The medial pain system: neural representations of the motivational aspect of pain.

In this article, we propose that the pathways mediating the motivational aspect of pain originate in laminae VII and VIII of the spinal cord, and in the deep layers of the spinal trigeminal complex, and projections from these areas reach three central structures where pain motivation is represented, the ventrolateral quadrant of the periaqueductal gray, posterior hypothalamic nucleus, and intralaminar thalamic nuclei. A final representation of the motivational aspect of pain is located within the anterior cingulate cortex, and this representation receives inputs from the intralaminar nuclei. Outputs from these representations reach premotor structures located in the medulla, striatum, and cingulate premotor cortex. We discuss pathways and structures that provide inputs to these representations, including those involved in producing involuntary (innate) and instrumental responses which occur in response to the recognition of stimuli associated with footshock and other nociceptive stimuli. Copyright 2002 Elsevier Science Inc.