Endogenous pain modulation is a complex phenomenon involved in the perception of pain. It consists of top-down inhibitory and facilitatory pathways that originate at higher sites within the central... Show moreEndogenous pain modulation is a complex phenomenon involved in the perception of pain. It consists of top-down inhibitory and facilitatory pathways that originate at higher sites within the central nervous system and converge at dorsal horn neurons in the spinal cord, to modulate incoming afferent nociceptive information. Dysfunction of inhibitory pain pathways or a shift in the balance between pain facilitation and pain inhibition has been associated with the development of chronic pain. This thesis describes the effect of several central-acting drugs on descending control of pain in both healthy volunteers and chronic pain patients to further understand the underlying mechanism of endogenous pain control in health and disease. Show less
Pain management in the ICU can be difficult due to lack of patient self report. This thesis describes pain management, including procedural pain in patients in the ICU after cardiac surgery.... Show morePain management in the ICU can be difficult due to lack of patient self report. This thesis describes pain management, including procedural pain in patients in the ICU after cardiac surgery. Chronic pain one year after cardiac surgery is also evaluated and risk factors for the development of chronic pain are identified. Recommendations for the management of acute and procedural pain in patients in the ICU and for the follow-up of chronic pain after cardiac surgery are provided. Show less
