Regulation of pain sensitivity in the central nervous system

Nociceptive information may be inhibited by stimulation of opiate receptors located presynaptically on primary afferent neurons. Sensory signals entering the spinal cord inhibit nociceptive signals by a non-opioid "gate" mechanism. Descending systems also modulate pain sensitivity at the spinal level. The descending 5-hydroxytryptamine (5-HT) system has a tonic inhibitory function, with diurnal fluctuations in intensity. The strong analgesic effects of electrical stimulation and morphine microinjections in certain brainstem structures is probably mediated by other descending systems. The ascending 5-HT system may influence the results of some complex tests for pain sensitivity by altering e.g. emotionality and habituation rate. Acupuncture analgesia involves opioid systems. In high frequency electroacupuncture and transcutaneous nerve stimulation, a non-opioid "gate" mechanism may predominate. Acute stress may produce analgesia by opioid as well as non-opioid mechanisms. The control of pain sensitivity is influenced by learning (e.g. biofeedback techniques and social factors), and may be affected in depression, mania and schizophrenia.