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. 2020 Jun 3;17(6):506–516. doi: 10.30773/pi.2020.0002

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Copyright © 2020 Korean Neuropsychiatric Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Figure 1. — Schematic diagrams of ascending and descending pain pathways. Afferent neurons of nociception in ascending pain pathway transmit from spinal cord to the amygdala, rostro ventromedial medulla (RVM) and periaqueductal gray matter (PAG). The pathways that originate from amygdala, hypothalamus and rostral anterior cingulated cortex (rACC) send their projections to PAG and they are related to emotional content. Also, Locus coeruleus (LC) received the RVM projections. In reverse pathway or descending pain pathway, dorsolateral prefrontal cortex (DLPFC) neurons transmit to amygdala that helps DLPFC select reward or punishment. PAG sends the projections to RVM and LC. LC in turn projects to spinal cord for suppressing the pain message. RVM also, sends the neurons to spinal cord for inhibiting the nociceptive neuron.