Show Summary Details
Page of

Central Nervous System Modulation of Pain: Neurophysiological and Clinical Evidence 

Central Nervous System Modulation of Pain: Neurophysiological and Clinical Evidence
Chapter:
Central Nervous System Modulation of Pain: Neurophysiological and Clinical Evidence
Author(s):

Kenneth L. Casey

DOI:
10.1093/med/9780190880231.003.0009
Page of

PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2021. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

date: 23 April 2021

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.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.