Podcast
Questions and Answers
Which type of fibres carry nociceptive inputs in the trigeminal nerve?
Which type of fibres carry nociceptive inputs in the trigeminal nerve?
Which type of pain is characterized by being dull and poorly localized?
Which type of pain is characterized by being dull and poorly localized?
What is the primary location of cell bodies for 1st order neurons in the afferent pain pathway?
What is the primary location of cell bodies for 1st order neurons in the afferent pain pathway?
What is unique about the sensory perception from within tooth pulp?
What is unique about the sensory perception from within tooth pulp?
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Where do the afferent fibres of the trigeminal nerve terminate in the brain?
Where do the afferent fibres of the trigeminal nerve terminate in the brain?
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Which of the following pain receptors is faster and myelinated, carrying sharp pain?
Which of the following pain receptors is faster and myelinated, carrying sharp pain?
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What is the mechanism by which signals passing to 2nd order neurons are modulated in the spinal cord?
What is the mechanism by which signals passing to 2nd order neurons are modulated in the spinal cord?
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What type of convergence enables precise localization of pain from the skin surface?
What type of convergence enables precise localization of pain from the skin surface?
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Which division of the trigeminal nerve is not responsible for transmitting pain information from the orofacial region?
Which division of the trigeminal nerve is not responsible for transmitting pain information from the orofacial region?
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What is the primary difference between afferent impulses passing to the dorsal horn of the spinal cord and those passing to the brain stem in the Trigeminal nerve?
What is the primary difference between afferent impulses passing to the dorsal horn of the spinal cord and those passing to the brain stem in the Trigeminal nerve?
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What determines the severity of pain in the trigeminal region?
What determines the severity of pain in the trigeminal region?
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What is the primary difference between pain pathways from teeth and oral cavity versus those from skin?
What is the primary difference between pain pathways from teeth and oral cavity versus those from skin?
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Which structure is responsible for modulating pain signals from the trigeminal nerve?
Which structure is responsible for modulating pain signals from the trigeminal nerve?
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What is the role of the 2nd order neurones in the pain pathway from the trigeminal nerve?
What is the role of the 2nd order neurones in the pain pathway from the trigeminal nerve?
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What is the function of the 'Gate' in pain modulation?
What is the function of the 'Gate' in pain modulation?
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Study Notes
Pain in the Trigeminal Region
- Facial pain from the trigeminal nerve can be influenced by emotions, anxiety, and worry
- Pain in the trigeminal region is similar to pain from other parts of the body
- Central structures involved are similar to those in other parts of the body, but with differing anatomy and structures innervated
Toothache Pain
- Pain from teeth and oral cavity is carried by:
- Faster myelinated Aβ and Aδ fibers carrying sharp pain
- Slow unmyelinated C fibers carrying dull, poorly localized pain
- Cell bodies of 1st order neurons are in the Trigeminal ganglion
- Signals pass to 2nd order neurons in the sensory nuclei within the Spinal Tract of the Trigeminal nerve
The 'Gate' Theory
- Pain pathways from teeth and oral cavity are analogous to those from skin
- Modulation of signals occurs in the sensory nucleus by the balance of inputs from Aβ and Aδ fibers and activity in fibers descending from higher centers
- This is the site of the 'Gate' Theory of pain modulation
Pain Classification
- Pain can be:
- Cutaneous
- Somatic
- Visceral
Trigeminal System Learning Objectives
- To review the passage of afferent pain impulses to the dorsal horn of the spinal cord and their regulation
- To consider the anatomical similarities and differences between afferent impulses passing to the dorsal horn of the spinal cord and those passing to the brain stem in the Trigeminal nerve
- To site this discussion in the context of afferent impulses from the teeth
- To emphasize that, although there are anatomical differences, the principles of the ‘Gate Theory’ hold true for the Trigeminal system
Trigeminal Nerve Anatomy
- The Trigeminal nerve anatomy is broadly analogous to that of the peripheral nervous system, but has certain unique features that can influence pathological conditions
- Processing of sensory information is carried out in similar regions of midbrain and sensory cortex
- Unique structures (e.g., teeth) innervated by the Trigeminal nerve result in unique sensory characteristics
Peripheral Anatomy of Trigeminal Nerve
- The Trigeminal nerve arises from the Pons just above the medulla and is mixed, with both afferent and efferent fibers, but afferent predominate
- The ganglion (semi-lunar or Trigeminal ganglion) is equivalent to the dorsal root ganglion
- The nerve splits shortly after the ganglion into three branches: Ophthalmic, Maxillary, and Mandibular divisions
- Nociceptive (Aδ and C fiber) inputs cross to the spinothalamic (now trigeminothalamic) tract and ascend via the medulla and pons to ventroposterior nuclei of the brainstem and onwards to the cortex
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Description
This quiz covers the different types of pain, including cutaneous, somatic, and visceral pain, and the neural pathways involved in pain transmission from the periphery to the cortex.