Cortical nociceptive systems.

There is evidence that the cerebral cortex is involved in the perception of pain but no specific area appears to be the 'pain centre'. Limited knowledge exists on the cortical processing of the noxious input. The nociceptors are most likely to activate at least two different systems with different characteristics. One has a bilateral cortical projection, no apparent topographical pattern, low synaptic security and excites cells in large areas. This system may give rise to the widespread increase in blood flow and the widely distributed surface potentials recorded in man following a painful stimulus. Noxious stimuli also excite a system with contralateral topographical projection, high synaptic security and termination in lamina IV. This system produces EPSP-IPSP sequences in cells in a restricted cortical area. Pronounced inhibition of cells in lamina IV and more superficial layers is induced by activity in low threshold afferents. Thus, similarly as at the segmental spinal level, the nociceptive input to cortical cells is processed and integrated with the activity in other afferent systems.