Cited by 290Pain Mechanisms and TreatmentsPain Management and TreatmentMusculoskeletal pain and rehabilitation

Abnormal endogenous pain modulation is a shared characteristic of many chronic pain conditions

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Staud, Roland·2012·Expert Review of Neurotherapeutics

Abstract

The intensity of acute and chronic pain depends on interactions between peripheral impulse input and CNS pain mechanisms, including facilitation and inhibition. Whereas tonic pain inhibition is a characteristic of most pain-free individuals, pain facilitation can be detected in many chronic pain patients. The capability to inhibit pain is normally distributed along a wide continuum in the general population and can be used to predict chronic pain. Accumulating evidence suggests that endogenous pain inhibition depends on activation of the prefrontal cortex, periaqueductal gray and rostral ventral medulla. Quantitative sensory test paradigms have been designed to acquire detailed information regarding each individual's endogenous pain inhibition and facilitation. Such tests include: temporal summation of pain, which is mostly used to assess facilitatory pain modulation by measuring the change in pain perception during a series of identical nociceptive stimuli; and conditioned pain modulation, which tests pain inhibition by utilizing two simultaneously applied painful stimuli (the 'pain inhibits pain' paradigm). Considerable indirect evidence seems to indicate that not only increased pain facilitation but also ineffective pain inhibition represents a predisposition for chronic pain. This view is supported by the fact that many chronic pain syndromes (e.g., fibromyalgia, temporomandibular joint disorder, irritable bowel syndrome, headache and chronic fatigue syndrome) are associated with hypersensitivity to painful stimuli and reduced endogenous pain inhibition. However, future prospective studies will be necessary to provide definitive evidence for this relationship. Such research would not only provide important information about mechanisms relevant to chronic pain but would also permit identification of individuals at high risk for future chronic pain.

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  • For children undergoing major surgery, parent pain catastrophizing scores predicted the child's post-surgical pain intensity.

    “For children undergoing major surgery, parent pain catastrophizing scores predicted the child’s post-surgical pain intensity 116, 119, 345.”

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  1. [12]Linton SJ Linton SJ Cognitive behavioral therapy in the prevention of musculoskeletal pain: description of a program New Avenues for the Prevention of Chronic Musculoskeletal Pain and Disability Elsevier Amsterdam, The Netherlands 269 276 2002
  2. [138]Price DD Casey KL Characterizing central mechanisms of pathological pain states by sensory testing and neurophysiological analysis Pain and Central Nervous System Disease: Mechanisms and Assessment Raven Press NY, USA 103 115 1991

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Authors
Staud, R.
Affiliations
University of Florida (US)
Corresponding author
Staud, Roland
Venue
Expert Review of Neurotherapeutics
Published
2012-05
Volume
12
Issue
5
Pages
577-585
ISSN
  • 1473-7175 (ISSN-L)
  • 1744-8360
OpenAlex
W1967320240
Cited by
290
References
145
Citations by year
2026: 12 · 2025: 17 · 2024: 27 · 2023: 26 · 2022: 9 · 2021: 27 · 2020: 20 · 2019: 22 · 2018: 32 · 2017: 25 · 2016: 20 · 2015: 22 · 2014: 14 · 2013: 17
FWCI
11.37
Type
journal article
Language
en
Open access
Locations
  • Expert Review of Neurotherapeutics (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (AR053541, R01AR053541)
Topics
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
endogenous pain modulation, chronic pain, pain facilitation, pain inhibition, temporal summation of pain, conditioned pain modulation, quantitative sensory testing, prefrontal cortex, periaqueductal gray, rostral ventromedial medulla, fibromyalgia, temporomandibular disorders, irritable bowel syndrome, headache, chronic fatigue syndrome, hyperalgesia
MeSH terms
Central Nervous System, Humans, Individuality, Pain Threshold, Central Nervous System Sensitization, Chronic Pain

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