The Functional Neuroanatomy of Pain Perception

Pain is usually a source of warning and protection; this is not the case for chronic pain. The experience of pain is a form of consciousness consisting of integrated physical and psychological neural inputs. It typically originates with the spinal transmission of noxious sensory stimuli arising from damaged tissues; this level of processing is termed nociception. Signals are conveyed from the spinal cord to supraspinal networks that include the brainstem, subcortical, and cortical regions. This processing network is termed the pain neuromatrix. It is the supraspinal network that transforms the sensation of nociception into the complex and uniquely individual experience that is pain. Pain modulation (inhibitory or facilitatory) is emerging as an important clinical target for pharmacologic and non-pharmacologic interventions. This chapter outlines the neuroanatomical and physiological mechanisms underlying the experience of acute (physiological) and chronic (pathological) pain. It also highlights the theoretical role of CAM techniques in pain modulation. Finally, in order to provide an integrative view of pain perception, the dimensions of the pain experience are presented and contrasted, including the discriminative, cognitive, and affective elements.

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