Neuropathic pain: An evolutionary hypothesis

Abstract

Background: Whereas nociceptive pain has a clear survival value, the evolutionary origins of neuropathic pain remains unexplained. Objectives: It is argued that neuropathic pain is an adaptation that has evolved to detect non-specific damage to the nervous system, and that it operates on the same principles of an analogous hypothesis that has been put forward to explain the evolutionary utility of motion sickness. Whereas motion sickness has been proposed to arise from an inappropriate activation of a system evolved to respond to incoherence between vestibular and visual reference frames as an indication of acute neurotoxicity, it is proposed that neuropathic pain arises from the activation of a system evolved to respond to incoherence between proprioceptive and motor outputs as an indication of nerve trauma. Results and conclusions: Evidence that supports this hypothesis is reviewed, followed by conclusions regarding consequences for pain theory and management. © 2012 Elsevier Ltd.