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Central nociceptive pathways and descending modulation 

Central nociceptive pathways and descending modulation
Chapter:
Central nociceptive pathways and descending modulation
Author(s):

Maria Fitzgerald

DOI:
10.1093/med/9780199642656.003.0008
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date: 18 June 2019

Infants and children respond to noxious stimulation from birth, but these responses arise from neural activity at different levels of the central nervous system. Nociceptive activity at the level of the spinal cord or brainstem can produce reflex movements, autonomic and metabolic responses that may parallel pain, but cannot be equated with true pain experience. The key to pain experience lies in neural activation of central regions of the brain responsible for sensory discrimination and emotional responses. Thus higher centres in the brain allow noxious events to be discriminated from innocuous ones and create a sense of unpleasantness and threat. Laboratory and clinical studies are building up a picture of the functional connections in regions of the brain concerned with sensory and emotional aspects of pain at different stages of infant and child development. There is also increasing understanding of the maturation of endogenous control systems generated by the brain, which are likely to determine a child’s ability to cope with pain. Furthermore, evidence is increasing that excess noxious stimulation in early life can alter the course of development of both central nociceptive pathways and descending modulation of pain.

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