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Emerging Strategies for the Treatment of Neuropathic Pain

James N. Campbell, Allan I. Basbaum, André Dray, Ronald Dubner, Robert H. Dworkin, Christine N. Sang. IASP Press, 2006 hardbound, 512 pages, 32 figures, 12 tables. US $80.00 [IASP members – US $64.00] ISBN 0-931092-61-2

Maisonneuve-Rosemont Hospital, Montréal, Canada

This monograph represents the outcome of a novel think-thank conference involving researchers from the academic sector and industry leaders, and was written by pain researchers specialists

The conference was held in Scottsdale, Arizona and took place over a five-day period in April 2005. Materials from the lectures presented at the meeting form the background information for this text. Specialists were divided into four groups, and the topics reviewed by each group reflect four current themes for drug development: 1) peripheral nervous system targets; 2) central nervous system targets; 3) disease-specific targets; and 4) development of measurement tools and application of new technologies. The materials present both the current state of knowledge and clinical practice in each of these domains, as well as a blue print for what is expected in the future.

The monograph contains 23 chapters divided into four parts. The first chapter in part I reviews the peripheral nervous system and its mechanisms, as well the common terminology of neuropathic pain including spontaneous pain, allodynia, hyperalgesia and hyperpathia. Related disease processes, including their cellular and molecular mechanisms, are elucidated. The role of sodium and potassium channels, neurotrophic factors, molecular changes in injured and uninjured afferent nerve fibers and protein trafficking are discussed. Finally, the role and limitations of animal experimentation and human surrogate models are reviewed.

Chapter 2 is an excellent chapter dealing with peripheral nerve generators of neuropathic pain. The author emphasizes the difference between excitation and excitability in the interpretation of neuropathic pain. An important table in this section clearly summarizes pain processes, potential target processes, potential target receptors and examples of target molecules.

Receptors are identified as possible targets for treatment. The concept of sensitization is presented in chapter 3, while chapter 4 discusses the possible role of sensitized, but otherwise normal primary afferents, in the genesis of neuropathic pain.

The second part of the monograph reviews the possible contribution of higher structures such as the brain and spinal cord, and the modulatory effects of the descending pathways. The activation of the neuroimmune system and the role of opioids are also discussed. Part three explores the poorly understood but strong link between depression and neuropathic pain. Growth factors, the inflammatory system and infectious neuropathies are also reviewed. Finally, part four of the monograph discusses the limitations of available animal models in reflecting the emotional aspects of pain, and the need to create ethical human paradigms. Imaging tools and their limitations are also covered.

In conclusion, this book was written by scientists who are leaders in their respective fields of neuropathic pain. Readers are presented with the very latest knowledge on neuropathic pain in a contextual frame-work which integrates recent findings into a larger and meaningful clinical context.

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