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©2009 Mark Tuttle Descending inhibition Brainstem Midbrain, Pons Pons-Medulla Enkephalin Raphe Magnus Enkephalin Serotonin Inhibit Presynaptic Primary Spinothalamic (Pain) Afferents Interneuron Periaqueductal Grey Enkephalin Lateral Tegmental Noradrenaline Enkephalin Inhibit Second Order Neurons Cortex Main/Spinal Trigeminal Interneurons Layer V (Pyramidal cells) Dorsal Column Nuclei Interneurons Spinal Cord Gray Interneurons Somatosensory Cortex Layer VI (Pyramidal cells) Thalamus VP Interneurons ©2009 Mark Tuttle Higher Order Cortical Processing Posterior Parietal Cortex Motor Areas of Frontal Cortex - Area 5 - Area 7 - Area 39 Primary Somatosensory Cortex Cingulate Cortex on Medial Wall - Area 40 Lateral Sulcus Cortex - Secondary Somatosensory Cortex - Insular Area 3b 1 Cutaneous tactile Nociceptor - Amygdala - Hippocampus - Retroinsular Area 3a Muscle, joint capsule Limbic System 2 Muscle, joint capsule ©2009 Mark Tuttle Rexed Laminae Lamina I II III-IV VII IX Name Marginal Zone Substantia Gelatinosa Nucleus Proprius Clarke’s Nucleus & Intermedolateral Nucleus Motor Tract Dominant Modality Pain Proprioception N/A Cortex Layers Lamina I II III IV V VI Name Molecular Layer Outer Granular Layer Outer Pyramidal Layer Inner Granular Layer Inner Pyramidal Layer Multiform Layer Dominant Modality Supragranular Granular Infragranular Body Region Occiput, neck, trunk, extremeties, viscera Nerve Spinal nn. Peripheral Ganglion Dorsal Root Ganglia Face, mouth CN V: Trigeminal Trigeminal Tract Lissauer’s Tract Dorsal Column Trigeminal Pinna, auditory canal, eardrum Pinna, auditory canal, eardrum Oral, nasal cavities, Pharynx, Carotid sinus Pinna, Auditory canal, eardrum Thoracic and abdominal viscera CN VII: Facial Geniculate Trigeminal CN IX: Glossopharyngeal Superior Trigeminal CN IX: Glossopharyngeal Petrosal Solitary CN X: Vagus Jugular Trigeminal CN X: Vagus Nodose Solitary Termination Zone Superficial Dorsal horn Dorsal Column Nuclei Main/Spinal Trigeminal nuclei Spinal trigeminal nuclei Spinal trigeminal nuclei Solitary nucleus Spinal Trigeminal nucleus Solitary nucleus ©2009 Mark Tuttle
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