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      Mechanisms of bone pain: Progress in research from bench to bedside

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          Abstract

          The field of research on pain originating from various bone diseases is expanding rapidly, with new mechanisms and targets asserting both peripheral and central sites of action. The scope of research is broadening from bone biology to neuroscience, neuroendocrinology, and immunology. In particular, the roles of primary sensory neurons and non-neuronal cells in the peripheral tissues as important targets for bone pain treatment are under extensive investigation in both pre-clinical and clinical settings. An understanding of the peripheral mechanisms underlying pain conditions associated with various bone diseases will aid in the appropriate application and development of optimal strategies for not only managing bone pain symptoms but also improving bone repairing and remodeling, which potentially cures the underlying etiology for long-term functional recovery. In this review, we focus on advances in important preclinical studies of significant bone pain conditions in the past 5 years that indicated new peripheral neuronal and non-neuronal mechanisms, novel targets for potential clinical interventions, and future directions of research.

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          Most cited references219

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          Osteoclast differentiation and activation.

          Osteoclasts are specialized cells derived from the monocyte/macrophage haematopoietic lineage that develop and adhere to bone matrix, then secrete acid and lytic enzymes that degrade it in a specialized, extracellular compartment. Discovery of the RANK signalling pathway in the osteoclast has provided insight into the mechanisms of osteoclastogenesis and activation of bone resorption, and how hormonal signals impact bone structure and mass. Further study of this pathway is providing the molecular basis for developing therapeutics to treat osteoporosis and other diseases of bone loss.
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            Neuropathic pain

            Neuropathic pain is caused by a lesion or disease of the somatosensory system, including peripheral fibres (Aβ, Aδ and C fibres) and central neurons, and affects 7-10% of the general population. Multiple causes of neuropathic pain have been described and its incidence is likely to increase owing to the ageing global population, increased incidence of diabetes mellitus and improved survival from cancer after chemotherapy. Indeed, imbalances between excitatory and inhibitory somatosensory signalling, alterations in ion channels and variability in the way that pain messages are modulated in the central nervous system all have been implicated in neuropathic pain. The burden of chronic neuropathic pain seems to be related to the complexity of neuropathic symptoms, poor outcomes and difficult treatment decisions. Importantly, quality of life is impaired in patients with neuropathic pain owing to increased drug prescriptions and visits to health care providers, as well as the morbidity from the pain itself and the inciting disease. Despite challenges, progress in the understanding of the pathophysiology of neuropathic pain is spurring the development of new diagnostic procedures and personalized interventions, which emphasize the need for a multidisciplinary approach to the management of neuropathic pain.
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              Unbiased classification of sensory neuron types by large-scale single-cell RNA sequencing.

              The primary sensory system requires the integrated function of multiple cell types, although its full complexity remains unclear. We used comprehensive transcriptome analysis of 622 single mouse neurons to classify them in an unbiased manner, independent of any a priori knowledge of sensory subtypes. Our results reveal eleven types: three distinct low-threshold mechanoreceptive neurons, two proprioceptive, and six principal types of thermosensitive, itch sensitive, type C low-threshold mechanosensitive and nociceptive neurons with markedly different molecular and operational properties. Confirming previously anticipated major neuronal types, our results also classify and provide markers for new, functionally distinct subtypes. For example, our results suggest that itching during inflammatory skin diseases such as atopic dermatitis is linked to a distinct itch-generating type. We demonstrate single-cell RNA-seq as an effective strategy for dissecting sensory responsive cells into distinct neuronal types. The resulting catalog illustrates the diversity of sensory types and the cellular complexity underlying somatic sensation.
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                Author and article information

                Contributors
                xcao11@jhmi.edu
                yguan1@jhmi.edu
                Journal
                Bone Res
                Bone Res
                Bone Research
                Nature Publishing Group UK (London )
                2095-4700
                2095-6231
                6 June 2022
                6 June 2022
                2022
                : 10
                : 44
                Affiliations
                [1 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Department of Orthopedics, Johns Hopkins University, , School of Medicine, ; Baltimore, MD 21205 USA
                [2 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, , School of Medicine, ; Baltimore, MD 21205 USA
                [3 ]GRID grid.430179.8, ISNI 0000 0004 0432 1012, Division of Pathology, , Sibley Memorial Hospital Washington, ; Washington, DC 20016 USA
                [4 ]GRID grid.24696.3f, ISNI 0000 0004 0369 153X, Department of Oncology, Beijing Luhe Hospital, , Capital Medical University, ; Beijing, 100149 China
                [5 ]GRID grid.24696.3f, ISNI 0000 0004 0369 153X, Department of Orthopedics, Beijing Luhe Hospital, , Capital Medical University, ; Beijing, 100149 China
                [6 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Department of Neurological Surgery, Johns Hopkins University, , School of Medicine, ; Baltimore, MD 21205 USA
                Author information
                http://orcid.org/0000-0001-7652-6226
                http://orcid.org/0000-0003-3505-5151
                http://orcid.org/0000-0003-1321-6655
                Article
                217
                10.1038/s41413-022-00217-w
                9170780
                35668080
                8be33295-cd2e-46c7-9a43-640b1b63034b
                © The Author(s) 2022

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 12 April 2022
                : 29 April 2022
                : 9 May 2022
                Categories
                Review Article
                Custom metadata
                © The Author(s) 2022

                pathogenesis,diseases
                pathogenesis, diseases

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