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Physiological pain is inevitable for us to avoid harmful stimuli as one of the self-defense mechanisms. On the other hand, pathological pain, especially deep tissue pain often persists and develops into chronic pain states. Patients suffering chronic pain often complain of pain and tenderness in various parts of the body, and chronic stress often exacerbates their pain. Fibromyalgia represents the extreme end of the spectrum of chronic widespread pain syndromes. In this chapter, we address questions as follows; why deep tissue pain tends to pass into a chronic state (is deep tissue pain more unpleasant than superficial pain?), how or why the whole body aches in these patients, and how chronic stress exacerbate their pain. We speculate that persistent pain-induced brain sensitization underlies these chronic pain states. Areas involved in the emotional aspects of pain, such as the anterior cingulate cortex (ACC), insular cortex (IC), amygdala, may be sensitized. Memory of pain based on sensitization of brain areas involved in emotional response is useful for us to avoid future damage. However, in some pathological conditions, descending pain control system may switch from inhibition to facilitation, with unknown mechanism, and facilitate pain sensation and behavior. Serotonin (5-HT) may be involved in the descending facilitation in pathological pain conditions. Understanding of the etiology, pathophysiology and treatment of chronic pain states is an urgent issue from the view points of patients’ quality of life and socio-economy.

Central Sensitization and Descending Facilitation in Chronic Pain State