The complexity of pain: part 1. No pain without gain: the augmentation of nociception in the CNS

Abstract

Pain is a highly complex phenomenon, central to trauma, disease and dysfunction and subject to detailed study by physiotherapists. The role of ascending information in the perception of pain and the mediation of this nociception is well established. This paper reviews the emerging evidence from neuroscience, and re-examines the central concept of nociception and the augmentation of ascending information. The role of the NMDA receptor and contemporary theories of its implication in the neuroplasticity of pain are explored fully. The review identifies plasticity as a mechanism of ‘weighting’ information at synapses and proposes the paradigm of complexity and complex adapting systems as a theoretical concept that unifies the primary domains (sensory, affective and cognitive) of pain experience.

Keywords:

• PAIN
• NEUROPLASTICITY
• NMDA (N-METHYL-D-ASPARTATE)
• COMPLEXITY