Descending Control Mechanisms and Chronic Pain
Descending Control Mechanisms and Chronic Pain
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DOI：
10.1007/s11926-019-0813-1
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发表时间：
2019-05-01
影响因子：
5
通讯作者：
Heinricher, Mary M.
中科院分区：
文献类型：
--
作者：
Chen, QiLiang;Heinricher, Mary M.
本综述的目的是强调我们对下行疼痛调节系统的理解的最新进展，以及这些系统如何导致持续疼痛状态，重点是关于自下而上（感觉）和自上而下（调节认知和情绪处理的高级结构）对疼痛调节回路的影响的当前知识状态。最近的发现在过去的30年里，这些系统的连通性、生理学和功能已经得到了广泛的研究。该领域现在开始询问这些系统如何以及何时参与调节疼痛。最近的研究重点是臂旁复合体，它现在被认为是疼痛调节回路中伤害性信息的主要中继，而这种回路的可塑性及其与RVM的连接在持续的炎症性疼痛中是显著的。自上而下的影响，从更高的结构，包括下丘脑，杏仁核和内侧前额叶区域，也被考虑。挑战将是梳理出一个特定的行为环境通过不同的回路来增强或抑制疼痛的机制，并了解这些机制如何促进慢性疼痛。
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.