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Neural Mechanisms of Cardiac Pain
Author Biography
Currently selected section: Introduction
Anterolateral System
Somatic vs. Visceral Nociceptive Processing
Angina Pectoris
Sympathetic Sensory Innervation
Referred Pain
Vagal Sensory Innervation
Other Ascending Pathways
Central Sensitization
Thalamus and Cerebral Cortex
Neurophysiology of Angina Pectorsis
Nausea and Vomiting


Chapter 25:Neural Mechanisms of Cardiac Pain: Introduction

The nociceptive pathway

Nociceptive stimuli are stimuli that injure or potentially injure tissue, and therefore excite nociceptors. Thus a nociceptive stimulus may or may not lead to the actual sensation of pain depending on an individual's specific environment.

For a nociceptive stimulus to be interpreted as pain, the nociceptive information must be transmitted from the periphery to the cerebral cortex. The "classic," and simplest, pain pathways use a three-neuron pathway to transmit nociceptive information:

  1. A primary sensory (or afferent) neuron in the peripheral nervous system that conducts nociceptive information from the periphery (such as skin) to the central nervous system (spinal cord and brain).
  2. A secondary sensory neuron in the spinal cord or brain stem that transmits the information to the thalamus.
  3. A tertiary sensory neuron that conveys the nociceptive information from the thalamus to the cerebral cortex.

This three-neuron pathway is primarily involved with localizing a nociceptive stimulus. More complex pathways contribute to the suffering quality of pain.

In this chapter, we will:

  • Describe the major pathways that play a role in transmitting nociceptive information from somatic structures (e.g. skin and muscle),
  • Discuss some general differences in nociceptive transmission between somatic structures versus visceral structures, and
  • Examine in detail the neurophysiology of cardiac pain or angina pectoris.
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