SOMATOSENSORY SYSTEM

AND PAIN

DR. SIMON ELEKU

 NERVOUS SYSTEM OVERVIEW
• The nervous system is the body’s
electrical system
• It is broadly divided into two parts:
 Central nervous system = CNS (brain and spinal
cord)
 Peripheral nervous system = PNS (nerves and
ganglia)
• The nervous system performs three
important functions:
 Sensory input
 Integration
 Motor output
NERVOUS SYSTEM ORGANIZATION

• The PNS is divided into three parts:

 The somatic nervous system (SNS) = “voluntary” = “skeletal muscles”
 The autonomic nervous system (ANS) = “involuntary” = “smooth muscles”
 The enteric nervous system (ENS) = “brain of the gut” = “GI tract NS”
• All communicate with the CNS
NERVOUS SYSTEM ORGANIZATION

• The ANS is divided into two parts:

 The sympathetic nervous system = “fight or flight”
 The parasympathetic nervous system “rest and digest”
OVERVIEW OF NEURAL TRANSMISSION
• Neurons receive input from other
neurons, especially through their
dendrites
• Neurons send output in the form of an
action potential (AP) along their axons
• When an AP arrives at the synaptic end
bulb of the presynaptic neuron,
neurotransmitter (NT) is released
• NT’s bind to receptors on the
postsynaptic neuron, which often opens
ion channels
• The flow of ions causes a an electrical
current in the membrane
• These graded potentials can be either
 Positive/Depolarization/Excitatory
 Negative/Hyperpolarization/
Inhibitory
• The graded potentials are summed in
the axon hillock
• If the sum exceeds threshold, then the
postsynaptic neuron will fire an action
potential
• When the action potential reaches the
synaptic end bulb, NT’s are released,
and the cycle begins again
 CLASSIFICATION OF SENSORY RECEPTORS
1. General senses: somatic and visceral.
i. Somatic: tactile and proprioceptive sensations ,thermal, pain, etc.
ii. Visceral: provide information about conditions within internal organs.

2. Special senses- smell, taste, vision, hearing and equilibrium or balance.

 CLASSIFICATION OF SENSORY RECEPTORS
BASED ON THE LOCATION
• Exteroceptors: sensory systems inform CNS about the external
environment
• Telereceptors (vision, audition, olfaction)
• contact receptors (taste [gustation], touch)

• Interoceptors: inform about the internal environment

• Proprioceptors: a special group informing about the position of the body

and the body parts
SUMMARY OF SENSORY RECEPTORS
NERVOUS SYSTEM TISSUE: GRAY &
WHITE MATTER

• Gray matter consists of cell bodies, unmyelinated axons, dendrites, and glial cells
• White matter consists of myelinated axons
NERVOUS SYSTEM TISSUE: GRAY & WHITE MATTER
 THE NEURONS OF THE SPINAL CORD
FORM NEURAL TRACTS
• In a spinal cord cross-section, the
axon pathways appear as “white
matter” (myelin sheaths make the
axons white) surrounding the “gray
matter” of the neuron cell bodies.
• The white matter forms three columns
(funiculi) on each side of the spinal cord:
the posterior (dorsal), anterior (ventral),
and lateral columns.
• Distinct neural tracts run through these three
columns.
• Each tract consists of axons that carry similar
types of signals in the same direction.
• Ascending tracts carry sensory input up
to the brain.
• Descending tracts send motor
commands downward to the body.
CROSS SECTION OF THE SPINAL CORD

Cross section of the

spinal cord, showing
the anatomy of the
cord gray matter and
of ascending sensory
tracts in the white
columns of the spinal
cord.
 SOMATIC SENSORY PATHWAYS
• The somatosensory system is a network of neural structures in the peripheral and
CNS that collects, transmits & integrates information (perceptions) from the surface
of the skin and of the internal organs & cavities.

• The ascending tracts refer to the neural pathways by which sensory information
from the peripheral nerves is transmitted to the cerebral cortex. Also known as
somatosensory pathways or systems. The major target being the post-central gyrus.
• Functionally, the ascending tracts can be divided into the type of information they
transmit – conscious or unconscious:
1. Conscious tracts – comprised of the dorsal column-medial lemniscal pathway and the
anterolateral system.
2. Unconscious tracts – comprised of the spinocerebellar tracts.
 SOMATIC SENSORY PATHWAYS
Tracts (pathways) in the spinal cord carries information
• The somatosensory system consists of two, anatomically and
physiologically separate parts:
• Posterior column pathway (dorsal column medial
lemniscus pathway = DCML)
• Anterolateral (Spinothalamic ) pathway
• Sensations that originate in different areas of the body can be
distinguished because sensory neurons from each body
region synapse in a specific brain region.
• Note: the sensory impulses are transmitted to the CNS by afferent
neurons of different sizes & myelination
 SOMATIC SENSORY PATHWAYS
• Dorsal (Posterior)Columns
• Fasciculus Gracilis
• Fasciculus Cuneatus
• Lateral Column
• Lateral Spinothalamic tract
• Dorsal Spinocerebellar tract
• Ventral Spinocerebellar tract
• Spinotectal tract
• Spinoreticular fibers
• Spino-olivary pathway
• Spinovestibular tract
• Ventral Column
• Anterior Spinothalamic tract
THE ORGANIZATION OF SENSORY PATHWAYS

First, second, and third order neurons

• First order neurons

• Sensory neurons that deliver sensory information to the CNS
(spinal cord or brain)
• Second order neurons
• First order neurons synapse on these in the brain (medulla) or
spinal cord
• Third order neurons
• Found in the thalamus
• Second order neurons synapse on these
 POSTERIOR (DORSAL) COLUMN –
MEDIAL LEMNICUS PATHWAY
Posterior column pathway carries sensation of:
1. Highly localized touch (tactile or fine touch), two-point
discrimination
2. Discriminative touch (astereognosis)
3. Pressure
4. Vibration
5. Position, proprioception
 POSTERIOR (DORSAL) COLUMN PATHWAY
• The dorsal column-medial
lemniscal pathway (DCML) carries the
sensory modalities of fine touch (tactile
sensation), vibration and proprioception.
• Its name arises from the two major
structures that comprise the DCML. In
the spinal cord, information travels via
the dorsal (posterior) columns. In the
brainstem, it is transmitted through
the medial lemniscus.
• There are three groups of neurones
involved in this pathway – first, second
and third order neurones.
 POSTERIOR (DORSAL) COLUMN PATHWAY
First Order Neurones
• The first order neurones carry sensory
information regarding touch, proprioception or
vibration from the peripheral nerves to the
medulla oblongata. There are two different
pathways which the first order neurones take:
• Signals from the upper limb (T6 and above) –
travel in the fasciculus cuneatus (the lateral part
of the dorsal column). They then synapse in
the nucleus cuneatus of the medulla oblongata.
• Signals from the lower limb (below T6) – travel
in the fasciculus gracilis (the medial part of the
dorsal column). They then synapse in the
nucleus gracilis of the medulla oblongata.
POSTERIOR (DORSAL) COLUMN PATHWAY
Second Order Neurons
• The second order neurons begin in the cuneate
nucleus or gracilis. The fibres receive the information
from the preceding neurons, and delivers it to the
third order neurons in the thalamus.
• Within the medulla oblongata, these
fibres decussate (cross to the other side of the CNS =
internal arcuate fibres). They then travel in the
contralateral medial lemniscus to reach the thalamus.
Third Order Neurons
• Lastly, the third order neurons transmit the sensory
signals from the thalamus to the ipsilateral primary
sensory cortex of the brain. They ascend from the
ventral posterolateral nucleus of the thalamus, travel
through the internal capsule and terminate at the
sensory cortex.
 POSTERIOR (DORSAL) COLUMN PATHWAY
• The dorsal
column–medial
lemniscal
pathway for
transmitting
critical types of
tactile signals.
Projection of the
dorsal column–
medial lemniscal
system through
the thalamus to the
somatosensory
cortex.
BRAIN FUNCTION: FUNCTIONAL AREAS OF THE
CEREBRAL CORTEX
FRONTAL LOBE PARIETAL LOBE
Primary motor cortex Primary somatic sensory cortex
Skeletal Motor association
muscle area (premotor cortex) Sensory association area
movement

OCCIPITAL LOBE

Visual
Prefrontal association
association area Vision
area
Visual
cortex

Taste Gustatory cortex

Smell Olfactory cortex Auditory Auditory

cortex association area
Hearing
TEMPORAL LOBE
Figure 9-15
Structurally distinct
areas, called
Brodmann’s areas, of
the human cerebral
cortex. Note specifically
areas 1, 2, and 3, which
constitute primary
somatosensory area I,
and areas 5 and 7,
which constitute
the somatosensory
association area.
 BRAIN FUNCTION: FUNCTIONAL AREAS OF THE
CEREBRAL CORTEX

AREAS:
I AND
II.
HOMUNCULUS - MOTOR AND SENSORY
 POSITION SENSES
1. Static position sense, which means conscious perception of the
orientation of the different parts of the body with respect to one
another,
2. Rate of movement sense, also called kinesthesia or dynamic
proprioception.

• Position Sensory Receptors Processing of Position Sense Information in the

Dorsal Column–Medial Lemniscal Pathway
• Sensory information is sent to cerebellum & cerebral cortex
• signals project from muscle, tendon, joint capsules & hair cells in
the vestibular apparatus
MUSCLE
SPINDLES

• Specialized intrafusal muscle fibers enclosed in a CT capsule and innervated by

gamma motor neurons
• Stretching of the muscle stretches the muscle spindles sending sensory information
back to the CNS
• Spindle sensory fiber monitor changes in muscle length
• Brain regulates muscle tone by controlling gamma fibers

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 GOLGI TENDON ORGANS
• Found at junction of tendon &
muscle
• Consists of an encapsulated
bundle of collagen fibers laced
with sensory fibers
• When the tendon is overly
stretched, sensory signals head for
the CNS & resulting in the
muscle’s relaxation

29
ANTEROLATERAL (SPINOTHALAMIC )
PATHWAY
• Anterolateral pathway provide conscious sensations of:
• poorly localized (crude) touch
• Pressure
• Pain
• Temperature
• Anterolateral pathway includes:
• Lateral spinothalamic tract – relays information
concerning pain and temperature
• Anterior spinothalamic tract – carry (crude) touch,
pressure sensation.
• Much like the DCML pathway, both tracts of the
anterolateral system have three groups of neurons
 ANTEROLATERAL SYSTEM
(SPINOTHALAMIC PATHWAY)
First Order Neurones
• The first order neurones arise from the
sensory receptors in the periphery. They
enter the spinal cord, ascend 1-2 vertebral
levels, and synapse at the tip of the dorsal
horn – an area known as the substantia
gelatinosa.
 ANTEROLATERAL SYSTEM
(SPINOTHALAMIC PATHWAY)
Second Order Neurones
• The second order neurons carry the sensory information from the
substantia gelatinosa to the thalamus. After synapsing with the first
order neurones, these fibres decussate (anterior commissure)
within the spinal cord, and then form two distinct tracts:
• Crude touch and pressure fibres – enter the anterior spinothalamic tract.
• Pain and temperature fibres – enter the lateral spinothalamic tract.
• Although they are functionally distinct, these tracts run alongside
each other, and they can be considered as a single pathway. They
travel superiorly within the spinal cord, synapsing in the thalamus.
Third Order Neurons
• The third order neurons carry the sensory signals from the
thalamus to the ipsilateral primary sensory cortex of the brain. They
ascend from the ventral posterolateral nucleus of the
thalamus, travel through the internal capsule and terminate at the
sensory cortex.
Anterior and
lateral divisions
of the
anterolateral
sensory pathway.
CHARACTERISTICS OF TRANSMISSION
IN THE ANTEROLATERAL PATHWAY
1. The velocities of transmission are only one third to one half those in
the dorsal column–medial lemniscal system, ranging between 8 and
40 m/sec;
2. The degree of spatial localization of signals is poor;
3. The gradations of intensities are also far less accurate, with most of
the sensations being recognized in 10 to 20 gradations of strength,
rather than as many as 100 gradations for the dorsal column system;
4. The ability to transmit rapidly changing or rapidly repetitive signals
is poor
 ANTEROLATERAL SYSTEM
(SPINO-CEREBELLAR PATHWAY)
• The DCML and the anterolateral tracts transmit conscious
sensations, such as pain, touch and temperature. The
tracts that carry unconscious proprioceptive information
are collectively known as the spinocerebellar tracts.
Although we cannot physically acknowledge these signals,
they help our brain co-ordinate and refine motor
movements.
• They transmit information from the muscles to the
cerebellum. Within the spinocerebellar tracts, there are
four individual pathways:
• Posterior spinocerebellar tract – Carries proprioceptive
information from the lower limbs to the ipsilateral
cerebellum.
• Cuneocerebellar tract – Carries proprioceptive information
from the upper limbs to the ipsilateral cerebellum.
• Anterior spinocerebellar tract – Carries proprioceptive
information from the lower limbs. The fibres decussate twice
– and so terminate in the ipsilateral cerebellum.
• Rostral spinocerebellar tract – Carries proprioceptive
information from the upper limbs to the ipsilateral cerebellum
SEGMENTAL FIELDS OF SENSATION-DERMATOMES

What Is a Dermatome?

• A dermatome is the area of the skin of the

human anatomy that is mainly supplied
by branches of a single spinal sensory
nerve root.
• These spinal sensory nerves enter the
nerve root at the spinal cord, and their
branches reach to the outside areas of the
body.
• The sensory nerves in that area are a type
of nerve that transmits signals from
sensations (for example, pain symptoms,
touch, temperature) to the spinal cord
from specific areas of our anatomy.
 CLINICAL RELEVANCE
(Injury to the Ascending Tracts)

DCML Pathway
• A lesion of the DCML pathway causes a loss of proprioception and fine touch.
However, a small number of tactile fibres travel within the anterolateral system,
and so the patient is still able to perform tasks requiring tactile information
processing.
• If the lesion occurs in the spinal cord (which is most common), the sensory loss will
be ipsilateral – decussation occurs in the medulla oblongata. DCML lesions can be
seen in vitamin B12 deficiency and tabes dorsalis (a complication of syphilis).
Anterolateral System
• Injury to the anterolateral system will produce an impairment of pain and
temperature sensation. In contrast to DCML lesions, this sensory loss will
be contralateral (the spinothalamic tracts decussate within the spinal cord).
 CLINICAL RELEVANCE

• Brown-Séquard syndrome refers to

a hemisection (one sided lesion) of the
spinal cord. This is most often due to
traumatic injury, and involves both the
anterolateral system and the DCML
pathway:
• DCML pathway – ipsilateral loss of touch,
vibration and proprioception.
• Anterolateral system – contralateral loss
of pain and temperature sensation.
• It will also involve the descending
motor tracts, causing an ipsilateral
hemiparesis.
 ASSIGNMENT
1. Describe the sensory modality of pain
• Definition
• Significance of pain
• Pain processing
• Transduction
• Transmission (fibres, spinal network & pathway)
• Modulation (Gate control theory & endogenous opiate theory)
2. Explain physiologically, the mechanism of pain control by the following:
Nonsteroidal anti-inflammatory drugs, lignocaine & morphine.
3. Explain the meaning of lumbar puncture, at what level is it done & give a
reason why?
THANK YOU