Central nervous system pathways for pain transmission and pain control: issues relevant to the practicing clinician

This review considers two areas important for the clinician; ascending pathways for pain transmission and endogenous pain control systems. The classic three-neuron pathway for pain transmission is presented and contrasted with more detailed, contemporary views on pain transmission found in the literature. The focus of the review is a discussion of spinal cord and brainstem pain control systems that modulate pain transmission. Evidence is presented which supports not only the existence of these pain modulation mechanisms but also that selected clinical procedures used by clinicians are capable of activating these mechanisms to control their patients' pain.