- Visibility 110 Views
- Downloads 77 Downloads
- Permissions
- DOI 10.18231/j.ijohd.12772.1758537791
-
CrossMark
- Citation
Pain pathway: An overview
Pain is a complex sensory and emotional experience that plays a crucial protective role by signalling potential injury or harm. Derived from the Latin poena (punishment) and Greek poine (price paid, penalty), pain involves both sensory and emotional components, which are influenced by psychological factors such as fear, anxiety, and past experiences. This article presents a comprehensive overview of the anatomical and physiological mechanisms involved in pain perception, emphasizing both ascending and descending pathways of pain modulation.. The ascending pathways, including the spinothalamic tract (STT) and trigeminal pathway, transmit nociceptive signals from peripheral tissues to the brain, where pain is perceived and localized. The descending pathways, originating from brain regions like the “periaqueductal gray” (PAG) and the “nucleus raphe magnus” (NRM), influence pain perception by regulating nociceptive signals at the spinal cord, either enhancing or suppressing their transmission. Key mechanisms such as Diffuse Noxious Inhibitory Control (DNIC), endogenous anti-nociception, and stress-induced analgesia (SIA) contribute to pain modulation. Furthermore, dysfunctions in these pathways can lead to chronic pain conditions, often characterized by central sensitization and failure of inhibitory control. Understanding these pain mechanisms, both in terms of physiology and psychological factors, is essential for developing effective pain management strategies and improving patient care. This review underscores the need for a holistic approach to pain, considering both the neurobiological and psychosocial aspects to enhance therapeutic outcomes.
References
- Ahammed J, Alam F, Al Rezowan Shoron MA, Niloy SD, Utpal BK, Roy SC. A review on flavonoids in neuropathic pain. Dinkum J Med Innovations. 2023;2(10):452.
- Fine PG. Long-term consequences of chronic pain: mounting evidence for pain as a neurological disease and parallels with other chronic disease states. Pain Med. 2011;12(7):996–1004. https://doi.org/10.1111/j.1526-4637.2011.01187.x
[Google Scholar] - Jackson TP, Stabile VS, McQueen KK. The global burden of chronic pain. ASA Monit. 2014;78(6):24–7.
- Okeson JP. Bell's Orofacial Pains. Chicago: Quintessence Publishing Co. Ltd; 1995.
- Khalid S, Tubbs RS. Neuroanatomy and neuropsychology of pain. Cureus. 2017;9(10):e1754. https://doi.org/10.7759/cureus.1754
[Google Scholar] - Sternberg TL. Textbook of pain. In: Wall PD, Melzack R, editors. Textbook of Pain. Edinburgh: Churchill Livingstone; 1989.
- DeLeo JA. Basic science of pain. J Bone Joint Surg Am. 2006;88(Suppl 2):58–62.
- Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition, ICHD-3. Cephalalgia. 2018;38:1–211.
- Peng KP, Oppermann T. Orofacial pain disorders: an overview and diagnostic approach. Cephalalgia Rep. 2022;5. https://doi.org/10.1177/25158163221097349
[Google Scholar] - Kettner NW. The functional neuroanatomy of pain perception. In: Integrative Pain Medicine: The Science and Practice of Complementary and Alternative Medicine in Pain Management. Totowa, NJ: Humana Press; 2008:63–83.
- Liu S, Kelliher L. Physiology of pain—a narrative review on the pain pathway and its application in the pain management. Digestive Med Res. 2022;5. https://doi.org/10.21037/dmr-21-100
[Google Scholar] - Vanegas H, Schaible H-G. Descending control of persistent pain: inhibitory or facilitatory? Brain Res Brain Res Rev . 2004;46(3):295–309. https://doi.org/10.1016/j.brainresrev.2004.07.004
[Google Scholar] - McPherson KB, Ingram SL. Cellular and circuit diversity determines the impact of endogenous opioids in the descending pain modulatory pathway. Front Syst Neurosci. 2022;16:963812. https://doi.org/10.3389/fnsys.2022.963812
[Google Scholar] - Stamford JA. Descending control of pain. Br J Anaesth. 1995;75(2):217–27. https://doi.org/10.1093/bja/75.2.217
[Google Scholar] - Yam MF, Loh YC, Tan CS, Adam SK, Manan NA, Basir R. General pathways of pain sensation and the major neurotransmitters involved in pain regulation. Int J Mol Sci. 2018;19(8):2164. https://doi.org/10.3390/ijms19082164
[Google Scholar] - Le Bars D, Dickenson AH, Besson J-M. Diffuse noxious inhibitory controls (DNIC). I. Effects on dorsal horn convergent neurones in the rat. Pain. 1979;6(3):283–304. https://doi.org/10.1016/0304-
[Google Scholar] 3959(79)90049-6. - Vanegas H, Vazquez E, Tortorici V. NSAIDs, opioids, cannabinoids and the control of pain by the central nervous system. Pharmaceuticals (Basel). 2010;3(5):1335–47. https://doi.org/10.3390/ph3051335
[Google Scholar] - Edvinsson JCA, Viganò A, Alekseeva A, Alieva E, Arruda R, De Luca C, et al. The fifth cranial nerve in headaches. J Headache Pain. 2020;21(1):65. https://doi.org/10.1186/s10194-020-01134-1
[Google Scholar] - Yao AL, Barad M. Diagnosis and management of chronic facial pain. BJA Educ. 2020;20(4):120–5. https://doi.org/10.1016/j.bjae.2020.01.001
[Google Scholar] - Andreou AP, Edvinsson L. Trigeminal mechanisms of nociception. In: Neuromodulation in Headache and facial pain management: principles, rationale and clinical data. Cham: Springer International Publishing; 2020:3–1. https://doi.org/10.1007/978-3-030-14121-
[Google Scholar] 9_1.
How to Cite This Article
Vancouver
Joseph RA, Madalli VB, Nandimath KR. Pain pathway: An overview [Internet]. Int J Oral Health Dent. 2025 [cited 2025 Oct 23];11(3):172-178. Available from: https://doi.org/10.18231/j.ijohd.12772.1758537791
APA
Joseph, R. A., Madalli, V. B., Nandimath, K. R. (2025). Pain pathway: An overview. Int J Oral Health Dent, 11(3), 172-178. https://doi.org/10.18231/j.ijohd.12772.1758537791
MLA
Joseph, Rachel Ann, Madalli, Vijaylaxmi B, Nandimath, Kirty R. "Pain pathway: An overview." Int J Oral Health Dent, vol. 11, no. 3, 2025, pp. 172-178. https://doi.org/10.18231/j.ijohd.12772.1758537791
Chicago
Joseph, R. A., Madalli, V. B., Nandimath, K. R.. "Pain pathway: An overview." Int J Oral Health Dent 11, no. 3 (2025): 172-178. https://doi.org/10.18231/j.ijohd.12772.1758537791