Eur J Neurosci 2014[Feb]; 39 (3): 508-19 PMID24494689show ga
Disorders of the skeleton are one of the most common causes of chronic pain and long-term physical disability in the world. Chronic skeletal pain is caused by a remarkably diverse group of conditions including trauma-induced fracture, osteoarthritis, osteoporosis, low back pain, orthopedic procedures, celiac disease, sickle cell disease and bone cancer. While these disorders are diverse, what they share in common is that when chronic skeletal pain occurs in these disorders, there are currently few therapies that can fully control the pain without significant unwanted side effects. In this review we focus on recent advances in our knowledge concerning the unique population of primary afferent sensory nerve fibers that innervate the skeleton, the nociceptive and neuropathic mechanisms that are involved in driving skeletal pain, and the neurochemical and structural changes that can occur in sensory and sympathetic nerve fibers and the CNS in chronic skeletal pain. We also discuss therapies targeting nerve growth factor or sclerostin for treating skeletal pain. These therapies have provided unique insight into the factors that drive skeletal pain and the structural decline that occurs in the aging skeleton. We conclude by discussing how these advances have changed our understanding and potentially the therapeutic options for treating and/or preventing chronic pain in the injured, diseased and aged skeleton.GRAPHICAL ABSTRACT: Skeletal pain is common and frequently difficult to fully control. Recent data suggests that the skeleton is innervated by a restricted set of nociceptors and that many skeletal pains have both a nociceptive and a neuropathic component. Significant progress has been made in defining the mechanisms that drive skeletal pain and the factors that control skeletal remodeling. These insights have the potential to fundamentally transform our understanding and ability to prevent and/or treat skeletal pain due to injury, disease, and aging.
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Eur+J+Neurosci 2014 ; 39 (3): 508-19
