PAIN PATHWAYS

OBJECTIVES

 INTRODUCTION
 FAST PAIN AND SLOW PAIN
 PAIN PATHWAY STAGES
 SPINOTHALAMIC TRACTS
 PALEOSPINOTHALAMIC PATHWAY
 NEOSPINOTHALAMIC PATHWAY
 PAIN CONTROL IN CNS
 HOW TO ATTEMPT
 INTRODUCTION

 PAIN PATHWAYS:
 The series of neural processes and structures responsible for
transmitting and processing pain signals from various parts of
the body to the brain.
 PAIN PATHWAYS

 There are two main pain pathways involved in the transmission of pain
signals:
 NEOSPINOTHALAMIC PATHWAY:
 The fast pain pathway – (Lateral spinothalamic tract)

 PALEOSPINOTHALAMIC PATHWAY:
 The slow pain pathway – (Anterior spinothalamic tract)
 PAIN PATHWAY STAGES

Transduction:
 specialized sensory nerve endings called nociceptors detect potentially harmful stimuli

Transmission :
 transmission of the pain signal from the peripheral nerves to the ascending pathways leading to
the brain.

Perception:
 The ascending pathways relay the pain signals through several brain regions, including the
thalamus and various areas of the cerebral cortex, such as the somatosensory cortex.
 SPINOTHALAMIC TRACT

 The lateral spinothalamic tract carries information about Fast

pain
 The anterior spinothalamic tract carries information about Slow
pain
 1ST ,2ND AND 3RD ORDER NEURONS

 1ST ORDER NEURON:

 Peripheral regions Stimulus  posterior gray matter( substantia
gelatinosa)
 2ND ORDER NEURON:
 Substantia gelatinosa  Thalamus (ventroposterolateral (VPL) nucleus)
 3RD ORDER NEURON:
 Thalamus  internal capsule  corona radiata Post central gyrus
PATHWAY
PALEOSPINOTHALAMIC PATHWAY –
(SLOW PAIN PATHWAY)
 Transmit slow, dull, and diffuse pain sensations,
 Poorly localized (non specific projection)
 Carried by Slow conducting-C fibers
 TRACT : Anterior/Medial Spinothalamic Tract
 1st, 2nd and 3rd ORDER NEURONS
 NEUROTRANSMITTER: Substance P
 1ST ORDER NEURON:
 Visceral/Deep somatic structures Pain stimulus  Nociceptors  dorsal horn
(lamina 2)
 2ND ORDER NEURON :
 Lamina 2  decussate  Ascend  Anterior spinothalamic tract 
Nonspecific nucleus (Thalamus)
 3RD ORDER NEURON:
 Nonspecific nucleus (Thalamus)  Cerebral cortex +limbic system
PATHWAY
 NEOSPINOTHALAMIC
PATHWAY-
(FAST PAIN PATHWAY)
 Transmit fast pain signals from the body (esp. skin) to the brain
 well-localized
 Carried by A-Delta fibres
 Tract : Lateral spino-thalamic tract
1st, 2nd and 3rd ORDER NEURONS

NEUROTRANSMITTERS: Glutamate

Pain stimulus A-delta nociceptors activate Neurotransmitters
release  1st order neuron activate

1ST ORDER NEURON:

Pain stimulus  Lamina 1 and 5 of dorsal horn

2ND ORDER NEURON :


Lamina 1 and 5  decussate  ascend lateral spinothalamic tract VPL nucleus (specific nucleus)


3RD ORDER NEURON :


VPL nucleus  sensory cortex
PATHWAY
 PAIN CONTROL IN CNS

 THE GATE CONTROL THEORY :

 The theory is based on the idea that there are "gates" in the spinal cord (at substantia
gelatinosa) that control the flow of pain signals from the peripheral nervous system
(such as pain receptors in the skin, muscles, and organs) to the brain.
 These gates can either allow pain signals to pass through or block their transmission.
 These gates close by rubbing , massaging , pressure etc, once the non-painful tactile
stimulation cease, the gates open again
 PAIN CONTROL IN CNS

 THE ANALGESIA SYSTEM:

 Body's natural mechanisms that are involved in reducing or
blocking the perception of pain
 Enkephalins , Endorphins and Serotonin serve as
neurotransmitters in analgesic system and inhibit the release of
substance P
 HOW TO ATTEMPT ?
 QUESTION: Give a brief account of pain pathway.
( 2013,2016,2017,2018)
 Introduction
 2 pain pathways
 Diagram
 Short course