Free Health Dissertations - There Are Two Different And Distinct Pathways For Transmission Of Pain In
There are two different and distinct pathways for transmission of pain in the CNS. These are transmitted either through the neospinothalamic tract for fast pain or paleospinothalamic tract for slow pain. For transmission for fast pain A-delta fibers terminate on lamina marginalis of the dorsal horns. Neospinothalalmic tract neurons branch off as long fibres and transmit signals upwards in the contralateral anterolateral columns. These fibres finally terminate on the ventrobasal complex of the thalamus. Fast pain is easily localized when A and delta fibres are stimulated with tactile receptors. Slow pain is however transmitted by the slower C fibres to lamina II and III or dorsal horns also known as substantia gelatinosa and neurons take off and join fast pain pathways and move upwards along the anterolateral pathway. These slow pain neurons terminate in the brain stem with a tenth of fibres stopping at the thalamus and also at the medulla, pons and mesencephalon although localization for slow pain is poor.
There are several clinical research studies conducted to help determine which pain management therapies are most effective in treating neck, back and body pain in general. There is no universally accepted definition, or classification of pain management techniques and pain management is usually grouped in terms of their effectiveness and invasiveness. Physical therapy methods are not invasive and do not involve the use of medications although pain medications may involve invasive techniques such as injections as medications are introduced in the body (Raj, 1986). Pain management can involve non-invasive non drug pain management, non-invasive pharmacologic pain management or invasive pain management.
Non invasive pain management may or may not involve drug administration and the non invasive non-drug treatments are widely available for back pain and neck pain and these can range from exercise, manual techniques such as massage, behavioral and cognitive behavioral therapy, cutaneous stimulation and electrotherapy. Exercise method can involve aerobics, flexions, water therapy or simple exercises necessary for musculoskeletal health. Manual techniques generally involve massage, osteopathy and are quite similar to cutaneous stimulation which uses hot and cold packs for heating and cooling of the skin. TENS or transcutaneous electrical nerve stimulation stimulates the nervous system by using low voltage electrical stimulation and is generally effective for back pain. Behavioral therapy, although not related to direct physiological manipulation helps in optimizing patient responses to painful stimuli by means of relaxation and coping techniques (Puder, 1988).
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