The descending modulation of pain

The brain modulates pain perception through descending pathways that exert bidirectional control over nociceptive inputs and spinal neuronal activity. Whether modulation is facilitatory or inhibitory depends on the coordinated output of the descending pain modulatory system (DPMS), comprising functionally distinct circuits that influence one another. Here, we outline the foundation studies informing our current understanding of mechanisms underpinning the descending modulation of pain. We indicate bold new approaches delivering novel insights regarding somatosensory processing and outline how, in the context of identifying and manipulating functionally relevant pathways encompassed by the DPMS, we can improve knowledge, and treatment, of pain.