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Discharge characteristics of fine medial articular afferents at rest and during passive movements of inflamed knee joints. Injuries of Nerves and Their Consequences. These substances, called endogenous opioid peptides, axe present within nerve cells of the peripheral and central nervous systems (Palkovits, 1984). The weight of evidence indicates that opiates produce analgesia in part by activating these pain-modulating networks.One of the most important discoveries in pain research was that the brain contains substances that have the same pharmacological properties as plant-derived opiates and synthetic opioid drugs. Although it is well known and well accepted that various psychosocial factors may enhance pain, the role of several physiological processes in amplifying and maintaining pain is perhaps not adequately taken into account when assessing patients' complaints.SensitizationTissue damage initiates a variety of processes that sustain and amplify pain. Lesions of the ventrocaudal thalamus and somatosensory cortex produce long-lasting deficits in the sensory aspects of pain that are very similar to those produced by lesions of the anterolateral spinal cord pathway.

Journal of Physiology 273:179-194, 1977. [PubMed: 6875640]Letobeck, F. Baltimore, MD: Williams & Wilkins, 1983.Turk, D.C., and Kerns, R.D. The mechanism of referred pain is unknown for any particular case.Referred pain can be a major source of confusion in the examination of patients complaining primarily of pain. Science 197:183-186, 1977. On the other hand, presumably because of the tissue-damaging potential of the noxious stimulus, aversive behavioral sequelae such as withdrawal and escape can terminate the stimulus and protect the organism. In this case, the production of a second site of noxious input in muscle is due to a spinal reflex. Clinical experiments have demonstrated both kinds of responses.This phenomenon of referred pain can present a serious problem to both patients and physicians when it goes unrecognized. The second-order cells relay the message through well-defined pathways to higher centers, including the brain stem reticular formation, thalamus, somatosensory cortex, and limbic system.

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