Journal
CURRENT RHEUMATOLOGY REPORTS
Volume 21, Issue 5, Pages -Publisher
SPRINGER
DOI: 10.1007/s11926-019-0813-1
Keywords
Pain modulation; Brainstem; Persistent pain; Inflammation; Hypersensitivity
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Funding
- NIAAA NIH HHS [R01 AA025024] Funding Source: Medline
- NIDA NIH HHS [R01 DA042565] Funding Source: Medline
- NINDS NIH HHS [R37 NS098660] Funding Source: Medline
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Purpose of ReviewThe goal of the review was to highlight recent advances in our understanding of descending pain-modulating systems and how these contribute to persistent pain states, with an emphasis on the current state of knowledge around bottom-up (sensory) and top-down (higher structures mediating cognitive and emotional processing) influences on pain-modulating circuits.Recent FindingsThe connectivity, physiology, and function of these systems have been characterized extensively over the last 30years. The field is now beginning to ask how and when these systems are engaged to modulate pain. A recent focus is on the parabrachial complex, now recognized as the major relay of nociceptive information to pain-modulating circuits, and plasticity in this circuit and its connections to the RVM is marked in persistent inflammatory pain. Top-down influences from higher structures, including hypothalamus, amygdala, and medial prefrontal areas, are also considered.SummaryThe challenge will be to tease out mechanisms through which a particular behavioral context engages distinct circuits to enhance or suppress pain, and to understand how these mechanisms contribute to chronic pain.
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