The role of the pituitary region in the endogenous pain control mechanism

textabstractIt is often difficult to come to grips with the phenomenon of pain . It is still impossible with any degree of elegance, to combine together under one single theory all our knowledge of pain prevention , and all the factors that play a role in pain perception. Indeed , the very defin1tion of pain presents problems and causes a furore of discussion . Muskey and Spear (1967) described pain as an unpleasant exper1ence associated with damaged tissue, or described in terms thereof , or both. Fordyce (1978 ) adds an extra dimension to this observation asserting that one can only speak of pain when it is accompan1ed by a visual or audible comment on behalf of the patient. The concept of pa1n attracts the attention of everyone who works in medicine, as he comes into contact directly with patients who are suffering pain. Every doctor or member of the ancillary medical services, indeed even the 'man in the street' , is daily confronted with pain sufferers. Science of pain is therefore not confined to one specialty but is to be approached from various disciplines, such as anatomy , neurophysiology, biochemistry, psychology, and philosophy. Members of all these specialities contribute pieces of the puzzle, but none has yet been able to fit them together to give a comprehensible picture of the whole of the pain phenomenon. A multidisciplinary approach to the patient is therefore unavoidable and the function of pain treatment teams, with members drawn frrnn many specialities, is therefore a very suitable approach, particulary when dealing with the chronic pain patient. The possibility of admitting to hospital, and evaluating patients with pain, a possibility that is only to a very limited extent present in the Netherlands, should be firmly built into any health service. This thesis consists of no more than another piece of the puzzle that fits together with other pieces contributed by other workers in this field. It is limited to an anatomical and physiological model in which the central place is not taken by man but by an experimental animal. It is hoped that it may open the way for a new clinical treatment modality for the patient with chronic unbearable pain