![]() One study found that these patients showed 5% to 11% less neocortical gray matter volume than control subjects and that the decreased volume was related to pain duration. Other imaging studies have reported structural changes in the brains of patients with chronic low back pain. Compared to healthy controls, chronic low back pain patients showed activation in pain-related brain regions during administration of experimental pain, differences in activation during emotional decision-making tasks, and changes in specific brain regions during a simple visual attention task (Kong et al., 2013). In a study of patients with chronic low back pain, neuroimaging showed significant differences in brain function. We are learning that pain is a result of complex interactions between the immune, nervous (both CNS and autonomic nervous system), and endocrine systems (Zouikr et al., 2016). Imaging techniques have allowed us to understand that pain results from activation of a number of brain regions such as the amygdala, insula, or the anterior cingulate cortex. Other magnetic resonance-based measures such as diffusion tensor imaging, spectroscopy, and volumetric imaging are being used to assess pain-related changes in the brain’s wiring, chemistry, and structure this will help gain further insights into the neurobiology of pain, particularly chronic pain (Lee & Tracey, 2013).Īs a result, we now know that pain sensation is more complex than previously thought and involves diverse regions of the brain. The development of positron emission tomography (PET) has allowed researchers, for the first time, to investigate neuronal activity throughout the entire brain (Casey, 2015).įunctional magnetic resonance imaging (fMRI), positron emission tomography (PET), magnetoencephalography (MEG), and scalp electroencephalography (EEG) have been used to study the neural bases of pain. The development of computed tomography (CT) and, soon thereafter, magnetic resonance imaging (MRI), allowed researchers to look into the living brain and gain some understanding of the parts of the brain affected by certain types of pain. Until the advent of these techniques, the living brain was largely invisible to clinicians and researchers. Our understanding of how the brain changes in response to chronic pain or to pharmacologic or other therapeutic interventions has been significantly improved as a result of neuroimaging techniques. If pain persists or becomes chronic it can even change the circuitry in the central nervous system. If an acute pain sensation is intense enough, it can cause system-wide responses: increased alertness focused attention the suppression of feeding, sleep, and reproduction and increased vascular tone, respiration, and blood sugar levels. Pain of thermal origin is the result of excessive heat or cold. Medications are usually a part of the management regimen for chemical or inflammatory pain. It is often constant but responds to positioning, therapy, rest, and gentle movement. Pain of chemical or inflammatory origin is associated with arthritis and other inflammatory disorders. ![]() ![]() It may be constant, variable, or intermittent in nature and is affected by movement and position. Pain of mechanical origin can be caused by acute trauma, injury, or overuse. Pain can be caused by a mechanical, chemical or inflammatory, or thermal mechanism. Rather than ascending to the thalamus however, spinoreticular neurons terminate within the brainstem. The spinoreticular tract is similar to the spinothalamic tract in that it is excited by similar sensory fibers. This spinal tract transmits sensory information related to pain, temperature, and crude touch.Īnother prominent pathway is the spinoreticular tract, which is involved in nociceptive processing. One of the most important central pain pathways is the spinothalamic tract, which originates in the spinal cord and extends to the thalamus. A-delta fibers, which are myelinated and thus conduct impulses rapidly, respond to mechanical (pressure) stimulus and produce the sensation of sharp, localized, fast pain. They respond to thermal, mechanical, and chemical stimuli and produce the sensation of dull, diffuse, aching, burning, and delayed pain. The C fibers are small and conduct impulses slowly. The brainstem reticular formation, which forms a diffuse, central core within the brainstem is the destination of the spinoreticular tract. The thalamus is the destination of spinothalamic tract-the sensory pathway responsible for processing pain, temperature, and crude touch. Destinations of the Spinothalamic and Spinoreticular Tracts in the Brain
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