Somatic Sensation & Pain

Prof. Yasmeiny Yazir

dr. Nuraiza Meutia

Dept. Fisiologi
FK USU
From Sensation to Perception
 Survival depends upon sensation and
perception
 Sensation is the awareness of changes in
the internal and external environment
 Perception is the conscious interpretation
of those stimuli
Organization of the Somatosensory
System
 Input comes from exteroceptors,
proprioceptors, and interoceptors
 The three main levels of neural
integration in the somatosensory
system are:
 Receptor level – the sensor receptors
 Circuit level – ascending pathways
 Perceptual level – neuronal circuits in
the cerebral cortex
Pathway for
somatic sensation
Processing at the Receptor Level
 The receptor must have specificity for
the stimulus energy
 The receptor’s receptive field must be
stimulated
 Stimulus energy must be converted into
a graded potential
 A generator potential in the associated
sensory neuron must reach threshold
Simple Receptors: Unencapsulated

Table 13.1.1
Simple Receptors: Encapsulated

Table 13.1.2
Simple Receptors: Encapsulated

Table 13.1.3
Simple Receptors: Encapsulated

Table 13.1.4
Processing at the Circuit Level
 Chains of three neurons (first-, second-, and
third-order) conduct sensory impulses upward to
the brain
 First-order neurons – soma reside in dorsal root
or cranial ganglia, and conduct impulses from the
skin to the spinal cord or brain stem
 Second-order neurons – soma reside in the
dorsal horn of the spinal cord or medullary
nuclei and transmit impulses to the
thalamus or cerebellum
 Third-order neurons – located in the
thalamus and conduct impulses to the
somatosensory cortex of the cerebrum
Processing at the Perceptual Level
 The thalamus projects fibers to:
 The somatosensory cortex
 Sensory association areas
 First one modality is sent, then those
considering more than one
 The result is an internal, conscious image
of the stimulus
PAIN
 Pain is an unpleasant sensory and emotional
experience associated with actual or potential tissue
damage or described in terms of such damage.
(Pain, Suppl 3, 1986)
 Function : warning that something is wrong
 Cause :
 Physiologic / acute pain
 Pathologic :
1. inflammatory pain
2. neuropathic pain
 Neuropathic pain arises from disordered, ectopic
nerve signals. It is burning or shocklike pain.
 Classic cases are post-stroke pain and tumor
invasion of the brachial plexus.
Receptors & Pathway
 Receptors : naked nerve endings
 Categories of pain receptors :
1. Mechanical nociceptors (cutting, crushing,
pinching)
2. Thermal nociceptors (temp.extremes)
3. Polymodal nociceptors (irritating chemicals)

 Fibers :
1. Myelinated Aδ (2-5 μm)
2. Unmyelinated C (0.4-1.2 μm)
 Pathway
 Pain receptors transmit
stimuli through sensory
nerves into the dorsal horn.
 These impulses synapse in
the dorsal horn, cross the
cord, and ascend by either
the neospinothalamic tract
(fast pain) or the
paleospinothalamic tract
(slow/dull pain).
 The neospinothalamic tract
ascends to the thalamus
(pain sensation) and
proceeds further to the
cortex (precision and
discrimination).

 The paleospinothalamic
tract ascends and branches
into the brain stem (pons
and medulla) and limbic
system.
Function of the Reticular Formation, Thalamus,
and Cerebral Cortex in the Appreciation of Pain
 Pain impulses entering the brain stem reticular
formation, the thalamus, and other lower brain
centers cause conscious perception of pain.

 This does not mean that the cerebral cortex

has nothing to do with normal pain
appreciation;
 However, it is believed that the cortex plays an
especially important role in interpreting pain
quality, even though pain perception might be
principally the function of lower centers.
Characteristic of Pain
Fast Pain Slow Pain

Occurs on stimulation of Occurs on stimulation of

mechanical & thermal polymodal nociceptors
nociceptors
Carried by myelinated A-delta Carried by unmyelinated C
fibers fibers
Produces sharp, prickling Produces dull, aching, burning
sensation sensation
Easily localized Poorly localized

Occurs first Occurs second; persist for

longer time; more
unpleasant.
Deep Pain
 The deep structures is relative deficiency
of Aδ fibers.
 Poorly localized, nauseating, and
frequently associated with sweating &
changes in blood pressure.
Muscle spasm & Rigidity

 Visceral pain can initiates reflex

contraction of nearby skeletal muscle.
Usually in the abdominal wall → rigid.

Muscle Spasm as a Cause of Pain.

 This pain probably results from the direct
effect of muscle spasm in stimulating
mechanosensitive pain receptors, or
 effect of muscle spasm to compress the
blood vessels and cause ischemia.
• Referred Pain
– Pain that is present in an area
removed/distant from its point of origin.
– The area expressing the referred pain is
supplied by the same spinal segment as the
actual pain site.
 Pain Suppression(“Analgesia”) System
in the Brain and Spinal Cord
• Several transmitter substances are
involved in the analgesia system;
especially are enkephalin and serotonin.
• Many nerve fibers derived from the
periventricular nuclei and from the
periaqueductal gray area secrete
enkephalin at their endings.
• Thus, the endings of many fibers in the
raphe magnus nucleus release
enkephalin .

• Fibers originating in this area send

• The serotonin causes
local cord neurons to
secrete enkephalin as
well.
• The enkephalin is
believed to cause both
presynaptic and
postsynaptic inhibition
of incoming type C and
type Ad pain fibers
where they synapse in
the dorsal horns.