePeripheralNociceptiveSystem 4
TheCentralPainSystem 11
ThePhysiologyofNociceptiveProcessingintheCNS 16
References 23
2. AssessmentofPainPerception.... 25
LarsArendt-NielsenandStifanLautenbacher
Introduction ................................................................................ 25
ExperimentalMethodsforPainInduction 27
ExperimentalMethodsofPainAssessment ........................ 32
Summary 40
References 40
3. DisturbancesofPainPerceptionin PrimaryHeadache:Migraine,
Tension-type,and ClusterHeadaches...... 43
AnkePie/stickerandStifanLautenbacher
Introduction ................................................................................ 43
Epidemiology 44
Painand FunctionalImpairment ................ .. 45
PsychologicalAntecedents,CausesandSequels 45
MuscleTensionandVascularReactions ............................................... 46
xi
xii Contents
CentralFactors 47
DisturbanceofPainPerception 48
Summary 53
References 54
4. DisturbancesofPainPerceptioninChronicBackPain..................... 59
MadelonPeters
DescriptionoftheDisorder ............................................................. 59
Disturbances inPainPerception 61
Conclusions andImplications ........................................................... 71
References 72
5. DisturbancesofPainPerceptionin Fibromyalgia..................................... 77
EvaKosek
DescriptionoftheSyndrome 77
DisturbanceofPainPerception 80
ConcludingRemarks 87
References 89
6. DisturbancesofPainPerceptionin MyofascialPainSyndromeandother
MusculoskeletalPains........................................................................ 93
Lars.Arendt-Nielsen, ThomasGraven-Nielsen,andPeterSvensson
Introduction 93
DefinitionoflVIPS 94
General CharacteristicsofMPS 94
TriggerPointsinMPS 96
Referred PaininMusculoskeletalPainConditions................................... 97
HyperalgesiainMusculoskeletalPainConditions 99
Summary 101
References 102
7. DisturbancesofPainPerceptioninTemporomandibularPainSyndrome..... 107
GaryB.RollmanandJoanneM GiJJespie
Introduction .............................................................................. 107
Epidemiology 107
Classification 108
Contrasting Concepts ......................................................... 108
