Harnessing the power of endogenous pain control mechanisms for novel therapeutics: how might innovations in neuroimaging help?

Abstract

Purpose of review This review explores the potential of using novel imaging approaches to deepen our understanding of descending modulatory mechanisms in pain, focussing on functional magnetic resonance imaging (fMRI) of the spinal cord and novel approaches to combining molecular and fMRI data. This review sheds light on the neural processes involved in pain modulation, paving the way for the development of targeted treatments. Recent findings The reviewed literature demonstrates significant advancements in pain research. Recent studies show the potential of using fMRI to investigate the spinal cord’s role in pain modulation. Furthermore, novel analytical approaches integrating molecular and fMRI data show promise in elucidating the complex neurobiological processes underlying pain regulation. The main themes explored here include the identification of neurochemical markers associated with pain modulation and the characterisation of neural circuits involved in descending pain control. Summary A comprehensive understanding of descending modulatory mechanisms in pain can inform the development of novel treatments, targeting dysfunction of these key pathways. By leveraging spinal fMRI and integrating molecular data into brain fMRI, researchers can identify potential therapeutic targets throughout the neuraxis. These advances may contribute to the development of personalised medicine approaches, allowing for tailored interventions based on individual pain profiles.

Recent developments and future avenues for human corticospinal neuroimaging

“…These neurons are primarily located in the dorsal horns of the spinal cord gray matter and can be activated explicitly upon experimental noxious stimulation (Figure 2B). The spinal level and laterality of activation was shown to correspond to the stimulated body area (i.e., dermatome) and body side (Eippert et al, 2009;Sprenger et al, 2012;Weber et al, 2016a;Tinnermann et al, 2021b;Howard et al, 2023). A study imaging the spinal cord and brain of healthy participants in separate sessions applied thermal stimulation at 49 • C to the right hand at cervical dermatome C8 and found noxious heat-induced representative activations in the spinal cord, brainstem, and cortical regions that correlated with subjective pain ratings (Khan and Stroman, 2015).…”