Pain wind-up

Pain wind-up is a phenomenon that occurs in the nervous system where the body's response to pain becomes progressively greater with each stimulus. This is due to the increased excitability of neurons in the spinal cord to the input from the peripheral nerves.

Mechanism

The mechanism of pain wind-up involves the activation of NMDA receptors on neurons in the spinal cord. These receptors are normally blocked by magnesium ions, but when a strong or repeated pain stimulus is applied, the magnesium block is removed and the NMDA receptors become activated. This leads to an influx of calcium ions into the neuron, which triggers a series of events that result in the neuron becoming more responsive to future pain stimuli.

Clinical significance

Pain wind-up is thought to play a role in the development of chronic pain conditions. It is believed that the increased excitability of neurons in the spinal cord can lead to a state of hyperalgesia, where a person experiences an increased sensitivity to pain. This can make it difficult to manage pain in conditions such as fibromyalgia, neuropathic pain, and migraine.

Treatment

Treatment strategies for pain wind-up focus on preventing the activation of NMDA receptors. This can be achieved through the use of medications such as ketamine and dextromethorphan, which are known to block NMDA receptors. Other treatments may involve physical therapy or cognitive behavioral therapy to help manage the psychological aspects of chronic pain.

See also

• Nociception
• Pain management
• Central sensitization

References

Pain wind-up Resources
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