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      Forebrain pain mechanisms.

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          Abstract

          Emotional-affective and cognitive dimensions of pain are less well understood than nociceptive and nocifensive components, but the forebrain is believed to play an important role. Recent evidence suggests that subcortical and cortical brain areas outside the traditional pain processing network contribute critically to emotional-affective responses and cognitive deficits related to pain. These brain areas include different nuclei of the amygdala and certain prefrontal cortical areas. Their roles in various aspects of pain will be discussed. Biomarkers of cortical dysfunction are being identified that may evolve into therapeutic targets to modulate pain experience and improve pain-related cognitive impairment. Supporting data from preclinical studies in neuropathic pain models will be presented. Neuroimaging analysis provides evidence for plastic changes in the pain processing brain network. Results of clinical studies in neuropathic pain patients suggest that neuroimaging may help determine mechanisms of altered brain functions in pain as well as monitor the effects of pharmacologic interventions to optimize treatment in individual patients. Recent progress in the analysis of higher brain functions emphasizes the concept of pain as a multidimensional experience and the need for integrative approaches to determine the full spectrum of harmful or protective neurobiological changes in pain.

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          Author and article information

          Journal
          Brain Res Rev
          Brain research reviews
          Elsevier BV
          0165-0173
          0165-0173
          Apr 2009
          : 60
          : 1
          Affiliations
          [1 ] Department of Neuroscience and Cell Biology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-1069, USA. voneugeb@utmb.edu
          Article
          S0165-0173(08)00153-7 NIHMS112892
          10.1016/j.brainresrev.2008.12.014
          2700838
          19162070
          7c5ec662-6f5d-4bc1-877f-e3c22cf75282

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