Neuropathic Pain and Chronic Opioid Use

Ryan Mirchel, John R. Zuniga, and Gary F. Bouloux

Introduction

Neuropathic pain is defined as pain caused by a lesion of the somatosensory system [1]. The etiologic source located within the somatosensory system differentiates neuropathic pain from nociceptive pain, which by definition represents the processing of noxious stimuli by a functional nervous system [2]. A broad range of disease and injury can result in neuropathic pain and there are multiple classification schema ranging from anatomic to etiologic; none are as of yet universally accepted. Generally, neuropathic pain can be subdivided into four classes:

  • 1. Focal lesions of the peripheral nervous system
  • 2. Generalized lesions of the peripheral nervous system
  • 3. Lesions of the central nervous system
  • 4. Complex neuropathies [3]

Neuropathic pain can be further divided into two broad groups by history and symptoms experienced by the patient: stimulus-evoked and stimulus-independent. Stimulus-evoked pain is characterized by the clinical entities allodynia,

R. Mirchel, DDS, MD

Division Oral and Maxillofacial Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA

J.R. Zuniga, DMD, MS, PhD (*)

Departments of Surgery and Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

G.F. Bouloux, MD, DDS, MDSc, FRACDS(OMS), FACS

Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

© Springer International Publishing AG 2017

G.F. Bouloux (ed.), Complications of Temporomandibular Joint Surgery, DOI 10.1007/978-3-319-51241-9_7

hyperpathia, and hyperalgesia. Allodynia is a sensation of pain evoked by a stimulus which would normally not elicit pain. Hyperpathia represents an explosive response to a painful stimulus that temporally outlasts the stimulus on removal. Hyperalgesia is an increased pain response out of proportion to a stimulus which would in normal circumstances cause pain. Stimulus-independent neuropathic pain represents persistent or spontaneous pain unassociated with a causative factor. Stimulus-independent pain is often burning and lancinating and can represent involvement of the sympathetic nervous system [4].

 
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