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The Physiology of Pain
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard Jacques Dalens, Brigitte Storme
The connections of afferent fibers with the interneurons and tracts of the spinal cord have been established from anatomical and electrophysiological studies, which have ascertained the spinal location of ascending nociceptive information. The spinocervical tract (from the spinal cord to the lateral cervical nucleus) and dorsal columns (from the spinal cord to ipsilateral dorsal column nuclei) would probably play an important role in the transmission of pain to supraspinal areas. In their review, Dennis and Melzack19 reported at least six ascending spinal pathways involved in the transmission of pain to the brain. These studies, however, remain incomplete and cannot explain the return of sensitivity to painful stimuli about 2 to 3 months after anterolateral spinal cordotomy. Some other tracts would probably be able to convey the relevant information after the usual paths have been destroyed.
Back and neck pain: A comparison between acute and chronic pain–related Temporomandibular Disorders
Published in Canadian Journal of Pain, 2022
Jack Botros, Mervyn Gornitsky, Firoozeh Samim, Zovinar der Khatchadourian, Ana Miriam Velly
Our findings suggest that central dysregulation mechanisms37,38 are implicated in the process of pain-related TMD chronification involving peripheral and central sensitization mechanisms. Central pain is characterized as being diffuse or multifocal and thus is associated with comorbid pain conditions.19,39 Another suggested mechanism is trigeminocervical convergence.40–42 The neurons in the trigeminal nucleus caudalis that extend to C2 and the lateral cervical nucleus are stimulated by trigeminal activation, causing symptoms in both the trigeminal and cervical regions. This mechanism could be activated as pain-related TMDs becomes chronic, leading to the observed association between chronic pain–related TMDs and neck pain but not back pain. Moreover, the association of chronic disability with neck pain calls attention to the importance of including disability as a factor defining chronic pain–related TMDs in addition to pain duration, which agrees with the latest IASP recommendations.25 This accurate distinction will aid clinicians in developing the most suitable and effective management protocols, which may involve a multidisciplinary team to address comorbidities associated with pain persistence or disability.