Gate control begins in the primary afferent

The primary afferent nociceptor as pattern generator

One of the most important advances in our understanding of the pain experience was the introduction of the 'gate control' theory which stimulated analysis of activity pattern in nociceptive pathways and its modulation. Advances in cellular and molecular biology have recently begun to provide detailed information on the mechanisms of stimulus transduction within primary afferent nociceptors as well as mechanisms that modulate the transduction process. From these new insights into the sensory physiology of the nociceptive nerve ending emerges a concept of the primary afferent as the first site of pattern generation in the nociceptive pathway, in which dynamic tuning of gain in the mosaic of inputs to individual primary afferents occurs. The electrical properties of the nociceptor membrane that converts the generator potential to a pattern of action potentials is also actively adjusted. Our present understanding of the intracellular mechanisms that modulate the pattern of activity in nociceptive primary afferents is summarized, and implications for future efforts to unravel the meaning of patterning in nociceptor activity are discussed.