Understanding pain pathways and pain processing is the key to the optimal management of both acute and chronic pain. Our understanding of pain perception is evolving as we now recognize that humoral factors as well as neural transmission are responsible for the activation and sensitization of regions involved in pain perception, suffering, and avoidance behavior. Although acute pain initiates withdrawal reflexes that minimize further tissue injury, chronic pain serves no adaptive benefit and can lead to long-term disability. Chronic pain is persistent and reflects altered neural transmission as well as long-term plasticity changes in the peripheral and central nervous systems. Preventing these alterations by employing a balanced multimodal analgesic approach, using functional MRI (fMRI) to measure and correct alterations in CNS activity, and aggressive physical therapy and rehabilitation may reduce the transition from acute to chronic pain.

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