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The Etiology and Symptomatology of Spontaneous Pain

      Recent years have witnessed a large number of failed analgesic drug trials, and in the subsequent soul-searching, 2 potential (and likely mutually exclusive) explanations have gained traction: either that clinical trials are failing to show efficacy of actually effective compounds,
      • Dworkin R.H.
      • Turk D.C.
      • Peirce-Sandner S.
      • Burke L.B.
      • Farrar J.T.
      • Gilron I.
      • Jensen M.P.
      • Katz N.P.
      • Raja S.N.
      • Rappaport B.A.
      • Rowbotham M.C.
      • Backonja M.M.
      • Baron R.
      • Bellamy N.
      • Bhagwagar Z.
      • Costello A.
      • Cowan P.
      • Fang W.C.
      • Hertz S.
      • Jay G.W.
      • Junor R.
      • Kerns R.D.
      • Kerwin R.
      • Kopecky E.A.
      • Lissin D.
      • Malamut R.
      • Markman J.D.
      • McDermott M.P.
      • Munera C.
      • Porter L.
      • Rauschkolb C.
      • Rice A.S.
      • Sampaio C.
      • Skljarevski V.
      • Sommerville K.
      • Stacey B.R.
      • Steigerwald I.
      • Tobias J.
      • Trentacosti A.M.
      • Wasan A.D.
      • Wells G.A.
      • Williams J.
      • Witter J.
      • Ziegler D.
      Considerations for improving assay sensitivity in chronic pain clinical trials: IMMPACT recommendations.
      or that preclinical pain science's almost exclusive focus on reflexive withdrawal measures has failed to accurately model clinical pain, leading to the development of largely ineffective compounds.
      • Mogil J.S.
      • Crager S.E.
      What should we be measuring in behavioral studies of chronic pain in animals?.
      • Vierck C.J.
      • Hansson P.T.
      • Yezierski R.P.
      Clinical and pre-clinical pain assessment: Are we measuring the same thing?.
      A solution to the latter problem is to instead measure “spontaneous pain,” and a number of new methodologies to accomplish this have been recently developed or rediscovered.
      • King T.
      • Vera-Portocarrero L.
      • Gutierrez T.
      • Vanderah T.W.
      • Dussor G.
      • Lai J.
      • Fields H.L.
      • Porreca F.
      Unmasking the tonic-aversive state in neuropathic pain.
      • Langford D.L.
      • Bailey A.L.
      • Chanda M.L.
      • Clarke S.E.
      • Drummond T.E.
      • Echols S.
      • Glick S.
      • Ingrao J.
      • Klassen-Ross T.
      • LaCroix-Fralish M.L.
      • Matsumiya L.
      • Sorge R.E.
      • Sotocinal S.B.
      • Tabaka J.M.
      • Wong D.
      • van den Maagdenberg A.M.J.M.
      • Ferrari M.D.
      • Craig K.D.
      • Mogil J.S.
      Coding of facial expressions of pain in the laboratory mouse.
      In his Focus Article, my colleague Gary Bennett examines the concept of spontaneous pain, and advances the highly intriguing notion that what we call spontaneous pain might actually be temporally summated hypersensitivity (allodynia and hyperalgesia) from activities of daily life.
      • Bennett G.J.
      What is spontaneous pain and who has it?.
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      References

        • Baliki M.N.
        • Baria A.T.
        • Apkarian A.V.
        The cortical rhythms of chronic back pain.
        J Neurosci. 2011; 31: 13981-13990
        • Bennett G.J.
        What is spontaneous pain and who has it?.
        J Pain. 2012; 13: 921-929
        • Dworkin R.H.
        • Turk D.C.
        • Peirce-Sandner S.
        • Burke L.B.
        • Farrar J.T.
        • Gilron I.
        • Jensen M.P.
        • Katz N.P.
        • Raja S.N.
        • Rappaport B.A.
        • Rowbotham M.C.
        • Backonja M.M.
        • Baron R.
        • Bellamy N.
        • Bhagwagar Z.
        • Costello A.
        • Cowan P.
        • Fang W.C.
        • Hertz S.
        • Jay G.W.
        • Junor R.
        • Kerns R.D.
        • Kerwin R.
        • Kopecky E.A.
        • Lissin D.
        • Malamut R.
        • Markman J.D.
        • McDermott M.P.
        • Munera C.
        • Porter L.
        • Rauschkolb C.
        • Rice A.S.
        • Sampaio C.
        • Skljarevski V.
        • Sommerville K.
        • Stacey B.R.
        • Steigerwald I.
        • Tobias J.
        • Trentacosti A.M.
        • Wasan A.D.
        • Wells G.A.
        • Williams J.
        • Witter J.
        • Ziegler D.
        Considerations for improving assay sensitivity in chronic pain clinical trials: IMMPACT recommendations.
        Pain. 2012; 153: 1148-1158
        • King T.
        • Vera-Portocarrero L.
        • Gutierrez T.
        • Vanderah T.W.
        • Dussor G.
        • Lai J.
        • Fields H.L.
        • Porreca F.
        Unmasking the tonic-aversive state in neuropathic pain.
        Nat Neurosci. 2009; 12: 1361-1363
        • Langford D.L.
        • Bailey A.L.
        • Chanda M.L.
        • Clarke S.E.
        • Drummond T.E.
        • Echols S.
        • Glick S.
        • Ingrao J.
        • Klassen-Ross T.
        • LaCroix-Fralish M.L.
        • Matsumiya L.
        • Sorge R.E.
        • Sotocinal S.B.
        • Tabaka J.M.
        • Wong D.
        • van den Maagdenberg A.M.J.M.
        • Ferrari M.D.
        • Craig K.D.
        • Mogil J.S.
        Coding of facial expressions of pain in the laboratory mouse.
        Nat Meth. 2010; 7: 447-449
        • Maier C.
        • Baron R.
        • Tolle T.R.
        • Binder A.
        • Birbaumer N.
        • Birklein F.
        • Gierthmuhlen J.
        • Flor H.
        • Geber C.
        • Huge V.
        • Krumova E.K.
        • Landwehrmeyer G.B.
        • Magerl W.
        • Maihofner C.
        • Richter H.
        • Rolke R.
        • Scherens A.
        • Schwarz A.
        • Sommer C.
        • Tronnier V.
        • Uceyler N.
        • Valet M.
        • Wasner G.
        • Treede R- D.
        Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes.
        Pain. 2010; 150: 439-450
        • Mogil J.S.
        • Crager S.E.
        What should we be measuring in behavioral studies of chronic pain in animals?.
        Pain. 2004; 112: 12-15
        • Scholz J.
        • Mannion R.J.
        • Hord D.E.
        • Griffin R.S.
        • Rawal B.
        • Zheng H.
        • Scoffings D.
        • Phillips A.
        • Guo J.
        • Laing R.J.
        • Abdi S.
        • Decosterd I.
        • Woolf C.J.
        A novel tool for the assessment of pain: Validation in low back pain.
        PLoS Med. 2009; 6: e1000047
        • Vierck C.J.
        • Hansson P.T.
        • Yezierski R.P.
        Clinical and pre-clinical pain assessment: Are we measuring the same thing?.
        Pain. 2008; 135: 7-10

      Linked Article

      • What Is Spontaneous Pain and Who Has It?
        The Journal of PainVol. 13Issue 10
        • Preview
          Spontaneous pain is often discussed in the context of both chronic inflammatory and neuropathic pain conditions, and it has been suggested that spontaneous pain, rather than stimulus-evoked pain, may be the more significant clinical problem. The following issues are discussed here. First, it is suggested that the concept of spontaneous pain makes no sense when the pain is the result of an ongoing inflammatory reaction. Evidence is reviewed that indicates that spontaneous pain is present in patients with neuropathic pain, but perhaps only in a subset of such patients.
        • Full-Text
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      • Reply to Drs. Loeser and Mogil
        The Journal of PainVol. 13Issue 10
        • Preview
          I thank my colleagues for their remarks and I am pleased that we agree on the usefulness of reassessing our terminology and for the need for research into the question of the role of stimulus-evoked pain and its summation as potential contributors to the pain patient's experience of persistent daily pain.
        • Full-Text
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