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Numerous systems within the central nervous system can act to increase or decrease incoming pain messages. Endogenous descending inhibitory and facilitatory control pathways, which originate in brain stem and higher brain areas and project to and terminate in the dorsal horn of the spinal cord, can alter spinal outputs and pain levels. This so-called top–down processing is a key current area of justifiably fervent investigative research; this is remarkable as 40 years have elapsed since the first set of studies were performed that described supraspinal modulation of spinal transmission.