The phrase "altered descending" is correct and usable in written English.
It can be used in contexts where something is modified or changed in a downward direction or order, such as in music, data analysis, or visual representation.
Example: "The altered descending scale created a unique sound that captivated the audience."
Alternatives: "modified descending" or "changed downward".
This model may have special value in understanding altered descending pain modulation after TBI and polytrauma.
Several possible non-mutually exclusive causes could be responsible for this: i) dysfunctioning descending aminergic, especially dopaminergic, control [164, 165], ii) malfunctioning hypothalamo-trigeminal control [166], and iii) altered descending opiatergic pain control system [153, 154].
This may be due to abnormal sensory input and/or altered descending inhibition from the supraspinal dopaminergic system.
We discuss two ways in which these changes may be maintained, namely neuroimmune activation and altered descending pain control, driven from the hypothalamic/pituitary/adrenal (HPA) axis.
These results indicate that central mechanisms e.g., central sensitization and altered descending control, are involved in chronic neck-shoulder pain since sensory hypersensitivity was found in areas distant to the site of clinical pain.
Peripheral nerve sprouting and dorsal horn central sensitization, disinhibition and neuroimmune priming are discussed in relation to the increased pain and hyperalgesia, while altered descending pain control systems driven, in part, by changes in the stress/HPA axis are discussed in relation to the widespread hypoalgesia.
These changes may then alter descending controls (Fig. 2).
Bupivacaine could be acting via (1) reducing ectopic firing activity in primary afferent fibers, (2) reducing central sensitization, and/or (3) altering descending facilitation, which is known to regulate the maintenance of pain rather than its onset [ 8, 12].
The effect was attributed to the drug's ability to increase acetylation at the hypoacetylated Gad2 promoter, enhancing GAD65 expression and γ-aminobutyric acid (GABA) inhibition, and thus altering descending pain modulation [ 84].
In the contour condition there were eight different standard melodies (presented on 80% of trials), each consisting of five notes all ascending in pitch, and the corresponding deviant melodies (20%) were altered to descending on their final note.
Thus, the net result of activation, of nociceptive intracranial dural structures, and altered (dysfunctional) descending modulation of central trigeminovascular neurons, in headache, is due to an altered perception of craniovascular inputs, and also a generalized increase in sensitivity of other sensory inputs, via the modulation by these same brainstem nuclei.
