• Nociceptive Pain-results from tissue damage

• localized, throbbing
• inflammatory chemicals are released from immune cells
• act on receptors on bare nerve terminals of unmyelinated c-fibers
• Responds to NSAIDS & opiods
• ex: NSAIDS block protaglandin synthesis from arachidonic acid
• Mild forms: spained ankle, infected cut
• Severe forms: rheumatoid arthritis, tumor, bone fracture
• Neuropathic pain-damage to nerves in the peripheral or central nervous system
• burns
• pain felt along distribution of nerves
• allydynia common
• Resistant to NSAIDS or opiods
• Antidepressants and anticonvulsanta are more effective
• Examples: Post herpetic neuralgia following shingles, diabetic neuropathy, entrapment
neuropathy
• Anterolateral System-pain, temperature, and crude touch sensation (when dorsal column is cut,
will still have crude touch sensation due to anterolateral system)
• Lesion reduces pain and temperature sensation
• not fine discrimination
• neurons terminate at different spinal cord levels

• Input: noxious stimulus to nocirecptors

• chemical, mechanical or thermal

• occurs at free endings of nociceptors

• found in skin, muscle, joints, bone and internal visceral organs

• Alpha, gamma myelinated: mediate first pain

• immediate, short-lasting, pricking quality

• C fibers (unmyelinated): second pain: delayed, long lasting, burining

• Nociceptors enter spinal cord at lateral dorsal horn

• terminate in LaminaI/II, lateral edge of spinal cord (lamina V) and central canal
(X)

• chemical synapse involves glutamate and substance P

• Second order nuerons: cross spinal cord w/in 2-3 segments

• ascend in anterolateral quadrant tracts (ventral lateral faniculus)

• on contralateral side (opposite of dorsal column afferents)

• Lesion causes contralateral loss of pain and temperature

• complete by 2-3 segments below lesion

• Central cord syndrome:-hole in cord

• Ex: springomyelia-cysts in cord

 • Cuts crossing anterolateral axons (occurs in cervical segments)

• pain and temp deficiets in dermatomes of affected spinal levels

• bilateral

• spares dorsal columns and fine discrimintation/tactile

sensation

• 3 termination pathways:

• Spinothalamic Tract (terminates in thalamus)

• Majority of secondary ascending fibers terminate in thalamus

• Best known pathway

• *mediates descrimiative aspects of pain and temperature

• location and intensity of noxious stimulus

• When u step on a tack, allows u to realize something sharp is

puncturing foot

• spinothalamic axons terminate in:

• 1) VPL nucleus and project to ipsilateral SI cortex

• Axons from dorsal column and spinothalamic synapse in two

different nuclei

• Somatotopically organized

• 2) Cental Laterl Nucleus of thalamus (intralaminar nucleus)

• 3rd order axons project to limbic cortex

• Not somatotopically organized

• Fxn of thalamus:

• procces pain and temperature and intiates limbic responses

• Relay information to SI cortex via the internal capsule's corona

radiata

• Spinoretucular Tract (spinal cord to retucular formation):

• Medulla and Pons

• axons then relay info to the thalamus and diffusely to cortex

• *mediates changes in level of attention to painful stimuli; invoved in

forebrain arousal and affective response to noxious stimulus
 • "ouch that hurts"

• spinomesencephalic Tract:

• Terminate in Midbrain in superior colliculus and periaqueductal gray matter

• *Stimulates the central modulation of pain; involved in stimulation

descending control pathways that project pack down to spinal cord

• "aw..that feels better"

• Somatosensory cortex-helps localize stimuls on body

• Cingulate Gyrus-part of limbic system

• involved in processing the emotion component of pain of fear, anxiety,

depression, anger attention

• Insular Cortex: Internal, autonomic state of body

• Stimulates heart, rapid breatying, dry bouth

• Integrates sensory information

• Lesions=asymbolia-patients perceive noxious stimuli as painful and can

localize it but display inappropirate emotional response

• ex: laugh, indifferent

• Central Control of Pain: inhibit descending pathway

• Reticular formation has prominent role
• Neurons with cell bodies in Peiaquductal Gray (midbrain)
• send axons down to the raphe nuclei in medulla and locus ceruleus of pons
• these send axons to spinal cord where they synapse on inhibitory
interneurons or on spinothalmic tract nuerons
• supresses transmission of noxious information toward thalamus and
cortex
• Referred Pain
• Visceral pain is referred to somatic tissues
• Area pain is referred corresponds to the dermatome of its spinal segment
• Visceral fibers coverge on same second order spinotahlamic tract neruons and brain
interprets spinothalamic tract impuses as stimuli from the somatic region of the
dermatome