Physiology of pain and its

pathway
 Class objectives

At the end of the class students are expected to

• Define pain, nociception and its importance
• Classify different types of pain
• Classify different pain fibers
• Describe pain pathway
• Describe applied aspect of pain
• Describe the modulation of pain
• Describe temperature sensation
Introduction to Pain and Nociception
Pain
An unpleasant sensory and emotional
experience associated with actual or potential
tissue damage, or described in terms of such
damage.
Nociception
The unconscious activity induced by a harmful
stimulus applied to sense receptors.
 Introduction
• Earliest indication of morbidity thus physiologically, it
is a protective phenomenon of the nature.

• Complex phenomenon and includes

– Pain is different from other sensations:

– Non-adapting
– Sounds a warning that something is wrong
– Associated with unpleasant effects
– It is better felt than experienced

Overall it is a gift !!
Classification of pain
 Classification of pain
• Fast pain Vs Slow pain
• Superficial pain Vs Deep pain
How does tissue damage cause pain?
 Nociceptors
• Responsive to noxious/ painful stimuli:
Nociceptors
• Free nerve endings
• Non-adapting nature
• 3 types of stimuli excite pain receptors
• Mechanical:
• Thermal: <5 or >45 0C
• Chemical :
 A-delta mechanical Polymodal C-fibre Nociceptors
Nociceptors
1. Terminals of A-delta fibers 1. Terminals of unmylinated C fibers
2. 2-5 micro met - diameter 2. 0.4-1.2 miro met- diameter
3.
•Conduction
By twospeed
fiber types
:12-30 m/s 3. Conduction speed :0.5-2 m/s
4. Fast fiber type 4. Slow fibre type
5. Responsible for fast type pain 5. Responsible for slow type pain
6. Activated by high intensity 6. Activated by high intensity mechanical, chem
mechanical stimuli and thermal (hot and cold)
7. Glutamate as neurotransmitters 7. Substance P or CGRP as neurotransmitter
8. Follow neospinothalamic tract 8. Follow paleospinothalamic tract
 Paleospinothalamic and
Neospinothalamic Pathways
 Visceral pain
• Poorly localized
• Mainly due to distention of viscera
• Unpleasant and associated with autonomic
symptoms
• Spasm and rigidity is associated in abdominal
muscle
• Radiates to other structures as referred pain.
 Referred pain
• Explained by the following theories
– Dermatome theory
Referred Pain
 Perception and appreciation of pain

• Complete removal of the somatic sensory areas of the

cerebral cortex does not destroy an animal’s ability to
perceive pain.

• Therefore, it is likely that pain impulses entering the

brainstem reticular formation, the thalamus and other
lower brain centers cause conscious perception of pain.

• However it is believed that the cortex plays role in

interpreting pain intensity, localization and
discrimination.
 Modulation of pain
• Gate control theory: In 1960 by Ronald Melzack and
Patric Wall in the from of gate control theory.
• Modulation of pain at spinal cord level by simultaneous
presence of non-noxious stimuli.
 Pain control Mechanism
Endogenous pain control mechanisms/analgesia
systems:
1.Neuronal analgesia system(descending pain
inhibiting)
– Descending Raphespinal Serotonergic pathway

2. Endogenous opioid system

 Important Endogenous Opioids
Opioids collectively called as Endorphins,
Important Endorphins are
Beta-endorphin
Met- and Leu-enkephalin
Dynorphin and alpha-neoendorphin

Opiate receptors are present at many parts of CNS

including dorsal horn cells and at peripheral
nerve terminals of nociceptors.
 How opioids work?
• Opiates such as morphine act pre- and post
synaptically to inhibit the transmission of impulses
from A-delta and C-fibres.

• Increases K+ conductance of post synaptic

membrane leads to post synaptic inhibition.

• Inhibit release of substance P from terminals of

sensory neurons results in pre synaptic inhibition.
Phantom pain