Descending control of nociception: Specificity, recruitment and plasticity

Mary Heinricher, I. Tavares, J. L. Leith, B. M. Lumb

Research output: Contribution to journalArticle

487 Citations (Scopus)

Abstract

The dorsal horn of the spinal cord is the location of the first synapse in pain pathways, and as such, offers a very powerful target for regulation of nociceptive transmission by both local segmental and supraspinal mechanisms. Descending control of spinal nociception originates from many brain regions and plays a critical role in determining the experience of both acute and chronic pain. The earlier concept of descending control as an "analgesia system" is now being replaced with a more nuanced model in which pain input is prioritized relative to other competing behavioral needs and homeostatic demands. Descending control arises from a number of supraspinal sites, including the midline periaqueductal gray-rostral ventromedial medulla (PAG-RVM) system, and the more lateral and caudal dorsal reticular nucleus (DRt) and ventrolateral medulla (VLM). Inhibitory control from the PAG-RVM system preferentially suppresses nociceptive inputs mediated by C-fibers, preserving sensory-discriminative information conveyed by more rapidly conducting A-fibers. Analysis of the circuitry within the RVM reveals that the neural basis for bidirectional control from the midline system is two populations of neurons, ON-cells and OFF-cells, that are differentially recruited by higher structures important in fear, illness and psychological stress to enhance or inhibit pain. Dynamic shifts in the balance between pain inhibiting and facilitating outflows from the brainstem play a role in setting the gain of nociceptive processing as dictated by behavioral priorities, but are also likely to contribute to pathological pain states.

Original languageEnglish (US)
Pages (from-to)214-225
Number of pages12
JournalBrain Research Reviews
Volume60
Issue number1
DOIs
StatePublished - Apr 2009

Fingerprint

Nociception
Pain
Periaqueductal Gray
Myelinated Nerve Fibers
Unmyelinated Nerve Fibers
Acute Pain
Psychological Stress
Chronic Pain
Synapses
Analgesia
Brain Stem
Fear
Neurons
Brain
Population

Keywords

  • Antinociception
  • Brainstem
  • Caudal ventrolateral medulla
  • Pain modulation
  • Periaqueductal gray
  • Pronociception
  • Raphe

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology

Cite this

Descending control of nociception : Specificity, recruitment and plasticity. / Heinricher, Mary; Tavares, I.; Leith, J. L.; Lumb, B. M.

In: Brain Research Reviews, Vol. 60, No. 1, 04.2009, p. 214-225.

Research output: Contribution to journalArticle

Heinricher, Mary ; Tavares, I. ; Leith, J. L. ; Lumb, B. M. / Descending control of nociception : Specificity, recruitment and plasticity. In: Brain Research Reviews. 2009 ; Vol. 60, No. 1. pp. 214-225.
@article{fdd22306853b4138a2afeea746a3368b,
title = "Descending control of nociception: Specificity, recruitment and plasticity",
abstract = "The dorsal horn of the spinal cord is the location of the first synapse in pain pathways, and as such, offers a very powerful target for regulation of nociceptive transmission by both local segmental and supraspinal mechanisms. Descending control of spinal nociception originates from many brain regions and plays a critical role in determining the experience of both acute and chronic pain. The earlier concept of descending control as an {"}analgesia system{"} is now being replaced with a more nuanced model in which pain input is prioritized relative to other competing behavioral needs and homeostatic demands. Descending control arises from a number of supraspinal sites, including the midline periaqueductal gray-rostral ventromedial medulla (PAG-RVM) system, and the more lateral and caudal dorsal reticular nucleus (DRt) and ventrolateral medulla (VLM). Inhibitory control from the PAG-RVM system preferentially suppresses nociceptive inputs mediated by C-fibers, preserving sensory-discriminative information conveyed by more rapidly conducting A-fibers. Analysis of the circuitry within the RVM reveals that the neural basis for bidirectional control from the midline system is two populations of neurons, ON-cells and OFF-cells, that are differentially recruited by higher structures important in fear, illness and psychological stress to enhance or inhibit pain. Dynamic shifts in the balance between pain inhibiting and facilitating outflows from the brainstem play a role in setting the gain of nociceptive processing as dictated by behavioral priorities, but are also likely to contribute to pathological pain states.",
keywords = "Antinociception, Brainstem, Caudal ventrolateral medulla, Pain modulation, Periaqueductal gray, Pronociception, Raphe",
author = "Mary Heinricher and I. Tavares and Leith, {J. L.} and Lumb, {B. M.}",
year = "2009",
month = "4",
doi = "10.1016/j.brainresrev.2008.12.009",
language = "English (US)",
volume = "60",
pages = "214--225",
journal = "Brain Research Reviews",
issn = "0165-0173",
publisher = "Elsevier",
number = "1",

}

TY - JOUR

T1 - Descending control of nociception

T2 - Specificity, recruitment and plasticity

AU - Heinricher, Mary

AU - Tavares, I.

AU - Leith, J. L.

AU - Lumb, B. M.

PY - 2009/4

Y1 - 2009/4

N2 - The dorsal horn of the spinal cord is the location of the first synapse in pain pathways, and as such, offers a very powerful target for regulation of nociceptive transmission by both local segmental and supraspinal mechanisms. Descending control of spinal nociception originates from many brain regions and plays a critical role in determining the experience of both acute and chronic pain. The earlier concept of descending control as an "analgesia system" is now being replaced with a more nuanced model in which pain input is prioritized relative to other competing behavioral needs and homeostatic demands. Descending control arises from a number of supraspinal sites, including the midline periaqueductal gray-rostral ventromedial medulla (PAG-RVM) system, and the more lateral and caudal dorsal reticular nucleus (DRt) and ventrolateral medulla (VLM). Inhibitory control from the PAG-RVM system preferentially suppresses nociceptive inputs mediated by C-fibers, preserving sensory-discriminative information conveyed by more rapidly conducting A-fibers. Analysis of the circuitry within the RVM reveals that the neural basis for bidirectional control from the midline system is two populations of neurons, ON-cells and OFF-cells, that are differentially recruited by higher structures important in fear, illness and psychological stress to enhance or inhibit pain. Dynamic shifts in the balance between pain inhibiting and facilitating outflows from the brainstem play a role in setting the gain of nociceptive processing as dictated by behavioral priorities, but are also likely to contribute to pathological pain states.

AB - The dorsal horn of the spinal cord is the location of the first synapse in pain pathways, and as such, offers a very powerful target for regulation of nociceptive transmission by both local segmental and supraspinal mechanisms. Descending control of spinal nociception originates from many brain regions and plays a critical role in determining the experience of both acute and chronic pain. The earlier concept of descending control as an "analgesia system" is now being replaced with a more nuanced model in which pain input is prioritized relative to other competing behavioral needs and homeostatic demands. Descending control arises from a number of supraspinal sites, including the midline periaqueductal gray-rostral ventromedial medulla (PAG-RVM) system, and the more lateral and caudal dorsal reticular nucleus (DRt) and ventrolateral medulla (VLM). Inhibitory control from the PAG-RVM system preferentially suppresses nociceptive inputs mediated by C-fibers, preserving sensory-discriminative information conveyed by more rapidly conducting A-fibers. Analysis of the circuitry within the RVM reveals that the neural basis for bidirectional control from the midline system is two populations of neurons, ON-cells and OFF-cells, that are differentially recruited by higher structures important in fear, illness and psychological stress to enhance or inhibit pain. Dynamic shifts in the balance between pain inhibiting and facilitating outflows from the brainstem play a role in setting the gain of nociceptive processing as dictated by behavioral priorities, but are also likely to contribute to pathological pain states.

KW - Antinociception

KW - Brainstem

KW - Caudal ventrolateral medulla

KW - Pain modulation

KW - Periaqueductal gray

KW - Pronociception

KW - Raphe

UR - http://www.scopus.com/inward/record.url?scp=63449092750&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=63449092750&partnerID=8YFLogxK

U2 - 10.1016/j.brainresrev.2008.12.009

DO - 10.1016/j.brainresrev.2008.12.009

M3 - Article

C2 - 19146877

AN - SCOPUS:63449092750

VL - 60

SP - 214

EP - 225

JO - Brain Research Reviews

JF - Brain Research Reviews

SN - 0165-0173

IS - 1

ER -