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Central Nervous System Modulation of Pain: Neurophysiological and Clinical Evidence 

Central Nervous System Modulation of Pain: Neurophysiological and Clinical Evidence
Central Nervous System Modulation of Pain: Neurophysiological and Clinical Evidence

Kenneth L. Casey

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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.

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