It is well established from preclinical studies that the brainstem contains multiple circuits that can modulate incoming nociceptive information. For example, regions such as the midbrain periaqueductal gray (PAG), the rostral ventromedial medulla (RVM), the locus coeruleus (LC), and the subnucleus reticularis dorsalis (SRD) can directly and indirectly inhibit and facilitate activity at the primary nociceptive synapse and thus influence nociceptive transmission to higher brain areas.5,7,22,35,47 Spontaneous activity within this network, particularly within the RVM, is dynamic and can fluctuate between inhibitory and facilitatory outputs even on short timescales in the order of seconds and minutes.
from The Journal of Pain https://ift.tt/3lKOqYR
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