Chapter

Central Nervous System Modulation of Pain

Kenneth L. Casey

in Chasing Pain: The Search for a Neurobiological Mechanism

Published on behalf of Oxford University Press

Published in print February 2019 | ISBN: 9780190880231
Published online February 2019 | e-ISBN: 9780190880248 | DOI: https://dx.doi.org/10.1093/med/9780190880231.003.0009
Central Nervous System Modulation of Pain

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  • Pain Medicine
  • Anaesthetics
  • Surgery

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Recordings from individual neurons in awake, trained monkeys show that attention, predictability, and reward anticipation can modify directly the earliest responses of CNS neurons to input from nociceptive fibers. Additional neuronal recording, selective stimulation, and focal lesion studies reveal brainstem structures that mediate direct nociceptive inhibitory and facilitatory functions through opioid and nonopioid mechanisms. The extensive functional-anatomical distribution and overlap of nociceptively activated circuits in the brain and brainstem, as revealed in part by the analysis of human electrophysiological and clinical lesion studies, severely limits the clinical application of these direct, physical interventions. Pathological and therapeutic interference with nociceptive mechanisms at any level can impair normal, endogenous pain control mechanisms, alter the normal relationship between tissue damage and sensory nerve fiber activity, and produce chronic, exaggerated (neuropathic) pain. In vivo brain imaging is needed to identify these and related pain-modulating circuits in humans.

Chapter.  4755 words.  Illustrated.

Subjects: Pain Medicine ; Anaesthetics ; Surgery

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