Definition

Pain is an unpleasant sensation

associated with actual or potential tissue
damage, and mediated by specific nerve
fibers to the brain, where its conscious
aprreciation may be modified by various
factors (Stedmans Medical Dictionary)
 The Purpose of Pain
Pain is a Protective Mechanism
Pain occurs whenever any tissues are being
damaged, and it causes the individual to
react to remove the pain stimulus.
Ex: Sitting for a long time on the ischia can
cause tissue destruction because of lack of
blood flow to the skin where it is compressed
by the weight of the body.
Types of Pain
Pain has been classified into two major types:
Fast pain
Is felt within about 0.1 second after a pain stimulus is
applied, Other names: sharp pain, pricking pain, acute pain, and
electric pain.

Slow pain
Begins only after 1 second or more and then increases
slowly over many seconds and sometimes even minutes.
Other names: slow burning pain, aching pain, throbbing pain, nauseous pain, and chronic
pain
This type of pain is asso. w/ tissue destruction
It can lead to prolonged, unbearable suffering.
It can occur both in the skin and in almost any deep tissue or organ.
Pain Receptors and Their Stimulation

Pain Receptors Are Free Nerve Endings.

The pain receptors in the skin and other
tissues are all free nerve endings.
They are widespread in the superficial layers
of the skin as well as in certain internal
tissues, such as the periosteum, the arterial
walls, the joint surfaces, and the falx and
tentorium in the cranial vault.
Any widespread tissue damage can summate to
cause the slow-chronic-aching type of pain in
most of these areas.
 Three Types of Stimuli Excite Pain Receptors

Mechanical, Thermal, and Chemical.

Fast pain is elicited by the mechanical and thermal types of
stimuli
Slow pain can be elicited by all three types.
Some of the chemicals that excite the chemical type of pain are
Bradykinin
Serotonin
Histamine
Potassium ions
Acids
Acetylcholine
Proteolytic enzymes.

In addition, prostaglandins and substance P enhance the

sensitivity of pain endings but do not directly excite them. The
chemical substances are especially important in stimulating the
slow, suffering type of pain that occurs after tissue injury.
 Nonadapting Nature of Pain Receptors.
In contrast to most other sensory receptors
of the body, pain receptors adapt very little
and sometimes not at all.
Under some conditions, excitation of pain
fibers becomes progressively greater,
especially so for slow-aching-nauseous
pain, as the pain stimulus continues.
This increase in sensitivity of the pain
receptors is called hyperalgesia.
 Transmission of Pain
Peripheral Pain Fibers
Fast Pain
Transmitted in the peripheral nerves to the spinal
cord by A fibers
Velocities between 6 and 30 m/sec
Because of this double system of pain innervation,
a sudden painful stimulus often gives a double
pain sensation: a fast-sharp pain that is
transmitted to the brain by the A fiber pathway
Plays an important role in making the person react
immediately to remove himself or herself from the
stimulus
 Transmission of Pain
Slow Pain
Transmitted to the spinal cord by type C fibers
Velocities between 0.5 and 2 m/sec
The slow pain tends to become greater over
time.This sensation eventually produces the
intolerable suffering of longcontinued pain and
makes the person keep trying to relieve the
cause of the pain.
 Transmission of Pain
Neospinothalamic tract (fast pain)
Peripheral fibers terminate mainly in lamina
I (lamina marginalis) of the dorsal horn.

Excitation of second order neurons of the

neospinothalamic tract

Give rise to long fibers that cross

immediately to the opposite side of the
cord through anterior commisure

Then turn upward passing to the brain in

the anterolateral columns

Glutamate as the Neurotransmitter

 Transmission of Pain
Paleospinothalamic tract (Slow pain)
Terminate in the spinal cord almost entirely in
laminae II and III of the dorsal horns (substantia
gelatinosa)

Most of the signals then pass through one or more

additional short fiber neurons within the dorsal
horns themselves before entering mainly lamina V,
also in the dorsal horn

Here the last neurons in the series give rise to long

axons that mostly join the fibers from the fast pain
pathway passing first through the anterior
commisure to the opposite side of the cord, then
upward to the brain in the anterolateral pathway
Termination of the Neospinothalamic
Tract in the Brain Stem & Thalamus

A few fibers of the

neospinothalamic
tract terminate in the
reticular areas of the
brain stem
Most pass all the
way to the thalamus
w/o interuption
 Termination of the Neospinothalamic
Tract in the Brain Stem & Thalamus
Terminating in the
Ventrobasal complex
along with the dorsal
column-medial
lemniscal tract for
tactile sensations
Few fibers also
terminate in the
posterior nuclear
group of the thalamus
From these thalamic
areas, the signals are
transmitted to other
basal areas
Paleospinothalamic Pathway into the
Brain Stem and Thalamus
This pathway terminates
widely in the brain stem
Only 1/10 to pass all the
way to the thalamus
Most terminate in one of
three areas:
Reticular nuclei of the
medulla, pons, and
mesencephalon
Tectal area of the
mesencephalon deep to
the superior and inferior
colliculi
Pariaqueductal gray region
surrounding the aqueduct
of Sylvius
Paleospinothalamic Pathway into the
Brain Stem and Thalamus
From the brain stem
pain areas, multiple
short-fiber neurons
relay the pain
signals upward into
the intralaminar and
ventrolateral nuclei
of the thalamus
And into certain
portions of the
hypothalamus and
other basal regions
of the brain.