Far Eastern University – Nicanor Reyes Medical Foundation Receptors are considered Excitable structures, they are capable of

Physiology B – General Senses responding to changes happening, generating Action Potential.

Felipe Barbon M.D.
Review:
What is Sensation?
 Simply the ability to know what is happening in the environment
due to the different effective stimuli that affects the sensory
receptors in the body.
 The lowest effective stimulus intensity is Threshold. Anything
equal or greater than the threshold can stimulate the different
sensory receptors and can generate Action Potential transmitted
to the sensory neurons towards the sensory center of the brain.
 It is essential that you first get exposed to the changes in the
environment to generate sensation.

SENSORY RECEPTORS:
 Responsible for responding to the different stimuli.
 The receptors are classified based on their different stimuli.
 That’s why receptors are very sensitive or it is having low
threshold to their specific stimulus, it can be easily stimulated by Resting Membrane Potential
that specific stimulus. - Resting electrical activity
 Sensory receptors are sensitive and specific. Threshold Potential
 The receptors can respond to other types of stimulus other than - Also called Critical Firing Level
its specific stimulus, provided that you give a stimulus higher  Once stimulated, there will be changes in the membrane
than threshold. potential until it reaches the threshold level, generating an
action potential.
Classification of Receptors based on their stimulus:  But when you stimulate it below threshold, it will not be enough
1. Mechanoreceptors to generate an action potential it will cause Local Depolarizing
2. Chemoreceptors Change, it is now called a Local Potential.
3. Thermoreceptors  In receptors, it is called a Receptor Potential commonly known
4. Photoreceptors (Telereceptors) as Generator Potential.
- It is also called Telereceptors because the stimuli to these
receptors are changes distant to the body. In Receptors
- Auditory receptors are NOT considered as telereceptors,  If the generator potential does not reach the threshold, you will
because it is mainly affected by the pressure inside the ear not feel any sensation.
causing changes in the endolymph.  However, if the generator potential is stimulated by a threshold
5. Nociceptors (Pain Receptors to Noxious stimuli) or higher than threshold intensity, it will now generate a
threshold potential.
 The changes affecting the body are in different form of energies
(thermal, chemical, mechanical), all these different energies are
being converted by the sensory receptors to Electrical Energy
called Action Potential.
 The center can only understand action potential that’s why the
sensory receptors need to convert it to electrical energy
 That’s why sensory receptors are likened to Body Transducers
capable of converting one form of energy to another form.

Location of the Sensory Receptors

1. Part of the nerves, usually the endings of neurons:
- Free Nerve Endings, Olfactory Nerve Endings
2. Mostly are specialized type of cells:
- Pacinian, Meissner’s, Rods & Cones.
Adaptation – once you are exposed to the change, the body is
aware of the change as long as the stimulus is effective. In
adaptation, you are aware of the change during the initial exposure,
but due to the continuous exposure of the stimulus, after some time
the sensation is diminished.
Example: Wearing watches.
- Upon wearing you can feel the watch, but after some time, you
can’t feel it anymore.
 Once receptors are effectively stimulated they are able to
generate multiple and repetitive action potentials to a single
effective stimulus.
 The generation of continuous action potentials is important
because this is to tell the center, via the sensory afferent
pathway, that the stimulus is still present and continuous.
REFLEX ACTION
 Once sensation is present, the center will now react.
 The activity of the center will now lead to the generation of new
set of impulses, transmitted via the efferent pathway towards
the effector, for the person to react to the stimulus that affects
the body.

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REFLEX ARC Some sensations are associated with initial acute, immediately
followed by chronic sense, they are called DUAL SENSATION. There
is sensation in the initial exposure to the stimulus, but after
removing the stimulus, the sensation is still there.

Examples: Pain, Tickle and Itch, & Temperature

SENSORY NEURONS
 The one responsible for transmitting the impulse from the
receptor to the center.
 Determines the duration of the sensation whether it is acute or
The reflex arc is composed of the receptor, the afferent neuron, the center, chronic.
the efferent neuron, and the effector. In sensation, the important part of the  Fast-transmitting nerves can cause acute sensation, and slow-
reflex arc is the Sensory Arm.
transmitting nerves can cause chronic or delayed sensation.
 The presence of myelin and the diameter of the neuron
Sensory Arm of the Reflex Arc
determine the speed of transmission.
 The sensory arm of the reflex arc is composed of:
- Receptor
Types of Sensory Neurons
- Afferent Neuron
- Center
 Any injury to any of the 3 components, sensation is lost.
 The sensitivity of different persons to the different stimuli will
depend on the activity of the sensory arm of the reflex arc.
 Previous experience to the said stimulus can also affect the
sensitivity whether it is pleasant or unpleasant stimulus.
 Autonomics is the one responsible in responding to the changes
happening in the body that we cannot sense.

TYPES OF SENSATION

According to the location of the stimulus:

1. Exteroceptive – stimulus comes from outside
2. Enteroceptive – stimulus comes from inside the body TYPE A - fast conducting due to large diameter and myelination.
 Aα – fastest conducting (120m/s)
According to ability to localize the body part affected:  Aβ – 70m/s
1. Protophatic
 Aγ – 40 m/s
- Poorly localized
 Aδ – 15m/s
- Usually, the receptors are found in the viscera
TYPE B – used for autonomics
2. Epicritic
TYPE C – slow conducting due to small diameter and unmyelinated,
- Easily localized
responsible for the chronic sensation.
- Usually the receptors are present in the skin
Functional Classification of Neurons
According to the receptors used
1. General
- Utilize receptors present in almost all parts of the body.
- Mostly uses Spinal Nerves
- Pain, Temperature, Touch, Pressure, Vibratory
2. Special
- Utilize receptors present in specific parts of the body.
- Mostly uses Cranial Nerves
- Vision (Eyes), Olfaction (Nose), Taste (Oral Cavity), Hearing
(Ears). **Crude touch (Tickle and Itch) is included in Group III and IV.

According to the onset of sensation PARAMETERS OF SENSATION

1. Immediate (Acute) 1. Quality or Modality of Sensation (What type of sensation)
- Less than one second 2. Stimulus Intensity
- Sensation is felt upon immediate contact with the stimulus 3. Localization (Precise localization of body part stimulated is called
2. Delayed (Chronic) Topognosis)
- More than one second is already considered chronic sense 4. Timing

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QUALITY OR MODALITY OF THE SENSATION
 We can easily distinguish the type, modality, and quality of
stimulus applied to the body, whether it is pain, temperature,
touch, etc., due to the specificity of the receptors.
LAW OF SPECIFIC NERVE ENERGIES
 Concerned with specificity of the receptors.
 It is also concerned with the specificity of the sensory neurons,
and the center.
Example:
Rods (light vision) and Cones (dark vision) in the Retina
Optic Nerve (Sensory Nerve)
Occipital Cortex (Brodmann’s Area 17)
Destruction of the Rods and Cones causes Peripheral Blindness
Destruction of the Center causes Central Blindness.
MULLER’S DOCTRINE
 Almost the same with the Law of Specific Nerve Energies.
 This focuses on the specificity seen at the center, in the cortex.
 The cortex contains different areas and centers for the different
stimuli (e.g. Somatosensory Cortex: Brodmann’s Area 3,1,2)
LABELLED LINE PRINCIPLE
 Describes the specificity seen in the Sensory Neurons.
 Sensory neurons follow a specific pathway or line when
transmitting impulses toward the center.
 Example: Vision. (Specific Sensory Neuron: Optic Nerve)
CODING MECHANISM
Temporal Pattern Coding
 You look at the manner of how the action potentials are
generated by the activated sensory receptors.
 The pattern of the discharge of the action potentials.
 Example: Thermoreceptors
- Less than 30O – Burst Firing (Frequent firing then pause)
- More than 30O – Regular Firing
Spatial Pattern Coding
 The center will look at the variation of the number of sensory
receptors stimulated
 Example: Visual (Color Perception)
- Cones: 3 types (Red, Blue, and Green-sensitive)
- If there is equal simultaneous stimulation of the 3 receptors,
you will see a white color.
- It is not about mixing the color; it’s about mixing the activity
of the receptors.
STIMULUS INTENSITY
WEBER-FECHNER LAW
 The magnitude of sensation felt by the person is directly
proportional to the logarithm of stimulus intensity.
 Meaning, you are able to determine the intensity of the initial
stimulation but if you add intensity lower than the initial
stimulus, you cannot feel it. If you add intensity higher than the
initial intensity of the stimulus, you can feel it.
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Example: (Weber-Fechner Law)
 If you carry a book, you can initially feel the book, but if you add
a piece of paper at the top of the book, you will not notice the
weight of the additional stimulus, since the stimulus of the paper
is less than the book.
 Same goes if you carry a paper, you are able to feel the paper,
and if you add a book you can feel the weight heavier, since the
stimulus of the book is greater than the paper.
POWER LAW (Steven Power Law)
 It states that the ability to know stimulus intensity is directly
related to the frequency of action potential discharge.
 Increasing the intensity, increases the frequency of AP firing.
The amplitude of the action potential cannot affect the intensity
of the stimulus due to the All or None Law. Once the action
potential is fired, it always generates maximal magnitude.
NUMBER OF RECEPTORS
 The intensity of the stimulus is directly proportional to the
number of receptors
 Less stimulation means less activated receptors, Greater
stimulation activates more receptors.
 Exposure to increasing stimulus intensity, recruits Sensory Units.
 SENSORY UNIT is the sensory receptor + sensory neuron.
 RECEPTIVE FIELD – any stimulus applied on this field, will
activate the sensory unit and generate action potential.
 In a body part where you have greater number of sensory
receptors, there is an overlapping of the receptive fields hence
you can activate multiple sensory units with one stimulus.
LOCATION
TOPOGNOSIS
 Major reason why we are capable of knowing specifically part of
the body directly affected by the stimulus even with eyes closed.
 Exact localization of the body part stimulated via the skin, there
is no topognosis in the viscera.
 Sensory Homunculus located in Brodmann’s area 1,2,3
commonly known as the primary somatosensory/primary
somatostethic cortex.
 Located in the Post-central Gyrus
 Stimulating the certain part of the body, will increase the activity
of the contralateral part of the parietal lobe representing the
said part of the body.
 Example: Increasing the stimulation in the right small finger will
increase the activity of the part of the left parietal lobe
responsible for the sensation of the small finger.

The sensory homunculus is represented in an inverted fashion. The
homunculus follows the distribution or the density of the sensory receptors in
the body part, the greater the number of the sensory receptors in the said
body part, it can have a greater representation. Meaning, the greater number
of the receptors are more sensitive to sensation. This is also the reason why
there is epicritic and protopathic sensation, Skin is epicritic due to its
numerous receptors it is also greatly represented by the homunculus and
Visceral Organs is protopathic since there is no representation of the viscera
in the sensory homunculus. The face is the most sensitive specifically the
lower lip since it has the largest representation in the homunculus.
LAW OF PROJECTION
 Stimulation anywhere in the area or the pathway of the sensory
nerve will produce a sensation in the area of the receptor that
utilizes the said sensory nerve.
 Example: If you stimulate the ulnar nerve, anywhere in the area
where the ulnar nerve travels, you will not feel the sensation in
that course, but you will feel the sensation in the area of the
receptor that utilizes the ulnar nerve: the small finger.
 The sensation is projected to the area of the sensory receptors.
SENSORY UNITS and RECEPTIVE FIELD
 Important in the localization of which body part is stimulated.
 Smaller Receptive Field: Easily localized
 Bigger Receptive Field: Hard to localize
Type 1 receptors (Superficial: Meissner’s & Merkel’s) have smaller
receptive fields, when stimulated there is better topognotic activity since the
area is smaller, localization is easier. Unlike Type 2 receptors (Deep: Pacinian
and Ruffini’s) have bigger receptive fields, when stimulated the sensation is
diffused, localization will be harder.
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LATERAL INHIBITION PROCESS (SURROUND INHIBITION)
 The part maximally stimulated or with greater activity will send
inhibitory impulses to the adjacent neurons rendering lesser
activity.
 This is to prevent the spreading of the impulses in the
surrounding of the part stimulated and provide a mechanism for
the specific localization of the body part stimulated.
SENSITIVITY
TWO-POINT DISCRIMINATION
 Simultaneous application of 2 pointed objects on a rested body
part, with subject blindfolded or closed eyes.
 The subject is then asked if he/she feels 2 or 1 stimulus.
 Continuously apply the 2 points in a decreasing distance until the
person perceives it as one stimulus, then increase the distance of
application until the person perceives it again as 2 stimuli.
 Measure the distance from where the person perceived is as one
stimulus and perceived it again as 2 stimuli.
 Two-Point Threshold – the smallest distance wherein the two
stimuli is perceived as two stimuli. This is the measure of
sensitivity or Tactile Acquity.
 Inversely Related: The smaller the distance, the more sensitive.
 Smallest in the Lower Lips: 1mm
In 2 point discrimination you are stimulating 2 separate units of receptors
there is perception of 2 stimuli, but as the 2 stimuli is too close to each other,
the perception will only be 1 stimulus, because the 2 stimuli is only affecting a
single receptive field.
STEREOGNOSIS
 The ability to recognize and describe the characteristic of a
three-dimensional object even when the eyes are closed.
 There is no need to correctly identify the object; what’s more
important is to describe the characteristic of the object.
GRAPHESTESIA
 Ability to recognize the number or letters written on the skin via
touching.
 Dermatographia: Inability to recognize the written stimulus due
to rough skin.
If the subject is ticklish, let the subject hold the hand of the
examiner, to lessen the tickling sensation.

ADAPTATION / DESENSITIZATION
 The person is still exposed continuously to the stimulus but the
sensation is already diminished.
 It’s wrong to say you are “immune” to a certain stimulus, you did
not utilize lymphocytes to remove the sensation, and instead it’s
more correct to say you are “adapted” to a certain stimulus. 
 The action potential being fired by an adapted receptor is
already diminished; however the receptor is still sensitive to a
certain degree of its stimuli.
 Adapted receptors can still adapt if the rate and intensity of the
stimuli is changed.
FAST ADAPTING
 Adapts in less than a second up to several minutes.
 Touch and Olfactory receptors
 Also called Phasic Receptors (On and Off)
 Once exposed to the stimulus which is not changing intensity
and rate, there is frequent firing of action potential but rapidly
declines, it is already adapted, sensation is lost.
 But if you remove the stimulus, the receptors will fire again
action potential and be sensitive again to stimulus.
 Example: You wear your watch, initial exposure to the stimulus
will send action potentials but after sometime it will decline and
you won’t sense your watch, but if you decide to remove the
watch, the receptors will again fire action potential and be
sensitive again to the stimulus.
SLOW ADAPTING
 Also called Tonic Receptors
 Takes days to weeks
 Baroreceptors take several days or weeks to adapt.
 Hypertensive people have adapted baroreceptors. The role of
the baroreceptor is to maintain the normal blood pressure, since
hypertensive people have elevated blood pressure, the
baroreceptors perceive that the elevated BP is the normal BP of
that person, and hence there are hypertensive patients.
NON-ADAPTING
 Does not adapt at all, continuous exposure to the stimulus will
send continuous AP, having constant sensation.
 Nociceptors (Pain) do not adapt, they are only capable of
changing the threshold for stimulation, but the sensation is still
there.
 Soldiers and Athletes possess high threshold for pain, or are
already Pain insensitive.
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MECHANISM OF ADAPTATION
1. Readjustment in shape or structure of the sensory receptor
 When the sensory receptors change their structure they can
stop firing action potential.
 Example: Pacinian Corpuscle
 Pacinian is oval-lamellated in shape and contains a fluid,
once it is deformed by pressure; the fluid will be distributed
and will activate the sensory neuron. But when the deformity
is complete and it lasted longer, it will now stop the activity of
the sensory nerve, the stimulus is there but there is no
sensation.
 But when you remove the stimulus, and the pacinian
corpuscle returns to its normal shape, the sensation will
return.
2. Change in Chemical Agent
 Undergo adaptation by changing the chemical agent.
 Example: Vision (Rhodopsin and Iodopsin pigments)
3. Accommodation in the afferent nerve
 There is a change in the sensory neurons.
 Accommodation means that the sensory nerves do not
generate anymore action potential, the sensory nerves
continuously receive impulses from the receptor but they
inhibit Sodium-Channels and stop the firing of APs.
IMPORTANCE OF ADAPATATION
 It is for the brain to rest.
 If there are no receptors adapting, every second of the whole
day, you are thinking that you are wearing your shirt, your
undergarments, and your socks.
But why are pain receptors non-adapting?
 This is because the sensation of pain is always perceived by the
center as damage to the tissue; hence pain sensation always lead
to pain reflex or withdrawal reflex. The center needs to tell you
to withdraw away from the painful stimuli and prevent tissue
damage, that’s why the receptors MUST NOT adapt from painful
stimuli.
REQUIREMENTS FOR ADAPTATION
 Continuous exposure to the stimulus
 Intensity of the stimulus is constant and non-changing
 Low to moderate levels of stimulus
- Best example is wearing a shoe or a shirt with the right fit, a too
tight or a too loose shoe or shirt will make you feel
uncomfortable.
GENERAL SENSATION (Somatic Sense)
 It is involved in the activation of receptors that are present in
almost all parts of the body.
TYPES OF SOMATIC SENSATION:
1. Mechanoreceptive Somatic Sense
2. Thermoreceptive Somatic Sense
3. Nociceptive Somatic Sense
MECHANORECEPTIVE SOMATIC SENSE
 Use receptors with low threshold, or highly sensitive receptors.
 These receptors are sensitive to mechanical stimuli
Mechanical Stimuli:
 Touch
 Pressure
 Vibration (Pallasthesia)
 Tickle and Itch (Crude Touch)
 Position Sense (Proprioception):
a.) Static Position Sense – ability to know the position of a non-
moving body part in relation to another body part or to the
environment.
b.) Dynamic Position Sense (Kinesthesia) – ability to know which
body part is moving along with the direction and the range of
movement.
THERMORECEPTIVE SOMATIC SENSE
 Utilize high threshold stimulus
 Receptors are sensitive to thermal stimuli
 Classified into three: Cold, Warm, and Pain
Warm Sensitive Thermoreceptors
 Activated at 44oC body temperature.
 Fewer in number in the body.
 Utilize Type C neurons and yield a chronic sensation.
Cold Sensitive Thermoreceptors
 Activated at 25oC body temperature.
 Greater in number in the body.
 Utilize dual sensation; possess both acute and delayed
sensation. They utilize Type Aδ neurons for the acute sensation
followed by Type C neurons for the chronic sensation.
Pain Sensitive Thermoreceptors
 Pain receptors also respond to other stimuli rather than noxious
stimulus. Mechanical, Thermal, and Chemical stimuli can also
stimulate pain receptors given that they give a higher than
threshold stimulus to activate the pain receptors. The stimulus is
usually a threat to tissue destruction.
 In thermal stimuli, less than 25 C and greater than 40 C can
o o
stimulate the pain receptors.
 Utilize dual sensation; possess both acute and delayed
sensation. They utilize Type Aδ neurons for the acute sensation
followed by Type C neurons for the chronic sensation.
Principle of Body Heat Loss and Gain
 Cold sensation: Heat is lost to the colder object.
 Warm sensation: Heat is gained from the warmer object.
 Indifferent sensation: No transfer of heat, there is equal warm
and cold stimuli. Body temperature of 36oC -37oC is considered
an indifferent thermal sensation.
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NOCICEPTIVE SOMATIC SENSE
 Utilize both high and low threshold receptors
 Can be affected by other stimuli (Mechanical, Chemical, &
Thermal stimuli), provided the stimuli are excessive.
 Pain receptors are mostly found in the coverings of the body
specially the skin. This is very important because the receptors
need to send to the center that there could be a possible tissue
injury from the stimuli and protect the body by withdrawing
from the pain.
Mechanosensitive Nociceptor
 Utilize type Aδ neurons, having an acute sensation
 Pain results from excessive mechanical stress to the body parts
(e.g. Excessive extension of fingers or twisting of the arms)
Thermosensitive Nociceptor
 Same as the Pain sensitive thermoreceptors
 Utilize dual sensation; possess both acute and delayed
sensation. They utilize Type Aδ neurons for the acute sensation
followed by Type C neurons for the chronic sensation.
Chemosensitive Nociceptor
 Utilize type C neurons, having a chronic sensation
 Pain results from chemical agents that respond in respond to
tissue damage called P-Factors or pain factors.
 P-Factors are only produced if there is tissue damage, especially
in cases of inflammation.
 Example: Myocardial Ischemia, if there is anoxia in the heart
tissues, those are not still damaged, but there is already chest
pain, sending signals to the center that there is impending tissue
damage. The tissue gets anaerobic due to O2 deficiency and
produces lactic acid. If the tissue gets damaged, it leads to
Myocardial Infarction and it gets more painful.
P-FACTORS (Pain Factors)
 Released during tissue damage
 These agents stimulate the chemosensitive nociceptors.
 Some of these agents do not directly affect the chemosensitive
nociceptors but they enhance pain by increasing sensitivity of
the pain nerve endings to the different P-Factors.
Agents that directly affect chemosensitive nociceptors:
 Bradykinin – most effective
 Serotonin
 Histamine
 CCK
 Acids: Lactic acid (Anoxic Pain)
 Acetylcholine
 Proteases
 Hydrogen & Potassium ions
Agents that enhance the sensitivity of pain nerve endings
(Tachykinins)
 Prostaglandins (Inhibited by Acetyl-Salicylic Acid/Aspirin)
 Substance-P (Inhibited by Opioids)
 CGRP (Calcium Gene Related Peptide) – inhibits the substance
that degrades Substance P, further enhancing pain.
Analgesics only reduce the intensity of the pain; if you want total
elimination of the pain you can give Anti-Prostaglandins.

 If there is tissue injury there is immediate release of chemicals
produced by our own bodies (Bradykinins, 5-HT, Histamines,
etc.).
 There is also enhancement of the sensitivity of the pain nerve
endings via the release of Prostaglandins and Substance P.
 CGRP further enhances secretion of Substance P, making it more
painful.
 CGRP also stimulates the mast cells to release more histamine.
 Platelets can also increase the pain sensation, since the platelets
can further secrete Serotonin (5-HT), making the pain sensation
greater.
OPIOIDS
 A potent analgesic which inhibits secretion of substance P.
 Decrease the duration of the action potential generated by the
Pain receptors.
 They also hyperpolarize the membrane of the dorsal horn of the
spinal cord.
 They act on 3 sites to provide analgesia:
- Local – site of injury
- Spinal – Can be half of the body
- General (Whole body) – targets the Brainstem
 The presence of P-Factors will enhance the sensitivity of the
other pain receptors. Persons who experience arthritis do not
want to move their joints since their mechanosensitive receptors
are already sensitive to pain.
CLASSIFICATION OF PAIN:
1. Hyperpathia – Pain insensitive, the pain threshold is already high
but the sensation is not diminished.
2. Hyperalgesia – Pain sensitive, the silent pain receptors are
sensitized, and they have exaggerated reaction to pain.
 Primary Hyperalgesia
- Problems arise from the origin of the receptors, which
are usually found in the skin.
 Secondary Hyperalgesia
- Problems arise from the sensory pathways or neurons for
pain (e.g. Spinal Cord & Brainstem)
NEUROPATHIC PAIN:
- Pain is due to damage in the afferent sensory neurons and not in
the receptors.
- Examples: Trigeminal Neuralgia & Phantom Limbs
CENTRAL PAIN:
- Severe and spontaneous pain involving the Spinothalamic tract
- Thick wallets in the back pocket causes compression of sciatic n.
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 Allodynia
- Supersensitive, an ordinary or light touch can cause pain.
- Example: Sunburn – skin gets very sensitive to the
lightest touch and even the wind.
FACTORS THAT AFFECT PAIN
Situational and Emotional Factors:
Example: (Expectation) Getting low scores at exams you thought
was easy, you did not get any tissue injury, but still it hurts and you
can get frustrated. But after sometime of constantly getting low
scores, your “pain threshold” is already high and you become
insensitive to low scores.
Psychological Factors:
Example: (Age) Older people have thinner skin, and become more
sensitive to pain.
Pain can undergo Facilitation or Inhibition:
If it gets facilitated the person can get sensitive.
If it gets inhibited the person gets pain insensitive.
PAIN SENSATION PATHWAYS
(Ascending: Spinothalamic Tract or Anterolateral Tract):
1. Neospinothalamic
2. Paleospinothalamic
Neospinothalamic (Acute Pain Sensation)
 Uses Type Aδ sensory nerves (Type A Delta)
 Ascending from the spinal cord to the reticular formation
(Pons: Pontine reticular activating system)
 Pain fibers will enter the dorsal horn of the spinal cord and will
immediately cross to the other side of the spinal cord and
ascend to the thalamus then to the higher center (cortex).
 Since the fibers can reach the cortex, it can reach the sensory
homunculus, and the localization of pain will be easier.
 Acute pain is easily localized (Epicritic Pain)
 Passes at Lamina I and V, some can pass via the Lamina X
 Major NTA: Glutamate, sometimes utilize Substance P
Paleospinothalamic (Chronic Pain Sensation)
 Uses Type C sensory nerves
 Pain fibers enter the dorsal horn and will immediately cross to
the other side; once it ascends it can only reach up to the
thalamus and cannot reach the cortex hence the name Thalamic
Pain.
 Since the nerves cannot reach the cortex, it cannot reach the
sensory homunculus, the characteristic of the pain is diffused,
and localization of pain is hard.
 Chronic Pain is hard to localize (Protopathic Pain)
 Some impulses can enter the center but will not go towards the
cortex, but will go to the limbic system, proving emotional
responses to chronic pain.
 Passes at the Lamina I, II and III  Initially, it is not a visceral pain, because the Visceral fibers and
 Major NTA: Substance P, sometimes utilize Glutamate the Somatic fibers when entering the Dorsal horn, become a
second-order neurons and converge into one and ascends as
Both neospinothalamic and paleospinothalamic utilize Lamina I one via the spinothalamic tract, so the center perceives it as a
pain from the skin, but as the injury gets aggravated, there will
PAIN SENSATIONS be more impulses coming from the visceral fibers, so the center
Classified as: will perceive it now as a visceral pain, that is called the
 Skin Pain (Superficial Pain) Convergence-Projection Theory.
- Easily localized  Pain sensation is associated with the activity of the Autonomic
 Phantom-Limb Pain (Projected Pain) Nervous System, especially Chronic Pain.
- Complain on body parts that are missing, usually for patients
who undergone amputation
- Diabetic patients have elevated blood sugar and experience
neuropathy, the pain sensation is lost. That’s why the
gangrenous portion of the limbs of a diabetic patient which was
amputated does not experience too much pain, unlike those
emergency amputations from accidents.
- Phantom-Limb Pain is only seen in 50-80% of amputees.
 Visceral Pain (Limb Pain)
- Tissue injury is present in the viscera or the internal organs.
 Referred Pain
- Pain is localized in the skin, but the actual injury is in the  The pain sensation can decrease if you expose that part to
visceral tissue or internal organ. another form of somatic stimulus.
- Examples: Appendicitis, the injury is in the appendix, but the  Example: Cephalalgia (Headache). Massaging or applying other
patient will complain of right hypogastric pain. form of somatic stimuli of higher intensity can stimulate the
Myocardial Ischemia, impending injury is in the heart tissues but Mechanoreceptors and send inhibitory impulses via inhibitory
the patient will complain of pain in the left shoulder. interneurons to the nociceptors and decrease the pain
sensation.

Pain sensation returns after the application of the other form of

stimuli, you did not remove the pain; you just decreased the activity
of the nociceptors via the inhibitory interneurons.

PAIN SUPPRESSION AND INHIBITION

 All referred pain will eventually become visceral pain. Since the
injury is located inside.
 The hypogastric pain of the patient experiencing appendicitis,
once the injury gets more aggravated, can now experience a
visceral pain and complain of his right pelvic area.
 Same goes with Myocardial Ischemia, once the patient is nearing
Myocardial Infarction, the patient will start to complain of chest
pain, since the injury in the heart tissues gets worse.
 Normally, people are pain sensitive (neither pain insensitive nor
hypersensitive) , but there are times they are transformed
immediately to pain insensitive persons due to suppressing areas
in our center:
1. Analgesia System
2. Gating Neurons (Instantly activated)
 These 2 systems suppress the activity of the pain fibers.
Analgesia (Opioid-mediated Analgesia)
 Found in the Brainstem:
- Periaqueductal Gray Area (Midbrain – Upper Pons)
- Raphe Magnus Nucleus (Lower Pons – Upper Medulla)
 Found in the Spinal Cord:
-Dorsal Horn (Pain inhibitory Complex)

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Analgesia System (cont.)
 Utilizes morphine-like agents: Enkephalins
 Morphine-like agents inhibit Substance P
 Utilize Serotonergic and Noradrenergic Neurons, these neurons
will stimulate and enhance the activity of the Enkephalin
Neurons, this will result to a decrease in the activity of the Pain
fibers: less pain impulses can reach the center.
 Permanent (Pain insensitive)
 Examples: Soldiers and Athletes that are constantly exposed to
pain can develop analgesia system.
Gating Neurons (Stress-induced Analgesia)
 Found in the Lamina II (Substancia gelatinosa) of the Spinal Cord
 Utilizes GABA or Glycine
 The analgesic effect is due to stress and increased cortical
activity, activating the gating neurons.
 The gating neurons decrease the activity of the pain pathways in
the Lamina II; there is sudden closure of the Lamina II via the
release of GABA and Glycine, inhibiting pain impulses from going
to the center: NO PAIN SENSATION.
 Since pain receptors commonly use Lamina I, all pain sensations
cannot pass Lamina II and no pain sensation can reach the
center.
 This analgesic system only lasts for a few seconds.
 Decreased cortical activity and decreased stress will stop the
activity of the gating neurons and open again the Lamina II, pain
sensation can now enter the center: PAIN SENSATION
 This analgesic system only lasts for a short period of time.
 Example: You got tripped while walking, you suddenly went up
and did not feel any pain because you are thinking of it as
shameful, and you have increased cortical activity, activating
gating neurons. However, after some time you will not think of
the shame anymore, the cortical activity decreases together with
the activity of the gating neurons, opening again Lamina II, from
then you can sense pain.
PURPOSE OF PAIN
 Warning or Threat for an impending tissue injury
 Basis for Learning
- You will not keep looking for the thing that hurt you before </3.
 For Protection
 Forces the body to rest by limiting the movement
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SENSORY ASCENDING PATHWAYS
Review:
First-order neuron: From the receptor before the decussation
Second-order neuron: From the area of decussation to thalamus
Third-order neuron: From the thalamus to the cortex
Dorsal Column (Medial Lemnisci)
 Limited to fine discriminative mechanical sensation:
- Fine Touch
- Fine Pressure
- Vibration
- Proprioception
- Muscle Tension.
 Decussates at the brainstem (Lower Medulla)
 Fibers from the mechanoreceptor will enter the dorsal horn and
ascend on the same side, decussation will happen in the
brainstem.
 Second-order neuron of Dorsal Column is at the Medulla.
 Utilizes fast-transmitting fibers (Type Aα & Type Aβ).
 Spatial orientation in the brain: associatied with Epicritic
sensation
 Greatly represented in the Sensory Homunculus
 One neuron carries one sensation and lesser number of synapses
when transmitting impulses towards the center
 Utilizes the ventral posterolateral nucleus of the thalamus
 Fibers use fasciculus gracilis and cuneatus when ascending to
the center.
- F. Gracilis – from lower extremities, utilizes the whole spinal
cord since it will transmit from the lower extremities upward.
- F. Cuneatus – from upper extremities, utilizes only the upper
half of the spinal cord since it only transmits from the upper
extremities.
- Facial sensation uses Trigeminal Nerve
Anterolateral (Spinothalamic)
 Limited to Pain and Temperature
 Also for non-discriminative sensations: Crude Touch (tickle and
itch), crude pressure, and pleasurable and sexual sensation
 Decussates at the level of entry in the spinal cord.
 Dual sense: Utilize Type Aδ and C
 One neuron carries several impulses and large receptive fields
 Spatial Orientation in the brain: associated with Protopathic
sensation
 Poorly represented in the Sensory Homunculus
 Uses ventrolateral nucleus of the Thalamus
 Multisynaptic in transmission of impulses towards the center.
 Does not utilize gracilis and cuneatus
 Involved mostly in Protopathic Sensation, EXCEPT for Acute Pain
Spiniothalamic is more important than the dorsal column, since all
types of sensation (mechanical, thermal, pain) is found in the
spinothalamic. The dorsal column only transmits mechanical
sensations.
LESIONS AND INJURY:
Dorsal Column Spinothalamic
Spinal Cord Ipsilateral Contralateral
Brainstem Contralateral Contralateral
Cortex Contralateral Contralateral
 Dorsal Column Spinothalamic  Loss of Deep Tendon Reflexes
Decussation Lower Medulla Upon entry at the Spinal  (+) Rhomberg’s Sign
Cord  Caused by Syphillis, hence the name Syphilitic myelopathy.
2nd-order Shorter Longer
neuron (Medulla to Thalamus) (Spinal Cord to Thalamus) Syringomyelia
Sensory Greatly represented Poorly represented  Central lesion of the spinal cord
Homunculus  More damage to the Spinothalamic
 Less damage to the dorsal column.
Spatial Higher degree Lower degree  Lateral Sparing, cape-like distribution of abnormality.
Orientation (Epicritic) (Protopathic except Acute Pain)  Loss of pain and temperature both sides.
Sensory Type Aα & Type Aβ Type Aδ and C
Neurons (Fast-transmitting) (Slow-transmitting) Anterior Spinal Artery Occlusion
 There is compression due to occluded blood flow
Receptive Smaller Larger  Motor deficit and spinothalamic damage.
Fields (Easier to localize) (Hard to Localize)
Mode of One neuron: One One neuron: Multiple Complete Transection of the Cord
Transmission Impulse impulses  If the injury is from the upper cervical the patient is dead. The
origin of the phrenic nerve comes from the upper cervical.
 Motor, Sensory and Autonomics are damaged: Spinal Shock
 Paralysis 1- 2 levels below the injury.

Spinal neurons take time to recover. However, Spinal nerves can

recover faster compared to cortical neurons. Age is a big factor in
the recovery, the younger the age, the higher chances of recovery.

Destruction of the Somatostethic Cortex

 Involves the destruction of the cortex particularly the parietal
lobe. The site of analysis of all sensory impulses got destroyed.
 Loss of the following functions:
- Ascending Tract Functions
- Loss of Proprioception (Dorsal Column)
- Loss of Thermal and Pain Sensation (Spinothalamic)
- Atopognosis (inability to localize sensation)
- Astereognosis (inability to recognize obejects via touching)
- Amorphosynthesis (Ignores contralateral side of the body)
DERMATOME LEVELS - Inability to approximate the weight of an object
- Inability to judge critical degrees of pressure sensation
- Inability to determine body position
 One Sensation remains intact: Chronic Pain
 Chronic pain remains intact since the thalamus is not damaged.
 Recall: Paleospinothalamic tract can only reach upto the
thalamus.
 Manifests contralaterally.

DETERMINING THE SEVERITY OF THE DAMAGE:

DEGREE OF DAMAGE SENSATION TO DISAPPEAR
Mild Fine Touch
Mild to Moderate Proprioception
CLINICAL CONDITIONS Moderate to Severe Thermal Sensation
Severe Acute Pain Sensation
Brown-Sequard’s Syndrome
 Lateral hemisection of the spinal cord On recovery, the last disappear, is the first to reappear
 Ipsilateral loss of proprioception (Dorsal Column) SENSATION TO REAPPEAR
 Contralateral loss of pain & temperature (Anterolateral) Acute Pain Sensation
 Ipsilateral paralysis of motor function (Corticospinal) Thermal Sensation
 Common cause is gunshot wounds Proprioception
Fine Touch
Tabes Dorsalis
 Damage to the dorsal column only
 Spinothalamic tract is spared “Zaldrizesse issi kostas jeme ilagon undes…”
 Loss of proprioception (dorsal column) both sides. (My dragons can sense if you are lying…)

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