The genetic epidemiology of pain

Abstract

Our fascination with pain mechanisms possibly dates back to our awareness of our existence. Yet our study of pain pathways only gained focus with the reflex theory advanced by René Descartes in 1664 (Descartes, 1664) and was rejuvenated time and again by a number of subsequent theories, such as the specificity theory (Schiff, 1858) and the sensory interaction theory (Noordenbos, 1959). On the other hand, pattern and neuromatrix theories have discounted the specific function assigned to anatomic components of the nervous system (e.g. Berkley & Hubscher, 1995a; Melzack, 1999; Nafe, 1934), particularly when it comes to pain processing; but they have been faced with challenges of their own, not the least of which is translating their theoretical framework into clinical applications. This chapter highlights recent advances in our knowledge of the pain system including our understanding of nociceptors, of the processing of nociceptive information in the spinal cord, brainstem, thalamus, and cerebral cortex and of descending pathways that modulate nociceptive activity. Some of this information might potentially lead to improvements in patient care.