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Pain: Present and Future Considerations 

Pain: Present and Future Considerations
Pain: Present and Future Considerations
Pain: Dynamics and Complexities

Daniel M. Doleys


This final chapter will (a) consider the potential effect of an expanded view of pain upon its treatment, (b) revisit the impact of recent data upon the existing notion of a ‘pain matrix’, and (c) highlight some future explorations. Appreciating the patient and their pain as a complex-adaptive-system (CAS) also requires a treatment algorithm with flexibility. As a hypothetical construct the term ‘pain’ becomes a euphemism for a complex and dynamic interaction among a variety of symptoms including nociceptive, emotional, cognitive, and behavioral variable. A degree of uncertainty surrounds the manner in which the outcomes of pain therapies should be evaluated. Linear-based physiological methodologies may or may not be capable of detecting the essence of the experience. Challenges against the notion of a ‘pain matrix’ and the option of ‘neruonal matrix’ are outlined. The chronification of pain and the genetics, behavioral, neurochemical, physiological processing, and psychological/mood factors involved is receiving more attention. From a dynamic network perspective, chronification is viewed as the ‘dynamic interplay between anatomy and function as the brain progresses into persistent pain’. Relatively new areas of exploration includes endophenotypes, epigenetics and the search for a human connectome. Endophenotypes are measurable biological, behavioral or cognitive markers that are found more often in individuals with a disease than in the general population. Epigenetics refers to functionally relevant modifications to the genome that lead to stable and/or heritable changes in gene function without any concomitant DNA sequence changes. The human connectome is an effort to provide a detailed and complete map of the brain’s neurocircuitry.

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