Article    Table of Contents                    Full Text of this article Free    Related articles in Annals  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Casey, K. L.    Related Articles in PubMed    PubMed Citation    PubMed

PERSPECTIVE

Match and Mismatch: Identifying the Neuronal Determinants of Pain

Kenneth L. Casey, MD

1 June 1996 | Volume 124 Issue 11 | Pages 995-998

Despite the increased intensity and sophistication of research on pain mechanisms in the past three decades, serious uncertainties remain about the neuronal origin of pain, especially in painful clinical conditions. Although a positive correlation between nociceptive afferent activity and the subjective perception of pain has been seen under controlled experimental conditions, important mismatches point to the critical importance of central nervous system processes as determinants of pain. Multiple peripheral, segmental, and supraspinal neuronal activities control nociceptive processing at all levels of the neuraxis. Three studies in this issue highlight the problem of identifying the neuronal determinants of pain by addressing contrasting mismatches: angina-like chest pain without an obvious cause and a potential source of angina (myocardial ischemia) without pain. The results of these studies suggest that selective visceral hyperalgesia and hypoalgesia of peripheral or central origin may be present without other clinical evidence for neurologic abnormality. Complex mechanisms interacting at several levels of the nervous system appear to be involved.

Author and Article Information

From Veterans Affairs Medical Center, Ann Arbor, Michigan. For the current author address, see end of text.
Grant Support: By Merit Review grants from the Department of Veterans Affairs.
Requests for Reprints: Kenneth L. Casey, MD, Neurology Service, Veterans Affairs Medical Center, 2215 Fuller Road, Ann Arbor, MI 48105.

Related articles in Annals:

Editorials
Does the Brain Know When the Heart Is Ischemic?
Carl J. Pepine

Annals 1996 124: 1006-1008. [Full Text]  

Editorials
Changing Focus on Unexplained Esophageal Chest Pain
Raj K. Goyal

Annals 1996 124: 1008-1011. [Full Text]  

Articles
Silent Ischemia as a Central Problem: Regional Brain Activation Compared in Silent and Painful Myocardial Ischemia
Stuart D. Rosen, Eraldo Paulesu, Petros Nihoyannopoulos, Dimitris Tousoulis, Richard S.J. Frackowiak, Christopher D. Frith, Terry Jones, AND Paolo G. Camici

Annals 1996 124: 939-949. [ABSTRACT][Full Text]  

Articles
Unexplained Chest Pain: The Hypersensitive, Hyperreactive, and Poorly Compliant Esophagus
Satish S.C. Rao, Hans Gregersen, Bernard Hayek, Robert W. Summers, AND James Christensen

Annals 1996 124: 950-958. [ABSTRACT][Full Text]  

Articles
Diagnostic Value of Esophageal Studies in Patients with Angina-like Chest Pain and Normal Coronary Angiograms
Ole Frobert, Peter Funch-Jensen, AND Jens Peder Bagger

Annals 1996 124: 959-969. [ABSTRACT][Full Text]  

This article has been cited by other articles:

				J. Giesecke, B. D. Reed, H. K. Haefner, T. Giesecke, D. J. Clauw, and R. H. Gracely Quantitative Sensory Testing in Vulvodynia Patients and Increased Peripheral Pressure Pain Sensitivity Obstet. Gynecol., July 1, 2004; 104(1): 126 - 133. [Abstract] [Full Text] [PDF]

				C. Mannheimer, P. Camici, M.R. Chester, A. Collins, M. DeJongste, T. Eliasson, F. Follath, I. Hellemans, J. Herlitz, T. Luscher, et al. The problem of chronic refractory angina. Report from the ESC Joint Study Group on the Treatment of Refractory Angina Eur. Heart J., March 1, 2002; 23(5): 355 - 370. [Full Text] [PDF]