Neuropathic Pain is chronic pain state caused by damage or disease affecting the nervous system. It may be divided into peripheral neuropathic pain, central neuropathic pain, or mixed (peripheral and central). Peripheral: After a peripheral nerve lesion, aberrant regeneration may occur. Neurons become unusually sensitive and develop spontaneously pathological activity, abnormal excitability, and heightened sensitivity to chemical, thermal and mechanical stimuli. This phenomenon is called "peripheral sensitization". Central: The dorsal horn cells give rise to the spinothalamic tract which constitutes the major ascending nociceptive pathway. With contentious activity in the peripheral nociceptors they develop increased responses to afferent impulses, including normally non harmful tactile stimuli. This phenomenon is called central sensitization. Central sensitization is an important mechanism of persistent neuropathic pain. Regarding PT role in Central and peripheral sensitization, manual therapy can produce central analgesic effects, through activation of descending anti-nociceptive pathways. which with repetition may results in long-term activation of descending anti-nociceptive pathways.
