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Neuronal Plasticity: Increasing the Gain in Pain
Abstract
We describe those sensations that are unpleasant, intense, or distressing as painful. Pain is not homogeneous, however, and comprises three categories: physiological, inflammatory, and neuropathic pain. Multiple mechanisms contribute, each of which is subject to or an expression of neural plasticity-the capacity of neurons to change their function, chemical profile, or structure. Here, we develop a conceptual framework for the contribution of plasticity in primary sensory and dorsal horn neurons to the pathogenesis of pain, identifying distinct forms of plasticity, which we term activation, modulation, and modification, that by increasing gain, elicit pain hypersensitivity.
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“Sometimes, however, central neural processing can be 'modified' so that initially peripherally induced central sensitization becomes independent of peripheral sensitization”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Woolf and Salter, 2000
In the citing paper
“Central sensitization is initiated by peripheral sensitization (Fig. 1) and maintained by continued input to the CNS from sensitized sensory afferent fibers”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Woolf and Salter, 2000
In the citing paper
“Changes in activity of peripherally sensitized fibers, due to estradiol and sympathetic modulation in the rat model, can 'modulate' activity of centrally sensitized neurons to affect pain severity”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Woolf and Salter, 2000
In the citing paper
“Central pain sensitization (CPS) results from neuronal plasticity that involves structural and functional changes in the central nervous system (CNS).”
From Effectiveness of acceptance and commitment therapy in central pain sensitization syndromes: A systematic review (2021) · cites this paper as [1]
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“Many studies on the mechanisms underlying neuropathic pain have demonstrated extensive structural and molecular plasticity of the neurons in the pain pathway following nerve injury (Dray et al., 1994; Ho ¨kfelt et al., 1994; Zigmond et al., 1996; Woolf & Mannion, 1999; Woolf & Salter, 2000 ) including a peripheral axo…”
InfluentialEffect of oral gabapentin on postoperative epidural analgesia
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Wilson, K., Girdler, N. M., & Welbury, R. R. (2003) · British Journal of Anaesthesia · doi:10.1093/bja/aeg278 · Cited by 110
Cortright, D. N., Krause, J. E., & Broom, D. C. (2007) · Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease · doi:10.1016/j.bbadis.2007.03.003 · Cited by 111
Molliver, D. C., Cook, S. P., Carlsten, J. A., Wright, D. E., & McCleskey, E. W. (2002) · European Journal of Neuroscience · doi:10.1046/j.1460-9568.2002.02253.x · Cited by 110
Nociceptive Neuropeptide Increases and Periorbital Allodynia in a Model of Traumatic Brain Injury
Elliott, M. B., Oshinsky, M. L., Amenta, P. S., Awe, O. O., & Jallo, J. (2012) · Headache The Journal of Head and Face Pain · doi:10.1111/j.1526-4610.2012.02160.x · Cited by 110
“According to Woolf and Salter, longlasting alterations in the expression of transmitters, receptors, or ion channels may alter the normal response characteristics to innocuous stimuli, in turn eliciting allodynia.(13) Other post-traumatic disturbances such as sensitization of cortical sensory neurons, loss of inhibito…”
Analgesic Effects of a Single Preoperative Dose of Pregabalin after Laparoscopic Sleeve Gastrectomy
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“In the last few years, there have been great advances in the understanding of the physiopathological mechanisms that trigger the postoperative pain response, which has been redefined as incisional pain [1–3].”
BackgroundXiong, H.-Y., Hendrix, J., Schabrun, S. M., Wyns, A., Campenhout, J. V., Nijs, J., & Polli, A. (2024) · Biomolecules · doi:10.3390/biom14010071 · Cited by 119
“Consequently, pain stems from profound changes within the CNS, which not only amplifies responses to nociceptive inputs but also fails to suppress painful signals [56].”
BackgroundIdentification of MEK1 as a novel target for the treatment of neuropathic pain
Ciruela, A., Dixon, A. K., Bramwell, S., González, M. I., Pinnock, R. D., & Lee, K. (2003) · British Journal of Pharmacology · doi:10.1038/sj.bjp.0705103 · Cited by 109
“Much of the cellular plasticity related to the hyperalgesic state may ultimately be regulated by temporal and spatial alterations in gene expression (Woolf & Salter, 2000).”
BackgroundDeval, E., Salinas, M., Baron, A., Lingueglia, É., & Lazdunski, M. (2004) · Journal of Biological Chemistry · doi:10.1074/jbc.m313078200 · Cited by 109
Anticonvulsant and Antinociceptive Actions of Novel Adenosine Kinase Inhibitors
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Microglia and intractable chronic pain
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Lindsey, A. E., LoVerso, R. L., Tovar, C. A., Hill, C. E., Beattie, M. S., & Bresnahan, J. C. (2000) · Neurorehabilitation and neural repair · doi:10.1177/154596830001400405 · Cited by 108
Rahn, E. J., Karlsson, M. G., & Sweatt, J. D. (2013) · Neurobiology of Learning and Memory · doi:10.1016/j.nlm.2013.06.008 · Cited by 113
“The first, more rapid temporal phase is dependent upon phosphorylation primarily associated with glutamatergic receptors and ion channel properties (for review see Woolf and Salter, 2000).”
BackgroundLiu, T., & Ji, R. (2012) · Neuroscience Bulletin · doi:10.1007/s12264-012-1207-9 · Cited by 110
“Second, both peripheral sensitization of primary sensory neurons and central sensitization of spinal cord and other CNS neurons are implicated in pain and itch hypersensitivity in pathological conditions([54-57]).”
Ilfeld, B. M., Madison, S. J., Suresh, P., Sandhu, N. S., Kormylo, N. J., Malhotra, N., Loland, V. J., Wallace, M. S., Mascha, E. J., Xu, Z., et al. (2014) · Annals of Surgical Oncology · doi:10.1245/s10434-014-4248-7 · Cited by 110
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“The mGluRs regulate nociceptive processes at different levels of the nervous system and are critically involved in central sensitization which is associated with chronic pain [56].”
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Pain amplification—A perspective on the how, why, when, and where of central sensitization
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An overview of pathways encoding nociception.
Rodríguez‐Carballeira, M., Solans, R., Larrañaga, J. R., García-Hernández, F. J., Ríos-Fernández, R., Nieto, J., Solanich, X., Martínez‐Valle, F., Fonseca, E., Muñoz, F. J., et al. (2017) · PubMed · Cited by 107
Katz, J. D., Cohen, L. G., Schmid, R., Chan, V. W. S., & Wowk, A. (2003) · Anesthesiology · doi:10.1097/00000542-200306000-00023 · Cited by 107
“The neurophysiology underlying these effects has been well described and involves an N-methyl-D-aspartate–mediated increase in dorsal horn neuron activity that follows the corelease of neuropeptides and excitatory amino acids from C fiber primary afferent terminals during tissue damage and inflammation.(13,42) The res…”
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“the induction and maintenance of persistent pain [9,57].”
BackgroundPain and chronic pancreatitis: A complex interplay of multiple mechanisms
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Pain relief by gabapentin and pregabalin via supraspinal mechanisms after peripheral nerve injury
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Enteric glial cells: new players in gastrointestinal motility?
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Candidate Gene Studies of Human Pain Mechanisms
Belfer, I., Wu, T., Kingman, A., Krishnaraju, R. K., Goldman, D. A., Max, M. B., & Warltier, D. C. (2004) · Anesthesiology · doi:10.1097/00000542-200406000-00032 · Cited by 108
Metadata
- Authors
- Woolf, C. J., & Salter, M. W.
- Affiliations
- Harvard University (US)
- University of Toronto (CA)
- Corresponding author
- Woolf, Clifford J.
- Venue
- Science
- Published
- 2000-06-09
- Volume
- 288
- Issue
- 5472
- Pages
- 1765-1768
- ISSN
- 0036-8075 (ISSN-L)
- 1095-9203
- OpenAlex
- W2133316133
- Cited by
- 3,781
- References
- 76
- Citations by year
- 2026: 62 · 2025: 101 · 2024: 96 · 2023: 104 · 2022: 99 · 2021: 99 · 2020: 129 · 2019: 112 · 2018: 124 · 2017: 140 · 2016: 150 · 2015: 170 · 2014: 142 · 2013: 188 · 2012: 166
- FWCI
- 13.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Science (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neuropharmacology Research
- Keywords
- neuroplasticity, pain, hyperalgesia, primary sensory neurons, dorsal horn neurons, neuropathic pain, inflammatory pain, plasticity mechanisms, pain modulation
- MeSH terms
- Animals, Humans, Inflammation, Models, Neurological, Synaptic Transmission, Neuronal Plasticity, Neurons, Afferent, Nociceptors, Pain, Signal Transduction, Posterior Horn Cells, Peripheral Nerve Injuries
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