12/20/2025
Loving this functional neurology info!
🧠🔥 THE CEREBELLUM & PAIN: A New Frontier in Brain-Based Pain Recovery (Evidence-Informed Insight from Current Neuroscience)
Traditionally, clinicians and patients alike have understood the cerebellum as the brain’s motor coordination center — facilitating balance, movement precision, posture, and timing.
But modern neuroscience is redefining that narrative.
📌 Emerging evidence now shows that the cerebellum plays a substantive role in how pain is perceived, anticipated, modulated, and emotionally interpreted.
This places the cerebellum at the intersection of sensory, cognitive, emotional, and nociceptive processing.
(From the review PMC11044115)
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🧠 HOW PAIN SIGNALS INVOLVE THE CEREBELLUM
The cerebellum receives input from multiple pain-related pathways:
🧩 Direct nociceptive inputs
Painful mechanical, thermal, and trigeminal stimuli activate specific cerebellar regions, including:
• Crus I & II
• lobules IV–VI
• lobule VIII
• posterior vermis
Trigeminal stimulation — particularly relevant for head, neck, TMJ, and migraine pain — strongly activates Crus I/II and lobules I–VI, underscoring the cerebellum’s role in craniofacial pain.
🧠 CHRONIC PAIN CHANGES THE CEREBELLUM
Imaging shows:
• altered Crus I/II connectivity
• increased vermis activation
• changes in cerebellar–brainstem–thalamic loops
These correlate with long-term pain conditions like:
• migraines
• neuropathic pain
• visceral pain
• low back pain
Meaning the cerebellum is not passively responding — it participates in pain chronification.
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🧠 MECHANISMS OF CEREBELLAR PAIN PROCESSING
🔹 Purkinje cell modulation
Purkinje cells influence dentate output, affecting pain circuits through:
• thalamus
• brainstem
• periaqueductal gray
🔹 Cerebello-limbic loops
Connections with:
• amygdala
• prefrontal cortex
• limbic structures
→ explain why stress worsens pain
→ why emotions alter pain
→ why pain feels threatening
🔹 Trigeminal & cervical integration
The cerebellum integrates:
• cervical afferents
• trigeminal input
• vestibular signals
Which explains the common triad of:
• neck pain
• headaches
• dizziness
Especially post-concussion and whiplash.
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💥 THE FNC APPROACH TO CEREBELLAR-RELATED PAIN
While traditional approaches try to block or mask pain…
👉 We target the neurological ROOT cause: cerebellar processing & modulation.
We evaluate for:
✔ cerebellar asymmetry and activation patterns
✔ altered cervical and trigeminal afferents
✔ vestibular integration
✔ proprioceptive mismatch
✔ autonomic dysregulation
✔ sensory filtering
✔ visual-oculomotor compensation
Then we design individualized strategies such as:
🟡 Cervical–cerebellar re-integration
• upper cervical proprioception
• myodural bridge awareness
• gentle manual therapy
• neck stabilization
• laser therapy for inflammation
• Ciatrix to improve CSF flow
🟡 Vestibular & oculomotor training
• VOR recalibration
• gaze stability
• optokinetic stimulation
🟡 Trigeminal modulation
• ARPwave neuromodulation
• cranial nerve stimulation
• jaw/TMJ alignment and proprioception
🟡 Autonomic & affective modulation
• neuromodulation
• breathwork and vagal integration
• recovery modalities like PEMF & oxygenation
🟡 Sensorimotor error correction
• gait & postural retraining
• reflexive stabilization
• cerebellar-driven dual-tasking
The goal is not to “treat the pain site.”
It is to retrain the pain network — especially the cerebellum’s integration, modulation, and output.
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🌍 WHY PATIENTS TRAVEL TO MINNESOTA
Because imaging can be normal.
Orthopedic tests may be negative.
Yet pain remains.
When cerebellar processing is the problem —
❌ injections don’t change it
❌ rest doesn’t resolve it
But…
✔ targeted sensory-motor rehab
✔ cervical + trigeminal integration
✔ vestibular recalibration
✔ autonomic regulation
can.
We see this in:
• chronic migraine
• post-concussion pain
• neck pain
• fibromyalgia-like symptoms
• TMJ and facial pain
• dysautonomia with pain
• EDS-related headaches
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🌟 THE TAKEAWAY
Pain is not just a tissue problem.
It is a brain-processing issue.
And the cerebellum — long ignored — plays a central role.
By understanding and addressing cerebellar pathways, we give patients the chance to:
✔ reduce pain
✔ restore movement
✔ decrease fear and sensitivity
✔ improve resilience
There is hope.
📍 The Functional Neurology Center — Minnesota
🌐 theFNC.com
📞 Complimentary phone consults
Pain is real.
Recovery is possible.
The cerebellum matters.
Resource:
https://www.jneurosci.org/content/44/17/e1538232024
The cerebellum receives afferent input from various cerebral structures involved in motor, somatosensory, cognitive, affective, and reward processing. Cortical and subcortical projections to the cerebellum are relayed via pontine nuclei as mossy fibers, or via the inferior olive as climbing fibers, as detailed in Armstrong (1974), Azizi et al. (1985), Brodal and Steen (1983), Giolli et al. (2001), Glickstein et al. (1985), Ikai et al. (1992), Kelly and Strick (2003), Kuypers and Lawrence (1967), Massion (1967), Mower et al. (1980), Olds and Milner (1954), Saint-Cyr and Courville (1981), Saint-Cyr and Courville (1982), Schmahmann (1996), Sheehan et al. (2004), Temel et al. (2005), and von Monakow et al. (1979). M1, primary motor cortex; S1, primary somatosensory cortex; V1, primary visual cortex; PFC, prefrontal cortex; VTA, ventral tegmental area; PAG, periaqueductal gray. Created with BioRender.com.