The Role of Activity in Developing Pain Pathways

摘要

The postnatal period is a critical time in the development of spinal sensory systems. It is a time of structural and functional reorganization of sensory connections accompanied by marked changes in expression of molecules, receptors, and channels associated with sensory transmission (Alvares and Fitzgerald 1999; Fitzgerald and Jennings 1999). In addition, it is becoming increasingly evident that these postnatal events are dependent upon neural activity and that synaptic development requires defined patterns of afferent input (Ben-Ari 2002; Debski and Kline 2002; Fox 2002). Abnormal or excessive activity related to pain and injury in early life may therefore change the course of development and cause long-term changes in soma-tosensory and pain processing (Alvares et al. 2000; Anand 2000). Clinical studies suggest that early pain related to surgical and procedural interventions during intensive care management of premature neonates can have long-term consequences upon pain behavior and perception in later life (Porter et al. 1999; Grunau 2000). This chapter discusses clinical and laboratory evidence for these changes and outlines possible underlying mechanisms.