Somatosensory Function, Pain, and Headache

The Somatosensory Component of the Nervous System

Function Provides an awareness of body sensations such as touch, temperature, limb position and pain

Composition
The sensory receptors consist of discrete nerve endings in the skin and other body tissues

Types of Sensory Neurons

General somatic afferent neurons Branches with widespread distribution and with many distinct types of receptors that result in sensations such as pain, touch, and temperature Special somatic afferent neurons (Kinesthetic sensation) Receptors located primarily in muscles, tendons, and joints that sense position and movement of the body General visceral afferent neurons Have receptors on various visceral structures and sense fullness and discomfort

Types of Neurons Found in Sensory Systems

First-order neurons (Dorsal root ganglion): Transmit sensory information from the periphery to the CNS

Second-order neurons
Communicate with various reflex networks and sensory pathways in the spinal cord and travel directly to the thalamus (crossing to opposite side). Third-order neurons Relay information from the thalamus to the cerebral cortex

Four Major Modalities of Sensory Experience

Discriminative touch Temperature sensation Body position Nociperception (Pain sense)

Pathways from the Spinal Cord to the Thalamic Level of Sensation

Discriminative pathway Crosses at the base of the medulla and the anterolateral pathway

Relays information to the brain for perception, arousal, and motor control
The anterolateral pathways Consist of bilateral multisynaptic slow-conducting tracts Provide for transmission of sensory information that does not require discrete localization of signal source or fine discrimination of intensity

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Symptoms of Tissue and Nerve Injury

Hyperalgesia Extreme sensitivity to pain Analgesia The absence of pain from stimuli that normally would be painful

Theories Explaining the Basis for Pain

Specificity theory Pain as a separate sensory modality evoked by the activity of specific receptors that transmit information to pain centers in the forebrain Gate control theory The presence of neural gating mechanisms at the segmental spinal cord level account for interactions between pain and other sensory modalities

Central Processing of Pain Information

Transmission to the somatosensory cortex Pain information is perceived and interpreted Limbic system Emotional components of pain are experienced Brain stem centers Autonomic nervous system responses are recruited

Modulation of the Pain Experience

Endogenous analgesic center in the midbrain Pontine noradrenergic neurons Nucleus raphe magnus in the medulla send inhibitory signals to dorsal horn neurons in the spinal cord

Types of Pain
Cutaneous Sharp, burning pain Origin in skin or subcutaneous tissues Deep More diffuse and throbbing origin in body structures

Types of Pain
Visceral Diffuse and poorly defined Results from stretching, distention or ischemia of tissues Referred Originates at a visceral site but perceived as originating in part of body wall that is innervated by neurons entering the same segment of the nervous system

Acute vs. Chronic Pain

Acute Pain Self limiting pain that lasts less than six months Chronic Pain Persistent pain that lasts longer than six months Lacks the autonomic and somatic responses associated with acute pain

Is accompanied debilitating responses

Non-pharmacologic Interventions for Pain

Cognitive-behavioral Relaxation Distraction Physical agents Heat and cold Stimulus-induced analgesia Acupuncture and acupressure

Pharmacologic Treatment of Pain

Non-narcotic analgesics Opioid analgesics Adjuvant analgesics Placebo response

Types of Neuralgia
Trigeminal neuralgia Manifested by facial tics or grimaces Characterized by stabbing, paroxysmal attacks of pain Pain may be triggered by light touch Postherpetic Neuralgia Develops in from 10% to 70% of patients with shingles The pain occurs in the areas of innervation of the infected ganglia

Phantom Limb Pain

Type of neurologic pain Follows amputation of a limb or part of a limb As many as 70% of amputees experience phantom pain The pain often begins as sensations of tingling, heat and cold, or heaviness, followed by burning, cramping, or shooting pain

Types of Headaches
Migraine headache Tension-type headache Chronic daily headache

International Headache Society Classification of Headaches

Primary headaches Headaches secondary to other medical conditions

Cranial neuralgias and facial pain

Categories of Migraine Headaches

Types of Migraines Migraine without aura Migraine with aura:visual,olfactory,auditory. Subtypes of migraine Ophthalmoplegic migraine Hemiplegic migraine Aphasic migraine Retinal migraine