The perception of harmful stimuli (termed nociception from Sherrington’s terms ‘nociceptive’ and ‘nociceptor’) is closely related to, but distinct from, the sensation of pain. Polymodal nociceptors (PMNs) are peripheral sensory neurons that respond to noxious (i.e. potentially tissuedamaging) stimuli. They are mainly non-myelinated C fibres whose endings respond to intense thermal, mechanical and chemical stimuli (and hence are ‘polymodal’). PMN fibres terminate in the dorsal horn of the spinal cord, forming synaptic connections with transmission neurons running to the thalamus. Chemical stimuli acting on PMNs include bradykinin, protons, ATP and vanilloids (e.g. capsaicin, the component of chilli peppers responsible for their fiery flavour). PMNs are sensitized by prostaglandins, which explains the analgesic effect of antiinflammatory drugs, particularly in the presence of inflammation. The transient receptor potential vanilloid receptor 1 (TRPV1) receptor responds to noxious heat as well as capsaicin-like agonists. Pain (distinct from nociception) includes a strong emotional component; its intensity depends critically on several additional factors in conjunction with the noxious stimulus itself, notably the context in which tissue injury occurs (e.g. football pitch vs. dentist’s chair), its chronicity and any associated inflammation. All of these strongly influence the threshold at which a potentially harmful stimulus is perceived as painful.Reduction in this threshold defines the state of hyperalgesia (enhanced pain from even a mildly noxious stimulus), familiar to anyone who has suffered a sprained ankle or a scald, and which results from a combination of sensitization of peripheral nociceptive nerve terminals and facilitation of central pain pathways. Peripheral sensitization is due to mediators such as bradykinin and prostaglandins, while the central component reflects facilitation of synaptic transmission in the central pain pathways [1]. Central facilitation displays the phenomenon of ‘wind-up’ (synaptic potentials steadily increase in amplitude with each stimulus) and is prevented by antagonists of NMDA, and of substance P and by inhibitors of nitric oxide synthesis, although none of these antagonists or inhibitors has as yet led to new and therapeutically useful analgesic drugs. Substance P and calcitonin gene-related peptide (CGRP), released from the central connections of C-fibres in the dorsal horn of the spinal cord, are also released peripherally (as a consequence of an axon reflex), causing neurogenic inflammation, which amplifies and sustains the activation of nociceptive afferent fibres. Nerve growth factor (NGF), a cytokine-like mediator produced by inflamed tissue, acts on a kinaselinked receptor known as TrkA located on PMNs, and increased production of NGF may cause hyperalgesia [2]. Many analgesics, particularly opioids, disproportionately reduce the distress associated with pain compared with their effect on awareness of the noxious stimulus per se, and this is not explained by nonspecific sedative effects. The activity of opioid analgesics in animal models such as the mouse ‘tail-flick’ (a flick of the tail in response to heat), which mainly assess antinociceptive activity, is poorly correlated with clinical efficacy [1]. Can tests in humans do better? Symptoms of pain in diseases such as myocardial infarction, arthritis or pancreatitis are dramatically Sherrington also introduced the term ‘synapse’. British Journal of Clinical Pharmacology DOI:10.1111/j.1365-2125.2010.03725.x