Descending modulation of pain.

Although interest in descending modulation of spinal cord function dates back to the time of Sherrington, the modern era began in the late 1960s when it was shown that focal electrical stimulation in the midbrain of the rat produced analgesia sufficient to permit surgery. From this report evolved the concept of endogenous systems of pain modulation. Initial interest focused on descending inhibition of spinal nociceptive processing, but we now know that descending modulation of spinal nociceptive processing can be either inhibitory or facilitatory. As our understanding of descending facilitatory, or pro-nociceptive influences grows, so too has our appreciation of its potential importance. Accumulating evidence suggests that descending facilitatory influences may contribute to the development and maintenance of hyperalgesia and thus contribute to chronic pain states.