Acute pain management in dermatology : Mechanisms and pathways - 14/09/15

Doi : 10.1016/j.jaad.2015.03.061

Natalie M. Meeks, MD ^a, Jonathan S. Glass, MD, CDR MC USN ^b, Bryan T. Carroll, MD, PhD ^c,^⁎
^a Eastern Virginia Medical School, Norfolk, Virginia
^b Department of Dermatology, Naval Medical Center Portsmouth, Portsmouth, Virginia
^c Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia

^∗Correspondence to: Bryan T. Carroll, MD, PhD, Eastern Virginia Medical School, Department of Dermatology, 721 Fairfax Ave, Ste 200, Norfolk, VA 23507.

Abstract

The number of dermatologic surgical procedures performed is increasing each year. The pain associated with these procedures is a major concern for patients and its treatment is part of the increasing emphasis on outcomes and quality of clinical care. Better understanding of pain signaling and how commonly used analgesics function can help improve our surgical pain management. This is part I of a 2-part review that will highlight the anatomy of acute pain signaling from the skin to the central nervous system and the factors that influence the plasticity of the pathway. Having this foundation of knowledge is needed to enhance the clinical treatment of pain. Part II will provide an updated review of available treatments, with an emphasis on their appropriate use for postsurgical pain management.

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Key words : analgesic, anesthetic, chronic pain, hyperalgesia, pain, surgery, transduction

Abbreviations used : CNS, COX, GABA, NSAID, PAG, RVM, STT, TRP

Plan

Introduction

Overview of acute pain

Cutaneous transduction

Processing of pain signals at the spinal cord

Cortical transmission and perception

Descending pain regulation from the cortex

Sensitization of pain signaling

Overview of chronic pain

	Funding sources: None.
	Conflicts of interest: None declared.
	The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.
	Dr Glass is a military service member. This work was prepared as part of our official duties. Title 17 U.S.C. 105 provides that ‘Copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person's official duties.
	Date of release: October 2015
	Expiration date: October 2018