Innovations In Clinical Neuroscience

MAY-JUN 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Innovations in CLINICAL NEUROSCIENCE [ V O L U M E 1 4 , N U M B E R 5 – 6 , M A Y – J U N E 2 0 1 7 ] 19 pleasurability might augment activity in m otor-related regions, irrespective of whether the skin was itchy or not. 36 Thus, while each of the above disorders present with different primary symptoms, they all share HSA. Imaging s tudies in each of the disorders have found functional abnormalities in overlapping and unique brain areas associated with sensory-related processing. 34–36 TREATMENT IMPLICATIONS A full review of the treatment for these chronic sensations is beyond the scope of this review; however, while each of the aforementioned sensations has sensory specific treatments, two classes of neuromodulatory medications have been shown to effectively treat the central processing aberrations that might occur in chronic pain, nausea, and pruritus symptoms: anticonvulsants and antidepressants. More specifically, those anticonvulsants selectively bind to the α2–δ subunit of neuronal voltage-gated calcium channels (i.e., gabapentin and pregabalin), resulting in inhibition of calcium currents, thus decreasing the excitatory transmitter release and spinal sensitization. 37 Additionally, those antidepressants that interfere in the neuronal reuptake of neurotransmitters such as serotonin and norepinephrine (i.e., tricyclic antidepressants, mirtazapine, duloxetine) result in recruitment of noradrenergic-descending pathways as well as the peripheral recruitment of noradrenaline from sympathetic fibers sprouting into dorsal root ganglia. There is evidence of definitive treatment successes in all three of these chronic sensory sensations with these classes of medications. 37–40 REFERENCES 1. Schrepf A, Harper DE, Williams DA, et al. Somatic awareness and tender points in a community sample. J Pain. 2016;0(0):170–176. doi:10.1016/j.jpain.2016.08.009. 2. 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