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Pain pathways. Incoming peripheral afferent fibers input into the DH of the spinal cord. Spinal projection neurons extend and synapse in regions such as the thalamus and brainstem. From these sites, interactions are also made with the limbic system and cortical structures. Descending pathways originate in the RVM and PAG and may act on both projection neurons and afferent fibers to modulate the pain signal.
