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Unfinished Business: A Sample 

Unfinished Business: A Sample
Chapter:
Unfinished Business: A Sample
Author(s):

Kenneth L. Casey

DOI:
10.1093/med/9780190880231.003.0012
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date: 20 September 2020

We still lack an ideal analgesic agent, one that would provide complete pain relief without addiction or other unwanted side effects, that has a controlled site and duration of action, and that is safe and easy to administer. Many other pain-related clinical, neuroscientific, and philosophical issues remain unresolved also. The cause of pain during tension-type and migraine headaches remains unknown, although some evidence suggests paroxysmal changes in central nervous system sensitivity to normally painless sensory input. Our concepts of the cerebral circuity that is necessary and sufficient for pain are challenged by case reports of preserved pain following extensive brain damage and by the experience of pain during surgical anesthesia. Our limited understanding of how pain is created impairs our ability to address ethical issues arising among patients without the capacity for conscious communication. Functional brain imaging studies of consciousness suggest that the critical pain circuitry emerges when dynamic connectivity is established among distinct upper brainstem and cortical sensory structures.

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