The anatomy of pain

  • David G. Gore
    David G Gore MBChB BSc(Hons) MSc(Dist) FRCA FFPMRCA completed his advanced pain training at Oxford University Hospitals, UK, and will undertake a post CCT pain fellowship in Queensland, Australia. Conflicts of interest: none declared
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      Pain is a sensory and emotional experience that is personal and unique to an individual. Nociception is different from pain and considers the neural process of encoding and processing noxious stimuli. Anatomically noxious stimuli are transduced by nociceptors to an electrical signal carried by first-order neurons to the dorsal horn of the spinal cord. From the spinal cord second-order neurons project in tracts to the thalamus, where third-order neurons continue to higher cerebral centres. There is no known primary pain processing centre in the brain, instead multiple different areas activate and interact in response to noxious stimuli. The brain centres associated with pain perception overlap with those involved in depression. The brain regulates the nociceptive information it receives and can exert both anti- and pro-nociceptive influence. Pathology in the peripheral and central nervous systems can contribute to nociception and pain, as can changes in the interaction of higher cerebral centres. Appreciating the anatomical structures involved in pain and nociception affords an understanding of where different therapies may be applied to alleviate pain.


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      Further reading

        • Garland E.L.
        Pain processing in the human nervous system: a selective review of nociceptive and biobehavioral pathways.
        Prim Car. 2012; 39: 561-571
        • Hohenschurz-Schmidt D.J.
        • Calcagnini G.
        • Dipasquale O.
        • et al.
        Linking pain sensation to the autonomic nervous system: the role of the anterior cingulate and periaqueductal gray resting-state networks.
        Front Neurosci. 2020; 14: 147
        • Yang S.
        • Chang M.C.
        Chronic pain: structural and functional changes in brain structures and associated negative affective states.
        Int J Mol Sci. 2019; 20: 3130