Recent developments in pain research: Central mechanisms of orofacial pain and its control

Abstract

In this review, recent advances in our knowledge of the central neural mechanisms underlying pain in the mouth and face are emphasized. The review first points out that pain is now conceptualized as a multifactorial experience that can be modified. This is accomplished by the cognitive, emotional, and motivational influences related to the patient's past experience and feelings about pain, stress and anxiety, other ongoing sensory experiences, etc. This article then focuses on recent research data which have identified critical neural elements in the brain concerned with the sensory-discriminative aspect of oral-facial pain. Descriptions are also provided of some of the central neural pathways and mechanisms involved in the modulatory influences on orofacial pain transmission. In addition to providing explanations of how pain can be transmitted and controlled, these recent findings have also provided insights into how particular orofacial pain problems may occur, and the review suggests possible mechanisms that may underlie problems such as spread and referral of pain and the possible role that deafferentation might play in several chronic orofacial pain states.