Peripheral injury triggers metabolic reprogramming in spinal oligodendrocytes that redirects lipids from myelin maintenance to neuroplastic remodeling, disrupting axonal integrity and driving neuronal β-amyloid production through a NAAA-dependent pathway that is both necessary and sufficient for the transition from acute to chronic pain.

Peripheral injury reprograms metabolism in spinal cord oligodendrocytes, initiating a molecular cascade that drives chronic pain via neuronal β-amyloid (Aβ) release. After injury, mouse spinal oligodendrocytes downregulate myelin protein synthesis and upregulate lipid biosynthesis—but reroute lipids toward neuroplastic remodeling and away from myelin maintenance. This metabolic reallocation disrupts myelin integrity and axonal function, causing neuronal accumulation of amyloid precursor protein, enhanced expression of its processing β-secretase BACE1, and local release of Aβ peptides. Blocking Aβ production or clearing Aβ deposits stops the transition to pain chronicity. Deleting the lysosomal lipid hydrolase NAAA in oligodendrocytes prevents both injury-induced Aβ production and chronic pain development. The findings identify an unexpected mechanistic link between chronic pain and Alzheimer’s-like neurodegeneration, positioning Aβ as a target for therapeutic intervention.