Bulgarian Neurology
Published December 30, 2025 | Version v1
Journal article Open

Pain matrix ‒ from nociception to awareness

Authors/Creators

  • 1. ROR icon Multiprofile Hospital for Active Treatment in Neurology and Psychiatry St. Naum
  • 2. ROR icon Medical University of Sofia

Description

Nociception is an afferent neural activity which carries sensory information about harmful stimuli. It often leads to a feeling of pain, but the two are not synonyms. Pain is defined as a conscious experience that can occur in the absence of nociception. There are several theories about the nature of pain. One of them is Descartes’ Specificity Theory, according to which there are specific pain receptors that transmit signals via the PNS to the spinothalamic tract of the spinal cord, and hence the thalamus in which the brain produces a sense of pain. Another theory is Nafe’s Model Theory of Pattern. It describes pain as a product of enhanced stimulation on nonspecific receptors. In 1965, Melzac and Wall presented their vision of nociception, also known as Gate Theory. It was followed by Melzac’s concept of central brain pain modulation with a network of structures, also called neuromatrix. This concept was most commonly used to explain clinical situations. Later, Plughaus and Boly developed a more specific term: the “pain matrix”.
The connection between pain matrix, emotions, attention, placebo effect, pain expectations, and anxiety was further explored and discussed. Some adaptive changes in the CNS in pain have also been found, such as that repetitive harmful stimulation can alter not only the function but also the structure of the brain. When pain is present, the amount of gray matter also varies.
Changes in patients’ neural and brain activity could be observed in the presence of various chronic pain disorders, as in analgesia, meditation, acupuncture, and hypnosis. There is also a relationship between the neuromatrix and pain insensitivity, as well as between the pain matrix and neuropathic pain.
Only the systematic research focused on the integrated brain function and structure could lead to a better understanding, and hence to a better management of pain.

Abstract (Bulgarian)

Ноцицепцията е аферентна невронна активност, пренасяща сетивна информация за вредни стимули. Тя често води до усещане на болка, но двете сами по себе си не са синоними. Болката се дефинира като съзнателно преживяване, което може да възникне и в отсъствие на ноцицепция. Съществуват няколко теории за същността на болката. Една от тях за Теорията на специфичността от Descartes, според която съществуват специфични болкови рецептори, пренасящи сигнали по ПНС към спиноталамичния тракт на гръбначния мозък, а оттам таламуса, в който мозъкът произвежда усещането за болка. Друга теория е Теорията на модела (патерна) от Nafe. Тя описва болката като продукт на усилена стимулация върху неспецифични рецептори. През 1965г. Melzack и Wall представят своето виждане за ноцицепцията, още познато като Теория на портата. То е последвано от концепцията на Мелзак за централна модулация на болката в мозъка с мрежа от структури, наречена още невроматрикс, използвана най-често при обяснение на клинични ситуации. По-късно Plughaus и Boly разработват по-специфичен термин ‒ матрикс на болката.
Занапред бива изследвана и разглеждана зависимостта между матрикса на болката, емоциите, вниманието, плацебо ефекта, очакванията за болка и тревожността. Откриват се и някои адаптивни промени в ЦНС при болка като например, че повтаряща се вредна стимулация може да промени не само функцията, но и структурата на мозъка.
Количеството на сиво вещество в структурите на матрикса при болка също се променя.
Наблюдават се и промени в невралната и мозъчната активност на пациентите при различни заболявания, свързани с болка, както и при повлияване на болката чрез медикаментозна аналгезия, медитация, акупунктура и хипноза. Съществува и зависимост между невроматрикса и нечувствителността към болка. С промени в различните нива на матрикса се обясняват и състоянията с невропатна болка.
Само изследването на интегрираната мозъчна функция и структура би могло да доведе до по-добро разбиране, а оттук и до лечение на болката.

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Additional details

Additional titles

Translated title (Bulgarian)
Матрикс на болката – от ноцицепцията до осъзнаването

Identifiers

ARK
ark:/53357/NEU.v26i2.210
URL
https://www.nevrologiabg.com/journal/index.php/neurology/article/view/210
ISSN
2815-2522

Dates

Issued
2025-12-30

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