Descending pain modulation and chronification of pain

Michael H. Ossipov, Kozo Morimura, Frank Porreca

Research output: Contribution to journalArticle

194 Citations (Scopus)

Abstract

Purpose of review Chronic pain is an important public health problem that negatively impacts quality of life of affected individuals and exacts an enormous socio-economic cost. Currently available therapeutics provide inadequate management of pain in many patients. Acute pain states generally resolve in most patients. However, for reasons that are poorly understood, in some individuals, acute pain can transform to a chronic state. Our understanding of the risk factors that underlie the development of chronic pain is limited. Recent studies have suggested an important contribution of dysfunction in descending pain modulatory circuits to pain 'chronification'. Human studies provide insights into possible endogenous and exogenous factors that may promote the conversion of pain into a chronic condition. Recent findings Descending pain modulatory systems have been studied and characterized in animal models. Human brain imaging techniques, deep brain stimulation and the mechanisms of action of drugs that are effective in the treatment of pain confirm the clinical relevance of top-down pain modulatory circuits. Growing evidence supports the concept that chronic pain is associated with a dysregulation in descending pain modulation. Disruption of the balance of descending modulatory circuits to favour facilitation may promote and maintain chronic pain. Recent findings suggest that diminished descending inhibition is likely to be an important element in determining whether pain may become chronic. This view is consistent with the clinical success of drugs that enhance spinal noradrenergic activity, such as serotonin/norepinephrine reuptake inhibitors (SNRIs), in the treatment of chronic pain states. Consistent with this concept, a robust descending inhibitory system may be normally engaged to protect against the development of chronic pain. Imaging studies show that higher cortical and subcortical centres that govern emotional, motivational and cognitive processes communicate directly with descending pain modulatory circuits providing a mechanistic basis to explain how exogenous factors can influence the expression of chronic pain in a susceptible individual. Summary Preclinical studies coupled with clinical pharmacologic and neuroimaging investigations have advanced our understanding of brain circuits that modulate pain. Descending pain facilitatory and inhibitory circuits arising ultimately in the brainstem provide mechanisms that can be engaged to promote or protect against pain 'chronification'. These systems interact with higher centres, thus providing a means through which exogenous factors can influence the risk of pain chronification. A greater understanding of the role of descending pain modulation can lead to novel therapeutic directions aimed at normalizing aberrant processes that can lead to chronic pain.

Original languageEnglish (US)
Pages (from-to)143-151
Number of pages9
JournalCurrent Opinion in Supportive and Palliative Care
Volume8
Issue number2
DOIs
StatePublished - 2014

Fingerprint

Pain
Chronic Pain
Acute Pain
Neuroimaging
Deep Brain Stimulation
Pain Management
Therapeutics
Pharmaceutical Preparations
Brain Stem
Animal Models
Public Health
Economics
Quality of Life
Costs and Cost Analysis
Brain

Keywords

  • Chronic pain
  • Descending inhibition
  • Noradrenergic pain inhibition
  • Pain modulation

ASJC Scopus subject areas

  • Oncology
  • Medicine(all)
  • Critical Care and Intensive Care Medicine
  • Oncology(nursing)

Cite this

Descending pain modulation and chronification of pain. / Ossipov, Michael H.; Morimura, Kozo; Porreca, Frank.

In: Current Opinion in Supportive and Palliative Care, Vol. 8, No. 2, 2014, p. 143-151.

Research output: Contribution to journalArticle

Ossipov, Michael H. ; Morimura, Kozo ; Porreca, Frank. / Descending pain modulation and chronification of pain. In: Current Opinion in Supportive and Palliative Care. 2014 ; Vol. 8, No. 2. pp. 143-151.
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