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Neurophysiology of Pain
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• 1/3 of adults treated for cancer and 2/3 with advanced disease
experience pain.
Dendrites which receive signals Nerve ending that connect to other cells.
from other nerve cells Also act of receptors for stimuli
Schwann Cell
Myelin Sheath
Cell nucleus
Nerve Cell-to-Nerve Cell Communication
The Synapse.
Basic Steps in Synaptic Transmission
Synaptic Transmission
Depolarization of
membrane potential
(Generator potential)
Action potential
TRP Channels
Silverthorn
Transmission of nociceptive signals from the
periphery to the brain
nociceptive
stimulus
Silverthorn
A delta (d) and C nerve fibers
Trigeminal pathway
Neuroscience Purves et al.
Unpleasant Quality and Autonomic Affective
Motivational Pathway for Pain
Spinal cord
Amygdala Insula
(involved in fear) Anterior cingulate gyrus
Hypothalamus Frontal lobe
(autonomic
responses, e.g
sweating)
Brain areas involved in processing of
nociceptive signals
Midbrain
Frontal cortex
The anterior cingulate and insula cortex are
activated in human subjects …
… in connection with an intense burning sensation
following hand contact with the thermal grill.
Adapted from Craig et al. 1994, 1996. From Principles of Neural Science, Kandell et al.
Control of Pain Perception
• There is difference between the objective and subjective
aspects of injury and pain.
• Despite similar injury, people can differ in how
much pain they feel.
• Depending on the context, pain may not be felt despite injury,
e.g. battlefield injury, during intense sports.
• This suggests that there is a physiological mechanism that
controls the transmission of nociceptive signals to the brain
or modifies the interpretation of pain.
• The pain control system can also explain
the placebo effect.
Pain Modulation
Pathway
Nerve signals are sent form the somatic
sensory cortex and hypothalamus to the
periaqueductal gray matter (PAG).
http://wikidoc.org/images/f/fe/Gate_control_A_firing.png
Clinical Application
Transcutaneous Nerve
Stimulation (TENS) is based
on the Gate Control Theory.
Nerves of the innocuous
sensory system are
stimulated and they in turn,
inhibit transmission of
nociceptive stimuli in the
spinal cord.
Abnormalities of Pain System
Phantom Pain
Neuroscience. 2nd edition. Purves D, Augustine GJ, Fitzpatrick D, et al., editors. Fig 25.14
Referred Pain
• Often originates from a visceral organ.
• May be felt in a part of the body remote from the site
of the pathology.
• The mechanisms may be spinal convergence of
visceral and somatic afferent fibers on spinothalamic
neurons.
• Common manifestations: cutaneous and deep
hyperalgesia, tenderness, muscular contractions.
Pain sensation referred from
visceral organs … … to another part of the body
surface
Purves et al.
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