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About Pain Last Updated: Oct 6, 2009 - 12:07:30 PM

Dorsal Horn Sensitisation Pain Theory
By Steele
Feb 16, 2009 - 4:21:00 PM

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One of the main characteristics of central sensitization associated with postinjury pain and chronic pain is increased excitability of the dorsal horn neurons in the spinal cord

Two electrophysiological features associated with the origin and modulation of central sensitization are wind-up of action potential frequency and long-term potentiation (LTP), which have been demonstrated previously in the intact dorsal horn.

  • Within hours of an injury, changes take place in the dorsal horn of the spinal cord which alter the way that sensory impulses are processed. When these changes have occurred the dorsal horn is said to have become sensitised. This means that sensory and painful signals are more likely to be transmitted up the spinal cord to the brain, rather than being blocked at the dorsal horn level. Sensitisation is said to be dependant on N-methyl-D-aspartate (NMDA) receptor activation. NMDA receptor antagonists (blockers) like ketamine can help prevent sensitisation occurring.
  • Clinically dorsal horn sensitisation can be measured as changes in pain and sensory thresholds e.g. for temperature sensation the normal comfortable range of 4 - 60 deg C is reduced to 30 - 40 deg C in the area of skin supplied by the sensitised dorsal horn.
  • Sensory thresholds can be altered for all the sensory modalities including vibration, heat, cold, light touch.
  • Thresholds for pain can also be altered in two ways:-
    • A stimulus which was not painful before is now perceived as painful.
    • What would have produced a little pain, now causes a great deal of pain.
  • Normally after an injury dorsal horn sensitisation reduces in line with tissue healing. However, in some people the sensitisation seems to go on for much longer, and may explain why some go on to develop chronic pain. In some of these people there is a continuing focus of pain in the periphery which continues to keep the dorsal horn sensitised, and in others the exact cause is unknown.
  • There is also a connection between emotions and dorsal horn sensitisation. In severe anxiety and depression states, lack of descending inhibition is enough to maintain the dorsal horn in its sensitised state.
  • Chronic pain management techniques can therefore be divided into three broad areas:-
    • Reducing the magnitude of pain signals coming from the periphery by either blocking the nerves that carry the pain or by doing something to the tissue that is generating the painful signal e.g. steroid injections reducing peripheral tissue  inflammation.
    • Reducing the degree of dorsal horn sensitisation by using analgesic drugs, TENS, Acupuncture, and spinal manipulation.
    • Improving descending inhibition by examining patient beliefs, improving education, treating anxiety and depression, and by providing reassurance that there is nothing terrible going on

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