DESCENDING CONTROL Studies in animals and man show
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DESCENDING CONTROL • Studies in animals and man show anti-nociception and analgesia from stimulation or opioid administration to many supraspinal centres • CORTEX – via corticospinal efferents – terminations in superficial laminae – may be inhibitory or excitatory and influence nonnoxious stimuli as well • HYPOTHALAMUS – many afferents and efferents - including NTS, PAG, LC, parabrachial nuclei, raphe nuclei – widespread reciprocal innervation – direct projection to lamina I – may be bulbospinal relay for descending inhibition
MID BRAIN • PERIAQUECDUCTAL GRAY (PAG) – surrounds cerebral aqueduct – extensive afferent and efferent projections – morphine and electrical stimulation produce potent antinociception – PAG descending inhibition is via NRM • EAA are neurotransmitters there • LOCUS COERULEUS (LC) – noradrenergic containing neurones – adjacent to 4 th ventricle – diffusely innnervates CNS at all levels – descending NAD fibres inhibit dorsal horn nociceptive activity and spinal nociceptive reflexes
(Serotonin) Text Fig. 18 -20
Text Fig. 18 -21
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