Pain pathways

What is pain?
Pain is and unpleasant sensory that provides body with the warning of potential or actual injury.

Nociceptors are the specialized sensory receptors responsible for the detection of
painful(noxious) stimuli, transforming the stimuli into electrical signals, which are then
conducted to the central nervous system.

2 main types of fibers that carry noxious sensory information:

Anerves are small in diameter and lightly myelinated which respond to mechanical and thermal
stimuli. They carry rapid, sharp pain and are responsible for the initial reflex response to acute
pain(Reddi,Curran,Stephens,2013).

C fibres are smallest type of primary afferent fibers, which are unmyelinated.
Hence they have slow conduction. Therefore C fibre activation leads to slow, burning pain.
C fibers respond to chemical, mechanical and thermal stimuli. (Reddi,Curran,Stephens,2013).

Ascending pathway

Pain/noxious signals from the peripheral nerves travel to the spinal cord. Within the dorsal horn
of spinal cord, electrical signals from the first order neurons are transmitted to the second order
neurons by release of neurotransmitters such as Glutamate(fast transmission) and substance
P(slow transmission). Signals are then passed up the spinal cord to the brain via 3 ascending
pathways(Wunder).
Lateral spinothalmic tract responsible for pain localization in posteriolateral nucleus of
thalamus.
Medial spinothalamic tract, projects unpleasant emotional perception of pain in the medial
thalamus.
Spinalreticular(brainstem) pain pathway responsible for arousal and autonomic responses to
pain.

Descending /inhibition pathway

Descending pathways from the somatosensory cortex travel through the medulla and spinal
cord, project to the dorsal horn to inhibit the ascending pain pathways, producing analgesia(pain
relief). Two main areas of the brain responsible for descending pain pathway, periaqueductal
grey (PAG) and rostral ventromedial medulla (RVM) of the brain, contain high concentrations of
opioid receptors and endogenous opioids, which helps explain why opioids are analgesic
(Reddi,Curran,Stephens,2013).These pathways utilise noradrenaline and serotonin as
neurotransmitters. Also gamma-aminobutyric acid (GABA) and glycine are important
neurotransmitters acting at inhibitory interneurons.

References:
Reddi D,Curran N, Stephens R, (2013)An introduction to pain pathways and mechanisms,
available from:
<https://www.ucl.ac.uk/anaesthesia/StudentsandTrainees/PainPathwaysIntroduction>
[ 16 august 2014]
Wunder L, Inroduction and overview of neuropathways, available from:
<http://c.ymcdn.com/sites/www.pana.org/resource/resmgr/docs/wunder,_linda__neuropath_s
pr.pdf > [15 august 2014]