The Role of Descending Pain Modulation in Chronic Primary Pain: Potential Application of Drugs Targeting Serotonergic System

Neural Plast. 2019 Dec 17:2019:1389296. doi: 10.1155/2019/1389296. eCollection 2019.

Abstract

Chronic primary pain (CPP) is a group of diseases with long-term pain and functional disorders but without structural or specific tissue pathologies. CPP is becoming a serious health problem in clinical practice due to the unknown cause of intractable pain and high cost of health care yet has not been satisfactorily addressed. During the past decades, a significant role for the descending pain modulation and alterations due to specific diseases of CPP has been emphasized. It has been widely established that central sensitization and alterations in neuroplasticity induced by the enhancement of descending pain facilitation and/or the impairment of descending pain inhibition can explain many chronic pain states including CPP. The descending serotonergic neurons in the raphe nuclei target receptors along the descending pain circuits and exert either pro- or antinociceptive effects in different pain conditions. In this review, we summarize the possible underlying descending pain regulation mechanisms in CPP and the role of serotonin, thus providing evidence for potential application of analgesic medications based on the serotonergic system in CPP patients.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Chronic Pain / drug therapy
  • Chronic Pain / physiopathology*
  • Drug Delivery Systems / methods*
  • Humans
  • Neuronal Plasticity / drug effects
  • Neuronal Plasticity / physiology
  • Pyramidal Tracts / drug effects
  • Pyramidal Tracts / physiopathology*
  • Receptors, Serotonin / physiology*
  • Serotonergic Neurons / drug effects
  • Serotonergic Neurons / physiology*
  • Serotonin / physiology*
  • Serotonin Agents / administration & dosage

Substances

  • Receptors, Serotonin
  • Serotonin Agents
  • Serotonin