Chronic cough and pain: Janus faces in sensory neurobiology?

Pulm Pharmacol Ther. 2013 Oct;26(5):476-85. doi: 10.1016/j.pupt.2013.06.010. Epub 2013 Jul 4.


Both chronic cough and chronic pain are critical clinical issues in which a large number of patients remain unsatisfied with available treatments. These conditions have considerable effects on sufferers' quality of life, who often show co-morbidities such as anxiety and depression. There is therefore a pressing need to find new effective therapies. The basic neurobiological mechanisms and pathologies of these two conditions show substantial homologies. However, whilst chronic pain has received a great deal of attention over the last few decades, the same cannot be said for the neurological underpinnings of chronic cough. There is a substantial literature around mechanisms of chronic pain which is likely to be useful in advancing knowledge about the pathologies of chronic cough. Here we compare the basic pain and cough pathways, in addition to the clinical features and possible pathophysiologies of each; including mechanisms of peripheral and central sensitisation which may underlie symptoms such as hyperalgesia and allodynia, and hypertussitvity and allotussivity. Due to the substantial overlap that emerges, it is likely that therapies may be effective over both areas.

Keywords: 5-hydroxytryptamine (serotonin); 5HT; AC; ATP; Allodynia; Allotussivity; BDNF; BK; CGRP; CNS; Chronic cough; Chronic pain; DRG; GABA; GPCR; Hypersensitivity; IL; JAK; Janus kinase; LC; MAPK; N-Methyl-d-aspartate; NA; NGF; NK1; NMDA; PAG; PG; PI3K; PKA/C; PLC; RTK; RVM; SNP; Sensitisation; TNF; TRPA1; TRPV1; Trk; adenosine triphosphate; adenylate cyclase; bradykinin; brain-derived neurotrophic factor; calcitonin gene related peptide; central nervous system; dorsal root ganglion; fMRI; functional magnetic resonance imaging; g protein coupled receptor; gamma-aminobutyric acid; interleukin; locus coeruleus; mitogen-activated protein kinase; nTS; nerve growth factor; neurokinin 1; noradrenaline; nucleus tractus solitarius; periaquiductal gray; phosphoinositide 3-kinase; phospholipase C; prostaglandin; protein kinase A/C; receptor tyrosine kinase; rostroventral medulla; single nucleotide polymorphism; transient receptor potential ankyrin 1; transient receptor potential vanilloid 1; tumour necrosis factor; tyrosine kinase.

Publication types

  • Review

MeSH terms

  • Animals
  • Chronic Disease
  • Chronic Pain / physiopathology*
  • Chronic Pain / therapy
  • Cough / physiopathology*
  • Cough / therapy
  • Humans
  • Hyperalgesia / physiopathology
  • Hyperalgesia / therapy
  • Quality of Life