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Descending pain modulatory pathway. The pathway originates in the cerebrum and descends to the periaqueductal gray (PAG) matter, rostral ventromedial medulla, and projects to the dorsal horn of the spinal cord. Bidirectional nociceptive pathways through the medullary nuclei are shown. The efferent pathway from the dorsal horn goes through the parabrachial nucleus, amygdala, and thalamic nuclei.
