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Neuroanatomy of the pain
structures in the spinal cord
Tural Abdullayev
Receptors
• Exteroreceptors/Telereceptor
– Takes information about the changes in the external
environment
• Interoreceptors/Visceroceptors
– Sensory receptor that detects stimuli within the body
1. Osmoreceptors
2. Baroreceptors
3. Chemoreceptors
• Proprioceptors
– Information about:
1. Joint position
2. Tension in muscles and tendons
3. Movement or position of head etc.
Skin receptors
• Free nerve endings
1. Pain
2. Touch and light pressure
3. Temperature
• Encapsulated end organs
1. Vibration
2. Fine touch
3. Pressure
4. Discrimination
Skin receptor organs
• Mechanoceptors
1. Touch
2. Pressure
• Thermoreceptors
1. Cold
2. Warm
• Nociceptors
– Pain
Special receptor organs of the skin
1. Peritrichial nerve endings
– Around the hair follicles
– Activated by movement of hair
2. Tactile capsules of Meissner – touch and pressure
receptors
– Only on glabrous skin, on the lips, tip of the tongue and
genitals
3. Laminated Vater-Pacini capsules – pressure receptors
– In area between the cutis and subcutis
4. End bulbs of Krause – cold receptors
5. Corpuscles of Ruffini – warm receptors
Dermatomes
Receptors in the deeper regions of the
body
1. Muscle spindles
– Respond to stretching of muscle
– Contain intrafusal muscle fibers
– Afferent fiber in the middle of the muscle spindle
• Very thick myelin sheath (Ia)
2. Golgi tendon organs
– Thick myelin sheath
– Respond to muscle stretching but at higher treshold
3. Laminated Vater-Pacini corpuscles and Golgi
Mazzoni corpuscles
– Pressure and pain
Peripheral nerve
• Action potentials arising in a receptor organ of one of
the types described above are conducted centrally
along an afferent fiber, which is the peripheral process
of the first somatosensory neuron, whose cell body is
located in a dorsal root ganglion
• Circumscribed area of the body run together in a
peripheral nerve; such nerves contain not only fibers
for superficial and deep sensation (somatic afferent
fibers) but also efferent fibers to striated muscle
(somatic efferent fibers) and fibers innervating the
internal organs,
Nerve plexus and posterior root
• Once the peripheral nerve enters the spinal canal
through the intervertebral foramen, the afferent
and efferent fibers go their separate ways: the
peripheral nerve divides into its two “sources,”
the anterior and posterior spinal roots:
– Anterior root contains the efferent nerve fibers
exiting the spinal cord
– Posterior root contains the afferent fibers entering it.
• A direct transition from the peripheral nerve to
the spinal nerve roots is found, however, only in
the thoracic region
Sensory fibers of a sinle radicular
segment are grouped together once
again to supply a characteristic
region
Each muscle is suplied by a single
peripheral nerve, which contains
fibers from multiple nerve roots, so-
called Polyradicular/Plurisegmental
innervation
Classification of nerve fibers
• A fibers
1. 
• Somatic motor
• Proprioception
– Muscle spindle – Ia
– Golgi tendon organ – Ib
2. 
• Touch and pressure – II
3. 
• Motor to muscle spindles
4. 
• Fast pain
• Cold
• Touch
• B fibers
1. Preganglionic
2. Sympathetic
• C fibers – most numerous
1. Dorsal root
• Slow pain
• Hot
• Mechanic and others
• Receptors
2. Sympathetic
• postganglionic
III
Myelinated
Diameter
and velocity
decreases
Ascending tracts
1. Dorsal system – fast system
– Fine touch
– 2-point discrimination
– Proprioception
2. Anterolateral system – slow system
– Lateral tract / Lateral spinothalamic tract
– Anterior tract / Ventral spinothalamic tract
– Light touch, pain, pressure, tickle, and itch
sensations
Ascending tracts
Dorsal system – Medial lemniscus
pathway
Receptor
Dorsal root nuclei
Central process
Posterior part
Medial fiber
F.Gracilis
Connects with n. Gracilis
Lower medulla
F. Cuneatus
Connects with n.Cuneatus
Dorsal system – Medial lemniscus
pathway
1st order fibers terminates in n.Cuneatus and n. Gracilis and 2nd order fibers starts
Internal arcuate fibes
Medial lemniscus
VPL of thalamus ( 2ndorder fibers terminates here and 3rd order fibers starts)
Fibers pass through the posterior limb of internal capsule and move
upward
Corona radiata is formed
Post-sensory gyrus
Dorsal system – Medial lemniscus
pathway
• Sensation from the lower limbs is deposited
medially – Gracilis fibers
• Sensation from the upper limbs is deposited
medially – Cuneate fibers
Anterolateral system
Temperature and pain
Free nerve ending
A or C fiber pathway
Dorsal root ganglion
Fibers entering the spinal cord
Substantia gelatinosa
Fibers cross to contralateral white matter
Cruel/Weak touch
Free nerve ending
Dorsal root ganglion
Fibers entering the spinal cord
Substantia gelatinosa
Fibers are running to anterior part
Anterolateral system
Anterior and lateral tracts fuse in medulla
Travel towards the thalamus
VPL nucleus
Fibers pass through the posterior limb of internal capsule and move upward
Postcentral gyrus
Slow pain
Intralaminar nucleus of thalamus Reticular
formation
Anterolateral system
Postcentral gyrus
Fast pain fibers
Emotions
Singulate gyrus
Slow pain fibers
Nausea
Vomiting
Tachycaria etc.
Insular cortex

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Neuroanatomy of the pain structures in the spinal

  • 1. Neuroanatomy of the pain structures in the spinal cord Tural Abdullayev
  • 2. Receptors • Exteroreceptors/Telereceptor – Takes information about the changes in the external environment • Interoreceptors/Visceroceptors – Sensory receptor that detects stimuli within the body 1. Osmoreceptors 2. Baroreceptors 3. Chemoreceptors • Proprioceptors – Information about: 1. Joint position 2. Tension in muscles and tendons 3. Movement or position of head etc.
  • 3. Skin receptors • Free nerve endings 1. Pain 2. Touch and light pressure 3. Temperature • Encapsulated end organs 1. Vibration 2. Fine touch 3. Pressure 4. Discrimination
  • 4. Skin receptor organs • Mechanoceptors 1. Touch 2. Pressure • Thermoreceptors 1. Cold 2. Warm • Nociceptors – Pain
  • 5. Special receptor organs of the skin 1. Peritrichial nerve endings – Around the hair follicles – Activated by movement of hair 2. Tactile capsules of Meissner – touch and pressure receptors – Only on glabrous skin, on the lips, tip of the tongue and genitals 3. Laminated Vater-Pacini capsules – pressure receptors – In area between the cutis and subcutis 4. End bulbs of Krause – cold receptors 5. Corpuscles of Ruffini – warm receptors
  • 7. Receptors in the deeper regions of the body 1. Muscle spindles – Respond to stretching of muscle – Contain intrafusal muscle fibers – Afferent fiber in the middle of the muscle spindle • Very thick myelin sheath (Ia) 2. Golgi tendon organs – Thick myelin sheath – Respond to muscle stretching but at higher treshold 3. Laminated Vater-Pacini corpuscles and Golgi Mazzoni corpuscles – Pressure and pain
  • 8. Peripheral nerve • Action potentials arising in a receptor organ of one of the types described above are conducted centrally along an afferent fiber, which is the peripheral process of the first somatosensory neuron, whose cell body is located in a dorsal root ganglion • Circumscribed area of the body run together in a peripheral nerve; such nerves contain not only fibers for superficial and deep sensation (somatic afferent fibers) but also efferent fibers to striated muscle (somatic efferent fibers) and fibers innervating the internal organs,
  • 9. Nerve plexus and posterior root • Once the peripheral nerve enters the spinal canal through the intervertebral foramen, the afferent and efferent fibers go their separate ways: the peripheral nerve divides into its two “sources,” the anterior and posterior spinal roots: – Anterior root contains the efferent nerve fibers exiting the spinal cord – Posterior root contains the afferent fibers entering it. • A direct transition from the peripheral nerve to the spinal nerve roots is found, however, only in the thoracic region
  • 10. Sensory fibers of a sinle radicular segment are grouped together once again to supply a characteristic region Each muscle is suplied by a single peripheral nerve, which contains fibers from multiple nerve roots, so- called Polyradicular/Plurisegmental innervation
  • 11. Classification of nerve fibers • A fibers 1.  • Somatic motor • Proprioception – Muscle spindle – Ia – Golgi tendon organ – Ib 2.  • Touch and pressure – II 3.  • Motor to muscle spindles 4.  • Fast pain • Cold • Touch • B fibers 1. Preganglionic 2. Sympathetic • C fibers – most numerous 1. Dorsal root • Slow pain • Hot • Mechanic and others • Receptors 2. Sympathetic • postganglionic III Myelinated Diameter and velocity decreases
  • 12. Ascending tracts 1. Dorsal system – fast system – Fine touch – 2-point discrimination – Proprioception 2. Anterolateral system – slow system – Lateral tract / Lateral spinothalamic tract – Anterior tract / Ventral spinothalamic tract – Light touch, pain, pressure, tickle, and itch sensations
  • 14. Dorsal system – Medial lemniscus pathway Receptor Dorsal root nuclei Central process Posterior part Medial fiber F.Gracilis Connects with n. Gracilis Lower medulla F. Cuneatus Connects with n.Cuneatus
  • 15. Dorsal system – Medial lemniscus pathway 1st order fibers terminates in n.Cuneatus and n. Gracilis and 2nd order fibers starts Internal arcuate fibes Medial lemniscus VPL of thalamus ( 2ndorder fibers terminates here and 3rd order fibers starts) Fibers pass through the posterior limb of internal capsule and move upward Corona radiata is formed Post-sensory gyrus
  • 16. Dorsal system – Medial lemniscus pathway • Sensation from the lower limbs is deposited medially – Gracilis fibers • Sensation from the upper limbs is deposited medially – Cuneate fibers
  • 17. Anterolateral system Temperature and pain Free nerve ending A or C fiber pathway Dorsal root ganglion Fibers entering the spinal cord Substantia gelatinosa Fibers cross to contralateral white matter Cruel/Weak touch Free nerve ending Dorsal root ganglion Fibers entering the spinal cord Substantia gelatinosa Fibers are running to anterior part
  • 18. Anterolateral system Anterior and lateral tracts fuse in medulla Travel towards the thalamus VPL nucleus Fibers pass through the posterior limb of internal capsule and move upward Postcentral gyrus Slow pain Intralaminar nucleus of thalamus Reticular formation
  • 19. Anterolateral system Postcentral gyrus Fast pain fibers Emotions Singulate gyrus Slow pain fibers Nausea Vomiting Tachycaria etc. Insular cortex