Pain: Spinal Sensory
Pathway
A series of neurons from sensory receptor neurons in the
periphery to the contralateral cerebral cortex
Nociceptive pathways
• Trigeminal and dorsal root ganglia
give rise to high-threshold Aδ and C
fibers innervating peripheral tissues.
• These specialized primary afferent
neurons, also called nociceptors,
transduce noxious stimuli into action
potentials and conduct them to the
dorsal horn of the spinal cord
Anterolateral system
• Distributed within the lateral and ventral spinal columns
• Contain sets of axons that synapse in separate brain regions:
– Spinothalamic tract
– Spinoreticular tract
– Spinomesencephalic tract
Spinothalamic tract
• Carries information important for pain, itch, and temperature sensations to
three major regions of the contralateral thalamus:
– Ventral posterior lateral nucleus- transmits information to the primary somatic sensory
cortex.
– Ventromedial posterior nucleus- transmit information to the posterior insular cortex,
important in stimulus perception.
– Medial dorsal nucleus of the thalamus- transmits information to the anterior cingulate
gyrus, a cortical region important in emotions.
• The insular and anterior cortical regions are collectively important in
behavioral and autonomic responses to pain, temperature, and itch
sensations and in the emotions and memories that these stimuli evoke
Spinoreticular tract
• Transmits sensory information to neurons in the reticular formation of the
pons and medulla, and many of these neurons project to the intralaminar
thalamic nuclei.
• The reticular formation
– one mean by which pain signals from the lower body reach the cerebral cortex.
– origin of the descending analgesic pathways.
Spinomesencephalic tract
• Terminates in the midbrain tectum and periaqueductal gray matter.
• Projections to the periaqueductal gray matter play a role in the feedback
regulation of pain transmission in the spinal cord.
– Neurons in the periaqueductal gray matter excite neurons in the raphe nuclei and reticular
formation, which inhibit pain transmission in the spinal cord.
• Projections to the tectum integrates somatic sensory information with
vision and hearing for orienting the head and body to salient stimuli
Thalamus
• Ventromedial posterior nucleus
– projects to the insular cortex.
– major site for processing information from spinothalamic tract neurons in the spinal cord.
• Medial dorsal nucleus
– also receives spinothalamic input and projects to the anterior cingulate gyrus.
• The ventromedial posterior and medial dorsal nuclei are thought to play
roles in the affective and motivational aspects of pain and in the memory
of painful stimuli
Limbic and Insular Areas Contain the Cortical
Representations of Pain, Itch, and Temperature
Sensations
• The primary somatic sensory cortex can become activated with a painful
stimulus, but this activation is inconsistent and depends on complex
factors, such as the context in which the stimulus is presented or the
person's expectation of pain.
Insular cortex & Anterior cingulate gyrus
• Consistently and intensely activated by a painful stimulus.
• The insular cortex has direct projections to the limbic system, which
comprises the cortical and subcortical circuitry for emotions.
• Limbic system structures that receive information about painful stimuli
include the amygdaloid complex and limbic association cortex.
• The anterior cingulate gyrus, which is part of the limbic system,
corresponds approximately to Brodmann's area 24
• The insular and anterior cingulate areas are thought to be important in the
affective and reactive components of pain.
(1) Spinal cord
(2) medulla
(3) pons
(4) cerebellum
(5) midbrain,
(6) diencephalon, which contains the hypothalamus and thalamus
(7) cerebral hemispheres, which contain the basal ganglia, amygdala, hippocampal formation, and cerebral
cortex.
• The external surface of the cerebral cortex is characterized by gyri (convolutions), sulci (grooves), and
fissures (particularly deep grooves).
• The cerebral cortex consists of four lobes: frontal, parietal, temporal, and occipital.
• The insular cortex is buried beneath the frontal, parietal, and temporal lobes.
• The corpus callosum, a commissure, interconnects each of the lobes.
• Three sets of structures lie beneath the cortical surface: the hippocampal formation, the
• amygdala, and the basal ganglia.
• The limbic system comprises a diverse set of cortical and subcortical structures.
• The olfactory bulbs lie on the orbital surface of the frontal lobes.
