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"Pain. Joints. Spine." 1 (21) 2016

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Innovative pain management in osteoarthritis

Authors: Hodinka L. - National Institute of Rheumatology and Physiotherapy, Budapest, Hungary

Categories: Rheumatology, Traumatology and orthopedics

Sections: Medical forums

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The article was published on p. 73


Mechanisms of nociception, central senzitization and central elaboration of chronic pain and the projection of pain in the central nervous system are reviewed. Mediators of pain perception with special respect to neuropeptides as Nerve Growth Factor (NGF) and Calcitonin-Gene-Related Peptide (CGRP) are evaluated as therapeutic targets and development of innovative interventions in pain management are discussed. Possibilities of modulation of pain perception by biological response modifying bioproteins, as monoclonal antibodies to NGF and CGRP and recent studies are presented.

Perception of chronic pain is projected in well defined areas of the brain where pain experience, emotions and behavioral patterns are coupled to the nociceptive input (insula, amygdala, hypothalamus and prefrontal cortex) and this complex result in chronic central pain. Descending modification is generated mostly in the anterior cingulate cortex and in the midbrain (cuneiform nucleus, periaqueductal grey material, dorsolateral pontine tegment and rostroventromedial medulla and results in pain behaviour. 
In osteoarthritis tissue injury evokes the nociceptive input for the central senzitization and antidrom neurogenic inflammation. Among small molecular neurotransmitters, NGF and CGRP neuropeptides play a crucial role in the maintenance of central pain. Painful effects of joint load and therapeutic interventions to modify pain sensation may be followed by functional MRI.
Blocking antibodies against neuropeptides specifically inhibit their neurological functions, mainly pain induction. However effective in pain management, NGF may accelerate necrotic processes in the target OA joints. 

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