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Pain Perception and Response: Central Nervous System Mechanisms

  • Arthur J. Hudson (a1)

Abstract:

Although several decades of studies have detailed peripheral and ascending nociceptive pathways to the thalamus and cerebral cortex, pain is a symptom that has remained difficult to characterize anatomically and physiologically. Positron emission tomography (PET) and functional magnetic imaging (fMRI) have recently demonstrated a number of cerebral and brain stem loci responding to cutaneous noxious stimuli. However, intersubject variability, both in the frequency and increased or decreased intensity of the responses, has caused uncertainty as to their significance. Nevertheless, the large number of available imaging studies have shown that many areas with recognized functions are frequently affected by painful stimuli. With this evidence and recent developments in tracing central nervous system connections between areas responding to noxious stimuli, it is possible to identify nociceptive pathways that are within, or contribute to, afferent spinothalamo-cortical sensory and efferent skeletomotor and autonomic motor systems. In this study it is proposed that cortical and nuclear mechanisms for pain perception and response are hierarchically arranged with the prefrontal cortex at its highest level. Nevertheless, all components make particular contributions without which certain nociceptive failures can occur, as in pathological pain arising in some cases of nervous system injury.

RÉSUMÉ:

Bien que des études effectuées au cours des dernières décennies aient décrit de façon détaillée les voies nociceptives périphériques et ascendantes vers le thalamus et le cortex cérébral, la douleur est demeurée un symptôme difficile à caractériser au point de vue anatomique et physiologique. La tomographie par l'émission de positons et l'imagerie par résonance magnétique fonctionnelle ont démontré récemment l'existence d'un certain nombre de sites qui répondent à des stimuli cutanés désagréables. Cependant, la variabilité entre les sujets, tant quant à la fréquence qu'à l'augmentation ou la diminution de l'intensité de la réponse, a causé de l'incertitude sur leur signification. Toutefois, les nombreuses études d'imagerie disponibles ont montré que plusieurs zones qui ont des fonctions bien reconnues sont fréquemment touchées par les stimuli douloureux. Avec ces données et les développements récents dans la cartographie des connections entre les zones répondant aux stimuli désagréables dans le système nerveux central, il est possible d'identifier les voies nociceptives qui sont à l'intérieur ou qui contribuent au système afférent sensitif spino-thalamo-cortical et aux systèmes efférents moteurs squelettique et autonome. Dans cette étude, l'hypothèse proposée est que les mécanismes corticaux et nucléaires de la perception de la douleur et de la réponse à la douleur sont structurés de façon hiérarchique, le cortex préfrontal étant placé au plus haut niveau de la hiérarchie. Cependant, toutes les composantes fournissent une contribution particulière sans laquelle certaines défaillances nociceptives peuvent survenir comme c'est le cas dans la douleur pathologique observée dans certains cas de lésion du système nerveux.

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Department of Clinical Neurological Sciences, London Health Sciences Centre, 339 Windermere Rd., London, Ontario, N6A 5A5

References

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Pain Perception and Response: Central Nervous System Mechanisms

  • Arthur J. Hudson (a1)

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