Descending Pain Modulation

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Nociceptive inputs are subjected to modulation by the descending pain modulatory systems prior to arrival at higher cortical centres. This well-characterised functional anatomical network regulates nociceptive processing, largely within the dorsal horn, to produce either facilitation (prono-ciceptive) or inhibition (antinociceptive) (Fig. 9) (53). The brain regions involved in this descending modulation include the frontal lobe, anterior cin-gulate cortex, insula, amygdala, hypothalamus, periaqueductal grey, nucleus cuneiformis, and rostral ventromedial medulla. Some components of this network overlap with the pain matrix as ascending pain stimuli are integrated with descending influences from the diencephalon and limbic fore-brain. Activation of this network occurs in various circumstances, for example, when concomitant changes in pain ratings are observed when subjects either attend to or are distracted from their pain. Sustained activation of pronociceptive components of this system is thought to play an important role in some states of chronic pain. Recognising the descending modulatory

Descending Pain Inhibitory System
Fig. 9. The descending pain modulatory system. NCF (nucleus cuneiformis); PAG (periaqueductal grey); DLPT (dorsolateral pontine tegmentum); ACC (anterior cingulate cortex). (Reprinted from Tracey and Mantyh (56), with kind permission from Elsevier.)

system in chronic pain states is likely to be important in future work and treatment developments.

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  • jorge
    Where is the location of the dorsolateral pontine nuclei?
    8 years ago

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