Transcriptional mechanisms underlying neuropathic pain: DREAM, transcription factors and future pain management?

Injury to peripheral nerves triggers a large-scale alteration in gene expression in sensory neurons as well as glial and immune cells. Neuropathic pain is believed to be the culmination of the plastic changes brought on by this 'genetic reprogramming'. However, an individual gene alteration may contribute to different processes induced by nerve injury, such as sensitization, regeneration or adaptation of endogenous analgesic mechanisms. Knowing which genes are altered in expression following nerve damage and perhaps, more importantly, understanding the transcription factors responsible for these changes, is a critical step toward more efficacious treatments for neuropathic pain. Recent genetic studies have revealed an important role for the novel transcriptional repressor, DREAM, in modulating acute and chronic pain and suggested the possibility of targeting this or other transcription factors for pain management in the future.