Pathophysiology Of Pain

In most cases, pain is transmitted from peripheral pain generators (nociceptors) to the spinal cord, where it proceeds up the lateral spinotha-lamic tract to the frontal cortex, which is responsible for the perception of pain. Pain is also affected on its descending pathways. At every stage of transmission, pain can be modulated (see Fig. 1). Interventional therapies (1) affect pain generators (leaky disk, myofascial pain, etc.) by blocking transmission of nociception, (2) enhance the body's pain control system using neuromodulation techniques (spinal cord stimulation [SCS]), or (3) capitalize on local receptors, nerves, or the spinal cord (and thus use, by intrathecal pumps, exceedingly low doses of pharmacological agents). By minimizing nociception, analgesic doses required to control pain can be minimized.

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