Pathway for pain blocking (modulation)
1. Signals from hypothalamus and cerebral cortex feed into central gray matter of midbrain
2. Midbrain relays signals to certain nuclei in the reticular formation of the medulla oblongata
3. Medulla issues descending, serotonin-secreting analgesic fibers to the spinal cord via the reticulospinal tract
4. Fibers terminate in the posterior horn at all levels of the spinal cord
5. Descending analgesic fibers synapse on short spinal interneurons
6. Interneurons secrete enkephalins and inhibit the second-order neuron (postsynaptically)
7. Some fibers from the medulla also exert presynaptic inhibition by synapsing on the axons of nociceptors and blocking the release of substance P