Descending control of spinal nociception is a major determinant of acute and chronic pain. The periaqueductal grey (PAG) is a major source of descending control and plays a critical role in co-ordinating functions essential for survival. These include cardiovascular regulation, sensory modulation and a variety of emotionally-related behaviours, including highly characteristic defensive responses triggered by aversive (fearful) or painful events. To date, attention has focused on mechanisms underlying autonomic and sensory aspects of PAG function, and polysynaptic descending pathways that modulate autonomic outflow and sensory processing at the level of the spinal cord are well described. In contrast, much less is known about the neural pathways and mechanisms that link PAG activity to distinct patterns of motor response; and whether descending control of sensory signals by the PAG extends to those signals that feed into (and can modify) supraspinal motor circuits that co-ordinate movement. This is a significant gap in our knowledge given the survival value of initiating, adapting or maintaining co-ordinated motor responses in aversive or threatening situations (‘active coping’; generated by output from the dorsolateral/lateral (dl/l) PAG), or of depressing motor activity during recuperation or chronic pain (‘passive coping’; generated by output from the ventrolateral (vl) PAG). The presentation will review current understanding of descending control of spinal nociception from the PAG in the context of its behavioural and clinical significance. It will then focus on recent studies that have investigated the descending control of sensory, in particular nociceptive, inputs to the cerebellum (the largest sensorimotor structure in the brain) and how this relates to movement control.