“…Several studies indicate that the periaqueductal gray (PAG) and the rostral ventromedial medulla (RVM) constitute the outflow of descending modulation and that peripheral damage can alter the balance between inhibition and facilitation of nociception by these brainstem structures (Niesters et al, 2013; De Felice et al, 2011; Heinricher et al, 2009; Vanegas and Schaible, 2004). The LH sends projections to both the PAG (Clement et al, 2012; Hsieh et al, 2011; Holden et al, 2009) and RVM (Barba, et al, 2014; Holden et. al., 2005; Herman, et al, 1997) as well as the descending noradrenergic neurons in the dorsolateral pontine tegmentum (Tokita et al, 2009; Holden and Naleway, 2000; Holden, et al, 2001).…”