Book contents
- Frontmatter
- Contents
- Preface
- 1 Discovery of the anterolateral system and its role as a pain pathway
- 2 Organization of the central pain pathways
- 3 Physiology of cells of origin of spinal cord and brainstem projections
- 4 Physiology of supraspinal pain-related structures
- 5 Functional brain imaging of acute pain in healthy humans
- 6 Pain modulatory systems
- 7 Peripheral and central mechanisms and manifestations of chronic pain and sensitization
- 8 Functional imaging of chronic pain
- 9 Functional implications of spinal and forebrain procedures for the treatment of chronic pain
- Index
- References
6 - Pain modulatory systems
Published online by Cambridge University Press: 05 October 2010
- Frontmatter
- Contents
- Preface
- 1 Discovery of the anterolateral system and its role as a pain pathway
- 2 Organization of the central pain pathways
- 3 Physiology of cells of origin of spinal cord and brainstem projections
- 4 Physiology of supraspinal pain-related structures
- 5 Functional brain imaging of acute pain in healthy humans
- 6 Pain modulatory systems
- 7 Peripheral and central mechanisms and manifestations of chronic pain and sensitization
- 8 Functional imaging of chronic pain
- 9 Functional implications of spinal and forebrain procedures for the treatment of chronic pain
- Index
- References
Summary
Introduction
It is well known that much of the sensory input to the central nervous system can be modulated by centrifugally organized control systems that originate in the central nervous system (Head and Holmes, 1911; Hagbarth, 1960). The control mechanisms can be excitatory or inhibitory processes that may occur in the periphery or within the central nervous system. Inhibition can be at pre- and/or postsynaptic sites (Fig. 6.1(I)). Presynaptic inhibition at the first central synapse of a sensory pathway has the potential advantage of being able to reduce sensory input prior to wide dissemination of that sensory input within the central nervous system through the activation of interneuronal networks and multiple ascending pathways, for example, in the spinal cord (Schmidt, 1973; see Chapter 3).
Pre- and postsynaptic inhibition can have somewhat different effects on the stimulus-response curves of second-order sensory neurons, as shown in Fig. 6.1(II). Postsynaptic inhibition involves inhibitory postsynaptic potentials that sum with excitatory postsynaptic potentials (Fig. 6.1(IIA)). If there is a linear summation, the stimulus-response curve will be shifted to the right in a parallel fashion (Carstens et al., 1980). However, if the IPSP is generated in a membrane area near that in which the EPSP is generated, the excitatory current may be shunted and the slope of the stimulus-response curve reduced, causing a reduction in the gain of synaptic transmission (Fig. 6.1(IIB)). A similar reduction in gain can be produced by presynaptic inhibition.
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- Chapter
- Information
- The Human Pain SystemExperimental and Clinical Perspectives, pp. 423 - 452Publisher: Cambridge University PressPrint publication year: 2010