AUTHOR=Chen Qiliang , Heinricher Mary M. 

TITLE=Shifting the Balance: How Top-Down and Bottom-Up Input Modulate Pain via the Rostral Ventromedial Medulla

JOURNAL=Frontiers in Pain Research

VOLUME=Volume 3 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2022.932476

DOI=10.3389/fpain.2022.932476

ISSN=2673-561X

ABSTRACT=The sensory experience of pain depends not only on the transmission of noxious information (nociception), but on the state of the body in a biological, psychological, and social milieu.  A brainstem pain-modulating system with its output node in the rostral ventromedial medulla (RVM) can regulate the threshold and gain for nociceptive transmission.  This review considers how RVM pain-modulating neurons, ON-cells and OFF-cells, are engaged by “top-down” cognitive and emotional factors, and by “bottom-up” sensory inputs, to enhance or suppress pain.