title: Pain Modulation and the Transition from Acute to Chronic Pain.
abstract: There is now increasing evidence that pathological pain states are at least in part driven by changes in the brain itself. Descending modulatory pathways are known to mediate top-down regulation of nociceptive processing, transmitting cortical and limbic influences to the dorsal horn. However, these modulatory pathways are also intimately intertwined with ascending transmission pathways through positive and negative feedback loops. Models of persistent pain that fail to include descending modulatory pathways are thus incomplete. Although teasing out individual links in a recurrent network is never straightforward, it is imperative that understanding of pain modulation be fully integrated into how we think about pain.
authors.affiliation: Dept. Neurological Surgery, Oregon Health & Science University, Portland, OR, 97239, USA. heinricm@ohsu.edu.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Heinricher
mesh_terms: D059787:Acute Pain / Q000150:complications / Q000503:physiopathology*; D000344:Afferent Pathways / Q000502:physiology; D000818:Animals; D059350:Chronic Pain / Q000209:etiology / Q000503:physiopathology*; D018450:Disease Progression; D004525:Efferent Pathways / Q000502:physiology; D025461:Feedback, Physiological; D006801:Humans; D008526:Medulla Oblongata / Q000503:physiopathology; D008959:Models, Neurological; D009473:Neuronal Plasticity; D059225:Nociception / Q000502:physiology*; D017288:Pain Threshold / Q000502:physiology; D010487:Periaqueductal Gray / Q000503:physiopathology; D066148:Spinal Cord Dorsal Horn / Q000503:physiopathology
keywords: Descending control; Feedback; Pain-modulation; Plasticity; Rostral ventromedial medulla