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Review
. 2022 Jun 9:3:910954.
doi: 10.3389/fpain.2022.910954. eCollection 2022.

History of Spinal Cord "Pain" Pathways Including the Pathways Not Taken

Allan Basbaum  1
Affiliations
Review

History of Spinal Cord "Pain" Pathways Including the Pathways Not Taken

Allan Basbaum. Front Pain Res (Lausanne). .

Abstract

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.

Keywords: Brown-Séquard Syndrome; anterolateral quadrant; multisynaptic spinal cord pathway; pain pathways; spinothalamic tract.

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Conflict of interest statement

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor TY and the reviewer HF declared a shared affiliation with the author at the time of review.

Figures

Figure 1
Figure 1
Consequences of cutting different spinal cord pathways. (A) Anterolateral cordotomy purportedly provokes contralateral analgesia below the lesion, albeit not permanently. (B) Brown-Sequard Syndrome produced by hemisection of the spinal cord. (C–F) Longitudinal views of different spinal cord pthways and lesions. (C) Unilateral hemisection; (D) Double hemisection performed on the same side of the spinal cord; (E) Spaced hemisection performed on opposite sides of the spinal cord; (F) Illustrates how a multisynaptic system that interconnects the two sides of the spinal cord can “escape” lesions to the long ascending pathways.
See this image and copyright information in PMC

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