Pain Pathophysiology: Central Pain and Higher Neural Mechanism

1. PAIN PATHOPHYSIOLOGY
SERIES
Ade Wijaya, MD – May
2019
Central Pain and Higher Neural
Mechanism

2. INTRODUCTION
• Pain can modulate neuronal function in supraspinal centers such as
the thalamus and somatosensory cortex
• Basal ganglia also appear to play a role in nociception
Millan MJ. The induction of pain: an integrative review. Prog Neurobiol. 1999;57:1-164
Chudler EH, Dong WK. The role of the basal ganglia in nociception and pain. Pain. 1995;60:3-38

4. Borsook D, Upadhyay J, Chudler EH, Becerra L. A key role of the basal ganglia in pain and analgesia-insights gained through human functional imaging.

5. Somatosensory cortical neurons display variable integration of pain
signaling
GABAergic, NMDA, excitatory amino acid, and glutamatergic
neurotransmitter systems have been implicated in supraspinal pain
sensation neuronal modulation
Millan MJ. The induction of pain: an integrative review. Prog Neurobiol. 1999;57:1-164
Lamour Y, Guilbaud G, Willer JC. Altered properties and laminar distribution of neuronal responses to peripheral stimulation in the SmI cortex of the arthritic rat.

6. Ong WY, Stohler CS, Herr DR. Role of the prefrontal cortex in pain processing. Molecular neurobiology. 2019 Feb

7. CENTRAL PAIN
• Damage to, or altered function of, the central nervous system itself
can lead to so-called central pain
• Injury to central pain processing centers often exacerbates the pain
sensation, which can be exceedingly difficult to treat
• Such injury elicits a response of neurotrophins, adhesion molecules,
glia, and many other cellular mediators, which is qualitatively similar
to that seen in the periphery
• Brain injury stimulates cytokine production in intrinsic neuroglial
cells as well as extrinsic migrating inflammatory macrophages and
mast cells
• Investigators have also focused on the role of the neuronal growth
associated phosphoprotein, GAP-43 (neuromodulin), in regulating