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History of Spinal Cord “Pain” Pathways Including the Pathways Not Taken

Traditional medical neuroanatomy/neurobiology textbooks teach that pain is generated by several ascending pathways that course in the anterolateral quadrant of the spinal cord, including the spinothalamic, spinoreticular and spinoparabrachial tracts. The textbooks also teach, building upon the mid-1...

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Autor principal: Basbaum, Allan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9218418/
https://www.ncbi.nlm.nih.gov/pubmed/35756909
http://dx.doi.org/10.3389/fpain.2022.910954
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author Basbaum, Allan
author_facet Basbaum, Allan
author_sort Basbaum, Allan
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description Traditional medical neuroanatomy/neurobiology textbooks teach that pain is generated by several ascending pathways that course in the anterolateral quadrant of the spinal cord, including the spinothalamic, spinoreticular and spinoparabrachial tracts. The textbooks also teach, building upon the mid-19th century report of Brown-Séquard, that unilateral cordotomy, namely section of the anterolateral quadrant, leads to contralateral loss of pain (and temperature). In many respects, however, this simple relationship has not held up. Most importantly, pain almost always returns after cordotomy, indicating that activation of these so-called “pain” pathways may be sufficient to generate pain, but they are not necessary. Indeed, Brown-Séquard, based on his own studies, eventually came to the same conclusion. But his new view of “pain” pathways was largely ignored, and certainly did not forestall Spiller and Martin's 1912 introduction of cordotomy to treat patients. This manuscript reviews the history of “pain” pathways that followed from the first description of the Brown-Séquard Syndrome and concludes with a discussion of multisynaptic spinal cord ascending circuits. The latter, in addition to the traditional oligosynaptic “pain” pathways, may be critical to the transmission of “pain” messages, not only in the intact spinal cord but also particularly after injury.
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spelling pubmed-92184182022-06-24 History of Spinal Cord “Pain” Pathways Including the Pathways Not Taken Basbaum, Allan Front Pain Res (Lausanne) Pain Research Traditional medical neuroanatomy/neurobiology textbooks teach that pain is generated by several ascending pathways that course in the anterolateral quadrant of the spinal cord, including the spinothalamic, spinoreticular and spinoparabrachial tracts. The textbooks also teach, building upon the mid-19th century report of Brown-Séquard, that unilateral cordotomy, namely section of the anterolateral quadrant, leads to contralateral loss of pain (and temperature). In many respects, however, this simple relationship has not held up. Most importantly, pain almost always returns after cordotomy, indicating that activation of these so-called “pain” pathways may be sufficient to generate pain, but they are not necessary. Indeed, Brown-Séquard, based on his own studies, eventually came to the same conclusion. But his new view of “pain” pathways was largely ignored, and certainly did not forestall Spiller and Martin's 1912 introduction of cordotomy to treat patients. This manuscript reviews the history of “pain” pathways that followed from the first description of the Brown-Séquard Syndrome and concludes with a discussion of multisynaptic spinal cord ascending circuits. The latter, in addition to the traditional oligosynaptic “pain” pathways, may be critical to the transmission of “pain” messages, not only in the intact spinal cord but also particularly after injury. Frontiers Media S.A. 2022-06-09 /pmc/articles/PMC9218418/ /pubmed/35756909 http://dx.doi.org/10.3389/fpain.2022.910954 Text en Copyright © 2022 Basbaum. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pain Research
Basbaum, Allan
History of Spinal Cord “Pain” Pathways Including the Pathways Not Taken
title History of Spinal Cord “Pain” Pathways Including the Pathways Not Taken
title_full History of Spinal Cord “Pain” Pathways Including the Pathways Not Taken
title_fullStr History of Spinal Cord “Pain” Pathways Including the Pathways Not Taken
title_full_unstemmed History of Spinal Cord “Pain” Pathways Including the Pathways Not Taken
title_short History of Spinal Cord “Pain” Pathways Including the Pathways Not Taken
title_sort history of spinal cord “pain” pathways including the pathways not taken
topic Pain Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9218418/
https://www.ncbi.nlm.nih.gov/pubmed/35756909
http://dx.doi.org/10.3389/fpain.2022.910954
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