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Functional Localization, the Spinothalamic Tract, and Neurosurgery for Pain 

Functional Localization, the Spinothalamic Tract, and Neurosurgery for Pain
Functional Localization, the Spinothalamic Tract, and Neurosurgery for Pain

Kenneth L. Casey

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date: 19 June 2021

Early experimental and clinical observations support the concept that neurological functions, including pain, have limited, discrete locations in the central nervous system (CNS). Beginning in the mid-19th century, surgical lesion experiments on animals suggested that selectively cutting fibers in the white matter of the spinal cord (the spinothalamic tract) could selectively reduce or eliminate behavioral responses to noxious (usually painful) stimulation; this led to the practice of surgical spinothalamic tractotomy for pain treatment. Subsequent experiments and clinical observations, however, showed that pain does not depend uniquely or completely on an intact spinothalamic pathway. Attempts to relieve pain by destroying sensory nerves or parts of the CNS often result in the loss of additional somatosensory functions, the creation of pain (central pain syndrome), and an impairment of other neurological functions. These observations highlighted the limitations of our knowledge of pain neurobiology and the need for research on the anatomical and physiological representation of pain in the nervous system.

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